Journal of Nursing Education

Disciplinary Boundary Maintenance in Nursing Education

Elizabeth R Lenz, RN, PhD

Abstract

ABSTRACT

This paper reports the results of two small-scale surveys examining the extent to which nursing education is reflecting patterns of insularity from other disciplines. One survey examined employment of non-nurse faculty and mechanisms for delivering non-nursing content in 16 baccalaureate and higher degree nursing programs; the other examined the disciplinary origins of required readings in 44 nursing courses. Non-nurse faculty were employed in half of the schools surveyed; however, non-nursing content was delivered primarily by nurses with advanced preparation in another discipline. There was heavy, but not total reliance on nursing authorship and journals in the courses surveyed. A pattern of relatively high insularity was inferred from reported and anticipated decreases in nonnurse faculty, the rarity of joint appointments, heavy reliance on nurses to deliver non-nursing content and use of high proportions of nursing literature.

Abstract

ABSTRACT

This paper reports the results of two small-scale surveys examining the extent to which nursing education is reflecting patterns of insularity from other disciplines. One survey examined employment of non-nurse faculty and mechanisms for delivering non-nursing content in 16 baccalaureate and higher degree nursing programs; the other examined the disciplinary origins of required readings in 44 nursing courses. Non-nurse faculty were employed in half of the schools surveyed; however, non-nursing content was delivered primarily by nurses with advanced preparation in another discipline. There was heavy, but not total reliance on nursing authorship and journals in the courses surveyed. A pattern of relatively high insularity was inferred from reported and anticipated decreases in nonnurse faculty, the rarity of joint appointments, heavy reliance on nurses to deliver non-nursing content and use of high proportions of nursing literature.

Introduction

Two current trends have potentially conflicting implications for nursing's long-term relationships with other disciplines. The first is a demand for increased interdisciplinary collaboration in practice and research, which implies the need for open disciplinary boundaries. The second is a movement to solidify the establishment of nursing as a legitimate and distinct academic discipline, which implies more rigid boundary maintenance. This paper reports the results of two small-scale studies - both preliminary investigations - undertaken as a beginning attempt to ascertain which of the two trends seems to be most influential in determining the nature of nursing's relationship with the other disciplines in its environment.

Background

Interdisciplinary collaboration among health professionals and basic scientists has been advocated as a necessary response to increased incidence and prevalence of chronic and life-style-related illnesses, a growing focus on health promotion and disease prevention and increased consumerism (DeLeon & Pallak, 1982; Hoekelman, 1978; Michael, 1982; Richmond, 1979; Smoyak, 1978). Successful collaboration is most likely to occur under conditions of complimentary expertise, status equity, mutual trust and respect, shared role expectations and a sufficiently common base of knowledge to permit effective communication (Hoekelman, 1978; Smoyak, 1978), but is hampered by preoccupation with and conflict over disciplinary domains (Bates, 1974, 1975; Montiero, 1978). Means frequently recommended to enhance collaboration between nurses and other scholars and/or practitioners include increasing students' exposure to faculty and peers from other disciplines (Hoekelman, 1979), and increasing the numbers of nurses with sufficient familiarity with non-nursing theories and research to allow them "... to travel between the traditional scientific areas and nursing practice" (Klein, 1978, p. 227). A trend toward increased interdisciplinary practice and research would suggest that nursing education cannot afford to be insulated or parochial, but should adopt an open and cosmopolitan orientation which permits moving beyond disciplinary ethnocentrism (Baltes, 1976; Campbell, 1969).

Stimulated initially by a desire for professional status and an identity distinct from medicine, and fueled subsequently by the women's movement and the politics of academia, considerable activity has been directed toward delineating the territorial boundaries of nursing's body of knowledge and sphere of practice. Domain definers differ in the degree of insularity which they advocate (Grace, 1978; Rogers, 1970; Walker & Avant, 1983). However, even those who clearly acknowledge nursing's reliance on other disciplines suggest that, by virtue of a unique perspective which conditions the way in which knowledge from other disciplines is selected, used and extended, nursing science is a distinct entity (Bloch, 1981; Norris, 1982). Nursing's emergence as a unique discipline is indicated by the existence of defined subject matter, a growing body of theory and research, a community of scholars, a belief that it exists, the emergence of doctoral programs in nursing, the increasing number of outlets for nursing research and the Institute of Medicine's (1983) recent recommendation to establish a Federal organizational entity to place nursing research in the mainstream of scientific investigation (Burr & Leigh, 1982).

Solidification and maintenance of disciplinary boundaries is undoubtedly desirable from the perspective of collegiate schools of nursing, in order to legitimate and strengthen their position in the academic community. Not inconsequentially, nursing education currently has unprecedented access to the resources necessary for boundary maintenance. The previous lack of nurses with advanced preparation in the basic sciences, which encouraged schools to hire non-nurse faculty, is rapidly changing. The current availability of published nursing literature related to practice theory, research methods and metatheory has reduced the necessity for relying on the literature of other disciplines for educating students. In short, nursing education now has access to enough resources to allow relative self-sufficiency. However, the dilemma now being confronted is whether or not such insularity from other disciplines is functional. On the one hand, survival in academia may depend on the ability to bound the discipline and claim a unique body of knowledge and realm of practice (Campbell, 1969). On the other hand, the potential for the occupation to make a valued contribution in response to societal demands - hence, perhaps its long-term survival - requires openness and receptivity to increasing interchanges with other disciplines. The present research examined selected current and anticipated patterns of employment and content delivery and current use of instructional materials in nursing education as indicative of the degree of isolation from other disciplines.

The first study addressed the use of non-nurse faculty and the mechanisms for delivering non-nursing content in nursing curricula. It was designed on the premise that restriction of faculty membership to those who are licensed members of the occupational group, and sole reliance on nurses to deliver the courses which fall under the auspices of the nursing department or school are indicators of boundary maintenance. Such mechanisms help to assure nursing control over the conditions of professional socialization and serve as a means for disciplinary gate-keeping, in that members of the profession screen and select the information from other disciplines which will be integrated into the curriculum and determine the way in which it will be addressed. Conversely, mechanisms which assure interaction between nurses and those from other disciplines, such as the employment of non-nurses in teaching roles and the existence of joint faculty appointments with other departments, were assumed to indicate a more open stance with respect to disciplinary boundaries (Aronson, 1969; Baltes, 1976).

The second study addressed the disciplinary origins of required readings in nursing courses, thus focused on the degree to which students are exposed to the literature of other disciplines as indicative of the degree of boundary maintenance. Heavy reliance on literature authored by nurses and found in nursing periodicals would seem to suggest insularity, whereas encouraging students to read the literature of other disciplines would suggest openness to other, potentially divergent perspectives, i.e., a more cosmopolitan orientation.

Methodology

Both studies were surveys conducted by means of mailed questionnaires. The first involved a random sample of 25 top administrators (deans, directors) of schools or departments of nursing accredited by the National League for Nursing. A total of 16 responses were received (64% response rate). The schools ranged in enrollment size from 130 to 1,151, with a mean enrollment of 600. Three of the schools responding offered only baccalaureate programs, nine offered both baccalaureate and master's programs, and four offered baccalaureate, master's and doctoral education. Two were located in colleges, seven in universities with health science centers, and seven in universities without health science centers.

The questionnaire, which employed a closed-ended format for all but two items, contained five sections. The first addressed characteristics of the school/department (five items); the second elicited numbers of nurse and non-nurse faculty employed (nine items); the third, applicable only to schools which employed non-nurse faculty, elicited information about their current roles (18 items). The fourth section required the administrator to indicate which of five mechanisms are currently employed to deliver each of 14 areas of non-nursing content, i.e., content derived primarily from another discipline, which are frequently incorporated in nursing curricula (18 items). The final section requested a ranking of the five mechanisms in terms of the degree of success with which they had been employed and requested projection of anticipated change and selection of the mechanism which would be preferred for content delivery, given unlimited resources.

The second study involved a two-step sampling procedure. The top administrators of 25 schools or departments (different from those in the first study) were asked to supply the names of the faculty member currently teaching the most advanced course in each of three content areas (research methods, nursing theory/theory development, and nursing of children) at baccalaureate, master's and doctoral levels. Once names were received, a questionnaire was sent to each faculty member. A total of 54 questionnaires were sent and 44 were returned (81% response rate). Of the courses surveyed 20 (46%) were undergraduate, 17 (39%) master's level and seven (16%) doctoral. A majority (n = 24; 55%) concerned research methods and 10 each concerned nursing theory and the nursing of children. Eightyfour percent of the courses were taught exclusively by nurses, 9% by a combination of nurses and non-nurses and 7% by non-nurses.

The questionnaire was course-specific and requested information about faculty composition, and the number of required books and articles which were authored solely by nurses, solely by non-nurses and jointly by nurses and nonnurses. The number of required articles located in nursing and non-nursing journals was also requested.

Because of small sample sizes, data analysis was restricted to the calculation of frequency distributions and measures of central tendency. A small number of crosstabulations were performed; however, no correlational analyses could be employed.

Findings

Employment of Non-nurse Faculty: Of the 16 schools surveyed with respect to the employment and use of non-nurse faculty, half reported employing only nurses. Where employed, non-nurse faculty numbered from one to 14 and represented an average of 5.4% of the total faculty. The highest percentage of non-nurse faculty reported was 11%. Schools employing non-nurse faculty reported higher numbers to be employed part-time (range = 1-14; x = 5.0) than full-time (range = 2-6; x = 3.3). The cross tabulations revealed that the employment of non-nurse faculty was most likely to occur in large schools (enrollment of 900 and above), schools with doctoral programs and schools located in universities with health science centers.

A majority of administrators (11) reported that the current level of non-nurse employment had not changed in five years; four reported a decrease and one reported an increase. Only two schools reported hiring any non-nurse faculty in the last two years. While non-nurse faculty continue to be employed in schools of nursing, these findings suggest a gradual decline in numbers.

Roles of Non-Nurse Faculty: The most prevalent pattern among schools employing non-nurse faculty was to appoint them to regular academic ranks and to assign them to teaching roles, most often giving them sole responsibility for the delivery of one or more courses. An average of 55% of the non-nurse faculty employed by each school were described as filling a solo teaching role, while joint teaching in conjunction with a nurse was reportedly carried by a mean of 29% of the non-nurse faculty. Little change in the numbers of courses being taught by non-nurses was reported as having occurred over a five-year period, with two schools reporting an increase, two reporting a decrease and four reporting no change. Employment of non-nurses in the capacity of administrator (reported by two schools), research facilitator (reported by one school) or clinical preceptor (reported by one school) was less prevalent than in classroom teaching roles. Where employed, non-nurse faculty were predominantly in positions which involve extensive student contact.

Joint Appointments: Half of the schools employing nonnurse faculty reported at least some to hold joint appointments with other departments. In all cases the major appointment was in the other department. The average percentages of non-nurse faculty reported as holding and not holding joint appointments were 28% and 60%, respectively.

Regarding joint appointments for nurse faculty, a majority of schools (10) reported none. The mean percentage of nurse faculty holding joint appointments was 2.3% with the maximum percentage reported being 10%. The likelihood of holding a joint appointment with another department was, therefore, greater for non-nurse faculty, however, joint appointments did not represent a frequently employed mechanism in the schools surveyed.

Mechanisms for Delivering Non-Nursing Content: Whether or not they currently employ non-nurse faculty, administrators were asked to indicate the mechanism(s) used for delivering non-nursing content to students. The response set of mechanisms included: 1) employing a nurse with educational preparation in another discipline, 2) employing a non-nurse, 3) contracting with another department to develop and teach a course specifically designed for nursing students, 4) requiring students to enroll in a course offered in another department but not specifically designed for nursing, and 5) requiring the content as prerequisite. A sixth mechanism, unfortunately not included on the instrument but added by some respondents, was to employ a nurse with preparation in nursing, rather than in another discipline. The data are presented in Table 1. The modal pattern manifested in 10 of the 18 content areas listed, was to employ a nurse with advanced preparation in the content of another discipline. The mechanism of employing nonnurses was used for 14 of the content areas, but for none was it the most prevalent pattern. Requiring students to take existing courses in other departments, either as prerequisites or part of the curriculum, was the modal pattern for delivering content related to statistics, normal physiology and nutrition. Contracting with another department to offer special courses for nursing students was the modal pattern only for delivering pharmacological content. Using nurses with formal presentation in nursing was the modal pattern for delivering content related to philosophy of science.

When ranked in terms of the degree of success with which the five mechanisms has been used, the employment of nurses with preparation in other disciplines was viewed most favorably, as reflected in the average rating. The least favorable ratings were assigned to employment of nonnurses and contracting with other departments for special courses. Problems identified in relation to hiring non-nurse faculty concerned their lack of understanding of and inability to relate their expertise to nursing; assets included their expertise and the ability to offer different perspectives. Problems regarding contracting with other departments related to cost and lack of interdepartmental cooperation.

Table

TABLE 1FREQUENCY WITH WHICH SELECTED MECHANISMS WERE REPORTEDLY EMPLOYED FOR DELIVERY OF NON-NURSING CONTENT (N = 15)p 1

TABLE 1

FREQUENCY WITH WHICH SELECTED MECHANISMS WERE REPORTEDLY EMPLOYED FOR DELIVERY OF NON-NURSING CONTENT (N = 15)p 1

When asked to indicate anticipated changes in the use of these mechanisms within the next five years, a majority of the administrators (nine) projected no change. One-third anticipated increase in the employment of nurses with formal preparation in another discipline. One anticipated an increase in contractual arrangements with other departments and one suggested that an increase would occur in the use of nurses with preparation in nursing. These findings suggest that employment of non-nurse faculty will probably decrease in the future and that, in general, nurses will be expected to assume more responsibility for delivering content from related disciplines.

Since availability of resources may override administrative preference in determining the means for delivering any curriculum, the administrators were asked to indicate the mechanism which they would choose to employ for delivering statistics and physiology content (two areas included in virtually all nursing curricula) under conditions of unlimited resources. For both content areas the modal choice was to hire a nurse with a doctorate in nursing. The next most frequent choice was to hire a nurse with a doctorate in the designated field. Hiring non-nurse faculty was not selected. The responses suggest that the current patterns for delivering content related to physiology and statistics are not considered optimal. The current scarcity of nurses with doctoral preparation in physiology helps explain reliance on using existing courses in physiology departments or employing non-nurse physiologists, despite preferences to the contrary. The current use of existing courses to deliver statistics content, despite the availability of nurses with statistical and research expertise, may reflect persistence of a pattern established previously when most nurses lacked such preparation.

Table

TABLE 2AUTHORSHIP OF BOOKS REQUIRED IN NURSING COURSES RELATED TO RESEARCH METHODS, NURSING THEORY, AND NURSING OF CHILDREN (N = 43-44)

TABLE 2

AUTHORSHIP OF BOOKS REQUIRED IN NURSING COURSES RELATED TO RESEARCH METHODS, NURSING THEORY, AND NURSING OF CHILDREN (N = 43-44)

Table

TABLE 3AUTHORSHIP AND LOCATION OF ARTICLES REQUIRED IN NURSING COURSES RELATED TO RESEARCH METHODS, NURSING THEORY AND NURSING OF CHILDREN (N = 31-32)*

TABLE 3

AUTHORSHIP AND LOCATION OF ARTICLES REQUIRED IN NURSING COURSES RELATED TO RESEARCH METHODS, NURSING THEORY AND NURSING OF CHILDREN (N = 31-32)*

Authorship of Required Course Reading: The total number of books required per course ranged from one to 11 with a mean of 3.31, and the total number of articles required ranged from 0 (reported for 10 courses) to 82 with a mean of 11.3. Respondents were asked to indicate the total number of required readings which were authored solely by nurses, solely by non-nurses and jointly by nurses and nonnurses. The results are shown in terms of percentages of the total required books and articles, respectively, in Tables 2 and 3.

Total reliance on nurse authored materials was relatively rare, having been reported in only six (14%) courses, all of which were undergraduate level and taught by nurses. Restriction of required books to those authored by nurses was reported in 12 courses (27%); and exclusive use of nurse authored articles was reported in 10 courses (31% of those requiring articles). The cross-tabulation analyses revealed this pattern to be most likely to occur at the undergraduate level and in courses taught exclusively by nurses. In fact, in no instance where a course was taught by a nonnurse were any books authored solely by nurses assigned as required reading. Approximately half (54%) of the research methods courses and exactly half of the clinical courses required only nurse authored texts.

Materials authored by non-nurses were required less frequently than nurse authored materials. Exclusive use of non-nurse authored materials did not occur in any course. Restriction of book and article requirements to those by non-nurse authors was reported in four and two courses, respectively; all involved nurse faculty. Requiring nonnursing material was most prevalent in doctoral -level courses.

Exclusive reliance on nursing journals as sources of required articles was relatively common, occurring in 15 (47%) of the courses in which articles were assigned; conversely, exclusive reliance on non-nursing periodicals was reported in only one course, which was an undergraduate course in research methods taught by a nurse. In general, however, the tendency to rely on nursing journals was greatest in undergraduate courses taught by nurse faculty. No clear pattern was revealed with respect to course content focus.

In general the findings revealed heavy, but not total, reliance on nurse authored materials and nursing periodicals for required readings. Sole or joint nurse authorship was reflected in approximately 70% of the books and 77% of the articles assigned as required reading; and over three-quarters of the articles assigned were from nursing journals. That heavier reliance was placed on nursing literature at undergraduate levels and in courses taught by nurses was not surprising from the perspective of professional socialization.

Discussion

The general pattern revealed in the schools surveyed was one of relatively high insularity from other disciplines. This pattern was inferred from reported decreases in nonnurse faculty, the relative rarity of joint appointments which provide structural linkages with other departments, heavy reliance on nurses to deliver non-nursing content and the use of high proportions of nursing literature in course teaching. There was also evidence suggesting continuation, even intensification, of insularity in the future: predictions that non-nursing content would increasingly be delivered by nurses and preferences to hire nurses with doctorates in their own discipline to deliver content related to statistics and physiology.

To the extent that these findings are representative of baccalaureate and higher degree nursing in general - which is questionable because of the small sample sizes - they suggest that nursing education may be acting to maintain disciplinary boundaries at a time when other disciplines are loosening theirs. Although disciplines vary in their degree of isolation (Crane, 1972) many health and basic science disciplines are taking steps to increase their potential for interdisciplinary collaboration (DeLeon, 1979; Sarason, 1981). The present findings suggest that nursing education may not be moving in the same direction.

Whether the tendency toward insularity indicated by the present findings is likely to continue indefinitely or represents an intermediate stage in the evolution of the discipline toward interdependence with others is unknown. Arguments by Rothberg (1973) and Baltes (1978) would favor the latter projection. They suggest that a stage of independence from other disciplines is necessary for solidifying nursing's identity and professional self-image, and must be completed before open interchange and truly collaborative relationships can become a reality. Having recently emerged from a period of considerable dependence on other disciplines, nursings current attention to boundary maintenance may, therefore, represent a transitional stage which will, in time, give way to interdisciplinary collaboration.

Although they may be necessary and ultimately beneficial, the boundary maintaining activities reflected in the present findings may also create problems. Reducing nursing students' exposure to scholars from other disciplines has potential to reduce the quantity and quality of nonnursing knowledge which they receive, as well as to limit their awareness of alternative world views. Given the rapidity with which knowledge is advancing, a period of isolation places nurses at risk of being unaware of important developments in related fields, hence left out of the mainstream of knowledge development. Even nurses who earn doctorates in another discipline frequently lose contact with colleagues and literature in the other field once they re-enter nursing, and their knowledge can remain static. Nurses who earn doctorates in nursing, by virtue of limited exposure, generally lack depth of knowledge in the non-nursing content they may be required to teach or use in research. The problem is compounded when students are exposed mainly to second- or third-generation renditions of theories, methods and research generated in other fields, rather than to primary sources in the literature of the parent discipline. Thus, the quality of nursing education may be compromised by insularity, particularly at the graduate level where the objective is to produce the specialists, teachers, scholars and researchers on whom will rest responsibility for movement beyond insularity to interdisciplinary collaboration.

Future research efforts should be directed initially toward ascertaining the reproducibility of these findings in larger samples and subsequently toward explaining the patterns observed. Only future developments will indicate whether boundary maintenance represents a terminal or transitional phase in nursing's development.

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TABLE 1

FREQUENCY WITH WHICH SELECTED MECHANISMS WERE REPORTEDLY EMPLOYED FOR DELIVERY OF NON-NURSING CONTENT (N = 15)p 1

TABLE 2

AUTHORSHIP OF BOOKS REQUIRED IN NURSING COURSES RELATED TO RESEARCH METHODS, NURSING THEORY, AND NURSING OF CHILDREN (N = 43-44)

TABLE 3

AUTHORSHIP AND LOCATION OF ARTICLES REQUIRED IN NURSING COURSES RELATED TO RESEARCH METHODS, NURSING THEORY AND NURSING OF CHILDREN (N = 31-32)*

10.3928/0148-4834-19851001-06

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