Evaluation of a Successful High Risk Nursing Student Assistance Program: One ADN Program's ...

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National Louis University
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Dissertations
4-2013
Evaluation of a Successful High Risk Nursing
Student Assistance Program: One ADN Program's
Journey
Ciaran O'Sullivan
National-Louis University
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NATIONAL LOUIS UNIVERSITY

EVALUATION OF A SUCCESSFUL HIGH RISK NURSING STUDENT ASSISTANCE
PROGRAM: ONE ADN PROGRAM’S JOURNEY.

A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE

DOCTOR OF EDUCATION
IN
COMMUNITY COLLEGE LEADERSHIP

BY
CIARÁN ANTHONY MARY O’SULLIVAN

CHICAGO, ILLINOIS
APRIL 2013
ii
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Dedication
This dissertation is dedicated to my three young children, for whom I hope this body of
work will perhaps one day mean something. It is not the subject matter, however, with which I
mean to impress, but rather that this work can be done by mere mortals. I want to forever share
with them the perseverance it took to complete the research and the patience to write the words,
over and over and over; one day, one hour, one sentence at a time. If for nothing else, I want my
children to realize that education is a privilege to be worked for; and once attained opens doors
to their lives; doors that will never close. Nothing of value is free, least of all education. But
once achieved, it will last forever.
Colin, Maeve, and Liam – my three most favorite people in the whole wide world – you
should know, quite simply, that I attained this degree for you, my darlings. You are the center of
Mommy’s and Dada’s lives. I wanted to show you how much I value my education, and yours,
and what it should mean to us all. Forever learning is critical to your lives and I want you to go
as far as possible with your education. Life presents amazing opportunities if you simply keep
your eyes and ears open and just look, listen and learn … and learn and learn. Once you do, your
world will be endlessly transformed. So keep reading and studying – forever and ever, as long as
you shall live. Education will change your lives.
I love you forever - your Dada.
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Acknowledgments
The writing of a dissertation is not an easy feat. But for those who “Pass Go”, the pot of
gold at the end of the rainbow is what makes this struggle so worthwhile. While the road to the
degree is made by one, there are many who share in the journey. I wish to thank those who made
this struggle bearable, and who are worth more than a pot of gold at the end of any rainbow.
I thank first and foremost my wife, Mary. Her love, understanding and support has
pushed, pulled, nudged and encouraged me through three long years of hard work. Without you
Mary, I would have never reached the finish line. You told me to “go for it” if the doctorate was
what I wanted, and so I did. Through the journey I was sometimes unsure, but you stuck by me
because you knew in your heart, and in mine, that it was important to reach my goal. Thank you,
Mary, from the bottom of my heart to the top of my soul. You are incredible; I love you.
I am grateful to my father Jim and mother Betty. My father’s gentle presence brought a
peaceful comfort that enabled me to draw upon a reserve of patience in this arduous process. My
mother’s endless belief in her children being able to do whatever they wanted always pushed us
to new heights throughout our lives. Her faith in mankind, in her children, and mostly in God
has kept her going full steam ahead all these years. She is a marvel to many and is the
cornerstone of our family. Thank you Dad and Mother; I love you.
I wish to thank my brother Cormac, who inspired me to forge this path after his own
doctorate was awarded several years earlier. His words of encouragement were always valued.
And I thank my sister Monica, who was as proud of her brothers as we were of her. I love you
and thank you both so very, very much.
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I am grateful for Dr. Audrey Styer at National Louis University for starting me on my
road to research. Her skill of questioning helped me to “think,” way outside of my box. I
appreciated that immensely.
I thank my Dissertation Chair, Dr. Rebecca Lake, without whose gentle pushing and
shoving and coaching and tutelage I would not have “walked” so soon. She helped me discover
that this research and writing was, in fact, not rocket science after all. Dr. Lake knew precisely
where to tap into me to realize the best outcomes. I am also grateful to the two other members of
my dissertation team, Dr. Dennis Haynes from National Louis University and Dr. Adam Hayashi
from Oakton Community College, for their review and recommendations of my work, and for
their encouragement and support that helped me through this process.
I thank my Doctoral Cohort – Doc 5 – Catherine, Isaac and Lee, with whom I began, and
now complete, my journey. Your experience, knowledge, ideas, perceptions and analyses all
helped me to become a better leader through this process. Thank you and best wishes always.
Lastly, I wish to thank my very good friend and compatriot in my doctoral travels, Lee
Resurreccion. We have worked together, taught together, laughed together and cried together;
and have now been educated together. His friendship, loyalty, and “just do it” attitude I will
forever respect and treasure. Most importantly, we made it … together. Thank you forever, Lee.
Now … onward and upward!
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Abstract
A college education is, for many in America, part and parcel of the American Dream, and
is certainly achievable. For countless reasons, students may enroll at community colleges
underprepared, unprepared, anxious, and destined for a high risk of failure. Although
community colleges are higher education institutions open and accessible to all who want to
pursue an education, some degree programs are selective enrollment programs, such as nursing.
Considering the stringent admission criteria and rigors of an associate degree in nursing (ADN)
program, few are admitted. However, due to the pending shortage of registered nurses,
assistance programs to help high risk nursing students succeed in school and pass their licensure
exams to become RNs are needed for the future of the profession.
The purpose of this exploratory study is to identify factors of the successful
Gateway/HRNS program embedded in the community college Associate Degree in Nursing
program that fostered student retention, graduation and passing of the NCLEX-RN licensure
exam on the first attempt. A qualitative case study methodology was utilized for this
comprehensive program evaluation of one very successful ADN nursing program in a Midwest
community college. Interviews of graduates of this high risk nursing program, focus groups of
faculty teaching in the program, and archival and current document analysis were used to
determined program factors that have helped high risk students over the past twenty years to
succeed and become licensed, employed RNs.
Findings revealed that students and faculty highly valued three components of the high
risk nursing student assistance program. These components were a) a pre-nursing summer
introduction to nursing component comprised of many small courses; b) a mid-curricular second
summer LPN option component; and c) regularly-scheduled weekly tutoring sessions throughout
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the two years of the ADN program. The most valued experience, according to program
graduates, was the mid-curricular LPN Option course, which is mandatory for these high risk
students and optional for other nursing students. It was felt this second summer component in
the assistance program helped students to integrate nursing theory coursework and clinical which
provided a substantial benefit as they entered their final year of the ADN program.
As a result of this study’s findings, the O’Sullivan Strive to Thrive (S2T) Model for
Student Success was developed to enable community college nursing leaders to develop
assistance programs for high risk nursing students. There are eight steps in the Strive to Thrive
(S2T) Model, designed to help ADN leaders and faculty promote and orchestrate the successful
persistence and graduation of high risk students. Also included are directions for each of the
steps as well as corresponding useful forms. This model to plan and design assistance programs
for high risk students can be adapted by nursing department leaders in community colleges, as
well as other nursing program venues and degree programs.
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TABLE OF CONTENTS
LIST OF TABLES …………………………………………………………………………... xv
LIST OF FIGURES …………………………………………………………………………. xvii
CHAPTER 1: INTRODUCTION ………………………………………………………… 1
Background and Context of the Issue ………………………………………………..… 2
History of Nursing ………………………………………………………….......... 3
Nursing Education………………………………………………………………... 3
Research Purpose ………………………………………………………………………. 5
Purpose of the Study ……………………………………………………………... 5
Research Questions ………………………………………………………………. 5
Significance of the Study ………………………………………………………………. 5
Brief Review of the Literature ………………………………………………………….. 7
Historical Background and Context of the Study ………………………………... 7
Nursing Education ………………………………………………………….......... 8
Nursing education in community colleges ………………………………. 9
Adult learning ……………………………………………………………. 10
Conceptual Framework for the Study ………………………………………………….. 11
Program Evaluation ……………………………………………………………… 11
Stufflebeam’s CIPP Model for Program Evaluation …………………………….. 12
Astin’s Theory of Student Involvement ………………………………………….. 13
Study Design …………………………………………………………………………… 13
Site Selection …………………………………………………………………….. 15
Data Collection …………………………………………………………………... 16
Participant Selection ……………………………………………………………... 16
Demographic Survey/Background Information Questionnaire ………………….. 17
Focus Groups …………………………………………………………………….. 17
Interviews ………………………………………………………………………… 18
Archival Documents ……………………………………………………………... 18
Data Analysis Procedures ………………………………………………………………. 19
Organization of the Dissertation ………………………………………………………... 19
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CHAPTER 2: REVIEW OF THE LITERATURE ………………………………………… 22
Introduction ...…………………………………………………………………………... 22
Historical Background of Community Colleges ……………………………………….. 25
Nursing Education …………………………………………………………................... 31
Three Basic Levels of Nursing …………………………………………………... 31
General History of Nursing Education in the United States …………………….. 35
Three Types of Nursing Programs Leading to Registered Nurse Licensure …….. 37
Community College ADN Education ……………………………………………. 37
Advanced Degrees in Nursing …………………………………………………… 40
Diversity Among Nursing ADN Applicants …………………………………….. 41
Need for Increased Numbers of RNs in the United States ……………………………... 43
Nursing Program Curriculum Accreditation and Regulation …………………………... 46
Accrediting Commission ………………………………………………………… 49
High Risk Students ……………………………………………………………………... 50
Conceptual Framework for the Study ………………………………………………….. 53
Connecting Students to Learning ……………………………………………….... 54
Astin’s Theory of Student Involvement .…………………………………………. 57
Student Involvement and Adult Learners ……...................................................... 64
Program Evaluation …………………………………………………………………….. 67
Reasons for Conducting a Program Evaluation ………………………………….. 68
Reason 1 ………………………………………………………………….. 69
Reason 2 ………………………………………………………………….. 69
Reason 3 ………………………………………………………………….. 69
Reason 4 ………………………………………………………………….. 69
Reason 5 ………………………………………………………………….. 69
Program Evaluation Models ……………………………………………………... 71
Stufflebeam’s CIPP Program Evaluation Model ………………………………… 73
Summary of Chapter 2 …………………………………………………………………. 76
CHAPTER 3: METHODOLOGY…………………………………………………………… 78
Introduction ………………………...…………………………………………………... 78
Purpose Statement ……………………………………………………………………… 78
Research Questions …………………………………………………………………...... 79