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Density, Energy and Metabolism of a proposed smart city
Density, Energy and Metabolism of a proposed smart city

This paper reports on a detailed analysis of the metabolism of the Island City of Mumbai should the Indian Government’s proposal for ‘smart’ cities be implemented. It focuses on the environmental impact of increased population density achieved by demolishing existing medium-rise (3-5 storey) housing and replacing it with the proposed high-rise (40-60 storey) towers. The resulting increase in density places a burden on the demand on such things as electricity and water and simultaneously increases the output flows of drainage, solid waste and greenhouse gas production. An extended urban metabolism analysis is carried out on a proposed development in Mumbai (Bhendi Bazaar) that has been put forward as an exemplar case study by the Government. The flows of energy, water and wastes are calculated based on precedents and from first principles. The results of the case study are then extrapolated across the City in order to identify the magnitude of increased demands and wastes should the ‘smart’ city proposals be fully realised. Mumbai is the densest city in the world. It already suffers from repeated blackouts, water rationing and inadequate waste and sewage treatment. The results of the study indicate, on a per capita basis, increasing density will have a significant further detrimental effect on the environment. JOURNAL OF CONTEMPORARY URBAN AFFAIRS (2017) 1(2), 57-68. https://doi.org/10.25034/ijcua.2017.3648

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A proposed plan of rotation through the medical and surgical services of a hospital

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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

All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion.

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UMI EP45758 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code

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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 .

//

/fJ T a

...............................................

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

COV 2 pi F < CDH g p} * 5c§ V £ » T o' CO p r G 3F* O CD CDCD O CL. 4 COH 4 CD CD CD O oHj C OO g CO 3 ca of *C+ CO sCD £c+ CDcr ct 6 £PiCD & CD a 3c+ |

’II