Constancy and difference in the dimensions and elements of nursing practice, 1901-1981 : a thesis presented in partial fulfilment of the requirements for the degree of M.A. (Soc. Sci.) at Massey University

Abstract

This study presents a selective literature review in which the three components of modern nursing (practice, education and research) are identified. Consideration is given to the dimensions and elements of two of the components - nursing education and nursing practice and the relationship between these two components is investigated using the examination system of nursing education as the connective link. From the literature review presented in the first three chapters, the Nursing Education Examination. Practice Model (N.E.E.P.) has been derived for this project which examines the constancy and differences in the six stated dimensions of nursing practice and their associated elements along a time continuum from 1901 to 1981. The model is used to collect and collate the data elicited from the analysis of the five yearly sample of State Final examination papers and the identification of historical trends in the New Zealand Nursing Journal, relating to the six dimensions of nursing practice and their associated elements. This two pronged approach allowed the author to crosscheck the findings from the two data sources. In addition, changes in the composition of nursing practice are studied in one specific area; the nursing care of patients with accidental trauma. The following propositions were derived from the literature review presented in the first section of this study; 1. That the six dimensions of nursing practice (care, cure, protection, teaching, co-ordination and patient advocacy) will remain constant over time and different practice setings; 2. that the elements of each dimension will vary with time and with practice setting. The findings elicited from the analysis of surgical examination papers revealed that the three dimensions of care, cure and co-ordination occur in all the time periods investigated in this study. The same three dimensions of nursing practice are evident in at least 81% of the time periods in which questions relating to accidental trauma in the examination papers are found. Therefore these three dimensions can be said to form the "heart" of nursing practice over the years. Although fluctuations occur in the importance placed upon the dimensions, from 1961 increasing emphasis is found in all the dimensions except the cure dimension where a declining trend is demonstrated. It was found that constancy in all six dimensions of nursing practice is apparent from this time. An examination of the elements of nursing practice shows that although the three dimensions of nursing practice remain constant over the years, findings relating to the elements making up three dimensions indicate both constancy and differences. The five elements of nursing practice which make up the "core" elements of nursing practice are; general nursing care; reference to specific patients; functional status; treatments; and nurse interactions. References to these elements appear in each of the 17 time periods in the general analysis. Their importance in relation to the nursing of patients with accidental trauma is also evident. At the other extreme are the elements of sleep, blood pressure, and T.P.R. which appear in less than 3 of the 17 time periods. Reference to patient preferences/ interests are never found in the data elicited from the examination papers. Examination of accidental trauma findings reveals similar trends to the general results. From 1961 particularly the journal articles substantiate the findings elicited from the examination analysis. A brief discussion of the implications of the constancy and difference in the dimensions of nursing practice and their associated elements for nursing is included.