on in an Evolving Health Care Environment Chapter 5.Becoming a Professional Nurse: Defining Nursing and Socialization into Practice Chapter 6.Nursing as a Regulated Practice: Legal Issues Chapter 7.Ethics: Basic Concepts for Professional Nursing Practice Chapter 8.Conceptual and Philosophical Foundations of Professional Nursing Practice Chapter 9.Nursing Theory: The Basis for Professional Nursing Chapter 10.The Science of Nursing and Evidence-Based Practice Chapter 11.Developing Nursing Judgment Through Critical Thinking Chapter 12.Communication and Collaboration in Professional Nursing Chapter 13.Nurses, Patients, and Families: Caring at the Intersection of Health, Illness, and Culture Chapter 14.Health Care in the United States Chapter 15.Political Activism in Nursing: Communities, Organizations, Government Chapter 16.Nursing Challenge: To Continue to Evolve Chapter 1.Nursing in Today’s Evolving Health Care Environment MULTIPLE CHOICE 1. Which of the following could eventually change the historical status of nursing as a female- dominated profession? a. More men graduating from baccalaureate and higher degree programs b. The proportion of men in nursing beginning to increase c. More male graduates of basic nursing programs entering the workplace d. Salary compensation increasing to attract more men Feedback A More men graduating from baccalaureate and higher degree programs is not the best answer because associate degree programs produce the most new graduates. B The percentage of men in nursing has increased 50% since 2000. C The more men who enter the workplace as nurses, the less nursing will be seen as a female-dominated profession. D Salary rates do not appear to relate to the recruitment of men into nursing. DIF: Cognitive Level: Comprehension REF: MCS: 2 2. The racial and ethnic composition of the nursing profession will change to more accurately reflect the population as a whole when a. the increased numbers of racial and ethnic minorities enrolled in educational programs graduate and begin to practice. b. the number of Asians or Native Hawaiian-Pacific Islanders begins to increase. c. the percentage of African-American and Hispanic nurses decreases more than the percentage of white nurses. d. the nonwhite portion of the general population decreases. Feedback A A larger percentage of minorities are enrolled in nursing educational programs than previously. B Asians and Native Hawaiian-Pacific Islanders are over represented in nursing compared to their percentage of the general population. C Not only would the percentage of African-American and Hispanic nurses need to increase, the percentage of white nurses would have to decrease in order to more accurately reflect the population as a whole. D The nonwhite portion of the general population is not likely to decrease. DIF: Cognitive Level: Comprehension REF: MCS: 3 3. Which of the following is a correct statement about the registered nurse (RN) population? a. The racial/ethnic composition of RNs closely resembles that of the general population. b. The number of men entering nursing has decreased steadily over the last decade. c. The rate of aging of RNs has slowed for the first time in the past 30 years. d. The majority of employed RNs working full time must work a second position. Feedback A The racial/ethnic composition of RNs is increasing, but does not approximate their percentage of the overall population. B The number of men entering nursing is increasing. C The average age of RNs in both 2004 and 2008 was 46. This is a result of the numbers of RNs under 30 in the workforce. D According to 2008 data, only 12% of nurses working full time hold second positions. DIF: Cognitive Level: Knowledge REF: MCS: 3 4. Which of the following best describes trends in nursing education? a. Numbers of RNs with bachelors and higher degrees are increasing. b. Numbers of RNs with associate degrees are decreasing. c. Foreign-born nurses practicing in the United States are seen as less knowledgeable because of their lesser educational preparation. d. Numbers of RNs with diploma educations are increasing. Feedback A Slightly over 50% of RNs eventually obtain their bachelors of science in nursing (BSN) or a higher nursing degree. B The majority of nurses in this country get their initial nursing education in associate degree in nursing (ADN) programs. C Foreign-born nurses practicing in the United States may be viewed as less knowledgeable by their peers because of language and cultural differences. D The numbers of diploma-educated nurses are declining. DIF: Cognitive Level: Knowledge REF: MCS: 4 5. Despite the variety of work settings available to the RN, data from 2008 indicate that the primary work site for RNs is a. ambulatory care settings. b. community health settings. c. long-term care facilities. d. acute care hospitals. Feedback A Ambulatory care settings account for about 10.5% of RNs places of employment. B Public health and community health settings account for 7.8% of employed RNs. C Long-term care facilities account for 5.3% of RNs places of employment. D Statistics show that 62.2% of RNs work in acute care hospitals. DIF: Cognitive Level: Knowledge REF: MCS: 5 6. One important advantage of clinical ladder programs for hospital-based RNs is that they a. allow career advancement for nurses who choose to remain at the bedside. b. encourage nurses to move into management positions in which they can influence patient care on a broader scale. c. encourage RNs to become politically active and guide the profession of nursing. d. provide training to staff nurses so they can move seamlessly across departments. Feedback A Clinical ladder programs allow nurses to advance professionally while remaining at the bedside. B Clinical ladder programs are designed to keep proficient nurses at the bedside. C Encouraging RNs to become politically active and guide the profession of nursing is not the goal of clinical ladder programs. D Clinical ladder programs are not designed to facilitate transfer between departments. DIF: Cognitive Level: Comprehension REF: MCS: 7 7. Which of the following statements is correct about community health nursing (CHN)? a. Prevention and community education are the cornerstones of CHN. b. Nursing care is rapidly moving from the home setting to the institutional setting. c. High-tech care such as ventilators and total parenteral nutrition cannot be handled in the home. d. Assessment skills are less important in CHN because patients are not acutely ill. Feedback A The community health nurse provides educational programs in health maintenance, disease prevention, nutrition, and child care. B Care is moving into the home setting. C Home care is increasing in complexity. D Community health nurses must have excellent assessment skills as they do not have the immediate backup that an acute care facility offers. DIF: Cognitive Level: Comprehension REF: MCS: 9 8. Which of the following is most essential for the nurse entrepreneur to be successful? a. Ability to take direction well b. Excellent time-management skills c. Avoidance of risks d. A college degree in business Feedback A Nurse entrepreneurs must function autonomously. B Nurse entrepreneurs must be well organized and efficient. C Starting a business involves risk. D A degree in business is not required to be a nurse entrepreneur. DIF: Cognitive Level: Analysis REF: MCS: 10 9. The major benefit of serving as a military nurse is a. broader responsibilities and scope of practice than civilian nurses. b. working with entirely baccalaureate-prepared peers on active duty. c. serving as an officer on active duty or in the reserves. d. the financial support to seek advanced degrees Feedback A Although military nurses do have broader responsibilities and scopes of practice than civilian nurses do, this is not the major benefit. B Although military nurses do work with entirely baccalaureate-prepared peers on active duty, this is not the major benefit. C Although military nurses serve as officers on active duty or in the reserves, this is not the major benefit. D Advanced education is supported by the military financially and also allows for promotion in rank at an accelerated pace. DIF: Cognitive Level: Comprehension REF: MCS: 13 10. Which of the following statements explains why the school nurse of today is truly a community health nurse? a. The school nurse may be called on to care for a students family members in underserved areas. b. The school nurses primary responsibility is centered on the well child. c. The school nurses primary responsibility is to maintain immunization records. d. The school nurse must be certified in CHN. Feedback A In medically underserved areas a school nurse may be called on to care for members of a childs immediate family. B Chronically ill, disabled, and physically challenged students are in regular classrooms. C School nurses detect developmental problems; counsel and educate children, parents, and teachers; and maintain immunization records. D Although school nurses are considered community health nurses, certification in community health is not required. DIF: Cognitive Level: Comprehension REF: MCS: 13 11. What has been found about the outcomes of patients cared for in hospitals with a higher percentage of BSN-prepared nurses as compared to patients in hospitals with a lower percentage of BSN-prepared nurses? a. Patient outcomes are more dependent on nurse-patient ratios. b. Outcomes were better in hospitals with more BSN-prepared nurses. c. Outcomes were similar in both types of hospitals. d. Medical patients had better outcomes, but surgical patients fared the same. Feedback A Nurse-patient ratio is an important determinant of patient care outcomes but has not been shown to be more or less important that the percentage of BSN-prepared nurses providing direct patient care. B Research by Aiken, et al, (2003) showed that patient outcomes were better in hospitals where higher percentages of BSN-prepared nurses were employed. C Research by Aiken, et al, (2003) showed that patient outcomes were better in hospitals where higher percentages of BSN-prepared nurses were employed. D Aiken, et al (2003) studied orthopedic, general surgical, and vascular surgery patients and found the outcomes were improved for these patients in hospitals with a higher percentage of BSN-prepared nurses. DIF: Cognitive Level: Knowledge REF: MCS: 7 12. Faith community nursing (FCN) was founded on which of the following premises? a. Nurses faith beliefs do not play a part in healing. b. The spiritual aspect takes precedence over the physical body in healing. c. Spiritual health is central to a persons well-being. d. Faith community nurses must receive formal training as a minister or clergy. Feedback A The nurses spiritual journey is believed to be an essential aspect of this nursing role. B Patients are treated holistically under FCN. C FCN is based on the belief that spiritual health is central to well-being. D Faith community nurses do not need to have formal training as a ministers. DIF: Cognitive Level: Comprehension REF: MCS: 16 13. One important advantage of the evolution of nursing informatics is that a. it allows any RN to become a certified informatics nurse. b. informatics nurses are best able to design systems with the needs and skills of nurses who use them. c. informatics nurses will reduce the need for direct caregivers to document care. d. benefits of informatics advancements include improved patient safety and increased variability of care. Feedback A Although all nurses may use informatics, a nurse specializing in informatics should have a BSN and additional knowledge and experience in the field of informatics. B Informatics nurses understand how the information needs to be used and how to make the systems work for the nurses. C Direct caregivers will still need to document the care provided. D Benefits do include improved patient safety, but decreased variability of care is expected with informatics systems. DIF: Cognitive Level: Comprehension REF: MCS: 17 14. Which of the following nursing roles is not considered an advanced practice role? a. Certified nurse-midwife (CNM) b. Community health nurse c. Certified nurse practitioner (CNP) d. Clinical nurse specialist (CNS) Feedback A A CNM is an advanced practice role. B The community health nurse is not an advanced practice role. C CNP is an advanced practice role. D CNS is an advanced practice role. DIF: Cognitive Level: Comprehension REF: MCS: 17 15. NPs are advanced practice nurses who a. are required to have physician collaboration or supervision. b. function under a set of universal advanced practitioner laws. c. cannot receive direct reimbursement for their services. d. can diagnose and treat common and chronic conditions. Feedback A The laws governing the practice of NPs vary from state to state, including the degree of supervision required and how they may be reimbursed for their services. B The laws governing the practice of NPs vary from state to state, including the degree of supervision required and how they may be reimbursed for their services. C The laws governing the practice of NPs vary from state to state, including the degree of supervision required and how they may be reimbursed for their services. D NPs are prepared to handle a wide range of basic health problems. DIF: Cognitive Level: Comprehension REF: MCS: 18 16. The clinical nurse leader (CNL) is a recently proposed role. The responsibilities of the person in this role include which of the following? a. Oversee and manage care delivery in specific settings. b. Manage and streamline operations in multiple nursing units. c. Replace the outdated CNS role. d. Provide daily care to a specific subset of patients with similar needs. Feedback A The CNL role is intended to provide the highest quality of nursing care by having masters-prepared nurses involved in the care of a distinct group of patients. B The CNL role was not intended as a managerial or administrative role. C The CNS role is not outdated, and some controversy exists because some CNSs view this new role as possibly disenfranchising them. D CNLs may on occasion provide direct patient care, but not on a daily basis. DIF: Cognitive Level: Knowledge REF: MCS: 20 MULTIPLE RESPONSE 1. Hospice and palliative care nursing is a rapidly developing specialty in nursing. Which facts have contributed to this growth? (Select all that apply.) a. End-of-life care is largely the responsibility of nurses. b. End-of-life needs are expected to increase with the aging population. c. Nursing curricula have prepared nurses to deal effectively with dying patients and their families. d. Palliative care is a new focus of advanced practice nurses. e. Hospice and palliative care nurses work in a variety of settings. , B, E Feedback Correct End-of-life care is largely the responsibility of nurses is correct because palliative care reflects the holistic philosophy of nursing, and comfort and relief have always been nursing responsibilities. End-of-life needs are expected to increase with the aging population is correct because as the population ages there will be a greater demand for end-of-life care as the number of individuals needing care increases. Hospice and palliative care nurses work in a variety of settings is correct because palliative care takes place in hospitals, homes, hospices, skilled nursing homes, etc. Incorrect Nursing curricula have prepared nurses to deal effectively with dying patients and their families is incorrect because nursing educational programs have not prepared nurses well as the content related to end-of- life issues and palliative care has been limited. Palliative care is a new focus of advanced practice nurses is incorrect because palliative care has been a focus of many nurses, not just advanced practice nurses. DIF: Cognitive Level: Comprehension REF: pp. 14-15 2. CNSs may (Select all that apply.) a. manage an inpatient nursing unit. b. develop educational programs for nursing staff. c. conduct practice outcomes research. d. prescribe medications for common illnesses. e. attend or assist in the delivery of low-risk newborns. , B, C Feedback Correct CNSs are prepared with an advanced nursing degree and the skills to function in a variety of settings and functional roles. Incorrect CNSs do not have prescribing authority. CNMs attend or assist at the delivery of low-risk newborns. Chapter 2.The History and Social Context of Nursing Z MULTIPLE CHOICE 1. Which early nursing leader founded the first training school for nurses that would later become a model for early nursing education? a. Dorothea Dix b. Florence Nightingale c. Clara Barton d. Mary Ann Bickerdyke Feedback A Dorothea Dix is best known as an advocate for the mentally ill, and she created a brief training program at two New York hospitals for women who wished to serve as nurses in the Civil War. B Florence Nightingale founded the first training school for nurses at St. Thomass Hospital in London in 1806. This became the model for nursing education in the United States. C Clara Barton is known for founding the American Red Cross. D Mary Ann Bickerdyke is best known for nursing services during the Civil War. DIF: Cognitive Level: Knowledge REF: MCS: 25 2. Who was the first educated African-American professional nurse? a. Linda Richards b. Phoebe Pember c. Sojourner Truth d. Mary Eliza Mahoney Feedback A Linda Richards was the first trained nurse in the United States. B Phoebe Pember was one of the first women placed in charge of a hospital. C Sojourner Truth was a famous abolitionist who served as a nurse for the Union forces in the Civil War. D Mary Eliza Mahoney was the first African-American professional nurse; she was educated at the New England Hospital for Women and Children. DIF: Cognitive Level: Knowledge REF: MCS: 27 3. To which early nursing leader is attributed the founding of the American Red Cross? a. Clara Barton b. Dorothea Dix c. Florence Nightingale d. Lavinia Lloyd Dock Feedback A Founding the American Red Cross is attributed to Clara Barton. B Dorothea Dix was superintendent of women nurses of the Union Army. C Florence Nightingale was an English pioneer in nursing. D Lavinia Lloyd Dock was influential in forming the National League for Nursing (NLN). DIF: Cognitive Level: Knowledge REF: MCS: 26 4. What were some of the application requirements of nursing education programs in the 1900s? a. Male, intelligent, strong b. Female, sensitive, subservient c. Female, docile, from poor background d. Male, high breeding, independent Feedback A Men were not thought to be sensitive enough for nursing. B Sensitivity, breeding, intelligence, ladylike behavior, and submission to authority were highly desired personal traits for nursing students. C High breeding was desirable for nursing education program applicants. D Men were not desired nursing education program applicants. DIF: Cognitive Level: Knowledge REF: MCS: 27 5. Which of the following statements best describes how the Chicago Worlds Fair of 1893 became a pivotal point in the history of nursing education in the United States? a. Florence Nightingales work on sanitation and its relationship to mortality rates was finally recognized. b. The organization today known as the NLN was formed to address issues in nursing education. c. The American Nurses Association (ANA) was formed to oversee nursing education in the United States. d. The International Council of Nurses (ICN) was formed to enhance collaboration between practicing nurses and educators. Feedback A Florence Nightingales paper was on scientific training of nurses. B Several influential nursing leaders met at the Chicago Worlds Fair and started the National League for Nursing Educationthe precursor to the NLN. C The NLN, not the ANA, was formed to oversee nursing education in the United States. D The ICN was not founded until 1899 and is not involved in U.S. education of nurses. DIF: Cognitive Level: Comprehension REF: MCS: 28 6. Which early nursing organization is credited with first recommending state registration for nurses? a. ICN b. NLN c. ANA d. National Association of Colored Graduate Nurses Feedback A The ICN was formed to unite all nursing organizations. The topic of the first meeting was registration for nurses by each country and state. B The NLN was formed to oversee nursing education in the United States. C The ANA was formed to enhance collaboration between practicing nurses and educators. D The National Association of Colored Graduate Nurses was formed to develop leadership among African-American nurses. DIF: Cognitive Level: Knowledge REF: MCS: 28 7. Which of the following nursing leaders, because of her work in the Henry Street Settlement, is considered the founder of public health nursing? a. Margaret Sanger b. Clara Barton c. Lillian Wald d. Lavinia Lloyd Dock Feedback A Margaret Sanger is known for her work on birth control with immigrant women from the Lower East Side of New York City. B Clara Barton founded the American Red Cross. C Lillian Wald founded the Henry Street Settlement, the first formalized public health nursing project. D Lavinia Lloyd Dock was instrumental in the formation of the NLN. DIF: Cognitive Level: Knowledge REF: MCS: 28 8. Despite the caring efforts of early public health nurses in the Henry Street Settlement, racial disparity left many people underserved. Which of the following African-American public health nurses was instrumental in providing excellent nursing care to underserved families despite these social challenges? a. Jessie Sleet Scales b. Margaret Sanger c. Lavinia Lloyd Dock d. Anita M. McGee Feedback A Jessie Sleet Scales established the Stillman House, a part of the Henry Street Settlement that provided care to African Americans. B Margaret Sanger worked to provide immigrant women on the Lower East Side of New York City with birth control information. C Lavinia Lloyd Dock founded the NLN. D Anita M. McGee was a physician appointed as head of the Hospital Corps, who recruited nurses for the Spanish-American War of 1898. DIF: Cognitive Level: Comprehension REF: MCS: 29 9. Which one of the following events occurring during the first decade of the twentieth century brought sweeping changes to nursing? a. It was required that all practicing nurses be licensed. b. Permissive licensing laws allowed registered nurses (RNs) to practice without a license if they registered with the state. c. All states required a standardized licensing examination. d. Nurses had to pass a licensing examination to use the title RN. Feedback A Practicing nurses did not have to be licensed but could not use the title. B Permissive licensing laws required all nurses using the title RN to be licensed. C Licensing examinations were not standardized until 1950. D Licensure laws were passed that required all people using the title of RN to be licensed. DIF: Cognitive Level: Comprehension REF: MCS: 30 10. What was the most significant impact on the profession of nursing made by Mary Breckenridge in her role as a frontier nurse? a. She demonstrated that nurses could provide primary care in rural settings. b. She demonstrated that female nurses could protect themselves in unsettled rural environments. c. She demonstrated that nurses were capable of teaching new mothers to care for babies. d. She demonstrated that nurses could provide care to many clients despite geographic boundaries. Feedback A Mary Breckenridge established frontier nursing services. She provided primary care to women and babies and demonstrated that nurses could provide primary care. B Safety was not the primary impact of the success of frontier nursing. C Although she was a nurse-midwife, this was not the most significant impact. D Demonstrating that nurses could provide care to many clients despite geographic boundaries was not the most significant impact made by Mary Breckenridge. DIF: Cognitive Level: Comprehension REF: MCS: 32 11. Which of the following trends in health care delivery that began in the second half of the twentieth century continues today? a. Widespread use of team nursing to address the nursing shortage b. Massive movement of nurses out of acute care and into home care c. Advent of primary care to replace specialized care d. Provision of care to the poor, elderly, and disabled through Medicare and Medicaid Feedback A Team nursing is rarely used today. B More nurses work in acute care today than in home care. C After World War II, specialization became popular. D Two amendments to the Social Security Act in 1965 designed to ensure access to health care for elderly, poor, and disabled Americans were the establishment of Medicare and Medicaid. DIF: Cognitive Level: Comprehension REF: MCS: 34 12. A recent trend in nursing has been an increase in the number of men and women with degrees in other fields or other careers applying to nursing programs. What is the single most important reason for this trend? a. Nursing as a career has gained increased status and prestige. b. Nursing salaries have outpaced many other fields. c. A nursing career provides both job security and meaningful employment. d. Working conditions in nursing have improved. Feedback A While true, nursings increased status and prestige is not a significant factor in the trend of people choosing it as a second career. B Salary is not a major factor. C The current appeal to men and women with degrees in other fields is that nursing can provide job opportunities, economic security, and the opportunity to help others. D Working conditions are not identified as a reason for choosing a second career in nursing. DIF: Cognitive Level: Knowledge REF: MCS: 39 13. What specialty of nursing was considered well suited for men at a time when other areas were excluding men from practicing? a. Obstetric nursing b. Pediatric nursing c. Psychiatric nursing d. Nurse educator Feedback A Obstetric nursing was not considered an appropriate area for men in nursing. B Pediatric nursing was not considered an appropriate area for men in nursing. C Psychiatric nursing was considered well suited for men because it required physical stamina and strength. D Education was not a specialty considered well suited for men in nursing. DIF: Cognitive Level: Knowledge REF: MCS: 37 14. When surveyed, what is the primary reason given by men for entering nursing? a. To make a difference b. High salaries c. Flexible schedules d. Opportunity for travel Feedback A Men who want to make a difference in peoples lives find nursing an appealing career choice B Economic and job security are important factors for men entering nursing, but more significant is the opportunity to make a difference in peoples lives. C Flexible schedules, where provided, are an attractive incentive for employment, but that is not as significant as being able to make a difference in peoples lives. D Opportunity for travel is available for travel and military nurses, otherwise it is not an important aspect of nursing as a career. DIF: Cognitive Level: Knowledge REF: MCS: 38 15. What was the purpose of the Hill-Burton Act? a. It established funding for the construction of hospitals. b. It provided women in the service with military rank. c. It established and funded the Frontier Nursing Service. d. It created the Cadet Nurse Corps. Feedback A The 1946 Hill-Burton Act provided funding for the construction of hospitals. B Congress passed a bill in 1920 that allowed women to hold military rank. C The Frontier Nursing Service, originally known as the Kentucky Committee for Mothers and Babies, was established by Mary Breckinridge. D The Cadet Nurse Corps was an alliance between military and collegiate nursing programs to train nurses and was funded by Congress. DIF: Cognitive Level: Knowledge REF: MCS: 33 16. When surveyed, which profession was chosen by the general public as highest in honesty and ethics? a. Physician b. Pharmacist c. Nurse d. Attorney Feedback A Physicians were not ranked over nurses. B Pharmacists were not ranked over nurses. C Gallup polls from 1999 to 2010 rated nursing as the top profession in honesty and ethics. D Attorneys were not ranked over nurses in honesty and ethics. DIF: Cognitive Level: Knowledge REF: MCS: 40 17. In 2002 which major American corporation partnered with nursing to design a media campaign to promote the image of nursing? a. Johnson & Johnson b. Baxter c. Microsoft d. Wal-Mart Feedback A In 2003 Johnson & Johnson began a $20 million campaignCampaign for Nursings Futureto enhance the image of nursing, to recruit new nurses and educators, and to retain nurses. B Baxter did not launch a media campaign to promote the image of nursing. C Microsoft did not launch a media campaign to promote the image of nursing. D Wal-Mart did not launch a media campaign to promote the image of nursing. DIF: Cognitive Level: Knowledge REF: MCS: 40 18. A shift in population growth is expected to place stress on nursing resources. Which age- group is expected to experience the greatest population growth in the next decade? a. Older than 85 years of age b. 75 to 85 years of age c. 35 to 65 years of age d. 18 to 35 years of age Feedback A People older than 85 years, known as the very old, represent the fastest-growing segment of the total population. B Although the 75 to 85 age-group is growing, it is not the fastest-growing segment of the population. C The group of individuals 35 to 65 years of age is not expected to grow as dramatically as is the group termed very old. D The 18 to 35 age-group is not expected to be the fastest-growing segment of the population in the next decade. DIF: Cognitive Level: Knowledge REF: MCS: 42 19. In which practice area was the first clinical nurse specialist (CNS) role developed? a. Mother-baby b. Psychiatric nursing c. Intensive care nursing d. Emergency nursing Feedback A The first CNS role was developed in psychiatric nursing in the 1960s. B The first CNS role was developed in psychiatric nursing in the 1960s. C The first CNS role was developed in psychiatric nursing in the 1960s. D The first CNS role was developed in psychiatric nursing in the 1960s. DIF: Cognitive Level: Knowledge REF: MCS: 34 20. Which of the following was an unsuccessful attempt by the American Medical Association (AMA) to alleviate the nursing shortage of the time? a. Creation of the nurse manager position b. Creation of the registered care technician c. Recruitment of RNs from English-speaking countries d. Redistribution of qualified nurses to certain geographic locations Feedback A The nurse manager position was not created by the AMA. B In response to the nursing shortage in the late 1980s, the AMA proposed a nurse extender called the registered care technician. C The recruitment of foreign nurses was not a proposal of the AMA. D Travel nursing was not a proposal of the AMA. DIF: Cognitive Level: Knowledge REF: MCS: 47 21. The first trained nurse in the United States graduated in 1873 and later became the supervisor of the Boston Training School. Who was this nurse? a. Mary Ann Bickerdyke b. Dorothea Dix c. Linda Richards d. Sallie Thompkins Feedback A Mary Ann Bickerdyke was an uneducated widow who organized the camp hospital in Cairo, Illinois, during the Civil War. B Dorothea Dix, a well-known advocate for the mentally ill, was instrumental in creating a month-long training program in two New York hospitals to train women wishing to serve in the Civil War. C In 1872 Linda Richards became the first student to enroll in the inaugural class of five students in the first American nurses training school run by Dr. Susan Dimock. She graduated 1 year later. D Sallie Thompkins established a hospital in Richmond, Virginia, and was commissioned a captain of Cavalry, unassigned by Confederate President Jefferson Davis. DIF: Cognitive Level: Knowledge REF: MCS: 26 22. During the Great Depression, staffing of hospitals changed with an impact lasting to the current day. What was this change? a. The employment of graduate nurses in hospitals b. The need for increased private duty nurses and rural health nurses decreased the number of nurses seeking employment in hospitals c. The opening of more schools of nursing in hospitals d. The increased number of collegiate schools of nursing, which allowed hospitals to increase the educational requirements for the staff Feedback A Hospitals were forced to close their schools of nursing; families were no longer able to afford private duty nurses in their homes; and hospitals hired the unemployed graduate nurses to care for the increased numbers of patients seeking care in hospitals. B Although there was a need for nurses in rural areas supported by the Civil Works Administration, the number of private duty nurses decreased due to the inability of families to afford them. C For economical reasons, hospitals could not afford to fund schools of nursing. D Although the number of collegiate schools increased, most nurses in hospitals were prepared in diploma programs. DIF: Cognitive Level: Comprehension REF: MCS: 32 23. What was the most important influence of war on nursing? a. It allowed for the development of hospitals. b. Nurses were able to perform medical procedures during war. c. Improved medical care increased soldiers survival rates. d. It provided for the creation of new technology to make work easier. Feedback A Wars allowed nurses to stretch the boundaries of their profession. Nurses have led the way in furthering their discipline by responding to needs during wartime. B Wars allowed nurses to stretch the boundaries of their profession. Nurses have led the way in furthering their discipline by responding to needs during wartime. C Wars allowed nurses to stretch the boundaries of their profession. Nurses have led the way in furthering their discipline by responding to needs during wartime. D Wars allowed nurses to stretch the boundaries of their profession. Nurses have led the way in furthering their discipline by responding to needs during wartime. DIF: Cognitive Level: Comprehension REF: MCS: 34 24. Florence Nightingale is often credited as being the first nurse researcher. This designation is based on a. her methods of reorganizing British hospitals. b. her use of data on the morbidity and mortality of soldiers in hospitals in Scutari. c. demonstration that trained nurses provided better nursing care. d. publication of Notes on Nursing, the first scholarly nursing publication. Feedback A Although Nightingale reformed both the British Army and British civilian hospitals on the basis of data she collected, the reformations were not researched. B Nightingale was educated in statistics and used the detailed data collected to effectively argue the case for the reform of the British Army hospital system. C Nightingale founded the first training school after she had gained fame based on the hospital reforms supported by her data collection during the Crimean War. D The publication reflected Nightingales philosophical thoughts on nursing. DIF: Cognitive Level: Comprehension REF: MCS: 25 25. The nursing profession is responsible for improving its own image. The most effective avenue for changing the image of nursing is to a. write letters expressing concerns to those responsible for negative images on television and in films. b. have nurses as consultants to the media to ensure that the media producers have accurate information about nursing. c. have nurses appear and behave professionally and explain what nurses do in each patient interaction. d. support the Johnson & Johnson campaign by distributing their information about nursing to students interested in nursing. Feedback A While appropriate, writing letters to professionals in television and film is not the most effective avenue for changing the image of nursing. B While appropriate, having nursing consultants to the media is not the most effective avenue for changing the image of nursing. C The major avenue for changing the image of nursing occurs one nurse-patient encounter at a time, where nurses look and behave professionally and demonstrate what it is nurses do. D While supporting Johnson & Johnsons Campaign for Nursings Future is appropriate, it is not the most effective avenue for changing the image of nursing. DIF: Cognitive Level: Application REF: MCS: 42 26. The diversity of the population entering the health care system is a challenge for nurses because a. the portion of minorities in nursing is greater than the portion of minorities in the general population. b. educators are culturally competent leaders for nurses and students. c. lessons about culture and cultural differences are not part of progressive education programs. d. ethnic minority group nurses are approximately 12% of nurses. Feedback A Only 12% of nurses are minorities, but approximately 31% of the general population is identified as a minority. B Managers, educators, and other nursing leaders will require training so they can be culturally competent leaders for nurses and students who may have backgrounds different from their own. C Culture and cultural differences are part of progressive education programs. However, understanding of health and illness in the context of cultural heritage is not consistently addressed in the health care system. D Approximately 1 in 10 nurses identify themselves as a member of a minority group. This might make it difficult for patients who identify as ethnic minorities to feel comfortable or confident with the health care system. DIF: Cognitive Level: Comprehension REF: MCS: 45 27. Biomedical technology involves the use of complex machines or devices in patient care situations. Because of the highly technological environment in which nurses work, it is important that nurses a. assume total responsibility for monitoring data generated by these devices. b. use human touch and words of reassurance frequently to convey caring. c. maintain the devices safety by assuring routine assessment by physicians. d. be careful not to frighten the patient and family with information about the device. Feedback A The monitoring and safety of machines and devices are most often the responsibility of nurses and technicians. B The use of technology needs to be combined with caring to maintain patient and family satisfaction. Technology must never take the place of human-to-human contact. C The monitoring and safety of machines and devices are most often the responsibility of nurses and technicians. D The patient and family need information about the use of the device, as well as the meaning of the information produced, to decrease stress and anxiety. DIF: Cognitive Level: Application REF: MCS: 46 28. Margaret Sanger, as a nurse and activist, worked on the Lower East Side of New York City in the early 1900s with immigrant women. What was the focus of her work? a. Sanitation to prevent disease transmission b. Health education for children c. Providing nursing care to underserved African-American families d. Safe contraception and family planning for women Feedback A Sanitation to prevent disease transmission may have been part of her work in her early years, but Sanger devoted her life to the birth control movement and became a national figure in that cause. B Health education for children may have been part of her work in her early years, but Sanger devoted her life to the birth control movement and became a national figure in that cause. C Providing nursing care to underserved African-American families may have been part of her work in her early years, but Sanger devoted her life to the birth control movement and became a national figure in that cause. D Margaret Sanger, inspired by the death of an immigrant woman from a self- attempted abortion, became determined to teach women about birth control. DIF: Cognitive Level: Knowledge REF: MCS: 29 MULTIPLE RESPONSE 1. Nursing practices during the Civil War advanced the cause of professional nursing. The move toward formal education and training was supported by (Select all that apply.) a. endorsement by the Catholic nursing orders (Sisters of Charity, Sisters of Mercy, and Sisters of the Holy Cross). b. a proposal by Dr. Samuel Gross in 1869 that large hospitals develop training schools for nurses. c. reports of inadequate conditions in hospitals reported by social reformers after the Civil War. d. lobbying by the United States Sanitary Commission for the creation of nursing schools. e. the appointment of Dorothea Dix as Superintendent of Women Nurses of the (Union) Army. , C, D, E Feedback Correct The proposal by Dr. Samuel Gross in 1869 that large hospitals develop training schools for nurses; reports of inadequate conditions in hospitals reported by social reformers after the Civil War; and lobbying by theUnited States Sanitary Commission for thecreation of nursing schools all led toward formal education and training for nursing practices. Support for thedevelopment of schools to train nurses was given by physicians who had observed thedifference training made in hospitals during thewar, as well as by theU.S. Sanitary Commission. Social reformation that started before theCivil War identified theshocking conditions in hospitals. Dorothea Dix created a month-long training program for women who wished to serve as nurses in theCivil War. Incorrect Endorsement by theCatholic nursing orders (Sisters of Charity, Sisters of Mercy, and Sisters of theHoly Cross) is incorrect because, although theCatholic nursing orders provided significant organized nursing care during thewar, even they did not develop formal education programs until later. DIF: Cognitive Level: Comprehension REF: MCS: 26 2. Historically, one solution that attempted to correct theshortage of RNs was to increase thesupply of nurses. Means of increasing thesupply of nurses included (Select all that apply.) a. implementation of team nursing. b. use of traveling nurses. c. development of associate degree programs. d. importation of nurses from English-speaking countries. e. use of registered care technicians. , C, D Feedback Correct Use of traveling nurses, development of associate degree programs, and importation of nurses from English-speaking countries are correct because all have been used to increase thenumbers of practicing nurses. Incorrect Implementation of team nursing is incorrect because although theimplementation of team nursing was intended to improve nurse availability, it did not increase thenumber of nurses. Registered care technicians were nurse extenders proposed by theAMA to ease theshortage, but this solution was quickly defeated. DIF: Cognitive Level: Comprehension REF: MCS: 47 3. Provisions of theAffordable Care Act include (Select all that apply.) a. lifetime limits of catastrophic care insurance will cover. b. children up to age 26 being allowed to stay on parents insurance. c. disallowing denial of coverage for children and teens preexisting conditions. d. the right to appeal coverage decisions. e. recommended preventative services without out-of-pocket cost to consumers. , C, D, E Feedback Correct Provisions of theAffordable Care Act include no lifetime limits on insurance coverage, allowing children up to age 26 to stay on their parents insurance plan, banning thepractice of denying coverage for children and teens with preexisting conditions, and a recommendation for preventative services to be covered with no out-of-pocket cost for theconsumer. Incorrect theAffordable Care Act does not place lifetime limits on covering catastrophic care. Chapter 3.Nursing’s Pathway to Professionalism MULTIPLE CHOICE 1. Which of thefollowing was recognized earliest as a true profession? a. Ministry b. Teaching c. Social work d. Engineering Feedback A Historically only medicine, law, and theministry were accepted as professions. B Teaching was not accepted as an early profession. C Social work was not accepted as an early profession. D Engineering was not accepted as an early profession. DIF: Cognitive Level: Knowledge REF: MCS: 52 2. Which of thefollowing characteristics of a profession were listed in Flexners work on professions? a. Activities of professions are more physically than intellectually oriented. b. Activities of professions are based on their own body of knowledge. c. Beliefs of professions are more theoretical than practical. d. Beliefs and traditions are handed down from generation to generation. Feedback A Flexner actually lists intellectual as opposed to physical activities. B Flexners characteristics of professions list a body of knowledge that can be learned and is refreshed and refined through research. C Flexner lists practical as well as theoretical beliefs. D Flexner stressed that in professions, information is taught through a process of highly specialized professional education. DIF: Cognitive Level: Comprehension REF: MCS: 53 3. Similarities exist between various ideas about what constitutes a profession. Which of thefollowing is believed to be a characteristic of a profession? a. Members have autonomy. b. Members are trained on thejob. c. Members are motivated primarily by financial reward. d. The group lacks a code of ethics. Feedback A A review of theliterature on characteristics of a profession yielded these similarities: service/altruism, specialized knowledge, and autonomy/ethics. B Specialized formal education is required. C Members are motivated by altruism. D Ethics or a code of ethics is a characteristic of professions. DIF: Cognitive Level: Knowledge REF: MCS: 54 4. Which of thefollowing best describes thedifference between an occupation and a profession? a. A profession requires a duty to serve. b. A profession is defined by members average income. c. In a profession, action is based on intuition. d. In a profession, knowledge is handed down from generation to generation. Feedback A Profession is defined as a duty, vocation, or form of employment that provides a needed service to society and possesses characteristics of expertise, autonomy, long academic preparation, commitment, and responsibility. B Average income does not determine thedifference between an occupation and a profession. C In a profession, action is based on long academic preparation, a body of knowledge, and instruction in techniques of theprofession, not on intuition. D Knowledge is transferred in formal academic preparation, not handed down. DIF: Cognitive Level: Comprehension REF: MCS: 59 5. According to thenurses Code of Ethics, thehallmark of nursing practice is a. autonomy. b. accountability. c. evidence-based practice. d. altruism. Feedback A Nurses do not have complete autonomy but work with other disciplines. B Individual accountability has become thehallmark of practice. Provision 4 of theCode of Ethics states, thenurse is responsible and accountable for individual practice. . . C Evidence-based practice is relatively new to nursing. D Although important to nursing, altruism is not thehallmark of nursing practice according to theCode of Ethics. DIF: Cognitive Level: Comprehension REF: MCS: 56 6. The document that provides professional standards and a framework for professional decision making that ensures decisions are made with thehighest integrity is the a. Nurse Practice Act. b. Code of Ethics. c. Nursings Social Policy Statement. d. bylaws of theAmerican Nurses Association (ANA). Feedback A The Nurse Practice Act defines thelegal scope of practice. B The Code of Ethics in nursing guides decisions and theconduct of practitioners. C Nursings Social Policy Statement describes theresponsibilities of nurses toward society. D Bylaws of theANA guide theprocesses of theorganization. DIF: Cognitive Level: Comprehension REF: MCS: 57 7. A component that separates occupations from professions is commitment. Which of thefollowing is thebest way that nurses can show commitment to each other? a. Reporting substandard practice by unlicensed personnel b. Reading theprofessional literature c. Mentoring nursing students and novice nurses d. Making a financial donation to a professional organization Feedback A Reporting substandard practice is not thebest example of commitment to each other. B Reading theliterature does not involve mentoring or disseminating knowledge to others. C Nurses show commitment to theprofession by mentoring others entering theprofession. D Donating to a professional organization is less effective than serving as an active member of theorganization and disseminating knowledge through active participation. DIF: Cognitive Level: Application REF: MCS: 60 8. The nursing profession has experienced barriers to professionalism. Which of thefollowing is theprimary current barrier to nursings professionalism? a. Too many men in nursing b. Unquestioning obedience to doctors c. Limitations placed on practice by state legislators d. Variability of educational backgrounds of nurses Feedback A Although increasing, thenumber of men in nursing is low. B Unquestioning obedience is not a current behavior. C Currently, nurse practice acts are broader than ever before. D No other profession allows entry into practice at less than thebaccalaureate level. In fact, many professions require postgraduate preparation for beginning professional practice. DIF: Cognitive Level: Comprehension REF: MCS: 60 9. The process of professionalization of an occupation typically follows a pattern of developmental stages. One of thestages is collective identity. Which of thefollowing is an example of collective identity? a. Legal right to practice profession to protect unique skills from outsiders b. Apprenticeship programs to develop skills c. A loose association of practitioners d. Definition of theprofessions mission related to full-time work Feedback A Professions will be defined legally to determine who can use theskills practiced by their members. B Professions have a formal educational process for all members. C Professions have very organized associations for their members that may set standards for practice. D To practice a profession, thework does not need to be full time only. DIF: Cognitive Level: Comprehension REF: MCS: 54 10. Preparation is a component that separates occupations from professions. Which of thefollowing is thebest way that a nurse demonstrates preparation for theprofession? a. Improves nursing practice through theuse of trial and error methods b. Focuses on theskills needed for thepractice setting c. Articulates thevalues of caring and compassion in patient-centered care d. Utilizes textbooks from college to support practice 5 years after graduation Feedback A Professional preparation enables practitioners to act in a logical, rational manner rather than relying on intuition, tradition, or trial and error. B The preparation includes more than just practice skills. C Preparation for a profession includes more than theacquisition of knowledge and skills. Preparation includes theorientation to thebeliefs, values, and attitudes expected of members of theprofession. D Professions have an ever-expanding base of knowledge, which means practitioners need to use themost current information to inform practice decisions. DIF: Cognitive Level: Application REF: MCS: 54 11. A barrier to professionalism attributed to nursings roots in altruism is illustrated when a nurse a. questions a medication order written by thephysician. b. takes thetime to listen to a patients fears about surgery. c. needs to seek approval from charge nurse to give a PRN medication. d. feels guilty for expecting to be paid well for work. Feedback A The nurse is serving as a patient advocate by questioning theorder if it is unclear; unquestioningly following theorder would violate thepatients trust. B Listening to patients concerns is an important aspect of nursing. C The nurse is an independent practitioner and does not require permission to provide nursing care. D As with other helping professions practitioners, thevalue of altruism frequently makes nurses feel guilty or greedy for expecting compensation for thecomplex and demanding work they do. DIF: Cognitive Level: Application REF: MCS: 62 12. A major challenge to full autonomy for nurses is/are a. state nurse practice acts. b. lobbyists for theAmerican Medical Association (AMA) and hospital associations. c. the status of nurses in hospital hierarchy. d. the view of physicians as thegatekeepers in health care. Feedback A Although nurse practice acts in many states reinforce nursings tenuous self- determination by requiring that nurses perform certain actions only when authorized by supervising physicians or hospital protocols, they are not themajor challenge. B Historically at least three groups have attempted to control nursing practice, organized medicine, and health service administration, as well as organized nursing. However, both themedical profession and health services administration have attempted to control nursing because they believed it was in their best interest to keep nurses dependent on them. C Although status within thehospital may influence autonomy of practice, it is not themajor challenge. D Although physician supervision or authorization is required before certain activities can occur, this is not themajor challenge to nursing autonomy. DIF: Cognitive Level: Knowledge REF: MCS: 57 13. One of thecharacteristics of a profession identified by Kelly was there is an organization (association) that encourages and supports high standards of practice. Which of thefollowing illustrates a concern for nursing meeting this characteristic? a. The ANA has existed for more than 100 years. b. Nursing specialty organizations have greater power to influence practice than a more general nursing organization. c. The membership of theANA is less than 10% of all nurses. d. The purpose of theANA does not address theeconomic and general welfare of nurses. Feedback A Although theANA has existed since 1896, thelongevity of theorganization does not assure thedevelopment of standards of practice. B Although specialty organizations may influence practice in specialty areas, theANA addresses theneeds of all nurses regardless of area of practice. C Fewer than 1 in 10 nurses belong to theANA, theofficial voice of nursing. D The ANA has a clear focus on theeconomic and general welfare of nurses historically. DIF: Cognitive Level: Comprehension REF: MCS: 58 MULTIPLE RESPONSE 1. Scholars have defined profession through theyears. Which of thefollowing were identified as common major characteristics according to scholars? (Select all that apply.) a. It is based on a body of knowledge that can be learned. b. It has a service orientation. c. Practice is in a single recognized setting. d. Professionals control their own practice. e. Skills can be learned in a variety of settings, including through job training. , B, D Feedback Correct Based on a body of knowledge that can be learned, has a service orientation, and professionals control their own practice are correct as these characteristics were identified by Flexner, Hall, and others. Incorrect Professionals control their own practice is incorrect because a profession is not always practiced in a single setting. For example, nursing may be practiced in organized health settings, as well as in thehome and community. theeducation and skills needed to learn a profession come from an institution of higher education. DIF: Cognitive Level: Comprehension REF: MCS: 53 2. An important aspect of professionalism is collegiality. Which of thefollowing demonstrates collegiality? (Select all that apply.) a. Assisting a nurse researcher with data collection related to measuring stress levels in hospitalized children b. Reporting a nursing assistant to thenurse manager when heart rate was not recorded in a patient c. Participating in weekly patient care conferences with physicians, social workers, and other therapists d. Sharing with another nurse that you heard thenurse manager is dating thenew physical therapist on theunit e. Serving as a preceptor to a nurse completing a refresher course to reactivate her nursing license. , C, E Feedback Correct Assisting nurse researcher with data collection related to measuring stress levels in hospitalized children; participating in weekly patient care conferences with physicians, social workers, and other therapists; and serving as a preceptor to a nurse completing a refresher course to reactivate her nursing license are correct because these actions demonstrate collegiality by sharing with, supporting, assisting, and counseling other nurses and health care providers. Incorrect Reporting a nursing assistant to thenurse manager when heart rate was not recorded in a patient is incorrect because this is not a supportive activity as everyone can make a mistake and needs to be given theopportunity to correct this behavior. Sharing with another nurse that you heard thenurse manager is dating thenew physical therapist on theunit is incorrect because participating in gossip and rumors does not support others. Chapter 4.Nursing Education in an Evolving Health Care Environment MULTIPLE CHOICE 1. In 1900, theprimary reason for hospital-based nursing education programs was to a. educate nurses to care for patients in hospitals. b. provide educational opportunities for women. c. staff thehospitals that operated theeducation programs. d. provide standardized preparation for nurses. Feedback A Most nurses worked in homes and very few worked in hospitals. B The education for women was not a value of society at thetime. C In thehospitals there were few paid staff nurses, and most of thecare was provided by thenursing students. D The programs of study varied in length, and each school set its standards and requirements. DIF: Cognitive Level: Knowledge REF: MCS: 131 2. Which of thefollowing nursing leaders is credited with being one of theearliest nursing educators in theworld? a. Isabel Hampton Robb b. Mary Adelaide Nutting c. Melinda Anne Richards d. Annie W. Goodrich Feedback A Robb studied nursing education. B Mary Adelaide Nutting was a professor at Teachers College in 1907, and she was also thefirst nursing professor. C Richards was thefirst trained nurse educated in theUnited States. D Goodrich became thefirst dean of theYale School of Nursing in 1924. DIF: Cognitive Level: Knowledge REF: MCS: 133 3. The Goldmark Report focused on what aspect of nursing? a. Consistency in length of nursing education programs b. Consistency in theory content across diploma programs c. Desirability of establishing schools of nursing within academic settings d. Increasing numbers of physicians teaching in nursing programs Feedback A Consistency in length of programs was not an issue. B Content was not theissue. C The Goldmark Report focused on clinical learning experiences of students, hospital control of schools of nursing, desirability of establishing schools of nursing in universities, lack of funding for nursing education, and lack of qualified faculty. D Nursing curriculum with instruction by physicians was not encouraged. DIF: Cognitive Level: Comprehension REF: MCS: 134 4. Which American university opened thefirst nursing school as a separate department within theuniversity? a. Harvard b. Teachers College c. Columbia d. Yale Feedback A Harvard was not thefirst American university to open a nursing school as its own department. B Teachers College was not thefirst American university to open a nursing school as its own department. C Columbia was not thefirst American university to open a nursing school as its own department. D In 1924, Yale University was thefirst American university to open a school of nursing as its own department. DIF: Cognitive Level: Knowledge REF: MCS: 134 5. Which of thefollowing recommendations resulting from the1934 study Nursing Schools Today and Tomorrow still has relevance today? a. Nursing students should be trained on thejob. b. Nursing students should be used to staff hospitals on theweekends. c. Nurses should be highly educated. d. Nurses with highly developed instincts do not require standards of practice. Feedback A Nurses should be highly educated in a university setting. B Students should not be used to staff hospitals. C The study made five recommendations: nursing education should be established within higher education; nurses should be highly educated; students should not be used to staff hospitals; standards of practice should be established; and students should meet minimal qualifications for graduation. D Standards of practice should be established. DIF: Cognitive Level: Knowledge REF: MCS: 134 6. The earliest type of formal nursing education program was the a. diploma program. b. associate degree program. c. bachelors degree program. d. grandfathered acceptance as registered nurse (RN). Feedback A Diploma programs of nursing began in thelate 1800s and were theearliest form of nursing education. B Associate nursing degree programs began in 1952. C Bachelors degree programs began in 1909 but became commonplace only in themid-1900s. D Nurses are not grandfathered into licensure. DIF: Cognitive Level: Knowledge REF: MCS: 134 7. The single most important reason for thedecline in thenumber of hospital-based diploma programs was a. shift in hospital occupancy from acute care to home care. b. increase in hospital-based medical residency programs competing for educational dollars. c. beginning of associate degree programs that were shorter in length. d. diploma educations position outside themainstream of higher education. Feedback A The increase in complexity of health care led to theneed for more advanced educational preparation for nurses. B Although it became more difficult for hospitals to fund diploma programs, this was not themost important reason for their decline. C The advent of associate degree programs led to thedecline in diploma programs, because associate degree programs are located in academic settings. D The movement of nursing education into theeducational mainstream, that is, colleges and universities, was responsible for therapid decrease in diploma programs. DIF: Cognitive Level: Knowledge REF: MCS: 135 8. Which of thefollowing is a primary reason for theinitial slow growth of bachelors degree nursing programs in theUnited States? a. Belief that hands-on training received in hospital-based diploma programs was superior to thetheoretical-focused content in bachelors degree programs b. Belief that hospital-based diploma programs were more scientifically based c. Belief that students prepared in hospital-based diploma programs were more compassionate caregivers d. Belief that hospital-based education programs facilitated career mobility Feedback A There was a great deal of acceptance of thehands-on teaching received in diploma programs. B Bachelors degree programs are more theoretically focused. C There is no difference in perception of caring between theprograms. D Bachelors degree education facilitates career mobility. DIF: Cognitive Level: Comprehension REF: MCS: 135 9. The 1948 Brown Report recommended which of thefollowing? a. Limit enrollment of men and minorities in nursing programs. b. Students admitted to nursing programs should not be required to meet admission requirements of theuniversity. c. Schools of nursing should be associated with teaching hospitals. d. Schools of nursin