Int. J. Nurs. Stud.Vol. 13,pp. 231-241,PergamonPress, 1976.Printedin Great Britain
Guided study student achievement CAROL L. MILLER, and MARGARET APPLEGATE,
R.N., Ed.D. R.N., M.S.,
Indiana University School of Nursing, Indianapolis, Indiana, U.S.A.
The purpose of this study was to measure change in student achievement, in a National League for Nursing accredited Associate Degree Nursing Program for Guided Study nursing students from 1971 to 1974, as this was contrasted to other Associate Degree nursing students in the same program. The study suggested that the grouping of students admitted with Scholastic Aptitude Test Verbal scores below 400 or High School Rank below 50 percentile or both of these scores would be appreciably enhanced if they were included in the group receiving remediation treatment. OBJECT of this article is to present to the nursing community, a continuing remediation program, Guided Study for nurses. Now in its fifth year, there is a need to evaluate the impact of the program by being both specific enough to permit accurate measurement and yet broad enough to be of practical use in program administration. By providing a means to compare and contrast mainly academic variables for goal achievement about students and their graduation in a specific type of remediation program, nursing administrators and educators might be guided to m-ore effP&wlv__, ____ imnlrment pgram: _A_n &Grt tG evaluate _ _._.._. r_________ their rp_me&tjnn the progress of students or lack of progress is expected to build a knowledge base upon which a successful program might be developed. According to Harnischfeger and Wiley ( 1976)) the nationwide, college-bound high school senior showed a decline in Scholastic Aptitude Test (SAT) verbal and mathematical scores over the past decade. Other widely used tests for collegebound high school seniors supported the downward trend of the SAT scores. They stated that females who used to earn higher scores than males in verbal aptitude fell below the male average, indicating a more drastic drop for female than for male students. A careful evaluation of the test composition and examinee sampling revealed no evidence of any systematic changes in test content and no evidence of significant modifications in the composition of the test taking groups. Their report included the general picture (1) of substantial decreases in general course taking which have not been substantially replaced by increases in elective and specialty THE
This Guided Study project was initiated through funding by Methodist Hospital of Indiana, Inc. at Indianapolis and Indiana University Foundation. 231
232
CAROL L. MILLER AJvD MARGARET
APPLEGATE
courses and (2) of an enrollment drop in the traditional basic courses of the college preparatory curricula, algebra, first-year foreign language, chemistry, and physics. These course enrollment declines paralleled closely the test score decline patterns which were largest for English, followed by mathematics and natural sciences. They concluded that this educational focus on the consequences of SAT test score decline would strongly promote a return to traditional learnings and strongly foster remedial action. The purpose of this study was to measure change in student achievement in a National League for Nursing accredited Associate Degree Nursing Program for Guided Study nursing students from 1971 to 1974 as this was contrasted to other Associate Degree nursing students in the same program. The objectives of this study were: 1. To compare and contrast Guided Study students to Conditional students in the nursing education program on academic performance. 2. To compare and contrast Conditional students to Approved students in the nursing education program on academic performance. 3. To compare and contrast Guided Study students to Approved students in the nursing education program on academic performance. In order to accomplish the purpose, the researcher and Associate Degree Nursing Program Director conferred to define boundaries which established student groupings. This process was conducted because currently the university has two groups in the nursing program, the Guided Study and the Admitted students and the regrouping of students might identify and clarify more information. The goals of the Guided Study project were reviewed as well as admission criteria for the program. Only those students who were inadmissible to both the University and the nursing program were considered for entry into the Guided Study program. The Guided Study faculty reviewed the records of those seeking admission to the nursing program who did not meet admission criteria and selected the Guided Study candidates based upon the data and personal interviews. Students entered the Guided Study program with a program goal of three years rather than the typical two year course of study. Included in the first or remediation year for the 1971-1974 students are: Credits
Dept.
Course
Educ. English Sociology
Semester I Reading-Learning Techniques I English Composition Introduction to Sociology
3 3 3
Educ. Biology
Semester II Reading-Learning Techniques II Elementary Human Anatomy
2 5
The Department of Education and nursing faculty worked together in presenting the learning techniques courses especially designed for these students. These two courses were designed as follows. Reading-learning techniques-I
This is a 3 credit hour course presented
in the first semester
of the 3 yr plan
GUIDED STUDY STUDENT
ACHIEVEMENT
233
designed for educationally disadvantaged students. It is composed of 1.5 credit hours of study skills and l-5 credit hours for basic medical and nursing terminology. This course deals with content and practice designed to develop basic reading skills and to give an introduction to medical and nursing terminology. Emphasis in the study skills section is placed on mechanics of reading, flexibility in reading, styles of learning, listening comprehension, vocabulary development, work attack, reading comprehension, and reading rate. The nursing section includes fundamentals basic to learning medical and nursing terminology, abbreviations and symbols, prefixes, s&Fixes, combining forms, and the relationship of various medical and nursing terms to their related systems. Reading-learning
techniques--II
This is a 2 credit hour course presented in the second semester of the first year of the 3 yr program designed for educationally disadvantaged students. This is a laboratory course including 1 hr/week for study skills and 3 hr/week in preparation for nursing. The nursing section deals with content and practice designed to give an introduction to selected nursing concepts. Emphasis is on utilization of library resources, the role of the nurse, related terminology, math applied to drug dosages and basic communication techniques. The course is structured to provide selected learning experiences in the classroom, laboratory and clinical facilities in order to assist the student in applying basic nursing theory. The study skill portion is individualized to meet specific needs. While completing these courses they also complete selected support courses in the University Division. Upon successful completion of this portion of the program, the students are admitted to the nursing major and become the Guided Study nursing students. The researcher then explained the procedure for grouping the Conditional students. These students had Scholastic Aptitude Test (SAT) Verbal scores below 400 or High School Rank below 50 percentile or both of these scores. Another grouping, the Approved students met the admission criteria and had SAT Verbal scores above 400 and High School Rank above 50 percentile. The three groupings of students were established to identify the impact of the Guided Study program. SAT Verbal scores and High School Rank are particularly strong predictors of the Associate Degree Nursing Program and the passing of the State Board Examinations (SBE) (Miller, 1974; Miller et al., 1968). SAT Verbal score of 400 and High School Rank of 50 percentile are ordinary baseline levels at which students function for the nursing program goal consequence of passing the SBE. Potential academic achievement variables were identified, and data were gathered and analyzed. Remedial instruction in nursing program
Miller (1974) developed and implemented plans for improving student achievement in the associate degree nursing program for nursing students during their first year. Their approach was through prediction of low achievement and failure in specific freshman courses through analysis of academic psychological and sociological variables through remediation in small-group sessions. It was concluded that the major impact of the tutorial program was on helping students get a passing grade
234
CAROL L. MILLER A.ND MARGARET
APPLEGATE
of 2-O on a 4 point scale or better in the course in which they were predicted to fail. Glanzrock and Stahl (197 1) provided tutorial and remedial services to freshman nursing program matriculants in five City University of New York colleges. Since the service was offered on a voluntary basis, students from different levels of academic ability requesting to join the program for tutoring in one or more courses were accommodated. The 381 freshmen enrolled in the program received between 7.5 and 14.3 hr of tutoring for each course in which help was requested. The number of trained tutors was 73. Because of the voluntary nature of the service of the program, a true control group was not available for the comparison of the tutored and their non-tutored counterparts. However, an analysis of covariance revealed that the short and long term achievement of tutored students tended to be poorer than that of the nontutored group, but achievement gains were significantly greater for the tutored group in the first year of the program. It was also found that students in the tutored group pursued more non-academic courses of study and exhibited poorer high school grades, particularly in science. In courses of high difficulty (i.e. science) and where tutoring was found to be most intensive, a significant positive correlation was found between the tutored students’ total tutoring hours and both their course grades and achievement gains. Furthermore, students who began their tutoring late in the program failed to exhibit achievement gains greater than their non-tutored counterparts. Finally, the authors reported that a significantly greater number of tutored students completed the nursing program than non-tutored students. Three other remedial programs for nursing students were reviewed which involved a much smaller group of nursing students and were of shorter duration than the studies cited above. DeFrank (1971) conducted a project in a hospital 3-yr nursing program with 20 unsuccessful applicants for admission to nursing. Thirty hours of remedial reading were given and 13 of the 20 were accepted into the nursing program as a result. Heins and Davis (1972) studied 13 high risk nursing students who were tutored for six weeks in a pre-school program. Eleven of them were admitted and eight completed the first quarter of the senior year. Henke (1971) g ave beginning students in a 3-yr program a stipend to participate in an eight week live-in remedial project. All had been initially rejected on the basis of the College Qualification Test scores or their high school grades. The program consisted of programmed instruction and lecture-discussion work periods. Particular emphasis was given to the development of basic skills. Frequent field trips were designed to be recreational as well as educational. Six of the nine were finally accepted into the degree program. Five remained in the program after one semester, but only four received satisfactory grades and evaluations in all courses. There are enumerative ways that one could plan a remediation program, such as by changing: (1) the number of persons in a group, (2) the number of instructors per group, (3) the selection of students to be tutored, (4) the content and method of instruction, (5) the selection and training of instructors, (6) the selection of course or courses, (7) the duration of assistance in hr/week, (8) the determination of semester(s) or year(s) and (9) the usage of sound instruments. Each variant within
GUiDED
STUD T STUDENT
ACHIEVEMENT
235
each developed and implemented system must be designed for evaluative research. Each program requires goals of achievement for the students, sound instruments for measuring their achievement, and sound predictors for measurement on students over a span of time with a large enough number of subjects to study each program’s effectiveness. One could ask oneself: What does the evaluation researcher recommend, after reviewing the literature on remedial programs, when one does not find whether a program is effective or ineffective ? Is the question for educators to ask: Were program changes made from recommendations of each study or is the question : Mow could there be program changes ? Nursing administrators do not have scores or hundreds of variants of a program that have been run, where success or much success are shown. Of course, there remains a vital role for evaluation research and that is to focus attention on the consequences of programs, to keep uncovering their shortcomings, and to locate those programs that do have positive effects and can be extended and expanded. Despite the conceptual and methodological shortcomings of the reviewed studies which need upgrading, the cumulative evidence has to be taken seriously.
Remedial
instruction
for college
students
in general
Mains and Collins (1960) described a developmental reading program at Coalinga College. They stated that it had little effect on the attrition rates and grade point averages of 109 students enrolled in the program when compared to a control group. Dalton et al. (1966) studied the effects of remedial reading instruction on the academic achievement of freshman students at the University of Missouri for three semesters. Students who had the remedial reading instruction made significant improvements in their overall academic grade averages. Ray (1965) a 1so studied the effects of remedial instruction in reading at the college level. The program consisted of 30 hr of instruction. The students were retested three months and six months after the completion of instruction. It was found that significant gains made during instruction were retained without significant loss after six months. Ahmann and Glock (1959) evaluated a remedial procedure in the College of Agriculture at Cornell University. The Cornell Mathematics Test was used to identify freshmen in need of remedial work in applied mathematics. Half were assigned to a remedial course and half served as the control. The results indicated that the control subjects obtained higher grades in related courses than the subjects who took the remedial course. However, the gain in scores on the Cornell Mathcmatics Test was significantly greater for the experimental group. Comparisons of drop-out rates revealed no significant differences. A program at Bakersfield College required students scoring below the tenth percentile on entrance exams to enter a remedial program. The program offered tutoring, counselling and orientation classes. Collins (1964) reported in a 3-yr study of the program that 43% of the 98 program students withdrew because of academic failure, while only 12% remained to complete the program. Thus, the program failed to produce higher grade point averages or greater persistance rates. Etters (1967) reported on the use of a special tutorial program in college core
236
CAROL L. MILLER AND MARGARET
APPLEGATE
courses for low achievers at Parsons College. The tutorial instruction consisted of 30 min or more of private tutoring per week. Low achievers made significant improvements in their academic grades averages as a result of participation in the tutorial program. Baehr (1969) evaluated a remedial program for ‘high risk’ freshman students at Chicago City College, Kennedy-King College. Remedial assistance included small seminars, counselling, and personalized student-staff relationships. Although a gain in grade point average was reported for the experimental condition, it was not significant. However, persistance in college did increase as a function of the program. Heinkel (1970) reported on the effectiveness of a General Studies Program at San Diego City College. Through intensive counselling, remedial instruction and emphasis on effective study habits, the program aimed to reduce attrition rates and to improve achievement for beginning students. The results showed that males and minority students were encouraged to re-enroll for a second semester. Also, minority students enrolled in the program dropped fewer units for the first semester than students not enrolled in the program. No other differences were found. Kester (1971) reported on the effects of a 3 yr attrition study, the ‘NORCAL’ Project. They compared treatment to control groups at 12 community colleges in Northern California. Treatments included counselling, skill learning, student services and special remedial courses for freshman students identified as potential dropouts. All colleges reported that the students in the treatment conditions reenrolled more often than those in the control group. Eight colleges reported significant levels of re-enrollment. Six of the twelve colleges reported higher grades among students in treatment groups, but only two reported significant differences when compared to the control group. Finally, all colleges reporting successful treatment programs included counselling in their procedures. Even though the effectiveness of many remedial programs has been negligible, reports of gains in the desired direction as higher grades warrant continued efforts in the exploration and implementation of Guided Study programs or other remediation systems. In general, the review indicates that multiple predictors of academic performance are desirable over any single predictor. The most accurate predictors of achievement include academic, psychological and sociological variables. Utilization of sound instruments and data as specific predictors will enable the development of multivariate equations to predict nursing student performance. Identification of probable failures or low achievers in specific courses enables direct intervention in the instructional process. A particularly adequate battery of predictors for academic performance might then include indices of previous achievement, selected personality variables, and relevant biographical data. Measures
Information for measurement purposes was gathered for all Guided Study nursing students entering in 1971-1974. SAT Verbal scores and High School Rank were gathered from the student’s academic folders of all nursing students who entered in 1971-1974. A random sample of Conditional students and of Approved students in the same year as the Guided Study students served as control groups.
GUIDED STUDY STiJDEflT
ACHIEVEMENT
237
The same information for measurement was gathered for these two groups of students as the Guided Study group of students. Data obtained from student academic folders included: high school rank; high school grade averages in math, science and English courses ; overall high school average; previous education; age ; previous nursing experience ; marital status ; and SAT Verbal. High School Rank was recorded in percentiles. High school grade averages in each of the three areas and overall high school averages were either calculated or provided directly from the student folders. Previous education before entering the Associate Degree Nursing Program or Guided Study was coded in years. Age in years was converted in months. Previous nursing experience was recorded from questionnaires administered either by Guided Study personnel for Guided Study students or the researcher (Miller, 1974) from a supported study. Previous nursing was coded as 1 when experience was scored for licensed practical nurse, nurse’s aide, technician, or others as medical assistant. Marital status was coded as 1 if the score was present in the student academic folder. SAT Verbal score was coded as 1 if the score was present in the student folder. SAT scores are not an admission requirement by Indiana University if the student was a past high school graduate of two years or more. In addition to admission biographical data, a number of criteria were used to evaluate the outcomes of all three groups within the nursing program. These criteria included : student grades in Anatomy, Physiology, Microbiology, Fundamentals of Nursing, and English ; first and second semester Grade Point Averages (GPA) and graduated from the nursing program. Student grades were coded in the form of a numerical grade 4 = A to 0 = F for each specified course. Graduation from the nursing program was coded as 1 and 0 if graduation did not occur. At a later time each students’ State Board Examination (SBE) scores were recorded from graduates who entered the nursing program in 1971 and 1972. The SBE in five areas of nursing: medical, surgical, obstetric, pediatric, and psychiatric were used. Method
of analysis
Correlations among the background variables of these three groups of students were done to show if significant relationships existed among student admission criteria and student performance. Analysis of variance for each background variable was used to test for statistically significant variances. When the F test was significant, the Newman-Keuls method was used in making tests on differences between all pairs of means. These pairs were: (1) Guided Study students - (2) Conditional students; (2) Conditional students - (3) Approved students; and (1) Guided Study students - (3) Approved students. In this way variations within scores for each group and between groups were ascertained, and each group was thus compared for predominance of the student admission criteria and student performance which differentiates it from thr other group. Results
The first step in the statistical
analysis was the correlation
matrix of the back-
CAROL L. MILLER
238
AND MARGARET
APPLEGATE
ground variables on 433 students. The correlations among various student admission criteria and student performance were done which indicated the degree of relationship between two variables. Significant relationships were found among all of the 19 variables as listed in Table 1. More than ten significant relationships above the TABLE 1. VARIABLES USES IN ANALYSIS OF VARIANCE
FOR
GROUPS
Year 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
Amount of education before entering nursing program Course grade in anatomy Course grade in English Course grade in fundamentals of nursing Course grade in microbiology Course grade in physiology Grade point average-First Semester Grade point average-Second Semester Graduated from nursing program High school English High school mathematics High school science High school overall High school rank Licensed practical nurse Marital status Nurse’s aide Previous experience in nursing before entering nursing program SAT verbal State
1. 2. 7 ,.
-
4. 5.
1972
1973
x *
X
X
X
X
X
1971
Age
board
PROGRAM (1971-1974)
IN NURSING
X
X
(2):(3)
-
-
X
x x
x
X
X
X
X
X
X
X
X
X
x
X
x
x
s
X
X
X
X
X
X
X
X
X
X
X
-
X
x i
i;
x
-
X
x .
: X x X X Medical nursing x X X X Surgical nursing X X x x X Obstetric nursing X x X X Pediatric nursing X X x ..i X Psychiatric nursing X x __. - ._._ -._.~ ___~ _- ---_-_ ..._. ..___ * x means the differences are significant at the 0.05 level: Group I Guided Study students, Group 2 Conditional students, and Group 3 Approved students.
20.
11. 12. 13. 14. 15. 16. 17. 18. 19.
X
X
X
X X
X
X
X
X
-
X
-
X X
X
X
(l)-(3) ___-
X
w-(2)
1973 (2)-(3)
(1971-1974).
X
(l)-(3)
-.-
PAIRS OF MEANS
X
-
BETWEEN
1972 (2)-(3)
X
-
X X
X
(l)-(2)
X
(l)-(3)
OF DIFFERENCE
x
X
X
1971 (2)-(3) --
'l-ABLE 2. SIGNIFICANCE
Groups (l)-(2) .-._.___ 1. Age 2. Amount of education before entering nursing program 3. Grade in anatomy X 4. Grade in English 5. Grade in fundamentals of x nursing 6. Grade in microbiology X X 7. Grade in physiology X 8. GPA-1st Sem. 9. GPA-2nd Sem. X 10. Graduated from nursing
___._._.
240
CAROL L. MILLER AND MARGARET
APPLEGATE
science, High School overall grade average in English, mathematics and science, High School rank in percentiles were found significant for years 1971 and 1974. Course grades in Microbiology, Physiology, and Fundamentals of Nursing were significant for years 1971, 1972, and 1973 and not significant in 1974 between Group 2 Conditional students and Group 3 Approved students. When the data was gathered, these course grades for Guided Study students were not completed. The course grade in English was significant for 1971, but no analysis was done during 1972-1974 because the course grading system was changed for the Guided Study students to the pass-fail method. Only in 1972 was the presence of SAT Verbal scores found significant. Two analyses on marital status and age were not significant from 1971 to 1974. For years 1971 and 1972 previous experience in nursing before entering the nursing program was gathered and found significant for 1971, but not for 1972. Licensed Practical Nurse was significant for 1972 while nurse’s aide was significant for both 1971 and 1972. Then for years 1971 and 1972 entrants who graduated were found significant for both 1971 and 1972. Finally, in 1971 and 1972 all of the SBE scores were found significant. As yet 1973 and 1974 students have not graduated. The significance of differences between pairs of means from 1971 to 1974 are shown in Table 2. From 197 1 to 1972 the Group 2-Group 3 decreased markedly in the number of significant variables. This may be due in part to changes in entrance requirements from open door admission to requirements of graduation in the upper half of his high school class and the achievement of reasonable scores on their SAT examination. In 1972, 1973, and 1974 the three groups presented relatively for the most part similar patterns in significant variables. Even though the university has two groups of students in the Associate Degree Nursing Program, the Guided Study students and the Admitted students, the following findings demonstrated that three groups of students were present. With more conservative admission policies in 1972 there was a significant difference among the three groups between Group 1 Guided Study students-Group 3 Approved students for graduating in the nursing program. The differences between pairs of means on SBE scores revealed, in general, that both the Group 1 Guided Study students and Group 2 Conditional students changed becoming closer to Group 3 in an individual student’s mastery of content on SBE scores. As of the date of this writing, 78 guided students had been admitted to the nursing major from its inception to 1973. Of these, 40 have successfully completed the program and 36 have passed the State Board Test Pool Examinations for licensure. This success study of a specific remediation program compares favorably to other similar programs and would reinforce continuation of the program. In this particular nursing program, another significant pattern emerges. The attrition rate, determined by the differences between pairs of means on those who graduated, for the Conditional students who have received no remediation treatment is similar to that of the Guided Study group. The attrition rate and findings of this study would suggest that the success rate of the Conditional students would be appreciably enhanced if they were included in the group receiving remediation treatment. If a program change is made for this recommendation, then further evaluative research is in order. It is not evident now and it should be clear that using the same teaching approaches in different combination is unlikely to pay off.
GUIDED STUDTSTUDEJVT
ACHIEVEMENT
241
References AHMANN, J. S. and GLOCK, M. D. (1957). The utility of study habits and attitudes inventory in a college reading program. 3. Educ. Res. 51, 297-303. BAEHR, R. F. (1969). Project success. Chicago City College, 111.Kennedy-King College, ED 039 870. Office of Education, Washington, D.C. COLLINS,J. J. (1964). Meeting the needs of the less able junior college student. A Report to the American Personnel and Guidance Association, Bakersfield College, California. DALTON, P. et al. (1966). Effect of reading improvement on academic achievement. 3. Reading 9, 242-252. DEFRANK, SISTER JOSEPH L. (1971). RIPS: A remedial instruction program. Nars. Outlook 19, 180-181. ETTERS, E. M. (1967). Tutorial assistance in college core courses. 3. Educ. Res. 60,406-407. GLANZROCK,N. M. and STAIIL, R. (1971). Nurse tutoring study of the City University of New York, City Univ. of New York, N.Y. Kingsborough Community COB., Final Report. HARNISCHFEGER, A. and WILEY, D. E. (1976). Achievement test scores drop. So what? Educ. Res. 5, 5-12. HEINKEL, 0. A. (1970). Evaluation of a general studies program for the potentially low academic achiever in California junior colleges: Final report, ERIC No. 039881, Office of Education (DHEW), Washington, D.C. HEINS, M. and DAVIS, M. (1972). How do we help ‘high risk’students? Xrs. Outlook20, 121-123. HENKE, SISTER GRACE (1971). Project tap-a tutorial program. Am. 3. Nurs. 71, 978-981. KESTER, D. (1971). California community college stopouts: a comparison of the three NOR-CALCCHE follow-up studies. Ed. 057 77 1, Office of Education, Div. of Academic Facilities, Washington, D.C. MAINS, M. F. and COLLINS, C. C. (1960). The developmental reading course and junior college objective. Junior College3. 31, 123-129. MILLER, C. L. (1974). Improving student achievement in nursing education through prediction and remediation of low achievement and failure in specific freshman courses, Public Health Service Grant DlO NU00522. MILLER, C. L., FELDHUSEN,J. F. and ASHER, J. W. (1968). Prediction of state board examination scores of graduates of an associate degree program. 3vurs.Res. 17, 555-558. RAY, D. D. (1965). Permanency of gains made in a college reading improvement program. 3. Educ. Res. 59, 17-20.
Guided study student achievement CAROL L. MILLER, and MARGARET APPLEGATE,
R.N., Ed.D. R.N., M.S.,
Indiana University School of Nursing, Indianapolis, Indiana, U.S.A.
The purpose of this study was to measure change in student achievement, in a National League for Nursing accredited Associate Degree Nursing Program for Guided Study nursing students from 1971 to 1974, as this was contrasted to other Associate Degree nursing students in the same program. The study suggested that the grouping of students admitted with Scholastic Aptitude Test Verbal scores below 400 or High School Rank below 50 percentile or both of these scores would be appreciably enhanced if they were included in the group receiving remediation treatment. OBJECT of this article is to present to the nursing community, a continuing remediation program, Guided Study for nurses. Now in its fifth year, there is a need to evaluate the impact of the program by being both specific enough to permit accurate measurement and yet broad enough to be of practical use in program administration. By providing a means to compare and contrast mainly academic variables for goal achievement about students and their graduation in a specific type of remediation program, nursing administrators and educators might be guided to m-ore effP&wlv__, ____ imnlrment pgram: _A_n &Grt tG evaluate _ _._.._. r_________ their rp_me&tjnn the progress of students or lack of progress is expected to build a knowledge base upon which a successful program might be developed. According to Harnischfeger and Wiley ( 1976)) the nationwide, college-bound high school senior showed a decline in Scholastic Aptitude Test (SAT) verbal and mathematical scores over the past decade. Other widely used tests for collegebound high school seniors supported the downward trend of the SAT scores. They stated that females who used to earn higher scores than males in verbal aptitude fell below the male average, indicating a more drastic drop for female than for male students. A careful evaluation of the test composition and examinee sampling revealed no evidence of any systematic changes in test content and no evidence of significant modifications in the composition of the test taking groups. Their report included the general picture (1) of substantial decreases in general course taking which have not been substantially replaced by increases in elective and specialty THE
This Guided Study project was initiated through funding by Methodist Hospital of Indiana, Inc. at Indianapolis and Indiana University Foundation. 231
232
CAROL L. MILLER AJvD MARGARET
APPLEGATE
courses and (2) of an enrollment drop in the traditional basic courses of the college preparatory curricula, algebra, first-year foreign language, chemistry, and physics. These course enrollment declines paralleled closely the test score decline patterns which were largest for English, followed by mathematics and natural sciences. They concluded that this educational focus on the consequences of SAT test score decline would strongly promote a return to traditional learnings and strongly foster remedial action. The purpose of this study was to measure change in student achievement in a National League for Nursing accredited Associate Degree Nursing Program for Guided Study nursing students from 1971 to 1974 as this was contrasted to other Associate Degree nursing students in the same program. The objectives of this study were: 1. To compare and contrast Guided Study students to Conditional students in the nursing education program on academic performance. 2. To compare and contrast Conditional students to Approved students in the nursing education program on academic performance. 3. To compare and contrast Guided Study students to Approved students in the nursing education program on academic performance. In order to accomplish the purpose, the researcher and Associate Degree Nursing Program Director conferred to define boundaries which established student groupings. This process was conducted because currently the university has two groups in the nursing program, the Guided Study and the Admitted students and the regrouping of students might identify and clarify more information. The goals of the Guided Study project were reviewed as well as admission criteria for the program. Only those students who were inadmissible to both the University and the nursing program were considered for entry into the Guided Study program. The Guided Study faculty reviewed the records of those seeking admission to the nursing program who did not meet admission criteria and selected the Guided Study candidates based upon the data and personal interviews. Students entered the Guided Study program with a program goal of three years rather than the typical two year course of study. Included in the first or remediation year for the 1971-1974 students are: Credits
Dept.
Course
Educ. English Sociology
Semester I Reading-Learning Techniques I English Composition Introduction to Sociology
3 3 3
Educ. Biology
Semester II Reading-Learning Techniques II Elementary Human Anatomy
2 5
The Department of Education and nursing faculty worked together in presenting the learning techniques courses especially designed for these students. These two courses were designed as follows. Reading-learning techniques-I
This is a 3 credit hour course presented
in the first semester
of the 3 yr plan
GUIDED STUDY STUDENT
ACHIEVEMENT
233
designed for educationally disadvantaged students. It is composed of 1.5 credit hours of study skills and l-5 credit hours for basic medical and nursing terminology. This course deals with content and practice designed to develop basic reading skills and to give an introduction to medical and nursing terminology. Emphasis in the study skills section is placed on mechanics of reading, flexibility in reading, styles of learning, listening comprehension, vocabulary development, work attack, reading comprehension, and reading rate. The nursing section includes fundamentals basic to learning medical and nursing terminology, abbreviations and symbols, prefixes, s&Fixes, combining forms, and the relationship of various medical and nursing terms to their related systems. Reading-learning
techniques--II
This is a 2 credit hour course presented in the second semester of the first year of the 3 yr program designed for educationally disadvantaged students. This is a laboratory course including 1 hr/week for study skills and 3 hr/week in preparation for nursing. The nursing section deals with content and practice designed to give an introduction to selected nursing concepts. Emphasis is on utilization of library resources, the role of the nurse, related terminology, math applied to drug dosages and basic communication techniques. The course is structured to provide selected learning experiences in the classroom, laboratory and clinical facilities in order to assist the student in applying basic nursing theory. The study skill portion is individualized to meet specific needs. While completing these courses they also complete selected support courses in the University Division. Upon successful completion of this portion of the program, the students are admitted to the nursing major and become the Guided Study nursing students. The researcher then explained the procedure for grouping the Conditional students. These students had Scholastic Aptitude Test (SAT) Verbal scores below 400 or High School Rank below 50 percentile or both of these scores. Another grouping, the Approved students met the admission criteria and had SAT Verbal scores above 400 and High School Rank above 50 percentile. The three groupings of students were established to identify the impact of the Guided Study program. SAT Verbal scores and High School Rank are particularly strong predictors of the Associate Degree Nursing Program and the passing of the State Board Examinations (SBE) (Miller, 1974; Miller et al., 1968). SAT Verbal score of 400 and High School Rank of 50 percentile are ordinary baseline levels at which students function for the nursing program goal consequence of passing the SBE. Potential academic achievement variables were identified, and data were gathered and analyzed. Remedial instruction in nursing program
Miller (1974) developed and implemented plans for improving student achievement in the associate degree nursing program for nursing students during their first year. Their approach was through prediction of low achievement and failure in specific freshman courses through analysis of academic psychological and sociological variables through remediation in small-group sessions. It was concluded that the major impact of the tutorial program was on helping students get a passing grade
234
CAROL L. MILLER A.ND MARGARET
APPLEGATE
of 2-O on a 4 point scale or better in the course in which they were predicted to fail. Glanzrock and Stahl (197 1) provided tutorial and remedial services to freshman nursing program matriculants in five City University of New York colleges. Since the service was offered on a voluntary basis, students from different levels of academic ability requesting to join the program for tutoring in one or more courses were accommodated. The 381 freshmen enrolled in the program received between 7.5 and 14.3 hr of tutoring for each course in which help was requested. The number of trained tutors was 73. Because of the voluntary nature of the service of the program, a true control group was not available for the comparison of the tutored and their non-tutored counterparts. However, an analysis of covariance revealed that the short and long term achievement of tutored students tended to be poorer than that of the nontutored group, but achievement gains were significantly greater for the tutored group in the first year of the program. It was also found that students in the tutored group pursued more non-academic courses of study and exhibited poorer high school grades, particularly in science. In courses of high difficulty (i.e. science) and where tutoring was found to be most intensive, a significant positive correlation was found between the tutored students’ total tutoring hours and both their course grades and achievement gains. Furthermore, students who began their tutoring late in the program failed to exhibit achievement gains greater than their non-tutored counterparts. Finally, the authors reported that a significantly greater number of tutored students completed the nursing program than non-tutored students. Three other remedial programs for nursing students were reviewed which involved a much smaller group of nursing students and were of shorter duration than the studies cited above. DeFrank (1971) conducted a project in a hospital 3-yr nursing program with 20 unsuccessful applicants for admission to nursing. Thirty hours of remedial reading were given and 13 of the 20 were accepted into the nursing program as a result. Heins and Davis (1972) studied 13 high risk nursing students who were tutored for six weeks in a pre-school program. Eleven of them were admitted and eight completed the first quarter of the senior year. Henke (1971) g ave beginning students in a 3-yr program a stipend to participate in an eight week live-in remedial project. All had been initially rejected on the basis of the College Qualification Test scores or their high school grades. The program consisted of programmed instruction and lecture-discussion work periods. Particular emphasis was given to the development of basic skills. Frequent field trips were designed to be recreational as well as educational. Six of the nine were finally accepted into the degree program. Five remained in the program after one semester, but only four received satisfactory grades and evaluations in all courses. There are enumerative ways that one could plan a remediation program, such as by changing: (1) the number of persons in a group, (2) the number of instructors per group, (3) the selection of students to be tutored, (4) the content and method of instruction, (5) the selection and training of instructors, (6) the selection of course or courses, (7) the duration of assistance in hr/week, (8) the determination of semester(s) or year(s) and (9) the usage of sound instruments. Each variant within
GUiDED
STUD T STUDENT
ACHIEVEMENT
235
each developed and implemented system must be designed for evaluative research. Each program requires goals of achievement for the students, sound instruments for measuring their achievement, and sound predictors for measurement on students over a span of time with a large enough number of subjects to study each program’s effectiveness. One could ask oneself: What does the evaluation researcher recommend, after reviewing the literature on remedial programs, when one does not find whether a program is effective or ineffective ? Is the question for educators to ask: Were program changes made from recommendations of each study or is the question : Mow could there be program changes ? Nursing administrators do not have scores or hundreds of variants of a program that have been run, where success or much success are shown. Of course, there remains a vital role for evaluation research and that is to focus attention on the consequences of programs, to keep uncovering their shortcomings, and to locate those programs that do have positive effects and can be extended and expanded. Despite the conceptual and methodological shortcomings of the reviewed studies which need upgrading, the cumulative evidence has to be taken seriously.
Remedial
instruction
for college
students
in general
Mains and Collins (1960) described a developmental reading program at Coalinga College. They stated that it had little effect on the attrition rates and grade point averages of 109 students enrolled in the program when compared to a control group. Dalton et al. (1966) studied the effects of remedial reading instruction on the academic achievement of freshman students at the University of Missouri for three semesters. Students who had the remedial reading instruction made significant improvements in their overall academic grade averages. Ray (1965) a 1so studied the effects of remedial instruction in reading at the college level. The program consisted of 30 hr of instruction. The students were retested three months and six months after the completion of instruction. It was found that significant gains made during instruction were retained without significant loss after six months. Ahmann and Glock (1959) evaluated a remedial procedure in the College of Agriculture at Cornell University. The Cornell Mathematics Test was used to identify freshmen in need of remedial work in applied mathematics. Half were assigned to a remedial course and half served as the control. The results indicated that the control subjects obtained higher grades in related courses than the subjects who took the remedial course. However, the gain in scores on the Cornell Mathcmatics Test was significantly greater for the experimental group. Comparisons of drop-out rates revealed no significant differences. A program at Bakersfield College required students scoring below the tenth percentile on entrance exams to enter a remedial program. The program offered tutoring, counselling and orientation classes. Collins (1964) reported in a 3-yr study of the program that 43% of the 98 program students withdrew because of academic failure, while only 12% remained to complete the program. Thus, the program failed to produce higher grade point averages or greater persistance rates. Etters (1967) reported on the use of a special tutorial program in college core
236
CAROL L. MILLER AND MARGARET
APPLEGATE
courses for low achievers at Parsons College. The tutorial instruction consisted of 30 min or more of private tutoring per week. Low achievers made significant improvements in their academic grades averages as a result of participation in the tutorial program. Baehr (1969) evaluated a remedial program for ‘high risk’ freshman students at Chicago City College, Kennedy-King College. Remedial assistance included small seminars, counselling, and personalized student-staff relationships. Although a gain in grade point average was reported for the experimental condition, it was not significant. However, persistance in college did increase as a function of the program. Heinkel (1970) reported on the effectiveness of a General Studies Program at San Diego City College. Through intensive counselling, remedial instruction and emphasis on effective study habits, the program aimed to reduce attrition rates and to improve achievement for beginning students. The results showed that males and minority students were encouraged to re-enroll for a second semester. Also, minority students enrolled in the program dropped fewer units for the first semester than students not enrolled in the program. No other differences were found. Kester (1971) reported on the effects of a 3 yr attrition study, the ‘NORCAL’ Project. They compared treatment to control groups at 12 community colleges in Northern California. Treatments included counselling, skill learning, student services and special remedial courses for freshman students identified as potential dropouts. All colleges reported that the students in the treatment conditions reenrolled more often than those in the control group. Eight colleges reported significant levels of re-enrollment. Six of the twelve colleges reported higher grades among students in treatment groups, but only two reported significant differences when compared to the control group. Finally, all colleges reporting successful treatment programs included counselling in their procedures. Even though the effectiveness of many remedial programs has been negligible, reports of gains in the desired direction as higher grades warrant continued efforts in the exploration and implementation of Guided Study programs or other remediation systems. In general, the review indicates that multiple predictors of academic performance are desirable over any single predictor. The most accurate predictors of achievement include academic, psychological and sociological variables. Utilization of sound instruments and data as specific predictors will enable the development of multivariate equations to predict nursing student performance. Identification of probable failures or low achievers in specific courses enables direct intervention in the instructional process. A particularly adequate battery of predictors for academic performance might then include indices of previous achievement, selected personality variables, and relevant biographical data. Measures
Information for measurement purposes was gathered for all Guided Study nursing students entering in 1971-1974. SAT Verbal scores and High School Rank were gathered from the student’s academic folders of all nursing students who entered in 1971-1974. A random sample of Conditional students and of Approved students in the same year as the Guided Study students served as control groups.
GUIDED STUDY STiJDEflT
ACHIEVEMENT
237
The same information for measurement was gathered for these two groups of students as the Guided Study group of students. Data obtained from student academic folders included: high school rank; high school grade averages in math, science and English courses ; overall high school average; previous education; age ; previous nursing experience ; marital status ; and SAT Verbal. High School Rank was recorded in percentiles. High school grade averages in each of the three areas and overall high school averages were either calculated or provided directly from the student folders. Previous education before entering the Associate Degree Nursing Program or Guided Study was coded in years. Age in years was converted in months. Previous nursing experience was recorded from questionnaires administered either by Guided Study personnel for Guided Study students or the researcher (Miller, 1974) from a supported study. Previous nursing was coded as 1 when experience was scored for licensed practical nurse, nurse’s aide, technician, or others as medical assistant. Marital status was coded as 1 if the score was present in the student academic folder. SAT Verbal score was coded as 1 if the score was present in the student folder. SAT scores are not an admission requirement by Indiana University if the student was a past high school graduate of two years or more. In addition to admission biographical data, a number of criteria were used to evaluate the outcomes of all three groups within the nursing program. These criteria included : student grades in Anatomy, Physiology, Microbiology, Fundamentals of Nursing, and English ; first and second semester Grade Point Averages (GPA) and graduated from the nursing program. Student grades were coded in the form of a numerical grade 4 = A to 0 = F for each specified course. Graduation from the nursing program was coded as 1 and 0 if graduation did not occur. At a later time each students’ State Board Examination (SBE) scores were recorded from graduates who entered the nursing program in 1971 and 1972. The SBE in five areas of nursing: medical, surgical, obstetric, pediatric, and psychiatric were used. Method
of analysis
Correlations among the background variables of these three groups of students were done to show if significant relationships existed among student admission criteria and student performance. Analysis of variance for each background variable was used to test for statistically significant variances. When the F test was significant, the Newman-Keuls method was used in making tests on differences between all pairs of means. These pairs were: (1) Guided Study students - (2) Conditional students; (2) Conditional students - (3) Approved students; and (1) Guided Study students - (3) Approved students. In this way variations within scores for each group and between groups were ascertained, and each group was thus compared for predominance of the student admission criteria and student performance which differentiates it from thr other group. Results
The first step in the statistical
analysis was the correlation
matrix of the back-
CAROL L. MILLER
238
AND MARGARET
APPLEGATE
ground variables on 433 students. The correlations among various student admission criteria and student performance were done which indicated the degree of relationship between two variables. Significant relationships were found among all of the 19 variables as listed in Table 1. More than ten significant relationships above the TABLE 1. VARIABLES USES IN ANALYSIS OF VARIANCE
FOR
GROUPS
Year 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.
Amount of education before entering nursing program Course grade in anatomy Course grade in English Course grade in fundamentals of nursing Course grade in microbiology Course grade in physiology Grade point average-First Semester Grade point average-Second Semester Graduated from nursing program High school English High school mathematics High school science High school overall High school rank Licensed practical nurse Marital status Nurse’s aide Previous experience in nursing before entering nursing program SAT verbal State
1. 2. 7 ,.
-
4. 5.
1972
1973
x *
X
X
X
X
X
1971
Age
board
PROGRAM (1971-1974)
IN NURSING
X
X
(2):(3)
-
-
X
x x
x
X
X
X
X
X
X
X
X
X
x
X
x
x
s
X
X
X
X
X
X
X
X
X
X
X
-
X
x i
i;
x
-
X
x .
: X x X X Medical nursing x X X X Surgical nursing X X x x X Obstetric nursing X x X X Pediatric nursing X X x ..i X Psychiatric nursing X x __. - ._._ -._.~ ___~ _- ---_-_ ..._. ..___ * x means the differences are significant at the 0.05 level: Group I Guided Study students, Group 2 Conditional students, and Group 3 Approved students.
20.
11. 12. 13. 14. 15. 16. 17. 18. 19.
X
X
X
X X
X
X
X
X
-
X
-
X X
X
X
(l)-(3) ___-
X
w-(2)
1973 (2)-(3)
(1971-1974).
X
(l)-(3)
-.-
PAIRS OF MEANS
X
-
BETWEEN
1972 (2)-(3)
X
-
X X
X
(l)-(2)
X
(l)-(3)
OF DIFFERENCE
x
X
X
1971 (2)-(3) --
'l-ABLE 2. SIGNIFICANCE
Groups (l)-(2) .-._.___ 1. Age 2. Amount of education before entering nursing program 3. Grade in anatomy X 4. Grade in English 5. Grade in fundamentals of x nursing 6. Grade in microbiology X X 7. Grade in physiology X 8. GPA-1st Sem. 9. GPA-2nd Sem. X 10. Graduated from nursing
___._._.
240
CAROL L. MILLER AND MARGARET
APPLEGATE
science, High School overall grade average in English, mathematics and science, High School rank in percentiles were found significant for years 1971 and 1974. Course grades in Microbiology, Physiology, and Fundamentals of Nursing were significant for years 1971, 1972, and 1973 and not significant in 1974 between Group 2 Conditional students and Group 3 Approved students. When the data was gathered, these course grades for Guided Study students were not completed. The course grade in English was significant for 1971, but no analysis was done during 1972-1974 because the course grading system was changed for the Guided Study students to the pass-fail method. Only in 1972 was the presence of SAT Verbal scores found significant. Two analyses on marital status and age were not significant from 1971 to 1974. For years 1971 and 1972 previous experience in nursing before entering the nursing program was gathered and found significant for 1971, but not for 1972. Licensed Practical Nurse was significant for 1972 while nurse’s aide was significant for both 1971 and 1972. Then for years 1971 and 1972 entrants who graduated were found significant for both 1971 and 1972. Finally, in 1971 and 1972 all of the SBE scores were found significant. As yet 1973 and 1974 students have not graduated. The significance of differences between pairs of means from 1971 to 1974 are shown in Table 2. From 197 1 to 1972 the Group 2-Group 3 decreased markedly in the number of significant variables. This may be due in part to changes in entrance requirements from open door admission to requirements of graduation in the upper half of his high school class and the achievement of reasonable scores on their SAT examination. In 1972, 1973, and 1974 the three groups presented relatively for the most part similar patterns in significant variables. Even though the university has two groups of students in the Associate Degree Nursing Program, the Guided Study students and the Admitted students, the following findings demonstrated that three groups of students were present. With more conservative admission policies in 1972 there was a significant difference among the three groups between Group 1 Guided Study students-Group 3 Approved students for graduating in the nursing program. The differences between pairs of means on SBE scores revealed, in general, that both the Group 1 Guided Study students and Group 2 Conditional students changed becoming closer to Group 3 in an individual student’s mastery of content on SBE scores. As of the date of this writing, 78 guided students had been admitted to the nursing major from its inception to 1973. Of these, 40 have successfully completed the program and 36 have passed the State Board Test Pool Examinations for licensure. This success study of a specific remediation program compares favorably to other similar programs and would reinforce continuation of the program. In this particular nursing program, another significant pattern emerges. The attrition rate, determined by the differences between pairs of means on those who graduated, for the Conditional students who have received no remediation treatment is similar to that of the Guided Study group. The attrition rate and findings of this study would suggest that the success rate of the Conditional students would be appreciably enhanced if they were included in the group receiving remediation treatment. If a program change is made for this recommendation, then further evaluative research is in order. It is not evident now and it should be clear that using the same teaching approaches in different combination is unlikely to pay off.
GUIDED STUDTSTUDEJVT
ACHIEVEMENT
241
References AHMANN, J. S. and GLOCK, M. D. (1957). The utility of study habits and attitudes inventory in a college reading program. 3. Educ. Res. 51, 297-303. BAEHR, R. F. (1969). Project success. Chicago City College, 111.Kennedy-King College, ED 039 870. Office of Education, Washington, D.C. COLLINS,J. J. (1964). Meeting the needs of the less able junior college student. A Report to the American Personnel and Guidance Association, Bakersfield College, California. DALTON, P. et al. (1966). Effect of reading improvement on academic achievement. 3. Reading 9, 242-252. DEFRANK, SISTER JOSEPH L. (1971). RIPS: A remedial instruction program. Nars. Outlook 19, 180-181. ETTERS, E. M. (1967). Tutorial assistance in college core courses. 3. Educ. Res. 60,406-407. GLANZROCK,N. M. and STAIIL, R. (1971). Nurse tutoring study of the City University of New York, City Univ. of New York, N.Y. Kingsborough Community COB., Final Report. HARNISCHFEGER, A. and WILEY, D. E. (1976). Achievement test scores drop. So what? Educ. Res. 5, 5-12. HEINKEL, 0. A. (1970). Evaluation of a general studies program for the potentially low academic achiever in California junior colleges: Final report, ERIC No. 039881, Office of Education (DHEW), Washington, D.C. HEINS, M. and DAVIS, M. (1972). How do we help ‘high risk’students? Xrs. Outlook20, 121-123. HENKE, SISTER GRACE (1971). Project tap-a tutorial program. Am. 3. Nurs. 71, 978-981. KESTER, D. (1971). California community college stopouts: a comparison of the three NOR-CALCCHE follow-up studies. Ed. 057 77 1, Office of Education, Div. of Academic Facilities, Washington, D.C. MAINS, M. F. and COLLINS, C. C. (1960). The developmental reading course and junior college objective. Junior College3. 31, 123-129. MILLER, C. L. (1974). Improving student achievement in nursing education through prediction and remediation of low achievement and failure in specific freshman courses, Public Health Service Grant DlO NU00522. MILLER, C. L., FELDHUSEN,J. F. and ASHER, J. W. (1968). Prediction of state board examination scores of graduates of an associate degree program. 3vurs.Res. 17, 555-558. RAY, D. D. (1965). Permanency of gains made in a college reading improvement program. 3. Educ. Res. 59, 17-20.
