Professional nursing educators and practitioners in the field are forcefully aware of the changing milieu in which they participate. This awareness occurred as a result of many factors. Perhaps the most dramatic is the scientific and technological information explosion or "third wave," as Toffler describes it. A profession which in the past has applied theories from multiple disciplines is coming of age in the evolution of its own theoretical body of knowledge.
Transition into this information society is upon us. The interfacing of technology with the nurse-client relationship continues to accelerate. Electronic monitoring, computers, and other high technology equipment have caused an epidemic of innovative devices. Many nurses are not yet familiar with the use of these. In addition, the media have trained consumers of heatlh care to know more about themselves than ever before. They demand greater participation in their own care and greater accountability by those who deliver it.
In his keynote address to the 1980 NLN convention, Toffler predicted that third wave health care professionals will look for and have more responsibility for providing services that fully utilize their skills. However, present and future client needs and demands are not the only external pressures causing changes in the responsibilities of nurses. The tendency toward a planet-wide society changes orientations toward individual towns and cities. These changes, as well as changes in the occupational structure of other health care professionals must be looked at as nursing educators re-examine which knowledge, skills, and characteristics will be required of graduates to fulfill their professional roles during their working lifetimes.
There are many things on which nursing leaders in education disagree. However, through their professional organizations and their official statement of beliefs, nearly all of them reaffirm the original purpose of nursing: To care, bring comfort, and promote wellness through "the diagnosis and treatment of human responses to actual or potential health problems" (ANA, 1981). To fulfill this purpose, they address the need to place professional nursing education at the baccalaureate level. Consequently, a majority of the diploma programs have been phased out. The profession has not effectively prepared these diploma-educated nurses (who still make up the majority of nurses practicing in the field), for this change. Many of them are feeling pressures placed upon them by their professional associations and by their employers to earn their bachelor's degree.
Thus the profession of nursing is plagued with a high rate of stress and "burn out" precipitated by the impact of Tofflers third wave. For example, in 1978, graduations from basic RN programs reached a zero growth rate (Vaughn, 1979). After years of negative external reinforcement, large numbers of these nurses are leaving the profession to find more appealing, lucrative, and psychologically rewarding careers in other fields. Others temporarily retreat to the "ivory tower" of college to pursue a degree that will upgrade their "second class citizenship."
Psychologist Julian B. Rotter developed a diagnostic tool, the Internal-External Locus of Control Scale, to locate peoples' sense of control over the major aspects of their lives. The model - called the Social Learning Theory - which he devised to describe locus of control, is appropriate as it tests and describes nursing students' sense of lost control over their individual and collective professional futures.
Locus of Control concerns an individual's choices and how they are made. It is measurable, and is valuable as it indicates a number of personality characteristics and explains current trends and issues in education. According to Rotter, every behavior has a biological and environmental consequence. Individuals anticipate these consequences and perceive them to be under their control, or not under their control. Learning and performance differ when the learner perceives events as "contigent upon his own behavior or his own relatively permanent characteristics" (internal locus of control), and when the learner perceives that he lacks such control (external locus of control) or that events are "unpredictable because of surrounding forces" (Rotter, 1966, p. 3).
Since Rotter's test was first introduced into psychological literature in the mid-1950s, hundreds of studies have linked locus of control with many variables. Some of these variables may precede or at least mediate an individual's locus of control. The relationship between gender and locus of control is particularly significant. Several studies show that females are more externally controlled (Khanna, Molinari & Khanna, 1978; Zerega, Tseng, & Greever, 1976). Khanna and Prabha suggest that since 1960, the college population - regardless of gender - is becoming more external but females significantly more so (Khanna, Prabha, Molinari & Khanna, 1978).
Evidence supports the hypothesis that age is also a mediating variable. Recent studies indicate that internality increases with age (Costello, 1982; Newsome & Foxworth, 1980; Steitz, 1982), stabilizes in the middle years (Rykman & Malikioski, 1975), and then decreases (Tirado, 1978). In addition, Tirado found that younger professionals tend to be more internally controlled than older people and are more effective change agents. Research also indicates that those in the beginning stages of a program are more external than those such as college seniors, in the later stages (Behuniak & Gable, 1981).
Personality Characteristics and Locus of Control: Fifteen years of literature on locus of control strongly suggests the desirability of an internal locus of control for individuals in general and for professional nurses in particular. For instance, internally-controlled individuals seem to be more effective at self-discipline. They are cautious and unwilling to take unnecessary risks. Internals often have a highly developed sense of social responsibility and are motivated to contribute to group well-being and to building a better world (Collins, 1973; Rotter, 1972; Zerega, 1975). They have little need to control others, are open to other's influence, are more cohesive, and are trusted (Cicirelli, 1978). Internals value being recognized as competent more than do externals (Zerega, 1975). It would seem that internals are more effective change agents while externals are more likely to maintain the status quo.
An internal locus of control is also clearly related to selfesteem, a positive self-concept, and greater life satisfaction than externality (Mancini, 1981; Nehrke, Julicka & Morganti, 1980). In addition, Blomberg and Soneson (1976) found that internally controlled, field independent persons function at the highest of Kohlberg's morality levels.
Phares (1962) found that individuals with an internal locus of control were better at coping with stressful situations than externally controlled individuals, who also have higher anxiety levels (Strassberg, 1973). Other studies have found a significant positive correlation between alcohol consumption and externality (Cox & Luhrs, 1978) and smoking and externality (Schwebel & Kaemmerer, 1977). Others have linked externality with depression (Costello, 1982), suicide (Boor, 1976), accidents, and acute illnesses (Lefcourt, 1976). Perhaps one reason that internals tend to be healthier is that they take a greater interest in their own health and primary prevention measures and exhibit health seeking behaviors against disease (Strickland, 1973). Such self-responsible behavior is important for professional nurses to exemplify for the present and future health needs of society.
Of equal importance, is the large number of studies that have found significant links between both academic and work achievement and locus of control (Behuniak & Gable, 1981; Cowan, 1979; Gardner, 1981; Grover & Smith, 1981). Interestingly, a study by Munro (1980) found that, among collegiate nursing students, internals scored higher on measures of academic integration - a theory that supported previous studies which found internals to be hard working, achievement-oriented individuals.
Other variables related to locus of control include goal direction (Strickland, 1965), creativity (Churchill, 1976; Houtz & Coll, 1979), the ability to gather, process, and use information to solve problems (Strickland, 1965). Internals are more likely to disregard negative life events and become actively involved in problem solving for current and future life events (Lefcourt, Miller, Ware, & Sharke, 1981). This finding has special significance for nurses who use problem-solving skills to deal with human illness and also to prevent its future occurrence. A study by Kissinger and Munjas (1981) found that a predictive relationship exists between the ability to use nursing process and an internal locus of control. Since the philosophy of nursing education at the baccalaureate level embodies many of these variables as critical characteristics, an internal locus of control would certainly help professional nurses to characterize a philosophy based on self-responsibility and self care.
Though an internal locus of control is preferable, research suggests that externality is on the increase in our society, and significantly more so among college students (Khanna, Prabha, Molinari & Khanna, 1978; McLaughlin, 1976). It seems that internality, or self-responsibility is fading in our society, at a time when such futurists as Masuda (1980) and Toffler (1981) recognize its importance to anticipatory democracy and to survival of the transition into the twenty-first century. If college students are becoming more external as the literature suggests, then professionals of the future may be characterized by low selfesteem, alienation, vocational immaturity, and lack of selfresponsibility.
This has many implications for nursing. A nurse who embodies an attitude of powerlessness in the face of change and experiences lack of control over personal life events (i.e., external locus of control) is one who might have difficulty nurturing a more positive health-seeking attitude in clients. Taking responsibility for one's health begins at the personal level. It is then transferred to the interpersonal level and finally is extended to the community. Self-responsibility can only succeed if attempts are made to reverse the trend toward externality.
Futuristics as a Medium for Altering the Locus of Control: Within the past decade there have been many attempts to shift people toward greater internality. Some of the strategies involve counseling, behavior modification techniques, goal-setting exercises, literature readings, and life-planning workshops, just to name a few. The medium of futuristics was used in one previous study by Hay (1978), who first suggested and then established that future studies by their very focus would increase internality. "Previous research has established a correlation between an external locus of control and helplessness," indicating that externals have a negative and limited view of the future (Hay, 1978, p. 32).
Nurses' image of the future can affect their professional contribution not only in the future, but right now. For nurses to function effectively, they need to feel that they are moving into a professional world in which they will have a significant impact and for which they have been prepared. They must have the attitudes and possess the skills to be competent practitioners in a fast-changing health care system. It is logical that a course that explores in terms of the future, the transition into a professional nursing role would encourage greater internality in registered nurse students. Futuristics emphasizes the individuals' taking charge of their own lives by identifying not only how they fit into the future, but also how they can change it.
Though the study of futuristics can be traced back to the "think tanks" of World War II, futuristics as a standard component in college curriculae did not appear until the mid-1960s. Appropriately, Alvin Toffler, author of Future Shock and The Third Wave, taught one of the first of such courses at the New School for Social Research in New York City in 1966. Such courses rapidly proliferated and by the early 1980s, futuristic-oriented programs appeared on nearly every college campus in the country (Cornish, 1978, p. 212).
Futuristic educators generally advocate a series of steps for organizing both futures courses and the direction of a rapidly changing world. These steps include: becoming aware of the existing reality, developing awareness of where we have been historically, exploring future alternatives, becoming aware of trends established by experts, clarifying values about the future, decision-making, and developing transition strategies (Cornish, 1978; LaConte, 1975).
Statement of the Problem
By focusing on these issues and positive future alternatives that registered nurse students have at their disposal, it was assumed that nursing students would be able to transcend any professional confines (internal or external in nature) and perceive that they do in fact control the future of their profession, and, therefore, exhibit a more internal locus of control. The purpose of this study then, was to determine if a course which explores the transition into a futuristic professional nursing role would move registered nurse students toward stronger internality in their locus of control.
Design: This study was a basic pretest-intervention-post test. The Rotter I-E Scale was administered as a pretest and a post test to experimental (N=32) and control (N=32) groups of beginning registered nurse students. The basic research design is summarized in the Figure. Students in the control group received no intervention while those in the experimental group were exposed to a five-week course entitled "Transition Into a Futuristic Professional Nurse Role." To test the effectiveness of the course in moving students in the experimental group toward greater internality, statistics generated by using a one-way analysis of covariance were used. Pretest scores and years of clinical experience were chosen as covariates, on the basis of the literature review and empirical testing. An initial test of each covariate indicated that a common slope and linearity could be assumed. Thus, in using ANCOVA, the two adjusted post test means represents a statistical prediction as to how the two groups would have performed on the post test assuming that they had identical pretest means and identical years of clinical experience. Thus the change in the adjusted score on the Rotter I-E Scale from the pretest to the post test was the criterion by which the success of the experiment was evaluated.
Sampling: The sample was composed of 64 registered nurse students at Salve Regina - The Newport College. Located in Rhode Island, it is a private, Catholic, predominantly female institution with an annual enrollment of about 2,100 students, 650 of whom are nursing majors, about half of whom are already registered nurses. This study concerned itself with beginning registered nurse students only, none of whom had previous exposure to nursing courses at the baccalaureate level. All were nontraditional adult learners with a mean age of 36 for each group. The average number of years of clinical experience for the control group was 9.09 and for the experimental group, 7.5 years. There were four males in each group. The variables of race and socioeconomic class were controlled for by the nature of the population which comes from a predominantly white, private Catholic college with a narrow socioeconomic spread. Intelligence and academic achievement were controlled for by the rigid admissions criterion of the Nursing Department.
Instrumentation: The Rotter I-? Scale is a 29-item forced choice test containing six fillers and 23 items measuring the personality construct of internal versus external locus of control. A series of validation studies between 1961 and 1972 by Rotter found an internal consistency coefficient of r = .69 to .79. The test-retest reliability of the scale has also been reported with coefficients of r = .49 to .83 (Rotter, 1966; 1972).
The Intervention Course: The intervention used in this study was a one-credit seminar course giving the registered nurse student an opportunity to participate in a futuristicoriented exploration of the professional nurse's role. It facilitated active involvement in the process of values clarification and the need to recognize feelings concerning one's commitment to contemporary and future nursing practice. The course also provided an opportunity to identify the historical, contemporary, and futuristic nursing perspectives on current changes in the nursing field. Students were also oriented to the conceptual framework of the program as it addresses the knowledge and skills the graduates will need to perform during the lifetime of their nursing practice. Finally, the issue of role strain was considered, as well as strategies for transition into a changing role and resources within the college for overcoming some of the real and potential problems associated with the blended life cycle of RNs returning to school. Both course content and methodology were specifically chosen because they addressed one or more of the steps advocated by educational futurists for futurizing the classroom (Cornish, 1978; LaConte, 1975).
An examination of the univariate statistics indicates that there was a greater movement toward internality in the experimental group (that is, they scored lower on the Rotter I-E Scale). Table 1 depicts the means and standard deviation for the experimental and control groups. As Table 1 indicates, the experimental group as a whole changed an average of 1.53 points in the direction of internality. On the other hand, the control group as a whole changed an average of .41 and that change was in the direction of externality. A simple t-test suggested with a significance at the .0001 level that the groups differed. However, to more accurately test the hypothesis, the inferential statistic of analysis of covariance was used.
PRETEST AND POST TEST MEANS AND STANDARDS DEVIATIONS FOR EXPERIMENTAL AND CONTROL GROUPS
ANALYSIS OF COVARIANCE OF RN STUDENT GROUPS (EXPERIMENTAL VERSUS CONTROL) POST TEST PERFORMANCE, USING PRETEST SCORES AND YEARS OF CLINICAL NURSING EXPERIENCE AS COVARIATES
Table 2 indicates results of the analysis of covariance. As seen in the Table, the adjusted post test mean of 8.406 (experimental) versus 9.958 (control) were tested and the obtained F value clearly indicated the efficacy of the course in encouraging greater internality, F (3,60) = 49.55, p<0001.
While this study did establish that a futuristic-oriented course can move registered nurse students toward greater internality in their locus of control, a number of issues suggests the necessity for further research.
The intervention course content was chosen on the basis of its link with one or more of the steps to becoming more futuristic. The very nature of this content encouraged dialogue between the instructor and the students, and the teaching methods and strategies reflected this. Even though the instructor was not the researcher, this dialogue may also have contributed to altering the locus of control of the students. This suggests the need to replicate this study with teaching strategies in which there is no direct interaction between teacher and student.
Secondly, previous research has established that persistence in completing an educational goal has been linked with internality (Behuniak & Gable, 1981), as well as socioeconomic status. Therefore, it seems important to replicate this study using a less homogeneous population of registered nurses with respect to their socioeconomic level, race, and achievement status. Also, the intervention course should be tested on nurses in the field who are not planning to return to college, perhaps as an inservice or continuing education program.
Finally, a third issue of concern is that of the stability of the change in locus of control. Few longitudinal studies have been done in this area, though some research (McLaughlin, 1977; Zerega, Tseng, & Greever, 1976) suggests stability over several months to a year.
Because no previous attempt has been made to alter the locus of control of nursing students, either generic or registered nurses, these results have several implications for nursing programs, particularly those that address the needs of the registered nurse returning to college. It would seem that futuristics does have its place in nursing education, especially in encouraging positive attitudes. The implication that becomes evident is that futuristic concepts and strategies should be included in the nursing curriculum where students are beginning to deal with the issues of their profession. This does not need to be done as a separate course, but can be accomplished within the theoretical framework of the existing program and within each course. For example, in studying concepts of maternal-child health nursing, there should be consideration paid to such issues as genetic engineering and the choices that nurses have for participating in these decisions in their role as client-advocate. As another example, why couldn't the study of gerontology (which is generally lacking in baccalaureate programs) also identify how trends in primary health care will affect nursing care. Obviously, content and teaching methodologies can be developed that are applicable without changing the established curriculum.
A third implication is that futurizing may be effective for encouraging internality for students in the beginning stages of a program. Behuniak and Gable (1981) suggest that it is at this point that an individual is most likely to either change majors or fail to persist. It is also at this time that the student is most likely to perceive an external locus of control. Perhaps if efforts were made to reverse the externality of registered nurse students, these students may be more likely to persist through the early stages of thencollegiate career, and leave the "ivory tower" with a stronger perception that their choices do influence the future of the profession.
Finally, this study implies that instructors in colleges of nursing may need some consiousness-raising as to the exploration of the changes occurring today as well as rationally deliberating about the future of the nursing profession. Experts in nursing education will also need to assist future educators with finding appropriate materials, and in learning futurizing techniques such as delphi and others. Clarification of values and decision making would need to become as common as nursing process and levels of prevention.
As the trend toward externality is reversed, the attitude of nurses toward their profession may become more positive. With increasing internality and a positive attitude among students and educators alike, it is certainly plausible that burn out, passivity, and third wave shock may be minimized. An internal locus of control among the future practitioners in the nursing field may be a crucial element in the nurses' ability to transcend professional confines and perceive that they are self- responsible, and that they do control the future of their profession.
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PRETEST AND POST TEST MEANS AND STANDARDS DEVIATIONS FOR EXPERIMENTAL AND CONTROL GROUPS
ANALYSIS OF COVARIANCE OF RN STUDENT GROUPS (EXPERIMENTAL VERSUS CONTROL) POST TEST PERFORMANCE, USING PRETEST SCORES AND YEARS OF CLINICAL NURSING EXPERIENCE AS COVARIATES