As early as 1935, nursing education leaders recognized the need for a liberal education (Hanson, 1989, 1991). Stewart (1939) suggested that nursing education should not just train, but educate nurses for professional growth and life. It was important for nurses to have an education that was consistent with the education of other professionals. In 1986, the American Association of Colleges of Nursing (AACN, 1986) published the Essentials of College and University Education for Professional Nursing in which they comprehensively defined the knowledge, practice, and values that baccalaureate nurses should have. They reiterated the need for nurses to have a liberal education and for nursing faculty to integrate knowledge from the liberal arts and sciences into professional nursing education and practice.
Baccalaureate nursing educators and researchers have recently been able to provide empirical evidence to support a liberal education for professional nursing (Bottoms, 1983; DeBack & Mentkowski, 1986; Hagerty, 1989). In most nursing schools, the primary measure of a liberal education is the college grade point average (Clayton & Triplett, 1981). A review of the literature reveals that nursing programs are developing tools to evaluate the outcome of their graduates' liberal education, but little is known about the actual effects of liberal education.
The need to examine and justify a liberal education has become more important as institutions of higher education and nursing schools are finding themselves in greater competition for funding. The way nurses are educated has implications for health care costs, health care accessibility, and the type of services provided (Aiken, 1983).
The purpose of this study is to describe the nursing students' self-reported involvement in college experiences and activities as a measure of achievement of their liberal education goals and to compare them with norms established for the general college population. In this study, the terms liberal education and general education are used interchangeably.
The 1980s witnessed a remarkable upsurge of interest in the reform of liberal education. A number of higher education reports have highlighted concerns about the nature of professional education being narrow and specialized. Sakalys and Watson (1985) reviewed six of these reports and expressed concern with the increased emphasis in college education on career goals to the detriment of liberal education goals. In response, most colleges began to review general education offerings and make substantial reforms.
Liberal education is a difficult concept to define. It is ambiguous in both theory and practice and has evolved, along with the history of higher education, amid the turmoil of a rapidly changing society. Brown (1979) noted, "Like history, the liberal arts will be defined ad infinitum according to the season and reason of the day. Each age demands its own interpretation; indeed, it has a right to create one." Weaver (1991) offers a definition of what liberal education could be, namely, education emphasizing and incorporating critical inquiry. Most debates about liberal education simply accept the existence of departments and professional disciplines as structural facts and resolve the issue of liberal education by comparing the number of credit hours rather than looking at the outcomes (Kimball, 1986). Thus, colleges and universities often retreat to the simple solution of distribution courses. It reflects the failure of those responsible for integrating the universities' various functions and translating them to the many audiences of higher education (Rudolph, 1977).
Research on the effects of a Uberai education for nurses has been limited. It is one of the least understood concepts in the development of a professional nurse (Kramer, 1981). Yet, its importance has been noted consistently in the history of nursing education, despite criticism by nonnurses (Hanson, 1991). There is not a consensus among nurse educators on what the term liberal education* means. As a result, excessive requirements in the natural and behavioral sciences are recommended to the detriment of credit hours for the humanities and électives, and the concept of liberal education has been narrowed to mean "content" (Balcerski, 1981).
Some progress has been made in the area of identifying specific abilities important to professional practice and related to liberal education (Bottoms, 1983; DeBack & Mentkowski, 1986; Hagerty, 1989). The meaning of liberal education has evolved to include any experience that broadens a student's knowledge, values, skills, and motivation. It influences a nurse's perception of and response to involvement, risk taking, experimentation, and analysis of values (Hagerty), and enhances an individual's life outside the job (Bottoms). Both of these are expected outcomes of the higher education experience.
Background Studies on the Effects of College
Colleges today are being challenged to demonstrate that the intended outcomes of going to college are achieved. However, there are no widely accepted measures of achievement nor empirical research to validate that intended outcomes are realized. Efforts to summarize the research on the effects of college draw different conclusions. Pascarella and Terenzini (1991) synthesized 3,000 studies on the effects of college on students and concluded that college was a time of change for students in all areas, including intellectual, psychosocial, and moral dimensions.
Astin (1984) proposed a "theory of involvement" to explain the dynamics of student development. Involvement is the amount of physical and psychological energy a student devotes to the academic experience (Astin). Involvement creates connection between students, faculty, and staff that allows individuals to believe in their own personal worth. This is consistent with Pace's (1984) work on the quality of student effort. Change is likely to occur in the student to the extent that the student is involved in the activities and opportunities that colleges provide for students. Pace states that "all learning and development require an investment of time and effort by the student" and that "quality of effort is not the same as motivation, persistence or a personality trait." The quality of a student's college experience may be dependent on the quality of effort the student exerts in taking maximum advantage of the facilities and opportunities available within the college or university environment.
To accomplish the purposes of the study, the following research questions were asked:
1. What is the level of self-reported involvement by senior nursing students in the activities and opportunities that colleges and universities provide?
2. What is the level of nursing students' self-reported progress toward liberal education goals (personal and social development, general education, intellectual skills) and how do they compare with general college norms?
3. Which of the self-reported activities, opportunities, and facilities in which nursing students involve themselves contribute most to students' progress toward liberal education goals?
The sample consisted of senior nursing students enrolled in 11 randomly selected programs in Illinois, Indiana, Iowa, Kansas, Minnesota, and Missouri (N= 201). All programs included in the study were accredited by the National League for Nursing and located in the Midwest. Student participation in the study was voluntary and anonymous. Six of the participating schools are doctoral universities (n = 147); five are comprehensive liberal arts colleges (n=54). The nursing student profile for those participating in this study was age 22 years or younger (47%), white (87%), with self-reported grades between A - and B (87%), went to school full-time (84%), studied between 30 and 40 hours per week (65%), worked between 0 and 10 hours per week (60%), and had a self-reported interest in advanced studies (87%).
The sample for the norms for the general college population included 12 doctoral universities with approximately 9,000 students. The background characteristics were age 22 or younger (82%), female (58%), white (75%), with reported grades between A and B (69%), from majors other than health-related (90%), full-time students (96%), and spent between 30 and 40 hours weekly on school work and 0 to 10 hours weekly at a job (31%) (Pace, 1990a).
The College Student Experience Questionnaire (CSEQ) was originally published in 1979, slightly revised in content in 1983, and modified in format in 1986 and 1990. The CSEQ is a self-report survey of how students spend their time, the nature and quality of their activities, and the gains they make during college (Pace, 1986).
McCammon (1985) assessed the questionnaire to be psychometrically sound and the coefficient-alpha values range from 0.79 to 0.90. Studies of the validity of the CSEQ show that they are the best predictor of perceived gains from general education (Pike, 1991).
Several limitations may have affected the generalizability of this study and the completeness of information. First, there may be sampling bias in the study. Although the schools were randomly selected, it turned out that the majority of the usable data came from doctoral universities. The extent to which nursing students in other types of settings differ in their undergraduate experience is unknown. In addition, other variables, such as precollege characteristics, employment, residence, and quality of facilities, were not controlled. Responses were based on nursing students' self-reports and subject to individual differences in the meaning attributed to the responses, therefore requiring at least cautious interpretation (Pace, 1986).
Research Question 1
The largest part of the CSEQ is a list of activities (122) that are directly observable and voluntary rather than specifically required. The first research question measured how often during the current year nursing students engaged in the various activities related to the use of campus facilities and opportunities intended for their learning and development.
Of the 12 activity scales, five address students' use of major campus facilities: library experiences (LIBRARY), student union (UNION), athletic and recreation facilities (ATHL), clubs and organizations (CLUBS), art, music, theater (AMT). Seven scales address the other opportunities for experience in the college environment: experiences with faculty (FACULTY), course learning (COURSE), experience in writing (WRITE), personal experiences (PERS), student acquaintances (STACQ), topics of conversation (CONTPS), and information in conversations (CONINFO). The student is instructed as follows: "In your experience at this college during the current school year, about how often have you done each of the following?" The student responds by indicating "never," for which 1 point is received; "occasionally," for which 2 points are received; "often," for which 3 points are received; or "very often," for which 4 points are received. On a 10-item activity scale, the score could range from 1 to 40. On the 12-item activity scale (AMT), the score could range from 1 to 48, and on the 6-item activity scale (CONINFO), the score could range from 1 to 24. Nursing students' involvement is in the scale of "often" or "occasional" for most activities. In the "often" category are course learning, library activities, and faculty experience. Nursing students reported less involvement in athletic and recreational facilities, clubs, and arts, music, and theater activities.
When scores are compared as a group with norms for the general college population (Table 1), nursing students reported a significantly higher quality of effort for library experiences, interaction with faculty, course learning activities, writing experiences, and personal experiences. Nursing students reported a significantly lower quality of effort for activities in the student union, student acquaintances, and art, music, and theater. For athletic and recreational activities, clubs and organizations, conversation topics and information conversations, there were no significant differences between the two groups of students.
A two-tailed t test was used to investigate significant differences between the activity scores of nursing students and the general college population (Table 1). There were no significant differences in the areas of using athletic/ recreational activities, clubs/organizations, topics of conversation, and topics of information. However, there were significant differences at the n<.05 level for activities into which nursing students put more effort: library experiences, faculty interactions, course learning, and personal experiences. Writing experiences were significant at the p<.01 level for activities in which nursing students put less effort; the t test showed significantly lower scores for use of the student union, student acquaintances experiences, and art, music, and theater opportunities. There were no significant differences for nursing students' involvement in clubs and organizations, athletic and recreational facilities, topics of conversation, or topics of information.
Research Question 2
The final section of the questionnaire, called "Estimate of Gains," consists of 23 statements of college objectives and goals. Factor analysis of the 23 statements broke them down into five areas of growth and development for a liberal education: personal and social development; science and technology; general education, literature, and the arts; intellectual skills; and vocational preparation. This study examined only the estimate of gains for three areas: personal and social development; general education, literature, and the arts; and intellectual skills.
The second research question asked students to indicate the extent to which they felt they had gained or made progress toward each of the goals, with progress characterized as "very little," "some," "quite a bit," or "very much." Substantial progress was recorded as "quite a bit" and "very much." Because these answers are dealing with feelings and interpretations and not directly observable and measurable behavior, Pace (1990b) introduced the criterion of a "noticeable difference" as more appropriate than the criterion of a "statistically significant" difference because of the very small differences that would not be readily observable in the campus behavior of students. Data analysis for this research arbitrarily used a difference of 12 percentage points or greater to define a major difference, or one that would be "educationally significant" between nursing students and the norms for the general college population.
Two-tailed t Test Comparison of Means for Nursing Students and Norms for the General Population
At least 50% of the nursing students reported substantial progress, "quite a bit" or "very much" toward 11 of the 16 general education goals, and 70% toward seven of the goals. They reported the greatest progress toward the goals of personal and social development such as values, self-understanding, and understanding others. The development of intellectual skills (ability to analyze and be logical, the ability to see relationships and to synthesize, and the ability to pursue ideas and find information) was the next area of greatest progress. Nursing students reported the least progress toward general education, literature, and the arts goals. The least progress was made in developing an understanding and enjoyment of art, music, and drama.
The differences between nursing students and the general college population are reported in Table 2. Like nursing students, the general college population's selfreported gains are greatest toward the personal and social development goals with the next greatest gains reported in intellectual skills. The least amount of progress is reported toward general education, literature, and arts.
There is an "educationally significant" difference of 12 percentage points between the nursing students and the college population on 6 of the 16 goals. Of these, five are positive significant differences: analysis, inquiry, values, team, and health. Nursing students reported one negative significant difference: literature. These findings are not supportive to the debate that posits liberal education as conflicting and potentially incompatible with professional education. The findings support the previous research of Pace (1990b), which reported that students in health perceived greater gains in personal and social development than students in Uberai arts majors who report greater gains in general education, literature, and the arts. Cassells, Redman, and Jackson (1986) also found that nursing students reported progress toward personal development and intellectual gains. Similar support is observed in the gender research of Gilligan (1982), who demonstrated differences in moral development, and in the research of Belenky, Blythe, Clinchy, Goldberger, and Tarule (1986), who demonstrated women's relationships with others to be important to personal development that occurs as a result of the educational process.
Research Question 3
The third research question measured the progress students reported toward reaching the liberal education goals: (a) personal/social development, (b) general education, and (c) intellectual skills.
The activity scales measuring QE produced three factors: scholarly/intellectual activities (ACADEMIC FACTOR), informal interpersonal activities (INTERPER FACTOR), and activities that use group facilities (GRPFACIL). Factor analysis of the eight separate ratings of environmental characteristics produced two factors: scholarly/intellectual (ENVSCH) and supportive personal relationships (ENVREL). Factor analysis of the 16 goals produced three factors: personal/social development (PERSONAL); general education, literature, and arts (GENEDUC); and intellectual skills (INTSKILL).
Comparison of Significant Differences Between Nursing Students and Norms of General College Population for Self-Reported Gains Toward Liberal Education Goals^sup a^
To identify which of the QE factors contributed most to the growth and development of nursing students' goals for intellectual skills, general education goals, and personal/ development goals, a stepwise maximum R-square (MAXR) multiple regression was completed.
Results of the regression analysis for the development of intellectual skill goals demonstrated that the ACADEMIC factor with an R-square of .24, the INTERPER factor increased to an R-square of .35, and the ENVSCH factor increased to an R-square of .37 contributed 37% of the variability in the development of intellectual skills. The variables GRPFACIL and ENVREL did not increase the R-square significantly at the o<.05 level.
The results of the regression for general education, literature, music, and arts goals showed four important factors: the INTERPER factor contributed .28 to the R-square, the variable ENVREL increased to .35 the R-square, the variable ENVSCH increased to .38 the R-square, and the variable ACADEMIC increased to .39 the R-square. Thirty-nine percent of the variability in the development of this goal was contributed by the four factors. The variable that did not increase the R-square significantly at the p <. 05 level was GRPFACIL.
The results of the three-step regression procedure for the personal and social development goals demonstrated that the variable INTERPER contributed .13 to the R-square, the variable GRPFACIL increased to .23 the R-square, and the variable ENVSCH increased to .25 the R-square. The three variables contributed 25% of the variability of the personal/social development goals. The variables ENVREL and ACADEMIC did not increase the R-square significantly at the p <. 05 level.
Interpersonal factors contributed to the goals of intellectual, general education, and personal development. Academic factors contributed two of the goals (intellectual and general education). These findings support the recent reports in higher education that stress the importance of peer and faculty interaction in creating a learning environment, student involvement in learning, and sharing of values and goals (Astin, 1984).
The scholarly environmental factor contributed to three of the goals (personal, intellectual, and general education), and the environmental relations factor contributed to two of the four goals (general education and satisfaction).
The evidence of nursing students' self-reported involvement in activities and facilities in their college environments were consistent with that of the general college population, as well as their progress toward liberal education goals. Nursing students' involvement in the academic setting is mostly with other nursing students and faculty. This is reflected in their self-reported progress toward liberal education goals and their overall satisfaction with college. This is in agreement with Pace's general conclusions that progress in Uberai education goals will be correlated with the amount of effort students use to participate in the activities and opportunities available in college.
These results validate the concerns stated in many of the recent national reports about the narrow experience many students have in college. For many, involvement in college does not go beyond their major and the development of intellectual knowledge and skills. Little effort is put into using the activities and costly facilities made available by colleges.
With the move of nursing education to colleges and universities, it has assumed the shape and texture of scientific academics. Memorizing nursing facts and theories, writing research papers, attending lectures, and writing nursing care plans may be useful activities for developing professional educational goals, but they may not be enough for long-term professional competence or living a full and responsible civic life. Without giving up hard-earned success in development of nursing science, some modest adjustments in faculty attitudes and curriculum components such as student- teacher interactions, student advisement, and a more participatory pedagogy may produce some substantial benefits for the development of liberal education competencies.
The dialogue on curriculum change has begun and includes those in nursing as well as nursing's public constituencies. AU learning experiences, both in and out of the classroom, can contribute to the development of liberal education competencies. The accent needs to be on questions, discovery, and reflection of students' lived experiences (Bevis & Murray, 1990; Tanner, 1987). Opportunities, both in and out of the classroom, abound for students to assess, clarify, and apply values to situations mirroring those they will encounter professionally. Practice learning experiences can be an excellent opportunity to develop liberal education competencies. Together, faculty and staff at practice sites can cooperate to create the context and fabric for a liberal education.
Nursing education will need to bring into better alignment its lofty ideal for a liberal education for professional nurses and its actual curricular patterns and outcomes. Administration must create a climate in which research on the outcomes of a liberal and professional education is supported and new educational policy development is based on research findings.
Liberal education can become the very center of intellectual life of the nursing education community, which should be a common ground of inquiry that binds the academic community in a shared commitment to the cultivation of social and personal values (Boyer, 1989). Academic policy, research, and deliberate focus on values, curriculum reform, and pedagogical reform insist that changes in providing a liberal education need to be conceived not only in the light of course content, but in the larger community of learners in which liberal education takes place.
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Two-tailed t Test Comparison of Means for Nursing Students and Norms for the General Population
Comparison of Significant Differences Between Nursing Students and Norms of General College Population for Self-Reported Gains Toward Liberal Education Goals^sup a^