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Enhancing Interest in Nursing as a Career Choice with Fifth-Grade Students

Permanent Link: http://ufdc.ufl.edu/UFE0022517/00001

Material Information

Title: Enhancing Interest in Nursing as a Career Choice with Fifth-Grade Students
Physical Description: 1 online resource (149 p.)
Language: english
Creator: Turner, Pamela
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2008

Subjects

Subjects / Keywords: age, career, children, development, education, in, nursing, school
Nursing -- Dissertations, Academic -- UF
Genre: Nursing Sciences thesis, Ph.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: This research was designed to provide information on the career development of fifth-grade students and to explore the influence of an education program on children's interest in nursing as a career choice, especially related to gender. Interest in nursing is conceptualized as interest, competence perception, and desire to help other people. A sample of 70 fifth-grade students recruited from a public elementary school in a large metropolitan city in the Southeast completed the study. The students' interest in nursing as a career was measured before and after participation in a four-week career education program about nursing. The four-week career education curriculum was designed in accordance with the National Career Development Guidelines. Data were collected to determine the effect of the education program on the students' interest, competence perception, and desire to help other people based on John Holland's (1959) theory of career development, Albert Bandura's (1977) theory of self-efficacy, and Jean Watson's (1985) theory of human caring. In addition, data were collected from pre- and post-questionnaires asking the students if they would consider nursing as a career to evaluate the effects of the education program on school age children expressing their consideration for nursing as a future career choice. Results indicated the education program had a highly significant effect on students' expressed consideration of nursing as a career choice, achieving a 61% increase in the number of students indicating they would consider nursing after participating in the education program. This positive influence was discovered between male and female students, resulting in a 114% increase in the number of male students and a 43% increase in the number of female students indicating they would consider nursing after participating in the education program. Results provided a pre- and post-career assessment of the students' career types based on John Holland's theory of vocational personalities and work environments. The career assessments for these students were congruent with findings from previous studies, especially related to gender differences. Lastly, the desire to help other people manifested itself with female students scoring significantly higher and male students showing no significant change after participating in the career education program.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Pamela Turner.
Thesis: Thesis (Ph.D.)--University of Florida, 2008.
Local: Adviser: Elder, Jennifer H.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2010-08-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2008
System ID: UFE0022517:00001

Permanent Link: http://ufdc.ufl.edu/UFE0022517/00001

Material Information

Title: Enhancing Interest in Nursing as a Career Choice with Fifth-Grade Students
Physical Description: 1 online resource (149 p.)
Language: english
Creator: Turner, Pamela
Publisher: University of Florida
Place of Publication: Gainesville, Fla.
Publication Date: 2008

Subjects

Subjects / Keywords: age, career, children, development, education, in, nursing, school
Nursing -- Dissertations, Academic -- UF
Genre: Nursing Sciences thesis, Ph.D.
bibliography   ( marcgt )
theses   ( marcgt )
government publication (state, provincial, terriorial, dependent)   ( marcgt )
born-digital   ( sobekcm )
Electronic Thesis or Dissertation

Notes

Abstract: This research was designed to provide information on the career development of fifth-grade students and to explore the influence of an education program on children's interest in nursing as a career choice, especially related to gender. Interest in nursing is conceptualized as interest, competence perception, and desire to help other people. A sample of 70 fifth-grade students recruited from a public elementary school in a large metropolitan city in the Southeast completed the study. The students' interest in nursing as a career was measured before and after participation in a four-week career education program about nursing. The four-week career education curriculum was designed in accordance with the National Career Development Guidelines. Data were collected to determine the effect of the education program on the students' interest, competence perception, and desire to help other people based on John Holland's (1959) theory of career development, Albert Bandura's (1977) theory of self-efficacy, and Jean Watson's (1985) theory of human caring. In addition, data were collected from pre- and post-questionnaires asking the students if they would consider nursing as a career to evaluate the effects of the education program on school age children expressing their consideration for nursing as a future career choice. Results indicated the education program had a highly significant effect on students' expressed consideration of nursing as a career choice, achieving a 61% increase in the number of students indicating they would consider nursing after participating in the education program. This positive influence was discovered between male and female students, resulting in a 114% increase in the number of male students and a 43% increase in the number of female students indicating they would consider nursing after participating in the education program. Results provided a pre- and post-career assessment of the students' career types based on John Holland's theory of vocational personalities and work environments. The career assessments for these students were congruent with findings from previous studies, especially related to gender differences. Lastly, the desire to help other people manifested itself with female students scoring significantly higher and male students showing no significant change after participating in the career education program.
General Note: In the series University of Florida Digital Collections.
General Note: Includes vita.
Bibliography: Includes bibliographical references.
Source of Description: Description based on online resource; title from PDF title page.
Source of Description: This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility: by Pamela Turner.
Thesis: Thesis (Ph.D.)--University of Florida, 2008.
Local: Adviser: Elder, Jennifer H.
Electronic Access: RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2010-08-31

Record Information

Source Institution: UFRGP
Rights Management: Applicable rights reserved.
Classification: lcc - LD1780 2008
System ID: UFE0022517:00001


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6285bc87ec55756f775d8b857c6a09b41c9d0a79







ENHANCING INTEREST IN NURSING AS A CAREER CHOICE
WITH FIFTH-GRADE STUDENTS





















By

PAMELA LEE TURNER


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA

2008




































2008 Pamela Lee Turner

































To my husband, Joe; my daughter, Elizabeth; and my son, Walker.









ACKNOWLEDGMENTS

I gratefully acknowledge the wisdom and counsel that I received from my academic

mentor and supervisory committee chair, Dr. Jennifer Elder, throughout the planning and

development of this research. It was her insight of my potential to conduct this research project

that brought it to fruition. I appreciatively acknowledge my dissertation committee members and

their individual contributions: Dr. M. Harry Daniels for his boundless knowledge in the field of

counselor education and patiently helping me discover the direction of my research, Dr, Alice

Poe for her enthusiasm and interest of this research project and her gentle guidance during the

IRB process, and Dr. Veronica Feeg for her unequaled editing skills and believing in me.

I am grateful for my nurse colleagues, Kip Deckerhoff and Fern Hannigan. I appreciate

Kip serving as a male nurse role model and assisting me with the curriculum instruction

throughout the entire study. His calm presence during the classroom instruction put me at ease

when at times things seemed chaotic and overwhelming. As well, I appreciate Fern helping with

the curriculum instruction and providing me endless support and encouragement all through my

doctoral education. I acknowledge Kip and Fern's advocacy of the nursing profession and proud

they exemplify nursing.

I am especially thankful for Norma Copper mentoring me as a doctoral student while I

assisted her with The Future Gator Nurse Project. This experience served as the springboard for

the development of my research project. I will forever be grateful for the wisdom and

knowledge Norma imparted to me. In addition, I gratefully acknowledge Blue Cross and Blue

Shield of Florida (BCBSF) for expanding the work of the Future Gator Nurse Project by funding

a substantial grant to support my research. I am thankful BCBSF recognized the value of this

study to encourage young students to view a career in nursing as a possibility and achievable

goal.









I acknowledge the principal and staff at the elementary school for graciously allowing me

to conduct my research with their fifth-grade students. I am grateful for each student who

participated in the study and honored that I was able to represent the nursing profession with this

group of young people. There was no greater reward than to introduce these students to the

nursing profession and to watch them eagerly explore a career in nursing.

I am appreciative for my friend and professional mentor, Carolyn Johnson, whose

commitment to life-long learning served as an inspiration and encouragement for me to begin

and sustain my doctoral education.

Lastly, I wish to express my love and appreciation to my husband, Joe; my daughter,

Elizabeth; and my son, Walker for their unwavering faith in me to never give up my dreams.

They provided me love, understanding, and motivation from the beginning to the end of my

doctoral education. As well, I lovingly acknowledge other members of my family who were

constant sources of inspiration: my brother, Bert; my sister-in-law, Carolyn; and my niece-in-

law, Joy. I am also thankful for my friends Shea, Jackie, and Teri, who were always present for

encouragement and mirth.









TABLE OF CONTENTS

page

A C K N O W L E D G M E N T S ..............................................................................................................4

LIST OF TABLES ..................................................................................................................................

LIST OF FIGURES .................................. .. .... ..... ................. 10

A B S T R A C T ........................................... ................................................................. 1 1

CHAPTER

1 INTRODUCTION ............... ................. ........... .............................. 13

B ack g rou n d ................... ...................1...................3..........
Future Supply of Nurses .................................... .................... .. .............. 15
Lack of Interest in Nursing as a Career Choice.................................. .....................16
Significance for Nursing... ....................................... ........ .... ............... 17
Promoting Interest in Nursing as a Career Choice ...................... ...................18
Origins of a Career Development Program for School age Children.................................19
Theoretical Structure ......................... ........ .. ... ... .. .................. 21
Interest ............................................. 21
Perceived C om petence ............................................ .. .... .... ......... .. .... .. 23
D esire to H elp O their People............................................................................. ...... 25
Purpose of the Study ............... ............... .......... .................... ......... 27
S u m m atio n ................... ...................2...................7..........
Research Questions........... .......... ........... ... .. .... ...... .... .......... 28

2 R E V IEW O F L ITER A TU R E ................................................................... ... .....................30

The Nursing Shortage ............... ................. ............ ...................... ..... 30
C current O outreach E efforts ........................................................................ ...................30
P o licy m a k e rs ..................................................................................................... 3 0
Private organizations ..................................... ........ .. ....... ...............3 1
K indred organizations .................................... ............... .... ....... 32
R e su lts .............................................................................. 3 3
F u tu re O u tlo o k s ..................................................................................................... 3 3
F future R ecom m endations ..................................................................... .....................34
Career Education Program for School age Children ................................... .................35
Nursing ................................ .............................. ......... 35
C career D evelopm ent in C children ............................................................................. ...... 43
H ow E early? ............. .................. .................................................................43
Developmental Career Counseling............................................... 44
Expression and Permanence of Career Aspirations............................. ...............46
G ender R ole E expectations ....................................................................... ..................47
H olland's Theory of Career D evelopm ent ........................................ ........................ 48


6









B andura's Theory of Self-E efficacy ........................................................................... .... ... 51
Interest and Self-E efficacy ............................................................................. .................... 52
W atson's Theory of Human Caring...................................................................... 56
In N ursing Theory and Practice.................... ........................... ..................57
Future Directions of Watson's Theory of Human Caring.............................................58
Sum m ary .............................................................................. ...........................59

3 M E T H O D ..........................................................................6 3

P artic ip an ts .........................................................................6 3
Intervention.........................................65
C u rricu lu m D e sig n ............................................................................................................ 6 5
In structional U nits ................................................................67
R e se a rc h D e sig n ............................................................................................................... 6 8
In stru m en ts .........................................................................6 9
Q u e stio n n a ire s ........................................................................................................... 6 9
ICA-R ......... ......... ......... ............................... ............... 70
Concern for Others .................................................................................. ..... ....... ........ 73
Intervention Implementation and Data Collection ......................................... .......73
Threats to Internal V alidity.................................... 74
S statistical A n aly se s ...................... .. ............. .. ....................................................7 6
Questionnaires ....................................... ............. ............. 76
Interest and Competence RIASEC Scores and Caring Scores ................................. 77

4 R E S U L T S ............................................................................................................. .. 8 2

Questionnaire Data ............................... ...... .......... ..................82
Variables of Interest Before Participating in the Education Program ...........................83
G en d e r .......................................................................................................... 8 4
F am ily m em b er ..............................................................................................84
Race and knowing a nurse other than a family member .......................................85
Effects of the Career Education Program ........................... ............................. 85
Gender ........................................... 86
R a c e ............................................................................... 8 7
F am ily m em b er ................................................................88
Knowing a nurse ........................................................... 88
ICA-R and Concern for Others Data .............. ................................ ....... 89
Within-Subjects Comparison of the Total Sample ............................... 90
ICA -R analyses ........................................................ ...... 90
Concern for O others analysis................................... ....................................... 90
Within-Subjects Comparison of Male and Female Students ................ .......... 91
IC A -R an a ly se s ................................................................................................... 9 1
RIA SEC career assess ent ........................................ ........ .. .. .. ............ 92
Concern for O others analysis........................................................... ............... 93
S cale R eliab ilities ...........................................................................................9 3
ICA-R ....... ......... ......... .............................93
I C A -R ............... e r ........... ... .... .......... ... ............... ... ........................................................... 9 3
C on cern for O th ers .............................................................................................. 94


7









Summary of Findings ..................................... ............ ..............94
Q u e stio n 1 ..............................................................9 4
Q u e stio n 2 .............................................................9 5
R a c e ............................................................................... 9 5
F am ily m em b er ................................................................9 5
K n o w in g a n u rse ................................................................................................. 9 6
Q u e stio n 3 .............................................................9 6
Q u e stio n 4 .............................................................9 7

5 D IS C U S S IO N ......................................................................................... 10 9

Interpretations of the Effects of the Career Education Program ..........................................111
Expressed Interest in N ursing .................................................................. .... .. ......111
G e n d e r ......................................................................................................1 1 3
R a c e .............................. .................................................................................... 1 14
Having a family member who is a nurse ..............................................................116
Knowing a nurse other than a family member ........................... .....................118
Effects on Interest, Competence Perception, and Desire to Help Others ......................120
Interest and com petence perception ................................................. ........... 120
D esire to help other people ................................................................ ...........123
R research D design .............................................. .......................126
Strengths, Limitations, and Implications for Future Research ............................................126
P practice Im plications ....................................................... 130

APPENDIX CAREER EDUCATION CURRICULUM FOR FIFTH-GRADE STUDENTS.. 134

L IST O F R E F E R E N C E S ...................................................................................................... 139

BIOGRAPHICAL SKETCH ..... .......... ... ................ ......... 149























8









LIST OF TABLES


Table page

3-1 D em graphic characteristics of students ........................................ ....................... 78

3-2 Crosswalk of national career development competencies for elementary school and
fifth-grade career education intervention by unit of instruction.............. ... .............79

3-3 Internal consistency and 1-year stability estimates of RIASEC scales across grade
group p s ............. ... ..... ......... ............. ............................................80

3-4 Timeline for career education intervention....................... .......... ...............81

4-1 Pearson's chi-square tests of students' "Yes" and "No" responses before
participating in the education program ........................................ ......................... 99

4-2 McNemar results of students who want to be a nurse after participating in the
education program .................................... ... .. .......... ....... .... 100

4-3 Paired t-tests for interest and competence RIASEC scale scores for the total sample ....101

4-4 Paired t-tests of interest and competence RIASEC scale scores for male and female
stu d en ts ........................................................ ................................. 10 2

4-5 Paired t-tests of caring scores for total sample, male, and female students.................103

4-6 Internal consistency estimates of ICA-R's interest and competence scales and
C concern for O others scale ........................................................................ ...................103









LIST OF FIGURES


Figure page

1-1 Theoretical model of a career education program for school age children......................29

2-1 A hexagonal model for defining the psychological resemblances among personality
types and environments and their interactions. Source: Holland, 1997............................61

2-2 The original ten carative factors. Source: Watson, 1985, pg. 11 ....................................62

4-1 Percent increase in the number of students who would be a nurse after participating
in the education program ........................................................................ ...................104

4-2 Increase in the number of students who would be a nurse after participating in the
education program .................................... ... .. .......... ....... .... 105

4-3 Interest assessment: comparing male and female students before and after the
education program .................................... ... .. .......... ....... .... 106

4-4 Competence assessment: comparing male and female students before and after the
education program .................................... ... .. .......... ....... .... 107

4-5 Paired t-tests of caring scores for total sample, male, and, female students ....................108

5-1 Gender effect for the interest and competence scales.................................................133









Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

ENHANCING INTEREST IN NURSING AS A CAREER CHOICE
WITH FIFTH-GRADE STUDENTS

By

Pamela Lee Turner

August 2008

Chair: Jennifer H. Elder
Major: Nursing Sciences

This research was designed to provide information on the career development of fifth-

grade students and to explore the influence of an education program on children's interest in

nursing as a career choice, especially related to gender. Interest in nursing is conceptualized as

interest, competence perception, and desire to help other people. A sample of 70 fifth-grade

students recruited from a public elementary school in a large metropolitan city in the Southeast

completed the study.

The students' interest in nursing as a career was measured before and after participation

in a four-week career education program about nursing. The four-week career education

curriculum was designed in accordance with the National Career Development Guidelines. Data

were collected to determine the effect of the education program on the students' interest,

competence perception, and desire to help other people based on John Holland's (1959) theory of

career development, Albert Bandura's (1977) theory of self-efficacy, and Jean Watson's (1985)

theory of human caring. In addition, data were collected from pre- and post-questionnaires

asking the students if they would consider nursing as a career to evaluate the effects of the









education program on school age children expressing their consideration for nursing as a future

career choice.

Results indicated the education program had a highly significant effect on students'

expressed consideration of nursing as a career choice, achieving a 61% increase in the number of

students indicating they would consider nursing after participating in the education program.

This positive influence was discovered between male and female students, resulting in a 114%

increase in the number of male students and a 43% increase in the number of female students

indicating they would consider nursing after participating in the education program.

Results provided a pre- and post-career assessment of the students' career types based on

John Holland's theory of vocational personalities and work environments. The career

assessments for these students were congruent with findings from previous studies, especially

related to gender differences. Lastly, the desire to help other people manifested itself with

female students scoring significantly higher and male students showing no significant change

after participating in the career education program.









CHAPTER 1
INTRODUCTION

Background

In the upcoming years, the nursing profession in the United States will encounter perhaps

the largest challenge in its history. The current nursing shortage, which began in 1998, remains

remarkably persistent throughout the nation. Today's nursing shortage is considered one of the

most important challenges affecting the country's hospitals. A recent study conducted by the

American Hospital Association indicated that within hospitals the nursing shortage has caused

emergency department overcrowding, diversion of emergency patients, reduced number of

staffed beds, discontinuation of programs and services, and the cancellation of surgeries (First

Consulting Group, 2002). In addition, surveys of nurses have indicated that the shortage has

negatively affected hospital's care processes with nurses reporting delays in nurses' responses to

pages and telephone calls, interrupted staff communications, increased number of complaints

about nursing care, reduced numbers of available hospital beds, increased patient wait times for

surgeries and tests, and delayed patient discharges (Buerhaus et al., 2005b).

Research has revealed that nurses are essential to patient safety and the delivery of efficient

and effective healthcare (Aiken, Clark, Sloane, Sochalski, & Silber, 2002). However, recent

state and national surveys have reported that the shortage is interfering with nurses' ability to

provide quality patient care. Nurses are often stating that within their current work environment

it is more difficult to provide quality patient care because of perceived workforce shortages

(Aiken et al. 2002; First Consulting Group, 2002). Results from two recent national surveys in

2002 and 2004 assessing nurses' perceptions of the nursing shortage indicated that nurses felt the

shortage had affected their nursing care by decreasing the amount of time nurses had to spend

with patients, the ability to detect patient complications early, and the capacity to maintain









patient safety (Buerhaus et al., 2005a). Further studies have demonstrated an increased risk of

medical errors associated with inadequate nurse staffing. These medical errors have resulted in

deleterious patient outcomes to include patient mortality (Blegen, Good, & Reed, 1998; Lichtig,

Knauf, & Milholland, 1999; Aiken et al., 2002).

Buerhaus and colleagues recently reported that the majority of nurses (79%) and Chief

Nursing Officers (68%) believe the nursing shortage is affecting the overall quality of patient

care in hospitals, as well as in other healthcare settings. Their study indicated that 93 percent of

hospital nurses express considerable concerns of not having enough time for patients and 68

percent express concern for their ability to maintain patient safety (Buerhaus et al. 2005b). The

shortage has also reached the awareness of the American public with 81 percent reporting

knowledge of the nursing shortage, 93 percent having the opinion that the shortage threatens the

quality of care, and 65 percent considering the nursing shortage as a national problem (Johnson

& Johnson, 2001).

Since the 1950s, the nursing supply has emerged with cycles of abundance followed by

shortages. These past shortages in nursing were usually a direct effect of healthcare expansion in

both size and technological advancements. Yet, the current nursing shortage is more complex

and enduring than in previous shortages from past decades. Today's nursing supply crisis is

driven by a richer and broader set of issues never before experienced, such as an aging

population, fewer workers, an aging workforce, gender and ethnic disparities, more options for

women, the generation gap, a challenging work environment for nurses, consumer activism, and

a burgeoning healthcare system (Robert Wood Johnson Foundation, 2002). An updated forecast

of the nursing supply and demand a decade from now indicates a projected shortage of 340,000









nurses, three times larger than the size of the current shortage when it was at its peak in 2001

(Auerbach, Buerhaus, & Staiger, 2007).

Future Supply of Nurses

Looking ahead, a study conducted by Buerhaus and colleagues created concern for the

future supply of nurses influenced by the aging nurse workforce. According to their predictions,

the nursing workforce will continue to age and diminish, and will be unable to meet the projected

workforce requirements if this trend is not reversed (Buerhaus, Staiger, & Auerbach, 2000). The

recent National Sample Survey of Registered Nurses conducted by the Department of Health and

Human Services, Health Resources and Services Administrations (HRSA), the key Federal

agency responsible for nursing workforce and development in the United States, indicated the

average age of the nurse workforce will increase over the upcoming years, rising from an

average of 43.5 years in 2005 to 44.7 in 2012 and beyond (Heath Resources and Services

Administration, 2004). In 2005, the largest age group of nurses in the workforce was nurses in

their forties, followed closely by those in their fifties. It is projected that in four years (2012),

more employed nurses will be in their sixties than in their twenties (Auerbach, et al., 2007).

Other key factors contributing to the aging of nursing are the persistent trend of declining

interest in nursing by women and the ever-decreasing number of people born after 1955 who

have chosen nursing as a career (Buerhaus et al., 2000). In addition, there has been a recent

trend toward later entry into nursing. Nurses today are less likely to enter a nursing education

program immediately after high school and nursing has become an attractive career option for

people in their twenties or early thirties. Therefore, recent nursing graduates have a higher

average age at the time of graduating from nursing school than from previous years (Auerbach et

al., 2007).









An additional critical problem directly affecting the nation's supply of nurses is the

shortage of nursing faculty in the United States, which is projected to worsen in future years. A

considerable increase in nursing graduates is needed to meet the projected demand for new

nurses in 2020. This corresponds to an increase in the demand for nursing faculty. The Robert

Wood Johnson Foundation (2002, p. 2) recently reported, Substantial evidence at both the

national and state levels shows that the current inadequate supply of nursing faculty constrains

the level of enrollment in nursing programs necessary to meet future demands of nurses." The

American Association of Colleges of Nursing's (AACN) preliminary findings reported that

32,323 qualified applications to entry-level baccalaureate programs were not accepted in 2006

based on responses from 449 schools throughout the country. The number of qualified

applications turned away each year from these nursing programs remains high with 37,514,

29,425, 15,944, and 3,600 students turned away in 2005, 2004, 2003 and 2002, respectively.

Shortage of faculty was indicated by 76.1 percent of the surveyed schools as the main factor that

limited admissions. In addition, the adequacy of the supply of future faculty will be strongly

influenced by the high average age of nursing faculty. In 2001, the reported average age of

doctorate-prepared faculty was about 53 years and masters-prepared faculty was about 49 years.

It was also reported that not only do nurses enter the faculty role relatively late in their careers,

but they retire young at an average age of 62.5 years (American Association of Colleges of

Nursing, 2006b).

Lack of Interest in Nursing as a Career Choice

Given projections of a future and an even larger nursing shortage in the next decade,

efforts to promote the nursing profession and attract people to pursue a career in nursing are

essential. Moreover, the aging of the nursing workforce suggests the importance of recruiting

younger students into nursing. Unfortunately, previous research has demonstrated that high









school students rarely consider nursing as a career choice based upon students' attitudes,

perceptions, and knowledge of nursing (Firby, 1990; Hemsley-Brown & Foskett, 1999; Kohler &

Edwards, 1990; Marriner-Tomey, Schwier, Maricke, & Austin, 1990; Stevens & Walker, 1993).

Other research has indicated that attitudes of children toward nursing grow increasingly negative

as they progress from elementary to high school, and well into college (May, Austin &

Champion, 1988). These findings were supported in a study done by Marriner-Tomey and

colleagues, who discovered that the gap between students' perceptions of an ideal career and a

nursing career widens, as children get older, and by high school a very small percentage view

nursing as a potential career (Marriner-Tomey, Schwier, Maricke, & May, 1996).

Significance for Nursing

It is suggested that the most important factor contributing to the aging and diminishing of

the nursing workforce is the persistent trend of declining interest in nursing by young women

(Buerhaus et al., 2000). Staiger and colleagues recently examined the reasons for this declining

penchant of women to choose nursing as a career. They found that the peak interest to become a

nurse occurred in women graduating from high school around 1973. Additional information

from this study indicated a 40 percent drop of college freshman declaring that nursing was

among their top career choices. One of the major reasons for this dramatic decline was credited

to the concurrent expansion of opportunities for capable young women to enter formerly male-

dominated professions such as medicine, law, and managerial occupations (Staiger, Auerbach, &

Buerhaus, 2000).

This disturbing review of evidence demonstrating the rapidly aging nurse workforce

partnered with the decline of interest in nursing as a career presents an unsettling picture of the

future of the nursing profession. How will a profession with a majority of its members retiring in









the near future replace itself with the current low interest among young people to choose nursing

as a career?

Promoting Interest in Nursing as a Career Choice

The promotion and dissemination of information about the nursing profession has shown

to be successful in promoting nursing as a career choice with high school students. Past surveys

of high school students' interest in nursing as a possible career indicated that receiving

information about nursing positively affects their attitudes about nursing (Marriner-Tomey et al.,

1996) and is correlated with considering nursing as a future career choice (Erickson, Holm,

Chelminiak, & Ditomassi, 2005). In addition, a presentation on nursing presented to middle

school students provided further support that perceptions and attitudes of nursing as a career can

be influenced positively through a classroom presentation. Using pre- and post-presentation

assessments, 48 percent of the students indicated they had more interest in becoming a nurse

after the classroom presentation (Hoke, 2006).

Evidence from these studies suggests education outreach has a positive impact on the

student's perception of nursing as a possible career choice. Thus, it is prudent to design

education initiatives to stimulate interest in nursing by promoting the many career opportunities

in nursing and by increasing awareness of the value of the nursing profession to students,

beginning as early as elementary school and continuing through high school. As well, those

students who receive accurate information about the nursing profession before ruling out nursing

as a career too early may have more incentive to continue their exploration of nursing.

Conceivably, a career education program designed to enhance interest in nursing as a career

choice with elementary, middle, and high school students can be considered a promising

initiative to strengthen the nursing workforce in the United States to meet the healthcare

challenges of the future.









Origins of a Career Development Program for School age Children

We now know that career choice and development is not a matter exclusive of adolescence

or adulthood and that childhood and its contexts are also important precursors of future

vocational behaviors (Vondracek, 2001). Vocational theorists generally agree that career

development begins in childhood and continues through adulthood. They recognize the need for

career education for children to begin in their preschool and early elementary years so that

knowledge and experiences related to career education are systematically organized across the

years from preschool to high school. Clearly, these formative years of childhood have a large

potential to influence future career decisions (Sharf, 2006).

Although career education at the elementary school age level might seem premature,

studies have demonstrated that career development is an important antecedent for school age

children to understand the world-of-work. Seligman and colleagues have shown that children by

the age of 10 have done quite a bit of thinking about their future and can clearly articulate their

career aspirations (Seligman, Weinstock, & Heflin, 1991). In addition, McMahon and

colleagues found that children's career development was enhanced as a result of career education

lessons, with children showing an increased ability to list occupations and identify a favorite

occupation (McMahon, Gillies, & Carroll, 1999). These studies and others have provided

empirical evidence that suggest children as young as kindergarten (Trice & King, 1991) are not

too young for and would benefit from early career counseling.

Additionally, the monograph representing the work of Super and his associates' theory of

vocational development indicates that most children by the age of 10 have passed through the

fantasy vocational life stage of career development into the interest stage. During the interest

stage, children's dreams of occupations are influenced by information about the world, resulting

in interest development of certain occupations (Super et al., 1957). Therefore, the researcher









conceives that encouraging a child's emerging interests by their participating in a career

education program about nursing is pragmatic in the development of their decision-making

related to career preferences, specifically related to interest in nursing as a career choice.

A corollary concept to vocational life stage development is that of developmental tasks that

need to be mastered by growing children in relation to their environment. According to Erik

Erikson's (1993) theory of psychosocial development, he distinguishes the crisis of the middle

childhood years, occurring between six years and puberty, as the psychological stage of industry

versus inferiority. Erikson holds that successful experiences give the child a sense of industry

and a feeling of competence and mastery, while failures give the child a sense of inadequacy and

inferiority (Miller, 1993). Thus, the researcher suggests a career education program that

provides both informational and experiential learning activities associated with nursing is

important in the development of a child's perceived competence to consider nursing as a possible

career choice.

Thus far, the role of career education in promoting career development with children has

been discussed, yet seldom researched. Education models that could prompt career development

in elementary school children have been proposed, yet the impact of such interventions has

seldom been studied and reported. In one of the few studies, McMahon and colleagues, found

that children's career development was enhanced as a result of a career education program

resulting in children being able to list various occupations and even identify a preferred

occupation (McMahon et al., 1999). Another study involving sixth-grade students reported

increased interest in career information as a result of career education activities (Gillies,

McMahon, & Carroll, 1998). Hence, the impetus for this research was founded on information

indicating that career development is a lifelong process beginning very early in childhood and









that career education programs have reported support of spawning children's interests in certain

careers.

Theoretical Structure

Review of the current literature does not offer a well-developed conceptual model to use as

a foundation to develop a children's career education program, partly because of the limited

amount and scope of research conducted in career development in children. Therefore, the

researcher constructed an integrated and parsimonious conceptual framework that was used in

the development of a career education program for school age children to influence their interest

in nursing as a career choice. The proposed conceptual model in the study examines interest,

competence perception, and the desire to help other people as critical attributes that contribute to

the understanding and operationalizing of the career education program for school age children.

These attributes are empirically evaluated and their contributions to the ultimate goal, to

positively influence school age children's interest in nursing as a career choice.

The interest component of the model is consistent with John Holland's theory of vocational

personalities and work environments (Holland, 1997). The model's element of competence

perception is supported by Albert Bandura's theory of self-efficacy mechanism in human agency

(Bandura, 1982). Lastly, the desire to help other people is influenced by nurse theorist Jean

Watson's philosophy and science of human caring (Watson, 1985). Thus, the underpinnings of

these three theories provided a theoretical framework for a career education program

(intervention) for school age children intended to positively influence interest in nursing as a

career choice.

Interest

John Holland published his theory of vocational psychology in 1959 and many consider

Holland's impact on vocational psychology in the past 35 years unprecedented (McDaniel &









Snell, 1999). Holland's career classification hexagon, described in detail in Chapter 2, is a

distinguished icon that represents a theory both rich with researchable propositions and

assessment tools of great counseling utility. In fact, the American Association of Counseling and

Development states that no other career development theory equals the contributions that

Holland's work has provided for both the theoretical researcher and the applied practitioner. His

book entitled Making Vocational Choices has been by far the most cited work in the field of

vocational psychology (Rayman & Atanasoff, 1999).

In career counseling, the satisfied relationship between an individual and an occupation is

referred to as congruence. Congruence exists to the extent that a person selects an occupation

that matches some predefined characteristic of that person. Career information delivery systems

are designed to help individuals identify occupations that are congruent with their vocational

personality that lead to satisfying careers. These delivery systems typically define congruence

along multiple characteristics including interests, abilities, values, and education. Holland's

theory is the primary interest model utilized in the nearly 50 information delivery systems and

almost all the systems incorporate Holland's career classification scheme (McDaniel & Snell,

1999).

Additionally, Holland's theory on vocational choice has added organization, structure,

simplification, and improved interpretations to most all interest inventories utilized in career

counseling. It has provided a framework for organizing and measuring occupational interest data

within the field of vocational psychology. The robustness of Holland's work has influenced

nearly all contemporary interest inventories such as the Campbell Interest and Skill Survey, the

Suder Occupational Interest Survey and Career Search Schedule, Holland's Self-Directed-

Search, the Strong Interest Inventory and Skills Confidence Inventory, and the Unisex edition of









the ACT Interest Inventory (Campbell & Borgen, 1999). Accordingly, Holland's theory and

occupational information has come to dominate the development, validation, and application of

interest inventories

It is Holland's theoretical value, especially related to the structure of vocational interests,

that the researcher chose Holland's theory of careers to operationally illustrate interest. The

instrument used to measure interest in children is the ICA-R and is explained in Chapter 3.

Perceived Competence

The portion of Albert Bandura's general social cognitive theory that has received the most

attention in the career development literature involves the assessments of self-efficacy (Bandura,

Barbaranelli, Caprara, Pastorelli, 2001). According to Bandura (1986, p. 391), "Self-efficacy

refers to people's judgments of their capabilities to organize and execute courses of action

required to attain designated types of performances." The term "career self-efficacy" is a term

intended to summarize the possibility that low expectations of efficacy related to career behavior

may serve as a detriment to optimal career choice and development in an individual (Betz &

Hackett, 1981).

Betz and Hackett introduced self-efficacy into the career literature in 1981. They

conducted a study involving both male and female college students to investigate the

applicability of Bandura's self-efficacy theory to the process of career selection. They postulated

a causal model of career choice in which perceived self-efficacy functions as a major mediator of

career selection. Additionally, they discovered that the level of perceived self-efficacy correlates

positively with the range of career options critically considered by students and the degree of

interest shown in them. Overall, the data from the study suggest that the strongest predictors of

career choice were self-efficacy and interest (Betz & Hackett, 1981).









According to Holland, although many different career related activities are pursued during

a person's formative years, people generally develop characteristic patterns of career interests.

The development of these patterns of career interests is thought to crystallize during adolescence

or young adulthood. Holland's theory posits that people tend to select careers that are

compatible with their interests (Holland, 1997).

In addition, Bandura (1977) suggests a reciprocal relationship between self-efficacy and

interests, such that, vocational interests are related to self-efficacy because they increase the

likelihood of successful performance in the areas of interest. Reciprocally, expectations of self-

efficacy are suggested to influence the areas of behavior pursued and those avoided. Thus,

avoidance of certain activities as a result of low self-efficacy may prevent the development of

interests, whereas engaging in a variety of activities is likely to expand an individual's range of

interests. More specifically, it is likely that individuals form enduring interests in activities in

which they view themselves to be efficacious and in which they anticipate positive outcomes

(Bandura, 1986; Lent, Brown & Hackett, 1994). The little research that does exist in children

suggests that children 10-12 years of age do engage in career exploration and employ their

interests and aptitudes to guide how and what they learn about the world-of-work (Hartung,

Porfeli, & Vondracek, 2005).

Tracey (2002) examined the structure of interest in children and in a study of fifth and

seventh-grade students reported that just as interest led to the development of a sense of

competence, the development of a sense of self-competence fostered interest. Additionally,

Holland (1997) proposed that self-efficacy estimates are related to interests and incorporated

measures of self-efficacy into his interest scales. This approach to parallel measurements of









perceived competency (self-efficacy) and interest has distinct implications for career counseling

and education and is discussed more entirely in Chapter 2.

It is Bandura's theory of self-efficacy that explains why certain activities generate different

vocational interests over time (Bandura, 1977; 1982). The theory also fits well with the current

scholarly focus of self-efficacy and its extension to vocational behavior (Lent, et al., 1994). For

these reasons, the researcher chose Bandura's theory of self-efficacy to operationally typify

competence perception. The instrument used to measure competence perception in children is

the ICA-R and is described in Chapter 3.

Desire to Help Other People

From a nursing and anthropological viewpoint, the concept of caring for self and others is

one of the oldest forms of human expression and has incited humans to convey their feelings of

caring toward others. Historically, caring has been reported as the most frequent response given

for selecting nursing as a career and continues to be a major influence for those choosing

nursing. In a study examining student's choice of nursing as a career, researchers found that the

concepts of caring and nurturance were identified as high motivators for selecting nursing. The

study also indicated that students described the meaning of nursing related to caring issues such

as helping others, giving care and comfort, serving, supporting, and sharing (Kersten, Bakewell,

& Meyer, 1991). In addition, Grossman and Northrop's (1993) study of eleventh-grade students'

opinions of nursing as a career reported that most of the students perceived nursing as a career

that provides opportunities to care for people in a time of need. More recent studies examining

the most important personal influences of why students chose nursing as a career, reported a

desire to help people (Wilson & Mitchell, 1999; Hemsley-Brown & Foskett, 1999). These

studies continue to reinforce society's time-honored views in relation to the overwhelming image

of nursing as a caring and helping profession.









According to nurse theorist Jean Watson, the nursing profession acknowledges its claims

to the concept of caring describing their professional services to others as nursing care,

therapeutic care, caring for others, and other related caring expressions. Therefore, Watson

contends that a science of caring is essential and the foundation for nursing practice. Watson

asserts that nursing is both scientific and artistic, combing science with humanism. She views

nursing as a therapeutic interpersonal process, yet at the same time, must continue to advance the

science of nursing through scientific knowledge and research (Watson, 1985). Her ambition is to

"study nursing as a humanistic-scientific discipline as well as an academic-clinical profession"

(Watson, 1985, p. xvii).

Swanson's (1999) meta-analysis of published nursing research on the concept of caring

resulted in a proposed framework to integrate the current state of substantive knowledge about

caring in nursing. Findings about the characteristics of a caring nurse were categorized as "the

capacity for caring" and suggest that the caring nurse is compassionate, empathetic,

knowledgeable, confident, and reflective. Previous studies have raised the question as whether

these traits and characteristics are inherent (nature) or if they may be environmentally enhanced

or diminished (nurture) (Ray, 1987; Clarke & Wheeler, 1992). However, in a survey design

study, Soldwisch (1983) supported the association between capacity to care and maturational

readiness (experience).

The researcher proposed a measurement of the desire to help other people to explore and

quantify the caring capacity of the sample population of fifth-grade students and the effects of an

education intervention on the students' caring capacity. The instrument used to measure helping

others in children was developed from the Child Development Project; Scales from Student

Questionnaires, of the Developmental Studies Center titled Concern for Others (Grades 3-6) and









is discussed in Chapter 3. According to Dr. Watson (personal communication, November 5,

2006) the instrument is one possible tool that can measure caring reflective of her theory of

human caring.

Purpose of the Study

The purpose of the study was to develop and examine the effects of a career education

program to strengthen the future professional nursing workforce by encouraging an interest in

nursing as a career choice with school age children, specifically fifth-grade students. The

research was designed to provide information on the career development of fifth-grade students,

approximately ages 10 to 11, and to explore the influence of a career education program on

children's interest in nursing as a career choice. The following aims guided the study:

* Evaluate the effects of a career education program designed to enhance fifth-grade
students' interest of nursing as a career on: (a) interest, (b) competence perception, and
(c) desire to help other people, considering gender. Interest in nursing as a career choice
is operationally illuminated by the concepts of interest (Holland, 1959), competence
perception (Bandura, 1977), and desire to help other people (Watson, 1985).

* Evaluate the effects of a career education program about nursing on children's expressed
consideration of nursing as a future career choice, considering gender.

Summation

In summation, choosing a future occupation is one of the most vital decisions young

people face. Vocational development begins much earlier in the life span than generally

assumed, and what children learn about work and occupations has a profound effect on the

choices they make as adolescents and young adults, and ultimately, on their occupational careers.

The theoretical suppositions presented in this study suggest that many children in the range of

10-12 years of age engage in dynamic career explorations, using their interests and aptitudes to

guide how and what they learn and the goals they formulate in relation to the world-of-work.









The theoretical model that has been proposed served as a functional foundation to

develop a career education program for school age children, particularly fifth-grade students,

intended to enhance interest in nursing as a career choice. The proposed theoretical model is

shown in Figure 1-1 including a relational synthesis of the three conceptual components: (a)

interest, (b) perceived competency, and (c) desire to help other people.

Research Questions

1. What is the effect of a career education program on fifth-grade students' interest in
nursing as a career choice measured by changes in the students' "yes" or "no" responses
when asked if they would consider being a nurse when grown, taking into account
gender?

2. What are the effects of race, having a family member who is a nurse, and knowing
someone who is a nurse other than a family member on the students' "yes" or "no"
responses when asked if they would consider being a nurse when grown before and after
participating in a career education program about nursing?


3. What are the effects of a career education program on fifth-grade students' interest in
nursing as a career choice measured by changes in interest (ICA-R), competence
perception (ICA-R), and desire to help other people (Concernfor Others)? Interest in
nursing as a career choice is operationally illuminated by the concepts of interest
(Holland, 1959), competence perception (Bandura, 1977), and desire to help other people
(Watson, 1985).

4. Is there a difference in how male and female fifth-grade students respond to a career
education program about nursing as a career choice measured by scores on the ICA-R and
Concernfor Others?




































Figure 1-1. Theoretical model of a career education program for school age children









CHAPTER 2
REVIEW OF LITERATURE

The Nursing Shortage

Thinking about today's nursing shortage can be overwhelming. Almost everyone feels an

obligation to do their part to address the shortage of qualified nurses in this country. Duly, the

American Association of Colleges of Nursing (AACN), the national voice for university and

four-year-college education programs in nursing, is concerned about the nursing shortage and is

working with colleges and universities, policy makers, kindred organizations, and the media to

bring attention to this healthcare emergency. The AACN is functioning to enact legislation,

identify strategies, and form public and private partnerships to help strengthen the nursing

workforce (American Association of Colleges of Nursing, 2006a). In addition, other major

national outreach efforts are underway aimed at drawing attention to the nursing shortage,

promoting the image of nursing, and attempting to attract people into the nursing profession

(Donelan et al., 2005).

Current Outreach Efforts

Policy makers

On February 22, 2002 the Bush administration released a national news bulletin identifying

the nursing shortage as a national priority and unveiled a plan to promote careers in nursing

among America's young people. Endorsed by the Bush administration, Health and Human

Services' (HHS) Secretary Tommy G. Thompson and Education Secretary Rod Paige launched a

government campaign to encourage schoolchildren to consider a career in nursing. During this

public announcement, Secretary Thompson is quoted saying "Secretary Paige and I both want

students to realize that nursing is an exciting and satisfying career that makes a difference in

people's lives" (HRSA News Room, 2002, p. 1). Secretary Paige went on to say, "By making









students in America's schools and postsecondary institutions aware of careers in the health

profession, particularly nursing, we hope we can interest these outstanding young people in

filling the critical need of qualified nurses" (HRSA News Room, 2002, p. 1).

During the press release, Secretaries Thompson and Paige unveiled "Kids into Health

Careers" (KIHC). KIHC operates through the Health Resources and Services Administration's

Bureau of Health Professionals (BHPr) and is a government sponsored education campaign to

encourage children's interest in nursing and other health professions. KIHC stresses the need to

reach children at an early age to encourage them to choose a career as a healthcare professional.

Their agenda includes raising the image of and interest in nursing within communities

throughout the country by promoting the nursing profession in local schools, particularly at the

elementary school level (Kids into Health Careers, 2003).

Private organizations

The private sector also became involved at about the same time that Secretaries Thompson

and Paige introduced KIHC with the Johnson & Johnson Company announcing it had begun a

multi-year, multi-million dollar national campaign, The Johnson & Johnson Campaignfor

Nursing's Future, aimed at attracting young people to the nursing profession. The campaign was

developed following a review of current research on the nursing shortage and after consulting

with professional nursing organizations, schools of nursing, hospitals, and other healthcare

agencies. As well, the campaign was assisted by healthcare researchers studying the nursing

shortage at Vanderbilt University Medical Center's School of Nursing and Center for Health

Services Research (Johnson & Johnson, 2001).

Led by Peter Buerhaus, Associate Dean of Nursing at Vanderbilt and a leading researcher

on the nursing shortage, a national poll was conducted to gain insights on Americans'

perceptions related to the nursing shortage. The nationwide poll commissioned by Johnson &









Johnson consisted of telephone interviews of 1,005 Americans, 21 years of age or older (Smith,

2002). Based on the analysis of the study, Buerhaus commented:

The biggest problem is that people are unaware of the array of opportunities and rewards in
nursing today. They are unaware that nursing salaries are very competitive with other
professions or that nursing offers career opportunities in health research, hospital
management, and family and community health care, in addition to traditional patient care.
We need to get these messages out to parents, teachers, counselors and, above all, students
at all levels. (Smith, 2002, p. 3)

Therefore, one of the campaign's central objectives was to publicly promote opportunities in

nursing and increase awareness of the value of the nursing profession to America's healthcare

system. The campaign included providing free recruitment brochures, posters and videos to

hospitals, high schools, nursing schools, and other nursing organizations; as well as a national

advertising campaign that celebrated nursing and their contributions to healthcare (Johnson &

Johnson, 2001). One of the primary goals of the campaign was to stimulate interest in nursing as

a career choice through national advertising. Noteworthy, five years (1995-2000) prior to the

campaign the nation had experienced a drop in enrollments into nursing education programs.

Yet, after the campaign was launched enrollments in nursing programs increased impressively

within the next three years (American Association of Colleges of Nursing, 2006b).

Kindred organizations

Nurses for a Healthier Tomorrow (2007), a coalition of 43 nursing and healthcare

organizations working together to wage a communications campaign to attract people to the

nursing profession launched its national media campaign to encourage interest in nursing careers.

The coalition conducted nationwide focus groups, launched a Web site, created public service

announcements, and designed print ads that were distributed to the American public to bolster

the image of nursing and to educate the public on the opportunities offered by a career in

nursing. Its mission states:









The potential and the solution to the nursing shortage lies in the profession of nursing itself
and in the tremendous range of opportunity it offers to young people considering a career
in health care. Our job is to communicate that message and bring the image of the nursing
profession in line with the realities of its tremendous social importance and personal
potential for career satisfaction. (Nurses for a Healthier Tomorrow, 2007, p.1)

Results

Joining together in 2003, Tommy G. Thompson, Health and Human Services Secretary,

and James T. Lenehan, President and Vice Chairman of the Board of Johnson & Johnson,

announced to the American public that baccalaureate nursing school enrollments increased by

more than eight percent in 2002. Overall, 84 percent of all nursing schools nationwide were

experiencing increased applications and enrollments as a result of these major recruitment

projects (Smith 2002). Accordingly, AACN (2006b) reported a 3.7 percent enrollment increase

in 2001 in entry-level baccalaureate programs in nursing, an 8.1 percent increase in 2002, a 16.6

percent increase in 2003, a 14.1 percent increase in 2004, a 9.6 percent increase in 2005, and a

five percent increase in 2006 (based on preliminary data). Additionally, AACN's (2006b)

annual survey indicated an 18 percent increase from 2005 to 2006 in the number of graduates

from entry-level baccalaureate nursing programs; as well as 3.2, 4.3, 14, and 13.4 percent

increases in the number of graduates in 2002, 2003, 2004, and 2005, respectively.

Future Outlooks

Although these increases in enrollment and number of graduates are encouraging, the

federal report published by the Health Resources and Services Administration (2004) projecting

future nurse supply and demand entitled What is Behind HRSA 'S Projected Supply, Demand, and

Shortage ofRegistered Nurses? indicates that the U.S. must graduate approximately 90 percent

more nurses from its nursing programs to meet the projected growth in the demand for nursing

services. This equates to a deficit of one million new nurses by the year 2020, suggesting that 64

percent of projected demands for nursing services will not be met (Health Resources and









Services Administration, 2004). This survey is completed every four years and is considered the

most extensive and comprehensive statistical resource on registered nurses with a current license

to practice in the United States. However, an updated forecast of the nursing supply and demand

a decade from now is not quite as ominous, projecting a shortage of 340,000 nurses, which is still

three times larger than the size of the current shortage when it was at its peak in 2001 (Auerbach,

et. al., 2007).

A contributing factor to the increased demand for nursing services is the rising elderly

population in proportion to the projected increase in the number of nurses and other caregivers.

The future demand for nurses is expected to increase dramatically as the baby boomers reach

their sixties and beyond. It is projected that the population of people 65 years old and older will

double between 2000 and 2030. The increasing age of the general population and the growing

need for management of chronic disease conditions, suggest that the overall requirement for

nursing services will increase (Buerhaus et al., 2000). This obvious disparity between the future

supply of and demand for nurses continues to widen the gap between the number of people

needing care and those available to provide that care (United Stated General Accounting Office,

2001). Even with AACN's (2006b) report of increased enrollment in nursing programs and

graduates for the past six years, it is evident that the need for more nurses will billow in the years

ahead related to the increasing demands for nursing services heightened by an aging workforce

exiting the profession.

Future Recommendations

The researcher suggests that this recent robust interest in the nursing profession,

demonstrated by the increase in student enrollment and number of graduates in nursing colleges

and universities for the sixth consecutive year, is in part an outcome of the dissemination of

positive information about the nursing profession and its myriad of career opportunities through









these above mentioned national outreach efforts (Smith, 2002; American Association of Colleges

of Nursing, 2006b). Therefore, the researcher recommends that initiatives aimed at continuing to

increase interest in nursing careers must be expanded and sustained to help stabilize this

disequilibrium of the supply and demand in the nursing workforce.

Career Education Program for School age Children

The purpose of this review is to provide a general overview of the current study's proposed

concept of a career education program as it relates to the development of school age children's

interest in nursing as a career choice. Career development information from the disciplines of

nursing, Holland's (1959) theory of career development, Bandura's (1977) theory of self-

efficacy, and Watson's (1985) theory of human caring were identified and reviewed. Although

limited in scope for school age children, the research that does exist suggests many children in

the range of 10-12 years of age do engage in dynamic career exploration, using their interests to

guide how and what they learn and the goals they formulate in relation to their world-of-work

(Wahl & Blackhurst, 2000).

Nursing

The researcher reviewed past nursing research that examined various perceptions of

nursing as a career and specific influencing factors of those students considering or choosing

nursing as a career. To begin, in 1988 a survey regarding the public's perceptions of an ideal

career and nursing as a career was conducted by May and associates for Sigma Theta Tau

International. The overall goal of the study was to provide information that could be used to

enhance recruitment into nursing and ultimately reduce the nursing shortage in Indiana. College

freshmen, students from grades six through 12, their parents, teachers, counselors, and school

nurses were sent a questionnaire developed by the researchers. Among the various findings was

that students in grades six to 12 had more positive attitudes toward nursing career attributes than









did the other groups in the study. Based on this particular result, the researchers proposed that a

potential recruitment group for nursing is school age students because of their more positive

attitudes toward nursing as a career. In addition, the researchers recommended that parents,

teachers, counselors, and college students receive education and be involved in recruitment

strategies intended to raise the image of nursing (May, Austin, & Champion, 1988).

A group of nurse researchers (Marriner-Tomey, et al., 1990) conducted a similar study

involving only high school students. The purpose of their research was to identify career

characteristics that sophomore high school students value along with their perceptions of those

characteristics in nursing. To elicit this information they used the questionnaire developed by

May and associates (1988) with minor changes in the demographic questions. The questionnaire

was distributed to 450 high school sophomores to compare sophomore high school students'

perceptions of an ideal career with their perceptions of nursing as a career. The researchers

reported:

Students wanted significantly more criteria to be met in an ideal career than they perceived
in nursing as a career: always have a job; be appreciated; know a great deal; make a large
amount of money; work in a safe place; be a leader; make decisions; be powerful; and have
respect. They wanted significantly less of the other criteria to be met in an ideal career
than they perceived in nursing as a career: care for people; work very hard; work with my
hands; be very busy; and work with high-tech equipment. (Marriner-Tomey et al., 1990, p.
28)

Results of the study incited the researchers to recommend strategies to change students'

perceptions about nursing as an ideal career to include development of public relations

campaigns about the advantages of nursing as a career and for school programs to educate

students, school counselors, and career advisors about nursing (Marriner-Tomey et al., 1990).

In 1989, a survey of 300 middle school students was conducted by Grossman and

colleagues to elicit students' perceptions of nursing and to explore the relationship between the

experiences of having a nursing role model and the decision to consider nursing as a career.









They found that the majority of students were aware of the caring and helping aspects of nursing

but had little knowledge about the expanded roles and diverse opportunities available in a

nursing career. In addition, the results indicated a significant relationship between the

experience of having a nurse role model and consideration of nursing as a career choice. The

researchers suggested that this particular finding has important implications and must be

considered in the recruitment of young people into the nursing profession (Grossman, Arnold,

Sullivan, Cameron, & Munro, 1989).

Similar findings were reported in a study (Kersten, et al., 1991) that focused on the

motivation factors in a nursing student's choice of nursing as a career. The study explored

current nursing students' definition of nursing, reasons for choosing nursing, and who or what

influenced their choice to be a nurse. The researchers developed a questionnaire and collected

data from a random sample of 20 nursing schools. They concluded that practicing nurses were

identified most frequently as influencing students' image of nursing and their reason for

selecting nursing as a career. The data also indicated that caring continues to be a major

motivating factor for individuals going into nursing in that caring and nurturance of others gave

the students a feeling of satisfaction (Kersten et al., 1991).

Additionally, Pillitteri (1994) surveyed 102 undergraduate students enrolled in a general

education course at a large university in an attempt to identify differences in how nursing and

non-nursing college students view nursing. Demographic information included if the student had

a relative who was a nurse. Accordingly, the study revealed that exposure to nurses was

correlated to a student's view of nursing as an enjoyable occupation. Pillitteri suggested that an

effective recruitment intervention for nursing would be to introduce prospective college students

to practicing nurses. The researcher recommended that students interested in nursing would









benefit from, "early introduction to nursing instructors, exposure of nurses to junior and senior

students, or ideally, spending a day with a nurse in actual practice" (Pillitteri, 1994, p. 133).

Along the same line, in a recent survey of nursing students, Buerhaus and colleagues (2005b)

found that information or advice from practicing nurses was identified by 65 percent of nursing

students as a factor positively influencing their decision to be a nurse. Similarly, researchers

(Donelan, Buerhaus, Ulrich, Norman, & Dittus, 2005) found that teenage students highly

recommended the nursing profession when the students were given the opportunity to talk with

nurses about nursing rather than with a school counselor, suggesting that nurses themselves are

key influencers of young students considering a career in nursing.

In a study involving high school students, Kohler and Edwards surveyed 306 students'

beliefs about nurses and nursing as a career. The students responded to a questionnaire asking

about education requirements, working conditions, earning power, and social status of nurses.

Of the 306 high school students, only 8.6 percent were considering nursing as a career choice.

The findings also indicated that students perceived nursing education to be too difficult and

costly in view of the potential return on their investment related to status or monetary

compensation. The researchers proposed nursing to become further expanded and integrated into

high school career education curricula and to offer students a personal experience with nurses in

actual work settings. They felt perceptions about nursing would be enhanced by expanding the

informational sources related to nursing, thereby facilitating the recruitment of young students

into nursing (Kohler & Edwards, 1990).

On the other hand, a study (Stevens & Walker, 1993) analyzing 641 college bound high

school seniors was designed to determine the reasons these students do not select nursing as a

career more frequently. Some of the findings from this study were consistent with previously









reported nursing research, such as citing a lack of knowledge about the expanded roles and

diverse opportunities available in a nursing career (Grossman et al., 1989; Marriner-Tomey et al.,

1990). Other findings indicated the students were unaware that nurses worked with computers

(91.8%) or high-tech equipment (84.1%), directed health programs (85.5%), or held management

positions (81.2%). Only slightly more than half of the students believed that nurses made their

own decisions (62.2%), had many opportunities for promotion (55%), and could always get ajob

(52.6%). Approximately one third of the students acknowledged that nurses had opportunities to

travel (34.4%), were in demand (28.5%), and that nursing was an exciting career (38.9%). In

addition, almost half of the students (43.8%) believed that nursing was mainly a career for

women (55.1% of the sample were female). Based on their findings the researchers

recommended that nurse educators participate in projects and activities that correctly inform and

improve the knowledge of high school students' understanding and perception of the nursing

profession. They further suggested offering career development activities with elementary and

secondary students before career decisions are made should be purposively considered and

explored to stimulate nursing as a career choice in younger children (Stevens & Walker, 1993).

High school guidance counselors' attitudes about nursing as a career were examined by

Hendrickx and Finke (1994). The questionnaire used in their study was the same questionnaire

used by Grossman and colleagues (1989) when they examined high school students' perception

of nursing as a career. The researchers were encouraged by their results in that most counselors

surveyed (96%) reported that they do recommend nursing as a positive career choice to high

school students and were well informed about the opportunities in nursing. Other studies

exploring the image of nursing held by high school guidance counselors also found that the

majority of counselors are well informed about nursing as a professional discipline and









considered nursing as a potential career for their students. The researchers celebrated their

results and emphasized the need for guidance counselors to continue to stay informed about

nursing and further suggested that the high school level may be too late for initial student

contacts about career choices and recommended counselors in middle and elementary grade

levels needed information about nursing as a career choice as well (Hendrickx & Finke, 1994;

Lippman & Ponton, 1993; Mignor, Cadenhead, & McKee, 2002).

A particular study of interest to the researcher explored the effects a presentation about

nursing has on a students' perception of nursing and whether it changes their perception of how a

career in nursing compares with an ideal career (Marriner-Tomey, et al., 1996). The

questionnaire used by May and colleagues (1988) in a Sigma Theta Tau International study

designed to elicit respondents' perceptions of nursing as a career was used in this study. The 450

Indiana students completed the questionnaire during their sophomore year of high school. Then,

during their junior year, a thirty-minute educational video about nursing was presented to these

same students. The video was followed by an informational session about nursing careers, to

include where nurses work, salaries, and job security. The same questionnaire was distributed a

second time during these students' junior year after attending the presentation to analyze the

effects of a presentation about nursing as a career option on the attitudes of high school students

toward nursing and their likelihood of entering the profession. Their findings compared pre-test

and post-test attitudes of a comparison group and an experimental group. The attitudes of the

experimental group revealed that significantly more students thought that nurses make money,

are leaders, and are powerful on the post-test as compared to the pre-test. Thus, the researchers

concluded that these findings support the hypothesis that a presentation about nursing delivered









to high school students can positively affect their attitudes about nursing as a career (Marriner-

Tomey et al., 1996).

Findings and implications from this previously described study (Marriner-Tomey et al.,

1996) generated the development of the Nursing 2000 model, a collaboration of nursing service

and nursing education serving eight central Indiana counties. The primary purpose of Nursing

2000 was public promotion and dissemination of information about the nursing profession. A

survey was conducted (Wilson & Mitchell, 1999) seven years after the implementation of

Nursing 2000 to determine the extent of influence it had on nursing students in choosing nursing

as a career. The majority of respondents (92%) indicated that they were aware of the programs

and activities of Nursing 2000. The researchers found five of the 13 programs sponsored by

Nursing 2000 to be statistically significant in the students' perception of the influence that

Nursing 2000 had on their career choice as a nurse. Those five programs were: (a) "Shadow a

Nurse Program", (b) career literature, (c) classroom presentations, (d) community presentations,

and (e) career counseling by telephone.

A study that was conducted in a small London borough found that students entering

college had very little interest in nursing as an occupational choice, with less than 2% of the

students declaring an interest in nursing (Firby, 1990). The researcher contends this is due in

part because nursing is no longer one of the few professions available for women. She declares

that women are no longer simply looking to teaching and nursing, but have widened their

horizons to incorporate many occupations, which in the past have been considered part of the

male domain. She explained that nursing is no longer in the privileged position of being one of

the few professions available for women and will have to compete with occupations offering

greater prestige and money. Inferring from the study, the researcher strongly recommended that









nurse leaders take urgent action in recruitment strategies about nursing in an attempt to increase

its appeal to young people. Firby (1990, p. 737) declared, "Unless nursing can increase its

appeal to the youngsters of today it really will become a career of yesterday."

Another study (Hemsley-Brown & Foskett, 1999) reported from southern England

consisted of focus groups and individual questionnaires using a sample of 410 young people,

ages, 11, 15, and 17. The specific purpose of the study was to examine and analyze how young

people choose a career by focusing on how nursing and engineering are perceived by students at

different ages and how these perceptions influence decision-making about subject choices while

in school, education and training pathways, and ultimate career ambitions. It was found that the

main reason for choosing nursing was to be involved with "helping people," although only 6.6

percent of the total sample expressed an interest in nursing as a possible career choice. The

majority of those choosing nursing as a career were 17-year-old girls. An additional 9.6 percent

of the 17-year-old group claimed that in the past they had wanted to become a nurse, but had

changed their minds and chosen another occupation before reaching 17, and half of that group

had changed their minds before reaching the age of 10. The most popular reason given by all

age groups for not wanting to be a nurse was that they were "not interested" (27.3%). Boys were

more likely to give the reason "not interested in nursing" (39.5%) as the main reason for not

choosing nursing and more likely to say that nursing is female work, particularly boys in the 15-

year-old group. Eighty-nine percent of young people had made a career choice without regard

for financial reward and had based their career choice on intrinsic factors such as "interest and

enjoyment" (Hemsley-Brown & Foskett, 1999). These results are similar to results cited in

various United States' studies, suggesting that young people in these two neighboring countries

have similar perceptions of nursing as a career choice.









Lastly, a study conducted by Buerhaus and colleagues (2005a) compared data from a 2002

and 2004 national random survey of nurses evaluating nurses' perceptions of nursing and

satisfaction with their current job. Comparing the results of the two surveys revealed that in both

surveys 83 percent of nurses were very or somewhat satisfied with their jobs, but those who were

very satisfied with theirjobs rose from 21 percent in 2002 to 34 percent in 2004. In addition,

both surveys found that the majority of nurses (87%) were either very or somewhat satisfied with

nursing. However, the number of nurses reporting they were very satisfied with being a nurse

increased from 37 percent in 2002 to 46 percent in 2004. Moreover, the comparison of the two

surveys indicated considerably more nurses would definitely or probably recommend a career in

nursing to qualified high school or college students, 60 percent in 2002 to 72 percent in 2004.

More notable, the nurses that would definitely recommend nursing nearly doubled, from 17

percent in 2002 to 33 percent in 2004. The results of this study are very encouraging for the

researcher and suggest that nurses being currently satisfied with nursing have potential

implications for recruitment activities. Since nurses are currently more satisfied with nursing as

a career, illustrated by the 2002 and 2004 survey (Buerhaus et al., 2005a), then it is reasonable

that a career education program for school age children designed to stimulate an interest in

nursing as a career choice include exposing young students to nurses and what nurses do in their

world-of-work.

Career Development in Children

How Early?

In essence, the question ensues, "How early is too early to begin career development?" To

answer this question the researcher reflected on a study conducted by Beverly Parks (1976)

where she evaluated if exposure to a career oriented curriculum increased the career awareness

of elementary school students in grades three, four, and five. Other purposes of the study were to









determine whether exposure to the curriculum reduces gender bias and what effect the

curriculum had on the students' choice of occupations. Results indicated that the curriculum did

not lead to significant differences in career awareness among all grade levels, although it did

have a significant impact on the gender-stereotyping behavior of both male and female students

in grades four and five, but not in grade three. Based on these results, Parks proposed that the

reduction in stereotyping might have the positive effect of having students consider more career

options and may ultimately be a more desirable outcome than increased career awareness.

Thereby, the researcher inferred that a curriculum intervention as early as fourth grade could

significantly reduce occupational stereotyping and perhaps lead to greater freedom of

occupational choices.

Developmental Career Counseling

Emerging in the 1950s, developmental career counseling is generally credited to Donald

Super (Super et al., 1957) for generating the major concepts that gave impetus to a

developmental approach to career counseling beginning in childhood and progressing into

adulthood. Developmental career counseling is based on traditions rooted in principles from

developmental psychology and is evidenced by the fact that many vocational theorists have used

life-span development as an organizer for their presentation of career development concepts

(Walsh & Osipow, 1990). Of recent, the perspective on career guidance has shifted from a focus

of vocational development during adolescence and early adulthood to include a broad view of

career development throughout the various life stages, including young children (Sharf, 2006).

The developmental theories of Erikson (1993) and Piaget (1972) describe the ways in

which children develop their understanding of the world. As well, life career theories, such as

those of Super (Super, et al, 1957) and Gottfredson (1981) provide a framework for

understanding the ways in which children develop their understanding of the world-of-work









(Sharf, 2006). Therefore, the researcher suggests that age-appropriate career development

activities for children be designed by weaving the underpinnings of both child and career

development theories that are appropriate to the various developmental stages of childhood.

Acknowledging that it is during childhood that crucial career related concepts and attitudes

are first formed (Super et al., 1957), the American School Counselor Association (ASCA) issued

the ASCA Policy Statement on Career Guidance citing the elementary school years as a period

for children to develop awareness of self and careers. The policy statement called for school

counselors to assume leadership in implementing developmental care guidance programs for all

students and to begin as early as kindergarten (American School Counselor Association, 1984).

In so doing, the importance of providing career development programs in the elementary schools

became a recommended standard of elementary school counseling programs. Thus, career

education is now recognized as a fundamental element of guidance programs at elementary and

middle school levels, and not just of high school students (American School Counselor

Association, 2006).

The importance of developmentally appropriate career guidance activities being introduced

at the elementary school level has gradually and increasingly been acknowledged in the career

development literature. However, the empirical literature focused on young children is relatively

sparse as compared with the rich literature on adolescent and adult career development (Trice,

Hughes, Odom, Woods, & McClellan, 1995). Areas of research related to childhood career

development have focused on the child's ability to express realistic occupations, permanence of

career preferences, the influence of gender role expectations, parental and role model influences,

social and status valuation, and personal interests on children's career aspirations (Sharf, 2006).









Based on the study's research questions, the researcher chose to review and include the

literature related to (a) expression and permanence of career preferences, (b) the influence of

gender role expectations, and (c) the effect of interests and competence perceptions on children's

career aspirations. These literature reviews are covered in the subsequent paragraphs.

Expression and Permanence of Career Aspirations

The review of the research literature uncovered several studies that have provided evidence

that young children are able to express career aspirations. One study (Trice & King, 1991)

interviewed 211 kindergartners at the beginning of the school year and again eight months later

concerning the children's career wishes. Seventy-four percent of the kindergartners gave a

realistic career as their first choice during the initial interview and the percentage increased to 84

percent on the second interview. Of those giving a realistic career on the first interview, 46

percent chose the same occupation at the second interview. Based on these results the

researchers concluded that kindergarten children have both realistic and stable career aspirations.

This study was subsequent to Trice (1990) reporting that 70 percent of 203 second-graders and

45 percent of 209 fifth-graders over a nine-month period gave the same answer to the question,

"What do you want to be when you grow up?" These studies suggest that even among five-year-

old children there is a degree of structure and stability in children's occupational aspirations

(Trice, 1990; Trice & King, 1991).

In a retrospective study, 620 full-time employed adults between the ages of 40 and 53 were

asked to identify their first realistic career aspirations and how old they were at the time. Results

indicated a majority, 59 percent, specified a first career aspiration before the age of 13. Of

particular attention, 41 percent of the childhood aspirations and 46 percent of the adolescent

aspirations matched current occupations. The researchers concluded that early career aspirations

are associated with adult career choices and that first choices aspired in childhood are as likely to









result in career achievement as those developed in adolescents (Trice, 1991). Other studies with

adults and college students (Costa & McCrae, 1986; Costa, McCrae, & Holland, 1984; Swanson

& Hansen, 1988) have also illustrated the stability of vocational interest patterns over the life

span.

Trice and McClellan (1993), in a study evaluating the permanence of occupation

preference with young children and adolescents, found a strong correlation between the career

aspirations of individuals interviewed at ages six to 17 and their actual careers 14 to 20 years

later, particularly in scientific, artistic, helping, and skilled trade professions. In addition, the

results of a study measuring the vocational interests of gifted adolescents supported assessing

vocational interests at age 13 can in fact offer a glimpse of eventual adult vocational-interest

patterns (Lubinski, Benbow, & Ryan, 1995). Hence, these studies demonstrate how critical the

career development of children can be on their subsequent career goals and illuminate the

predictive value of early occupational aspirations.

Gender Role Expectations

A seminal study (Looft, 1971) indicated gender differences in career aspirations develop

early in childhood, especially with females. The study suggested that females, as early as first

and second grade, identified a narrower range of career preferences and had lower expectations

of occupational achievement than males. A more recent study (Phillips, Cooper, & Johnson,

1995) indicated similar results, finding distinct differences between the career goals of girls and

boys in grades four through eight, with girls identifying a much narrower range of professional

occupations.

As well, studies (Phipps, 1995; Sellers, Satcher, & Comas, 1999) have found that young

children continue to think of occupations and choose occupations in terms of the occupations

being male or female. Research (Bailey & Nihleh, 1990; Bigler & Liben, 1990) has indicated









that same-gender role models in a particular career are one factor that influences men and

women's attitudes about the appropriateness of a career for members of their own gender. This

research suggested that exposure to nontraditional role models can lead to a reduction in

occupational gender stereotyping in school age children. The researcher gleaned several

recommendations from these studies to help dispel young students' gender stereotypes, such as:

(a) designing a curriculum that stresses the irrelevance of occupation gender versus the relevance

of interest, (b) bringing guests with nontraditional occupations into the classroom to discuss their

occupations, (c) reading stories whose characters hold nontraditional jobs, (d) taking field trips to

view workers in nontraditional settings, (e) depicting nontraditional workers on career posters

(such as male nurses), and (f) establishing mentoring and shadowing programs for children

interested in nontraditional careers.

Holland's Theory of Career Development

John Holland, vocational psychologist, first published his heuristic theory of vocational

choice in 1959. Holland's theory is unique and most notable among career theories in that it

provides an analogous method to describe people in terms of personality type (interest) and work

environment. The theory characterizes people by their resemblance to six personality types;

Realistic (R), Investigative (I), Artistic (A), Social (S), Enterprising (E), and Conventional (C),

collectively referred to as RIASEC. The more closely a person resembles a certain type, the

more likely the person will display personal traits and behaviors associated with the type.

Holland (1997, p. 6) explains, "The idea for a typology resulted from the frequent observation

that several broad classes account for most human interests, traits, and behaviors." A second

concept of Holland's theory is the environments in which people live and work can be

characterized by their resemblance to six model environments; Realistic (R), Investigative (I),









Artistic (A), Social (S), Enterprising (E), and Conventional (C), which correlate with the six

personality types (Holland, 1968).

Holland designed his iconic RIASEC hexagonal model (Figure 2-1) to portray similarities

and differences between and among the six types. Herein, the six types can be represented as

existing in a hexagonal arrangement where proximity between types represents the degree of

relation. Those that appear next to each other on the hexagon, such as Artistic and Social, have

similar interests and personality traits. Conversely, those types that are directly across on the

hexagon, such as Social and Realistic, are considered opposites with no similarity in interests or

personality traits (Holland, 1997).

In Holland's typology, both personality and environment are expressed in a three-letter

code, formed by selecting the three types that most closely distinguishes the person or the

person's work environment. The three-letter code, referred to as the Summary Code,

summarizes a person's characteristics by showing the degree of likeness to the three types

(Holland, 1997). As an example, a nurse has the three-letter code of SIA, indicting a nurse

typically has dominant Social beliefs, but also, to a lesser degree, exhibits Investigative and

Artistic characteristics. An individual is more likely to be successful, feel satisfied, and enjoy a

productive work life when there is congruence between personality characteristics and work

environment (Holland, 1997).

Two of Holland's basic assumptions are that people in the same occupation have similar

personalities and they choose occupational environments that are consistent with their

personality type (Rayman & Atanasoff, 1999). These two assumptions illustrate a secondary

concept of Holland's theory referred to as congruence. To illustrate, someone that is energetic,

self-confident, and attention getting will seek an environment in which these traits can be easily









expressed. This person could possibly find "that fit" in the occupational roles of business

executive, salesperson, or news reporter (Holland, 1997).

Other secondary concepts of Holland's theory include consistency, differentiation, and

identity. Consistency is determined by examining the relationship of the first two letters of the

Summary Code. In RIASEC theory, a personality pattern or interest profile is consistent if the

ideal types most resembled are closely related or adjacent on the hexagon. High consistency is

associated with stability in career direction and career selection. Differentiation is the extent that

a person or an environment is well defined. An individual that is clearly defined may closely

resemble only one type as opposed to someone that resembles many types, or undifferentiated.

Lastly, the concept of identity provides an estimate of the clarity and stability of a person's goals,

interests, and talents, as well as the clarity or explicitness of an environment's goals or

expectations. It is a general measure to rule out vocational decision-making difficulties (Reardon

& Lenz, 1999).

Two of the underlying six principles of Holland's theory are considered relevant to this

study and require enumeration. The two principles are: (1) The choice of a vocation is an

expression ofpersonality and (2) Interest inventories are personality inventories. Holland is

very clear that he believes personality and vocational choices are related stating:

If vocational interests are constructed as an expression of personality, then they represent
the expression of personality in work, school subjects, hobbies, recreational activities, and
preference. In short, what we have called "vocational interests" are an important aspect of
personality. If vocational interests are an expression of personality, then it follows that
interest inventories are personality inventories. (Holland, p. 8, 1997)

However, for the past 50 years, researchers have investigated the links between interests

and personality and a question remains, Does the available research findings support Holland's

(1973) view that vocational interests are an expression of personality, and if so, can interest

scales reflect personality characteristics? Perhaps Costa, McCrae, and Holland (1984) did the









largest study examining the relations between vocational interests and personality traits. Their

analyses supported the conclusion that personality dispositions show a strong and consistent

association with vocational interests. Later studies (Gottfredson, Jones, & Holland, 1993; Hogan

& Blake, 1999; Tokar & Swanson, 1995; Tokar, Vaux, & Swanson, 1995) have replicated the

correlation between interest scales and personality scales reporting small to moderate

correlations.

In relation to measurements of assessed interests, Holland's contributions to the

development of interest measurement have dominated the field with the redesign of the Strong

Interest Inventory and Holland's development of the Self-Directed Search and Vocational

Preference Inventory. These instruments continue to be the most popular interest inventories

used by contemporary career counselors. In precis, Holland's RIASEC hexagon has brought

structure, organization, and simplification to interest measurement (Reardon & Lenz, 1999;

Savickas & Gottfredson, 1999).

Bandura's Theory of Self-Efficacy

Bandura's social learning theory provides a philosophy of human agency to explain career

choice and development. Recent application of social learning theory to career development has

focused on the predominance of a sense of competency, specifically self-efficacy (Bandura,

1977, 1982, 1986; Betz & Hackett, 1981; Lent, et al., 1994), as leading to the development of

career behavior. According to Bandura and colleagues:

Among the mechanisms of human agency, none is more focal or pervading than people's
perceived self-efficacy. Unless people believe they can produce desired outcomes by their
actions, they have little incentive to act or to persevere in the face of difficulties. Perceived
self-efficacy is, therefore, posited as a pivotal factor in career choice and development.
(Bandura, et al., 2001, p. 187)

Self-efficacy is defined by Bandura (1986, p. 391) as ". .. people's judgment about their

capabilities to organize and execute a course of action required to attain designated types of









performances." Self-efficacy expectations refer to individuals' beliefs in their abilities to

perform particular behaviors successfully and are developed from their experiences with the

effects of their own past behavior (Bandura, 1977, 1982).

More than 20 years of research (Bandura, 1997; Betz, 2000; Betz & Hackett, 1981, 1997;

Hackett, 1985; Lent, et al., 1994) have indicated that beliefs of self-efficacy do in fact influence

occupational development and pursuits. However, while there is substantial research that

confirms the role of perceived self-efficacy in career choices in young adults, there has been little

research and knowledge development on how children develop their sense of occupational

efficacy and how it affects their career trajectories. One of the few studies involving children

ranging from 11 to 15 years old found that the pattern of children's perceived academic efficacy

had the most pervasive impact on children's judgments of their occupational efficacy. It was

explained that this perceived occupational efficacy influences the type of occupations children

believe they have the capability to perform and is linked to the kinds of career pursuits they

choose for their life's work (Bandura et al., 2001).

Interest and Self-Efficacy

A recent trend in the theory and practice of vocational psychology is to integrate the

concepts of vocational interest and self-efficacy. This trend is based on heightened empirical

evidence that vocational self-efficacy is a strong predictor of interest and career choice (Betz &

Hackett, 1981; Lent, et al., 1994). The reigning model, the Social Cognitive Career Theory

(SCCT) (Lent, et al, 1994), focuses on self-efficacy as providing a key theoretical link between

abilities and interests. In fact, the SCCT propositions the concepts of interest and self-efficacy as

conceptual partners when considering vocational behavior.

Several researchers have constructed self-efficacy ratings that parallel Holland's RIASEC

types and found that these self-efficacy RIASEC scales correlate highly with the matching









RIASEC scales from interest instruments (Betz, Harmon, & Borgen, 1996; Swanson, 1993).

Thus, with regard to adults, inventories have been designed to elicit parallel measures of

vocational interests, so that the mutual interpretation of interest and self-efficacy can occur. This

particular application of conjointly measuring interest and self-efficacy has implications for the

current study in that both interest and competence perception were measured to evaluate the

effects of a career education program on fifth-grade students' interest in nursing as a career.

Understandably, given the extensive literature with adults as compared to the extant

literature in children, the question emerges, How do you evaluate vocational interests and self-

efficacy in children? Explanation is made using Piaget's model of developmental salience.

According to Piaget (1975), it is expected that children will change their thinking during the

years from around fourth to ninth grade, from concrete cognitive organization to more abstract,

less egocentric, organization. He proposed that these formal operations develop as a result of

stimulation and that people are most likely to develop and use formal operations in areas where

they have special interests. This thought suggests that children will apply their newly learned

formal operations to those areas deemed most salient or of interest and make sense out of those

activities that they are most attracted to or like best. Thus, it could be supposed that if a child is

interested in activities involving caring for people, a characteristic of the nursing profession

(Watson, 1985), the child would begin to examine those activities of a Social type (prefers

helping and developing others and interpersonal pursuits) that incorporates the activity of caring

before the child would begin to examine activities related to other vocational types, such as the

Conventional type (prefers data management, numerical and organizational pursuits).

Tracey attributes this process of cognitive development to explain the adoption of the

RIASEC types by children and adolescents. In a conceptual analysis, Tracey uses Piaget's









model of salience to describe the developmental process that occurs in how children and

adolescents begin to structure interests. As a result of this analysis, Tracey suggested it is more

appropriate to study children's interest by examining the activities they like and perceive a sense

of competency (Tracey, 2001).

Thus, Tracey and Ward (1998), in a study designed to evaluate the structure of children's

interests and competence perceptions, ". sought to construct a brief instrument that would

include activities that are relevant to children: those that they engage in and have the necessary

experience to accurately assess their liking" (p. 290). Presuming the importance of the link

between self-efficacy and interest, Tracey and Ward concluded that instrumentation must be

generated to study both interest and perceived competence in children. Tracey and Ward

focused on perceptions of competence as a measure of self-efficacy based on information from

Lent and colleagues demonstrating the conceptual and empirical overlap of perceived

competence and self-efficacy (Lent, Brown, & Gore, 1997).

As a result, Tracey and Ward (1998) developed the Inventory of Children's Activities

(ICA) designed to assess a child's interests and competence perceptions. It consisted of

questions the child responded to in terms of what the child "liked to do" and what the child was

"good at doing." The ICA contained two sections of 34 identical activities. The first section

focused on interests and the second section focused on perceptions of competence.

The ICA was first administered to college, middle school, and elementary school students

to access longitudinally the structure of children's interests and competence perceptions and to

determine if they can be represented using the six RIASEC types: since the interest and

competence measures on the ICA-R were designed to parallel the RIASEC types. The results

indicated that there was overall support for the ICA representing the RIASEC relational structure









in the college sample; however, there was less support for the younger children. However, in

each age group the interest scores correlated highly with the competence perception scores

(Tracey & Ward, 1998).

In a subsequent study (Tracey & Ward, 1998), the ICA was altered to increase reliability

with the intent to provide additional support of the structures of interests and competence

perceptions. In addition, six extra items were added to help validate gender typing. The

researchers concluded that the revised ICA, the Inventory of Children's Activities-Revised

(ICA-R), appeared to be a reasonable instrument to examine children's interests and evaluate the

self-efficacy and interest linkage to career development and occupational choice in children.

Again, as in the previous study, the interest scores correlated highly with the competence

perception scores (Tracey & Ward, 1998).

In a later study, Tracey (2002) used the ICA-R scale to determine if it was a valid indicator

of interests and competence perceptions to yield RIASEC scale scores in a group of fifth and

eighth-grade students. The relationship of competence ratings to interest was also examined.

Unlike the results of Tracey and Ward (1998), the RIASEC model was found to provide an

adequate fit to the data for the elementary school sample. The researcher attributed this finding

to all the elementary students being in the fifth-grade and that the viability of the RIASEC scales

has been shown to have better structure with increased age. In addition, Tracey's notion of a

reciprocal causal relation between competence beliefs and interests, with interests leading to

competence development and competence beliefs leading to interest development, was found to

be the best description of the data for both the elementary and middle school sample (Tracey,

2002).









Watson's Theory of Human Caring.

The concept of caring has emerged as an important phenomenon fundamental to the

advancement of nursing knowledge, theories, and models of practice (Kyle, 1995; Lea &

Watson, 1996; McCance, McKenna, & Boone, 1997). Caring is continuing to be increasingly

recognized as a core concept characteristic of the nursing profession, both in science and in

practice. Recently, the revised social policy statement issued by the American Nurses

Association (2003) attests to the centrality of caring as part of nursing's focus with the inclusion

of caring and caring relationships as core aspects of the definition and scope of professional

nursing practice.

Many studies have investigated the concept of caring, adopting a dichotomous approach of

both qualitative and quantitative methodologies. However, much debate has been generated in

relation to the most appropriate method for researching the concept of caring. Historically,

researchers have advocated the qualitative approach based on the nebulous nature of caring

(Leininger, 1986). However, Watson (2002) recently published a book, Assessing and

Measuring Caring in Nursing and Health Science, which includes 21 of the most salient

instruments currently available to assess and measure caring. It is Watson's intention for these

instruments to be used by nurse researchers to advance the knowledge of caring by advancing the

empirical measurement of caring (Watson, 2002).

This central concept of caring within nursing has led to the development of several caring

theories. One of the most well known theories is Jean Watson's theory of human caring.

Watson posits nursing as the art and science of human caring where nursing is a human science

concentrating on the study of the relationship of caring to health and healing (Watson, 1997).

Watson introduced her theory in 1985 in a book entitled Nursing: The Philosophy and Science of









Caring. At the time, Watson considered the content of her book a perspective about nursing and

caring rather than a theory in itself (Watson, 2001).

Watson's original work was directed at designing an integrated baccalaureate nursing

curriculum (Fawcett, 2005), yet resulted in the establishment of ten carative factors (Figure 2-2)

which provided a framework for nursing and a foundation for Watson's theory of human caring

(Watson, 1985). According to Watson (1985), these carative factors represent the core of

nursing when all the techniques and technologies have been removed. In Watson's second book,

Nursing: Human Science and Human Care: A Theory ofNursing, Watson (1988) presents her

theory of human caring, describing it as an intersubjective human process where value is placed

upon the caring relationship between the nurse and the care recipient. The original ten carative

factors were further posited not only as a framework for nursing, but for all health and healing

practitioners and professions, thereby extending the application of her theory beyond nursing.

In developing the theory of human caring, Watson (2001, p. 345) ". .. sought to balance

the cure orientation of medicine, giving nursing its unique disciplinary, scientific, and

professional standing with itself and its public." Watson (1997) has distinguished nursing from

medicine and associates caring with nursing and curing with medicine. Watson (1985) considers

the knowledge within her theory of human caring provides the framework to advance nursing

practice that is distinct from, but complementary with current practices of modern medicine.

In Nursing Theory and Practice

The significance of Watson's theory of human caring lies in her concern with the

metaparadigm concepts of nursing (human beings, environment, health, and nursing), which

focuses on health and nursing, and more specifically the nursing process with effective positive

changes in health status (Fawcett, 2005). There is current evidence that nursing care and caring

are decisive variables that make a positive difference in patients' outcomes of health and









wellbeing (Swanson, 1999). Swanson's (1999) meta-analysis of 130 publications of empirical

caring studies in nursing research offers paramount evidence as to the importance of caring and

its favorable outcomes for both patients and nurses.

Numerous studies (Beck 2000; Boughn, 2001; Boughn, & Lentini, 1999; Kelly,

Shoemaker, & Steele, 1996; Kersten et al., 1991; Pillitteri, 1994; Stevens & Walker, 1993;

Williams, Wertenberger, & Gushuliak, 1997) have established an iterative theme of "caring for

others" as the major motivating factor for both men and women choosing nursing as a career.

Yet, nurses are continually confronted with having to practice nursing based on a task-oriented,

highly technological, biomedical model as opposed to a model of human caring that influenced

them to the profession in the first place. This challenge is compounded by the current nursing

shortage and today's fast-paced healthcare environment. It is reported that nurses who are not

able to practice within a caring context are characterized as hardened, oblivious, robot-like,

frightened, and worn down (Swanson, 1999). Conversely, nurses are much more satisfied,

fulfilled, more purposeful, and knowledge seeking when caring is present in their nursing

practice (Watson, 2002).

Future Directions of Watson's Theory of Human Caring

Of interest, Watson (2005) recently introduced her model of science, which she named

Caring Science, in her book Caring Science as Sacred Science. Watson (2002, p. 456) describes

caring science as an ". evolving philosophical-ethical-epistemic field of study and is grounded

in the discipline of nursing and informed by related fields." Watson acknowledges that some

may consider it somewhat of an oxymoron to juxtapose Caring with Science. However, to make

clear, Watson (2002, introduction) states, "Perhaps the time is right for such paradoxical

scientific considerations and integration, which allow science, morality, metaphysics, art, and









spirituality to co-mingle for new reasons." Watson also introduces the changing nature of the

Carative Factors toward using the language of"Caritas," described by Watson as:

... conveying a deep form of transpersonal caring and love to come into play as part of a
caring-healing perspective guiding Caring Science. It is when we include caring and love
in our science; we discover our caring-healing professions and disciplines are much more
than a detached scientific endeavor, but a life-giving and life-receiving endeavor for
humanity. (Watson, 2005, p. 3)

Summary

Although career development interventions at the elementary school age level might seem

premature, the studies reviewed in this chapter have shown that career development is an

important antecedent for school age children to understand the world-of-work. Seligman and

colleagues (1991) have shown that children by the age of 10 have done quite a bit of thinking

about their future and can clearly articulate their career aspirations. McMahon and associates

(1999) found that children's career development was enhanced as a result of career education

lessons, with children showing an increased ability to list occupations and identify a favorite

occupation. These studies and others have provided empirical evidence that suggest young

children are not too young for and would benefit from early career counseling.

In addition, research has demonstrated career interventions and the exposure to

nontraditional workers can lead to a reduction in occupational gender stereotyping in school age

children (Bailey & Nihlen, 1990; Bigler & Liben, 1990). An example is a male nurse teaching a

group of young students a career education program about nursing. This may be especially

efficacious if the career is considered nontraditional for a particular gender, such as nursing

(Betz, 2004).

The proposed career education program about nursing used in the study was evaluated to

determine its effect on fifth-grade students' interest in nursing as a career choice. Separate

components of the career education model (illustrated in Figure 1-1) are examined: (a) interest,









(b) competence perception, and (c) desire to help other people. The results of the study will

serve as a foundation for future development of career education programs designed particularly

for school age children.





























Conventional
Prefers data
management, C
numerical, and
organizational
pursuits





E


Enterprising
Prefers leadership,
influencing, and
persuasive pursuits


Artistic
A Prefers creative,
imaginative, and
intuitive pursuits






S

Social
Prefers helping,
developing others,
and interpersonal
pursuits


Figure 2-1. A hexagonal model for defining the psychological resemblances among personality
types and environments and their interactions. Source: Holland, 1997












1. The formation of a humanistic-altruistic system of values

2. The instillation of faith-hope

3. The cultivation of sensitivity to one's self and to others

4. The development of a helping-trust relationship

5. The promotion and acceptance of the expression of positive and negative feelings

6. The systematic use of the scientific problem-solving method for decision making

7. The promotion of interpersonal teaching-learning

8. The provision for a supportive, protective, and/or corrective mental, physical,

soiciocultural, and spiritual environment

9. The assistance with the gratification of human needs

10. The allowance for existential-phenomenological dimensions.


Figure 2-2. The original ten carative factors. Source: Watson, 1985, pg. 11









CHAPTER 3
METHOD

This study will evaluate career exploration activities with school age children before career

decisions are made to stimulate interest in nursing as a career choice. Specifically, the researcher

will develop a career education program about nursing's world-of-work for fifth-grade students,

incorporate the concepts from the proposed theoretical model (Figure 1-1), and study its effect

on students' interest in nursing. Therefore, the purpose of this study is to evaluate the influence

of a career education program on fifth-grade students' interest in nursing as a career choice. The

nature of comparisons is within-subjects with group comparison. Data were collected at two

points in time, pre- and post-education intervention. Because of the study's two measurement

points, it is considered a pre-test-post-test design, where the initial measure of the dependent

variable is referred to as the baseline measure and the post-test measure is referred to as the

outcome measure.

Participants

Study participants were recruited from fifth-grade classrooms from a public elementary

school in a large metropolitan city in the Southeast. The school consists of three fifth-grade

classes, each class having 20 to 25 students, resulting in a convenience sample of 70. Major

demographic variables were collected on each participant such as age, race/ethnicity, gender,

career aspirations, nurse as a family member, and nurse as an acquaintance. The sample of 70

fifth-grade students in the study reported by ethnic categories consisted of six students of

Hispanic origin and 64 students of non-Hispanic origin. The sample reported by racial

categories consisted of two students who identified themselves as Asian/Native Hawaiian or

Pacific, 16 students as Black/African American, and 52 students as White. The six students of

Hispanic origin reported themselves racially as White and therefore are part of the 52 students









reported in the racial category as White. For purposes of data analyses, race was defined and

dichotomized into two categories: (a) Black and (b) non-Black. The two Asian students were

placed into the non-black category resulting in 16 Black students and 54 non-Black students.

Table 3-1 illustrates the demographics related to age, gender, race, having a family member as a

nurse, and knowing a nurse for the total sample (N = 70), Group 1 (N = 35), and Group 2 (N=

35).

The researcher attended a parents' association meeting and explained the study to parents

(or legal guardians) of fifth-grade students. Following explanation of the study to the parents,

the researcher visited each fifth-grade classroom and explained the education program to the

students. The nurse researcher wore a nurse's uniform to the parents' meeting and to the

classrooms to provide a visual image of a nurse. In addition, a male nurse accompanied the

researcher to represent males as nurses.

Inclusion criterion consisted of teacher recommendation for a student to participate.

Exclusion criterion was difficulty reading English at a fourth grade level, reported by the school.

Consent to participate in the study was obtained from the student's parent or legal guardian.

Assent to participate was obtained from each student. Children were considered for enrollment

in the study if they met the inclusion criterion, gave assent to participate in the study, and had

signed consent from the student's parent or legal guardian.

In determining the sample size, the researcher established the level of significance to be

acceptable at.05 (a) and beta at .80 (1 8). Previous studies (Tracey & Ward, 1998; Tracey,

2002) have demonstrated that the strength of the relationships among the research variables as

moderately correlated. Thereby, based on apriori reason, the researcher proposed a moderate

effect size (y = .50). An approximate sample size of 60 is necessary to achieve this selected level









of power for the planned statistical analyzes that was conducted in this study: (a) Pearson's chi-

square test, (b) McNemar test, and (c) paired t- test (Polit & Beck, 2004).

Intervention

The current research incorporated a career education program for school age children

intended to influence fifth-grade students' interest in nursing as a career choice. The concepts of

interest, competency perception, and the desire to help people served as the theoretical

foundation for the career education program (Figure 1-1).

The career education program was comprised of four consecutive weekly education

sessions, each lasting approximately 212 hours. At the conclusion of the education program and

after post-assessment of all students, an optional field trip to a local children's hospital was

planned. The researcher suggested a field trip, a traditional, yet worthwhile activity, as an

opportunity for students to experience nursing's world-of-work first hand. The researcher

recognized that although a hospital is not the only setting where nurses work, a hospital employs

a diversity of nurses performing a wide range of occupational experiences, thereby allowing the

students to explore a number of diverse work settings.

In an attempt to maximize internal validity, the researcher exerted a high degree of

consistency of research conditions, especially as they related to the environmental context. Thus,

the students participated in the program the same day of the week, same time, and same

classroom. Additionally, the researcher provided all the student-training sessions for each group

of students.

Curriculum Design

The career education program used in this study entitled, Fifth-grade Career Education and

Awareness of Nursing as a Career Choice, consists of four instructional units:









(a) Everybody Can Learn about Nursing, (b) Learning What Nurses Need to Know about the

Body, (c) Learning about Skills that Nurses Perform, and (d) Learning What Nurses Need to

Know about Common Diseases, Such as the Common Cold. Appendix A provides a

comprehensive outline and description of the study's career education curriculum.

Each unit's learning objective and performance competencies were designed in accordance

with the curriculum framework provided by the National Career Development Guidelines

(NCDG). The NCDG initiative is a major national effort to foster excellence in career

development for students of all ages, genders, and cultural backgrounds. The guidelines are a

result of a collaborative effort among the National Occupational Information Coordinating

Committee (NOICC), the State Occupational Information Coordinating Committee (SOICC),

and leading career counseling and development professional organizations. The National Career

Development Association (NCDA), the American Counseling Association (ACA), the American

School Counselor Association (ASCA), and other counseling and career development

organizations endorse the guidelines. In addition, the guidelines identify key competencies that

students need to master at various stages throughout the career developmental process. These

competencies define general career development goals by age level: (a) elementary school, (b)

middle school, (c) high school, and (d) adult. There are twelve competencies for each age level

and are categorized into three areas: (a) self-knowledge, (b) educational and occupational

exploration, and (c) career planning (National Occupational Information Coordinating Council

1989). The development of these guidelines established a competency-based career guidance

and counseling program to career education. In a study (Freeman, 1994) of 1,273 randomly

selected school counselors, they were asked how important are each of the competencies from

the standpoint of practicing school counselors. The results of the study indicated that school









counselors consider the career development competencies within the guidelines to be important

to very important across all three areas for all age levels.

The researcher incorporated the twelve elementary school competencies as a foundation to

develop the learning objectives of the career education program about nursing that is applied in

the study. Table 3-2 provides a crosswalk of the NCDG's elementary school competencies and

the instructional content within each of the four units of the study's career education program

about nursing. The curriculum was given to a panel of experts consisting of: (a) two pediatric

nurse educators, (b) two fifth-grade teachers, and (c) one elementary school age counselor to

evaluate the appropriateness of the education program's content, interest level, and ability of

fifth-grade students to understand and participate. Each evaluator judged the education program

suitable in all aspects for fifth-grade students.

Instructional Units

Each instructional unit of the career education program states the: (a) specific learning

objective, (b) student's targeted competencies and skills, (c) recommended instructor

preparation, to include a list of suggested supplies, and (d) student learning assessment tools.

Each unit is instructor-directed and includes a group activity to reinforce the instructional lesson

and to help students master the targeted competencies and skills. The program includes various

modalities of learning to provide the students with information to help them develop a

comprehensive understanding of nursing as a career choice.

The developmentally appropriate fifth-grade curriculum was intended to encourage

"curious spirits" about nursing by weaving the natural curiosity of children with the writings of

child development and career development theorists, providing for both career awareness and

career exploration strategies. The curriculum included various experiential learning activities,

such as learning to take a temperature, blood pressure, heart rate, respiratory rate, and how to









properly wash hands. An advanced practice nurse from a local children's hospital was invited to

demonstrate proper hand-washing technique. Each student had an opportunity to wash their

hands and evaluate their performance by looking for germs left on their hands with a black light.

In addition, the students completed word searches and crossword puzzles to reinforce learning

instructions to include identifying and naming body parts and listing the many career

opportunities in nursing. Throughout the program, the students were provided information about

the nursing profession supplied by Johnson & Johnson's Campaign for Nursing's Future, which

included colorful brochures, coloring books, and book covers featuring The Nursing GangTM

They also received colorful handouts produced by Nemours Foundation, Kids Health for Kids

which outlined and reinforced information covered in each education session, such as

instructions for both parents and students on how to properly wash hands to prevent the spread of

germs. The researcher brought into the classroom anatomical models of the body, the skeleton,

and other major body parts, such as the heart, lungs, eye, and brain. In addition, the students

accessed and interacted with Johnson & Johnson's The Nursing Gang TM website, featuring four

contemporary animated nurses from diverse backgrounds making a difference in people's lives.

The website is packed with interactive games, jokes, music videos, fashion tips, trivia, and more,

all related to the nursing profession.

Research Design

The current study is a within-subjects design, often referred to as repeated-measured

design, involving comparisons of the same students at two points in time, pre- and post-

education intervention, where the students serve as their own control to evaluate the effects of

the career education program. An advantage of a within-subjects design is it requires fewer

subjects; the total number of subjects needed corresponds to the number required for any one

condition (Brink & Wood, 1998). An approximate sample size of 60 students is necessary to









achieve the selected levels of power (a = .05, 8 = .80 and y = .50) for the planned statistical

analyses used in the study.

A second advantage of a within-subjects design is the unsystematic error variance is

reduced making the study most sensitive to the evaluation of the education program (Fields,

2005). This means the current study because of the within-subjects design minimizes random

factors that may affect the results of the study.

Instruments

The researcher is interested in several dependent variables that involve the critical research

variable, interest in nursing as a career choice. These variables include: (a) interest, (b)

competence perception, and (c) the desire to help other people. Two psychometrically tested

instruments were used to evaluate the effects of the career education program on interest in

nursing, the ICA-R and Concernfor Others.

In addition, the researcher developed a pre- and post-intervention questionnaire. The pre-

questionnaire was designed to obtain demographic information of each student and answers to

questions related to the research questions. Questions on the questionnaire included: (a) Would

you consider being a nurse when you are grown? (b) Do you have a family member who is a

nurse? and (c) Do you know anyone other than a family member who is a nurse? The post-

intervention questionnaire asked if the student would consider being a nurse when grown. The

following information will provide a description of the instruments used in the study.

Questionnaires

The researcher designed the pre-questionnaire to elicit information prior to the students

participating in the education program. The students were asked to provide their age, gender,

ethnicity, and race. Questions on the pre-questionnaire included: (a) What job do you want to do

when you are grown? (b) Do you have a family member who is a nurse? (c) Do you know









anyone other than a family member who is a nurse? and (d) Would you ever consider being a

nurse when you are grown? All questions allowed for a "yes" or "no" response, except for the

question asking the student what job that wanted to do when they were grown, which allowed for

an open ended response. The post-questionnaire was designed to determine if the students would

consider being a nurse as a career after participating in the career education program about

nursing, The question allowed for a "yes" or "no" response.

ICA-R

Tracey and Ward (1998) designed an instrument, the Inventory of Children's Activities

(ICA) to assess Holland's RIASEC types of interest and competence perception with children.

The instrument was developed to examine the structure of children's interests. As well, given

the association of self-efficacy and perceived competence in the determination of interest by

well-known theorists (Bandura, 1982, 1986; Hackett, 1985; Lent et al., 1994), the instrument was

also developed to assess and rate perceptions of competence appropriate for children and

comparable to the interest scale.

Tracey and Ward (1998) first applied their ICA instrument in a cross-sectional study of

elementary students (grades four and five), middle school students (grades six, seven, and eight),

and college students. The college students were included to provide a comparison group to

examine the formation of career interests in children and adolescents. They found good internal

consistency in the samples of elementary and middle school students with alphas ranging from

.60 to .81 with a mean of .71 for the interest scales, and from .61 to .81 with a mean of .70 for the

competence scales. In addition, a 1-week test-retest reliability ranging from .58 to .73 with a

mean of .64 on the interest scales and from .60 to .84 with a mean of .70 on the competence

scales was documented.









However, in a second study, Tracey and Ward (1998) adopted the Inventory of Children's

Activities-Revised (ICA-R) from the ICA, replacing activities that had low scale correlations to

increase reliability in hopes of providing additional support of the structures of interests and

competence perceptions in children. In addition, six activities were added to help in the

validation of gender typing that resulted from their first study. To verify appropriateness of the

revised instrument, it was given to two fourth-grade teachers to check for its readability, clarity,

and ability to be accurately responded to by fourth-grade students. Based on the findings from

their second study, Tracey and Ward (p. 299) concluded, "Given the similarity of the interest and

competence structures in this study, issues relating to the structural difference across age relate

equally to both." Thereby, with corresponding scales for both interests and perceptions of

competence, the researchers concluded the ICA-R appears to be a reasonable instrument to

examine the perceived competence-interest causal link in children (Tracey & Ward, 1998).

In a subsequent longitudinal study of fifth and eighth-grade students, Tracey (2002) used

the ICA-R to examine several questions regarding the development of interests over time. A

primary purpose of the study was to determine if the ICA-R could be used as a valid indication of

interests and competence beliefs for these age groups, since previous studies (Tracey & Ward,

1998) found that younger children's responses to the ICA-R differed in structure from older

children. In addition, Tracey wanted to determine if the previous cross-sectional analyses

(Tracey & Ward, 1998) where hexagonal structure was supported more with age would be

replicated in a longitudinal study and if the scoring in ICA-R would appropriately yield RIASEC

scale scores in younger children. Based on the results of the study, Tracey (2000, p. 153)

concluded, "Unlike the results of Tracey and Ward (1998), the RIASEC model was found to

provide an adequate fit to the data for the elementary school sample." Tracey further reported:









The viability of the RIASEC scales here could be a function of the older basis of the
sample in this study in that all the elementary school students were at least in the fifth-
grade. With increased age, it would be expected that the RIASEC scales would hold
better. (Tracey, 2002, p. 159)

Another indication of the increasing appropriateness of the RIASEC scales with age is the

internal consistency of the scales. The elementary school sample in Tracey's (2002) study

demonstrated somewhat higher internal consistency estimates than found by Tracey and Ward

(1998), which in part could be attributable to greater scale coherence with age.

The composition of the ICA-R consists of two sections of 30 activities; five activities for

each of the RIASEC scales. These activities include behaviors that children commonly

participate and were endorsed by teachers and children, as well as researcher observations. In

the first section the child responds to each of the activities based on the extent to which the child

likes that activity (interests) using a 5-point scale with 1 = don't like at all to 5 = like a lot. The

child then responds to the same activities with respect to perceptions of competence using a

5-point scale with 1 = very bad at to 5 = very good at. RIASEC scores for interest (liking

items) and competence (good at items) are scored by averaging the five items on the scale.

The internal consistency and 1-year test-retest reliability estimates for the ICA-R are

presented in Table 3-3 for the elementary and middle school sample (Tracey, 2002). These

values are similar to those obtained by Tracey and Ward (1998) in their previous samples.

According to Tracey (2002, p., 151), "The values of the internal consistency estimates were

generally moderate, but these values are in part attributable to the relative brevity of the

instrument (five items per scale)."

The researcher of this study obtained permission to use the ICA-R from one of the

researchers who developed the instrument, Terence J. G. Tracey, PhD (personal communication,









August 14, 2006). Dr. Tracey provided the researcher the inventory, as well as the scoring

guidelines.

Concern for Others

The instrument, Concern for Others is an inventory designed to measure students' desire to

help other people. The Child Development Project (CDP), part of the Developmental Studies

Center, developed the instrument. The CDP is a research-based program focused on creating

caring and supportive learning environments that encourages students' sense of belonging and

connection to school. The program has received national recognition for its learning approaches

fostering students' academic, ethical, social, and emotional development. The CDP's past 20

years has been devoted to developing and validating measures of students' social, emotional,

ethical, and academic development (Developmental Studies Center, 2005).

The Concern for Others instrument is comprised of 10 items scored on a 5-point scale with

1 = Disagree a lot to 5 = Agree a lot. The instrument is designed for students in grades three to

six. The instrument's internal consistency reliability is .80 (Developmental Studies Center,

2005). According to Dr. Jean Watson (personal communication, November 5, 2006) the

instrument is one possible tool that measures caring reflective of her theory of human caring.

The Concern for Others inventory is a commercially distributed instrument within the public

domain.

Intervention Implementation and Data Collection

After the parent or legal guardian provided consent and the child gave assent, the

implementation timeline illustrated in Table 3-4 was followed throughout the study until

completion. To begin, the students were randomly assigned to either Group 1 or Group 2,

resulting in half of the students (N = 35) in Group 1 and half of the students (N = 35) in Group 2.

Two groups of 35 students, as opposed to a single group of 70 students, allowed for individual









instruction and greater intimacy with the students. Following group assignment, Group 1 was

administered the pre-test assessment and began the four-week intervention. Upon completion of

the intervention, Group 1 was administered the post-test assessment. Pre-test assessment and

post-test assessment consists of scores on the ICA-R and the Concernfor Others inventories, as

well as responses to the pre- and post-questionnaires.

After Group 1 completed the post-test assessment, Group 2 was administered the pre-test

assessment. Accordingly, Group 2 began the four-week career education intervention. Upon

completion of the intervention, Group 2 was administered the post-test assessment.

The pre- and post-assessments were administered by the researcher and the male nurse.

The students were given as much time as they needed to complete the instruments. It took

approximately 45 minutes for the students to complete the pre-assessment and the same amount

of time to complete the post-assessment.

The researcher was granted IRB approval to conduct the research project as presented. It

was documented in the IRB proposal and explained to the students and parents that there is no

anticipated risks to taking part in this study. However, it was clearly communicated to both the

parents and the students that students could withdraw without consequences from the study at

any time in the event, for any reason, the students cannot complete the career education program.

Threats to Internal Validity

Quasi-experimental studies, such as this study, are especially susceptible to threats to

internal validity and represent alternative explanation that competes with the independent

variable as a cause for the dependent variable. When subjects are not assigned randomly to

groups, the researcher must always be alert to the possibility that the groups are nonequivalent;

being aware that the possibility that a group difference on the dependent variable is the result of

initial differences rather than the effect of the independent variable (Polit & Beck, 2004). Thus,









to minimize this particular threat of internal validity, the researcher randomly assigned the

students to either Group 1 or to Group 2.

Another threat to internal validity is testing effects that results from the consequence of

taking a pre-test on the participants' performance on a post-test. It could be questioned that the

first administration of the pre-test (ICA-R, Concernfor Others, and the Pre- and Post-

Questionnaires) might sensitize the students to issues that they had not considered. This

potential sensitization may result in attitude changes regardless of whether the students receive

the career education intervention. If a comparison group is not used in the study, it is difficult to

segregate the effects of the instructional intervention from the effects of having taken the pre-

tests (Polit & Beck, 2004).

In addition, another possible threat to internal validity, especially with longitudinal studies

involving young children, results from maturation. Maturation is defined as a process occurring

within the subjects during the course of the study because of the passage of time rather than a

result of the independent variable, such as cognitive maturity (Polit & Beck, 2004). However,

the researcher questioned the probable threat of maturation because of the short time frame (four

weeks) between pre-test and post-test assessments.

Characteristics of special importance to the study include the age of the participants and

their reading abilities related to the readability of the instruments used in the study. The Flesch-

Kincaid Grade Level readability for the ICA-R is 3.1 and the Concernfor Others is 4.4. The

reading levels of the students were at least fourth-grade level as reported by the school. To

ensure readability of the Concernfor Others, the researcher read the items on the Concernfor

Others to the students to make certain all items for scoring were understood by all students.









Statistical Analyses


Questionnaires

To begin, the data obtained on the pre-questionnaires were analyzed to determine the

relationships of: (a) gender, (b) race, (c) having a family member who is a nurse, and (d)

knowing someone who is a nurse on students' interest in nursing as a career choice prior to the

education intervention. This information was analyzed for the total sample (N = 70),

Group 1 (N = 35), and Group 2 (N = 35) using a series of Pearson's chi-square tests. The

Pearson's chi-square test is the statistical test to use when determining the relationship between

two categorical variables (Fields, 2005).

The researcher was most interested in determining the overall effect of the education

intervention on students' "yes" or "no" responses when asked if the students would consider

being a nurse when grown on the pre-questionnaire prior to participating in the career education

program compared to responses on the post-questionnaire after participating in the career

education program. These analyses were accomplished using a series of McNemar tests. The

McNemar test determines differences in proportions between two related groups. It is typically

used when detecting changes in people's scores and it compares the proportion of people who

change their responses in one direction to those who change in the opposite direction. It is an

appropriate statistic when a pre-test post-test design is used to compare changes in proportions

on a dichotomous variable (Fields, 2005).

The researcher also analyzed the effects of the education program for other variables of

interest: (a) gender, (b) race, (c) having a nurse as a family member, and (d) knowing a nurse

other than a family member and their influences on students' interest in nursing as a career

choice. McNemar tests were conducted to determine if a change in students' responses to









consider nursing as a career occurred after participating in the education program and, if so, to

examine the influence of these variables of interest on the changes.

Interest and Competence RIASEC Scores and Caring Scores

In addition, the researcher was interested in evaluating several dependent variables

simultaneously (scores on RIASEC for both the interest and competence scales). However, the

researcher was most concerned with scores related to the Holland summary code for nursing,

SIA (Social, Investigative, and Artistic), particularly related to gender effect. In previous

studies, (Tracey & Ward, 1998; Tracey, 2002) the gender effect for the interest scale was

manifested in male students' having higher mean scores on Realistic and Investigative career

types, whereas female students had higher mean scores on Artistic, Social, and Conventional

career types. There was no gender mean difference on the Enterprising career type. An identical

gender mean difference was found on the competence scale with male students having higher

means on Realistic and Investigative career types and female students having higher means on

Artistic, Social, and Conventional career types, with no difference on the Enterprising career

type. Of equal importance, were the caring scores on the Concernfor Others inventory

measuring a desire to help other people.

A paired t-test was conducted on the total sample (N = 70) to analyze differences in mean

scores between pre-test and post-test RIASEC interest and competence scores and caring scores

as a result of the students participating in the career education program about nursing. A paired

t-test is appropriate when determining differences within two group means collected from the

same sample (Fields, 2005). Lastly, a paired t-test was performed to determine the differences

between pre-test and post-test RIASEC mean scores on the interest and competence scales and

caring scale within male and female students.









Table 3-1. Demographic characteristics of students
Total Sample Group 1 Group 2
N 70 N= 35 N=35
N % N % N %
Age
10 38 54% 16 46% 22 63%
11 29 41% 16 46% 13 37%
12 3 5% 3 8% 0 0%

Gender 17 49% 18 51%
Male 35 50% 17 41% 17 49%
Female 35 50% 18 51% 17 49%

Race
Black 16 23% 10 29% 2 17%
Non-Black 54 77% 25 71% 33 83%

Family Member 31% 14 40%
Yes 25 36% 11 31 14 40%
No 45 64% 24 69% 21 60%

Knows a Nurse 3
Yes 23 33% 10 29% 13 37%
No 47 67% 25 71% 22 63%









Table 3-2. Crosswalk of national career development competencies for elementary school and
fifth-grade career education intervention by unit of instruction. Source: National
Occupational Information Coordinating Council, 1989
Career Unit Unit Unit Unit


1 2 3 4


Competencies
Self-Knowledge
*Competency 1
Developing a good self-concept
*Competency 2
Interacting with others
*Competency 3
Growing and changing
Educational and Occupational
Knowledge
*Competency 4
Achieving in school
*Competency 5
Working and learning
*Competency 6
Using career information
*Competency 7
Developing good work habits
*Competency 8
Working and helping others
Career Planning
*Competency 9
Making decisions
*Competency 10
Working with others
*Competency 11
Contributing to others
*Competency 12
Planning for a Career









Table 3-3. Internal consistency and 1-year stability estimates of RIASEC scales across grade groups.
Source: Tracey, 2002, p. 152

Parameter Interest Scale Competence Scale
R I A S E C R I A S E C
Elementary
School
a fifth-grade .81 .71 .68 .74 .70 .65 .79 .70 .63 .67 .68 .70
a sixth-grade .78 .74 .75 .72 .74 .70 .78 .73 .71 .70 .72 .71
1-year retest .54 .62 .46 .50 .35 .44 .57 .60 .46 .55 .43 .57

Middle school
a seventh-grade .80 .75 .69 .78 .82 .78 .81 .75 .69 .76 .71 .76
a eighth-grade .79 .76 .79 .85 .84 .80 .77 .79 .81 .80 .81 .82
1-year retest .76 .77 .72 .81 .74 .79 .68 .77 .69 .76 .66 .70
RIASEC = Realistic, Investigative, Artistic, Social, Enterprising, and Conventional










Table 3-4. Timeline for career education intervention
PTA Visit Wk Wk Wk Wk Wk Wk Wk Wk Wk
Parameter Mtg. To 1 2 3 4 5 6 7 8 9
Classes
Consent X
Assent X
GROUP 1
Pre-test Assessment: X
Unit 1 X
Unit 2 X
Unit 3 X
Unit 4 X
Post-test Assessment X
Group 2
Pre-test Assessment: X
Unit 1 X
Unit 2 X
Unit 3 X
Unit 4 X
Post-test Assessment X
Completion of Study X









CHAPTER 4
RESULTS

The purpose of this study was to evaluate the influence of a career education program on

fifth-grade students' interest in nursing as a career choice. Seventy fifth-grade students from a

public elementary school in a large metropolitan city in the Southeast participated in the study.

The students were randomized into two groups, each group consisting of thirty-five students.

The first group of students (Group 1) participated in a four-week career education program about

nursing, followed by the second group of students (Group 2) participating in the same career

education program about nursing. Pre-test and post-test responses to a questionnaire and scores

on the ICA-R and Concernfor Others were analyzed to determine interest in nursing before and

after participating in the career education program about nursing and to answer the research

questions presented in the study.

Questionnaire Data

Data collected on the pre- and post-questionnaires were evaluated to answer the critical

research question: What is the effect of a career education program on fifth-grade students'

interest in nursing as a career choice measured by changes in the students' "yes" or "no"

responses when asked if they would consider being a nurse when grown, taking into account

gender? Other variables of interest: (a) race, (b) if the student has a family member who is a

nurse, and (c) if the student knew someone other than a family member who is a nurse were

collected on the pre-questionnaire to determine their influence on students' responses to consider

nursing as a career choice.

The pre-questionnaire asked for the student's name, age, gender, ethnicity, and race. Of

the 70 students, 38 students (54%) were 10 years old, 29 students (41%) were 11 years old and

three students (5%) were 12 years old. Interestingly, the total sample of students was comprised









of 35 male students and 35 female students. The sample was predominantly non-Black with 54

non-Black students (77%) and 16 Black students (23%).

The researcher evaluated the variability of the demographic data between Group 1 and

Group 2 and determined the groups were similar with regard to: (a) number of students in each

group, (b) age, (c) number of male and female students, (d) number of Black and non-Black

students, (e) number of students that have a family member who is a nurse, and (e) number of

students that knew a nurse other than a family member (Table 3-1). In addition, differences

between the two groups' pre-questionnaire "yes" and "no" responses to consider nursing as a

career were evaluated with a series of Pearson's chi-square tests. The results of these analyses

indicated no significant differences between the students' responses across: (a) group assignment

(Group 1 and Group 2), (b) gender, (c) race, (d) having a family member who is a nurse, and (e)

knowing someone other than a family member who is a nurse. Based on these comparisons, the

researcher determined the two groups appeared equivalent and therefore combined the two

groups into a single group creating a sample size of 70 students.

Hence, all data analyses were based on a within-subjects experimental study design where

(a) pre-test and post-test measures are taken on all subjects and (b) all subjects are exposed to all

levels of the independent variable (Brink & Wood, 1998). A within-subjects design allows for

an increased sample size and will take advantage of the relative power of a repeated measures

design. In addition, a repeated measures design intrinsically reduces the chance of unsystematic

error variance making it easier to detect any systematic variance (Fields, 2005).

Variables of Interest before Participating in the Education Program

The researcher was interested in the effect that: (a) gender, (b) race, (c) having a family

member who is a nurse, and (d) knowing someone who is a nurse other than a family member on

the students' "yes" or "no" responses to consider nursing as a career when grown prior to









participating in a career education program about nursing. Thus, a series of Pearson's chi-square

tests were conducted to determine the effects of the above listed variables of interest,

independent of the influence of the education intervention.

Gender

A Pearson's chi-square analysis indicated a highly significant association between gender

and whether the students would consider nursing as a career for the total sample (N=70), (X =

11.67, df= l,p< .01). Of the 28 students in the total sample who would consider being a nurse,

seven were males (25%) and 21 were females (75%). Of the 42 students who would not consider

nursing as a career, 28 were males (67%) and 14 were females (33%). Thus, based on the odds

ratio for this sample of students, with an equal number of male students (N = 35) and female

students (N = 35), the female students are six times (OR = 6.0, p < .01) more likely to consider

being a nurse as a career than the male students prior to participating in the education program.

Simply stated, it could be estimated that the likelihood of a fifth-grade student considering

nursing as a career choice is about six times greater if the student is a female than if the student is

a male.

Family member

The influence of a student having a family member who is a nurse and a student saying

"yes" to consider being a nurse as a career was highly significant (X2 = 12.70, df= 1,p < .001).

The 28 students in the total sample who would consider nursing prior to the education program,

17 students (61%) reported having a family member who is a nurse and 11 students (39%)

reported not having a family member who is a nurse. The 42 students who said "no" to consider

nursing as a career, only eight students (19%) reported having a family member who is a nurse

and 34 students (81%) reported not having a family member who is a nurse. Thus, based on the

odds ratio for this sample of students, students who have a family member who is a nurse are









almost seven times (OR = 6.6, p < .001) more likely to consider being a nurse than students

without a family member who is a nurse. Simply stated, it could be estimated that the likelihood

of a fifth-grade student considering nursing as a career choice is about seven times greater if the

student has a family member who is a nurse than if the student does not have a family member

who is a nurse.

Race and knowing a nurse other than a family member

Race and knowing someone other than a family member who is a nurse did not have a

significant effect on a student to consider nursing as a career prior to participating in the

education program. Thus, it can be concluded that there was no association between students'

race and knowing a nurse other than a family member as to whether they would consider nursing

as a career choice when grown. These descriptive statistics and Pearson's chi-square analyses

are presented in Table 4-1.

Effects of the Career Education Program

To begin, the researcher conducted a McNemar test to analyze students' pre-test and post-

test questionnaire responses to determine the effect of the career education program on fifth-

grade students' interest in nursing as a career choice measured by changes in the students' "yes"

or "no" responses when asked if they would consider being a nurse when grown, considering

gender. In addition, a series of McNemar tests were performed to determine the effects of the

other variables of interest: (a) race, (b) having a family member who is a nurse, and (c) knowing

someone other than a family member who is a nurse on students' responses to consider nursing

as a career after participating in the education program.

The data obtained from the pre- and post-questionnaires asking if the students' would

consider being a nurse were studied to determine the education program's effect on the students'

expressed consideration of nursing as a career when grown. The number of students (N = 70)









that indicated they would consider being a nurse prior to the education program was 28 students

(40%). Subsequently, an additional 19 students said they would consider nursing as a career

after participating in the education program. Two of the students who indicated they wanted to

be a nurse prior to the education program changed their responses not to consider nursing as a

career choice after participating in the education program. Yet, the overall positive change in

responses resulted in 45 students (64%) indicating they would consider being a nurse after

participating in the education program compared to the 28 students (40%) who would consider

being a nurse prior to the education program.

A McNemar analysis of these results documented a highly significant change in the

number of positive responses after the students participated in the education program (N =70, p <

.001). The change reflects an additional 17 positive responses (28 to 45 "yes" responses),

yielding a 61% increase in the number of positive responses to consider nursing as a career after

students participated in the education program. Thus, it can be concluded that the education

program had a significant positive influence on students' expressing they would consider being a

nurse when grown.

However, the researcher, despite a significant 61% increase in the number of students

indicating they would consider being a nurse after participating in the career education program,

acknowledged that this evaluative observation is susceptible to certain design limitations, such as

the influence of a spurious relationship or the potential for the Hawthorne effect. The researcher

will discuss in detail potential design limitations of the study in Chapter 5.

Gender

An important inquiry of this study was the effect of the career education program on both

male and female students. The 28 students who considered nursing as a career prior to the

education program, 21 students were female (75%) and seven students were male (25%).









Whereas, the 45 students indicating they would consider being a nurse after the education

program, 30 were females (67%) and 15 were males (33%). Nine additional male students and

10 additional female students said "yes" to consider nursing as a career after participating in the

education program. One male and one female student changed their responses from "yes" to

"no." Overall, these results reflect a 114% increase in the number of positive responses for male

students (seven to 15 "yes" responses) and a 43% increase for female students (21 to 30 "yes"

responses). A McNemar analysis indicated a statistically significant positive effect for both male

and female students to consider nursing after the education program (N = 35,p < .05). Based on

these finding, it can be concluded that the career education program had a significant positive

influence on both the male and female students' responses to consider nursing as a career when

grown.

Race

For the 28 students who considered nursing as a career prior to the education program, 22

students were non-Black (79%) and six were Black (21%). Whereas, the 45 students indicating

they would consider being a nurse after the education program, 34 students were non-Black

(76%) and 11 were Black (24%). Twelve additional non-Black students and five additional

Black students said "yes" to consider nursing as a career after participating in the education

program. Two non-Black students changed their responses from "yes" to "no" to consider

nursing after participating in the education program. These results reflect a 55% increase in the

number of positive responses for non-Black students (22 to 34 "yes" responses) and a 83%

increase for Black students (six to 11 "yes" responses).

A McNemar analysis indicated a statistically significant positive effect for non-Black

students (N = 54, p < .01), but not for Black students for this sample. The researcher suspects

the small sample size of Black students, N = 16, may have resulted in a Type II error.









Family member

A McNemar analysis determined the effect of the education program on students who do

and do not have a family member who is a nurse. Within the total sample, 25 students (36%)

reported having a family member who is a nurse and 45 students (64%) reported not having a

family member who is a nurse. The 25 students with a family member who is a nurse, 17

students (68%) said "yes" and eight students (32%) said "no" to consider being a nurse as a

career prior to participating in the education program. There was no change in responses for this

group of students after participating in the education program.

However, the 45 students reporting not having a family member who is a nurse, 11

students (24%) said "yes" and 34 students (76%) said "no" to consider being a nurse prior to

participating in the education program. A highly significant positive change in responses

resulted after these students participated in the education program, 28 students (62%) said "yes"

and 17 students (38%) said "no" to consider nursing as a career (N = 45,p < .001). This reflects

a 156% increase in positive responses (11 to 28 "yes" responses). Thus, it can be concluded, that

the education program about nursing had a significantly positive effect on students reporting not

having a family member that is a nurse, but not for students reporting having a family member as

a nurse.

Knowing a nurse

A McNemar analysis determined the effect of the education program on students who did

and did not know a nurse other than a family member. Within the total sample, 23 students

(33%) reported knowing a nurse and 47 students (67%) reported not knowing a nurse other than

a family member before participating in the education program. The 23 students who knew a

nurse other than a family member, 10 students (43%) said "yes" and 13 students (57%) said "no"

to consider being a nurse. After participating in the education program there was a significant









change in responses, 17 students (74%) said "yes" and six students said "no" (26%) to consider

nursing as a career (N = 23, p < .05). This reflects a 70% increase in positive responses (10 to 17

"yes" responses).

For the responses of the 47 students who did not know a nurse other than a family member,

18 students (38%) said "yes" and 29 students (62%) said "no" to consider being a nurse before

participating in the education program. As well, a highly significant change in responses

occurred after these students participated in the education program, 28 students (60%) said "yes"

and 19 students said "no" (40%) to consider nursing as a career (N = 47, p < .01). This reflects a

56% increase in positive responses (18 to 28 "yes" responses). Thus, it can be concluded that

participating in the education program about nursing had a significant positive effect on the

students who knew a nurse and a highly significant positive effect on the students who did not

know a nurse other than a family member.

The results of these McNemar tests are provided in Table 4-2. In addition, the percent

increases in the students' positive responses after participating in the education program are

illustrated in Figure 4-1. As well, the increases in the number of positive responses are

illustrated in Figure 4-2.

ICA-R and Concern for Others Data

The researcher analyzed data collected from the ICA-R's interest and competence scales

and the Concernfor Others scale to answer the research question asking what are the effects of a

career education program on fifth-grade students' interest in nursing as a career choice measured

by changes in interest (ICA-R's RIASEC interest scale), competence perception (ICA-R's

RIASEC competence scale), and desire to help other people (Concernfor Others scale). The

differences between the pre-test and post-test mean RIASEC interest and competence scores and

caring scores were examined to determine the effect of the education program for the following









student cohorts: (a) within-subjects comparison of the total sample using a paired t-test (N = 70),

and (b) within-subjects comparison of the male and female students using a paired t-test (N=

35).

Within-Subjects Comparison of the Total Sample

The researcher analyzed the data from a within-subj ects design using a paired t-test to

analyze the total sample, N = 70. A paired t-test was conducted on the difference of the mean

scores for the total sample (N = 70) at two points in time, before and after participating in the

education program for RIASEC interest and competence scores measured by the ICA-R

instrument, as well as caring scores measured by the Concernfor Others instrument.

ICA-R analyses

On average, there were no significant differences between the students' mean pre-test and

post-test measurements with the exception of the difference in mean scores on the competence

scale for the Investigative career type. The results revealed that the students' mean pre-test

competence Investigative score (M= 4.00) was significantly higher than the students' mean post-

test score (M= 3.83), (t (69) = 2.04,p < .05), yielding an effect size ofr = .24. This result was

of particular interest to the researcher because the Investigative career type is a component of the

Holland three-letter career code for nursing, SIA. This result is further discussed in Chapter 5.

The results of these paired t-tests are presented in Table 4-3.

Concern for Others analysis

A paired t-test was conducted on the difference of the caring mean scores measured by the

Concern for Others instrument for the total sample (N = 70) at two points in time, before and

after participating in the education program. The results indicated a positively significant change

in the mean caring scores after the students participated in the education program about nursing.

The students' mean post-test caring score (M= 2.78) was significantly higher than the student's









mean pre-test score (M= 2.58), (t (69) = -2.61,p < .05), yielding an effect size ofr = .30. Thus,

it can be concluded that the career education program has a significant positive effect on a

student's desire to help other people. The results of this analysis are presented in Table 4-5.

Within-Subjects Comparison of Male and Female Students

These final analyses were studied to answer the remaining research question asking if there

is a difference in how male and female fifth-grade students respond to a career education

program about nursing as a career choice measured by scores on the ICA-R and Concernfor

Others instruments.

ICA-R analyses

Paired t-tests were performed to determine the differences between pre-test and post-test

measures of RIASEC mean scores on the interest and competence scales within male and female

students. The gender effect for the interest scales was manifested in male students' mean scores

increasing on the Artistic and Conventional scales and female students' mean scores increasing

on the Realistic, Investigative, and Enterprising scales. The results of the competence scale

scores revealed no increase for both male and female students. However, all the analyses yielded

non-significant differences in mean pre-test and post-test scores.

Even so, the researcher presented in text the changes in mean interest and competence

scale scores for Social, Investigative, and Artistic, due to the relevance of these three Holland

codes to this study. Both male (M= 3.18) and female students (M= 3.87) scored lower on the

Social scale for interest after participating in the education program. On average, male students

scored higher (M= 3.80) on the Artistic scale for interest after participating in the education

program than before (M= 3.74) participating in the education program. The female students

scored higher (M= 3.70) on the Investigative scale for interest after participating in the education

program than before (M= 3.68) participating in the education program.









The comparisons of the male and female students' mean pre-test scores and post-test

scores for both the interest and competence scales are presented in Table 4-3.

RIASEC career assessment

The evaluation of the RIASEC scores on the interest and competence scales provided an

assessment of the career types for this sample of fifth-grade students at two points, before and

after participating in a career education program about nursing. Prior to the education program,

scores on the interest scale revealed the male students scored higher on the Realistic and

Enterprising scales, whereas, the female students scored higher on the Investigative, Artistic,

Social, and Conventional scales. The comparisons of the interest scale scores after the student

participated in the career education program were almost identical, with the exception of the

Enterprising scale scores. Again, the male students scored higher on the Realistic scale and the

female students scored higher on the Investigative, Artistic, Social, and Conventional scales.

The scores for the Enterprising scale were the same for male and female students. These

RIASEC interest assessments are illustrated in Figure 4-3.

Assessments of the competence scale scores were reciprocal to the interest scale scores.

The male students scored higher on the Realistic and Enterprising scales and the female students

scored higher on the Investigative, Artistic, Social, and Conventional scales prior to participating

in the education program. The comparisons of the scale scores after the students participated in

the study were almost identical, the male students scored higher on the Realistic scale and the

female students scored higher on the Investigative, Artistic, Social, and Conventional scales.

The scores for the Enterprising scale were the same for male and female students. These

RIASEC competency assessments are illustrated in Figure 4-4.









Interestingly, the gender effects manifested in this study for both the interest and

competence scales are similar to the gender effects Tracey found in his 2002 study (Tracey,

2002). These similarities are discussed in Chapter 5.

Concern for Others analysis

Likewise, the researcher analyzed the caring data from a within-subjects design using a

paired t-test to analyze differences in mean pre-test and post-test scores for males and females.

The results demonstrated a significant difference in the mean pre-test and post-test scores for the

female students, but not for the male students. The female students' mean post-test caring score

(M= 2.86) was significantly higher than their mean pre-test caring score (M = 2.63), (t (34) = -

2.22,p < .05), yielding a moderate effect size, r = .36. Thus, it can be concluded that only the

female students' caring scores were significantly influenced by participating in the education

program about nursing. The results of this analysis are presented in Table 4-5 and Figure 4-5.

Scale Reliabilities

ICA-R

The internal consistency reliability estimates for the ICA-R for both interest and

competence RIASEC scales are presented in Table 4-6 for this sample of fifth-grade students. In

general, these values are better than the values obtained by Tracey and Ward (1998) and Tracey

(2000) in their samples. The values of the internal consistency estimates in this study were

generally acceptable with Cronbach's alphas ranging from .79 to .81 on both the interest and

competence scales. The overall reliability of the scales resulted in a Cronbach's a of .81 for the

interest scale and .80 for the competence scale.









Concern for Others

The internal consistency reliability estimate for the Concern for Others scale was .83 for

this sample of fifth-grade students. This estimate is comparable to the internal consistency

reliability of .80 reported by the Child Developmental Studies Center (2005).

Summary of Findings

Question 1

1. What is the effect of a career education program on fifth-grade students' interest in

nursing as a career choice measured by changes in the students' "yes" or "no" responses when

asked if they would consider being a nurse when grown, taking into account both male and

female students' responses?

The researcher answered this question by conducting a McNemar test to analyze changes

in students' "yes" and "no" responses when asked if they would consider being a nurse when

grown before and after participating in the career education program. The results documented a

highly significant change in the number of positive responses after the students participated in

the education program (N = 70, p < .001). The change reflects an additional 17 positive

responses (28 to 45 "yes" responses), yielding a 61% increase in the number of positive

responses to consider nursing as a career after students participated in the education program.

In addition, an important inquiry of this study was the effect of the career education

program on gender. A McNemar analysis indicated a statistically significant positive effect for

both male and female students to consider nursing after participating in the education program

(N = 35,p < .05). These results reflect a 114% increase in the number of positive responses for

male students (seven to 15 "yes" responses) and a 43% increase for female students (21 to 30

"yes" responses). Thus, it can be concluded that the education program had a significant positive









influence on both male and female students' expressing they would consider being a nurse when

grown.

Question 2

2. What are the effects of race, having a family member who is a nurse, and knowing

someone who is a nurse other than a family member on the students' "yes" or "no" responses

when asked if they would consider being a nurse when grown before and after participating in a

career education program about nursing?

Race

Results of a McNemar analysis indicated the education program had a significant positive

effect for the non-Black students (N= 54, p < .01), but not for the Black students to consider

nursing as a career choice. However, the researcher suspects the small sample size of Black

students, N = 16, may have resulted in a Type II error.

Family member

A McNemar analysis determined that the education program did not have a significant

effect on students who have a family member who is a nurse. There was no change in responses

for this group of students after participating in the education program. Conversely, a highly

significant positive change in responses resulted after the students who reported not having a

family member that is a nurse participated in the education program (N = 45,p < .001). This

reflects a 156% increase in positive responses (11 to 28 "yes" responses). Thus, it can be

concluded that the education program had a significant positive effect on the students reporting

not having a family member who is a nurse, but did not have a significant effect on the students

reporting having a family member that is a nurse.









Knowing a nurse

A McNemar analysis determined the effect of the education program on students who

reported knowing and not knowing a nurse other than a family member prior to participating in

the education program. The results indicated that the education program had a significant effect

for both groups of students. A significant change in positive responses to consider nursing as a

career after participating in the education program occurred with the students that reported

knowing a nurse other than a family member (N = 23,p < .05). This reflects a 70% increase in

positive responses (10 to 17 "yes" responses). As well, a highly significant change in positive

responses occurred after participating in the education program with the students that reported

not knowing a nurse other than a family member (N = 47,p < .01). This reflects a 56% increase

in positive responses (18 to 28 "yes" responses). Thus, it can be concluded that participating in

the education program about nursing had a significant positive effect on the students who know a

nurse and a highly significant positive effect on the students who did not know a nurse other than

a family member.

The results of these McNemar tests answering research questions 1 and 2 are provided in

Table 4-2. In addition, the percent increases in the students' positive responses after

participating in the education program are illustrated in Figure 4-1. As well, the increases in the

number of positive responses are illustrated in Figure 4-2.

Question 3

3. What are the effects of a career education program on fifth-grade students' interest in

nursing as a career choice measured by changes in interest (ICA-R), competence perception

(ICA-R), and desire to help other people (Concernfor Others)?

The researcher analyzed data collected from the ICA-R's interest and competence scales

and the Concernfor Others scale before and after participating in the education program to









answer the research question. A within-subjects comparison of the total sample (N = 70) using

paired t-tests determined the differences between the pre-test and post-test mean RIASEC

interest and competence scores and caring scores. Overall, the results revealed no significant

differences between the students' mean pre-test and post-test measurements on the ICA-R's

RIASEC interest and competence scales with the exception of the difference in mean scores on

the competence scale for the Investigative career type. This isolated significant result reflected a

decrease in the competence score for the Investigative career type and is discussed in Chapter 5.

The results of these paired t-tests are presented in Table 4-3.

In addition, the paired t-test conducted on the difference of the mean caring scores

indicated a positively significant change after the students participated in the education program

about nursing. The students' mean post-test caring score (M= 2.78) was significantly higher than

the student's mean pre-test caring score (M = 2.58), (t (69) = -2.61, p < .05), yielding an effect

size of r = .30. The results of this analysis are presented in Table 4-5.

Question 4

4. Is there a difference in how male and female fifth-grade students respond to a career

education program about nursing as a career choice measured by scores on the ICA-R and

Concernfor Others?

A within-subjects comparison of male and female students using paired t-tests (N = 35)

was performed to determine the differences between pre-test and post-test measures of RIASEC

mean scores on the interest and competence scales within male and female students, yielding

non-significant differences for all mean pre-test and post-test scores. The comparisons of the

male and female students' mean pre-test scores and post-test scores for both the interest and

competence scales are presented in Table 4-3.









Lastly, the caring data was analyzed using a paired t-test to determine differences in mean

pre-test and post-test scores for male and female students. The results demonstrated a significant

difference in the mean pre-test and post-test scores for the female students, but not for the male

students. The female students' mean post-test caring score (M= 2.86) was significantly higher

than their mean pre-test caring score (M = 2.63), (t (34) = -2.22, p < .05), yielding a moderate

effect size, r = .36. Thus, it can be concluded that only the female students' caring scores were

significantly influenced by participating in the education program about nursing. The results of

this analysis are presented in Table 4-5 and Figure 4-5.









Table 4-1. Pearson's chi-square tests of students' "Yes" and "No" responses before participating
in the education program
Responses
Group: Yes No X2
Gender
N= 28 N=42 **11.67
Male 7 (25%) 28 (67%)
Female 21 (75%) 14 (33%)

Race
N =28 N = 42 NS
Black 6(21%) 10(24%)
Non-Black 22 (79%) 32 (76%)

Family Member
N=28 N=42 ***12.7
Yes 17 (61%) 8(19%)
No 11(39%) 34 (81%)

Knows A Nurse
N= 23 N= 47
Yes 10 (36%) 18(38%) NS
No 13(64%) 29(62%)

**p <.01, ***p <.001, df 1









Table 4-2. McNemar results of students who want to be a nurse after participating in the
education program
% Increase
Student of Positive
Responses: Yes No N p Responses
Total Sample
Before 28 42 70 <.001 61%
After 45 25 70
Male
Before 7 28 35 <.05 114%
After 15 20 35
Female
Before 21 14 35 <.05 43%
After 30 5 35
Non-Black
Before 22 32 54 <.01 55%
After 34 20 54
Black
Before 6 10 16 NS 83%
After 11 5 16
With Family
Before 17 8 25 NS 0%
After 17 8 25
Without Family
Before 11 34 45 <.001 154%
After 28 17 45
Knows a Nurse
Before 10 13 23 <.05 70%
After 17 6 23
Does Not Know
a Nurse
Before 18 29 47 <.01 56%
After 28 19 47









Table 4-3. Paired t-tests for interest and competence RIASEC scale scores for the total sample
Total Sample
N= 70
Scale: Mean SD t p


Interest Scale
Realistic


Investigative


Artistic


Social


Enterprising


Conventional


Competence
Scale
Realistic


Investigative


Before
After


2.75
2.74


Before 3.64 .67
After 3.59 .76

Before 3.91 .69
After 3.94 .66

Before 3.61 .77
After 3.52 .86


Before
After


3.61
3.57


Before 2.85 .92
After 2.96 1.05



Before 3.11 1.06
After 3.10 1.08


Before
After


4.00 .61
3.83 .86


Before 4.13 .72
After 4.08 .77


Social


Enterprising


Conventional


Before
After

Before
After


3.67
3.67

3.79
3.78


Before 3.50 .95
After 3.42 1.05


.11 NS


.67 NS


-.45 NS


1.21 NS


.58 NS


-1.51 NS





.17 NS


2.04 < .05


.97 NS


.07 NS


.15 NS


.82 NS


Artistic









Table 4-4. Paired t-tests of interest and competence RIASEC scale scores for male and female
students
Male Female
N=35 N=35
Scale: Mean SD Mean SD t p
Interest Scale
Realistic


Investigative


Artistic


Social


Enterprising


Conventional


Competence
Scale
Realistic


Investigative


Artistic


Social


Enterprising


Conventional


Before 2.95 .96
After 2.88 .99

Before 3.59 .67
After 3.47 .68

Before 3.74 .64
After 3.80 .73

Before 3.33 .67
After 3.18 .79

Before 3.67 .63
After 3.57 .78

Before 2.60 .80
After 2.69 .91


Before 3.25 1.05
After 3.23 1.02

Before 3.94 .64
After 3.76 .81

Before 3.89 .61
After 3.88 .75

Before 3.33 .71
After 3.29 .84

Before 3.81 .93
After 3.78 .76

Before 3.19 .81
After 3.15 .92


2.54 .86 -.75
2.59 .94

3.68 .67 -.90
3.70 .81

4.08 .69 .53
4.07 .54

3.90 .76 -.82
3.87 .78

3.55 .53 -.81
3.57 .65

3.09 .97 -.33
3.23 1.12


2.98 1.05 -.03
2.97 1.12

4.05 .56 -.21
3.90 .90

4.37 .75 -.69
4.27 .75

4.01 .89 -.34
4.03 .99

3.77 .67 -.22
3.78 .77


3.81 .98
3.69 1.11


.36 NS


NS


NS









Table 4-5. Paired t-tests of caring scores for total sample, male, and female students
Desire to Help Other
People Scale Mean SD t p
Total Sample (N = 70)
Before 2.58 .70 -2.61 < .05
After 2.78 .89
Males (N = 35)
Before 2.53 .45 -1.50 NS
After 2.70 .85
Females (N = 35)
Before 2.63 .89 -2.22 < .05
After 2.86 .94


Table 4-6. Internal consistency estimates ofICA-R's interest and competence scales and
Concern for Others scale
Caring
Parameter Interest Scale Competence Scale Scale
R I A S E C R I A S E C
a .80 .79 .81 .81 .81 .81 .81 .79 .81 .80 .81 .80 .83














69% 68%


64%


U Before


After


*p < .05
**p < .01 o
***p< .001


Figure 4-1. Percent increase in the number of students who would be a nurse after participating
in the education program





















21 22


17 17


Before

After


: s- ^
&*


*p < .05 c
**p <.01 0'
***p < .001
Figure 4-2. Increase in the number of students who would be a nurse after participating in the
education program






























105


I I


I I I I


I I I I











4.5


4


3.5

3


2.5


2


1.5


1


0.5


0


* Male

Female


Figure 4-3. Interest assessment: comparing male and female students before and after the
education program


I I I I I I I I I I I















4.5

4-

3.5

3


2.5

2


1.5

1

0.5

0


-


SMale

Female


Figure 4-4. Competence assessment: comparing male and female students before and after the
education program


I I I I I


I I I I I I











2.86


2.78


2.9



2.8



2.7



2.6


2.5



2.4



2.3




J\>
<^3


65'
4


Figure 4-5. Paired t-tests of caring scores for total sample, male, and, female students


2.58

2.53


-Before


-After


A't


*p <.05









CHAPTER 5
DISCUSSION

The researcher developed a career education program for fifth-grade students in

accordance with the National Career Development Guidelines hoping to stimulate young

students' interest in nursing as a future career choice. A review of past research presented in the

study has shown that the promotion and dissemination of information about the nursing

profession is successful in promoting nursing as a career choice with students of all ages. In

addition, information from vocational theory indicates that career development and choice is not

a matter exclusive of adolescence or adulthood and that childhood and its contexts are important

precursors of future vocational behaviors (Vondracek, 2001). Thus, the researcher thought it a

prudent and promising initiative to help strengthen the future nursing workforce by designing a

career education program to spawn interest in nursing as a career choice among young people,

beginning as early as elementary school. BlueCross and BlueShield of Florida also recognized

the value of this initiative to encourage young students to view a career in nursing as a possibility

and achievable goal and sponsored a substantial grant to support the research.

When designing the career education program the researcher took into account past nursing

research demonstrating that the number one influence for prospective nurses is another nurse.

Recently, a survey conducted by Buerhaus and colleagues (2005a) found that information or

advice from practicing nurses was identified by 65% of nursing students as a factor positively

influencing their decision to become a nurse. Therefore, the researcher considered it crucial that

a practicing nurse teach the curriculum. This also allowed the researcher to personalize the work

of a nurse and better create awareness of a nurses' world-of work by speaking first-hand from

lived experiences about the various rewarding job opportunities in nursing.









The theoretical framework of the career education program was founded on an integrated

conceptual model that examined interest, competence perception, and the desire to help other

people. The interest component is consistent with John Holland's (1959) theory of personalities

and work environments. The competence perception component is supported by Albert

Bandura's (1977) theory of self-efficacy. The desire to help other people component is largely

influenced by Jean Watson's (1985) philosophy and science of human caring. Thus, interest in

nursing is operationally illuminated by these three concepts: (a) interest, (b) competence

perception, and (c) desire to help other people (Figure 1-1).

The primary purpose of the study was to examine the effects of a career education program

on fifth-grade students' interest in nursing as a career choice when grown. The concepts of

interest and competence perception were evaluated by an instrument developed by Tracey and

Ward, (1998), the Inventory of Children's Activities-Revised (ICA-R), which includes activities

children commonly engage in and is designed to assess Holland's six career types (Realistic,

Investigative, Artistic, Social, Enterprising, and Conventional, referred to collectively as

RIASEC) among children. For the most part, the results of the study did not demonstrate

significant changes in mean scores on the RIASEC interest and competence scales as an effect of

the students' participation in the career education program. However, the scores provided an

assessment of the structure of vocational interests in fifth-grade students measured at two points

in time, at the beginning and at the end of the four-week career education program. Thus, the

students' career assessments (types) based on ICA-R scores on the RIASEC interest and

competence scales are evaluated in an attempt to examine career interests within this sample of

fifth-grade students.









The concept of desire to help other people was measured by an instrument, Concernfor

Others, designed to quantify students' characteristics of caring, referred to by Swanson (1999) as

an individual's caring capacity. The Child Development Project created the instrument and

according to Dr. Jean Watson (personal communication, November 5, 2006) it is one possible

tool that measures caring reflective of her theory of human caring. Caring is increasingly

recognized as a core concept, characteristic of the nursing profession. In fact, the revised social

policy statement issued by the American Nurses Association (2003) attests to the centrality of

caring as part of the definition and scope of professional nursing practice. Numerous studies

discussed in Chapter 2 established an iterative theme of "caring for others" as the major

motivating factor for both men and women to consider nursing as a career. In addition, caring is

traditionally viewed by the public as the foundation for the nursing profession and is foremost in

the public's perceptions of nursing. Recognizing the fundamental phenomenon of caring within

the nursing profession, the nurse researcher was interested in discovering fifth-grade students'

caring capacity and determining the effect of a career education program about nursing on a

students' concern for and desire to help other people. These results are presented in a context

reflecting the deeply human nature of nursing's caring works.

In addition, questions were addressed regarding the students' expressed interest in nursing

as a career before and after participating in the education program to determine the influences of

four factors: (a) gender, (b) race, (c) having a family member who is a nurse, and (d) knowing

someone other than a family member who is a nurse.

Interpretations of the Effects of the Career Education Program

Expressed Interest in Nursing

One of the goals of the current study was to examine the effect of a career education

program about nursing on fifth-grade students' expressed interest in nursing as a career choice









when grown. The majority of literature on the development of children's interests focuses

almost exclusively on expressed aspirations, asking children what career they would like to

pursue when grown (Phipps, 1995; Trice, 1990, 1991; Trice & King, 1991; Trice et al., 1995,

Vondracek, 2001). These studies revealed that children are able to express career ambitions and

often these early career goals are associated with adult career choices, illuminating the predictive

value of early expressions of career aspirations.

Overall, the results clearly supported the education program as an effective career

development initiative to stimulate fifth-grade students' expressed interest in nursing as a career

choice. The current study demonstrated a significant 61% increase in the number of students

expressing their consideration of a nursing career after participating in the career education

program. Interestingly, two students changed their responses from "yes" to "no" to consider

nursing after participating in the education program. One student is a White female, age 10, and

was in Group 1, and the other student is a White male, age 11, and was in Group 2. The female

student reported her grandmother is a nurse, but she did not know anyone else who is a nurse.

She indicated on the pre-questionnaire she wanted to be, "A chef. Or a vet. Maby a pet shop

owner," and on the post-questionnaire she indicated wanting only to be a chef when grown. The

male student reported his mom is a nurse and that he knew someone other than a family member

who is a nurse. On the pre- and post-questionnaires he originally indicated he would consider

being a nurse when grown, but on the post-questionnaire he erased his answer, changing it to a

"no" response. He expressed he wanted to be a tree surgeon when grown on both the pre- and

post-questionnaires. The researcher thought it of special interest that both of these students have

a close family member who is a nurse, yet changed their responses not to consider nursing after









participating in the education program. This result is discussed later in the chapter in the context

of having a family member who is a nurse and its influence on children's career choices.

The following discussions are related to specific sub-groups of students considering: (a)

gender, (b) race, (c) having a family member who is a nurse, and (d) knowing someone other

than a family member who is a nurse.

Gender

Another purpose of the current study was to concentrate on the issue of career gender bias

within nursing by having students participate in an education program about nursing that

discussed and portrayed males as nurses and to determine its effect on male students. Much of

the focus on children's expressed career aspirations has revealed that children tend to have

gender-typed career preferences that develop early in childhood, with boys demonstrating more

rigid gender typing than girls (Trice et al., 1995). Gottfredson (1981) postulated that one of the

first things children learn is "sex-typing" and that this is a primary filter for children to evaluate

and consider occupations in terms of their being male or female. Several studies have

demonstrated the effectiveness of career education programs with elementary school age

children to help reduce career gender stereotyping.

In spite of the efforts to attract men into the nursing profession, men still comprise a very

small percentage of the total number of nurses in the United States. Data for 2007 indicated

among all full-time employed nurses, only 9% were males (Johnson & Johnson, 2007).

Evidence suggests that same-gender role models can influence the attitudes about the

appropriateness of a career for members of their own gender and children have been shown to

accept the concept of adults in nontraditional roles if models are visible in these roles (Bailey &

Nihlen, 1990; Bigler & Liben, 1990).









Therefore, the researcher included a male nurse as a strategic component of the career

education program to help dispel the idea that nursing is a career primarily for females. The

male nurse participated in the administration of the pre- and post-questionnaires and assisted the

researcher in the education sessions. An intriguing observation by the researcher was the

tendency for the male students to gravitate to the male nurse during the classroom learning

activities. Intentionally, the education curriculum was filled with information about males as

nurses with posters and education videos featuring both men and women in pivotal nursing roles.

The students were given brochures and coloring books portraying and describing males as

nurses. In addition, Johnson & Johnson supplied each student with a Be a Nurse tee shirt with

pictures of nurses silk-screened on the front, which included a male nurse.

At the completion of the study, the male students reported a significant 114% increase in

the number of positive responses to consider nursing as a career. Thus, it can be inferred that

engaging students in an education program that includes not only information about males in

nursing, but also a male nurse as an integral part of the curriculum for students to identify as a

role model, has the potential to reduce the traditional gender stereotyping of nursing as a female

profession. The researcher recommends that gender focused education programs, similar to the

one in the study, continue to be offered to young students to help their understanding of nursing

as a socially appropriate occupation, regardless of gender. Subsequent studies are recommended

to replicate the results of the current study to advance the existing empirical literature on the

influence that male nurses can have on young male students' attitudes about the appropriateness

of a career in nursing.

Race

Even though this was not a central question of the current study, the researcher evaluated

the effect of the education program considering students' race and ethnicity, since race and









ethnicity data were collected on the student sample and the recruitment and retention of minority

students into the nursing profession continues to be a problem. The diversity of the nursing

population remains far less than that of the general United States' population and is expected to

get worse with racial/ethnic minorities projected to constitute an estimated 40% of America's

population by 2030 (Health Resources and Services Administration, 2004). Therefore, the

researcher thought it useful to evaluate the effect the education program had on the different

racial/ethnic backgrounds represented in the study to determine its utility as a potential

intervention to stimulate interest in nursing.

The sample of 70 fifth-grade students reported by ethnic categories consisted of six

students of Hispanic origin and 64 students of non-Hispanic origin. The sample reported by

racial categories consisted of two students who identified themselves as Asian/Native Hawaiian

or Pacific, 16 students as Black/African American, and 52 students as White. The six students of

Hispanic origin reported themselves racially as White and therefore are part of the 52 students

reported in the racial category as White. For purposes of data analyses, race was defined and

dichotomized into two categories: (a) Black and (b) non-Black. The two Asian students were

placed into the non-Black category resulting in 16 Black students and 54 non-Black students.

The results of the study yielded a significant positive effect for non-Black students, but not

for Black students, even though the percent increase of positive responses for Black students was

greater than the increase of positive responses among non-Black students after participating in

the education program. The increase in positive responses for Black students was 83%

compared to a 55% increase in positive responses for non-Black students. However, the

researcher suspects this non-significant finding may be an outcome of insufficient power, due to

the small sample size of Black students in the study, resulting in a Type II error. It is the









researcher's interpretation that the sample size in this study is not large enough to support the

division of the sample to test the effects of specific sub-groups, especially when one group has

only 16 subjects, such as the sub-group of Black students.

Having a family member who is a nurse

Other aims of the study were to evaluate the effect of the education program on students'

reporting whether or not they have a family member who is a nurse and if they know someone

other than a family member who is a nurse. Interest in a nursing career can frequently be

inspired by having family members or friends who are nurses. Evidence has shown that young

people who have a nurse in the family have a more positive view of nursing than those who do

not (Pillitteri, 1994).

The pre-questionnaire data analyses are consistent with the evidence supporting the

influence of family dynamics on a child's consideration of a particular career. The students' pre-

questionnaire responses revealed that having a family member who is a nurse had a highly

significant effect on students' expressed consideration of nursing as a career choice. For the

current study, 25 students reported having a family member who is a nurse and of those 25

students, 17 students (68%) indicated they would consider nursing as a career prior to

participating in the education program.

This highly positive finding of the influence of having a family member who is a nurse is

congruent with Roe's (1956) seminal work describing the impact of the relationships between

family background and the development of children's early educational and career aspirations.

The researcher views the theoretical underpinning of family influence as an opportunity to enrich

the current career education program by involving parents of young students as part of the career

education process. The researcher envisions that parent education programs taught concurrently

with student programs have the potential to establish a family orientation to the lifelong nature of









career development beginning in early childhood. Once implemented, the effectiveness of parent

education programs would warrant evaluation to determine their influence on parents'

perceptions of nursing as a potential career choice for their children.

Interestingly, there were no changes in the number of positive responses for this group of

students after they participated in the education program, indicating that overall the education

program did not have an influence on students with a family member who is a nurse to consider

nursing as a career. This result could possibly infer that family influence is stronger than an

education program about nursing in its utility to positively affect students' consideration of

nursing.

As mentioned in an earlier section of this chapter, two students who have a family member

who is a nurse changed their responses to consider nursing from "yes" to "no" after participating

in the education program. This meant that two other students who have a family member who is

a nurse changed their responses from "no" to "yes" to consider nursing after participating in the

education program. Further exploration of these two students who changed from "no" to "yes"

revealed that both students were male. One of the students is non-Black, was in Group 1, aspires

to be a professional athlete when grown, and reported he has an aunt who is a nurse. The other

student is Black, was in Group 2, aspires to be a police officer when grown and reported he has

an aunt who is a nurse. The researcher cannot dismiss the inference that for these two students

who changed their responses to consider nursing was due in part, to their participation in the

education program, especially in lieu of the significant effect of the education program on the

male students.

Yet, on the other hand, the career education program had a highly significant influence on

the students reporting not having a family member who is a nurse. Of the 45 students in the









sample who do not have a family member who is a nurse, only 11 students would consider being

a nurse prior to participating in the education program compared to 28 students who would

consider being a nurse after participating in the education program. This is an increase of 17

students, reflecting a 154% increase. This finding lends support to the efficacy of a career

education program about nursing to stimulate expressed interest in nursing with fifth-grade

students, especially for students without a family member who is a nurse. However, the

researcher cannot disregard and separate the idea that the personal interactions that took place

between the researcher and the male nurse with the students during the course of the four-week

education program influenced the students' expressed interest to consider nursing as a career

when grown. The potential for this type of spurious relationship is discussed later in the chapter.

Knowing a nurse other than a family member

Not only having a family member, but also having a friend or knowing someone who is a

nurse has shown to provide motivation and direction with young children which eventually led to

nursing as a career choice (Beck, 2000). The present study attempted to replicate the influence

of knowing a nurse on students' expressed interest in nursing as a career. However, pre-

questionnaire data analyses of the present study revealed that knowing a nurse other than a

family member did not have a significant influence on students' expressed consideration of

nursing as career when grown.

As the next step, the researcher evaluated the effects of the career education program on

students who reported knowing a nurse other than a family member compared to students not

knowing a nurse other than a family member. Slightly less than one-third or 23 students reported

knowing a nurse and of those 23 students, only 10 students would consider nursing as a career

choice prior to participating in the education program. After this group of students participated









in the education program, a significant increase of an additional seven students expressed they

would consider being a nurse when grown.

Of even greater significance was the increase in the number of students who did not know

a nurse and would consider being a nurse after participating in the education program. Forty-

seven students reported not knowing a nurse other than a family member and of these 47

students, 18 students expressed considering nursing prior to participating in the education

program. Yet, after this group of students participated in the education program, an additional 10

students positively changed their expressed consideration of nursing. An observation worth

mentioning is that several students stated they knew a nurse other than a family member and

listed the nurse researcher and/or the male nurse as the nurse they knew. Although these

responses were not counted as the student knowing a nurse for the purpose of analysis, it may

suggest the question was not clear to the students or that the researcher and male nurse had

enough impact on several students at the onset of the education intervention to be considered a

nurse who the students knew.

Overall, based on these results from the current study the researcher proposes a potential

linkage between the positive influences of the education program with the intentionally planned

experiences for students to have personal contact with practicing nurses. This implication

supports the argument that personal exposure with nurse role models has the potential to

influence students to view nursing as an enjoyable career and supports previous studies

demonstrating the correlation between nursing role models and students' decisions to pursue a

career in nursing. Simply stated, the more contact young people have with nurses, the better the

chance of positively influencing their decision to become a nurse.









These results underscore the responsibility of each practicing nurse as potential recruiter of

future nurses and substantiate the importance of exposing young students to practicing nurses as

a key strategy to stimulate interest in nursing. Nurses are in a unique position to build on the

profession's credible reputation, help dispel any existing negative images of nursing, and educate

young people on the many benefits and opportunities a career in nursing can offer. To encourage

students of all ages to consider the nursing profession would be one way that all nurses can help

maintain a steady recruitment of young people into the future nursing workforce.

Effects on Interest, Competence Perception, and Desire to Help Others

Interest and competence perception

The small body of extant literature on children's career interests focuses primarily on

aspirations and not on the broader construct of interests in the younger ages where it is presumed

the establishment of interests occurs. Despite the simple methodology, the current study's

attempt to evaluate children's expressed career aspirations has been revealing and the results

have clearly demonstrated that the career education program about nursing had an overall

significant positive influence on fifth-grade students' expressed interest in nursing. However,

the researcher wanted to explore a broader representation of children's career interests

incorporating John Holland's (1959) theory of vocational choices, Albert Bandura's (1977)

theory of self-efficacy, and Jean Watson's (1985) theory of human caring.

After a comprehensive review of the existing research on children's career interests, the

researcher located an instrument designed by Tracey and Ward (1998) that measured school age

children's interests and competence ratings on Holland' RIASEC scale of career types. The

instrument, the Inventory of Children's Activities Revised (ICA-R), consists of an interest scale

and a competence scale that concomitantly measures interests and perceived competencies

appropriate for children. There are questions children respond to in terms of what they "like to









do" (interest) and what they are "good at doing" (perceived competence). Locating an

instrument that was appropriate to examine fifth-grade students' interests based on Holland's

RIASEC structure allowed the researcher to explore the effects of a career education program on

the students' RIASEC career types.

The study evaluated the effects of a career education program on fifth-grade students'

interest in nursing based on changes in pre-test and post-test mean scores on the ICA-R's interest

and competence scales. The results of a paired t-test yielded one isolated significant effect. This

one effect demonstrated a decrease in the mean competence score for the Investigative career

type. Remarkably, after visually examining all of the differences between the mean pre- and

post-interest and competence RIASEC scores, the researcher observed a decrease in most of the

mean scores. There was a decrease in the mean interest scores for the Realistic, Investigative,

Social, and Enterprising career types and a decrease in the mean competence scores for the

Realistic, Investigative (p < .05), Artistic, Enterprising, and Conventional career types.

Otherwise, there were two increases in mean scores on the interest scale for the Artistic and

Conventional career types, and no change on the competence scale for the Social career type.

These changes in mean scores are consistent with other research findings documenting a

pattern of decreasing interest and competence ratings with age and maturation. It seems that

young children first view their interests and competence perceptions as relatively high and

undifferentiated, and as they mature developmentally from elementary school to middle school,

they slowly start to differentiate interests and competence perceptions with their ability to reason

more abstractly (Holland, 1968; Piaget, 1972). In addition, as children grow and age, they begin

to view themselves differently as their social comparisons and competition increases, often

resulting in children's overall levels of competence ratings decreasing over time (Roberts &









Peterson, 1992). Tracey (2002, p. 160) posits, 'This process of differentiation could manifest

itself in an overall decrease in the mean levels of interest and competence as children are

deciding what things they do not like or are not good at." Thus, it would be predicted that

instead of the highly undifferentiated ratings of interests and competence perceptions present in

the earlier years, older children would drop their levels of interests and competence perceptions

in some areas, resulting in an overall drop in mean RIASEC scores.

Even though it is unclear if a four-week period between the pre-test and the post-test

accounts for developmental and/or social changes, the researcher proposes that merely

participating in the education program may have affected how the students cognitively organized

their responses to the questions on the ICA-R. Therefore, the researcher proposes that the overall

drop in mean scores demonstrated in the study contributes to the existing literature documenting

a general decrease in interest and competence ratings associated with the process of

differentiation in children. However, the potential of the testing effect and its threat to this

study's internal validity must be considered.

Regarding gender, the results of a paired t-test to determine the effects of the education

program between male and female students uncovered no significant changes for any of the

RIASEC mean scores on both the interest and competence scales. Therefore, as a next step, the

researcher focused on the assessment of differences among post-test RIASEC mean scores across

gender to determine if there were any gender differences. In general, the gender differences

found for both the interest and competence mean scores supported gender patterns found in

previous research (Tracey & Ward, 1998; Tracey 2002).

The current study revealed the gender effect for the interest scale was manifest with male

students having higher mean scores on the Realistic scale, whereas the female students had









higher mean scores on the Investigative, Artistic, Social, and Conventional scales. There was no

gender mean difference on the Enterprising interest scale. An identical pattern was discovered

on the competence scale. The male students scored higher on the Realistic scale and the female

students scored higher on the Investigative, Artistic, Social, and Conventional scales. Again,

there was no gender mean difference on the Enterprising competence scale. These interest and

competence mean scores for the male and female students are depicted in Figure 5-1.

The mirroring of the interest and competence mean scores indicated a high degree of

similarity across the RIASEC mean scores for these two scales. This important finding provided

support of previous research conducted by Tracey and Ward (1998; Tracey, 2002) demonstrating

the structural similarity between interests and competence perceptions, with no differences

between the structures for males and females within the same age group. As described, one of

the purposes of Tracey and Ward's 1998 study was to develop an instrument that enabled the

examination of interests and competence perceptions with commensurate measures, resulting in

the development of the ICA-R. The similarity of the RIASEC mean scores for interests and

competence perceptions for both male and female students demonstrated in this study adds

validity to the ICA-R's ability to examine the structure of children's career interests. These

results also support the primacy ascribed by many career theorists to the link between interest

and perceived competence in the determination of career interests (Bandura, 1982; Lent et al.,

1994; Holland, 1997). However, longitudinal examinations of the structures of interests and

competence perceptions and how they develop across age are warranted.

Desire to help other people

As discussed in Chapter 2, there is extensive evidence that describes caring as a principal

quality and a primary reason nurses consider a career in nursing. As part of this discussion, the

researcher proposed the theoretical model conceptualizing interest in nursing as a career choice









include the desire to help other people, guided by the underpinnings of Watson's theory of

human caring. Therefore, an important aim of the current study was to examine the effect of the

career education program on students' desire to help other people or capacity to care as described

by Swanson (1999).

The results of a paired t-test concluded the education program had a significant positive

effect on students' desire to help other people. This discovery raised a question with the

researcher whether caring is a characteristic trait that remains as a constant and inherent behavior

(nature) or is it a dynamic and learnable behavior enhanced or diminished by instruction,

experience, or modeling (nurture). This result suggests that a career education program that

includes the caring work of nursing presented by practicing nurses can potentially affect and

nurture fifth-grade students' desire to help other people. In addition, the research findings align

with some of Benner's (1984) original work of her concept of novice to expert, where in her

phenomenological investigation of excellence in nursing practice she discovered that the ability

to practice expert caring is deepened and expanded with knowledge and practice.

Evidence from the current study indicates that caring instruction and modeling have

positive implications for nurse educators. This information should be considered when

establishing academic standards and activities in nursing curricula that incorporate the art and

science of human caring to ensure future nurses are learning how to practice within a framework

of caring. This would be the first step to establish a model of nursing that advances the science

of human caring in education, practice, and research. Watson posits, "It is when we include

caring and love in our science, we discover our caring-healing professions and disciplines are

much more than a detached scientific endeavor, but a life-giving and life-receiving endeavor for

humanity" (Watson, 2005. p. 3).









The last aspect of the research was to determine if male and female students' desire to help

others responds differently to a career education program about nursing. A paired t-test

evaluating differences in pre-test and post-test mean scores for males and females determined

that only the female students' caring scores were significantly influenced by participating in the

education program. The result could lend support to some authors' views that stress a greater

affinity of females to characterize the relational and emotional ethical attitudes of caring when

compared to males. Yet, these traditional social conventions are not to say that males are unable

to care and that caring for others is a phenomenon exclusive of females. In fact, surveys of male

nurses have reported that one of the motivating factors in men who chose nursing was the desire

to help people (Kelly, et al., 1996; Marsland, Robinson, & Murrells, 1996).

The researcher supports a more gender neutral attitude about a person's capacity to care

based on the suppositions of Watson's theory of human caring describing caring as an

ontological trait of being human and a fundamental trait of human relatedness (Watson, 2001),

and therefore not a privilege of any one group of people. However, a limitation of the current

study is its small sample size, suggesting that the conclusion of the differences between male and

female students' responses to their desire to help other people as an effect of the education

program are tentative and future research is needed to further examine gender differences.

Furthermore, a number of limitations should be considered when using quantitative

research methods to investigate the concept of caring. Researchers have discussed the

complexity of the concept of caring, highlighting that it is more than a simple set of caring

behaviors, and that risks exist when evaluating caring strictly from a quantitative approach.

Caring reflects the humanitarian side of nursing, which is often difficult to quantify and can

benefit from the more interpretive methods of knowledge building. Therefore, the researcher









recommends future research evaluating children's caring attributes include multiple paradigms of

scientific inquiry to include both qualitative and quantitative research to build upon the results of

the current study. This quest of new knowledge from a quantitative paradigm would require

developing instruments that are specifically designed to measure caring attributes in children

reflective of Watson's theory of human caring, since none currently exists.

Research Design

The current study is a within-subjects design, often referred to as repeated-measured

design. An advantage of a within-subjects design is it requires fewer subjects; the total number

of subjects needed corresponds to the number required for any one condition (Brink & Wood,

1998). It was only when sub-groups, like race and gender, were evaluated that the statistical

power of the study was threatened.

A second advantage of a within-subjects design is the unsystematic error variance is

reduced making the study most sensitive to the evaluation of the education program (Fields,

2005). This means the current study because of the within-subjects design minimizes random

factors that may affect the results of the study. However, a disadvantage of the study's design is

the lack of a comparison group. Therefore, much greater confidence can be placed in the

findings of this study if the results can be replicated in other settings with different subjects.

Strengths, Limitations, and Implications for Future Research

Many of the study's strengths, limitations, and implications for future research were

discussed within the context of the interpretations of the various results. Yet, additional

strengths, limitations, and research recommendations that apply to the study as a whole are

elucidated in this section.

Strengths of the current research point to the overall contributions made to the existing

evidence supporting the efficacy of a career education program's utility to stimulate school age









students' expressed interest in nursing as a career choice. In addition, the intentional

interventions designed to address gender bias of nursing were effective in significantly

influencing the male students to consider nursing as a career choice when grown. However, the

researcher is sensitive that these causal relationships may be attributed to the influence of a third

variable or spurious relationship, the person or persons presenting the education program, giving

way to a possible Type I error. Without a comparison group, it is difficult to separate spurious

effects of other extraneous variables, thereby threatening the internal validity of the study.

The researcher acknowledges there is a possibility that any positive influence of the career

education program may reflect the relationships established between the students and the

researcher and/or the male nurse delivering the career education program. Then again, was that

not the desired outcome of exposing students to "real" nurses, for the students to identify with

nurse role models as a dynamic influence on students' consideration of nursing as a career

choice? Another pause to the positive influence of the education program is the potential of the

Hawthorne effect. The plain fact that the students were participating in the education program

may have had an effect on the students' behaviors and positive responses to the education

program.

A limiting factor of the current study is the incomplete results related to racial/ethnic

influences. Further career education programs should be designed similarly to the one developed

for this study that addressed gender barriers, but should include a concerted focus describing and

portraying racial/ethnic minorities in pivotal nursing roles to increase awareness of nursing as a

career choice within diverse groups of young students. It is the researcher's belief that efforts to

build a more diverse nursing workforce will benefit both the nursing profession and the

individuals entrusted in their care.









An additional limiting factor of the current study is it did not examine whether the scoring

of the ICA-R for the current study's sample of fifth-grade students supported the measurement of

the RIASEC scales. Findings from Tracey and Ward's (1998) study suggested the RIASEC

basis of the instrument was inappropriate for elementary school age children. However, the

results in Tracey's (2002) study were different in that his sample of elementary school children's

ICA-R scores supported the measurement of RIASEC scales. Tracey attributes the viability of

the RIASEC scales in his 2002 study a function of the students being older, in that all of the

students were in the fifth-grade. Previous studies (Mueller, 1991; Tracey & Ward, 1998; Tracey,

2002) determined that the extent to which the RIASEC scales were supported was positively

related to age, with older grades having a better fit.

To determine if the ICA-R could be scored using the RIASEC structure, Tracey (2002)

conducted a separate confirmatory factor analysis (CFA) on each of the item responses from both

the interest and the competence scales using LISREL with maximum-likelihood estimation.

These statistical analyses examined whether: (a) the items loaded on the six RIASEC scales and

(b) if the hexagonal structure among the RIASEC scales was valid. The results of these CFAs

are thoroughly detailed in Tracey's 2002 study. The researcher recommends the same analyses

be conducted on the current fifth-grade sample's interest and competence mean scores to confirm

if the ICA-R appropriately measured RIASEC career types for this sample of students.

Nonetheless, according to Tracey and Ward (1998; Tracey, 2002), another indication of the

ICA-R's ability to score career interests using the RIASEC format is the evaluation of the

internal consistencies of the interest and competence scales. The fifth-grade school sample in the

study demonstrated much larger internal consistency estimates, ranging from .79 to .81, than

found by Tracey and Ward (1998; Tracey, 2002), providing some support of the ICA-R's









reliability in measuring RIASEC career types for this sample of students. The internal

consistency estimates of each RIASEC score for both the interest and competence scales are

presented in Table 4-6. However, more research is needed to validate the ICA-R's

appropriateness in evaluating elementary school students' RIASEC scores, especially in light of

the dearth of research on interests in the younger ages. Pragmatically, the ICA-R was easily

administered by the researcher using a common set of directions, was relatively brief, the

directions were easily understood by the students, and the students seemed not to have any

difficulty with any of the questions.

Other limitations of the study are related to the study's sample. First, the current study was

conducted with a small number of participants from one elementary school. The sample was

relatively homogeneous with all of the students living in a suburb close to a large city, coming

from a middle-class background. Therefore, the ability to generalize the results of the study to

students from a more diverse background should be considered with caution. The researcher

recommends further studies of this nature are needed to see if the same results are obtainable in

other more diverse populations of fifth-grade students.

Secondly, the sample size in the study is adequate when testing differences between two

means for the total sample (N = 70) of students in the study. However, when analyses are

conducted between sub-groups of the total sample, it places the study at risk for a Type II error.

This was most apparent when evaluating the effect of the education program with Black students

(N = 16). Therefore, it is important to replicate the study's findings with larger and more diverse

samples of students.

Lastly, a weakness of the study is its cross-sectional nature. Longitudinal research is

recommended to examine just how long the students' expressed consideration of nursing as a









career remained constant. For instance, the post-questionnaire was administered immediately

after the last education session, which raises the question as to how long students' expressed

interest in nursing will last. Longitudinal studies are needed to study the effects of a career

education program on students over time to determine its influence on students choosing nursing

as a career.

Practice Implications

The education program was designed primarily to increase awareness of and interest in a

career in nursing with fifth-grade students. Yet, as children mature, career exploration becomes

a greater emphasis than career awareness to stimulate vocational interests. Thus, it is

recommended that as children move into the middle school years, career education programs,

like the one designed for the current study, be enriched with developmentally appropriate

opportunities to further explore nursing's world-of-work. These activities could include field

trips to local hospitals, shadowing experiences with practicing nurses, partnerships with schools

and healthcare facilities to sponsor mentorship programs for students at all grade levels, and even

part-time employment as appropriate. All of these activities have shown to have a positive

influence on students' perception of nursing as a career choice.

Related to the current study, the researcher recommends the students who expressed an

interest in nursing as a career to be encouraged to participate in subsequent career exploration

activities. These activities could include, but not be limited to, the aforementioned career

exploration activities. The participation in additional career exploration activities would be

particularly valuable for those students in the study whose assessed career types were Social.

Longitudinal evaluations of the proposed career awareness and exploration activities are

essential to determine the relationship between increased interest in nursing as a career and a

student's actual career choice and enrollment in nursing school.









The findings from the current study examining the structure of children's interest and

competence perceptions supported many findings from previous research on interest

development in children. First, the gender mean differences found on all the scales except the

Investigative scales (both interest and competence) mirrored the results of Tracey (2002) on a

similar sample of students. Secondly, the findings illustrated a general decrease in ratings of

interest and competence scores, which is supported by previous studies and explained by

developmental and vocational psychology as a function of differentiation as children decide what

they 'do not like or are not good at'. Additionally, the results provided some support for the

ICA-R to score RIASEC types for the current study's sample of fifth-grade students based on the

internal consistency estimates of RIASEC scales.

Since the structures of interests and competence perceptions in children change over time,

especially in the transition years from elementary to middle school and do not stabilize until late

adolescence, more research of a longitudinal nature is needed to examine interest development in

late elementary and middle school students. A longitudinal approach would some shed light on

the question of how children shift from a concrete orientation to a more abstract perspective,

especially related to the synthesis of career awareness and exploration. A better understanding

of how children change in their thinking about their interests and competence perceptions has

great promise with respect to the future design of career interventions to assist children to work

with and understand their interests.

Overall, the results demonstrated the importance of research focusing on the career

development of children and the positive effect that career education can have on children's

career interests. As well, the review of the career development literature supports the notion that

career counseling programs should be an integral part of students' daily educational environment









and a fundamental component of the academic mission of elementary, middle, and high schools.

Thus, the researcher recommends that a foundational principle of our nation's pedagogy include

career development instructions and experiences as part of a comprehensive career counseling

program to be introduced at the elementary level and continued through high school and that

research be supported to study the effects on the development of children's career interests and

choices over time. In conclusion, many of the students' responses in this study to a career

education program about nursing are conceived as empirical contributions to existing knowledge

for theorists, practitioners, and researchers to build upon, within the sciences of nursing and

vocational psychology.












4.5

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4 3.8 3.87
3.7
3.57
3.4;
3.5
3 12 3.23

S- 2.88

o 2.59
0 2.59

m Male

2 Female
Ut-
C-

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1


0.5


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4.5 4.27

4 03
4 3n 336;


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323 3

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Realistic Investigative Artistic Social Enterprising Conventional

Figure 5-1. Gender effect for the interest and competence scales








APPENDIX
CAREER EDUCATION CURRICULUM FOR FIFTH-GRADE STUDENTS

Fifth-Grade Career Education and Awareness
Of Nursing as a Career Choice




A R












JOIN THE ONES WHO DARE TO CARE P --*.
diicovmrnufsing.crm


Unit 1: Everybody Can Learn about Nursing

Unit 2: Learning What Nurses Need to Know about the Body

Unit 3: Learning about Skills that Nurses Perform

Unit 4: Learning What Nurses Need to Know about Everyday Infections, Such as
the Common Cold









Unit 1: Everybody Can Learn about Nursing
1 Obj ective
* To help students broaden their view of nursing as a career choice, appreciate that nurses
come from diverse backgrounds, and recognize that nurses are both male and female
1 Competencies and Skills
* Students will:
* Describe the many roles and responsibilities of a nurse
* Discuss the advanced education beyond high school that is required of a nurse, and
suggested high school subjects to prepare the student to study nursing
* List various job opportunities and places a nurse can work
* Discuss employment, advancement opportunities, and job outlook
* State the earning potential of nurses
* Acknowledge that nurses are both male and female and they comprise all ethnicities
1 Instructor Preparation
* Gather information from the "Occupational Outlook Handbook, 2006-07 Edition,"
Registered Nurses http://www.bls.gov/oco/ocos083.htm
o Nature of the work
o Working conditions
o Work values, skills, and, abilities
o Required education, other qualifications, and advancement
o Recommended school courses
o Employment and job outlook
o Earnings
o Related occupations
1 Include both a female and male nurse during class instruction
SDisplay posters of nurses depicting various ethnic backgrounds
1 Supplies
o Johnson & Johnson Recruitment Posters
o Johnson & Johnson Coloring Book, "You Can be a Nurse"
o Johnson & Johnson Video, They Dare to Care"
o Johnson & Johnson Nursing Pin, "We Dare to Care"
o Nursing Gang CD, "Making a Difference Everyday"
o "Nursing Crossword Puzzle"
1 Classroom Instruction
o Video "They Dare to Care"
o Roles and responsibilities
o Nursing education
o Employment opportunities
o Diverse backgrounds
o Distribute coloring book, nursing pin, and CD
1 Assessment
o Nursing Crossword Puzzle
o Assign Optional Homework, "Career Report"









Unit 2: Learning about What Nurses Need to Know
1 Objective
* To help students understand that nurses need to know the parts of the human body and
their functions
1 Competencies and Skills
* Students will:
* Recognize the location of the major organs of the body
* State the primary function of the major organs of the body
1 Instructor Preparation
* Prepare an introductory lesson on all the organs of the Anatomy Apron. Information
included in "The Anatomy Apron Teacher's Guide"
o Brain
o Lungs
o Heart
o Stomach
o Liver
o Large and small intestines
o Kidneys
1 Supplies
o Education Insights "Anatomy Apron"
o Handouts -
"My Body"
"The Brain is the Boss"
"The Real Deal on the Digestive System"
"All About the Heart"
"What Kids Need to Know about Kidneys"
"Looking at Your Lungs"
"The Whole Story on Skin"
1 Classroom Instruction
o Discuss handout "My Body"
1 Assessment
o Locate major organs of the human body using the "Anatomy Apron"
o State primary functions of the body's major organs

Unit 3: Learning about Skills that Nurses Perform
1 Objective
* To help students understand basic skills required of nurses, specifically, major vital signs
assessment skills
1 Competencies and Skills
* Students will:
* List the major vital signs assessment skills
o Heart rate (HR)
o Respiratory rate (RR)
o Temperature (T)
o Blood pressure (BP)









* Recognize equipment used to assess major vital signs
o Stethoscope
o Thermometer
o Blood pressure cuff
* Demonstrate accurately taking another student's vital signs and recording on the "Vital
Signs Sheet" the student's HR, RR, T, and BP
1 Instructor Preparation
* Prepare an introductory lesson on the major vital signs describing what they are and how
to take and record them
1 Supplies
o "Tools Clues" handout
o "Vital Signs Sheet"
o Stethoscope(s)
o Thermometer(s)
o Blood pressure cuff(s)
- Classroom Instruction
o Discussion of major vital signs (HR, RR, T, and BP)
o Demonstrate how to take major vital signs (HR, RR, T, and BP)
1 Assessment
o Complete handout "Vital Signs Sheet"
o Complete handout "Tools Clues"

Unit 4: Learning What Nurses Need to Know about Everyday Infections, Such as the
Common Cold
1 Obj ective
* To help students identify everyday infections, how to protect yourself and others from
these infections, and how to prevent the spread of these infections
1 Competencies and Skills
* Students will:
* Recognize and describe common childhood infections
* Discuss how nurses can protect themselves and others from the spread of germs and
infections by certain isolation precautions
* Acknowledge that hand hygiene is the most effective means to prevent the spread of
germs and infection
1 Instructor Preparation
* Prepare an introductory lesson of common childhood infections and ways to prevent the
spread of infection
o Common Cold
o Conjunctivitis (Pinkeye)
o Cellulitis from everyday cuts and scrapes
* Prepare a lesson on how nurses protect themselves and others from the spread of germs
and infections by wearing gloves, gowns, and masks
* Prepare a lesson on correct hand hygiene techniques to include: (1)proper hand-washing
technique using antimicrobial soap and (2)proper antimicrobial foam application
technique









1 Supplies
o Gloves, gowns, and masks
o Face shields
o Optional: hair covers and shoe covers
o Soap
o Anti-microbial hand foam
o Handouts
"Chilling Out with Colds"
"Pinkeye"
"Cellulitis"
"What are Germs?"
"Why Do I Need to Wash My Hands?"
1 Guest Speaker (optional)
o Nurse Epidemiologist from local children's hospital
1 Classroom Instruction
o Common childhood infectious diseases and ways to prevent the spread of
infection
o Isolation techniques
o Hand hygiene techniques
1 Assessment
o Demonstrate proper donning and removal of gloves, gown and mask
o Demonstrate proper hand hygiene technique using antimicrobial foam


Instructional Sources
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2006-
2007 Edition, Registered Nurses, on the Internet at http://wwwbls.gov/oco/ocos083.htm

Educational Insights, Inc. (2000). The anatomy apron: Teacher's guide, Carson, CA.
Nemours Foundation, KidsHealth for Kids, Everyday Illnesses and Injuries, on the
Internet at http://www.kidshealth.org/kid/illinjure/index.html

Nemours Foundation, KidsHealth for Kids, My Body, on the Internet at
http://www.kidshealth.org/kid/body/mybody.html

Office of Science Education, National Institutes of Health, LifeWorks, Registered Nurses, on
the Internet at
http://www.science.education.nih.gov/LifeWorks.nsf/Alphabetical+List/Nurse,+Register
ed

O*NET OnLine, on the Internet at http://online.onetcenter.org/link/details/29- 1111.00#menu
National Occupational Information Coordinating Council. (1989). The national career
development guidelines local handbook [Brochure]. Washington, DC.









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BIOGRAPHICAL SKETCH

Pamela Lee Turner was born and raised in Jacksonville, Florida. Pamela graduated from

Wolfson High School in Jacksonville in 1971. She earned a Bachelor of Science in Nursing

from Florida State University in 1975 and a Master of Science in Nursing from the University of

Florida in 1977. Pamela has achieved national certification from the Pediatric Nursing

Certification Board as a Certified Pediatric Nurse and from the American Nurses Credentialing

Center as a Nurse Executive, Advanced-Board Certified.

Pamela's nursing career has primarily been spent in acute care facilities specializing in

pediatric nursing care. She is currently Director of Pediatric Education and Research at Wolfson

Children's Hospital. Pamela has served as adjunct faculty as a clinical instructor for several

colleges of nursing. Her career includes being the first female fireman to be employed by the

Jacksonville Fire and Rescue Department where she functioned as a member of the rescue

division. After receiving her PhD, Pamela will continue her work as a pediatric practitioner and

seek professional opportunities that will allow her to advance the science and practice of nursing.

Pamela has been married to Joe W. Turner for 31 years. They have a daughter and a son.

Their daughter, Elizabeth, is studying to be a physician. Their son, Walker, is studying to be an

electrical/computer engineer.





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1 ENHANCING INTEREST IN NURS ING AS A CAREER CHOICE WITH FIFTH-GRADE STUDENTS By PAMELA LEE TURNER A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLOR IDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2008

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2 2008 Pamela Lee Turner

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3 To my husband, Joe; my daughter, E lizabeth; and my son, Walker.

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4 ACKNOWLEDGMENTS I gratefully acknowledg e the wisdom and c ounsel that I received from my academic mentor and supervisory committee chair, Dr. Jennifer Elder, thr oughout the planning and development of this research. It was her insight of my potential to conduct this research project that brought it to fruition. I appreciatively acknowledge my dissertation committee members and their individual contributions: Dr. M. Harry Dani els for his boundless knowledge in the field of counselor education and patiently helping me discover the direc tion of my research, Dr, Alice Poe for her enthusiasm and interest of this re search project and her ge ntle guidance during the IRB process, and Dr. Veronica Feeg for her unequ aled editing skills and believing in me. I am grateful for my nurse colleagues, Kip Deckerhoff and Fern Hannigan. I appreciate Kip serving as a male nurse role model and as sisting me with the curriculum instruction throughout the entire study. His calm presence during the classroom instruction put me at ease when at times things seemed chaotic and overwhelm ing. As well, I appreciate Fern helping with the curriculum instruction and providing me e ndless support and encouragement all through my doctoral education. I acknowledge Kip and Ferns advocacy of the nursing profession and proud they exemplify nursing. I am especially thankful for Norma Copper mentoring me as a doctoral student while I assisted her with The Future Gator Nurse Project. This experience served as the springboard for the development of my research project. I wi ll forever be grateful for the wisdom and knowledge Norma imparted to me. In addition, I gratefully acknowledge Blue Cross and Blue Shield of Florida (BCBSF) for expanding the work of the Future Gator Nurse Project by funding a substantial grant to support my research. I am thankful BCB SF recognized the value of this study to encourage young students to view a caree r in nursing as a possibility and achievable goal.

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5 I acknowledge the principal and staff at the elementary school for graciously allowing me to conduct my research with their fifth-grade students. I am grateful for each student who participated in the study and honored that I was able to represent th e nursing profession with this group of young people. There was no greater reward than to in troduce these students to the nursing profession and to watch them eag erly explore a career in nursing. I am appreciative for my friend and prof essional mentor, Carolyn Johnson, whose commitment to life-long learning served as an inspiration and encouragement for me to begin and sustain my doctoral education. Lastly, I wish to express my love and a ppreciation to my husband, Joe; my daughter, Elizabeth; and my son, Walker for their unwavering faith in me to never give up my dreams. They provided me love, understanding, and motivation from the beginnin g to the end of my doctoral education. As well, I lovingly acknow ledge other members of my family who were constant sources of inspiration: my brother, Be rt; my sister-in-law, Ca rolyn; and my niece-inlaw, Joy. I am also thankful for my friends Sh ea, Jackie, and Teri, who were always present for encouragement and mirth.

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6 TABLE OF CONTENTS page ACKNOWLEDGMENTS...............................................................................................................4 LIST OF TABLES................................................................................................................. ..........9 LIST OF FIGURES.......................................................................................................................10 ABSTRACT...................................................................................................................................11 CHAP TER 1 INTRODUCTION..................................................................................................................13 Background.............................................................................................................................13 Future Supply of Nurses..................................................................................................15 Lack of Interest in Nurs ing as a Career Choice ............................................................... 16 Significance for Nursing.........................................................................................................17 Promoting Interest in Nursing as a Career Choice ................................................................. 18 Origins of a Career Development Program for School age Children..................................... 19 Theoretical Structure.......................................................................................................... ....21 Interest.............................................................................................................................21 Perceived Competence.................................................................................................... 23 Desire to Help Other People............................................................................................ 25 Purpose of the Study........................................................................................................... ....27 Summation..............................................................................................................................27 Research Questions............................................................................................................. ....28 2 REVIEW OF LITERATURE.................................................................................................30 The Nursing Shortage.............................................................................................................30 Current Outreach Efforts.................................................................................................30 Policy makers........................................................................................................... 30 Private organizations................................................................................................ 31 Kindred organizations..............................................................................................32 Results...................................................................................................................... 33 Future Outlooks...............................................................................................................33 Future Recommendations................................................................................................34 Career Education Program for School age Children..............................................................35 Nursing...................................................................................................................................35 Career Development in Children............................................................................................ 43 How Early?......................................................................................................................43 Developmental Career Counseling.................................................................................. 44 Expression and Permanence of Career Aspirations ......................................................... 46 Gender Role Expectations...............................................................................................47 Hollands Theory of Career Development............................................................................. 48

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7 Banduras Theory of Self-Efficacy......................................................................................... 51 Interest and Self-Efficacy..................................................................................................... ..52 Watsons Theory of Human Caring........................................................................................ 56 In Nursing Theory and Practice....................................................................................... 57 Future Directions of Watson s Theory of Hum an Caring............................................... 58 Summary.................................................................................................................................59 3 METHOD......................................................................................................................... ......63 Participants.............................................................................................................................63 Intervention.............................................................................................................................65 Curriculum Design.............................................................................................................. ....65 Instructional Units..................................................................................................................67 Research Design.....................................................................................................................68 Instruments.................................................................................................................... .........69 Questionnaires.................................................................................................................69 ICA-R ...............................................................................................................................70 Concern for Others ..........................................................................................................73 Intervention Implementation and Data Collection................................................................. 73 Threats to Internal Validity................................................................................................... ..74 Statistical Analyses........................................................................................................... ......76 Questionnaires.................................................................................................................76 Interest and Competence RIAS EC Sc ores and Caring Sco r es........................................ 77 4 RESULTS...............................................................................................................................82 Questionnaire Data.................................................................................................................82 Variables of Interest Before Partic ipating in the E ducation Program.............................83 Gender......................................................................................................................84 Family member........................................................................................................ 84 Race and knowing a nurse other than a family member.......................................... 85 Effects of the Career Education Program........................................................................ 85 Gender......................................................................................................................86 Race..........................................................................................................................87 Family member........................................................................................................ 88 Knowing a nurse.......................................................................................................88 ICA-R and Concern for Others Data ......................................................................................89 Within-Subjects Comparison of the Total Sample.......................................................... 90 ICA-R analyses .........................................................................................................90 Concern for Others analysis ..................................................................................... 90 Within-Subjects Comparison of Male and Female Students...........................................91 ICA-R analyses .........................................................................................................91 RIASEC career assessment......................................................................................92 Concern for Others analysis ..................................................................................... 93 Scale Reliabilities...................................................................................................................93 ICA-R ...............................................................................................................................93 Concern for Others ..........................................................................................................94

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8 Summary of Findings............................................................................................................ .94 Question 1........................................................................................................................94 Question 2........................................................................................................................95 Race..........................................................................................................................95 Family member........................................................................................................ 95 Knowing a nurse.......................................................................................................96 Question 3........................................................................................................................96 Question 4........................................................................................................................97 5 DISCUSSION.......................................................................................................................109 Interpretations of the Effects of the C areer Education Program........................................... 111 Expressed Interest in Nursing........................................................................................ 111 Gender....................................................................................................................113 Race........................................................................................................................114 Having a family member who is a nurse................................................................ 116 Knowing a nurse other than a family member....................................................... 118 Effects on Interest, Competence Percep tion, and Desire to Help Others ...................... 120 Interest and competence perception....................................................................... 120 Desire to help other people..................................................................................... 123 Research Design...................................................................................................................126 Strengths, Limitations, and Implications for Future Research............................................. 126 Practice Implications.......................................................................................................... ..130 APPENDIX CAREER EDUCATON CURRICULUM FOR FIFTH-GRADE STUDENTS .. 134 LIST OF REFERENCES.............................................................................................................139 BIOGRAPHICAL SKETCH.......................................................................................................149

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9 LIST OF TABLES Table page 3-1 Demographic characteristics of students........................................................................... 783-2 Crosswalk of national career developmen t competencies for elementary school and fifth-grade career education inte rvention by unit of instruction........................................ 793-3 Internal consistency and 1-year stability estimates of RIASEC scales across grade groups.................................................................................................................................803-4 Timeline for career education intervention........................................................................ 814-1 Pearsons chi-square te sts of students Yes a nd No responses before participating in the education program..............................................................................994-2 McNemar results of students who want to be a nurse after participating in the education program...........................................................................................................1004-3 Paired t -tests for interest and com petence RIAS EC scale scores for the total sample.... 1014-4 Paired t -tests of interest and competence RIASEC scale scores for male and female students....................................................................................................................... .....1024-5 Paired t -tests of caring scores for total sample, male, and female students..................... 1034-6 Internal consistency estimates of ICA-R s interest and competence scales and Concern for Others scale.................................................................................................103

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10 LIST OF FIGURES Figure page 1-1 Theoretical model of a career educ ation program for school age children........................ 29 2-1 A hexagonal model for defining the psychological resem blances among personality types and environments and their in teractions. Source: Holland, 1997............................61 2-2 The original ten carative f actors. Source: W atson, 1985, pg. 11...................................... 62 4-1 Percent increase in the number of student s who would be a nurs e af ter participating in the education program................................................................................................. 104 4-2 Increase in the number of students who w ould be a nurse after participating in the education program ...........................................................................................................105 4-3 Interest assessment: comparing male a nd fe male students before and after the education program...........................................................................................................106 4-4 Competence assessment: comparing male and female students before and after the education program ...........................................................................................................107 4-5 Paired t -tests of caring scores for total sam ple, male, and, female students.................... 108 5-1 Gender effect for the inte rest and competence scales ...................................................... 133

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11 Abstract of Dissertation Pres ented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy ENHANCING INTEREST IN NURS ING AS A CAREER CHOICE WITH FIFTH-GRADE STUDENTS By Pamela Lee Turner August 2008 Chair: Jennifer H. Elder Major: Nursing Sciences This research was designed to provide in formation on the career development of fifthgrade students and to explore the influence of an education program on childrens interest in nursing as a career choice, especially related to gender. Interest in nursing is conceptualized as interest, competence perception, an d desire to help other people. A sample of 70 fifth-grade students recruited from a public elementary schoo l in a large metropolitan city in the Southeast completed the study. The students interest in nursi ng as a career was measured be fore and after participation in a four-week career education program a bout nursing. The four-week career education curriculum was designed in accordance with the Na tional Career Development Guidelines. Data were collected to determine the effect of th e education program on th e students interest, competence perception, and desire to help othe r people based on John Hollands (1959) theory of career development, Albert Banduras (1977) theory of self-efficacy, and Jean Watsons (1985) theory of human caring. In addition, data were collected from preand post-questionnaires asking the students if they would consider nursing as a career to evaluate the effects of the

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12 education program on school age children expressi ng their consideration for nursing as a future career choice. Results indicated the education program ha d a highly significant effect on students expressed consideration of nursing as a career choice, achieving a 61% increase in the number of students indicating they would c onsider nursing after participati ng in the education program. This positive influence was disc overed between male and female students, resulting in a 114% increase in the number of male students and a 43% increase in the number of female students indicating they would consider nursing after participating in the education program. Results provided a preand post-career assessment of the st udents career types based on John Hollands theory of vocational personali ties and work environments. The career assessments for these students were congruent w ith findings from previous studies, especially related to gender differences. Lastly, the desire to help other people ma nifested itself with female students scoring signifi cantly higher and male students showing no significant change after participating in the car eer education program.

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13 CHAPTER 1 INTRODUCTION Background In the upcom ing years, the nursing profession in the United States will encounter perhaps the largest challenge in its history. The curren t nursing shortage, which began in 1998, remains remarkably persistent throughout the nation. Today s nursing shortage is considered one of the most important challenges affecting the count rys hospitals. A recent study conducted by the American Hospital Association indicated that within hospitals the nursing shortage has caused emergency department overcrowding, diversion of emergency patients, reduced number of staffed beds, discontinuation of programs and serv ices, and the cancellation of surgeries (First Consulting Group, 2002). In addition, surveys of nurses have indicated th at the shortage has negatively affected hospitals care processes with nurses reporting delays in nurses responses to pages and telephone calls, interrupted staff co mmunications, increased number of complaints about nursing care, reduced numbers of available hospital beds, increased patient wait times for surgeries and tests, and dela yed patient discharges (Bue rhaus et al., 2005b). Research has revealed that nurses are essential to patient safety and th e delivery of efficient and effective healthcare (Aiken, Clark, Sloane, Sochalski, & Silber, 2002). However, recent state and national surveys have reported that the shortage is interfering with nurses ability to provide quality patient care. Nurs es are often stating that within their current work environment it is more difficult to provide quality patient care because of perceived workforce shortages (Aiken et al. 2002; First Consulting Group, 2002). Results from two recent national surveys in 2002 and 2004 assessing nurses perceptions of the nursing shortage indicate d that nurses felt the shortage had affected their nursing care by decr easing the amount of time nurses had to spend with patients, the ability to detect patient co mplications early, and the capacity to maintain

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14 patient safety (Buerhaus et al., 2005a). Further st udies have demonstrated an increased risk of medical errors associated with inadequate nurse staffing. These medical errors have resulted in deleterious patient outcomes to include patien t mortality (Blegen, Good, & Reed, 1998; Lichtig, Knauf, & Milholland, 1999; Aiken et al., 2002). Buerhaus and colleagues recently reported th at the majority of nurses (79%) and Chief Nursing Officers (68%) believe the nursing shortage is affecting the overall quality of patient care in hospitals, as well as in other healthcare settings. Their study indicated that 93 percent of hospital nurses express consider able concerns of not having enough time for patients and 68 percent express concern for their ability to mainta in patient safety (Buerhaus et al. 2005b). The shortage has also reached the awareness of the American public with 81 percent reporting knowledge of the nursing shortage, 93 percent havi ng the opinion that the shortage threatens the quality of care, and 65 percent considering the nursing shortage as a national problem (Johnson & Johnson, 2001). Since the 1950s, the nursing supply has emer ged with cycles of abundance followed by shortages. These past shortages in nursing were usually a direct e ffect of healthcare expansion in both size and technological advancements. Yet, the current nursing shortage is more complex and enduring than in previous shortages from past decades. Todays nursing supply crisis is driven by a richer and broader set of issues never before experienced, such as an aging population, fewer workers, an aging workforce, gender and ethnic disparities, more options for women, the generation gap, a challenging work e nvironment for nurses, consumer activism, and a burgeoning healthcare system (Robert Wood Johnson Foundation, 2002). An updated forecast of the nursing supply and demand a decade from now indicates a projected shortage of 340,000

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15 nurses, three times larger than the size of the current shortage when it was at its peak in 2001 (Auerbach, Buerhaus, & Staiger, 2007). Future Supply of Nurses Looking ahead, a study conducted by Buerhaus and colleagues created concern for the future supply of nurses influenced by the aging nur se workforce. According to their predictions, the nurs ing workforce will continue to age and dimi nish, and will be unable to meet the projected workforce requirements if this trend is not reve rsed (Buerhaus, Staiger, & Auerbach, 2000). The recent National Sample Survey of Registered Nu rses conducted by the Department of Health and Human Services, Health Resources and Services Administrations (HRSA), the key Federal agency responsible for nursing workforce and de velopment in the United States, indicated the average age of the nurse workforce will increas e over the upcoming years, rising from an average of 43.5 years in 2005 to 44.7 in 2012 and beyond (Heath Resources and Services Administration, 2004). In 2005, the largest age gr oup of nurses in the workforce was nurses in their forties, followed closely by th ose in their fifties. It is pr ojected that in four years (2012), more employed nurses will be in their sixties than in their twenties (Auerbach, et al., 2007). Other key factors contributing to the aging of nursing are the pe rsistent trend of declining interest in nursing by women and the ever-decrea sing number of people born after 1955 who have chosen nursing as a career (Buerhaus et al ., 2000). In addition, ther e has been a recent trend toward later entry into nursing. Nurses t oday are less likely to enter a nursing education program immediately after high school and nursing has become an attractive career option for people in their twenties or early thirties. Th erefore, recent nursing graduates have a higher average age at the time of graduating from nursing school than from previous years (Auerbach et al., 2007).

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16 An additional critical problem directly a ffecting the nations supply of nurses is the shortage of nursing faculty in the United States, which is projected to worsen in future years. A considerable increase in nursing graduates is needed to meet the projected demand for new nurses in 2020. This corresponds to an increase in the demand for nursing faculty. The Robert Wood Johnson Foundation (2002, p. 2) recently re ported, Substantial evidence at both the national and state levels shows th at the current inadequate suppl y of nursing faculty constrains the level of enrollment in nursing programs necessary to meet future demands of nurses. The American Association of Colleges of Nursing s (AACN) preliminary fi ndings reported that 32,323 qualified applications to entry-level baccalaureate programs were not accepted in 2006 based on responses from 449 schools throughout the country. The number of qualified applications turned away each year from th ese nursing programs remains high with 37,514, 29,425, 15,944, and 3,600 students turned away in 2005, 2004, 2003 and 2002, respectively. Shortage of faculty was indicated by 76.1 percent of the surveyed sc hools as the main factor that limited admissions. In addition, the adequacy of the supply of future faculty will be strongly influenced by the high average age of nursing f aculty. In 2001, the reported average age of doctorate-prepared faculty was a bout 53 years and masters-prepared faculty was about 49 years. It was also reported that not only do nurses enter the faculty role relatively late in their careers, but they retire young at an average age of 62.5 years (American Association of Colleges of Nursing, 2006b). Lack of Interest in Nursing as a Career Choice Given projections of a future and an even larger nursing shortage in the next decade, efforts to promote the nursing profession and at tract people to pursue a career in nursing are essential. Moreover, the aging of the nursing workforce suggests the importance of recruiting younger students into nursing. Unfortunately, pr evious research has de monstrated that high

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17 school students rarely consider nursing as a career choice based upon students attitudes, perceptions, and knowledge of nur sing (Firby, 1990; Hemsley-Brown & Foskett, 1999; Kohler & Edwards, 1990; Marriner-Tomey, Schwier, Maricke, & Austin, 1990; Stevens & Walker, 1993). Other research has indicated that attitudes of ch ildren toward nursing grow increasingly negative as they progress from elementary to high school, and well into college (May, Austin & Champion, 1988). These findings were supporte d in a study done by Marriner-Tomey and colleagues, who discovered that the gap between students percep tions of an ideal career and a nursing career widens, as childre n get older, and by high school a very small percentage view nursing as a potential career (Marriner-Tomey, Schwier, Maricke, & May, 1996). Significance for Nursing It is suggested that the most im portant factor contributing to the aging and diminishing of the nursing workforce is the pe rsistent trend of declining interest in nursing by young women (Buerhaus et al., 2000). Staiger and colleagues recently examined the reasons for this declining penchant of women to choos e nursing as a career. They found th at the peak interest to become a nurse occurred in women graduating from high school around 1973. Additional information from this study indicated a 40 percent drop of college freshman declaring that nursing was among their top career choices. One of the major r easons for this dramatic decline was credited to the concurrent expansion of opportunities for capable young women to enter formerly maledominated professions such as medicine, law, and managerial occupations (Staiger, Auerbach, & Buerhaus, 2000). This disturbing review of evidence demons trating the rapidly ag ing nurse workforce partnered with the declin e of interest in nursing as a career presents an unsettling picture of the future of the nursing profession. How will a profe ssion with a majority of its members retiring in

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18 the near future replace itself with the current low interest among young people to choose nursing as a career? Promoting Interest in Nursing as a Career Choice The prom otion and dissemination of informa tion about the nursing profession has shown to be successful in promoting nursing as a car eer choice with high school students. Past surveys of high school students interest in nursing as a possible car eer indicated that receiving information about nursing positively affects their attitudes about nursing (Marriner-Tomey et al., 1996) and is correlated with considering nursing as a future career choice (Erickson, Holm, Chelminiak, & Ditomassi, 2005). In addition, a presentation on nursing presented to middle school students provided further s upport that perceptions and attitudes of nur sing as a career can be influenced positively through a classroom pr esentation. Using preand post-presentation assessments, 48 percent of the st udents indicated they had more interest in becoming a nurse after the classroom pres entation (Hoke, 2006). Evidence from these studies suggests educat ion outreach has a positive impact on the students perception of nursing as a possible career choice. Thus, it is prudent to design education initiatives to stimulate interest in nursing by promoting th e many career opportunities in nursing and by increasing awareness of the va lue of the nursing profession to students, beginning as early as elementary school and c ontinuing through high scho ol. As well, those students who receive accurate information about th e nursing profession befo re ruling out nursing as a career too early may have more incentive to continue their ex ploration of nursing. Conceivably, a career education program designed to enhance interest in nursing as a career choice with elementary, middle, and high school students can be considered a promising initiative to strengthen the nursing workforce in the United States to meet the healthcare challenges of the future.

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19 Origins of a Career Development Program for School age Children We now know that career choice and developm ent is not a matter exclusive of adolescence or adulthood and that childhood and its contexts are also important precursors of future vocational behaviors (Vondracek, 2001). Vocati onal theorists generall y agree that career development begins in childhood and continues through adulthood. They recognize the need for career education for children to begin in their preschool and early elementary years so that knowledge and experiences related to career education are system atically organized across the years from preschool to high sc hool. Clearly, these formative years of childhood have a large potential to influence future career decisions (Sharf, 2006). Although career education at the elementary school age level might seem premature, studies have demonstrated that career development is an impo rtant antecedent for school age children to understand th e world-of-work. Seligman and colleagues have shown that children by the age of 10 have done quite a bit of thinking ab out their future and can clearly articulate their career aspirations (Seligma n, Weinstock, & Heflin, 1991). In addition, McMahon and colleagues found that childrens career development was enhanced as a result of career education lessons, with children showing an increased ability to list occupations and identify a favorite occupation (McMahon, Gillies, & Carroll, 1999). These studies and others have provided empirical evidence that suggest children as young as kindergar ten (Trice & King, 1991) are not too young for and would benefit fr om early career counseling. Additionally, the monograph repres enting the work of Super and his associates theory of vocational development indicates that most ch ildren by the age of 10 have passed through the fantasy vocational life stage of car eer development into the interest stage. During the interest stage, childrens dreams of occ upations are influenced by information about the world, resulting in interest development of certain occupations (Super et al., 1957). Theref ore, the researcher

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20 conceives that encouraging a childs emerging interests by their participating in a career education program about nursing is pragmatic in the development of their decision-making related to career preferences, sp ecifically related to interest in nursing as a career choice. A corollary concept to vocational life stage deve lopment is that of developmental tasks that need to be mastered by growing children in rela tion to their environment. According to Erik Eriksons (1993) theory of psychosocial developmen t, he distinguishes th e crisis of the middle childhood years, occurring between six years and puberty, as the psychological stage of industry versus inferiority. Erikson holds that successful experiences give the child a sense of industry and a feeling of competence and mastery, while failu res give the child a sense of inadequacy and inferiority (Miller, 1993). Thus, the research er suggests a career e ducation program that provides both informational and experiential learning activities associated with nursing is important in the development of a childs percei ved competence to consider nursing as a possible career choice. Thus far, the role of career education in promoting career development with children has been discussed, yet seldom researched. Educatio n models that could prompt career development in elementary school children have been propos ed, yet the impact of such interventions has seldom been studied and reported. In one of the few studies, McMahon and colleagues, found that childrens career development was enhanced as a result of a career education program resulting in children being able to list various occupations and even identify a preferred occupation (McMahon et al., 1999). Another st udy involving sixth-gr ade students reported increased interest in career information as a result of career educa tion activities (Gillies, McMahon, & Carroll, 1998). Hence, the impetus for this research was founded on information indicating that career developm ent is a lifelong process beginning very early in childhood and

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21 that career education programs have reported sup port of spawning childrens interests in certain careers. Theoretical Structure Review of the current literature does not offe r a well-developed conceptual m odel to use as a foundation to develop a childre ns career education program, partly be cause of the limited amount and scope of research conducted in car eer development in children. Therefore, the researcher constructed an integr ated and parsimonious conceptual framework that was used in the development of a career education program fo r school age children to influence their interest in nursing as a career choice. The proposed c onceptual model in the study examines interest, competence perception, and the desire to help other pe ople as critical attribut es that contribute to the understanding and operationali zing of the career education pr ogram for school age children. These attributes are empirically evaluated and their contributions to the ultimate goal, to positively influence school age childrens interest in nursing as a career choice. The interest component of the model is consis tent with John Hollands theory of vocational personalities and work environments (Holland, 1997). The models element of competence perception is supported by Albert Banduras theory of self-efficacy mechanism in human agency (Bandura, 1982). Lastly, the desire to help ot her people is influenced by nurse theorist Jean Watsons philosophy and science of human carin g (Watson, 1985). Thus, the underpinnings of these three theories provided a theoretical framework for a career education program (intervention) for school age children intended to positively influence interest in nursing as a career choice. Interest John Holland published his theory of vocational psychology in 1959 and m any consider Hollands impact on vocational psychology in th e past 35 years unprece dented (McDaniel &

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22 Snell, 1999). Hollands career classification hexa gon, described in detail in Chapter 2, is a distinguished icon that represents a theory both rich with researchable propositions and assessment tools of great counseli ng utility. In fact, the American Association of Counseling and Development states that no othe r career development theory e quals the contributions that Hollands work has provided for both the theoretical researcher and the app lied practitioner. His book entitled Making Vocational Choices has been by far the most c ited work in the field of vocational psychology (Rayman & Atanasoff, 1999). In career counseling, the satisfied relationship between an individual and an occupation is referred to as congruence. Congruence exists to the extent that a person selects an occupation that matches some predefined characteristic of that person. Career information delivery systems are designed to help individuals identify occupations that are congruent with their vocational personality that lead to satisfying careers. These delivery systems typically define congruence along multiple characteristics including interests, abilities, values and education. Hollands theory is the primary interest model utilized in the nearly 50 information delivery systems and almost all the systems incorporate Hollands ca reer classification scheme (McDaniel & Snell, 1999). Additionally, Hollands theory on vocational choice has adde d organization, structure, simplification, and improved interpretations to most all interest inventorie s utilized in career counseling. It has provided a fr amework for organizing and measur ing occupational interest data within the field of vocational psychology. The robustness of Hollands work has influenced nearly all contemporary interest inventories such as the Campbell Interest and Skill Survey, the Suder Occupational Interest Su rvey and Career Search Sche dule, Hollands Self-DirectedSearch, the Strong Interest Inventory and Skills Confidence Invent ory, and the Unisex edition of

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23 the ACT Interest Inventory (Campbell & Borg en, 1999). Accordingly, Hollands theory and occupational information has come to dominate th e development, validation, and application of interest inventories It is Hollands theoretical value, especially related to the structure of vocational interests, that the researcher chose Hollands theory of car eers to operationally illustrate interest. The instrument used to measure interest in children is the ICA-R and is explained in Chapter 3. Perceived Competence The portion of Albert Banduras gen eral social cognitive theory that has received the most attention in the career developmen t literature involves the assessm ents of self-efficacy (Bandura, Barbaranelli, Caprara, Pastor elli, 2001). According to Ba ndura (1986, p. 391), Self-efficacy refers to peoples judgments of their capabilities to organize and execute courses of action required to attain designated types of performan ces. The term career se lf-efficacy is a term intended to summarize the possibility that low expect ations of efficacy rela ted to career behavior may serve as a detriment to optimal career choi ce and development in an individual (Betz & Hackett, 1981). Betz and Hackett introduced self-efficacy in to the career literatu re in 1981. They conducted a study involving both male and fema le college students to investigate the applicability of Banduras self-effi cacy theory to the process of career selection. They postulated a causal model of career choice in which perceived self-efficacy functions as a major mediator of career selection. Additionally, they discovered that the level of perceived self-efficacy correlates positively with the range of career options critically considered by students and the degree of interest shown in them. Overall, the data from the study suggest that the strongest predictors of career choice were self-efficacy and in terest (Betz & Hackett, 1981).

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24 According to Holland, although many different career related activities are pursued during a persons formative years, people generally develop characteristic patterns of career interests. The development of these patterns of career interests is thought to crysta llize during adolescence or young adulthood. Hollands theo ry posits that people tend to select careers that are compatible with their interests (Holland, 1997). In addition, Bandura (1977) suggests a recipr ocal relationship between self-efficacy and interests, such that, vocational interests are related to self-effi cacy because they increase the likelihood of successful performance in the areas of interest. Reci procally, expectations of selfefficacy are suggested to influence the areas of behavior pursued and those avoided. Thus, avoidance of certain activities as a result of low self-efficacy may prevent the development of interests, whereas engaging in a va riety of activities is likely to expand an individu als range of interests. More specifically, it is likely that individuals form enduring interests in activities in which they view themselves to be efficacious an d in which they anticipate positive outcomes (Bandura, 1986; Lent, Brown & Hack ett, 1994). The little research that does exist in children suggests that children 10-12 y ears of age do engage in career exploration and employ their interests and aptitudes to guide how and what they learn about the world-of-work (Hartung, Porfeli, & Vondracek, 2005). Tracey (2002) examined the structure of intere st in children and in a study of fifth and seventh-grade students reported th at just as interest led to the development of a sense of competence, the development of a sense of self -competence fostered interest. Additionally, Holland (1997) proposed that self-efficacy estimates are related to interests and incorporated measures of self-efficacy into his interest scales. This approach to parallel measurements of

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25 perceived competency (self-efficacy) and interest has distinct implicati ons for career counseling and education and is discussed mo re entirely in Chapter 2. It is Banduras theory of self -efficacy that explains why certain activities generate different vocational interests over time (Bandura, 1977; 1982). The theory also fits well with the current scholarly focus of self-efficacy and its extension to vocational behavior (Lent, et al., 1994). For these reasons, the researcher chose Banduras th eory of self-efficacy to operationally typify competence perception. The instrument used to measure competence perception in children is the ICA-R and is described in Chapter 3. Desire to Help Other People From a nursing and anthropological viewpoint, the concept of caring for self and others is one of the oldest forms of human expression and has incited humans to convey their feelings of caring toward others. Historical ly, caring has been reported as th e most frequent response given for selecting nursing as a career and continues to be a major influence for those choosing nursing. In a study examining stude nts choice of nursing as a car eer, researchers found that the concepts of caring and nurturan ce were identified as high motivators for selecting nursing. The study also indicated that students described the meaning of nursing related to caring issues such as helping others, giving care a nd comfort, serving, supporting, a nd sharing (Kersten, Bakewell, & Meyer, 1991). In addition, Grossman and Northr ops (1993) study of eleventh-grade students opinions of nursing as a career re ported that most of the stude nts perceived nursing as a career that provides opportunities to care for people in a time of need. More recent studies examining the most important personal influences of why students chose nursing as a career, reported a desire to help people (Wilson & Mitchell, 1999 ; Hemsley-Brown & Foskett, 1999). These studies continue to reinforce societys time-honored views in relation to the overwhelming image of nursing as a caring and helping profession.

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26 According to nurse theorist Jean Watson, th e nursing profession ac knowledges its claims to the concept of caring describing their prof essional services to others as nursing care, therapeutic care, caring for othe rs, and other related caring expr essions. Therefore, Watson contends that a science of car ing is essential and the foundatio n for nursing practice. Watson asserts that nursing is both scientific and artis tic, combing science with humanism. She views nursing as a therapeutic interpersona l process, yet at the same time, must continue to advance the science of nursing through scientific knowledge a nd research (Watson, 1985). Her ambition is to study nursing as a humanistic-scientific discipli ne as well as an academic-clinical profession (Watson, 1985, p. xvii). Swansons (1999) meta-analysis of published nursing research on th e concept of caring resulted in a proposed framework to integrate the current state of substantive knowledge about caring in nursing. Findings about th e characteristics of a caring nur se were categorized as the capacity for caring and suggest that the caring nurse is compassionate, empathetic, knowledgeable, confident, and reflective. Previous studies have raised the question as whether these traits and characteristics ar e inherent (nature) or if they may be environmentally enhanced or diminished (nurture) (Ray, 1987; Clarke & Wheeler, 1992). However, in a survey design study, Soldwisch (1983) supported the association between capacity to care and maturational readiness (experience). The researcher proposed a measurement of the desire to help other people to explore and quantify the caring capacity of the sample population of fifth-grade students and the effects of an education intervention on the students caring capacity. The instrument used to measure helping others in children was developed from the Child Development Project; Scales from Student Questionnaires, of the Developm ental Studies Center titled Concern for Others (Grades 3-6) and

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27 is discussed in Chapter 3. According to Dr. Watson (personal communication, November 5, 2006) the instrument is one possi ble tool that can measure cari ng reflective of her theory of human caring. Purpose of the Study The purpose of the study was to develop and exam ine the effects of a career education program to strengthen the future professional nursing workforce by encouraging an interest in nursing as a career choice with school age child ren, specifically fifth-grade students. The research was designed to provide information on the career devel opment of fifth-grade students, approximately ages 10 to 11, and to explore th e influence of a caree r education program on childrens interest in nursing as a career choice. The follo wing aims guided the study: Evaluate the effects of a career educati on program designed to enhance fifth-grade students interest of nursing as a career on: (a) interest, (b) co mpetence perception, and (c) desire to help other people, considering gender. Interest in nursing as a career choice is operationally illuminated by the concepts of interest (Holland, 1959), competence perception (Bandura, 1977), and desire to help other people (Watson, 1985). Evaluate the effects of a career education program about nursing on childrens expressed consideration of nursing as a future career choice, considering gender. Summation In summ ation, choosing a future occupation is one of the most vital decisions young people face. Vocational development begins mu ch earlier in the life span than generally assumed, and what children learn about work and occupations has a profound effect on the choices they make as adolescen ts and young adults, and ultimately, on their occupational careers. The theoretical suppositions presen ted in this study suggest that many children in the range of 10 years of age engage in dynamic career explorat ions, using their intere sts and aptitudes to guide how and what they learn and the goals they formulate in re lation to the world-of-work.

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28 The theoretical model that has been proposed served as a functional foundation to develop a career education program for school age children, partic ularly fifth-grade students, intended to enhance interest in nursing as a career choice. Th e proposed theoretical model is shown in Figure 1-1 including a relational synthesis of the three concep tual components: (a) interest, (b) perceived competency, and (c) desire to help other people. Research Questions 1. What is the effect of a career education pr ogram on fifth-grade st udents interest in nursing as a career choice measured by changes in the students yes or no responses when asked if they would consider bei ng a nurse when grown, taking into account gender? 2. What are the effects of race, having a fa mily member who is a nurse, and knowing someone who is a nurse other than a family member on the students yes or no responses when asked if they would consider being a nurse when grown before and after participating in a career educati on program about nursing? 3. What are the effects of a career education pr ogram on fifth-grade students interest in nursing as a career choice measur ed by changes in interest ( ICA-R), competence perception ( ICA-R ), and desire to help other people ( Concern for Others )? Interest in nursing as a career choice is operationally illuminated by the concepts of interest (Holland, 1959), competence perception (Bandura, 1977), and desire to help other people (Watson, 1985). 4. Is there a difference in how male and fema le fifth-grade students re spond to a career education program about nursing as a caree r choice measured by scores on the ICA-R and Concern for Others?

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29 Banduras Theory of Self-Efficacy Hollands Theory of Career Development Watsons Theory of Human Caring Desire to help other people Interest Competence Perception Score on ICA R Score on ICA R Score on Concern for Others Interest in Nursing as a Career Choice Figure 1-1. Theoretical model of a career education program for school age children

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30 CHAPTER 2 REVIEW OF LITERATURE The Nursing Shortage Thinking about todays nursing sh ortage can be overwhelm ing. Almost everyone feels an obligation to do their part to address the shortage of qualified nurses in th is country. Duly, the American Association of Colleges of Nursing (AACN), the national voice for university and four-year-college education progr ams in nursing, is concerned about the nursing shortage and is working with colleges and universities, policy makers, kindred organizations, and the media to bring attention to this healthcare emergency. The AACN is functioning to enact legislation, identify strategies, and form public and private partnerships to help strengthen the nursing workforce (American Association of Colleges of Nursing, 2006a). In addition, other major national outreach efforts are unde rway aimed at drawing attention to the nursing shortage, promoting the image of nursing, and attempting to attract people into the nursing profession (Donelan et al., 2005). Current Outreach Efforts Policy makers On February 22, 2002 the Bush adm inistration re leased a national news bulletin identifying the nursing shortage as a nationa l priority and unveiled a plan to promote careers in nursing among Americas young people. Endorsed by th e Bush administration, Health and Human Services (HHS) Secretary Tommy G. Thompson and Education Secretary Rod Paige launched a government campaign to encourage schoolchildren to consider a career in nursing. During this public announcement, Secretary Thompson is quot ed saying Secretary Paige and I both want students to realize that nursing is an exciting and satisfying care er that makes a difference in peoples lives (HRSA News Room, 2002, p. 1). S ecretary Paige went on to say, By making

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31 students in Americas schools and postsecondary institutions awar e of careers in the health profession, particularly nursing, we hope we can interest th ese outstanding young people in filling the critical need of qualified nurses (HRSA News Room, 2002, p. 1). During the press release, Secretaries Thom pson and Paige unveiled Kids into Health Careers (KIHC). KIHC operates through the Health Resources and Services Administrations Bureau of Health Professionals (BHPr) and is a government sponsored education campaign to encourage childrens interest in nursing and other health professions. KIHC stresses the need to reach children at an early age to encourage them to choose a career as a healthcare professional. Their agenda includes raising the image of and interest in nursing within communities throughout the country by promoti ng the nursing profession in local schools, particularly at the elementary school level (Kids into Health Careers, 2003). Private organizations The private sector also b ecame involved at a bout the same time that Secretaries Thompson and Paige introduced KIHC with the Johns on & Johnson Company announcing it had begun a multi-year, multi-million dollar national campaign, The Johnson & Johnson Campaign for Nursings Future, aimed at attracting young people to th e nursing profession. The campaign was developed following a review of current resear ch on the nursing shortage and after consulting with professional nursing organizations, schools of nursing, hospitals, and other healthcare agencies. As well, the campaign was assisted by healthcare research ers studying the nursing shortage at Vanderbilt University Medical Cent ers School of Nursing and Center for Health Services Research (Johnson & Johnson, 2001). Led by Peter Buerhaus, Associate Dean of Nurs ing at Vanderbilt and a leading researcher on the nursing shortage, a national poll was c onducted to gain insights on Americans perceptions related to the nur sing shortage. The nationwid e poll commissioned by Johnson &

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32 Johnson consisted of telephone interviews of 1,005 Americans, 21 years of age or older (Smith, 2002). Based on the analysis of the study, Buerhaus commented: The biggest problem is that people are unaware of the array of opport unities and rewards in nursing today. They are unaware that nursing salaries are very competitive with other professions or that nursing offers career opportunities in health research, hospital management, and family and community health ca re, in addition to traditional patient care. We need to get these messages out to parents, teachers, counselors a nd, above all, students at all levels. (Smith, 2002, p. 3) Therefore, one of the campaign s central objectives was to pub licly promote opportunities in nursing and increase awareness of the value of the nursing profession to Americas healthcare system. The campaign included providing free r ecruitment brochures, posters and videos to hospitals, high schools, nursing schools, and othe r nursing organizations; as well as a national advertising campaign that celebr ated nursing and their contributi ons to healthca re (Johnson & Johnson, 2001). One of the primary goals of the campaign was to stimulate interest in nursing as a career choice through national advertising. No teworthy, five years ( 1995-2000) prior to the campaign the nation had experienced a drop in enrollments into nursing education programs. Yet, after the campaign was launched enrollment s in nursing programs increased impressively within the next three years (American Association of Colleges of Nursing, 2006b). Kindred organizations Nurses for a Healthier T omorrow (2007), a coalition of 43 nursing and healthcare organizations working together to wage a comm unications campaign to attract people to the nursing profession launched its national media campai gn to encourage interest in nursing careers. The coalition conducted nationwide focus groups, launched a Web site, cr eated public service announcements, and designed print ads that were di stributed to the American public to bolster the image of nursing and to educate the public on the opportunities offered by a career in nursing. Its mission states:

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33 The potential and the solution to the nursing shortage lies in the profession of nursing itself and in the tremendous range of opportunity it offers to young people considering a career in health care. Our job is to communicate that message and bring the image of the nursing profession in line with the realities of its tremendous social importance and personal potential for career satisfaction. (Nurses for a Healthier Tomorrow, 2007, p.1) Results Joining together in 2003, To mm y G. Thompson, Health and Human Services Secretary, and James T. Lenehan, President and Vice Chairman of the Board of Johnson & Johnson, announced to the American public that baccalaureate nursing school enrollments increased by more than eight percent in 2002. Overall, 84 percent of all nursing schools nationwide were experiencing increased applications and enroll ments as a result of these major recruitment projects (Smith 2002). Accordingly, AACN (2006b) reported a 3.7 percent enrollment increase in 2001 in entry-level baccalaureate programs in nursing, an 8.1 percent increase in 2002, a 16.6 percent increase in 2003, a 14.1 pe rcent increase in 2004, a 9.6 pe rcent increase in 2005, and a five percent increase in 2006 (based on preliminary data). Additionally, AACNs (2006b) annual survey indicated an 18 percent increase from 2005 to 2006 in the number of graduates from entry-level baccalaureate nursing progr ams; as well as 3.2, 4.3, 14, and 13.4 percent increases in the number of graduate s in 2002, 2003, 2004, and 2005, respectively. Future Outlooks Although these increases in enrollm ent and number of graduates are encouraging, the federal report published by the Health Resources and Services Administ ration (2004) projecting future nurse supply and demand entitled What is Behind HRSAS Projected Supply, Demand, and Shortage of Registered Nurses? indicates that the U.S. must gr aduate approximately 90 percent more nurses from its nursing programs to meet the projected growth in the demand for nursing services. This equates to a deficit of one m illion new nurses by the year 2020, suggesting that 64 percent of projected demands for nursing services will not be met (Health Resources and

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34 Services Administration, 2004). Th is survey is completed every f our years and is considered the most extensive and comprehensive statistical reso urce on registered nurses with a current license to practice in the United States. However, an u pdated forecast of the nursing supply and demand a decade from now is not quite as ominous, proj ecting a shortage of 340,000 nurses, which is still three times larger than the size of the current shortage when it was at its peak in 2001 (Auerbach, et. al., 2007). A contributing factor to the increased dema nd for nursing services is the rising elderly population in proportion to the projected increase in the number of nurses and other caregivers. The future demand for nurses is expected to in crease dramatically as the baby boomers reach their sixties and beyond. It is projected that the population of people 65 years old and older will double between 2000 and 2030. The increasing age of the general popula tion and the growing need for management of chronic disease conditio ns, suggest that the overall requirement for nursing services will increas e (Buerhaus et al., 2000). This ob vious disparity between the future supply of and demand for nurses continues to widen the gap between the number of people needing care and those available to provide that care (United Stated Ge neral Accounting Office, 2001). Even with AACNs (2006b) report of in creased enrollment in nursing programs and graduates for the past six years, it is evident th at the need for more nurses will billow in the years ahead related to the increasing demands for nursi ng services heightened by an aging workforce exiting the profession. Future Recommendations The researcher suggests that this recent robust intere st in the nursing prof ession, demonstrated by the increase in student enrollm ent and number of graduates in nursing colleges and universities for the sixth c onsecutive year, is in part an outcome of the dissemination of positive information about the nursing profession and its myriad of career opportunities through

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35 these above mentioned national out reach efforts (Smith, 2002; Amer ican Association of Colleges of Nursing, 2006b). Therefore, the researcher reco mmends that initiatives aimed at continuing to increase interest in nursing caree rs must be expanded and sustained to help stabilize this disequilibrium of the supply and demand in the nursing workforce. Career Education Program for School age Children The purpose of this review is to provide a general overview of the current studys proposed concept of a career education program as it rela tes to the developm ent of school age childrens interest in nursing as a career choice. Career development information from the disciplines of nursing, Hollands (1959) theory of career de velopment, Banduras ( 1977) theory of selfefficacy, and Watsons (1985) theo ry of human caring were iden tified and reviewed. Although limited in scope for school age children, the research that does exist suggests many children in the range of 10-12 years of age do engage in dyna mic career exploration, using their interests to guide how and what they learn and the goals they formulate in relation to their world-of-work (Wahl & Blackhurst, 2000). Nursing The researcher rev iewed past nursing research that examined various perceptions of nursing as a career and specific influencing fact ors of those students c onsidering or choosing nursing as a career. To begin, in 1988 a survey regarding the publics perceptions of an ideal career and nursing as a career was conducted by May and associates for Sigma Theta Tau International. The overall goal of the study was to provide information that could be used to enhance recruitment into nursing and ultimately reduce the nursing shortage in Indiana. College freshmen, students from grades six through 12, th eir parents, teachers, counselors, and school nurses were sent a questionnaire developed by the researchers. Among the various findings was that students in grades six to 12 had more positiv e attitudes toward nursing career attributes than

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36 did the other groups in the study. Based on this pa rticular result, the rese archers proposed that a potential recruitment group for nursing is school age students because of their more positive attitudes toward nursing as a ca reer. In addition, the researchers recommended that parents, teachers, counselors, and college students recei ve education and be involved in recruitment strategies intended to raise the image of nursing (May, Austin, & Champion, 1988). A group of nurse researchers (Marriner-Tomey, et al., 1990 ) conducted a similar study involving only high school student s. The purpose of their rese arch was to identify career characteristics that sophomore hi gh school students value along w ith their perceptions of those characteristics in nursing. To elicit this info rmation they used the questionnaire developed by May and associates (1988) with minor changes in the demographic questions. The questionnaire was distributed to 450 high school sophomores to compare sophomore high school students perceptions of an ideal career with their perceptions of nursing as a career. The researchers reported: Students wanted significantly more criteria to be met in an id eal career than they perceived in nursing as a career: always have a job; be appreciated; know a great deal; make a large amount of money; work in a safe place; be a leader; make decisions; be powerful; and have respect. They wanted significantly less of th e other criteria to be met in an ideal career than they perceived in nursing as a career: ca re for people; work very hard; work with my hands; be very busy; and work with high-tech equipment. (Marriner-Tomey et al., 1990, p. 28) Results of the study incited the researchers to recommend strategies to change students perceptions about nursing as an ideal career to include de velopment of pub lic relations campaigns about the advantages of nursing as a career and for school programs to educate students, school counselors, a nd career advisors about nursing (Marriner-Tomey et al., 1990). In 1989, a survey of 300 middle school students was conducted by Grossman and colleagues to elicit students pe rceptions of nursing and to explore the relationship between the experiences of having a nursing role model and the decision to c onsider nursing as a career.

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37 They found that the majority of students were aw are of the caring and help ing aspects of nursing but had little knowledge about the expanded roles and divers e opportunities available in a nursing career. In addition, the results indi cated a significant relationship between the experience of having a nurse role model and cons ideration of nursing as a career choice. The researchers suggested that this particular finding has important implications and must be considered in the recruitment of young people into the nursing profe ssion (Grossman, Arnold, Sullivan, Cameron, & Munro, 1989). Similar findings were reported in a study (K ersten, et al., 1991) that focused on the motivation factors in a nursing students choi ce of nursing as a career. The study explored current nursing students definition of nursing, reasons for c hoosing nursing, and who or what influenced their choice to be a nurse. The re searchers developed a que stionnaire and collected data from a random sample of 20 nursing schools. They concluded that practicing nurses were identified most frequently as influencing st udents image of nursing and their reason for selecting nursing as a career. The data also indicated that caring continues to be a major motivating factor for individuals going into nursing in that caring and nurturance of others gave the students a feeling of satisfaction (Kersten et al., 1991). Additionally, Pillitt eri (1994) surveyed 102 undergraduate students enrolled in a general education course at a large unive rsity in an attempt to identify differences in how nursing and non-nursing college students view nursing. Demogr aphic information included if the student had a relative who was a nurse. Accordingly, the st udy revealed that e xposure to nurses was correlated to a students view of nursing as an en joyable occupation. Pilli tteri suggested that an effective recruitment intervention for nursing woul d be to introduce prospective college students to practicing nurses. The researcher recomme nded that students interested in nursing would

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38 benefit from, early introduction to nursing instruct ors, exposure of nurses to junior and senior students, or ideally, spending a day with a nur se in actual practice (P illitteri, 1994, p. 133). Along the same line, in a recent survey of nur sing students, Buerhaus and colleagues (2005b) found that information or advice from practicing nurses was identified by 65 percent of nursing students as a factor positively in fluencing their decision to be a nurse. Similarly, researchers (Donelan, Buerhaus, Ulrich, Norman, & Dittus, 2005) found that teenage students highly recommended the nursing profession when the students were given the opportunity to talk with nurses about nursing rather than wi th a school counselor, suggesting that nurses themselves are key influencers of young students cons idering a career in nursing. In a study involving high school students, Kohler and Edwards surveyed 306 students beliefs about nurses and nursing as a career. The students res ponded to a questionnaire asking about education requirements, working conditions, earning power, and social status of nurses. Of the 306 high school students, only 8.6 percent were considering nursing as a career choice. The findings also indicated that students perc eived nursing education to be too difficult and costly in view of the potential return on thei r investment related to status or monetary compensation. The researchers proposed nursing to become further expanded and integrated into high school career education curricula and to offe r students a personal experience with nurses in actual work settings. They felt perceptions about nursing would be enhanced by expanding the informational sources related to nursing, there by facilitating the recruitment of young students into nursing (Kohler & Edwards, 1990). On the other hand, a study (Stevens & Walker, 1993) analyzing 641 college bound high school seniors was designed to determine the re asons these students do no t select nursing as a career more frequently. Some of the findings from this study were consistent with previously

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39 reported nursing research, such as citing a lack of knowledge about the expanded roles and diverse opportunities available in a nursing career (Grossman et al., 1989; Marriner-Tomey et al., 1990). Other findings indicated the students were unaware that nurses worked with computers (91.8%) or high-tech equipment (84.1%), directed health programs (85.5%), or held management positions (81.2%). Only slightly more than half of the students believed that nurses made their own decisions (62.2%), had many o pportunities for promotion (55%), and could always get a job (52.6%). Approximately one third of the student s acknowledged that nurses had opportunities to travel (34.4%), were in demand (28.5%), and that nursing was an exciting career (38.9%). In addition, almost half of the students (43.8%) believed that nursing was mainly a career for women (55.1% of the sample were female). Based on their findings the researchers recommended that nurse educators participate in pr ojects and activities that correctly inform and improve the knowledge of high school students understanding and perception of the nursing profession. They further suggest ed offering career development act ivities with elementary and secondary students before career decisions ar e made should be purposively considered and explored to stimulate nursing as a career choice in younger children (Stevens & Walker, 1993). High school guidance counselors attitudes about nursing as a career were examined by Hendrickx and Finke (1994). The questionnaire used in their study was the same questionnaire used by Grossman and colleagues (1989) when they examined high school students perception of nursing as a career. The researchers were encour aged by their results in that most counselors surveyed (96%) reported that they do recomm end nursing as a positive career choice to high school students and were well informed about the opportunities in nur sing. Other studies exploring the image of nursi ng held by high school guidance counselors also found that the majority of counselors are well informed a bout nursing as a prof essional discipline and

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40 considered nursing as a potential career for th eir students. The researchers celebrated their results and emphasized the need for guidance couns elors to continue to stay informed about nursing and further suggested that the high school level may be too late for initial student contacts about career choices and recommended counselors in middle and elementary grade levels needed information about nursing as a career choice as well (Hendrickx & Finke, 1994; Lippman & Ponton, 1993; Mignor, Cadenhead, & McKee, 2002). A particular study of interest to the researcher explored the effects a presentation about nursing has on a students percepti on of nursing and whether it changes their perception of how a career in nursing compares w ith an ideal career (Marri ner-Tomey, et al., 1996). The questionnaire used by May and colleagues (1988 ) in a Sigma Theta Tau International study designed to elicit respondents pe rceptions of nursing as a career was used in this study. The 450 Indiana students completed the questionnaire during their sophomore year of high school. Then, during their junior year, a thir ty-minute educational video about nursing was presented to these same students. The video was followed by an in formational session about nursing careers, to include where nurses work, salaries, and job security. The same questionnaire was distributed a second time during these students junior year after attending th e presentation to analyze the effects of a presentation about nursing as a care er option on the attitudes of high school students toward nursing and their likelihood of entering the profession. Th eir findings compared pre-test and post-test attitudes of a comparison group and an experimental group. The attitudes of the experimental group revealed that significantly more students thought that nurses make money, are leaders, and are powerful on th e post-test as compared to the pre-test. Thus, the researchers concluded that these findings support the hypothesis that a pres entation about nursing delivered

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41 to high school students can positively affect thei r attitudes about nursing as a career (MarrinerTomey et al., 1996). Findings and implications from this previous ly described study (Marriner-Tomey et al., 1996) generated the development of the Nursing 2000 model, a collaboration of nursing service and nursing education serving eight central Indiana counties. The primary purpose of Nursing 2000 was public promotion and dissemination of in formation about the nursing profession. A survey was conducted (Wilson & Mitchell, 1999) seven years after the implementation of Nursing 2000 to determine the ex tent of influence it had on nurs ing students in choosing nursing as a career. The majority of respondents (92%) indicated that they were aware of the programs and activities of Nursing 2000. The researcher s found five of the 13 programs sponsored by Nursing 2000 to be statistically significant in the students pe rception of the influence that Nursing 2000 had on their career choice as a nur se. Those five programs were: (a) Shadow a Nurse Program, (b) career literature, (c) classr oom presentations, (d) co mmunity presentations, and (e) career counseling by telephone. A study that was conducted in a small London borough found that students entering college had very little interest in nursing as an occupational c hoice, with less than 2% of the students declaring an interest in nursing (Firby, 1990). The researcher contends this is due in part because nursing is no longer one of the few professions available for women. She declares that women are no longer simply looking to teaching and nursing, but have widened their horizons to incorporate many occupations, which in the past have been considered part of the male domain. She explained that nursing is no longer in the privileged position of being one of the few professions available for women and w ill have to compete with occupations offering greater prestige and money. Inferring from th e study, the researcher strongly recommended that

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42 nurse leaders take urgent action in recruitment strategies about nur sing in an attempt to increase its appeal to young people. Fi rby (1990, p. 737) declared, Unl ess nursing can increase its appeal to the youngsters of today it rea lly will become a career of yesterday. Another study (Hemsley-Brown & Foskett, 1999) reported from southern England consisted of focus groups and individual ques tionnaires using a sample of 410 young people, ages, 11, 15, and 17. The specific purpose of the study was to examine and analyze how young people choose a career by focusing on how nursing and engineering are perc eived by students at different ages and how these perceptions influe nce decision-making about subject choices while in school, education and training pathways, and ultimate career amb itions. It was found that the main reason for choosing nursing was to be i nvolved with helping people, although only 6.6 percent of the total sample expressed an intere st in nursing as a possibl e career choice. The majority of those choosing nursing as a career were 17-year-old girls. An additional 9.6 percent of the 17-year-old group claimed that in the pa st they had wanted to become a nurse, but had changed their minds and chosen another occupa tion before reaching 17, and half of that group had changed their minds before reaching the age of 10. The most popular reason given by all age groups for not wanting to be a nurse was that they were not interested (27.3%). Boys were more likely to give the reason not interested in nursing" (39.5%) as the main reason for not choosing nursing and more likely to say that nursing is female wo rk, particularly boys in the 15year-old group. Eighty-nine percent of young pe ople had made a career choice without regard for financial reward and had based their career choice on intrinsic factors such as interest and enjoyment (Hemsley-Brown & Foskett, 1999). These results are simila r to results cited in various United States studies, suggesting that young people in these tw o neighboring countries have similar perceptions of nursing as a career choice.

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43 Lastly, a study conducted by Buerhaus and co lleagues (2005a) compared data from a 2002 and 2004 national random survey of nurses eval uating nurses percep tions of nursing and satisfaction with their current job. Comparing the results of the two surveys revealed that in both surveys 83 percent of nurses were very or somewhat satisfied with their jobs, but those who were very satisfied with their jobs rose from 21 percent in 2002 to 34 percent in 2004. In addition, both surveys found that the majority of nurses (87%) were either very or somewhat satisfied with nursing. However, the number of nurses reporting they were very satisfied with being a nurse increased from 37 percent in 2002 to 46 percent in 2004. Moreover, the comparison of the two surveys indicated considerably more nurses would definitely or probably recommend a career in nursing to qualified high school or college st udents, 60 percent in 2002 to 72 percent in 2004. More notable, the nurses that would definite ly recommend nursing nearly doubled, from 17 percent in 2002 to 33 per cent in 2004. The results of this study are very encouraging for the researcher and suggest that nurses being cu rrently satisfied with nursing have potential implications for recruitment activities. Since nur ses are currently more satisfied with nursing as a career, illustrated by the 2002 and 2004 survey (Buerhaus et al., 2005a), then it is reasonable that a career education program for school age ch ildren designed to stimulate an interest in nursing as a career choice includ e exposing young students to nurse s and what nurses do in their world-of-work. Career Development in Children How Early? In essence, the question ensues, Ho w early is too early to begin car eer development? To answer this question the researcher reflect ed on a study conducted by Beverly Parks (1976) where she evaluated if exposure to a career orient ed curriculum increased the career awareness of elementary school students in grades three, four, and five. Other purposes of the study were to

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44 determine whether exposure to the curriculum reduces gender bias and what effect the curriculum had on the students choice of occupations Results indicated that the curriculum did not lead to significant differen ces in career awareness among all grade levels, although it did have a significant impact on th e gender-stereotyping behavior of both male and female students in grades four and five, but not in grade three. Based on these results, Parks proposed that the reduction in stereotyping might have the positive effect of having students consider more career options and may ultimately be a more desirabl e outcome than increased career awareness. Thereby, the researcher inferred th at a curriculum intervention as early as fourth grade could significantly reduce occupationa l stereotyping and perhaps le ad to greater freedom of occupational choices. Developmental Career Counseling Em erging in the 1950s, developmental career coun seling is generally credited to Donald Super (Super et al., 1957) for generating the major concepts that gave impetus to a developmental approach to career counseli ng beginning in childhood and progressing into adulthood. Developmental career counseling is based on traditions rooted in principles from developmental psychology and is evidenced by the fact that many vocationa l theorists have used life-span development as an organizer for thei r presentation of career development concepts (Walsh & Osipow, 1990). Of recent, the perspect ive on career guidance has shifted from a focus of vocational development duri ng adolescence and early adulthood to include a broad view of career development throughout the va rious life stages, including young children (Sharf, 2006). The developmental theories of Erikson (1993) and Piaget (1972) de scribe the ways in which children develop their understa nding of the world. As well, li fe career theories, such as those of Super (Super, et al, 1957) and Go ttfredson (1981) provide a framework for understanding the ways in which children de velop their understanding of the world-of-work

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45 (Sharf, 2006). Therefore, the researcher sugge sts that age-appropriate career development activities for children be desi gned by weaving the underpinnings of both child and career development theories that are appropriate to the various developmenta l stages of childhood. Acknowledging that it is during ch ildhood that crucial career rela ted concepts and attitudes are first formed (Super et al., 1957), the American School Counsel or Association (ASCA) issued the ASCA Policy Statement on Career Guidance c iting the elementary school years as a period for children to develop awareness of self and careers. The policy statement called for school counselors to assume leadership in implemen ting developmental care guidance programs for all students and to begin as early as kindergarten (American School Counselor Association, 1984). In so doing, the importance of providing career development programs in the elementary schools became a recommended standard of elementary school counseling programs. Thus, career education is now recognized as a fundamental el ement of guidance programs at elementary and middle school levels, and not just of high school students (American School Counselor Association, 2006). The importance of developmentally appropriate career guidance activi ties being introduced at the elementary school level has gradually a nd increasingly been ac knowledged in the career development literature. However, the empirical literature focused on young children is relatively sparse as compared with the rich literature on adolescent and adult career development (Trice, Hughes, Odom, Woods, & McClellan, 1995). Areas of research related to childhood career development have focused on the childs ability to express realistic occupations, permanence of career preferences, the influence of gender role e xpectations, parental and role model influences, social and status valuation, and personal interests on childrens career aspirations (Sharf, 2006).

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46 Based on the studys research que stions, the researcher chose to review and include the literature related to (a) expre ssion and permanence of career pref erences, (b) the influence of gender role expectations, and (c) the effect of interests and competence perceptions on childrens career aspirations. These literat ure reviews are covered in the subsequent paragraphs. Expression and Permanence of Career Aspirations The review of the research li terature uncovered several studie s that have provided evidence that young children are able to express career aspirations. One study (Trice & King, 1991) interviewed 211 kindergartners at the beginning of the school year and again eight months later concerning the childrens career wishes. Seventyfour percent of the kindergartners gave a realistic career as th eir first choice during the in itial interview and the percentage increased to 84 percent on the second interview. Of those giving a realistic ca reer on the first interview, 46 percent chose the same occupation at the second interview. Based on these results the researchers concluded that kinderg arten children have both realistic and stable career aspirations. This study was subsequent to Trice (1990) repo rting that 70 percent of 203 second-graders and 45 percent of 209 fifth-graders ov er a nine-month period gave the same answer to the question, What do you want to be when you grow up? Th ese studies suggest that even among five-yearold children there is a degree of structure and stability in childrens occupational aspirations (Trice, 1990; Trice & King, 1991). In a retrospective study, 620 full-time employed adults between the ages of 40 and 53 were asked to identify their first realistic career aspira tions and how old they were at the time. Results indicated a majority, 59 percent, specified a fi rst career aspiration befo re the age of 13. Of particular attention, 41 percent of the childhood aspirations and 46 per cent of the adolescent aspirations matched current occupations. The res earchers concluded that early career aspirations are associated with adult career choices and that first choices as pired in childhood are as likely to

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47 result in career achievement as those developed in adolescents (Trice, 1991). Other studies with adults and college students (C osta & McCrae, 1986; Costa, McCrae, & Holland, 1984; Swanson & Hansen, 1988) have also illustrated the stabil ity of vocational intere st patterns over the life span. Trice and McClellan (1993), in a study evaluating the permanence of occupation preference with young children and adolescents, found a strong correlation between the career aspirations of individuals interviewed at ages six to 17 and their actual careers 14 to 20 years later, particularly in scientific, artistic, help ing, and skilled trade prof essions. In addition, the results of a study measuring the vocational inte rests of gifted adoles cents supported assessing vocational interests at age 13 can in fact offer a glimpse of eventual a dult vocational-interest patterns (Lubinski, Benbow, & Ryan, 1995). Hence, these studies demonstrate how critical the career development of children can be on their subsequent career goals and illuminate the predictive value of early o ccupational aspirations. Gender Role Expectations A se minal study (Looft, 1971) indicated gender differences in career aspirations develop early in childhood, especially with females. The study suggested that females, as early as first and second grade, identified a narrower range of career preferences and had lower expectations of occupational achievement than males. A more recent study (Phillips, Cooper, & Johnson, 1995) indicated similar results, find ing distinct differences between the career goals of girls and boys in grades four through eight with girls identifying a much narrower range of professional occupations. As well, studies (Phipps, 1995; Sellers, Sa tcher, & Comas, 1999) have found that young children continue to thin k of occupations and choose occupa tions in terms of the occupations being male or female. Research (Bailey & Nihleh, 1990; Bigler & Li ben, 1990) has indicated

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48 that same-gender role models in a particular career are one factor that influences men and womens attitudes about the approp riateness of a career for member s of their own gender. This research suggested that exposure to nontraditio nal role models can lead to a reduction in occupational gender stereotyping in school age children. The researcher gleaned several recommendations from these studies to help disp el young students gender stereotypes, such as: (a) designing a curriculum that stresses the irre levance of occupation gender versus the relevance of interest, (b) bringing guests with nontraditional occupations into the classroom to discuss their occupations, (c) reading stories whose characters hold nontraditional jobs, (d) taking field trips to view workers in nontraditional settings, (e) depicting nontraditional workers on career posters (such as male nurses), and (f) establishing me ntoring and shadowing programs for children interested in nontraditional careers. Hollands Theory of Career Development John Holland, vocational psychologist, first pub lished his heuristic theory of vocational choice in 1959. Hollands theory is unique and most notable am ong career theories in that it provides an analogous method to desc ribe people in terms of personal ity type (interest) and work environment. The theory characterizes people by their resemblance to six personality types; Realistic (R), Investigative (I), Artistic (A), Social (S), Enterp rising (E), and Conventional (C), collectively referred to as RIASEC. The more closely a person resembles a certain type, the more likely the person will displa y personal traits and behaviors associated with the type. Holland (1997, p. 6) explains, The idea for a ty pology resulted from the frequent observation that several broad classes account for most human interests, tr aits, and behaviors. A second concept of Hollands theory is the environments in which people live and work can be characterized by their resemblance to six model e nvironments; Realistic (R), Investigative (I),

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49 Artistic (A), Social (S), Enterp rising (E), and Conventional (C), which correlate with the six personality types (Holland, 1968). Holland designed his iconic RIASEC hexagonal m odel (Figure 2-1) to portray similarities and differences between and among the six types. Herein, the six types can be represented as existing in a hexagonal arrangement where proxim ity between types represents the degree of relation. Those that appear next to each other on the hexagon, such as Artistic and Social, have similar interests and personality traits. Conversely, those types that are directly across on the hexagon, such as Social and Realistic, are consid ered opposites with no similarity in interests or personality traits (Holland, 1997). In Hollands typology, both personality and envi ronment are expressed in a three-letter code, formed by selecting the three types that most closely distinguishes the person or the persons work environment. The three-letter code, referred to as the Summary Code, summarizes a persons characteristics by showing the degree of likene ss to the three types (Holland, 1997). As an example, a nurse has th e three-letter code of SIA, indicting a nurse typically has dominant Social be liefs, but also, to a lesser degr ee, exhibits Investigative and Artistic characteristics. An individual is more li kely to be successful, feel satisfied, and enjoy a productive work life when there is congruence between personality ch aracteristics and work environment (Holland, 1997). Two of Hollands basic assumptions are that pe ople in the same occupation have similar personalities and they choose occupational envi ronments that are consistent with their personality type (Rayman & Atanasoff, 1999). These two assumptions illustrate a secondary concept of Hollands theory referred to as congruence. To illustrate, someone that is energetic, self-confident, and attention getting will seek an environment in which these traits can be easily

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50 expressed. This person could po ssibly find that fit in the occupational roles of business executive, salesperson, or news reporter (Holland, 1997). Other secondary concepts of Hollands theo ry include consistency, differentiation, and identity. Consistency is determined by examining the relationship of the first two letters of the Summary Code. In RIASEC theory, a personality pa ttern or interest profile is consistent if the ideal types most resembled are closely related or adjacent on th e hexagon. High consistency is associated with stability in caree r direction and career selection. Differentiation is the extent that a person or an environment is well defined. An individual that is clea rly defined may closely resemble only one type as opposed to someone th at resembles many types, or undifferentiated. Lastly, the concept of identity pr ovides an estimate of the clarity and stability of a persons goals, interests, and talents, as well as the clarity or explicitness of an environments goals or expectations. It is a general measure to rule out vocational de cision-making difficulties (Reardon & Lenz, 1999). Two of the underlying six principl es of Hollands theory are c onsidered relevant to this study and require enumeration. The two principles are: (1) The choice of a vocation is an expression of personality and (2) Interest inventories are personality inventories. Holland is very clear that he believes personality and vocational choi ces are related stating: If vocational interests are cons tructed as an expression of pe rsonality, then they represent the expression of personality in work, school subjects, hobbies, recreat ional activities, and preference. In short, what we have called vocational interest s are an important aspect of personality. If vocational interests are an e xpression of personality, then it follows that interest inventories are personality inventories. (Holland, p. 8, 1997) However, for the past 50 years, researchers have investigated the links between interests and personality and a question remains, Does th e available research fi ndings support Hollands (1973) view that vocationa l interests are an expr ession of personality, a nd if so, can interest scales reflect personality char acteristics? Perhaps Costa, McCrae, and Holland (1984) did the

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51 largest study examining the relations between vocational interests and personality traits. Their analyses supported the conclusi on that personality dispositions show a strong and consistent association with vocatio nal interests. Later studies (Go ttfredson, Jones, & Holland, 1993; Hogan & Blake, 1999; Tokar & Swanson, 1995; Tokar, Vaux, & Swanson, 1995) have replicated the correlation between interest scales and persona lity scales reporting small to moderate correlations. In relation to measurements of assessed interests, Hollands contributions to the development of interest measurement have dom inated the field with the redesign of the Strong Interest Inventory and Hollands development of the Self-Directed Search and Vocational Preference Inventory. These instruments continue to be th e most popular interest inventories used by contemporary career counselors. In prcis, Hollands RIASEC hexagon has brought structure, organization, and simplif ication to interest measurement (Reardon & Lenz, 1999; Savickas & Gottfredson, 1999). Banduras Theory of Self-Efficacy Banduras social learning theory provides a philosophy of hum an agency to explain career choice and development. Recent application of soci al learning theory to career development has focused on the predominance of a sense of competency, specifically self-efficacy (Bandura, 1977, 1982, 1986; Betz & Hackett, 1981; Lent, et al., 1994), as lead ing to the development of career behavior. According to Bandura and colleagues: Among the mechanisms of human agency, none is more focal or pervading than peoples perceived self-efficacy. Unless people believ e they can produce de sired outcomes by their actions, they have little incentive to act or to persevere in the face of difficulties. Perceived self-efficacy is, therefore, posited as a pivotal factor in career choice and development. (Bandura, et al., 2001, p. 187) Self-efficacy is defined by Bandura (1986, p. 391) as . peoples judgment about their capabilities to organize and execute a course of action required to atta in designated types of

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52 performances. Self-efficacy expectations refer to individuals beliefs in their abilities to perform particular behaviors successfully and are developed from their experiences with the effects of their own past be havior (Bandura, 1977, 1982). More than 20 years of research (Bandura, 1997; Betz, 2000; Betz & Hackett, 1981, 1997; Hackett, 1985; Lent, et al., 1994) have indicated that beliefs of self-efficacy do in fact influence occupational development and pursuits. However, while there is substantial research that confirms the role of perceived se lf-efficacy in career choices in young adults, there has been little research and knowledge development on how chil dren develop their sense of occupational efficacy and how it affects their career trajecto ries. One of the few studies involving children ranging from 11 to 15 years old found that the pa ttern of childrens perceived academic efficacy had the most pervasive impact on childrens judgments of their occupational efficacy. It was explained that this perceived occupational efficac y influences the type of occupations children believe they have the capability to perform a nd is linked to the kinds of career pursuits they choose for their lifes work (Bandura et al., 2001). Interest and Self-Efficacy A recent trend in the theory and practice of vocational psy chology is to integrate the concepts of vocational interest and self-efficacy. This trend is based on heightened empirical evidence that vocational self-efficacy is a strong pr edictor of interest and career choice (Betz & Hackett, 1981; Lent, et al., 1994). The reigning model, the Social Cognitive Career Theory (SCCT) (Lent, et al, 1994), focuses on self-effica cy as providing a key theoretical link between abilities and interests. In fact, the SCCT propositions the concep ts of interest and self-efficacy as conceptual partners when considering vocational behavior. Several researchers have cons tructed self-efficacy ratings th at parallel Hollands RIASEC types and found that these self-efficacy RIASEC scales correlate high ly with the matching

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53 RIASEC scales from interest instruments (Betz, Harmon, & Borgen, 1996; Swanson, 1993). Thus, with regard to adults, inventories have been designed to elic it parallel measures of vocational interests, so that the mutual interpretation of interest and self-efficacy can occur. This particular application of conjointly measuring interest and self -efficacy has implications for the current study in that both inte rest and competence perception were measured to evaluate the effects of a career education prog ram on fifth-grade students intere st in nursing as a career. Understandably, given the extens ive literature with adults as compared to the extant literature in children, the questi on emerges, How do you evaluate vocational intere sts and selfefficacy in children? Explanation is made usi ng Piagets model of developmental salience. According to Piaget (1975), it is expected th at children will change their thinking during the years from around fourth to ninth grade, from concrete cognitive organization to more abstract, less egocentric, organization. He proposed that these formal operations develop as a result of stimulation and that people are most likely to develop and use formal operations in areas where they have special interests. This thought s uggests that children will ap ply their newly learned formal operations to those areas deemed most salie nt or of interest and make sense out of those activities that they are most attracted to or like be st. Thus, it could be sup posed that if a child is interested in activities involving caring for pe ople, a characteristic of the nursing profession (Watson, 1985), the child would begin to examine those activities of a So cial type (prefers helping and developing others and interpersonal pursuits) that incorporates the activity of caring before the child would begin to examine activities related to other vocational types, such as the Conventional type (prefers data manageme nt, numerical and orga nizational pursuits). Tracey attributes this process of cognitive development to explain the adoption of the RIASEC types by children and adolescents. In a conceptual analysis, Tracey uses Piagets

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54 model of salience to describe the developmen tal process that occurs in how children and adolescents begin to structure inte rests. As a result of this anal ysis, Tracey suggested it is more appropriate to study childrens interest by examining the activities they lik e and perceive a sense of competency (Tracey, 2001). Thus, Tracey and Ward (1998), in a study designed to evaluate the structure of childrens interests and competence perceptions, . sought to construct a brief instrument that would include activities that are relevant to children: th ose that they engage in and have the necessary experience to accurately assess th eir liking (p. 290). Presum ing the importance of the link between self-efficacy and interest, Tracey and Wa rd concluded that instrumentation must be generated to study both interest and perceive d competence in children. Tracey and Ward focused on perceptions of competence as a meas ure of self-efficacy based on information from Lent and colleagues demonstrating the concep tual and empirical overlap of perceived competence and self-efficacy (Lent, Brown, & Gore, 1997). As a result, Tracey and Ward (1998) develo ped the Inventory of Childrens Activities ( ICA ) designed to assess a childs interests a nd competence perceptions It consisted of questions the child responded to in terms of what the child liked to do and what the child was good at doing. The ICA contained two sections of 34 identi cal activities. The first section focused on interests and the second section focused on perceptions of competence. The ICA was first administered to college, middl e school, and elementary school students to access longitudinally the struct ure of childrens interests and competence perceptions and to determine if they can be represented using th e six RIASEC types: since the interest and competence measures on the ICA-R were designed to parallel th e RIASEC types. The results indicated that there was overall support for the ICA representing the RIASEC relational structure

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55 in the college sample; however, there was less support for the younger children. However, in each age group the interest scores correlated highly with the competence perception scores (Tracey & Ward, 1998). In a subsequent study (Tracey & Ward, 1998), the ICA was altered to increase reliability with the intent to provide additional support of the structures of interests and competence perceptions. In addition, six ex tra items were added to help validate gender typing. The researchers concluded that the revised ICA the Inventory of Childrens Activities-Revised ( ICA-R ), appeared to be a reasonable instrument to examine childrens interests and evaluate the self-efficacy and interest linkage to career de velopment and occupational choice in children. Again, as in the previous study, the interest scores correlated highly with the competence perception scores (Tracey & Ward, 1998). In a later study, Tracey (2002) used the ICA-R scale to determine if it was a valid indicator of interests and competence perceptions to yiel d RIASEC scale scores in a group of fifth and eighth-grade students. The relationship of competence ratings to interest was also examined. Unlike the results of Tracey and Ward (1998) the RIASEC model wa s found to provide an adequate fit to the data for the elementary schoo l sample. The researcher attributed this finding to all the elementary students being in the fifth-gr ade and that the viability of the RIASEC scales has been shown to have better st ructure with increased age. In addition, Traceys notion of a reciprocal causal relation between competence belie fs and interests, with interests leading to competence development and competence beliefs l eading to interest development, was found to be the best description of the data for both th e elementary and middle school sample (Tracey, 2002).

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56 Watsons Theory of Human Caring. The concept of caring has em erged as an important phenomenon fundamental to the advancement of nursing knowledge, theories, an d models of practice (Kyle, 1995; Lea & Watson, 1996; McCance, McKenna, & Boone, 1997). Caring is continuing to be increasingly recognized as a core concept ch aracteristic of the nursing prof ession, both in science and in practice. Recently, the revised social polic y statement issued by the American Nurses Association (2003) attests to the centrality of caring as part of nursings focus with the inclusion of caring and caring relationships as core aspects of the defi nition and scope of professional nursing practice. Many studies have investigated the concept of caring, adopting a dichotomous approach of both qualitative and quantitative methodologies. However, much de bate has been generated in relation to the most appropriate method for res earching the concept of caring. Historically, researchers have advocated the qualitative appr oach based on the nebulous nature of caring (Leininger, 1986). However, Wats on (2002) recently published a book, Assessing and Measuring Caring in Nursing and Health Science which includes 21 of the most salient instruments currently available to assess and measur e caring. It is Watsons intention for these instruments to be used by nurse researchers to advance the knowledge of caring by advancing the empirical measurement of caring (Watson, 2002). This central concept of caring within nursing has led to the development of several caring theories. One of the most well known theories is Jean Watsons theory of human caring. Watson posits nursing as the art and science of human caring where nursing is a human science concentrating on the study of the relationship of caring to health and healing (Watson, 1997). Watson introduced her theory in 1985 in a book entitled Nursing: The Philosophy and Science of

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57 Caring. At the time, Watson considered the content of her book a perspective about nursing and caring rather than a theory in itself (Watson, 2001). Watsons original work was directed at de signing an integrated baccalaureate nursing curriculum (Fawcett, 2005), yet resulted in the esta blishment of ten carative factors (Figure 2-2) which provided a framework for nursing and a foundation for Watsons theory of human caring (Watson, 1985). According to Watson (1985), these carative factors re present the core of nursing when all the techniques and technologies have been re moved. In Watsons second book, Nursing: Human Science and Human Care: A Theory of Nursing, Watson (1988) presents her theory of human caring, describing it as an intersubjective human process where value is placed upon the caring relationship between the nurse and the care recipien t. The original ten carative factors were further posited not only as a fram ework for nursing, but for all health and healing practitioners and professions, thereby extendi ng the application of her theory beyond nursing. In developing the theory of human caring, Watson (2001, p. 345) . sought to balance the cure orientation of medicine, giving nur sing its unique disciplinary, scientific, and professional standing with itself and its public. Watson (1997) ha s distinguished nursing from medicine and associates caring with nursing and curing with medi cine. Watson (1985) considers the knowledge within her theory of human car ing provides the framework to advance nursing practice that is distinct from, but complementary with current practices of modern medicine. In Nursing Theory and Practice The significance of W atsons theory of human caring lies in her concern with the metaparadigm concepts of nursing (human bei ngs, environment, health, and nursing), which focuses on health and nursing, and more specific ally the nursing process with effective positive changes in health status (Fawcett, 2005). There is current evidence that nursing care and caring are decisive variables that make a positive difference in patients outcomes of health and

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58 wellbeing (Swanson, 1999). Swansons (1999) meta -analysis of 130 publications of empirical caring studies in nursing research offers paramo unt evidence as to the importance of caring and its favorable outcomes for both patients and nurses. Numerous studies (Beck 2000; Boughn, 2001; Boughn, & Lentini, 1999; Kelly, Shoemaker, & Steele, 1996; Kersten et al., 1991; Pillitteri, 1994; Stevens & Walker, 1993; Williams, Wertenberger, & Gushuliak, 1997) have established an iterative theme of caring for others as the major motivating factor for both men and women choosing nu rsing as a career. Yet, nurses are continually conf ronted with having to practice nursing based on a task-oriented, highly technological, biomedical model as opposed to a model of human caring that influenced them to the profession in the first place. This challenge is compounded by the current nursing shortage and todays fast-paced healthcare environm ent. It is reported that nurses who are not able to practice within a cari ng context are characterized as hardened, oblivious, robot-like, frightened, and worn down (Swanson, 1999). Conversely, nurses are much more satisfied, fulfilled, more purposeful, and knowledge seeking when caring is present in their nursing practice (Watson, 2002). Future Directions of Watsons Theory of Human Caring Of interest, Watson (2005) recently introduced her m odel of science, which she named Caring Science, in her book Caring Science as Sacred Science. Watson (2002, p. 456) describes caring science as an . evolving philosophical -ethical-epistemic field of study and is grounded in the discipline of nursing and informed by re lated fields. Watson acknowledges that some may consider it somewhat of an oxymoron to juxta pose Caring with Science. However, to make clear, Watson (2002, introduction) states, Perhaps the time is right for such paradoxical scientific considerations and integrations, which allow scie nce, morality, metaphysics, art, and

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59 spirituality to co-mingle for new reasons. Wats on also introduces the changing nature of the Carative Factors toward using the language of Caritas described by Watson as: conveying a deep form of transpersonal cari ng and love to come into play as part of a caring-healing perspective guiding Caring Science. It is when we include caring and love in our science; we discover our caring-healing professions an d disciplines are much more than a detached scientific endeavor, but a life-giving and life-re ceiving endeavor for humanity. (Watson, 2005, p. 3) Summary Although career developm ent interventions at the elementary school age level might seem premature, the studies reviewed in this chapte r have shown that career development is an important antecedent for school age children to understand the world-of-work. Seligman and colleagues (1991) have shown that children by the age of 10 have done quite a bit of thinking about their future and can clearly articulate their career aspirations. McMahon and associates (1999) found that childrens career development wa s enhanced as a result of career education lessons, with children showing an increased ability to list occupations and identify a favorite occupation. These studies and others have provided empirical evidence that suggest young children are not too young fo r and would benefit from early career counseling. In addition, research has demonstrated career interventions and the exposure to nontraditional workers can lead to a reduction in occupational gender stereotyping in school age children (Bailey & Nihlen, 1990; Bigler & Liben, 1990). An example is a male nurse teaching a group of young students a career education program about nursing. This may be especially efficacious if the career is considered nontraditional for a particular gender, such as nursing (Betz, 2004). The proposed career education program about nu rsing used in the study was evaluated to determine its effect on fifth-grade students intere st in nursing as a career choice. Separate components of the career education model (illustrat ed in Figure 1-1) are examined: (a) interest,

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60 (b) competence perception, and (c) desire to help other people. The results of the study will serve as a foundation for future development of career education programs designed particularly for school age children.

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61 Figure 2-1. A hexagonal model for defining the psychological resemblances among personality types and environments and their interactions. Source: Holland, 1997

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62 Figure 2-2. The original ten carati ve factors. Source: Watson, 1985, pg. 11 1. The formation of a humanis tic-altruistic system of values 2. The instillation of faith-hope 3. The cultivation of sensitivity to ones self and to others 4. The development of a helping-trust relationship 5. The promotion and acceptance of the expr ession of positive and negative feelings 6. The systematic use of the scientific problem-solving method for decision making 7. The promotion of interpersonal teaching-learning 8. The provision for a supportive, protective, and/or corrective mental, physical, soiciocultural, and spiritual environment 9. The assistance with the gratification of human needs 10. The allowance for existentialphenomenological dimensions.

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63 CHAPTER 3 METHOD This study will evaluate career exp loration activ ities with school age children before career decisions are made to stimulate interest in nursing as a career choice. Specifically, the researcher will develop a career education program about nurs ings world-of-work for fifth-grade students, incorporate the concepts from the proposed theo retical model (Figure 11), and study its effect on students interest in nursing. Therefore, the purpose of this st udy is to evaluate the influence of a career education program on fi fth-grade students interest in nursing as a career choice. The nature of comparisons is within-subjects with group comparison. Data were collected at two points in time, preand post-e ducation intervention. Because of the studys two measurement points, it is considered a pretest-post-test design, where the in itial measure of the dependent variable is referred to as the baseline measure and the post-test measure is referred to as the outcome measure. Participants Study participants were recru ited from fifth-grade classrooms from a public elementary school in a large metropolitan city in the Southeas t. The school consists of three fifth-grade classes, each class having 20 to 25 students, re sulting in a convenience sample of 70. Major demographic variables were collected on each part icipant such as age, race/ethnicity, gender, career aspirations, nurse as a family member, and nurse as an acquaintance. The sample of 70 fifth-grade students in the st udy reported by ethnic categories consisted of six students of Hispanic origin and 64 students of non-Hispanic origin. The sample reported by racial categories consisted of two st udents who identified themselves as Asian/Native Hawaiian or Pacific, 16 students as Black/African American, and 52 students as White. The six students of Hispanic origin reported themselves racially as White and therefore are part of the 52 students

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64 reported in the racial category as White. For pu rposes of data analyses, race was defined and dichotomized into two categories: (a) Black and (b) non-Black. The two Asian students were placed into the non-black category resulting in 16 Black students and 54 non-Black students. Table 3-1 illustrates the demographics related to age, gender, race, having a family member as a nurse, and knowing a nurse for the total sample (N = 70), Group 1 (N = 35), and Group 2 (N = 35). The researcher attended a parents associati on meeting and explaine d the study to parents (or legal guardians) of fifth-grade students. Fo llowing explanation of th e study to the parents, the researcher visited each fifth-grade classr oom and explained the education program to the students. The nurse researcher wore a nurses uniform to the parents meeting and to the classrooms to provide a visual image of a nur se. In addition, a male nurse accompanied the researcher to represent males as nurses. Inclusion criterion consisted of teacher reco mmendation for a student to participate. Exclusion criterion was difficulty re ading English at a fourth grad e level, reported by the school. Consent to participate in the study was obtained from the students parent or legal guardian. Assent to participate was obtained from each student. Children were considered for enrollment in the study if they met the inclusion criterion, gave assent to particip ate in the study, and had signed consent from the students parent or legal guardian. In determining the sample size, the researcher established the level of significance to be acceptable at.05 ( ) and beta at .80 (1 ). Previous studies (Tracey & Ward, 1998; Tracey, 2002) have demonstrated that th e strength of the relationships among the research variables as moderately correlated. Thereby, based on a priori reason, the researcher proposed a moderate effect size ( = .50). An approximate sample size of 60 is necessary to achieve this selected level

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65 of power for the planned statistical analyzes that was conducted in this st udy: (a) Pearsons chisquare test, (b) McNemar test, and (c) paired t test (Polit & Beck, 2004). Intervention The current research incorporated a career education program for school age children intended to influence fifth-grade st udents interest in nursing as a ca reer choice. The concepts of interest, competency perception, and the desire to help people served as the theoretical foundation for the career education program (Figure 1-1). The career education program was comprised of four consecutive weekly education sessions, each lasting approximately 2 hours. At the conclusion of the education program and after post-assessment of all stude nts, an optional field trip to a local childrens hospital was planned. The researcher suggested a field trip, a traditional, yet worthwhile activity, as an opportunity for students to experi ence nursings world-of-work first hand. The researcher recognized that although a hospital is not the only setting where nurses work, a hospital employs a diversity of nurses performing a wide range of occupational experiences, thereby allowing the students to explore a number of diverse work settings. In an attempt to maximize internal validity, the researcher exerted a high degree of consistency of research conditions, especially as they related to th e environmental context. Thus, the students participated in the program the same day of the week, same time, and same classroom. Additionally, the res earcher provided all the studenttraining sessions for each group of students. Curriculum Design The career education program used in this study entitled, Fifth-grade Career Education and Awareness of Nursing as a Career Choice, consists of four instructional units:

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66 (a) Everybody Can Learn about Nursing, (b) Learning What Nurses Need to Know about the Body, (c) Learning about Skills that Nurses Perf orm, and (d) Learning What Nurses Need to Know about Common Diseases, Such as the Common Cold. Appendix A provides a comprehensive outline and description of th e studys career education curriculum. Each units learning objective and performance competencies were designed in accordance with the curriculum framework provided by th e National Career Development Guidelines (NCDG). The NCDG initiative is a major national effort to foster excellence in career development for students of all ages, genders, and cultural backgrounds. The guidelines are a result of a collaborative effort among the National Occupational Information Coordinating Committee (NOICC), the State Occupational Information Coordinating Committee (SOICC), and leading career counseling and development professional organi zations. The National Career Development Association (NCDA), the American Counseling Association (ACA), the American School Counselor Association (ASCA), and other counseling and career development organizations endorse the guideline s. In addition, th e guidelines identify ke y competencies that students need to master at various stages throughout the career developmental process. These competencies define general career development goals by age level: (a) elementary school, (b) middle school, (c) high school, and (d) adult. Ther e are twelve competenci es for each age level and are categorized into three areas: (a) self-knowledge, (b) educational and occupational exploration, and (c) career plan ning (National Occupational Info rmation Coordinating Council 1989). The development of these guidelines es tablished a competency-based career guidance and counseling program to career education. In a study (Freeman, 1994) of 1,273 randomly selected school counselors, they were asked how important are each of the competencies from the standpoint of practicing school counselors. The results of the study indicated that school

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67 counselors consider the career development compet encies within the guidelines to be important to very important across all three area s for all age levels. The researcher incorporated th e twelve elementary school co mpetencies as a foundation to develop the learning objectiv es of the career education program about nursing that is applied in the study. Table 3-2 provides a crosswalk of th e NCDGs elementary school competencies and the instructional content within each of the f our units of the studys career education program about nursing. The curriculum was given to a pa nel of experts consisti ng of: (a) two pediatric nurse educators, (b) two fifth-grade teachers, and (c) one elem entary school age counselor to evaluate the appropriateness of the education programs content, interest level, and ability of fifth-grade students to understand and participate. Each evalua tor judged the education program suitable in all aspects for fifth-grade students. Instructional Units Each instruc tional unit of the career education program states the: (a) specific learning objective, (b) students targeted competenci es and skills, (c) recommended instructor preparation, to include a list of suggested supplies, and (d) stude nt learning assessment tools. Each unit is instructor-directed and includes a group activity to re inforce the instructional lesson and to help students master the targeted competencies and skills The program includes various modalities of learning to provide the students with information to help them develop a comprehensive understanding of nursing as a career choice. The developmentally appropriate fifth-grad e curriculum was intended to encourage curious spirits about nursing by weaving the natu ral curiosity of childre n with the writings of child development and career development theori sts, providing for both career awareness and career exploration strategies. The curriculum in cluded various experiential learning activities, such as learning to take a temperature, blood pr essure, heart rate, respir atory rate, and how to

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68 properly wash hands. An advanced practice nurse from a local childrens hospital was invited to demonstrate proper hand-washing technique. Each student had an opportunity to wash their hands and evaluate their performance by looking fo r germs left on their hands with a black light. In addition, the students completed word search es and crossword puzzles to reinforce learning instructions to include id entifying and naming body part s and listing the many career opportunities in nursing. Throughout the program, th e students were provided information about the nursing profession supplied by Johnson & Johnsons Campaign for Nursings Future, which included colorful brochures, coloring books, and book covers featuring The Nursing Gang TM. They also received colorful handouts produ ced by Nemours Foundation, Kids Health for Kids which outlined and reinforced information c overed in each education session, such as instructions for both parents and students on how to properly wash hands to prevent the spread of germs. The researcher brought into the classr oom anatomical models of the body, the skeleton, and other major body parts, such as the heart, lu ngs, eye, and brain. In addition, the students accessed and interacted with Johnson & Johnsons The Nursing Gang TM website, featuring four contemporary animated nurses from diverse back grounds making a difference in peoples lives. The website is packed with interactive games, j okes, music videos, fashion tips, trivia, and more, all related to the nursing profession. Research Design The current study is a within-subjects desi gn, often referred to as repeated-m easured design, involving comparisons of the same stude nts at two points in time, preand posteducation intervention, where the st udents serve as their own contro l to evaluate the effects of the career education program. An advantage of a within-subjects de sign is it requires fewer subjects; the total number of subjects needed corresponds to the number required for any one condition (Brink & Wood, 1998). An approximate sample size of 60 students is necessary to

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69 achieve the selected levels of power ( = .05, = .80 and = .50) for the planned statistical analyses used in the study. A second advantage of a within-subjects desi gn is the unsystematic error variance is reduced making the study most sensitive to the evaluation of the education program (Fields, 2005). This means the current study because of the within-subjects design minimizes random factors that may affect the results of the study. Instruments The researcher is interested in several dependent variables that involve the critical research variable, in terest in nursing as a career choice. Thes e variables include: (a) interest, (b) competence perception, and (c) the desire to help other people. Two psychometrically tested instruments were used to evaluate the effects of the career education program on interest in nursing, the ICA-R and Concern for Others In addition, the resear cher developed a preand post-in tervention questionnaire. The prequestionnaire was designed to obtain demographic information of each student and answers to questions related to the research questions. Questions on the questionnaire included: (a) Would you consider being a nurse when you are grown? (b) Do you have a family member who is a nurse? and (c) Do you know anyone other than a family member who is a nurse? The postintervention questionnaire asked if the student would consider being a nurse when grown. The following information will provide a descripti on of the instruments used in the study. Questionnaires The researcher designed the pre-questionnaire to elicit inform ation prior to the students participating in the education program. The st udents were asked to prov ide their age, gender, ethnicity, and race. Questions on the pre-questionna ire included: (a) What job do you want to do when you are grown? (b) Do you have a fam ily member who is a nurse? (c) Do you know

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70 anyone other than a family member who is a nurse? and (d) Would you ev er consider being a nurse when you are grown? All qu estions allowed for a yes or no response, except for the question asking the student what j ob that wanted to do when they were grown, which allowed for an open ended response. The post-questionnaire wa s designed to determine if the students would consider being a nurse as a career after partic ipating in the career education program about nursing, The question allowed for a y es or no response. ICA-R Tracey and Ward (1998) designed an instrum e nt, the Inventory of Childrens Activities ( ICA ) to assess Hollands RIASEC types of intere st and competence perception with children. The instrument was developed to examine the stru cture of childrens interests. As well, given the association of self-efficacy and perceived co mpetence in the determination of interest by well-known theorists (Bandura, 1982, 1986; Hackett, 1985; Lent et al., 1994), the instrument was also developed to assess and rate perceptions of competence appropriate for children and comparable to the interest scale. Tracey and Ward (1998) first applied their ICA instrument in a cross-sectional study of elementary students (grades four and five), middl e school students (grades six, seven, and eight), and college students. The college students we re included to provide a comparison group to examine the formation of career interests in chil dren and adolescents. They found good internal consistency in the samples of elementary a nd middle school students with alphas ranging from .60 to .81 with a mean of .71 for the interest scales and from .61 to .81 with a mean of .70 for the competence scales. In addition, a 1-week test-retest reliabil ity ranging from .58 to .73 with a mean of .64 on the interest scales and from .60 to .84 with a mean of .70 on the competence scales was documented.

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71 However, in a second study, Tracey and Ward (1998) adopted the Inventory of Childrens Activities-Revised ( ICA-R) from the ICA replacing activitie s that had low scale correlations to increase reliability in hopes of providing additional s upport of the structures of interests and competence perceptions in children. In additi on, six activities were a dded to help in the validation of gender typing that resulted from thei r first study. To verify appropriateness of the revised instrument, it was given to two fourth-grade teachers to check for its readability, clarity, and ability to be accurately responded to by fourth-grade students. Based on the findings from their second study, Tracey and Ward (p. 299) concluded, Given the similarity of the interest and competence structures in this study, issues relating to the structural difference across age relate equally to both. Thereby, with corresponding s cales for both interest s and perceptions of competence, the researchers concluded the ICA-R appears to be a reasonable instrument to examine the perceived competence-interest causa l link in children (Tracey & Ward, 1998). In a subsequent longitudinal st udy of fifth and eighth-grade students, Tracey (2002) used the ICA-R to examine several questions regarding the deve lopment of interests over time. A primary purpose of the study was to determine if the ICA-R could be used as a valid indication of interests and competence beliefs for these age gr oups, since previous studies (Tracey & Ward, 1998) found that younger childr ens responses to the ICA-R differed in structure from older children. In addition, Tracey wanted to determin e if the previous cross-sectional analyses (Tracey & Ward, 1998) where hexagonal structur e was supported more with age would be replicated in a longitudinal study and if the scoring in ICA-R would appropriat ely yield RIASEC scale scores in younger children. Based on the results of the study, Tracey (2000, p. 153) concluded, Unlike the results of Tracey a nd Ward (1998), the RIASEC model was found to provide an adequate fit to the data for the elem entary school sample. Tracey further reported:

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72 The viability of the RIASEC scales here co uld be a function of the older basis of the sample in this study in that all the elementa ry school students were at least in the fifthgrade. With increased age, it would be e xpected that the RIASEC scales would hold better. (Tracey, 2002, p. 159) Another indication of the increasing appropriate ness of the RIASEC scal es with age is the internal consistency of the scales. The elem entary school sample in Traceys (2002) study demonstrated somewhat higher internal consis tency estimates than found by Tracey and Ward (1998), which in part could be attributable to greater scale coherence with age. The composition of the ICA-R consists of two sections of 30 activities; five activities for each of the RIASEC scales. These activities include behaviors that children commonly participate and were endorsed by teachers and children, as well as researcher observations. In the first section the child responds to each of the activities based on the extent to which the child likes that activity (interests ) using a 5-point scale with 1 = dont like at all to 5 = like a lot The child then responds to the same activities with respect to pe rceptions of competence using a 5-point scale with 1 = very bad at to 5 = very good at. RIASEC scores for interest (liking items) and competence (good at items) are scored by averaging the five items on the scale. The internal consistency and 1-year te st-retest reliability estimates for the ICA-R are presented in Table 3-3 for the elementary and middle school sample (Tracey, 2002). These values are similar to those obtained by Tracey and Ward (1998) in their previous samples. According to Tracey (2002, p., 151), The values of the internal consistency estimates were generally moderate, but these values are in part attributable to the relative brevity of the instrument (five items per scale). The researcher of this study obtained permission to use the ICA-R from one of the researchers who developed the instrument, Terence J. G. Tr acey, PhD (personal communication,

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73 August 14, 2006). Dr. Tracey provided the resear cher the inventory, as well as the scoring guidelines. Concern for Others The instrument, Concern for Others is an inventory designed to m easure students desire to help other people. The Child Development Proj ect (CDP), part of the Developmental Studies Center, developed the instrument. The CDP is a research-based program focused on creating caring and supportive learning environments that encourages students sense of belonging and connection to school. The program has received national recognition for its learning approaches fostering students academic, ethical, social, a nd emotional development. The CDPs past 20 years has been devoted to developing and valida ting measures of students social, emotional, ethical, and academic development (Dev elopmental Studies Center, 2005). The Concern for Others instrument is comprised of 10 items scored on a 5-point scale with 1 = Disagree a lot to 5 = Agree a lot. The instrument is designed for students in grades three to six. The instruments internal consistency re liability is .80 (Developmental Studies Center, 2005). According to Dr. Jean Watson (per sonal communication, November 5, 2006) the instrument is one possible tool that measures caring reflective of her theory of human caring. The Concern for Others inventory is a commercially distributed instrument within the public domain. Intervention Implementation and Data Collection After the parent or legal guardian provided consent and the child gave assent, the im plementation timeline illustrated in Tabl e 3-4 was followed throughout the study until completion. To begin, the students were random ly assigned to either Group 1 or Group 2, resulting in half of the students (N = 35) in Group 1 and half of the students (N = 35) in Group 2. Two groups of 35 students, as opposed to a sing le group of 70 students, allowed for individual

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74 instruction and greater intimacy with the students. Follo wing group assignment, Group 1 was administered the pre-test assessment and began the four-week intervention. Upon completion of the intervention, Group 1 was administered the po st-test assessment. Pre-test assessment and post-test assessment consists of scores on the ICA-R and the Concern for Others inventories, as well as responses to the preand post-questionnaires. After Group 1 completed the post-test assessment, Group 2 was administered the pre-test assessment. Accordingly, Group 2 began the fou r-week career educatio n intervention. Upon completion of the intervention, Group 2 was ad ministered the post-te st assessment. The preand post-assessments were administer ed by the researcher and the male nurse. The students were given as much time as they needed to complete the instruments. It took approximately 45 minutes for the students to co mplete the pre-assessment and the same amount of time to complete the post-assessment. The researcher was granted IRB approval to con duct the research project as presented. It was documented in the IRB proposal and explained to the students and pa rents that there is no anticipated risks to taking part in this study. However, it was clearly communicated to both the parents and the students that students could withdraw without consequences from the study at any time in the event, for any reason, the students cannot complete the career educ ation program. Threats to Internal Validity Quasi-experim ental studies, such as this st udy, are especially susceptible to threats to internal validity and represent alternative ex planation that competes with the independent variable as a cause for the de pendent variable. When subjects are not assigned randomly to groups, the researcher must always be alert to the possibility that the groups are nonequivalent; being aware that the possibility that a group difference on the depende nt variable is the result of initial differences rather than the effect of th e independent variable (P olit & Beck, 2004). Thus,

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75 to minimize this particular threat of internal validity, the research er randomly assigned the students to either Group 1 or to Group 2. Another threat to internal validity is testing effects that results from the consequence of taking a pre-test on the participan ts performance on a post-test. It could be questioned that the first administration of the pre-test ( ICA-R, Concern for Others, and the Preand PostQuestionnaires) might sensitize the students to issues that they had not considered. This potential sensitization may result in attitude changes regardless of whether the students receive the career education intervention. If a comparison group is not used in the study, it is difficult to segregate the effects of the instructional interv ention from the effects of having taken the pretests (Polit & Beck, 2004). In addition, another possible threat to internal valid ity, especially with longitudinal studies involving young children, results fr om maturation. Maturation is de fined as a process occurring within the subjects during the course of the stud y because of the passage of time rather than a result of the independent variable, such as c ognitive maturity (Polit & Beck, 2004). However, the researcher questioned the probable threat of maturation because of the short time frame (four weeks) between pre-test and post-test assessments. Characteristics of special importance to the study include the age of the participants and their reading abilities related to the readability of the instruments used in the study. The FleschKincaid Grade Level readability for the ICA-R is 3.1 and the Concern for Others is 4.4. The reading levels of the students were at least f ourth-grade level as repor ted by the school. To ensure readability of the Concern for Others the researcher read the items on the Concern for Others to the students to make certain all items for scoring were understood by all students.

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76 Statistical Analyses Questionna ires To begin, the data obtained on the pre-questionnaires were analyzed to determine the relationships of: (a) gender, (b ) race, (c) having a family me mber who is a nurse, and (d) knowing someone who is a nurse on students interest in nursing as a career choice prior to the education intervention. This information was analyzed for the total sample (N = 70), Group 1 (N = 35), and Group 2 (N = 35) using a se ries of Pearsons chi-square tests. The Pearsons chi-square test is the statistical test to use when determining the relationship between two categorical variables (Fields, 2005). The researcher was most interested in dete rmining the overall effect of the education intervention on students yes or no responses when asked if the students would consider being a nurse when grown on the pre-questionnaire pr ior to participating in the career education program compared to responses on the post-ques tionnaire after particip ating in the career education program. These analyses were accomplis hed using a series of McNemar tests. The McNemar test determines differences in proportions between two related groups. It is typically used when detecting changes in peoples scores and it compares the proportion of people who change their responses in one direction to those who change in the opposite direction. It is an appropriate statistic when a pretest post-test design is used to compare changes in proportions on a dichotomous variable (Fields, 2005). The researcher also analyzed the effects of the education program for other variables of interest: (a) gender, (b ) race, (c) having a nurse as a family member, and (d) knowing a nurse other than a family member and their influences on students interest in nursing as a career choice. McNemar tests were conducted to determ ine if a change in st udents responses to

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77 consider nursing as a career o ccurred after participating in the education program and, if so, to examine the influence of these variables of interest on the changes. Interest and Competence RIASEC Scores and Caring Sco r es In addition, the researcher was interested in evaluating several dependent variables sim ultaneously (scores on RIASEC for both the in terest and competence scales). However, the researcher was most concerned with scores related to the Holland summary code for nursing, SIA (Social, Investigative, and Artistic), particularly related to gender effect. In previous studies, (Tracey & Ward, 1998; Tracey, 2002) the gender effect for the interest scale was manifested in male students having higher mean scores on Realistic and Investigative career types, whereas female students had higher mean scores on Artistic, Social, and Conventional career types. There was no gender mean difference on the Enterprising career type. An identical gender mean difference was found on the compet ence scale with male students having higher means on Realistic and Investigative career t ypes and female students having higher means on Artistic, Social, and Conventional career types, with no difference on th e Enterprising career type. Of equal importance, were the caring scores on the Concern for Others inventory measuring a desire to help other people. A paired t -test was conducted on the total sample (N = 70) to analyze differences in mean scores between pre-test and post-test RIASEC interest and competence scores and caring scores as a result of the students part icipating in the career educatio n program about nursing. A paired t -test is appropriate when dete rmining differences within two group means collected from the same sample (Fields, 20 05). Lastly, a paired t -test was performed to determine the differences between pre-test and post-test RIASEC mean sc ores on the interest and competence scales and caring scale within male and female students.

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78 Table 3-1. Demographic char acteristics of students Total Sample N = 70 N % Group 1 N = 35 N % Group 2 N = 35 N % Age 10 11 12 38 54% 29 41% 3 5% 16 46% 16 46% 3 8% 22 63% 13 37% 0 0% Gender Male Female 35 50% 35 50% 17 49% 18 51% 18 51% 17 49% Race Black Non-Black 16 23% 54 77% 10 29% 25 71% 2 17% 33 83% Family Member Yes No 25 36% 45 64% 11 31% 24 69% 14 40% 21 60% Knows a Nurse Yes No 23 33% 47 67% 10 29% 25 71% 13 37% 22 63%

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79 Table 3-2. Crosswalk of nationa l career development competencies for elementary school and fifth-grade career educati on intervention by unit of inst ruction. Source: National Occupational Information Coordinating Council, 1989 Career Competencies Unit 1 Unit 2 Unit 3 Unit 4 Self-Knowledge Competency 1 Developing a good self-concept Competency 2 Interacting with others Competency 3 Growing and changing Educational and Occupational Knowledge Competency 4 Achieving in school Competency 5 Working and learning Competency 6 Using career information Competency 7 Developing good work habits Competency 8 Working and helping others Career Planning Competency 9 Making decisions Competency 10 Working with others Competency 11 Contributing to others Competency 12 Planning for a Career

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80 Table 3-3. Internal consistency a nd 1-year stability estim ates of RIASEC scales across grade groups. Source: Tracey, 2002, p. 152 Parameter Interest Scale Competence Scale R I A S E C R I A S E C Elementary School fifth-grade .81 .71 .68 .74 .70 .65 .79 .70 .63 .67 .68 .70 sixth-grade .78 .74 .75 .72 .74 .70 .78 .73 .71 .70 .72 .71 1-year retest .54 .62 .46 .50 .35 .44 .57 .60 .46 .55 .43 .57 Middle school seventh-grade .80 .75 .69 .78 .82 .78 .81 .75 .69 .76 .71 .76 eighth-grade .79 .76 .79 .85 .84 .80 .77 .79 .81 .80 .81 .82 1-year retest .76 .77 .72 .81 .74 .79 .68 .77 .69 .76 .66 .70 RIASEC = Realistic, In vestigative, Artistic, Social Enterprising, and Conventional

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81 Table 3-4. Timeline for car eer education intervention Parameter PTA Mtg. Visit To Classes Wk 1 Wk 2 Wk 3 Wk 4 Wk 5 Wk 6 Wk 7 Wk 8 Wk 9 Consent X Assent X GROUP 1 Pre-test Assessment: Unit 1 Unit 2 Unit 3 Unit 4 Post-test Assessment X X X X X X Group 2 Pre-test Assessment: Unit 1 Unit 2 Unit 3 Unit 4 Post-test Assessment Completion of Study X X X X X X X

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82 CHAPTER 4 RESULTS The purpose of this study was to evaluate th e influence of a career education program on fifth-grade students inte rest in nursing as a career choice. Seventy fifth-grade students from a public elementary school in a large metropolitan city in the Southeast par ticipated in the study. The students were randomized into two groups, each group consisting of thirty-five students. The first group of students (Group 1) participated in a four-week career education program about nursing, followed by the second group of students (Group 2) participating in the same career education program about nursing. Pre-test and post-test responses to a qu estionnaire and scores on the ICA-R and Concern for Others were analyzed to determine interest in nursing before and after participating in the caree r education program about nursing and to answer the research questions presented in the study. Questionnaire Data Data collected on the preand post-questionnai res were evaluated to ans wer the critical research question: What is the effect of a career education program on fifth-grade students interest in nursing as a career choice measured by changes in the students yes or no responses when asked if they would consider being a nurse when grown, taking into account gender? Other variables of interest: (a) race, (b ) if the student has a family member who is a nurse, and (c) if the student knew someone other than a family member who is a nurse were collected on the pre-questionnaire to determine their influence on st udents responses to consider nursing as a career choice. The pre-questionnaire asked for the students name, age, gender, ethnicity, and race. Of the 70 students, 38 students (54%) were 10 years old, 29 students (41%) were 11 years old and three students (5%) were 12 years old. Interestin gly, the total sample of students was comprised

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83 of 35 male students and 35 female students. The sample was predominantly non-Black with 54 non-Black students (77%) and 16 Black students (23%). The researcher evaluated the variability of the demographic data between Group 1 and Group 2 and determined the groups were similar with regard to: (a) number of students in each group, (b) age, (c) number of male and female students, (d) number of Black and non-Black students, (e) number of students that have a family member who is a nurse, and (e) number of students that knew a nurse other than a family member (Table 3-1). In addition, differences between the two groups pre-questionnaire yes a nd no responses to co nsider nursing as a career were evaluated with a series of Pearsons chi-square tests. The results of these analyses indicated no significant differen ces between the students respons es across: (a) group assignment (Group 1 and Group 2), (b) gender, (c) race, (d) ha ving a family member who is a nurse, and (e) knowing someone other than a family member who is a nurse. Based on these comparisons, the researcher determined the two groups appeared equivalent and therefore combined the two groups into a single group creating a sample size of 70 students. Hence, all data analyses were based on a within-subjects experimental study design where (a) pre-test and post-test measures are taken on all subjects and (b ) all subjects are exposed to all levels of the independent vari able (Brink & Wood, 1998). A with in-subjects design allows for an increased sample size and will take advantage of the relative power of a repeated measures design. In addition, a repeated measures design in trinsically reduces the chance of unsystematic error variance making it easier to detect a ny systematic variance (Fields, 2005). Variables of Interest before Participating in the Education Program The researcher was interested in th e effect that: (a) gender, (b) race, (c) having a family member who is a nurse, and (d) knowing someone w ho is a nurse other than a family member on the students yes or no re sponses to consider nursing as a career when grown prior to

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84 participating in a career educa tion program about nursing. Thus, a series of Pearsons chi-square tests were conducted to determine the effects of the above li sted variables of interest, independent of the influence of the education intervention. Gender A Pearsons chi-square analys is indicated a highly significan t association between gender and whether the students would consider nursing as a career f or the total sample (N=70), ( X2 = 11.67, df = 1, p < .01). Of the 28 students in the total sample who would consider being a nurse, seven were males (25%) and 21 were females (75 %). Of the 42 students who would not consider nursing as a career, 28 were male s (67%) and 14 were females (33 %). Thus, based on the odds ratio for this sample of students, with an equa l number of male students (N = 35) and female students (N = 35), the female students are six times (OR = 6.0, p < .01) more likely to consider being a nurse as a career than the male students prior to participating in the education program. Simply stated, it could be estimated that the likelihood of a fifth-grade student considering nursing as a career choice is about si x times greater if the student is a female than if the student is a male. Family member The influence of a student having a fam ily me mber who is a nurse and a student saying yes to consider being a nurse as a career was highly significant ( X2 = 12.70, df = 1, p < .001). The 28 students in the total sample who would consider nursing prior to the education program, 17 students (61%) reported havi ng a family member who is a nurse and 11 students (39%) reported not having a family member who is a nurse. The 42 students who said no to consider nursing as a career, only eight st udents (19%) reported having a family member who is a nurse and 34 students (81%) reported not having a family member who is a nurse. Thus, based on the odds ratio for this sample of st udents, students who have a family member who is a nurse are

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85 almost seven times (OR = 6.6, p < .001) more likely to consider being a nurse than students without a family member who is a nurse. Simply stated, it could be esti mated that the likelihood of a fifth-grade student consideri ng nursing as a career choice is about seven times greater if the student has a family member who is a nurse than if the student does not have a family member who is a nurse. Race and knowing a nurse other than a family member Race and kn owing someone other than a family member who is a nurse did not have a significant effect on a student to consider nursing as a career prior to participating in the education program. Thus, it can be concluded th at there was no association between students race and knowing a nurse other than a family memb er as to whether they would consider nursing as a career choice when grown. These descriptive statistics and Pearsons chi-square analyses are presented in Table 4-1. Effects of the Career Education Program To begin, the researcher conducted a McNem ar te st to analyze students pre-test and posttest questionnaire responses to determine the effect of the career education program on fifthgrade students interest in nursing as a career ch oice measured by changes in the students yes or no responses when asked if they would consider being a nurse when grown, considering gender. In addition, a series of McNemar tests were performed to determine the effects of the other variables of interest: (a) race, (b) having a family member who is a nurse, and (c) knowing someone other than a family member who is a nurse on students respon ses to consider nursing as a career after participating in the education program. The data obtained from the preand post-que stionnaires asking if the students would consider being a nurse were studied to determin e the education programs effect on the students expressed consideration of nursing as a career when grown. The number of students (N = 70)

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86 that indicated they would consider being a nurse prior to the education program was 28 students (40%). Subsequently, an addi tional 19 students said they would consider nursing as a career after participating in the education program. Two of the students who indicated they wanted to be a nurse prior to the education program change d their responses not to consider nursing as a career choice after partic ipating in the education program. Ye t, the overall positive change in responses resulted in 45 student s (64%) indicating th ey would consider being a nurse after participating in the education program compared to the 28 students (40%) who would consider being a nurse prior to the education program. A McNemar analysis of these results docum ented a highly significant change in the number of positive responses after the students participated in the education program (N =70, p < .001). The change reflects an additional 17 positive responses (28 to 45 yes responses), yielding a 61% increase in the numbe r of positive responses to consider nursing as a career after students participated in the education program. Thus, it can be concl uded that the education program had a significant positiv e influence on students expressi ng they would consider being a nurse when grown. However, the researcher, despite a significant 61% increase in the number of students indicating they would consider be ing a nurse after participating in the career education program, acknowledged that this evaluative observation is susceptible to cer tain design limitations, such as the influence of a spurious rela tionship or the potential for the Ha wthorne effect. The researcher will discuss in detail potential design lim itations of the study in Chapter 5. Gender An i mportant inquiry of this study was the e ffect of the career education program on both male and female students. The 28 students who considered nursing as a career prior to the education program, 21 students were female ( 75%) and seven students were male (25%).

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87 Whereas, the 45 students indicating they would consider being a nurse after the education program, 30 were females (67%) and 15 were males (33%). Nine additional male students and 10 additional female students said yes to consider nursing as a career afte r participating in the education program. One male and one female st udent changed their responses from yes to no. Overall, these results reflect a 114% increa se in the number of positive responses for male students (seven to 15 yes responses) and a 43 % increase for female students (21 to 30 yes responses). A McNemar analysis indicated a sta tistically significant positive effect for both male and female students to consider nursi ng after the education program (N = 35, p < .05). Based on these finding, it can be concluded that the career education program had a significant positive influence on both the male and female students re sponses to consider nursing as a career when grown. Race For the 28 students who considered nursing as a career prior to the education program, 22 students were non-Black (79%) and six were Black (21%). Whereas, the 45 students indicating they would consider being a nurse after the education program, 34 students were non-Black (76%) and 11 were Black (24%). Twelve additional non-Black students and five additional Black students said yes to c onsider nursing as a career after participating in the education program. Two non-Black students changed their re sponses from yes to no to consider nursing after participating in the education program. These results reflect a 55% increase in the number of positive responses for non-Black stude nts (22 to 34 yes responses) and a 83% increase for Black students (six to 11 yes responses). A McNemar analysis indicated a statistica lly significant positive effect for non-Black students (N = 54, p < .01), but not for Black students for this sample. The researcher suspects the small sample size of Black students, N = 16, may have resulted in a Type II error.

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88 Family member A McNemar analysis determined the effect of the education program on students who do and do not have a family member who is a nurse Within the total sample, 25 students (36%) reported having a family member who is a nur se and 45 students (64% ) reported not having a family member who is a nurse. The 25 student s with a family member who is a nurse, 17 students (68%) said yes and ei ght students (32%) said no to consider being a nurse as a career prior to participating in the education prog ram. There was no change in responses for this group of students after part icipating in the education program. However, the 45 students reporting not having a family member who is a nurse, 11 students (24%) said yes and 34 st udents (76%) said no to consider being a nurse prior to participating in the education program. A highly significant positive change in responses resulted after these students participated in th e education program, 28 st udents (62%) said yes and 17 students (38%) said no to consider nursing as a career (N = 45, p < .001). This reflects a 156% increase in positive response s (11 to 28 yes responses). Thus, it can be concluded, that the education program about nursing had a significantly positive e ffect on students reporting not having a family member that is a nurse, but no t for students reporting having a family member as a nurse. Knowing a nurse A McNem ar analysis determined the effect of the education program on students who did and did not know a nurse other th an a family member. Within the total sample, 23 students (33%) reported knowing a nurse a nd 47 students (67%) reported not knowing a nurse other than a family member before participating in the education program. The 23 students who knew a nurse other than a family member, 10 students (43%) said yes and 13 students (57%) said no to consider being a nurse. Afte r participating in the education program there was a significant

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89 change in responses, 17 students (7 4%) said yes and six students said no (26%) to consider nursing as a career (N = 23, p < .05). This reflects a 70% increas e in positive responses (10 to 17 yes responses). For the responses of the 47 st udents who did not know a nurse other than a family member, 18 students (38%) said yes and 29 students (62%) said no to consider being a nurse before participating in the education program. As well, a highly significant change in responses occurred after these students participated in th e education program, 28 students (60%) said yes and 19 students said no (40%) to c onsider nursing as a career (N = 47, p < .01). This reflects a 56% increase in positive responses (18 to 28 yes responses). Thus, it can be concluded that participating in the education program about nursing had a significant positive effect on the students who knew a nurse and a highly significa nt positive effect on the students who did not know a nurse other than a family member. The results of these McNemar tests are provid ed in Table 4-2. In addition, the percent increases in the students positive responses afte r participating in the education program are illustrated in Figure 4-1. As well, the incr eases in the number of positive responses are illustrated in Figure 4-2. ICA-R and Concern for Others Data The researcher analyzed data collected from the ICA-Rs interest and competence scales and the Concern for Others scale to answer the research questi on asking what are the effects of a career education program on fifth-gr ade students interest in nursing as a career choice measured by changes in interest ( ICA-Rs RIASEC interest scale), competence perception ( ICA-Rs RIASEC competence scale), and desire to help other people ( Concern for Others scale). The differences between the pre-test and post-test mean RIASEC intere st and competence scores and caring scores were examined to determine the ef fect of the education program for the following

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90 student cohorts: (a) within-s ubjects comparison of the total sample using a paired t -test (N = 70), and (b) within-subjects comparison of the ma le and female students using a paired t -test (N = 35). Within-Subjects Comparison of the Total Sample The researcher analyzed the data from a within-subjects design using a paired t -test to analyze the total sample, N = 70. A paired ttest was conducted on the difference of the mean scores for the total sample (N = 70) at two point s in time, before and after participating in the education program for RIASEC interest and competence scores measured by the ICA-R instrument, as well as caring scores measured by the Concern for Others instrument. ICA-R analyses On average, there were n o significant differen ces between the students mean pre-test and post-test measurements with the exception of the difference in mean scores on the competence scale for the Investigative career type. The resu lts revealed that the st udents mean pre-test competence Investigative score ( M = 4.00) was significantly higher th an the students mean posttest score ( M = 3.83), ( t (69) = 2.04, p < .05), yielding an effect size of r = .24. This result was of particular interest to the re searcher because the Investigative career type is a component of the Holland three-letter career code for nursing, SIA. This re sult is further discussed in Chapter 5. The results of these paired ttests are presented in Table 4-3. Concern for Others analysis A paired ttest was conducted on the difference of th e caring m ean scores measured by the Concern for Others instrument for the total sample (N = 70) at two points in time, before and after participating in the education program. The results indicated a positi vely significant change in the mean caring scores after the students participated in the education program about nursing. The students mean post-test caring score ( M = 2.78) was significantly higher than the students

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91 mean pre-test score ( M = 2.58), ( t (69) = -2.61, p < .05), yielding an effect size of r = .30. Thus, it can be concluded that the career education program has a significant positive effect on a students desire to help other peop le. The results of this analysis are presented in Table 4-5. Within-Subjects Comparison of Male and Female Students These final analyses were stud ied to answer the remaining research question asking if there is a difference in how male and female fifth-grade students respond to a career education program about nursing as a career choice measured by scores on the ICA-R and Concern for Others instruments ICA-R analyses Paired t -tests were perform ed to determine the di fferences between pre-test and post-test measures of RIASEC mean scores on the interest and competence scales within male and female students. The gender effect for the interest scales was manifested in male students mean scores increasing on the Artistic and Conventional scales and female students mean scores increasing on the Realistic, Investigative, and Enterprising scales. The results of the competence scale scores revealed no increase for bot h male and female students. Ho wever, all the analyses yielded non-significant differences in mean pre-test and post-test scores. Even so, the researcher presen ted in text the changes in mean interest and competence scale scores for Social, Investigative, and Artis tic, due to the relevanc e of these three Holland codes to this study. Both male (M = 3.18) and female students (M = 3.87) scored lower on the Social scale for interest after participating in the education program. On average, male students scored higher ( M = 3.80) on the Artistic scale for interest after partic ipating in the education program than before ( M = 3.74) participating in the educat ion program. The female students scored higher ( M = 3.70) on the Investigative scale for intere st after participati ng in the education program than before ( M = 3.68) participating in the education program.

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92 The comparisons of the male and female stude nts mean pre-test scores and post-test scores for both the interest and competence scales are presented in Table 4-3. RIASEC career assessment The evaluation of the RIASEC scores on the in terest and competen ce scales provided an assessment of the career types for this sample of fifth-grade students at two points, before and after participating in a career education program about nursing. Prior to the education program, scores on the interest scale re vealed the male students scor ed higher on the Realistic and Enterprising scales, whereas, the female students scored higher on the Investigative, Artistic, Social, and Conventional scales. The comparisons of the interest scale scores after the student participated in the career education program we re almost identical, with the exception of the Enterprising scale scores. Agai n, the male students scored higher on the Realistic scale and the female students scored higher on the Investigative, Ar tistic, Social, and C onventional scales. The scores for the Enterprising scale were the same for male and female students. These RIASEC interest assessments are illustrated in Figure 4-3. Assessments of the competence scale scores were reciprocal to the interest scale scores. The male students scored higher on the Realistic and Enterprising scales and the female students scored higher on the Investigative, Artistic, Social, and Conventional scales prior to participating in the education program. The comparisons of the scale scores after the st udents participated in the study were almost identical, the male students scored higher on the Realistic scale and the female students scored higher on the Investigative, Ar tistic, Social, and C onventional scales. The scores for the Enterprising scale were the same for male and female students. These RIASEC competency assessments ar e illustrated in Figure 4-4.

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93 Interestingly, the gender effects manifested in this study for bot h the interest and competence scales are similar to the gender effects Tracey found in his 2002 study (Tracey, 2002). These similarities are disc ussed in Chapter 5. Concern for Others analysis Likewise, th e researcher analyzed the caring data from a within-subjects design using a paired t -test to analyze differences in mean pre-test and post-test scores for males and females. The results demonstrated a signifi cant difference in the mean pre-te st and post-test scores for the female students, but not for the male students. The female students mean post-test caring score ( M = 2.86) was significantly higher than their mean pre-test caring score ( M = 2.63), ( t (34) = 2.22, p < .05), yielding a moderate effect size, r = .36. Thus, it can be concluded that only the female students caring scores we re significantly influenced by participating in the education program about nursing. The results of this anal ysis are presented in Table 4-5 and Figure 4-5. Scale Reliabilities ICA-R The inte rnal consistency reliability estimates for the ICA-R for both interest and competence RIASEC scales are presented in Table 4-6 for this sample of fifth-grade students. In general, these values are bette r than the values obtained by Tracey and Ward (1998) and Tracey (2000) in their samples. The va lues of the internal consistenc y estimates in this study were generally acceptable with Cronbachs alphas rang ing from .79 to .81 on both the interest and competence scales. The overall reliability of the scales resulted in a Cronbachs of .81 for the interest scale and .80 for the competence scale.

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94 Concern for Others The inte rnal consistency reliability estimate for the Concern for Others scale was .83 for this sample of fifth-grade student s. This estimate is comparable to the internal consistency reliability of .80 reported by the Child Developmental Studies Center (2005). Summary of Findings Question 1 1. W hat is the effect of a career educati on program on fifth-grade students interest in nursing as a career choice measured by changes in the students yes or no responses when asked if they would consider being a nurse when grown, taking into account both male and female students' responses? The researcher answered this question by c onducting a McNemar test to analyze changes in students yes and no responses when aske d if they would consider being a nurse when grown before and after participa ting in the career education pr ogram. The results documented a highly significant change in the number of positive responses after the students participated in the education program (N = 70, p < .001). The change reflects an additional 17 positive responses (28 to 45 yes responses), yieldi ng a 61% increase in the number of positive responses to consider nursing as a career after students participat ed in the education program. In addition, an important inquiry of this study was the effect of the career education program on gender. A McNemar analysis indicate d a statistically significant positive effect for both male and female students to consider nursi ng after participating in the education program (N = 35, p < .05). These results reflect a 114% increas e in the number of positive responses for male students (seven to 15 yes responses) a nd a 43% increase for female students (21 to 30 yes responses). Thus, it can be concluded that the education program ha d a significant positive

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95 influence on both male and female students expr essing they would consid er being a nurse when grown. Question 2 2. W hat are the effects of race, having a family member who is a nurse, and knowing someone who is a nurse other than a family member on the stude nts yes or no responses when asked if they would consider being a nurse when grown before and af ter participating in a career education progra m about nursing? Race Results of a McNem ar analysis indicated the education program had a significant positive effect for the non-Black students (N = 54, p < .01), but not for the Bl ack students to consider nursing as a career choice. Howe ver, the researcher suspects the small sample size of Black students, N = 16, may have resulte d in a Type II error. Family member A McNem ar analysis determined that the e ducation program did not have a significant effect on students who have a family member wh o is a nurse. There was no change in responses for this group of students after participating in the education program Conversely, a highly significant positive change in responses resulted after the students who reported not having a family member that is a nurse participated in the education program (N = 45, p < .001). This reflects a 156% increase in posit ive responses (11 to 28 yes responses). Thus, it can be concluded that the education pr ogram had a significant positive effect on the students reporting not having a family member who is a nurse, but did not have a significan t effect on the students reporting having a family member that is a nurse.

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96 Knowing a nurse A McNemar analysis determined the effect of the education program on students who reported knowing and not knowing a nurse other than a family member prior to participating in the education program. The result s indicated that the education pr ogram had a significant effect for both groups of students. A significant change in positive responses to consider nursing as a career after participating in the education prog ram occurred with the students that reported knowing a nurse other than a family member (N = 23, p < .05). This reflects a 70% increase in positive responses (10 to 17 yes responses). As well, a highly significant change in positive responses occurred after particip ating in the education program with the students that reported not knowing a nurse other than a family member (N = 47, p < .01). This reflects a 56% increase in positive responses (18 to 28 yes responses). Thus, it can be concluded that participating in the education program about nursi ng had a significant positive effect on the students who know a nurse and a highly significant posi tive effect on the students who did not know a nurse other than a family member. The results of these McNemar tests answering research questions 1 and 2 are provided in Table 4-2. In addition, the percent increases in the students positive responses after participating in the education program are illustra ted in Figure 4-1. As well, the increases in the number of positive responses are illustrated in Figure 4-2. Question 3 3. W hat are the effects of a career education program on fifthgrade students interest in nursing as a career choice measur ed by changes in interest ( ICA-R), competence perception ( ICA-R ), and desire to help other people ( Concern for Others )? The researcher analyzed data collected from the ICA-R s interest and competence scales and the Concern for Others scale before and after participating in the education program to

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97 answer the research question. A within-subjects comparison of th e total sample (N = 70) using paired t -tests determined the differences between the pre-test and post-test mean RIASEC interest and competence scores and caring scores. Overall, the results revealed no significant differences between the students mean pr e-test and post-test measurements on the ICA-R s RIASEC interest and competence scales with th e exception of the difference in mean scores on the competence scale for the Investigative career type This isolated signif icant result reflected a decrease in the competence score for the Investiga tive career type and is di scussed in Chapter 5. The results of these paired ttests are presented in Table 4-3. In addition, the paired ttest conducted on the difference of the mean caring scores indicated a positively significant change after the students participated in the education program about nursing. The students m ean post-test caring score ( M = 2.78) was significantly higher than the students mean pre-test caring score ( M = 2.58), ( t (69) = -2.61, p < .05), yielding an effect size of r = .30. The results of this analysis ar e presented in Table 4-5. Question 4 4. Is there a difference in how m ale and fema le fifth-grade students respond to a career education program about nursing as a caree r choice measured by scores on the ICA-R and Concern for Others? A within-subjects comparison of male and female students using paired t -tests (N = 35) was performed to determine the differences between pre-test and post-test measures of RIASEC mean scores on the interest and competence scales within male and female students, yielding non-significant differences for all mean pre-test and post-test scores. The comparisons of the male and female students mean pre-test scores and post-test scores for both the interest and competence scales are presented in Table 4-3.

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98 Lastly, the caring data was analyzed using a paired t -test to determine differences in mean pre-test and post-test scores for male and female students. The results demonstrated a significant difference in the mean pre-test and post-test scor es for the female students, but not for the male students. The female students mean post-test caring score ( M = 2.86) was significantly higher than their mean pre-test caring score ( M = 2.63), ( t (34) = -2.22, p < .05), yielding a moderate effect size, r = .36. Thus, it can be concluded that only the female students caring scores were significantly influenced by partic ipating in the education progra m about nursing. The results of this analysis are presented in Table 4-5 and Figure 4-5.

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99 Table 4-1. Pearsons chi-square tests of students Yes and No responses before participating in the education program Group: Responses Yes No X2 Gender Male Female N = 28 N = 42 7 (25%) 28 (67%) 21 (75%) 14 (33%) **11.67 Race Black Non-Black N = 28 N = 42 6 (21%) 10 (24%) 22 (79%) 32 (76%) NS Family Member Yes No N = 28 N = 42 17 (61%) 8(19%) 11 (39%) 34 (81%) ***12.7 Knows A Nurse Yes No N = 23 N = 47 10 (36%) 18 (38%) 13 (64%) 29 (62%) NS** p < .01, ***p < .001, df = 1

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100 Table 4-2. McNemar results of students who wa nt to be a nurse afte r participating in the education program Student Responses: Yes No N p % Increase of Positive Responses Total Sample Before After 28 45 42 25 70 70 <.001 61% Male Before After 7 15 28 20 35 35 <.05 114% Female Before After 21 30 14 5 35 35 <.05 43% Non-Black Before After 22 34 32 20 54 54 <.01 55% Black Before After 6 11 10 5 16 16 NS 83% With Family Before After 17 17 8 8 25 25 NS 0% Without Family Before After 11 28 34 17 45 45 <.001 154% Knows a Nurse Before After 10 17 13 6 23 23 <.05 70% Does Not Know a Nurse Before After 18 28 29 19 47 47 <.01 56%

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101 Table 4-3. Paired t -tests for interest and competence RIASEC scale scores for the total sample Total Sample N = 70 Scale: Mean SD t p Interest Scale Realistic Before 2.75 .93 .11 NS After 2.74 .97 Investigative Before 3.64 .67 .67 NS After 3.59 .76 Artistic Before 3.91 .69 -.45 NS After 3.94 .66 Social Before 3.61 .77 1.21 NS After 3.52 .86 Enterprising Before 3.61 .59 .58 NS After 3.57 .71 Conventional Before 2.85 .92 -1.51 NS After 2.96 1.05 Competence Scale Realistic Before 3.11 1.06 .17 NS After 3.10 1.08 Investigative Before 4.00 .61 2.04 < .05 After 3.83 .86 Artistic Before 4.13 .72 .97 NS After 4.08 .77 Social Before 3.67 .88 .07 NS After 3.67 .99 Enterprising Before 3.79 .81 .15 NS After 3.78 .77 Conventional Before 3.50 .95 .82 NS After 3.42 1.05

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102 Table 4-4. Paired t -tests of interest and competence RIASEC scale scores for male and female students Male N = 35 Scale: Mean SD Female N = 35 Mean SD t p Interest Scale Realistic Before 2.95 .96 2.54 .86 -.75 NS After 2.88 .99 2.59 .94 Investigative Before 3.59 .67 3.68 .67 -.90 NS After 3.47 .68 3.70 .81 Artistic Before 3.74 .64 4.08 .69 .53 NS After 3.80 .73 4.07 .54 Social Before 3.33 .67 3.90 .76 -.82 NS After 3.18 .79 3.87 .78 Enterprising Before 3.67 .63 3.55 .53 -.81 NS After 3.57 .78 3.57 .65 Conventional Before 2.60 .80 3.09 .97 -.33 NS After 2.69 .91 3.23 1.12 Competence Scale Realistic Before 3.25 1.05 2.98 1.05 -.03 NS After 3.23 1.02 2.97 1.12 Investigative Before 3.94 .64 4.05 .56 -.21 NS After 3.76 .81 3.90 .90 Artistic Before 3.89 .61 4.37 .75 -.69 NS After 3.88 .75 4.27 .75 Social Before 3.33 .71 4.01 .89 -.34 NS After 3.29 .84 4.03 .99 Enterprising Before 3.81 .93 3.77 .67 -.22 NS After 3.78 .76 3.78 .77 Conventional Before 3.19 .81 3.81 .98 .36 NS After 3.15 .92 3.69 1.11

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103 Table 4-5. Paired t -tests of caring scores for total sample, male, and female students Desire to Help Other People Scale Mean SD t p Total Sample (N = 70) Before After 2.58 .70 2.78 .89 -2.61 < .05 Males (N = 35) Before After 2.53 .45 2.70 .85 -1.50 NS Females (N = 35) Before After 2.63 .89 2.86 .94 -2.22 < .05 Table 4-6. Internal c onsistency estimates of ICA-R s interest and competence scales and Concern for Others scale Parameter Interest Scale Competence Scale Caring Scale R I A S E C R I A S E C .80 .79 .81 .81 .81 .81 .81 .79 .81 .80 .81 .80 .83

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104 Figure 4-1. Percent increase in th e number of students who would be a nurse after participating in the education program

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105 Figure 4-2. Increase in the numbe r of students who would be a nurse after participating in the education program

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106 Figure 4-3. Interest assessment: comparing male and female students before and after the education program

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107 Figure 4-4. Competence assessment: comparing ma le and female students before and after the education program

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108 Figure 4-5. Paired t -tests of caring scores for total sample, male, and, female students

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109 CHAPTER 5 DISCUSSION The researcher develop ed a career educati on program for fifth-grade students in accordance with the National Career Devel opment Guidelines hoping to stimulate young students interest in nursi ng as a future career choice. A review of past research presented in the study has shown that the promotion and dissemination of information about the nursing profession is successful in promoting nursing as a career choice with students of all ages. In addition, information from vocational theory indicat es that career develo pment and choice is not a matter exclusive of adolescence or adulthood and that childhood and its contexts are important precursors of future vocational behaviors (Vondr acek, 2001). Thus, the re searcher thought it a prudent and promising initiative to help stre ngthen the future nursing workforce by designing a career education program to spaw n interest in nursing as a ca reer choice among young people, beginning as early as elementary school. BlueCross and BlueShield of Florida also recognized the value of this initiative to encourage young stud ents to view a career in nursing as a possibility and achievable goal and sponsored a substantia l grant to support th e research. When designing the career education program the researcher took into account past nursing research demonstrating that the number one influencer for prospective nurses is another nurse. Recently, a survey conducted by Buerhaus and colleagues (2005a) found that information or advice from practicing nurses was identified by 65% of nursing students as a factor positively influencing their decision to become a nurse. Ther efore, the researcher considered it crucial that a practicing nurse teach the curriculum. This also allowed th e researcher to personalize the work of a nurse and better create aw areness of a nurses world-of work by speaking first-hand from lived experiences about the various rewa rding job opportunities in nursing.

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110 The theoretical framework of the career educ ation program was founded on an integrated conceptual model that examined interest, competence perception, and the desire to help other people. The interest component is consistent with John Hollands (1959) th eory of personalities and work environments. The competence perception component is supported by Albert Banduras (1977) theory of self-efficacy. The desire to help other people component is largely influenced by Jean Watsons (1985) philosophy and science of human caring. Thus, interest in nursing is operationally illuminated by these th ree concepts: (a) interest, (b) competence perception, and (c) desire to he lp other people (Figure 1-1). The primary purpose of the study was to examin e the effects of a career education program on fifth-grade student s interest in nursing as a career choice when grown. The concepts of interest and competence perception were evalua ted by an instrument developed by Tracey and Ward, (1998), the Inventory of Childrens Activities-Revised (ICA-R) which includes activities children commonly engage in and is designed to assess Holland s six career types (Realistic, Investigative, Artistic, Social, Enterprising, and Conventional, referred to collectively as RIASEC) among children. For the most part, th e results of the study did not demonstrate significant changes in mean scores on the RIASEC interest and competence scales as an effect of the students participation in the career educa tion program. However, the scores provided an assessment of the structure of vo cational interests in fifth-grade students measured at two points in time, at the beginning and at the end of the four-week caree r education program. Thus, the students career assessm ents (types) based on ICA-R scores on the RIASEC interest and competence scales are evaluated in an attempt to examine career interests within this sample of fifth-grade students.

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111 The concept of desire to help other people was measured by an instrument, Concern for Others, designed to quantify students characteristics of caring, referred to by Swanson (1999) as an individuals caring capacity. The Child Development Project created the instrument and according to Dr. Jean Watson (personal commun ication, November 5, 2006) it is one possible tool that measures caring reflective of her theory of human caring. Caring is increasingly recognized as a core concept, char acteristic of the nursing professi on. In fact, the revised social policy statement issued by the American Nurses Association (2003) attest s to the centrality of caring as part of the definition and scope of professional nursi ng practice. Numerous studies discussed in Chapter 2 established an iterati ve theme of caring for others as the major motivating factor for both men and women to consid er nursing as a career. In addition, caring is traditionally viewed by the public as the foundation for the nursing profession and is foremost in the publics perceptions of nursi ng. Recognizing the fundamental phenomenon of caring within the nursing profession, the nurse re searcher was interested in discovering fifthgrade students caring capacity and determining the effect of a career education program about nursing on a students' concern for and desire to help other pe ople. These results are presented in a context reflecting the deeply human nature of nur sings caring works. In addition, questions were addressed regarding the students expressed interest in nursing as a career before and after participating in the education program to determine the influences of four factors: (a) gender (b) race, (c) having a family memb er who is a nurse, and (d) knowing someone other than a family member who is a nurse. Interpretations of the Effects of the Career Education Program Expressed Interest in Nursing One of the goals of the current study was to examine the effect of a career education program about nursing on fifth-grade students expressed interest in nursing as a career choice

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112 when grown. The majority of literature on th e development of childrens interests focuses almost exclusively on expressed aspirations, as king children what career they would like to pursue when grown (Phipps, 1995; Trice, 1990, 1991; Trice & King, 1991; Trice et al., 1995, Vondracek, 2001). These studies revealed that child ren are able to express career ambitions and often these early career goals are associated with adult career choices, illuminating the predictive value of early expression s of career aspirations. Overall, the results clearly supported the education program as an effective career development initiative to stimulate fifth-grade st udents expressed interest in nursing as a career choice. The current study demonstrated a signi ficant 61% increase in th e number of students expressing their consideration of a nursing career after participating in the career education program. Interestingly, two students changed thei r responses from yes to no to consider nursing after participating in th e education program. One student is a White female, age 10, and was in Group 1, and the other student is a White male, age 11, and was in Group 2. The female student reported her grandmother is a nurse, but she did not know anyone else who is a nurse. She indicated on the pre-questionnaire she wanted to be, A chef. Or a vet. Maby a pet shop owner, and on the post-questionnaire she indicated wanting only to be a chef when grown. The male student reported his mom is a nurse and that he knew someone other than a family member who is a nurse. On the preand post-questionnai res he originally indicated he would consider being a nurse when grown, but on the post-questionnaire he erased his an swer, changing it to a no response. He expressed he wanted to be a tree surgeon when gr own on both the preand post-questionnaires. The researcher thought it of special interest th at both of these students have a close family member who is a nurse, yet change d their responses not to consider nursing after

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113 participating in the education program. This result is discussed later in the chapter in the context of having a family member who is a nurse and its influence on children s career choices. The following discussions are related to specif ic sub-groups of stude nts considering: (a) gender, (b) race, (c) having a family member who is a nurse, and (d) knowing someone other than a family member who is a nurse. Gender Another purpose of the current study was to conc entrate on the issue of career gender bias within nursing by having students participate in an education program about nursing that discussed and portrayed males as nurses and to determine its effect on male students. Much of the focus on childrens expressed career aspiratio ns has revealed that children tend to have gender-typed career preferences th at develop early in childhood, with boys demonstrating more rigid gender typing than girls (Tri ce et al., 1995). Gottfredson ( 1981) postulated that one of the first things children learn is sex-typing and that this is a primary filter for children to evaluate and consider occupations in terms of their be ing male or female. Several studies have demonstrated the effectiveness of career e ducation programs with elementary school age children to help reduce career gender stereotyping. In spite of the efforts to attract men into th e nursing profession, men still comprise a very small percentage of the total number of nurses in the United States. Data for 2007 indicated among all full-time employed nurses, only 9% were males (Johnson & Johnson, 2007). Evidence suggests that same-gender role mode ls can influence the attitudes about the appropriateness of a career for members of thei r own gender and children have been shown to accept the concept of adults in nontraditional roles if models are visible in these roles (Bailey & Nihlen, 1990; Bigler & Liben, 1990).

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114 Therefore, the researcher included a male nur se as a strategic component of the career education program to help dispel the idea that nursing is a career primarily for females. The male nurse participated in the administration of the preand post-questionnaires and assisted the researcher in the education sessions. An in triguing observation by the researcher was the tendency for the male students to gravitate to the male nurse during the classroom learning activities. Intentionally, the education curricu lum was filled with information about males as nurses with posters and education videos featuring both men and women in pivotal nursing roles. The students were given broc hures and coloring books portray ing and describing males as nurses. In addition, Johnson & Johnson supplied each student with a Be a Nurse tee shirt with pictures of nurses silk-screened on the fr ont, which included a male nurse. At the completion of the study, the male stude nts reported a significant 114% increase in the number of positive responses to consider nursi ng as a career. Thus, it can be inferred that engaging students in an education program that includes not only information about males in nursing, but also a male nurse as an integral part of the curricul um for students to identify as a role model, has the potential to reduce the tradi tional gender stereotyping of nursing as a female profession. The researcher reco mmends that gender focused education programs, similar to the one in the study, continue to be offered to young students to help their understanding of nursing as a socially appropriate occ upation, regardless of gender. S ubsequent studies are recommended to replicate the results of the current study to advance the exis ting empirical literature on the influence that male nurses can have on young male students attitudes ab out the appropriateness of a career in nursing. Race Even though this was not a central question of the current study, the researcher evaluated the effect of the education pr ogram considering students race and ethnicity, since race and

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115 ethnicity data were collected on the student samp le and the recruitment a nd retention of minority students into the nursing professi on continues to be a problem. The diversity of the nursing population remains far less than that of the general United States populati on and is expected to get worse with racial/ethnic minorities projected to constitute an estimated 40% of Americas population by 2030 (Health Resources and Services Administration, 2004). Therefore, the researcher thought it useful to evaluate the e ffect the education program had on the different racial/ethnic backgrounds represented in the study to determine its utility as a potential intervention to stimulate in terest in nursing. The sample of 70 fifth-grade students repor ted by ethnic categories consisted of six students of Hispanic origin and 64 students of non-Hispanic origin. The sample reported by racial categories consisted of two students who identified themse lves as Asian/Native Hawaiian or Pacific, 16 students as Black/African America n, and 52 students as White. The six students of Hispanic origin reported themselves racially as White and therefore are part of the 52 students reported in the racial category as White. For pu rposes of data analyses, race was defined and dichotomized into two categories: (a) Black and (b) non-Black. The two Asian students were placed into the non-Black category resulting in 16 Black students and 54 non-Black students. The results of the study yielded a significant positive effect for non-Black students, but not for Black students, even though th e percent increase of positive responses for Black students was greater than the increase of positive responses among non-Black students after participating in the education program. The increase in pos itive responses for Black students was 83% compared to a 55% increase in positive res ponses for non-Black students. However, the researcher suspects this non-signifi cant finding may be an outcome of insufficient power, due to the small sample size of Black students in the st udy, resulting in a Type II error. It is the

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116 researchers interpretation that the sample size in this study is not large enough to support the division of the sample to test the effects of specific sub-groups, especially when one group has only 16 subjects, such as the sub-gro up of Black students. Having a family member who is a nurse Other aim s of the study were to evaluate the effect of the education program on students reporting whether or not they have a family member who is a nurse and if they know someone other than a family member who is a nurse. Interest in a nursing car eer can frequently be inspired by having family members or friends who are nurses. Evidence has shown that young people who have a nurse in the family have a more positive view of nursing than those who do not (Pillitteri, 1994). The pre-questionnaire data analyses are c onsistent with the ev idence supporting the influence of family dynamics on a childs consideration of a particular career. The students prequestionnaire responses revealed that having a family member who is a nurse had a highly significant effect on students ex pressed consideration of nursing as a career choice. For the current study, 25 students reported having a fami ly member who is a nurse and of those 25 students, 17 students (68%) indicated they woul d consider nursing as a career prior to participating in the education program. This highly positive finding of the influence of having a family member who is a nurse is congruent with Roes (1956) seminal work descri bing the impact of the relationships between family background and the development of childre ns early educational a nd career aspirations. The researcher views the theoretical underpinning of family influence as an opportunity to enrich the current career education progr am by involving parents of young st udents as part of the career education process. The researcher envisions that parent education progra ms taught concurrently with student programs have the pote ntial to establish a family orientation to the lifelong nature of

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117 career development beginning in ea rly childhood. Once implemented, the effectiveness of parent education programs would warrant evaluation to determine their influence on parents perceptions of nursing as a potentia l career choice for their children. Interestingly, there were no changes in the number of positive responses for this group of students after they participated in the education program, indica ting that overall the education program did not have an influen ce on students with a family memb er who is a nurse to consider nursing as a career. This result could possibly infer that family influence is stronger than an education program about nursing in its utility to positively aff ect students consideration of nursing. As mentioned in an earlier section of this ch apter, two students who have a family member who is a nurse changed their res ponses to consider nursing from y es to no after participating in the education program. This meant that two other students who have a family member who is a nurse changed their res ponses from no to yes to consider nursing after participating in the education program. Further exploration of thes e two students who changed from no to yes revealed that both students were male. One of the students is non-Black, was in Group 1, aspires to be a professional athlete when grown, and repor ted he has an aunt who is a nurse. The other student is Black, was in Group 2, aspires to be a police officer when grown and reported he has an aunt who is a nurse. The researcher cannot dismiss the inference that for these two students who changed their responses to consider nursing wa s due in part, to their participation in the education program, especially in lieu of the si gnificant effect of the education program on the male students. Yet, on the other hand, the career education pr ogram had a highly significant influence on the students reporting not having a family member who is a nurse. Of the 45 students in the

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118 sample who do not have a family member who is a nurse, only 11 students would consider being a nurse prior to participating in the educati on program compared to 28 students who would consider being a nurse after par ticipating in the educat ion program. This is an increase of 17 students, reflecting a 154% increase. This finding lends support to the efficacy of a career education program about nursing to stimulate expr essed interest in nursi ng with fifth-grade students, especially for student s without a family member who is a nurse. However, the researcher cannot disregard and separate the idea that the personal interactions that took place between the researcher and the male nurse with the students during the c ourse of the four-week education program influenced the students expr essed interest to cons ider nursing as a career when grown. The potential for this type of spuri ous relationship is discusse d later in the chapter. Knowing a nurse other than a family member Not only having a fam ily member, but also ha ving a friend or knowing someone who is a nurse has shown to provide motivation and direction with young child ren which eventually led to nursing as a career choice (Beck, 2000). The present study attempte d to replicate the influence of knowing a nurse on students expressed intere st in nursing as a ca reer. However, prequestionnaire data analyses of the present st udy revealed that knowing a nurse other than a family member did not have a significant influence on students expressed consideration of nursing as career when grown. As the next step, the researcher evaluated th e effects of the career education program on students who reported knowing a nur se other than a family member compared to students not knowing a nurse other than a family member. Sli ghtly less than one-third or 23 students reported knowing a nurse and of those 23 students, only 10 students would consid er nursing as a career choice prior to participating in the education program. After th is group of students participated

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119 in the education program, a significant increase of an additional seven students expressed they would consider being a nurse when grown. Of even greater significance was the increase in the number of students who did not know a nurse and would consider bei ng a nurse after participating in the education program. Fortyseven students reported not knowing a nurse ot her than a family member and of these 47 students, 18 students expressed considering nursing prior to pa rticipating in the education program. Yet, after this group of students partic ipated in the education program, an additional 10 students positively changed their expressed cons ideration of nursing. An observation worth mentioning is that several students stated they knew a nurse other than a family member and listed the nurse researcher and/ or the male nurse as the nur se they knew. Although these responses were not counted as the student knowi ng a nurse for the purpose of analysis, it may suggest the question was not clear to the students or that the researcher and male nurse had enough impact on several students at the onset of the education intervention to be considered a nurse who the students knew. Overall, based on these results from the curr ent study the researcher proposes a potential linkage between the positive influences of the education program with the intentionally planned experiences for students to have personal contact with practicing nurses. This implication supports the argument that personal exposure wi th nurse role models has the potential to influence students to view nursing as an en joyable career and suppor ts previous studies demonstrating the correlation be tween nursing role models and students decisions to pursue a career in nursing. Simply stated, the more cont act young people have with nurses, the better the chance of positively influencing their decision to become a nurse.

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120 These results underscore the res ponsibility of each pr acticing nurse as pote ntial recruiter of future nurses and substantiate the importance of exposing young st udents to practicing nurses as a key strategy to stimulate interest in nursing. Nurses are in a unique position to build on the professions credible reputation, help dispel any existing negativ e images of nursing, and educate young people on the many benefits and opportunities a career in nursing can offer. To encourage students of all ages to consider the nursing profession would be one way that all nurses can help maintain a steady recruitment of young people into the future nursing workforce. Effects on Interest, Competence Perception, and Desire to Help Others Interest and competence perception The sm all body of extant literature on child rens career interests focuses primarily on aspirations and not on the broader construct of interests in the younger ages where it is presumed the establishment of interests occurs. Desp ite the simple methodology, the current studys attempt to evaluate childrens expressed career aspirations has been revealing and the results have clearly demonstrated that the career education program about nursing had an overall significant positive influence on fifth-grade student s expressed interest in nursing. However, the researcher wanted to explore a broader representation of childrens career interests incorporating John Hollands (1959) theory of vocational choices, Albert Banduras (1977) theory of self-efficacy, and Jean Watsons (1985) theory of human caring. After a comprehensive review of the existing re search on childrens career interests, the researcher located an instrume nt designed by Tracey and Ward (1998) that measured school age childrens interests and compet ence ratings on Holland RIASEC scale of career types. The instrument, the Inventory of Childrens Activities Revised (ICA-R), consists of an interest scale and a competence scale that concomitantly meas ures interests and perceived competencies appropriate for children. There are questions child ren respond to in terms of what they like to

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121 do (interest) and what they are good at doing (perceived competence). Locating an instrument that was appropriate to examine fifth-grade students inte rests based on Hollands RIASEC structure allowed the researcher to expl ore the effects of a car eer education program on the students RIASEC ca reer types. The study evaluated the effects of a career education program on fifth-grade students interest in nursing based on changes in pr e-test and post-test mean scores on the ICA-Rs interest and competence scales. The results of a paired t -test yielded one isolated significant effect. This one effect demonstrated a decrease in the m ean competence score for the Investigative career type. Remarkably, after visually examining all of the differences between the mean preand post-interest and competence RIASEC scores, the re searcher observed a decr ease in most of the mean scores. There was a decrease in the mean in terest scores for the Realistic, Investigative, Social, and Enterprising career types and a decrease in the mean competence scores for the Realistic, Investigative ( p < .05), Artistic, Enterprising, a nd Conventional career types. Otherwise, there were two increases in mean sc ores on the interest scale for the Artistic and Conventional career types, and no ch ange on the competence scale for th e Social career type. These changes in mean scores are consistent with other research findings documenting a pattern of decreasing in terest and competence ratings with age and maturation. It seems that young children first view their interests and co mpetence perceptions as relatively high and undifferentiated, and as they mature developmentally from elementary school to middle school, they slowly start to differentiate interests and competence perceptions with their ability to reason more abstractly (Holland, 1968; Pi aget, 1972). In addition, as childr en grow and age, they begin to view themselves differently as their social comparisons and competition increases, often resulting in childrens overall levels of competence ratings decreas ing over time (Roberts &

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122 Peterson, 1992). Tracey (2002, p. 160) posits, Thi s process of differentiation could manifest itself in an overall decrease in the mean leve ls of interest and competence as children are deciding what things they do not like or are not good at. Th us, it would be predicted that instead of the highly undifferentiated ratings of interests and competence perceptions present in the earlier years, older children would drop their levels of interests and competence perceptions in some areas, resulting in an ove rall drop in mean RIASEC scores. Even though it is unclear if a four-week pe riod between the pre-te st and the post-test accounts for developmental and/or social cha nges, the researcher proposes that merely participating in the education program may have affected how the students cognitively organized their responses to the questions on the ICA-R Therefore, the research er proposes that the overall drop in mean scores demonstrated in the study c ontributes to the existin g literature documenting a general decrease in interest and competen ce ratings associated with the process of differentiation in children. However, the potential of the testing effect and its threat to this studys internal validity must be considered. Regarding gender, the results of a paired t -test to determine the effects of the education program between male and female students uncovered no significant changes for any of the RIASEC mean scores on both the interest and competence scales. Therefore, as a next step, the researcher focused on the assessment of differen ces among post-test RIASEC mean scores across gender to determine if there were any gender di fferences. In general, the gender differences found for both the interest a nd competence mean scores supp orted gender patterns found in previous research (Tracey & Ward, 1998; Tracey 2002). The current study revealed the gender effect for the interest scale was manifest with male students having higher mean scores on the Real istic scale, whereas the female students had

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123 higher mean scores on the Investigative, Artistic Social, and Conventiona l scales. There was no gender mean difference on the Enterprising interest scale. An identical pattern was discovered on the competence scale. The male students scored higher on the Realistic scale and the female students scored higher on the Investigative, Ar tistic, Social, and Conventional scales. Again, there was no gender mean difference on the Enterp rising competence scale. These interest and competence mean scores for the male and female students are depicted in Figure 5-1. The mirroring of the interest and competence mean scores indicated a high degree of similarity across the RIASEC mean scores for th ese two scales. This important finding provided support of previous research conducted by Tra cey and Ward (1998; Tr acey, 2002) demonstrating the structural similarity between interests and competence perceptions, with no differences between the structures for males and females wi thin the same age group. As described, one of the purposes of Tracey and Wards 1998 study was to develop an instrument that enabled the examination of interests and competence percepti ons with commensurate measures, resulting in the development of the ICA-R The similarity of the RIASEC mean scores for interests and competence perceptions for both male and female students demonstrated in this study adds validity to the ICA-Rs ability to examine the structure of childrens career interests. These results also support the primacy ascribed by many career theorists to th e link between interest and perceived competence in the determination of career interests (Bandura, 1982; Lent et al., 1994; Holland, 1997). However, longitudinal examinations of the structures of interests and competence perceptions and how they devel op across age are warranted. Desire to help other people As discussed in Chapter 2, there is extensive evidence that d escribes caring as a principal quality and a primary reason nurses consider a care er in nursing. As part of this discussion, the researcher proposed the theore tical model conceptualizing interest in nursing as a career choice

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124 include the desire to help ot her people, guided by the underpi nnings of Watsons theory of human caring. Therefore, an important aim of the current study was to examine the effect of the career education program on students desire to help other people or capacity to care as described by Swanson (1999). The results of a paired t -test concluded the education program had a significant positive effect on students desire to help other people. This discovery raised a question with the researcher whether caring is a characteristic trait that remains as a constant and inherent behavior (nature) or is it a dynamic and learnable beha vior enhanced or diminished by instruction, experience, or modeling (nurture). This result suggests that a career education program that includes the caring work of nursing presented by practicing nurses can potentially affect and nurture fifth-grade students desire to help other people. In add ition, the research findings align with some of Benners (1984) original work of her concept of novice to expert, where in her phenomenological investigation of excellence in nu rsing practice she discovered that the ability to practice expert caring is deepened and expanded with knowledge and practice. Evidence from the current study indicates th at caring instruction and modeling have positive implications for nurse educators. Th is information should be considered when establishing academic standards and activities in nursing curricula that incorporate the art and science of human caring to ensure future nurses are learning how to practice within a framework of caring. This would be the first step to esta blish a model of nursing th at advances the science of human caring in education, pr actice, and research. Watson posits, It is when we include caring and love in our science, we discover ou r caring-healing professi ons and disciplines are much more than a detached scientific endeavor but a life-giving and life-receiving endeavor for humanity (Watson, 2005. p. 3).

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125 The last aspect of the research was to determin e if male and female students desire to help others responds differently to a career education program about nursing. A paired t -test evaluating differences in pre-test and post-test mean scores fo r males and females determined that only the female students caring scores were signi ficantly influenced by participating in the education program. The result could lend support to some authors views that stress a greater affinity of females to characterize the relationa l and emotional ethical attitudes of caring when compared to males. Yet, these traditional social conventions are not to say that males are unable to care and that caring for others is a phenomenon ex clusive of females. In fact, surveys of male nurses have reported that one of the motivating factors in men who chose nursing was the desire to help people (Kelly, et al., 1996; Marsland, Robinson, & Murrells, 1996). The researcher supports a more gender neutral attitude about a person s capacity to care based on the suppositions of Watsons theory of human caring desc ribing caring as an ontological trait of being huma n and a fundamental trait of human relatedness (Watson, 2001), and therefore not a privilege of any one group of people. However, a limitation of the current study is its small sample size, suggesting that th e conclusion of the differences between male and female students responses to thei r desire to help other people as an effect of the education program are tentative and future research is needed to further examine gender differences. Furthermore, a number of limitations should be considered when using quantitative research methods to investigate the concept of caring. Researchers have discussed the complexity of the concept of caring, highlighting that it is more than a simple set of caring behaviors, and that risks exist when evaluating caring strictly from a quantitative approach. Caring reflects the humanitarian side of nursi ng, which is often difficult to quantify and can benefit from the more interpretive methods of knowledge building. Therefore, the researcher

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126 recommends future research evaluating childrens caring attributes include multiple paradigms of scientific inquiry to in clude both qualitative and quantitative research to build upon the results of the current study. This quest of new knowledge from a quantitative paradigm would require developing instruments that are sp ecifically designed to measur e caring attributes in children reflective of Watsons theory of huma n caring, since none currently exists. Research Design The current study is a within-subjects desi gn, often referred to as repeated-m easured design. An advantage of a within-subjects design is it requires fewer s ubjects; the total number of subjects needed corresponds to the number required for any one condition (Brink & Wood, 1998). It was only when sub-groups, like race and gender, were evaluated that the statistical power of the study was threatened. A second advantage of a within-subjects desi gn is the unsystematic error variance is reduced making the study most sensitive to the evaluation of the education program (Fields, 2005). This means the current study because of the within-subjects design minimizes random factors that may affect the results of the study. However, a disadvantage of the studys design is the lack of a comparison group. Therefore, mu ch greater confidence can be placed in the findings of this study if the results can be replicated in other settings with different subjects. Strengths, Limitations, and Impl ications fo r Future Research Many of the studys strengths, limitations, and implications for future research were discussed within the context of the interpretati ons of the various resu lts. Yet, additional strengths, limitations, and research recommenda tions that apply to th e study as a whole are elucidated in this section. Strengths of the current research point to the overall contributions made to the existing evidence supporting the efficacy of a career education programs utility to stimulate school age

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127 students expressed interest in nursing as a career choice. In addition, the intentional interventions designed to address gender bias of nursing were eff ective in significantly influencing the male students to consider nursing as a career c hoice when grown. However, the researcher is sensitive that these causal relationshi ps may be attributed to the influence of a third variable or spurious relations hip, the person or persons presen ting the education program, giving way to a possible Type I error. Without a comparison group, it is di fficult to separate spurious effects of other extraneous variab les, thereby threatening the inte rnal validity of the study. The researcher acknowledges there is a possibility that any positive influence of the career education program may reflect the relationshi ps established between the students and the researcher and/or the male nurse delivering the career education program. Then again, was that not the desired outcome of exposing students to r eal nurses, for the studen ts to identify with nurse role models as a dynamic influence on st udents consideration of nursing as a career choice? Another pause to the pos itive influence of th e education program is the potential of the Hawthorne effect. The plain fact that the students were particip ating in the education program may have had an effect on the students beha viors and positive responses to the education program. A limiting factor of the current study is the incomplete results related to racial/ethnic influences. Further career education programs s hould be designed similarly to the one developed for this study that addressed gender barriers, bu t should include a concerted focus describing and portraying racial/ethnic minorities in pivotal nursi ng roles to increase awareness of nursing as a career choice within diverse groups of young students. It is the rese archers belief that efforts to build a more diverse nursing workforce will benefit both the nursing profession and the individuals entrusted in their care.

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128 An additional limiting factor of the current study is it did not examine whether the scoring of the ICA-R for the current studys sample of fifthgrade students supported the measurement of the RIASEC scales. Findings from Tracey a nd Wards (1998) study suggested the RIASEC basis of the instrument was inappropriate for elementary school age children. However, the results in Traceys (2002) study were different in that his sample of elementary school childrens ICA-R scores supported the measurement of RIASEC scales. Tracey attributes the viability of the RIASEC scales in his 2002 study a function of the students bei ng older, in that all of the students were in the fifth-grade. Previous studies (Mueller, 1991; Tr acey & Ward, 1998; Tracey, 2002) determined that the extent to which the RIASEC scales were supported was positively related to age, with older gr ades having a better fit. To determine if the ICA-R could be scored using the RI ASEC structure, Tracey (2002) conducted a separate confirmatory factor analysis (CFA) on each of the item responses from both the interest and the competen ce scales using LISREL with maximum-likelihood estimation. These statistical analyses examined whether: (a ) the items loaded on the six RIASEC scales and (b) if the hexagonal structure am ong the RIASEC scales was vali d. The results of these CFAs are thoroughly detailed in Traceys 2002 study. Th e researcher recommends the same analyses be conducted on the current fifth-grade samples in terest and competence mean scores to confirm if the ICA-R appropriately measured RIASEC career ty pes for this sample of students. Nonetheless, according to Tracey and Ward ( 1998; Tracey, 2002), another indication of the ICA-R s ability to score career interests using th e RIASEC format is the evaluation of the internal consistencies of the inte rest and competence scales. The fifth-grade school sample in the study demonstrated much larger internal consis tency estimates, ranging from .79 to .81, than found by Tracey and Ward (1998; Tracey, 2002), providing some support of the ICA-R s

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129 reliability in measuring RIASEC career types fo r this sample of students. The internal consistency estimates of each RIASEC score fo r both the interest and competence scales are presented in Table 4-6. However, more research is needed to validate the ICA-R s appropriateness in evaluating elemen tary school students RIASEC scores, especially in light of the dearth of research on interests in the younger ages. Pragmatically, the ICA-R was easily administered by the researcher using a common se t of directions, was relatively brief, the directions were easily unders tood by the students, and the stud ents seemed not to have any difficulty with any of the questions. Other limitations of the study are related to th e studys sample. First, the current study was conducted with a small number of participants from one elementary school. The sample was relatively homogeneous with all of the students living in a subur b close to a large city, coming from a middle-class background. Th erefore, the ability to genera lize the results of the study to students from a more diverse background should be considered with caution. The researcher recommends further studies of this nature are need ed to see if the same results are obtainable in other more diverse populations of fifth-grade students. Secondly, the sample size in the study is ad equate when testing differences between two means for the total sample (N = 70) of student s in the study. However, when analyses are conducted between sub-groups of the total sample, it places the study at risk for a Type II error. This was most apparent when evaluating the eff ect of the education progr am with Black students (N = 16). Therefore, it is important to replicat e the studys findings with larger and more diverse samples of students. Lastly, a weakness of the study is its cross-sectional nature. Longit udinal research is recommended to examine just how long the stud ents expressed consideration of nursing as a

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130 career remained constant. For instance, the pos t-questionnaire was administered immediately after the last education session, which raises th e question as to how l ong students expressed interest in nursing will last. Longitudinal studies are needed to study the effects of a career education program on students over time to determ ine its influence on students choosing nursing as a career. Practice Implications The education program was designed primarily to increase awareness of and interest in a career in nursing with fifth-grade students. Yet, as children mature, career exploration becomes a greater emphasis than career awareness to s timulate vocational inte rests. Thus, it is recommended that as children move into the mi ddle school years, care er education programs, like the one designed for the current study, be enriched with developmentally appropriate opportunities to further explore nursings world-of-work. These activities could include field trips to local hospitals, shadowi ng experiences with pr acticing nurses, partnerships with schools and healthcare facilities to spons or mentorship programs for student s at all grade levels, and even part-time employment as appropriate. All of these activities have shown to have a positive influence on students perception of nursing as a career choice. Related to the current study, the researcher recommends the students who expressed an interest in nursing as a career to be encouraged to participate in subsequent career exploration activities. These activities could include, but not be limite d to, the aforementioned career exploration activities. The participation in ad ditional career exploration activities would be particularly valuable for those students in the study whose assessed career types were Social. Longitudinal evaluations of the proposed career awareness and explor ation activities are essential to determine the relatio nship between increased interest in nursing as a career and a students actual career choice a nd enrollment in nursing school.

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131 The findings from the current study examining the structure of childrens interest and competence perceptions supported many findings from previous research on interest development in children. First, the gender m ean differences found on a ll the scales except the Investigative scales (both intere st and competence) mirrored the results of Tracey (2002) on a similar sample of students. Secondly, the findings illustrated a general decrease in ratings of interest and competence scores, which is s upported by previous studies and explained by developmental and vocational psychology as a functi on of differentiation as children decide what they do not like or are not good at. Additi onally, the results provided some support for the ICA-R to score RIASEC types for the current study s sample of fifth-grade students based on the internal consistency estimates of RIASEC scales. Since the structures of interests and compet ence perceptions in children change over time, especially in the transition years from elementa ry to middle school and do not stabilize until late adolescence, more research of a longitudinal nature is needed to examine interest development in late elementary and middle school students. A longitudinal approach would some shed light on the question of how children shift from a concrete orientation to a more abstract perspective, especially related to the synt hesis of career awareness and exploration. A better understanding of how children change in their thinking about their interests and comp etence perceptions has great promise with respect to the future design of career interventions to assist children to work with and understand their interests. Overall, the results demonstrated the im portance of research focusing on the career development of children and the positive effect that career education can have on childrens career interests. As well, the re view of the career development li terature supports the notion that career counseling programs should be an integral pa rt of students daily educational environment

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132 and a fundamental component of the academic mi ssion of elementary, middle, and high schools. Thus, the researcher recommends that a foundati onal principle of our nations pedagogy include career development instructions and experiences as part of a comprehensive career counseling program to be introduced at the elementary le vel and continued through high school and that research be supported to study th e effects on the development of childrens career interests and choices over time. In conclusion, many of the students responses in this study to a career education program about nursing ar e conceived as empirical contri butions to existing knowledge for theorists, practitioners, and researchers to build upon, within the sciences of nursing and vocational psychology.

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133 Figure 5-1. Gender effect for the interest and competence scales

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134 APPENDIX CAREER EDUCATON CURRICULUM FOR FIFTH-GRADE STUDENTS Fifth-Grade Career Education and A wareness Of Nursing as a Career Choice Unit 1: Everybody Can Learn about Nursing Unit 2: Learning What Nurses Need to Know about the Body Unit 3: Learning about Skills that Nurses Perform Unit 4: Learning What Nurses Need to Know about Everyd ay Infections, Such as the Common Cold

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135 Unit 1: Everybody Can Learn about Nursing Objective To help students broaden their view of nursi ng as a career choice, appreciate that nurses come from diverse backgrounds, and recogni ze that nurses are both male and female Competencies and Skills Students will: Describe the many roles and responsibilities of a nurse Discuss the advanced education beyond high sc hool that is required of a nurse, and suggested high school subjects to pr epare the student to study nursing List various job opportunities and places a nurse can work Discuss employment, advancement opportunities, and job outlook State the earning pot ential of nurses Acknowledge that nurses are both male and fe male and they comprise all ethnicities Instructor Preparation Gather information from the Occupational Outlook Handbook, 2006-07 Edition, Registered Nurses http://www.bls.gov/oco/ocos083.htm o Nature of the work o Working conditions o Work values, skills, and, abilities o Required education, other qualifications, and advancem ent o Recommended school courses o Employment and job outlook o Earnings o Related occupations Include both a female and male nurse during class instruction Display posters of nurses depic ting various ethnic backgrounds Supplies o Johnson & Johnson Recruitment Posters o Johnson & Johnson Coloring Book, You Can be a Nurse o Johnson & Johnson Video, They Dare to Care o Johnson & Johnson Nursing Pin, We Dare to Care o Nursing Gang CD, Making a Difference Everyday o Nursing Crossword Puzzle Classroom Instruction o Video They Dare to Care o Roles and responsibilities o Nursing education o Employment opportunities o Diverse backgrounds o Distribute coloring book, nursing pin, and CD Assessment o Nursing Crossword Puzzle o Assign Optional Homework, Career Report

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136 Unit 2: Learning about What Nurses Need to Know Objective To help students understand that nurses n eed to know the parts of the human body and their functions Competencies and Skills Students will: Recognize the location of the major organs of the body State the primary function of the major organs of the body Instructor Preparation Prepare an introductory lesson on all the or gans of the Anatomy Apron. Information included in The Anatomy Apron Teachers Guide o Brain o Lungs o Heart o Stomach o Liver o Large and small intestines o Kidneys Supplies o Education Insights Anatomy Apron o Handouts My Body The Brain is the Boss The Real Deal on the Digestive System All About the Heart What Kids Need to Know about Kidneys Looking at Your Lungs The Whole Story on Skin Classroom Instruction o Discuss handout My Body Assessment o Locate major organs of the human body using the Anatomy Apron o State primary functions of the bodys major organs Unit 3: Learning about Skills that Nurses Perform Objective To help students understand basic skills required of nurses, specifically, major vital signs assessment skills Competencies and Skills Students w ill: List the major vital signs assessment skills o Heart rate (HR) o Respiratory rate (RR) o Temperature (T) o Blood pressure (BP)

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137 Recognize equipment used to assess major vital signs o Stethoscope o Thermometer o Blood pressure cuff Demonstrate accurately taking another students vital signs and reco rding on the Vital Signs Sheet the students HR, RR, T, and BP Instructor Preparation Prepare an introductory lesson on the major vital signs describing what they are and how to take and record them Supplies o Tools Clues handout o Vital Signs Sheet o Stethoscope(s) o Thermometer(s) o Blood pressure cuff(s) Classroom Instruction o Discussion of major vital signs (HR, RR, T, and BP) o Demonstrate how to take major vi tal signs (HR, RR, T, and BP) Assessment o Complete handout Vital Signs Sheet o Complete handout Tools Clues Unit 4: Learning What Nurses Need to Know about Everyday Infections, Such as the Common Cold Objective To help students identify ev eryday infections, how to prot ect yourself and others from these infections, and how to preven t the spread of these infections Competencies and Skills Students will: Recognize and describe common childhood infections Discuss how nurses can protect themselves a nd others from the spread of germs and infections by certain isolation precautions Acknowledge that hand hygiene is the most ef fective means to prev ent the spread of germs and infection Instructor Preparation Prepare an introductory lesson of common childhood infections and ways to prevent the spread of infection o Common Cold o Conjunctivitis (Pinkeye) o Cellulitis from everyday cuts and scrapes Prepare a lesson on how nurses protect them selv es and others from the spread of germs and infections by wearing gloves, gowns, and masks Prepare a lesson on correct hand hygiene techni ques to include: (1)proper hand-washing technique using antimicrobial soap and (2 )proper antimicrobial foam application technique

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138 Supplies o Gloves, gowns, and masks o Face shields o Optional: hair covers and shoe covers o Soap o Anti-microbial hand foam o Handouts Chilling Out with Colds Pinkeye Cellulitis What are Germs? Why Do I Need to Wash My Hands? Guest Speaker (optional) o Nurse Epidemiologist from local childrens hospital Classroom Instruction o Common childhood infectious diseases a nd ways to prevent the spread of infection o Isolation techniques o Hand hygiene techniques Assessment o Demonstrate proper donning and rem oval of gloves, gown and mask o Demonstrate proper hand hygiene technique using antimicrobial foam Instructional Sources Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 20062007 Edition Registered Nurses, on the Internet at http://wwwbls.gov/oco/ocos083.htm Educational Insights, Inc. (2000). The anatomy apron: Teachers guide Carson, CA. Ne mours Foundation, KidsHealth for Kids, Everyday Illnesses and Injuries, on the Internet at http://www.kidshealth.org/ kid/ill_injure/index.htm l Nemours Foundation, KidsHealth for Kids, My Body, on the Internet at http://www.kidshealt h.org/kid/body/mybody.ht ml Office of Science Education, Nati onal Institutes of Health, LifeWorks Registered Nurses, on the Internet at http://www.science.educati on.nih.gov/LifeW orks.nsf/Alpha betical+List/Nurse,+Register ed O*NET OnLine, on the Internet at http://online.onetcenter.org/link/details/29-1111.00#menu National Occupational Infor mation Coordinating Council. (1989). The national career development guidelines local handbook [Brochure]. Washington, DC.

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139 LIST OF REFERENCES Aiken, L., Clarke, S., Sloane, D., Sochalski, J ., & Silber, J. (2002). Ho spital nurse staffing and patient mortality, nurse bur nout, and job dissatisfaction. Journal of the American Medical Association, 288(16), 1987-1993. American Association of Colleges of Nursing. (2006a, December 5). Nursing shortage fact sheet. Retrieved December 11, 2006, from http://www.aacn.nche.edu American Association of Colleges of Nursing (2006b, December 5). Student enrollment rises in U.S. nursing colleges and universities fo r the 6th consecutive year. Retrieved December11, 2006 from http://www.aacn.nche.e du/Media/NewsReleases/06Survey.htm American Nurses Association (2003). Nursing's Social Policy Statement (2nd ed.). Silver Spring, MD: nursesbooks.org. American School Counselor Association (1984). The role of the school counselor in care guidance: Expectations and responsibilities. The ASCA Counselor, 21 (5), 8-10. American School Counselor Association. (Rev. 2006). ASCA position statements Auerbach, D. I., Buerhaus, P. I., & Staiger, D. O. (2007). Better late than never: Workforce supply implication of later entry into nursing. Health Affairs. 26 (1), 178-185. Bailey, B. A., & Nihlen, A. S. (1990). Effect s of experience with nontraditional workers on psychological and social dimensions of occupational gender-r ole stereotyping by elementary school children. Psychological Reports, 66, 1273-1282. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215. Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37 (2), 122-147. Bandura, A. (1986). Social foundations of thought and acti on: A social cognitive theory Englewood Cliffs, NJ: Prentice-Hall. Bandura, A. (1997). Self-efficacy: the exercise of control New York: Freeman. Bandura, A., Barbaranelli, C., Caprara, G. V., & Pastorelli, C. (2001). Self-efficacy beliefs as shapers of children's aspirations and career trajectories. Child Development, 72 (1), 187206. Beck, C. T. (2000). The experience of choosing nursing as a career. Journal of Nursing Education, 39 (7), 320-322. Benner, P. (1984). From novice to expert. Memphis Park, CA: Addison-Wesley.

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140 Betz, N. E. (2000). Self-efficacy theory as a basis for career assessment. Journal of Career Assessment, 8, 205-222. Betz, N. E. (2004). An expert's perspective: Self-efficacy Contribution of self-efficacy theory to career counseling: A personal perspective. The Career Development Quarterly, 52, 340353. Betz, N. E., & Hackett, G. (1981). The relationship of career-related self-effi cacy expectations to perceived career options in college women and men. Journal of Counseling Psychology, 28(5), 399-410. Betz, N. E., & Hackett, G. (1997). Application of self-efficacy theory to the career assessment of women. Journal of Career Assessment, 5, 383-402. Betz, N. E., Harmon, L. W., & Borgen, F. H. ( 1996). The relationships of self-efficacy for the Holland themes to gender, occupational gr oup membership, and vocational interests. Journal of Counseling Psychology, 43 (1), 90-98. Bigler, R. S., & Liben, L. S. (1990). The role of attitudes and interventi ons in gender-schematic processing. Child Development, 61, 1440-1452. Blegen, M., Good, C., & Reed, l. (1998) Nurse staffing and patient outcomes. Nursing Research, 47 (1), 43-49. Boughn, S. (2001). Why women and men choose nursing? Nursing and Health Care Perspectives, 22 (1), 14-19. Boughn, S., & Lentini, A. (1999) Why do women choose nursing? Journal of Nursing Education, 38 (4), 156-161. Brink, P., J., & Wood, M. J. (1998). Advanced design in Nursing Research (2nd ed.). Thousand Oaks: SAGE Publications, Inc. Buerhaus, P. I., Donelan, K., Ulrich, B. T ., Kirby, L., Norman, L., & Dittus, R. (2005a). Registered nurses' perceptions of nursing. Nursing Economic$, 23(3), 110-118. Buerhaus, P. I., Donelan, K., Ulrich, B. T., Norman, L., Williams, M., & Dittus, R. (2005b). Hospital RN's and CNO's perceptions of the im pact of the nursing shortage on the quality of care. Nursing Economic$, 23(5), 214-221. Buerhaus, P. L., Staiger, D. O ., & Auerbach, D. I. (2000). Implic ations of an aging registered nurse workforce. JAMA, 283, 2948-2954. Campbell, D. P., & Borgen, F. H. (1999). Holland's theory and the development of interest inventories. Journal of Vocational Behavior, 55, 86-101.

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141 Clarke, J. B., & Wheeler, S. J. (1992). A view of the phenomenon of caring in nursing practice. Journal of Advanced Nursing, 7, 1283-1290. Costa, P. T., Jr., & McCrae, R. R. (1986). Persona lity stability and its imp lications for clinical psychology. Clinical Psychology Review, 6, 407-423. Costa, P. T., Jr., McCrae, R. R., & Holland, J. L. (1984). Personality and voc ation interests in an adult sample. Journal of Applied Psychology, 69 (3), 390-400. Developmental Studies Center. (2005). Child Development Project Retrieved October 24, 2006, from Developmental Studies Center Web Site: http://www.devs tu.org/cdp/index.html Donelan, K., Buerhaus, P. I., Ulrich, B. T., Norman, L., & Dittus, R. (2005). Part three: Awareness and perceptions of the Johnson & Johnson campaign for nursings future: Views from nursing students, RNs, and CNOs. Nursing Economic$, 23 (4), 150-156, 180. Erikson, E.H. (1993). Childhood and society. New York: Norton. Erickson, J. I., Holm, L. J., Chelminiak, L., & Ditomassi, M. ( 2005). Why not nursing? Nursing2005, 35(7), 46-49. Fawcett, J. (2005). Contemporary nursing knowledge: Analys is and evaluation of nursing models and theories (2nd ed.). Philadelphia: F. A. Davis Company. Fields, A. (2005). Discovering Statistics Using SPSS (2nd ed.). Thousand Oak: SAGE Publications, Ltd. First Consulting Group (2002, January). The healthcare workforce shortage and its implications for America's hospitals American Hospital Association. Retrieved November 12, 2006. http://www.aha.org/key_issues/workforce/re sources.Content/FcgWorkforceReport.pdf Freeman, B. (1994). Importance of the national career development guidelines to school counselors. Career Development Quarterly, 42 (3), 224-227. Firby, P. A. (1990). Nursing: A career of yesterday? Journal of Advanced Nursing, 15, 732-737. Gillies, R. M., McMahon, M. L., & Carroll, J. ( 1998). Evaluating a career education intervention in the upper elementary school. Journal of Career Development, 24 (4), 267-287. Gottfredson, G. D. (1999). John L. Holland's cont ributions of vocationa l psychology: A review and evaluation. Journal of Vocational Behavior, 55, 15-40. Gottfredson, G. D., Jones, E. M., & Holland, J. L. (1993). Personality a nd vocational interests: The relation of Holland's six interest dimensions to five robust dimensions of personality. Journal of Counseling Psychology, 40 (4), 518-524.

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142 Gottfredson, L.S. (1981). Circumscription a nd compromise; A developmental theory of occupational aspirations. Journal of Counseling Psychology, 28, 545-579. Grossman, D., Arnold, L., Sullivan, J., Came ron, M. E., & Munro, B. (1989). High school students' perceptions of nursi ng as a career: A pilot study. Journal of Nursing Education, 28(1), 18-21. Grossman, D. G., & Northrop, C. (1993). What high school students think of a nursing career: A survey of Dade County senior high schools. Journal of Nursing Education, 32(4), 157162. Hackett, G. (1985). Role of ma thematics self-efficacy in the c hoice of math-related majors of college women and men: A path analysis. Journal of Counseling Psychology, 32 (1), 4756. Hartung, P. J., Porfeli, E. J., & Vondracek, F. W. (2005). Child vocational development: A review and reconsideration. Journal of Vocational Behavior, 66, 365-419. Health Resources and Services Administration (2004). What is behind HRSA's projected supply, demand, and shortage of registered nurses? Washington, DC: U.S. Government Printing Office. Hemsley-Brown, J., & Foskett, N. H. (1999). Car eer desirability: Young people's perceptions of nursing as a career. Journal of Advanced Nursing, 29 (6), 1342-1350. Hendrickx, L., & Finke, L. (1994). High school guidance counselors' attitudes toward nursing as a career. Journal of Nursing Education, 33(2), 87-88. Hogan, R., & Blake, R. (1999). John Holland' s vocational typology and personality theory. Journal of Vocational Behavior, 55, 41-56. Hoke, J. L. (2006). Promoting nursing as a career choice. Nursing Economic$, 24 (2), 94-101. Holland, J. L. (1959). A theory of vocational choice. Journal of Counseling Psychology, 6 (1), 35-45. Holland, J. L. (1968). Explorations of a theory of vocational choice: VI. A longitudinal study using a sample of typical college students. Monograph Supplement. Journal of Applied Psychology, 52(No.1, Part 2), 1-37. Holland, J. L. (1973). Making vocational choices: A theory of careers Englewood Cliffs, NJ: Prentice Hall. Holland, J. L. (1997). Making vocational choices: A theory of vocational personalities and work environments (3rd ed.). Odessa, Florida: Psycho logical Assessment Resources, Inc.

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143 HRSA News Room (2002). Bush admini stration promotes careers in nursing. HHS News. Retrieved December 10, 2006 from http://newsroom.hrsa.gov/releases.2002r eleases/nursesevent2with.pics.htm Johnson & Johnson (2001). Survey of American opinion of nursing Vanderbilt University, Penn. Schoen & Berland Associates. Johnson & Johnson (2007). Nursing trends: 2007: Key facts about a changing workforce. Vanderbilt Medical Center. Kelly, N., Shoemaker, M., & Steele, T. (1996). The experience of being a male student nurse. Journal of Nursing Education, 35, 170-174. Kersten, J., Bakewell, K., & Meyer, D. (1991). Motivating factors in a students choice of nursing as a career. Journal of Nursing Education, 30(1), 30-33. Kids into Health Careers. (2003). In Kids into health careers. Retrieved September 12, 2006, from Heath Resources and Serv ices Administration Web Site: http://bhpr.hrsa.gov/ki dscareers/about.htm Kohler, P. A., & Edwards, T. A. (1990). High sch ool students' perceptions of nursing as a career choice. Journal of Nursing Education, 29 (1), 26-30. Kyle, T. V. (1995). The concept of caring: A review of the literature. Journal of Advanced Nursing, 21, 506-514. Lea, A., & Watson, R. (1996). Caring research and concepts: A selected review of the literature. Journal of Clinical Nursing, 5, 71-77. Leininger, M. M. (1986). Care facilitation and resi stance factors in th e culture of nursing. Topics of Clinical Nursing, 8 (2), 1-12. Lent, R. W., Brown, S. D., & Gore, P. A. ( 1997). Discriminant and predictive validity of academic self-concept, academic self-efficac y, and mathematics-specific self-efficacy. Journal of Counseling Psychology, 44 (3), 307-315. Lent, R. W., Brown, S. D., & Hackett, G. (1994). Monograph: Toward a unifying social cognitive theory of career and academic interest, choice, and performance. Journal of Vocational Behavior, 45, 79-122. Lichtig, L., Knauf, R., & Milholland, K. (1999). Some impacts of nursing on acute care hospital outcomes. Journal of Nursing Administration, 29 (2), 25-33. Lippman, D. T., & Ponton, K. S. (1993). The image of nursing among high school guidance counselors. Nursing Outlook, 41, 129-134.

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146 Sharf, R. S. (2006). Applying career development theory to counseling (4th ed.). Canada: Thomson Corporation. Smith, K. (2002). Johnson & Johnson launches ad, recruiting campaign to reduce nursing shortage. Piscataway: Johnson & Johnson Health Care Systems Inc. Soldwisch, S. S. (1993). Care, caritas, a nd ego development. In D. Gaut (Ed.), A global agenda for caring (pp. 293-307). New York: National League for Nursing. Staiger, D. O., Auerbach, D. I., & Buerhaus, P. I. (2000). Expanding career opportunities for women and the declining intere st in nursing as a career. Nursing Economic$, 18 (5), 230236. Stevens, K. A., & Walker, E. A. (1993). Choosing a career: Why not nursing for more high school seniors? Journal of Nursing Education, 32 (1), 13-17. Super, D. E., Crites, J. O., Hummel, R. C., Mose r, H. P., Overstreet, P. L., & Warnath, C. F. (1957). Vocational development: A framework for research New York: Teachers College, Columbia University. Swanson, J. L. (1993). Integrated assessment of vocational interests and self-rated skills and abilities. Journal of Career Assessment, 1, 50-65. Swanson, J. L., & Hansen, J. C. (1988). Stability of vocational interests over 4-year, 8-year, and 12-year intervals. Journal of Vocational Behavior, 33, 185-202. Swanson, K. (1999). What is known a bout caring in nursing science. In Handbook of Clinical Nursing Research (Hinshaw A. S., Feetham, S. L., & Shaver, J. L., eds). Thousand Oaks, California: Sage. Tokar, D. M., & Swanson, J. L. (1995). Evaluation of the correspondence between Holland's vocational personality typology and the five-factor mode of personality. Journal of Vocational Behavior, 46, 89-108. Tokar, D. M., Vaux, A., & Swanson, J. L. ( 1995). Dimensions relating Holland's vocational personality typology and the five-factor model. Journal of Career Assessment, 3(1), 5774. Tracey, T. J. (2001). The development of structure of interest in chil dren: Setting the stage. Journal of Vocational Behavior, 59, 89-2001. Tracey, T. J. (2002). Development of interests and competency beliefs: A 1-year longitudinal study of fifth-to eighth-grade students usi ng the ICA-R and struct ural equation model. Journal of Counseling Psychology, 49 (2), 148-163. Tracey T. J. (2006, August 14). ICA-R. Me ssage posted to terence,tracey@asu.edu

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147 Tracey, T. J., & Ward, C. C. (1998). The stru cture of children's interests and competence perceptions. Journal of Counseling Psychology, 45(3), 290-303. Trice, A. D. (1990). Stability of children's career aspirations. The Journal of Genetic Psychology, 152(1), 137-139. Trice, A. D. (1991). A retrospective study of career development: I. Relationship among first aspirations, parental occupati ons, and current occupations. Psychological Reports, 68, 287-289. Trice, A. D., Hughes, M. A., Odom, C., Woods, K., & McClellan, N. C. (1995). The origins of children's career aspirations: IV. Testing hypotheses from four theories. The Career Development Quarterly, 43 (4), 301-322. Trice, A. D., & King, R. (1991). Stability of kindergarten children 's career aspirations. Psychological Reports, 68, 1378. Trice, A. D., & McClellan, N. (1993). Do children' s career aspirations pred ict adult occupations? An answer from a secondary analysis of a longitudinal study. Psychological Reports, 72, 368-370. United Stated General Accounting Office (2001). Nursing workforce: Emerging nurse shortages due to multiple factors (GAO-01-944). Washington, DC: U.S. Government Printing Office. Retrieved December 6, 2012, from S ubcommittee on Health, Committee on Ways and Means, House of Representatives We b Site: http://search ing.gao.gov.query.html Vondracek, F. W. (2001). The developmen tal perspective in vocational psychology. Journal of Vocational Behavior, 59, 252-261. Wahl, K. H. & Blackhurst, A. (2000). Factors affecting the occupational and educational aspirations of children and adolescents. Professional School Counseling, 3 (5), 367-374. Walsh, W. B., & Osipow, S. H. (1990). Career counseling: Contempor ary topics in vocational psychology Hillsdale: Lawrence Erlbaum Associates. Watson, J. (1985). Nursing: The philosophy and science of caring Niwot, Colorado: University Press of Colorado. Watson, J. (1988). Nursing: Human science and human care. Boulder: Colorado Associated University Press. Watson, J. (1997). The theory of human car ing: Retrospective and prospective. Nursing Science Quarterly, 10, 49-52. Watson, J. (2001). Jean Watson: Theory of human caring. In M.E. Parker (Ed.), Nursing theories and nursing practice Philadelphia: F. A. Davis.

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148 Watson, J. (2002). Assessing and measuring caring in nursing and health science New York: Springer Publishing Company, Inc. Watson, J. (2005) Caring Science as Sacred Science Philadelphia: F.A. Davis Company. Williams, B., Wertenberger, D. H., & Gushu liak, T. (1997). Why students choose nursing. Journal of Nursing Education, 36, 346-348. Wilson, C. S., & Mitchell, B. S. (1999). Nurs ing 2000: Collaboration to promote careers in registered nursing. Nursing Outlook, 47 (2), 56-61.

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149 BIOGRAPHICAL SKETCH Pa mela Lee Turner was born and raised in Jack sonville, Florida. Pamela graduated from Wolfson High School in Jacksonville in 1971. Sh e earned a Bachelor of Science in Nursing from Florida State University in 1975 and a Master of Science in Nursing from the University of Florida in 1977. Pamela has achieved nationa l certification from the Pediatric Nursing Certification Board as a Certified Pediatric Nurs e and from the American Nurses Credentialing Center as a Nurse Executive, Adva ncedBoard Certified. Pamelas nursing career has primarily been sp ent in acute care facili ties specializing in pediatric nursing care. She is currently Director of Pediatric Education and Research at Wolfson Childrens Hospital. Pamela has served as adjunc t faculty as a clinical instructor for several colleges of nursing. Her career includes being th e first female fireman to be employed by the Jacksonville Fire and Rescue Department where she functioned as a member of the rescue division. After receiving her PhD, Pamela will c ontinue her work as a pediatric practitioner and seek professional opportunities that will allow her to advance the science and practice of nursing. Pamela has been married to Joe W. Turner for 31 years. They have a daughter and a son. Their daughter, Elizabeth, is study ing to be a physician. Their son, Walker, is studying to be an electrical/computer engineer.