THE subcommittee on graduate education of the Department of Baccalaureate and Higher Degrees of the National League for Nursing has been working on the problem of defining graduate content and of differentiating graduate education in nursing from that of the baccalaureate level. Since the subcommittee's 1963 meeting in Phoenix, Arizona, the various clinical and functional specialties in nursing also have been concerned with this problem. A sharing of the conceptualization of the problem and the philosophy relevant to its resolution appears to be the major task at this time. With the many specialized programs in graduate education in nursing and many specialized branches of the medical sciences that need the services of graduates of these programs, it seems reasonable that a philosophy should exist regarding the allocation, dispensation, usefulness, and differentiation between graduate content and baccalaureate content.
In psychiatric nursing, for example, the catalogs, brochures, and interviews with individual students from the various programs suggest that graduate education rests on "therapy" and "community services." Such may be very appropriate to a successful end in the practice of psychiatric nursing. However, the aims of graduate preparation in psychiatric nursing have not been clearly established. This is not to say what the content is nor to specify the scope of practice which the graduate will undertake. Rather, it is to set forth a practical philosophy for carrying out effective graduate preparation in psychiatric nursing.
Differentiation between baccalaureate and graduate study in psychiatric nursing must proceed from the demonstrated performance and abilities, or assets, which the student exhibits in performing the role of a psychiatric nurse. Psychiatric nursing may be assessed on the basis of (1) knowledge, (2) attitudes-values, beliefs, (3) social and/or personal values, and importantly, (4) demonstrated or indicated behaviors. The developmental processes of these components are relative to differentiating between baccalaureate and graduate education.
Graduate students may be differentiated from baccalaureate students to a statistically significant degree in their accumulation of psychiatric and psychiatric nursing knowledge and techniques. Such differenentiation may be assessed by means of any standardized or subjective testing devices. This differentiation may be obtained (1) by intensifying content through a thorough, systematic analysis of mental and emotional development and psychopathology and (2) by emphasis on therapeutic (e.g., interpretive) rather than milieu (i.e., social) behavior associated with dealing with psychiatric patients. Additionally, a breadth of knowledge is obtained by the graduate which is not readily available to the undergraduate. This occurs through a study of other than neo-analytically oriented psychiatry or psychiatric nursing. Specificaly, this occurs through psychological, clinical, and traditional studies of human behavior rather than through the traditional pathologically oriented behaviors stressed in psychiatry, and incorporates appropriate elements from sociology, anthropology, education, and related disciplines. It also occurs through participation in clinically associated studies (e.g., mental health consultation) which are not offered to the undergraduate.
Basic Attitudes -Values or Beliefs
The mode of practice of psychiatric nursing by the individual practitioner is a reflection of the basic attitudes and value systems held by the practitioner. These attitudes and systems are on a continuum which may be designated as ranging between the extremes of custodial care (nontherapeutic or even detrimental) to individualized therapeutic values. It is expected that the graduate student will be differentiated from the baccalaureate student to a statistically significant degree as measured by any therapeutically oriented measurement currently used in practice. It is further anticipated that statistically the baccalaureate student would not be significantly different from the staff nurse, whereas the graduate student would have the attitudes and values held by the instructional staff. Such attitudes and values are believed to be capable of subjective elicitation through the expressed philosophy of the student based upon professional practices and knowledge relevant to creating and mamtaining therapeutic psychiatric clinical facilities. This represents an enhancement or refinement beyond that which the baccalaureate student is expected to achieve, and is based upon an exploration by, and integration within, the graduate as a result of more intense reading and tutelage than is afforded the undergraduate.
Social and Personal Values
In the belief that an individual gravitates toward a personal, social, cultural, and economic climate which is conducive to his personal integrity, his choice of vocation will reflect these variables and will possess a dictating affective influence on the individual. It therefore follows that the individual would express continuing and increasing acceptance of the social, cultural, and economic standards relevant to his vocation. Such may be determined for baccalaureate and graduate students, and is expected to vary to a statistically significant degree between them. This is basically due to the aforementioned variables, and may also be due to the building and conditioning process associated with an intimate relationship to the vocation. The average baccalaureate student does not have role identification with psychiatric nursing whereas the graduate student does. This role identification is one of the major determinants of personal development and integration.
Indicated and Demonstrated Behaviors
The baccalaureate student is prepared to function in a beginning psychiatric nurse staff position under supervision. This implies the ability to carry out conventional beginning psychiatric nursing practices which contribute to the effective functioning of the psychiatric ward or unit. The graduate student is expected to develop the ability to function without supervision in identifying, defining, executing, maintaining, and evaluating the ward habitat. In caring for individual patients, the undergraduate is geared toward traditional nursing procedures involving the daily maintenance and progressive well being of the patient, but she is not expected to reflect the sophistication of goal-directed and planned total care which the graduate student should possess. For example, the undergraduate would maintain a basically "healthful," socially accepting supportive milieu for the patient. The consequent relation with the patient is that of a benign, if not superficial, relation predicated by the realities of available time. Believing that subtleties gained or observed in practice are as valuable and necessary as didactic presentation or conceptual development, the baccalaureate student cannot be regarded as having more than the minimal opportunities and experience for professional development. The graduate student is afforded the opportunity for additional experience, coupled with role playing in professional (i.e., therapeutic) as opposed to milieu (i.e., social) relationships and freedom to choose and develop avenues and techniques of interest. Generally, the graduate student is expected to be cognizant of, and to weigh in importance, categories of psychiatric nursing practice. Specifically, she is expected to assess and deal with patient relationships ( 1 ) by identifying the appropriate psychotherapeutic activity to be prescribed for an individual patient, (2) by knowing and indicating to the appropriate degree the purpose of the activity, (3) by describing and critically evaluating the means to be taken to achieve the purpose, (4) by giving evidence of achievement of purpose or failure to achieve, (5) by exploring alternate approaches when indicated, (6) by suggesting and readily incorporating changes, (7) by verifying or identifying activity or behavior to be retained or built upon, and (8) by citing theoretical and fundamental principles for action proposed or undertaken, and (9) by giving reasons for a) what has occurred, (b) recommendations, and/ or (c) post hoc events.
When the product of psychiatric nursing education is viewed in this light it becomes easier to state objectives and to determine specific content and practice for the student. Within such a structure the philosophy and concepts of the faculty become reality through a genuine feeling of positive production rather than mode satisfaction. While the discussion has centered on psychiatric nursing, a similar model would be equally appropriate to any clinical or functional specialty in nursing.
- Field, W. E., Jr.: Role Perception And Acquisition In Psychiatric Nursing, Austin, The University of Texas, 1965. Unpublished doctoral dissertation.
- Butler, H. J.: "The Role of the Psychiatric Nurse," Nursing Research, 10: 27-31, 1961.
- Butler, H. J., and Anne G. Livingston: "The Image of the Psychiatric Nurse," Journal of Psychiatric Nursing, 1:264-268, 1963.