The Indigenous People's Access Program to Nursing was implemented on May 26, 1986. In 1987, the program's name was changed to National Native Access Program to Nursing. The purpose of the nineweek summer access program was to increase the number of indigenous individuals with baccalaureate preparation in nursing.
Statistics Canada (1984) reports that there are 24,783 Canadian nurses who have baccalaureate or higher preparation. Of these, less than 20 are known to be of indigenous ancestry (Jean Goodwill, personal communication, August 31, 1986). The dearth of native nurses in Canada is a cause for concern. Native nurses make a unique contribution to Canadian health care in general and to native Canadian health in particular. By the year 2000, it is expected that all nurses entering practice will be required to have a baccalaureate degree. Therefore, it is imperative that potential native nursing students be prepared for entry into nursing at this level.
A university-entrance access program was determined to be an important step in this recruitment. It is likely that the reason there are so few native nurses with baccalaureate training is because of problems experienced by native students in accessing and pursuing nursing studies at university (Indian/Inuit Health Careers Program, Health and Welfare Canada, Medical Services Branch, November, 1985). The National Native Access Program to Nursing (NNAPN) was designed to help alleviate these problems.
The program was first implemented in the summer of 1986. The program, which was held at the University of Saskatchewan, was a nine-week course and was attended by 11 students. Students accepted into the program had passed university matriculation level courses required by the faculty of nursing at the university they hoped to attend. However, their high school averages were not high enough to insure acceptance into nursing through the regular selection process. Upon successful completion of the access program, students were accepted by participating universities that had agreed to hold places in their programs for successful students.
The main goals of the program were to orient the student to the demands of university studies in nursing and to the urban environment in which university studies occur; to capitalize on the strengths of each individual's learning style in teaching basic learning and study skills; to provide academic upgrading as appropriate in subject areas specified as important in nursing studies (science/mathematics, nursing theory/practice, social sciences); and to do the above in a way that was culturally supportive. This included promoting an awareness of native culture and native health concerns, as well as providing supportive successful native role models via tutors, native student support systems, native nurses, and instructors. These goals had been determined by representatives of native organizations, nursing organizations, educational institutions involved, as well as the National Native Nursing Organization and the government funding department. All of these representatives advised the program coordinator on a continuing basis.
Purpose of this Report
The purpose of this article is to examine a process that was used to develop evaluation priorities for this program. Basically, this process involved the following steps:
PROCEDURE-Firet, interviews were held with all potential members of the advisory committee. A questionnaire based on the interview responses was administered using a modified version of the Total Design Method (Dillman, 1978). The foci of the interviews and the questionnaire were: 1) problems facing native students in pursuing university-level nursing studies and nursing careers, 2) appropriateness of proposed program activities, 3) prioritization of program activity goals, 4) suggested evaluation activities (interviews only). Finally, other similar Canadian programs were consulted on their evaluation activities. Evaluation priorities were developed based on the interviews and questionnaire data.
Based on all the above information, evaluation activities to meet these priorities were proposed. Important characteristics of the process were:
1. Information was gathered using qualitative and quantitative techniques. Gathering qualitative information can be an important first step in exploring an evaluation area by providing a solid information base for deriving quantitative measures (Patton, 1980).
Key Informants: Seven of the eight advisory committee members, representing the organizations described above, served as key informants for the qualitative interviews.
2. All persons associated with the educational program were involved in developing the topics considered pf interest in the evaluation process. This was in order to:
a) utilize information from a variety of different sources.
b) gain support of evaluation activities from all program advisors. By using the program advisors as a source of qualitative information, it was expected that their investment in the evaluation process would be obtained, because their views would be acknowledged as important, and their expertise would be utilized (Rossi and Freeman, 1982). This last point may be particularly important in politically sensitive cross-cultural endeavors. Here, many differing views abound, and evaluatore must show sensitivity to all concerns involved in the birth and nurturance of such a program. In this way, the process was similar to Rutman's (1980) E val liability Assessment but was less time consuming, and information gathered could be directly utilized for gathering quantitative data from physically distant sources.
3. Native baccalaureate student and graduate nurses were polled to determine their views. This information was used to prioritize educational experiences and goals. It is highly desirable to consult with the target population about the program in question when developing evaluation activities (Rossi & Freeman, 1982).
Prior to this time, Canadian native nurses and nursing students did not feel that they had been asked about the problems that they experienced while attending university. They also had not been asked their opinion about the types of access program activities considered to be important for success at university (J. Goodwill, personal communication, 1986).
Seventeen subjects were selected for the questionnaire. Each subject, identified through the Indian and Inuit Nurses Association of Canada, was either a graduate of a baccalaureate nursing program or currently enrolled in one.
Fifteen of the 17 questionnaires were returned. Seven of eight students (87.5%) and eight of nine graduates (88.9%) responded, giving an overall return rate of 88.2%.
Results and Discussion
Evaluation suggestions that resulted from this study were perceived as useful in program planning by the program coordinator and by members of the advisory committee. Two major sources of ideas were used. The results of the questionnaire were supportive of the ideas generated by the qualitative interviews in the area of problems faced by the students, useful activities for this program, and program goals. The questionnaire respondents also added some new ideas and prioritized the problems and activities, providing useful new information as well. Support from the respondents, confirming the original proposal that the access program was needed and useful, was provided.
Program priorities, specific objectives, evaluation activities, detailed timelines, and suggested measurement strategies for evaluation were also guided by the interview questionnaire and information from other programs. These were given in the final report to the program.
The process itself was deemed valuable in that program advisors were given a forum in which they could express their hopes and concerns for the program. Participation in and support for evaluation activities were gained right from the beginning, making implementation of program activities easier. This support was shown by the willingness of the advisory committee to be interviewed and by the enthusiasm that met the interim and final reports of findings from this process. As well, evaluation suggestions have begun to be implemented.
Open-ended responses from the native students and graduates indicated a need for them to express their views related to their university experience. They also expressed support for the program and willingness to provide input into evaluation activities. This process hopefully will result in a program responsive to the needs of native nursing students. This is important for maintaining enrollment both in our program and in their future university placement.
Other benefits that may have accrued from the process outlined in this article include raising awareness of the program nationally by involving native nurses who are more likely to promote it to potential students. Another major advantage of the approach may have been that it contributed to positive public relations by inviting input from the many groups associated with the program. These perceptions are based on personal communications. An increase in referrals in future years could be used to support these perceptions.
The process outlined in this article was designed to prioritize evaluation activities, which it did very effectively. The expense and difficulties encountered in implementing the process were minimal. Many bonuses were associated with it as outlined above.
However, a major shortcoming was observed. The population surveyed may differ somewhat from the potential NNAPN students, since the baccalaureate students and graduates had grades high enough for regular admission processes. They may have had to develop their own particular success strategies. However, since there was no access to baccalaureate progam drop-outs, the successful students and graduates were the population closest to the potential access program clientele. Future evaluation research should survey the opinions of access program graduates. This type of follow up has been planned now that the program has been implemented.
This article has attempted to document application of a general evaluation process to a specific nursing education program involving a seldom consulted target population. This application was deemed to be successful in its outcome. Further research involving proper experimental or quasiexperimental controls is needed to determine if the results could be achieved as easily with other evaluation priority-setting approaches in politically sensitive areas. Finally, such a process may be useful to nursing programs in general, as administrative support, responsiveness to student needs, and perspectives of graduates combine to enhance education of all professional nurses.
- Dillman, D. A. (1978). Mail and telephone surveys: The total design method. Toronto: John Wiley and Sons.
- Health Manpower Statistics Section. Health Division. Statistics Canada. (1984). Revised registered nurses data series Ottawa: Statistics Canada publication.
- Kidder, L.H. (1985). Selltiz, Wrightsman, and Cooks Research methods in social relations. New York: Holt, Rinehart & Winston.
- Patton, M.Q. (1980). Qualitative evaluation methods. Beverly Hills: Sage Publications.
- Rossi, PH., & Freeman, H.E. (1982). Evaluation: A systematic approach (2nd ed.). Beverly Hills: Sage Publications.
- Rutman, L. (1980). Planning useful evaluations: Evaluability assessment. Beverly Hills: Sage Publications.