Graduate Psychiatric (Psychosocial) Nursing Program Overview

Overview of the graduate program in psychiatric (psychosocial) nursing, compiled in 1988.

Graduate Psychosocial Program The baccalaureate program was accredited in 1955. An important goal of Dean Quinn's five year plan was to initiate a master's degree, preferably in public health nursing. A fortuitous set of circumstances influences how the goal was to be achieved. Performance of the University of Utah students on the State Board Test Pool Examinations was impressive, and particularly so in psychiatric nursing. (!_,~ ---- Teaching in the area was Lucille Johannesen~), a particularly effective clinical specialist who earned her master's degree in psychosocial nursing at the University of Colorado •. One official who became interested in the test scores of the Utah students was Esther Garrison, Chief of the Nursing Branch of the National Institute of Mental Health (check title?). The NIMH was the federal agency implementing the National Mental Health Act of 1946. The legislation was meant to correct the scandalous level of care of the mentally ill following World War II. High on the list of NIMH priorities was to tr~in mental health professionals to give care to the neglected mentally ill and to conduct research into the causes and treatment of people with psychiatric disorders. Esther Garrison, a young Public Health Service nurse from Minnesota, was appointed as the first Chief of the Nursing Branch. It was her early decision to emphasize preparing nurses at the master's level in order to build a virtually non-existent leadership void. A second priority was to strengthen mental health knowledge and understanding at the baccalaureate level through grants to integrate mental health principles into basic programs. Creation of graduate programs in psychiatric nursing across the country was the outcome of generous NIMH grants to fund faculty, traineeships, and other expenses. Ms. Garrison visited the University of Utah in 1956 in order to study the program with the high scores on State Board examinations in psychiatric nursing. Her advice to Dean Rordame was to consider establishing a graduate program. A grant was written by Ms. Rordame and Ms. Johannesen requesting funds to develop and build the background for a master's program in psychiatric nursing. The request was for $23,868.00 for start-up costs. Part of the preparation for the grant was the work of a Training Committee which included, in addition to Dean Rordame and Ms. Johanneson, Ms. Bernice Chapman, the Director (Dean?) of the BYU nursing program and other professional nursing leaders at the Utah State Hospital in Provo. Minutes of their meetings from April to August 1956 demonstrate guarded enthusiasm, curiosity and admitted ignorance about what the new professional might be able to do. One conclusion of the committee on August 29 was that the graduate student might be. offered the following "opportunities" at the State Hospital. The graduate student should have the right to: 1. Be awkward and clumsy and slow 2. Make errors 3. Make decisions free from bias of harmful criticism 4. Carry plans through to completion without undue interference or sudden changes not arrived at in joint conference 5. Recognition and encouragement from the agency for improvement in practice even though still short of mature competency Guarded agreement that the program was a good idea is apparent in this mixed professional committee considering graduate education in nursing. It perhaps should be noted that five members of the committee (Chapman, Johanneson, Krauss, Rordame) held master's degrees. Other groups also provided written support for the proposed program and, in due time, the planning grant was funded. Sumiko (Sue) Fujiki was hired in 1957 to plan the new graduate program. A baccalaureate graduate of the College of Nursing, Ms. Fujiki earned the master of science degree in psychiatric nursing at Washington University in St. Louis. In addition, she studied two years there as a career teacher. At Utah, her major responsibilities for the year were to work with other faculty to create a curriculum that would become the framework for the general graduate program of the College, to prepare the curriculum in psychiatric nursing, to negotiate with clinical facilities for a virtually unknown new professional student, and to recruit students for the first class of Autumn 1958. 2 NIMH funding marked the beginning of a remarkable record of success in attracting federal grants in all areas of both graduate and other programs. Indeed, more than half the budget of the College of Nursing for many years was derived from federal sources, a characteristic of other health professions in Utah and throughout the country. The NIMH grant for the first operational year of the graduate program in psychiatric nursing was $45,073. The amount included traineeships for four students at $3,000.00 each and $15,126.00 to support two faculty positions. In addition, there was money for secretarial assistance and a grand total of about $1,500 for travel, books and supplies. Decisions of long lasting impact were to work with the Graduate Council of the University to develop a strong master of science degree. The option would have been to develop the professional master of nursing, which did not require scrutiny by the Graduate Council to ensure meeting standards established by that prestigious body. The second decision was to prepare the graduate for clinical specialization, which together with other requirements, dictated a two year program of study. require a thesis. The third decision was to emphasize research and The fourth d~<::is.ion wa.s to require theory and practice in both teaching and supervision. required. In addition, a minor or supportive study was Suggested areas of study for the minor were anthropology, education, business administration, biological sciences, and the fine arts. The curriculum in psychiatric nursing was built on a strong theory base, emphasizing the psychodynamic approach to patient care. That meant the theoretical base must include principles of human growth and development, study of major theorists in psychiatry (using the original works as texts), as well as dynamic theories of psychiatric nursing, and the development of skills in professional practice which incorporated those theories. Clinical facilities required negotiating with psychiatric agency personnel who were accustomed to the nurse being the keeper and distributor of medications and the manager of state hospital wards of disturbed patients. nurses being qualified therapists was unheard of. The notion of Indeed, for many years the word "therapy" was not used in writt.en course materials because of the opposition of psychiatrists and psychologists. A nurse might be "therapeutic" in the same sense as a potted plant, but "therapist?" 3 Never! During the first years of the program, the Utah State Hospital in Provo and the inpatient services of the Salt Lake County General Hospital provided clinical placements for the graduate students. The most productive agency relationship was with the Granite Community Mental Health Center, a relationship that has continued over 30 years and expanded to include the enlarged Salt Lake County Community Mental Health System. There was a rare congeniality of theory and philosophy of practice between the nursing faculty and Dr. Norman Anderson, Director of the Granite Center. For many years, Dr. Anderson was the only psychoanalyst holding such a position in a community program in the country. He valued the unique potential contribution of the nurse specialist on the mental health team, and he sponsored appointment of one of the early graduates, LaPrele Rasmussen, to the Center staff. That move established the precedent that psychiatric nursing should be one of the four key disciplines, along with psychiatry, psychology, and social work, in Utah's young system of developing mental health centers. Dr. Anderson became an auxiliary faculty member of the College of Nursing, taught a course in psychopathology for many years, participated in seminars, and was generally a cherished friend and college of faculty, students, and the Graduate Program. The first graduate curriculum offered by the College of Nursing in 1958 demonstrates the scholarly approach taken by faculty toward education of the clinical specialist. It shaped graduate education in the College for the future and merits review. It was established as 6 quarters of study over 2 academic years with the intervening summer "free". There was, however, a suggestion that the students might wish to concentrate on their minor or supporting study courses during the summer quarter. Graduate Psychiatric Nursing Curriculum College of Nursing Bulletin, 1958-59 First Year (course credit hours are in brackets) Psychiatry 200, Medical Psychology and Introduction to Clinical Psychiatry (3) Social Work 230, A,B,C, Growth and Behavior (2, 2, 2) Nursing 275, 276, 278, Advanced Psychiatric Nursing (Theories of Nursing Practice), I, II, III (3, 3, 3) 4 Nursing 275, 277, 279, Practicum courses (1-2, 3, 3) Soci~logy 128, Social Statistics (3) Social Work 228, Social Research (2) Nursing 300, A, B, C, Research and Thesis (9-15 total) Second Year Nursing 374, 376, 378, Seminar, Psychiatric Nursing (2, 2, 2) Nursing 375, 377, 379, Practicum courses ( 3' 3' 3) Nursing Education 214, 215, Curriculum Development and Teaching Methods I, ¢II (3, 3) Nursing Education 219 Evaluation of Teaching, Learning in Nursing (3) Nursing Education 220-A, 220-B, Experience in Teaching and Experience in Administration (1-4, 1-4) Nursing Education 270, Supervision in Nursing (3) Supporting work (minor) (9-12 total) The required coursework amounted to a minimum of 75 credit hours and· a maximum of approximately 90 hours. The 3 hour practicum courses were required each of the 6 quarters and maintained a ratio of three clinical hours per credit hour. Students admitted to the program were granted NIMH traineeships generous enough to allow students to study full time. They were not allowed outside employment, other than during the summer session. Four students entered the program Autumn 1958: Robinson, Mary Gorrow and Alice Ray Harmon. Camilla Wood, Ora Loy The four completed the program of study in August 1960, establishing a norm of sorts of completing the rigorous program within the recommended two years. On May 6, 1961, the NLN Collegiate Board of Review granted accreditation to the new master's degree program and continuing accreditation to the baccalaureate program. Changes were apparent wHhin 5 years, with a strengthening of nursing didactic courses in particular. For example, the course, Psychiatry 200, and the Social work 230 series (6 hours) were dropped and replaced by nursing theory 5 courses. In addition, the student was given the option of taking a practicum in either teaching or 1;1t;t__p~ry:j,:;i;i9p,_rat,her than being required to take both. The choice of the "functional area" requirement continued well into the 1970' s when the courses became elective. The Utah Graduate Psychiatric Nursing Program is perhaps best known for a strong family orientation in theory and practice. The family approach to care of people with psychiatric disorders and the fostering of mental health was apparent early on. The second year theory and clinical courses focused on psychiatric nursing care of the disturbed family beginning in 1963. This was an innovation in nursing education at the time since students functioned as the sole family therapist in the home, assuming responsibility for case management under supervision of nursing faculty and with psychiatric consultative assistance. Family problems ranged from school problems to divorce to child abuse and incest. Family members suffered from a range of psychia trio disorders from autis:n to adolescent rebellion to depression to psychopathy to schizophrenia. The Western Council of Higher Education in Nursing held their annual Spring Graduate Seminar in Salt Lake City in 1964. Seven second year College of Nursing students presented reports of their clinical work with severely disturbed families to the Seminar. This was the first work of that dimension reported by graduate nursing students and those attending the meeting were deeply impressed. Emphasis on family nursing care - now bravely called family therapy - has continued as a major emphasis to the present time. General emphasis in the program changed from time to time as the emphasis at NIMH changed. For example, underserved populations became targets of importance, and continued funding of training grants depended on addressing those priorities effectively. Underserved populations variously included children and adolescents, the aged, the poor, minority groups, and most recently the chronically mentally ill. The integrity of the Graduate Psychiatric Program remained stable as the target populations changed, that is, students consistent.ly developed clinical competence as therapists with individuals, groups, and families. Clinical placements were influenced by the requirements of the current grant. 6 . An example• occurred in· 19.:.:.:_: when two second year stud~tits ·elected ·to devcite a quarter of clinical work to the Navajo people served by the Four Corners Mental Health Center at Moab, Utah. The Center's catchment area reached into vast expanses of the adjacent Navajo Reservation. The students, Joyce Matsuno and Brenda Brennan, conducted group therapy with adolescents at Shiprock, New Mexico, and worked with disturbed families in hogans, accompanied by Navajo translators. The students were supervised "long distance" by Sue Fujiki who traveled to Moab and beyond on a weekly schedule. Although successful from a therapeutic and public relations standpoint, the Four Corners project proved to be too expensive to continue. However, it demonstrated the potential for students to learn effective psychiatric nursing interventions across cultural barriers. (needs a conclusion) 7 Dean Quinn announced her intention to retire effective June 1973. A search .. o.ommit:tee .for .a new. dean. was .. a.ppointed.. by President David Gardner, Cha·ired·-b-y ·-; Assistant Dean Minnie Walton and including other distinguished members of the University faculty (should we name the whole committee - Gayle Eliason, Dr. Lowell A. Glasgow, June Goodson, Dr. Marie Holley, Dr. John M. Legler, Dr. Ewart A. Swinyard, Dr. Anthony R. Temple, Dr. Camilla S. Wood, Robert L. Bliss). Early Spring 1973, Dr. Madeleine, Dean of the College of Nursing, University of Washington, visited the Utah campus. She was interviewed by University officials, College of Nursing faculty, administrators, and students as well as the search committee. Dr. Leininger was clear in stating that her major goal, if appointed dean, would be to establish the long-deferred doctoral program in nursing, and that she would recruit a significant number of doctorally prepared nursing faculty appropriate to initiate the advanced degree program. publications would have to be accelerated. Nursing research and Securing federal funding for the doctoral and research programs would have high priority. Dr. Leininger was appointed Dean of the College of Nursing and agreed to asstuile the position on July 1, 1974, leaving a one year interim period. In May 1973, Academic Vice President Jerry Anderson invited Associate Professor Bonnie Clayton to assume the position of acting dean for the interim year. Scheduled for a sabbatical leave to complete her doctorate, 1973-74, Ms. Clayton refused the appointment, suggested other candidates, then went on vacation with the promise "to think it over". Bonnie Clayton later recalled the second conversation with Vice President Anderson on her return. "When I told Dr. Anderson I had decided to take the sabbatical leave rather than the acting deanship, he said he would then appoint his Associate Vice President for Academic Affairs to 'manage the College on the side'. I thought that was outrageous and agreed to take the job as Acting Dean, with written assurance that the sabbatical leave would be available upon completion of the year of 'service to the University"'. A later comment confirmed Ms. Clayton's anticipation that the position would be that of a non-person in a non-position. 8 Dr. Leininger visited the College of Nursing several times during the interim .. y:ear, discussing. potentia-1---federal~ -gran-t- a-pplications, faculty,· program;· · ·· ·· · · budget, and other issues with various individuals and groups. Office of Dean in July 1974. She assumed the Among other feats, she persuaded Ms. Clayton to accept appointment as the Associate Dean for Baccalaureate Programs in order to facilitate transition to the new administration. As planned, the agenda to initiate 6the doctoral program was given highe~t priority and the endorsement of the University administration. Dean Leininger's goal of increasing the number of doctorally prepared faculty to 20 was pursued, along with preparation of grant proposals for support of faculty research and initiation of the doctorate. Federal funds were granted in 197 to initiate the doctorate in nursing. Effectiveness of the concentrated effort to recruit doctoral faculty can be seen in a brief comparison of the faculty rosters of 1972 and 1977. 1972 was a very successful one in all respects: The year numbers of highly qualified baccalaureate and master's level graduates, the respectable reputation for faculty teaching, extraordinary faculty success in· attracting training grants from federal and other sources, and considerable faculty and student involvement in affairs on "lower campus". Four full-time teaching nurse faculty held the earned Ph.D. degree (Chinn, Holley, Jacobs, Wood). In addition, two individuals holding the Ph.D. were listed whose major position was with the VAMC (Dyer, Grimmett). One physician was listed (Davis -- Bonnie, I think Shiprock). Five years later in 1977, the College Bulletin listed 21 full or part-time teaching faculty with earned doctorates. Fifteen of them were nurses (Abbey, Bulbrook, Clayton, Collins, Dimond, Fujiki, Holley, Jacobs, Leininger, Minckley, Moses, Osman, Overfield, Peters, Simms). Four non-nurses with doctorates were listed (Litton-Hawes, Shand-Kovach, Sorenson, Wolfer). Two research faculty were listed, one was a nurse with the VAMC (Dyer), and one was a non-nurse (Sullivan). The grant total was 21, a significant enough mass of faculty with advanced degrees to merit serious consideration for funding by the Division of Nursing to initiate the doctoral program. The first doctoral students were admitted Autumn 1977. 9 Traineeships were available to (who? all?) Research areas of faculty qualified to supervise doctoral students were: ·nursing educational administration, ·psychosocial, physiological, and transcultural nursing. The doctoral program brought a new dimension to the College with a healthy increase in faculty research and publication efforts. Increase in the number of doctoral faculty shifted major emphases away from the earlier focus on the education of baccalaureate nurses and clinical specialists at the master's level. The change in emphasis was not endorsed by a number of faculty members, creating a schism that persisted throughout dean Leinigner's six year tenure. (Do we need more elaboration on the Leininger years?) 10