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A PROPOSED PLAN OF ROTATION THROUGH THE MEDICAL AND SURGICAL SERVICES OF A HOSPITAL
A P ro je c t P re se n te d to th e F a c u lty o f th e School o f E d u catio n The U n iv e rs ity o f S outhern C a lif o r n ia
In P a r t i a l F u lf illm e n t o f th e R equirem ents f o r th e Degree M aster o f S cien ce in E ducation
Ly M ild red L. Brown June 1950
UMI Number: EP45758
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'S O
3 P7 ^
T’A/j project reporty written under the direction of the candidate’s adviser and a p p r o ved by him, has been presented to and accepted by the Faculty of the School of Education in partial fulfillment of the requirements fo r the degree of M a ster of Science in Education .
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A dvis er
Dean
TABLE OF CONTENTS CHAPTER I.
PAGE
THE PROBLEM AND ITS IMPORTANCE.................................... The problem
..........................
1
Purpose o f th e i n v e s t ig a t io n • •
..................
1
.................... .
1
* ...............................
2
O rg a n iz a tio n o f th e rem ainder o f th e p r o j e c t
5
Method o f p ro c ed u re Importance" o f th e problem
II.
1
THE S T U D Y .................................................... C urriculum
7
.........................................................
Ward p r a c t ic e c u rric u lu m . • . ..................... . . T h e o r e tic a l c u r r i c u l u m ............................................ M edical and s u r g i c a l s e r v ic e s
...............................
7 & 10 12
M edical s e r v ic e s used f o r c l i n i c a l p r a c t ic e
12
S u rg ic a l s e r v ic e s used f o r c l i n i c a l p r a c tic e
12
A n a ly sis o f m ed ical e x p e rie n c e ...............................
19
Range in number o f p r a c t ic e days . . . . . .
19
Number o f s tu d e n ts p lace d on each m ed ical s e r v ic e
• • • • • • • • • • .........................
.
19
Range o f tim e o f e x p e rie n c e t o classro o m in s tru c tio n
22
A n a ly sis o f s u r g i c a l ex p e rie n c e . . . . . . . Range in number o f p r a c t ic e days
. . . . . .
25 25
Number o f s tu d e n ts p la c e d on each s u r g ic a l s e r v ic e
. ♦ . . ...............
. . . . . .
27
iii
CHAPTER
PAGE R e la tio n o f tim e o f e x p e rie n c e to c l a s s room i n s t r u c t i o n
III.
. . . . .............................•
27
SUMMARY AND RECOMMENDATIONS................................... .
31
Summary
. . . . . . . . . . . . . . . . . .
R e c o m m e n d a tio n s ........................................ . . . . BIBLIOGRAPHY
. . . . . . .
31 36 37
LIST OF TABLES
TABLE I.
PAGE A Comparison o f th e Rank and D eath R ates f o r th e Ten Leading Causes o f D eath in th e U nited S ta te s i n 1944 w ith th e Rank a n d D eath R ates f o r th e Same Causes i n 1900 . * .
II*
.......................
5
Number o f Weeks o f C lin i c a l E x p erien ce R equired in th e S ta te o f C a lif o r n ia and Number o f Weeks Given t o S tu d e n ts in Z School o f N ursing
III*
. . .
9
Number o f Hours o f I n s t r u c t i o n R equired byC a l i f ornia*B oard o f Nurse Exam iners and Number o f Hours Given by Z School o f N ursing in M edical and S u rg ic a l N ursing
............................... . . . . .
11
IV* The Numbers and Types o f M edical Wards A ssigned to S u p e rv is o rs A and B
.................................................
13
V. Number o f P a t i e n t s A dm itted t o G eneral M edical Wards i n 1943 A ccording to D i a g n o s i s .................. VI* S u rg ic a l S e rv ic e s A v a ila b le f o r S tu d e n t P r a c tic e VII*
16 13
Number o f S tu d e n ts P laced on th e E ig h t M edical S e rv ic e s and T h e ir Length o f S e rv ic e A ccording to W e e k s ..........................
V III*
21
Number o f S tu d e n ts P laced on M edical S e rv ic e s B e fo re , A f te r , and C o n c u rre n tly w ith I n s t r u c t i o n i n Terms o f M o n th s .....................................
.. •
23
V
TABLE IX*
PAGE Number o f S tu d e n ts P laced on th e Twelve S u rg ic a l S e rv ic e s and T h e ir Length o f S e rv ic e Accord in g t o W e e k s .......................................* • * . . . . .
X.
2$
Number o f S tu d e n ts P laced on S u rg ic a l S e rv ic e s B e fo re , A f te r , and C o n c u rre n tly w ith I n s t r u c t i o n i n Terms o f Months • . . .........................................
XI*
29
D iv is io n o f G eneral M edical and G eneral S u rg ic a l S e rv ic e s Used f o r S tu d en t E x p erien ce i n Z H o s p ita l i n t o B locks o f Three Weeks
X II.
34
Proposed P lan o f R o ta tio n th ro u g h th e G eneral M edical and G eneral S u rg ic a l S e rv ic e s which Allows A ssignm ents to th e S p e c ia l S e rv ic e s t o be U n i n t e r r u p t e d ................................................
. • .
35
LIST OF FIGURES
FIGURE I.
PAGE
Range i n Number o f Days o f P r a c tic e on th e E ig h t M edical S e rv ic e s . . ♦
II*
...................................
. . •
20
Range i n Number o f Days o f P r a c tic e on th e Twelve S u rg ic a l S e rv ic e s
......................................
26
CHAPTER
I
THE PROBLEM AND ITS IMPORTANCE The method o f p la c in g s tu d e n t n u rse s on th e m edical and s u r g i c a l s e r v ic e s o f Z H o s p ita l has been a m a tte r o f concern to th e f a c u l ty o f th e School o f N ursing f o r s e v e r a l months be cau se i t was f e l t t h a t much o f th e le a r n in g v a lu e o f th e c l i n i c a l e x p e rie n c e has been l o s t th ro u g h in a d e q u a te c o n t r o l o f s tu d e n t placem ent* I.
THE PROBLEM
P urpose o f th e i n v e s t i g a t i o n *
I t was th e purpose o f
t h i s p r o je c t t o p ropose a p la n o f r o t a t i o n th ro u g h th e m edical and s u r g ic a l s e r v ic e s o f Z H o s p ita l which would in s u r e a more l o g i c a l sequence o f c l i n i c a l p r a c tic e p e r io d s . Method o f p ro c e d u re *
The s te p s u n d e rta k e n to stu d y th e
c u rric u lu m as i t was b e in g a d m in is te re d were
( 1 ) o u tlin in g th e
t h e o r e t i c a l and ward p r a c tic e c u rric u lu m o f th e sc h o o l o f Nur s in g ; (2 ) a n a ly z in g th e m edical and s u r g i c a l s e r v ic e s a v a ila b le f o r s tu d e n t p r a c t i c e ; ( 3 ) i n v e s t i g a t in g th e e x p e rie n c e o f a c la s s o f tw en ty -se v en s tu d e n ts on th e m ed ical and s u r g i c a l s e r v ic e s i n r e l a t i o n to th e ran g e i n number o f days o f p r a c t i c e , th e number o f s tu d e n ts who re c e iv e d e x p e rie n c e on each s e r v ic e , and th e r e l a t i o n o f tim e o f e x p e rie n c e to tim e o f classro o m in s tru c tio n .
Im portance o f th e problem *
I t h as been s a id t h a t l e a r n
in g i n n u rs in g i s knowledge p u t to u s e .
Sidney L. P re s se y , in
h is Psychology and th e New E d u c a tio n , s a y s , O ther th in g s b e in g e q u a l, m a t e r i a l w i l l be remembered i n p ro p o rtio n a s i t i s m ean in g fu l, and i t i s th e m eaning f u l elem ent i n any g iv en u n i t o f s u b je c t- m a tte r which i s b e s t remembered. L earning w i l l l a s t i n p ro p o rtio n a s i t i s made s i g n i f i c a n t to th e l e a r n e r . 1 The m ean in g fu l elem en t, th e needs o f p a t ie n ts f o r n u rsin g c a r e , i s alw ays p r e s e n t.
Knowledge, th e n e c e s s a ry t o o l f o r
le a r n in g i s , s y s te m a tic a lly ta u g h t b u t i t s u se i s n o t alw ays w e ll c o r r e la te d o r i n t e g r a t e d w ith th e p a t i e n t s i t u a t i o n . The b e l i e f t h a t th e o ry and p r a c t ic e m ust be c lo s e ly r e l a t e d th ro u g h o u t th e n u rs in g c o u rse i s h e ld by th e Committee on S tan d ard s o f The N a tio n a l League o f N ursing E d u c a tio n .
To
c l a r i f y t h e i r p o s i t io n , th ey add, "The p r o p o r tio n a te em phasis on th e s e two ty p e s o f le a r n in g e x p e rie n c e sh o u ld v ary a c c o rd in g to th e e d u c a tio n a l needs o f th e s tu d e n t, and n o t a c c o rd in g to th e economic needs o f th e h o s p i t a l . ”
2
T his d e f i n i t e s ta n d would
n o t have been n e c e s s a ry i f th e p r a c t ic e o f u sin g s tu d e n ts f o r s e r v ic e had n o t been e s ta b lis h e d p re v io u s ly in n u rs in g e d u c a tio n . The Committee on C urriculum o f th e N a tio n a l League o f N ursing E d u catio n a ls o s t r e s s e s th e im p o rtan ce o f r e l a t i n g
■^Sidney L. P re s s e y , Psychology and th e New E d u catio n (New York: H arper and B ro th e rs , 1 ^4 4 ), p . 4(57* o Committee on S ta n d a rd s, E s s e n t ia l s o f a Good School o f N ursing (New York: N a tio n a l League o f N ursing E d u c a tio n , 19A ?)> P* 37*
th e o ry and p r a c t ic e i n i t s p u b lic a tio n A C urriculum Guide f o r Schools o f N u rsin g .
I n t h e i r d is c u s s io n o f t h i s problem th ey
s a y , "The main e f f o r t must be to re d u c e as f a r as p o s s ib le th e tim e e la p s in g betw een th e l e c t u r e s and c la s s e s in th e c l i n i c a l s u b je c ts and th e r e l a t e d e x p e rie n c e in th e c a re o f p a t i e n t s in th e c l i n i c a l
f i e l d s .
The tim e elem ent o f c l i n i c a l e x p e rie n c e i s n o t th e only a s p e c t to be c o n s id e re d b ecau se th e ty p e o f c l i n i c a l m a te r ia l a v a il a b l e f o r s tu d e n t p r a c t ic e i s e q u a lly im p o rta n t.
The con
t e n t o f th e c l i n i c a l e x p e rie n c e i s in d ic a te d i n th e fo llo w in g q u o ta tio n from th e I n t e r n a t i o n a l C ouncil o f N urses a s i t was ex p ressed i n 1935*
T his sta te m e n t may be s a id to r e p r e s e n t th e
p o s itio n ta k e n by t h i r t y member c o u n tr ie s b e lo n g in g to th e C o u n c il, in c lu d in g th e U nited S ta te s o f A m erica. The program o f e d u c a tio n which le a d s to th e p r o f e s s io n a l diplom a o f t r a i n e d o r g ra d u a te n u rs e , sh o u ld in c lu d e a w e ll-o rg a n iz e d c o u rse o f i n s t r u c t i o n i n th e s c i e n t i f i c , t e c h n i c a l , and s o c i a l a s p e c ts o f n u rs in g , w ith a c lo s e ly c o r r e l a t e d program o f p r a c t i c a l ex p e rie n c e i n h o s p i t a l s , o u t - p a t i e n t d e p a rtm e n ts, and o th e r h e a lth a g e n c ie s o f re c o g n iz e d s ta n d in g which p ro v id e th e number and v a r ie ty o f c a s e s n e c e s s a ry f o r e x p e rie n c e i n a l l t h e common c la s s e s o f d is e a s e found i n th e c o u n try i n w hich th e p r e p a r a tio n i s g iv e n . T his e x p e rie n c e sh o u ld be so o rgan iz e d and s u p e rv is e d t h a t each n u rse w i l l be p re p a re d to g iv e com petent n u rs in g c a re to p a t i e n t s o f b o th sex e s and a l l a g e s .4 3Committee on C u rricu lu m , A C urriculum Guide f o r Schools o f N ursing (New York: N a tio n a l League o f N ursing E d u c a tio n , IS377T p . 127.
4
A ccording to t h i s d e f i n i t i o n n u rs e s m ust be so p re p a re d t h a t th e y w i l l be com petent to g iv e n u rs in g c a re to p a t i e n t s s u f f e r in g from th e common, o r m ost f r e q u e n t, d i s e a s e s .
V ita l
s t a t i s t i c s p u b lish e d by th e U. S. D epartm ent o f Commerce, Bureau o f
C en su s^
show th e te n le a d in g cau ses o f d e a th i n th e
U n ited S ta te s in 1944 to be d is e a s e s o f th e h e a r t , ca n cer and o th e r m a lig n a n t tu m o rs, i n t r a c r a n i a l le s i o n s o f v a s c u la r o r i g i n , n e p h r i t i s , pneumonia and in f lu e n z a , a c c id e n ts (o th e r th a n m otor v e h i c l e ) , t u b e r c u lo s is o f r e s p i r a t o r y sy stem , d ia b e te s m e l l i t u s , p rem atu re b i r t h s , and m otor v e h ic le a c c id e n ts .
T able I shows
th e com parison o f th e ran k and d e a th r a t e s in 1944 w ith th o s e o f 1900.
The n u rs in g c a re o f p a t i e n t s s u f f e r in g from th e s e
d is e a s e s m u st, t h e r e f o r e , form th e c o re o f th e s t u d e n t s 1 c l i n i c a l e x p e rie n c e .
A ll th e s e c o n d itio n s , e x c e p t prem ature b i r t h s ,
a re found on th e m ed ical and s u r g i c a l s e r v ic e s o f Z H o s p ita l on which s tu d e n ts a r e p la c e d f o r c l i n i c a l p r a c t i c e . B ecause o f p re s s u r e s e x e rte d by World War I I on n u rs in g e d u c a tio n i t became n e c e s sa ry to c r i t i c a l l y examine th e c u r r ic u lum.
To h e lp s c h o o ls o f n u rs in g s tre a m lin e t h e i r c l i n i c a l ex
p e rie n c e program w ith o u t s a c r i f i c i n g th e q u a l it y o f t h e i r program s
^ I s a b e l M. S te w a rt, E d u c a tio n a l Programme o f th e School o f N u rsin g . I n t e r n a t i o n a l C ouncil o f N u rse s, Geneva, S w itz e rla n d , 1^34, p . 29, c i t e d by Committee on S ta n d a rd s , E s s e n tia ls o f a Good School o f N u rsin g . New York: N a tio n a l League o f N ursing E d u ca tio n , 19^3> P* 55* ^ V ita l S t a t i s t i c s o f th e U nited S t a t e s . 1944. P a rt I . U. S. D epartm ent o f Commerce, B ureau o f th e C ensus, W ashington, D. C ., T able V, p p . 9 -1 4 .
5
TABLE
I
A COMPARISON OF THE RANK AND DEATH RATES FOR THE TEN LEADING CAUSES OF DEATH IN THE UNITED STATES IN 1944 WITH THE RANK AND DEATH RATES FOR THE SAME CAUSES IN 1900
Causes o f d e a th —
... Rank 1944 1900
R ates p e r 100,000 p o p u la tio n 1900 1944
D ise a se s o f th e h e a r t
1
4v
315.4
137.4
Cancer and o th e r m a lig n a n t tum ors
2
8
129.1
6 4 .0
I n t r a c r a n i a l le s io n s o f v a s c u la r o r ig in
3
5
9 3 .7
106.9
N e p h r itis
4
6
69 .2
88.6
Pneumonia ( a l l form s) and in f lu e n z a
5
1
6 1 .7
202.2
A ccid en ts (o th e r th a n m otor v e h ic le )
6
7
53.5
72.3
T u b e rc u lo s is o f r e s p i r a t o r y system
7
2
38 .3
174.5
D ia b e te s M e llitu s
8
18
2 6 .4
1 1 .0
P rem ature b i r t h s
9
11
2 5 .0
3 2 .4
Motor V eh icle A ccid en ts
10
18.3
a Committee on E d u c a tio n a l Problem s i n Wartime was form ed.
A
s e r i e s o f fo u rte e n b u l l e t i n s was p u b lish e d d e a lin g w ith problem s o f c u rric u lu m a c c e l e r a ti o n .
H ere, a g a in , th e c l i n i c a l p r a c t ic e
i s c o n s id e re d th e c o re o f th e n u rs in g c u rric u lu m about which a l l e l s e i s to be b u i l t . fo r c lin ic a l ro ta tio n .
T his r e q u ir e s a w e ll-o rg a n iz e d p lan In d ev e lo p in g such a p lan th e ty p e ,
th e le n g th , and th e sequence o f th e c l i n i c a l assig n m en ts m ust 6 be shown f o r each c l a s s . I t i s p a te n tly im p o ssib le f o r a l l members o f one c l a s s to proceed from one s e r v ic e t o a n o th e r a t th e same tim e o r i n th e same o r d e r . O rg a n iz a tio n o f th e rem ain d er o f th e p r o j e c t .
C hapter
I I r e p o r t s th e r e s u l t s o f a stu d y o f th e c l i n i c a l e x p e rie n c e o f tw en ty -se v en s tu d e n ts on th e m edical and s u r g i c a l s e r v ic e s o f Z H o s p ita l.
The t h e o r e t i c a l and ward p r a c tic e c u rric u lu m a s i t
m eets s t a t e minimum re q u ire m e n ts i s o u tlin e d f i r s t .
The m ed ical
and s u r g i c a l c l i n i c a l f a c i l i t i e s used f o r s tu d e n t p r a c tic e a r e c o n sid e re d in re g a rd to ty p e o f d is e a s e c o n d itio n s p r e s e n t, s i z e , and o r g a n iz a tio n o f s e r v i c e s .
The r e s t o f th e c h a p te r p re s e n ts
th e e x p e rie n c e o f s tu d e n ts on th e s e s e r v i c e s . The t h i r d c h a p te r c o n ta in s a summary o f th e p r o j e c t and recom m endations made.
A proposed p la n o f r o t a t i o n th ro u g h th e
m ed ical and s u r g i c a l s e r v ic e s i s in c lu d e d . 6 Committee on E d u c a tio n a l Problem s i n W artim e? D evelop in g a M aster P lan f o r R o ta tio n o f S tu d e n ts th ro u g h C l in i c a l A ssignm ents (New York: N a tio n a l League o f N ursing E d u c a tio n , N ursing E d u catio n i n Wartime B u l l e t i n No. 11, M arch, 1 , 19 4 5 ), p. 2.
CHAPTER
II
THE STUDY The c l a s s o f s tu d e n ts s e le c te d f o r stu d y was composed o f tw e n ty -se v e n s tu d e n ts who w ere com pleting th e l a s t s i x months o f th e n u rs in g c o u rs e .
T his was f e l t t o be d e s ir a b le because
o f th e a v a i l a b i l i t y o f th e r e c o r d s , t h e o r e t i c a l and c l i n i c a l e x p e rie n c e , and th e f a c t t h a t th ey had com pleted two y e a rs o f p ra c tic e .
D uring t h i s tim e th e y should have f i n i s h e d , or n e a rly
s o , t h e r e q u ir e d amount o f m ed ical and s u r g ic a l n u rs in g p r a c t i c e . These s tu d e n ts e n te re d i n F eb ru a ry , 1947 which means t h a t th e y r e p r e s e n t a p o st-w a r group which was n o t s u b je c te d to th e same p re s s u r e s as p re v io u s c l a s s e s .
The ty p e o f c l i n i c a l ex
p e rie n c e th e y r e c e iv e d would b e , t h e r e f o r e , m ost c h a r a c t e r i s t i c o f fu tu re c la s s e s .
The cu rric u lu m and ty p es o f m ed ical and
s u r g i c a l s e r v ic e s on which th e y re c e iv e d e x p e rie n c e a r e de?» s c r ib e d i n fo llo w in g p a ra g ra p h s .
The sequence o f s e r v ic e s and
th e r e l a t i o n o f tim e o f s e r v ic e to tim e o f i n s t r u c t i o n f o r t h a t c l i n i c a l a r e a a r e a l s o d is c u s s e d . I,
CURRICULUM
A sc h o o l o f n u rs in g must meet th e minimum re q u ire m e n ts o f th e Board o f N urse Exam iners o f th e s t a t e i n which i t i s lo c a te d so t h a t i t s g ra d u a te s can se c u re r e g i s t r a t i o n . re q u ire m e n ts govern s u b je c ts ta u g h t as w e ll as le n g th o f
These
c l i n i c a l e x p e rie n c e i n th e v a rio u s s e r v i c e s .
The le n g th o f
th e . n u rs in g c o u rse i s th r e e c a le n d a r y e a rs or one hundred and f i f t y - s i x w eeks. Ward p r a c t ic e c u rric u lu m .
The minimum re q u ire m e n ts o f
th e C a lif o r n ia Board o f Nurse Examiners f o r c l i n i c a l e x p e rie n c e and th e weeks o f e x p e rie n c e g iv en to s tu d e n t n u rse s i n Z School o f N ursing a r e shown i n T able I I . The sequence o f th e c l i n i c a l e x p e rie n c e i s such t h a t p r a c t i c e on th e m ed ical and s u r g ic a l w ards fo llo w s im m ediately a f t e r th e p r e c l i n i c a l p e r io d .
The le n g th o f tim e f o r which
each s tu d e n t w i l l be a s s ig n e d v a r ie s becau se i t i s im p o ssib le t o accom odate a l l on each s e r v ic e a t one tim e th ro u g h o u t th e co u rse w ith o u t je o p a r d iz in g t h e i r le a r n in g e x p e rie n c e s and d i s r u p tin g th e r o u tin e s o f p a t i e n t c a r e .
The u s u a l p ro c ed u re i s
t o a s s ig n them t o e i t h e r th e m edical o r s u r g i c a l s e r v ic e in b lo c k s o f th r e e to s i x w eeks. Depending on th e number o f s tu d e n ts i n th e c l a s s , s tu d e n ts w i l l be r o t a t e d th ro u g h th e D ie t T herapy, O p e ra tin g Room, and Communicable D ise a se d ep artm en ts b eg in n in g th e second o r t h i r d month fo llo w in g th e p r e c l i n i c a l p e r io d .
A ll s tu d e n ts must have
had O p eratin g Room e x p e rie n c e b e fo re th e y may be a s s ig n e d to th e O b s t e t r i c a l o r P e d i a t r i c s d e p a rtm e n ts. Assignm ents t o a l l s p e c ia l s e r v ic e s a r e u n in te r r u p te d so t h a t th e s tu d e n t com pletes h e r e x p e rie n c e b e fo re she i s r e a s s ig n e d .
T h is i s n o t t r u e o f th e m ed ical and s u r g ic a l
9 TABLE
II
NUMBER OF WEEKS OF CLINICAL EXPERIENCE REQUIRED IN THE STATE OF CALIFORNIA AND NUMBER OF WEEKS GIVEN TO STUDENTS IN Z SCHOOL OF NURSING C lin ic a l e x p e rie n c e
C a lif o r n ia re q u ire m e n ts
Z School o f N ursing re q u ire m e n ts
P r e c l i n i c a l p e rio d
24*
24
M edical N ursing
20
24
S u rg ic a l N ursing
20
24
D ie t Therapy
4
4
O p eratin g Room Technique
a
12
O b s te tr ic N ursing
12
14
N ursing o f C h ild re n
12
14**
4
6
V acatio n
12
12
S e le c te d E x p e rie n e e : (to com plete 156 weeks)
40
Communicable D isea se N ursing o r T u b e rc u lo sis N ursing
P s y c h ia tr ic N ursing
4
O rth o p ed ic N ursing
4 12
A s s is ta n t Head N urse
4
U nassigned tim e T o ta l
156
156
❖This p e rio d may be o f 16 weeks d u r a tio n i f th e c l a s s a d m itte d has had p r e p a r a tio n i n th e p r e c l i n i c a l scien ce* ❖❖The a d d i t i o n a l two weeks a r e d ev o ted t© e x p e rie n c e i n th e Form ula S ta tio n *
e x p e rie n c e w hich m ust f i t around th e s p e c ia l s e r v ic e a s s ig n m ents i f a l l s tu d e n ts a r e to have th e r e q u ir e d amount o f p ra c t i c e i n a l l s e r v ic e s d u rin g th e t h r e e - y e a r c o u r s e .
T his means
t h a t an in d iv id u a l s tu d e n t may com plete h e r m ed ical o r s u r g ic a l e x p e rie n c e only a f t e r re p e a te d re a ssig n m e n ts to th e d iv i s io n i n th e two and o n e - h a lf y e a rs a f t e r th e p r e c l i n i c a l p e r io d . T his b re a k s th e c o n tin u ity and sequence o f h e r s e r v ic e t o th e p o in t t h a t th e le a r n in g v a lu e o f th e p r a c tic e p e rio d i s l e s s ened. T h e o r e tic a l c u rric u lu m .
Only t h a t p a r t o f th e t h e o r e t i
c a l cu rric u lu m which p e r ta in s to th e m ed ical and s u r g i c a l s e r v ic e s used f o r s tu d e n t e x p e rie n c e i s g iv e n i n T able I I I .
The
C a lif o r n ia minimum re q u ire m e n t f o r a l l G eneral M edical and S u r g ic a l n u rs in g c la s s e s i s 160 h o u rs . a t o t a l o f 224 h o u rs a r e g iv e n .
I n 2 School o f N ursing
T able I I I shows th e breakdown
o f th e s e c la s s e s a c c o rd in g to s u b je c t and number o f ho u rs g iv en The sequence o f th e c la s s e s i s such t h a t M edical N ursing S u rg ic a l N u rsin g , and D ie t Therapy a r e ta u g h t d u rin g th e s i x months im m ediately fo llo w in g th e p r e c l i n i c a l p e r io d .
These a r e
c o n sid e re d b a s ic to i n s t r u c t i o n i n a l l o th e r c l i n i c a l e n t i t i e s . D uring th e n e x t s i x months s tu d e n ts r e c e iv e i n s t r u c t i o n i n G y n eco lo g ical N ursing a s w e ll as Eye, E a r, Nose, and T hroat N u rsin g . Neuro M ed ica l, O rth o p e d ic , and Neuro S u rg ic a l N ursing
11 TABLE
III
NUMBER OF HOURS OF INSTRUCTION REQUIRED BY CALIFORNIA BOARD OF NURSE EXAMINERS AND NUMBER OF HOURS GIVEN BY Z SCHOOL OF NURSING IN MEDICAL AND SURGICAL NURSING Type o f in s tru c tio n M edical and S u rg ie a l N ursing ( i n c . p ath o lo g y )
Minimum hours re q u ir e d
160
Hours g iv e n
224
G eneral M edical N ursing
4#
G eneral S u rg ic a l N ursing
40
D erm atology, in c . A lle rg y
16
O p eratin g Room Technique
16
O rthopedic N ursing
32
Eye, E a r, Nose and T hroat N ursing
24
U ro lo g ic a l and V enereal D ise a se N ursing
16
N e u ro lo g ic a l N ursing
32
D ie t Therapy
16
❖ G ynecological N ursing P s y c h ia tr ic N ursing
32 16
32
32
❖The s t a t e re q u ire m e n t i s 4$ h o u rs o f combined O b s t e t r i c a l and G y n eco lo g ical N ursing* Z School o f N ursing g iv e s 32 h o u rs i n s t r u c t i o n i n O b s t e t r ic a l N ursing and 16 ho u rs i n s t r u c t i o n i n G y n eco lo g ical N ursing*
12
c la s s e s a r e o ffe re d betw een th e se v e n te e n th and tw e n tie th m onths• U ro lo g ic a l and D erm ato lo g iea l N ursing c la s s e s fo llo w betw een th e n in e te e n th and tw en ty -seco n d m onths.
In s tru c tio n
i n P s y c h ia tr ic N ursing does n o t b eg in u n t i l th e tw e n ty -fo u rth m onth.
T his sequence o f s u b je c ts fo llo w s th e g e n e r a lly a c c e p te d
cu rric u lu m p a t t e r n . II.
MEDICAL AND SURGICAL SERVICES
The School o f N ursing a s s ig n s th e s tu d e n t f o r a s t a t e d number o f weeks to th e m ed ical o r s u r g ic a l d e p a rtm e n ts .
It
th e n becomes th e r e s p o n s i b i l i t y o f th e n u rs in g departm ent to p la c e th e s tu d e n t on any o f th e G eneral M edical o r G eneral S u r g ic a l s e r v i c e s .
The School o f N ursing has no v o ic e i n th e
placem ent o f th e s tu d e n ts w ith in th e s e two g e n e ra l d i v i s io n s . M edical s e r v ic e s used f o r c l i n i c a l p r a c t i c e .
Two f l o o r s
o f H o s p ita l Z a re d ev o ted to th e c a re o f p a t i e n t s w ith m edical d ia g n o se s and a r e known a s th e G eneral M edical s e r v i c e s .
Each
f l o o r has i t s own s u p e rv is o r whose r e s p o n s i b i l i t i e s in c lu d e th e d i r e c t i o n o f th e n u rs in g e a re o f a p p ro x im a te ly two hundred and f i f t y to t h r e e hundred p a t i e n t s d a ily a s w e ll a s th e r o t a t i o n o f s tu d e n t n u rs e s th ro u g h th e dep artm en t f o r t h e i r c l i n i c a l e x p e rie n c e .
The number and ty p e o f wards a s s ig n e d to each
s u p e r v is o r a r e l i s t e d i n T able IV .
13 TABLE
IV
THE NUMBER AND TYPES OF MEDICAL WARDS ASSIGNED TO SUPERVISORS A AND B
Type o f ward
Number o f wards S u p e rv iso r A S u p e rv iso r B
G eneral M edical Male
2
2
Female
1
1
Male and fem ale
2
2
De rm a to lo g i c a l
1
D ia b e tic
1
A dm itting
1
1
Pneumonia
1
O u t- P a tie n t c l i n i c s
2
T o ta ls
9
14
Eaeh ward was d e sig n e d to accom odate th i r t y - s e v e n p a t i e n t s b u t, d u rin g th e w in te r m onths, th e d a i ly p a t i e n t census may re a c h f i f t y - f i v e to s i x t y p a t i e n t s .
The s u p e rv is o r may a s s ig n
s tu d e n ts t o any o f th e l o c a tio n s on th e s e r v ic e when th e s t u d en t has been a s s ig n e d to h e r f o r m ed ical e x p e rie n c e .
Ho
cu m u lativ e re c o rd w hich would show th e p a s t e x p e rie n c e o f th e s tu d e n t i s a v a il a b l e f o r use by th e s u p e rv is o r to a s s i s t h e r i n making a ssig n m e n ts. Of th e te n le a d in g causes o f d e a th l i s t e d i n 1944, s i x a r e found on th e two G eneral M edical f l o o r s .
(See T able I . )
These a r e d is e a s e s o f th e h e a r t , c a n c e r, pneum onia, a c c id e n ts (o th e r th a n m otor v e h i c l e ) , t u b e r c u lo s i s , and d ia b e te s m e l l i t u s . A m alignancy ward i s in c lu d e d on th e s u r g ic a l s e r v i c e , b u t p a t i e n t s w ith c a n cer a r e a d m itte d to th e m ed ical w ards when tre a tm e n t o f m ed ical c o n d itio n s i s o f prim ary im p o rta n c e . P a t i e n t s w ith i n t r a c r a n i a l le s io n s o f v a s c u la r o r i g i n , which ra n k s as th e t h i r d le a d in g cau se o f d e a th , a r e a d m itte d to th e Neuro M edical s e r v i c e .
N e p h r itic p a t i e n t s a r e c a re d f o r on
th e G e n ito -U rin a ry s e r v i c e .
P a tie n ts w ith i n j u r i e s due to
m otor v e h ic le a c c id e n ts a re a d m itte d to e i t h e r th e Neuro S u rg i c a l o r O rth o p ed ic s e r v ic e depending on th e n a tu r e o f th e i n j u r y . No m a tte r what ty p e o f m ed ical o r s u r g ic a l problem d ia b e tic p a t i e n t s may have th e y a r e alw ays a d m itte d t o one o f th e D ia b e t i c w ards b ecau se o f th e d i e ta r y problem s o f t h i s n u t r i t i o n a l d is e a s e .
15
A sam pling was made o f th e number o f p a t i e n t s a d m itte d to th e te n G eneral M edical wards pirns th e Penumonia ward w ith d iag n o ses o f th e above m entioned le a d in g cau ses o f d e a th , ex c lu s iv e o f d ia b e te s m e l l i t u s .
T his was done to d eterm in e
w hether s tu d e n t n u rs e s need t o have assig n m en ts to a l l G eneral M edical w ard s.
The sam pling was made by ta b u la t in g th e number
o f p a t i e n t s a d m itte d to th e s e w ards th e f i r s t week o f every month d u rin g 194#•
The t o t a l number o f ad m issio n s f o r th e
y e a r was c a lc u la te d by th e fo rm u la: t o t a l number o f p a t i e-nj —t s a d m itte d i n 12 weeks-
x 52.
C au tio n m ust be used i n th e i n t e r p r e t a t i o n o f th e f ig u r e s de r iv e d b ecau se th e y r e p r e s e n t th e t o t a l s o f a d m ittin g d iag n o ses r a t h e r th a n f i n a l d ia g n o s e s.
I t i s h ig h ly p ro b a b le t h a t a
com parison o f th e two would show d i f f e r e n c e s , b u t th e y a r e u se f u l i n showing s i m i l a r i t i e s o f c l i n i c a l m a te r ia l on each w ard. The r e s u l t s o f t h i s t a b u l a ti o n a r e shown i n T able V. The o th e r m ed ical w ards which a re used in c lu d e th r e e wards o f p a t i e n t s c l a s s i f i e d a s Neuro M ed ica l.
These wards
co rresp o n d i n s i z e and occupancy r a t e to th e G eneral M edical w ard s. The A d m ittin g D epartm ent r e c e iv e s a l l p a t i e n t s e n te r in g th e h o s p i t a l .
Here i n i t i a l d ia g n o se s a r e made and emergency
tre a tm e n t i s g iv e n when n e c e s s a ry ;
From h e re th e p a t i e n t s
a r e s e n t to th e a d m ittin g w ards o f th e s e r v ic e to which th e y
TABLE
V
NUMBER OF PATIENTS ADMITTED TO GENERAL MEDICAL WARDS IN 3194S ACCORDING TO DIAGNOSIS
Ward
D iseases of ; h e a rt
Cancer
Pneumonia
A ccidents (E xclusive o f motor v e h ic le )
399 156 350 499 463
113 17 78 61 65
69 35 95 117 134
130 26 65 39 69
4
186 377 274 238 443. 470
30 78 56 35 113 39
524 82 65 69 108 108
48 130 48 65 56 69
17
T uberculosis of r e s p ir a to r y system
S u p erv iso r A Female Ward Male and Female Ward Male and Female Ward Male Ward Male Ward
4 4 9
S u p erv iso r B Pneumonia Ward Female Ward Male and Female Ward Male and Female Ward Male Ward Male Ward
4 9 13
H S
17
have been assig n ed * The P s y c h ia tr ic D iv is io n i s s e p a ra te d from th e main h o s p ita l*
The c a p a c ity o f t h i s d i v i s io n i s n in e ty -tw o p a t i e n t s
b u t t h e d a i l y census f r e q u e n tly re a c h e s one hundred and f i f t y p a tie n ts . S u rg ic a l s e r v ic e s used f o r c l i n i c a l p r a c t i c e *
T able
VI shows th e ty p e s o f s u r g i c a l s e r v ic e s a v a ila b le f o r p r a c t i c e and th e number o f wards devoted to ea ch . The G eneral S u r g ic a l, B urn, and C hest wards a r e combined under th e a d m in is tr a tio n o f one s u p e r v is o r .
D re s s in g s , a te c h
niq u e w hich r e q u ir e s s k i l l and competency from th e n u r s e , i s a ls o a p a r t o f t h i s s e r v i c e . A nother co m b in ation o f s e r v ic e s under one s u p e rv is o r i s composed o f G ynecology, I n f e c te d O b s t e t r i c s , and M alignancy. The rem ain d er o f th e s e r v ic e s a r e u n d er s e p a r a te s u p e r v is o r s . A ll o f th e s e wards have a c a p a c ity o f t h i r t y - s e v e n p a t i e n t s b u t, l i k e th e m ed ical w ards, have a p a t i e n t census o f f i f t y o r more p a t i e n t s d u rin g some p e rio d s o f th e y e a r . R ecords o f th e ad m issio n s t o th e G eneral S u rg ic a l w ards w ere n o t a v a i l a b l e .
However, o b s e rv a tio n has shown t h a t p a t i e n t s
w ith d is e a s e s o f th e h e a r t , which ra n k s f i r s t a s a le a d in g cau se o f d e a th , and c a n cer which ra n k s seco n d , a r e a d m itte d to th e s e wards -when th e y a r e a s u r g ic a l problem .
TABLE
VI
SURGICAL SERVICES AVAILABLE FOR STUDENT PRACTICE Wards
G eneral S u rg ic a l Burns Chest
3 1 1
E ar, Nose, and Throat Eye G enito-U rinary
1 1 3
Gynecology In fe c te d o b s te tr ic s M alignancy
2 1 1
Neuro S u rg ical O rthopedics
2 3
Surgery
1 1 1
O u t-P a tie n t c lin ic
A dm itting ward
P la s te r room
1 1 1
1
1
1
* H
03-
19
III.
ANALYSIS OF MEDICAL EXPERIENCE
Range i n number o f p r a c tic e d a y s.
The v a r i a t i o n in
number o f days o f p r a c t ic e on th e m ed ical s e r v ic e s ra n g ed from two to one hundred and one d a y s. made i n term s o f w eeks.
A ll c l i n i c a l assig n m en ts a r e
As can be seen from F ig u re I some s t u
d e n ts had l e s s th a n one week o f p r a c t i c e on th e Female M ed ical, D e rm a to lo g ic a l, D ia b e tic , and Pneumonia w ard s.
These fo u r
ty p e s o f m e d ic a l s e r v ic e s a r e under th e s u p e rv is io n o f Super v is o r s A and B whose r e s p o n s i b i l i t y i t i s to r o t a t e th e s tu d e n ts th ro u g h t h e d e p a rtm e n t.
The only f e a s i b l e e x p la n a tio n f o r th e s e
p r a c t ic e p e rio d s o f l e s s th a n one week i s t h a t th e s tu d e n t* s r e g u la r assig n m en t was broken i n o rd e r t o co v er emergency s i t u a t i o n s on th e s e r v i c e .
E v id e n tly th e s u p e r v is o r ’s i n t e r p r e t a t i o n
o f th e s t u d e n t ’s assig n m en t i s to th e whole s e r v ic e i r r e g a r d l e s s o f th e lo c a tio n w ith in th e s e r v ic e . Number o f s tu d e n ts p la c e d on each m ed ical s e r v i c e . T able V II shows th e number o f s tu d e n ts p la c e d on each o f th e e ig h t m ed ical s e r v i c e s .
A ll s tu d e n ts had p r a c t ic e on th e Female
M ed ical, Male M e d ic a l, and Neuro M edical w ard s. d e n ts were s e n t to th e A dm itting D epartm ent.
Only fo u r s t u
A t o t a l o f seven
s tu d e n ts had p r a c t i c e p e rio d s o f l e s s th a n one week on fo u r o f th e s e r v i c e s . The th r e e s tu d e n ts who had l e s s th a n one week o f ex p er ie n c e on th e Female M edical wards were s e n t t o th e Male M edical
20 FIGURE
I
RANGE IN NUMBER OF DAYS OF PRACTICE ON , THE EIGHT MEDICAL SERVICES
Female M edical
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 7
Male M edical
101
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
D e rm a to lo g ic a l
xxxxxxxxxxxxxxx
D ia b e tic
xxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxx
Neuro S u rg ic a l 3
20
xxxxxxxxxxxxxxxxxxxx
Penumonia
xxxxxxxxxxxx
P s y c h ia try
xxxxxxxxxxxx
A dm itting D epartm ent
0
NOTE: T his s e r v ic e th e on th e Male from 7 days
f i g u r e sh o u ld be re a d as fo llo w s : In th e Female M edical number o f days o f p r a c t ic e ranged from 4 days to 66 days; M edical s e r v ic e th e number o f days o f p r a c t ic e ranged t o 101 d ay s, e t c .
TABLE
VII
NUMBER OF STUDENTS PLACED ON THE EIGHT MEDICAL SERVICES AND THEIR LENGTH OF SERVICE ACCORDING TO WEEKS Number o f stu d e n ts p laced
Less than 1
1
2
3
Number o f weeks 4 5 6 7 a 9 10
1
4
1
3
6
3
2
2
2
1
3
3
1
6
4
3
1
2
6
2
Female M edical
27
Male M edical
27
D erm atological
IS
2
3
5
D ia b e tic
25
2
2
a 5 5 2 1
Neuro M edical
27
1
2
7 10
7
Pneumonia
16
3
3
2
1
1
P s y c h ia tric
13
1
2
a 2
1
2
A dm itting departm ent
4
3
6
1
1
ll
12
13
1
14
15
1
M edical wards 3 s tu d e n ts had a s e rv ic e of le s s than 3 weeks, 1 stu d e n t was placed fo r one week, 4 s tu d e n ts were p laced fo r two weeks, 1 fo r th re e weeks, 3 fo r fo u r weeks, 6 fo r f iv e weeks, th r e e fo r s ix weeks, 2 f o r seven weeks, 2 fo r e ig h t weeks, and 2 f o r nine weeks» H
22
wards f o r p e rio d s ra n g in g from s i x to f i f t e e n weeks*
T his
sh o u ld have g iv en them ad e q u ate e x p e rie n c e i n th e c a re o f p a t i e n t s w ith g e n e ra l m ed ical d ia g n o se s . Because d ia b e te s ra n k s e ig h th as a cau se o f d e a th in th e U n ited S ta te s s tu d e n ts co u ld w e ll use a t l e a s t two weeks p ra c t i c e i n th e c a re o f th e s e p a t i e n t s .
Four s tu d e n ts had le s s
th a n two weeks o f p r a c t ic e on t h i s s e r v i c e .
Of th e tw en ty -
seven s tu d e n ts in th e c la s s two s tu d e n ts have n o t had a s e r v ic e on th e D ia b e tic w ard s. I t i s n o t so im p o rta n t t h a t e le v e n s tu d e n ts had no ex p e rie n c e on th e Pneumonia wards because p a t i e n t s w ith a d ia g n o s is o f pneumonia a r e found on th e G eneral M edical w ards. T h irte e n s tu d e n ts have n o t been s e n t to th e P s y c h ia tr ic s e rv ic e .
However, th e y w i l l be s e n t to t h i s d ep artm en t b e fo re
th e n u rs in g c o u rse i s com pleted becau se i t i s one o f th e r e q u ire d assig n m en ts o f th e " s e le c te d e x p e rie n c e " a s shown in T able I I . Range o f tim e o f e x p e rie n c e to classro o m i n s t r u c t i o n . T able V III g iv e s a summary o f th e numbers o f s tu d e n ts who had c l i n i c a l e x p e rie n c e on th e m ed ical s e r v ic e s b e f o r e , a f t e r , and c o n c u rre n tly w ith classro o m i n s t r u c t i o n .
No s tu d e n t had p ra c
t i c e on th e Fem ale, M ale, D ia b e tic , and Pneumonia wards b e fo re i n s t r u c t i o n was g iv e n .
S u b je c t m a tte r co n c ern in g th e c a re o f
p a t i e n t s w ith d iag n o ses found on th e s e w ards i s g iv e n in th e
TABLE
V III
NUMBER OF STUDENTS PLACED ON MEDICAL SERVICES BEFORE, AFTER, AND CONCURRENTLY WITH INSTRUCTION IN TERMS OF MONTHS
Medical serv ice
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