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The overall goal of this research was to analyze implementation processes translating the nursing education reform agenda into practice across 20 Western European countries. The analysis centered on the substantial changes in structure and ethos created in nursing programs and the adjustments required from nursing faculty members as part of their integration into higher education institutions. Based on the model of implementing organizational change by Pettigrew, Ferlie, and McKee, three major implementation domains were analyzed: (1) the adjustment of nursing faculty members into higher education settings and toward their new roles; (2) the applicability of the graduate profile; and (3) the adequacy of the nursing curriculum for higher education institution and the reformed health care systems. A critical analysis of the scientific literature and policy documents revealed a striking similarity with regard to the difficulties and concerns appearing in the various Western European countries implementing nursing education reforms. Three sorts of difficulties emerge repeatedly in the reforming nursing education programs. These difficulties are related to (1) the adjustment of nursing faculty members into higher education settings and toward their new roles, (2) the competencies held by graduates of preregistration programs, and (3) the content and structure of the nursing curriculum. Future questions, lessons, and potential directions are discussed in this article.

The aim of this review was to provide a comprehensive outlook on nursing education reforms enacted in Western Europe in the last three decades. Specifically, this analysis aimed to describe major trends in the implementation processes of nursing education reforms and the current academic status of nursing programs across Western Europe. A critical analysis of the scientific literature and policy documents was conducted. The results indicate that two major phases of reform were initiated in nursing education over the last three decades. The first phase was geared at creating a unified European platform of solid preregistration programs. The second phase was predominantly geared at integrating nursing programs into higher education institutions. In contrast to the first stage of reform, which yielded unity, the second phase resulted in a notable variation among existing structures, levels of education, duration of studies, and the titles (degrees) awarded. As a result, Western Europe today represents a myriad of arrangements for preregistration nursing programs. Nursing has viewed these reforms in the education system as vital in promoting the profession and crucial for responding to the reforming health care system. This research indicates that nursing goals have only been partially obtained.

Swiss nurses' knowledge related to health care reforms: an exploratory study Background. This study examines health care reforms' implementation processes from the perspective of nurses' knowledge regarding the reforms. The research has been carried out in the Swiss (Canton Vaud) context, where health care reforms have been initiated, on the National (Federal) level, in 1996. Objectives. Three research questions were formulated: (a) What is the level of nurses' knowledge regarding the basic principles of LAMal (Loi federale sur l'assurance maladie, Federal Health Insurance Law)? (b) What is the level of nurses' knowledge concerning the principles of health care reforms in Canton Vaud (NOPS, Nouvelles Orientations de la Politique Sanitaire)? and (c) Are there knowledge differences relating to employment setting (hospital, community, and education), nurses' roles (managerial vs. staff nurses) and level of education? Methods. The sample consisted of a total of 74 nurses. Of these, 20 were employed in the community, 30 in hospital settings and 24 worked in schools of nursing. The research tool utilized was 40-items nurses' knowledge questionnaire developed for the purpose of this study. Three knowledge subscales and a subscale of certainty were constructed. Results. Overall, data showed a moderate to high mean level of knowledge (around 70% correct responses) on all knowledge scales considered. Community setting, managerial position, and a nonacademic nursing degree were all positively related to higher levels of reforms' knowledge. On the contrary, employment in a hospital setting and having a university degree had both negative impacts on achieving a high score of knowledge. Levels of certainty were significantly higher for LAMal than NOPS and for correct rather than for wrong responses.

This longitudinal study examined changes in the occupational perceptions of nursing students studying in a non-traditional undergraduate nursing program. The respondents, 210 first- and second-year nursing students, completed a questionnaire measuring the perceived importance of traditional and non-traditional nursing interventions and values. Questionnaires were administered at the beginning and at the end of the academic year. Students studying in a more traditional program comprised the control group. The results show that certain traditional nursing activities and values are perceived as more important by first-year students compared with second-year students in both programs, whereas the perceived importance of non-traditional activities is higher among second-year students. The preference for non-traditional interventions is stronger among students in the non-traditional nursing program. The results are discussed with regard to the gradual effect of nursing education on students' occupational perceptions.

Entering the postmodern world in which society is confronting crossroads, paradoxes, and complexity, the health care system is encountering a transformation more comprehensive and revolutionary than has ever been seen before. Analysis of the state of nursing vis a vis these transformations indicates that the current paradigm does not ensure the existence of the profession in the postmodern health care system. That is because of increased difficulties in consolidating the economic and quality issues into the core of nursing, and in understanding the complexity inherent in health related situations.

This exploratory, qualitative study compared traditional and biomedical pregnancy and delivery practices from the perspective of Ethiopian immigrant women in Israel. Findings documented that certain beliefs, such as the belief that nonmedical factors (i.e., moral behavior, God, and proper nutrition) were responsible for pregnancy outcomes, were relatively unaffected by immigration. After immigration to Israel, Ethiopian women, however, chose to deliver their babies in the hospital rather than import traditional home delivery practices from their homeland. Despite many negative aspects of labor and delivery in Israel, Ethiopian immigrant women felt that it was worth enduring negative Israeli health care practices in order to have "clean," "safe," and expert deliveries. Findings from this study assist health care professionals to provide more culturally sensitive care to this immigrant group.In order to gather information which will allow health care professionals to improve the cultural sensitivity of the care they offer to Ethiopian women immigrants in Israel, a 1991 qualitative study compared pregnancy and delivery practices in the two countries from the perspective of these women. The study sample consisted of 19 women who had migrated from Ethiopia 23-25 months previously. Six had given birth only in Ethiopia, four only in Israel, and nine in both countries. Analysis of data gained through interviews revealed that the women believed that the outcome of pregnancy and delivery depended upon proper nutrition and upon "God's will or power." Thus, the women failed to avail themselves of prenatal care. In Ethiopia, the women delivered their babies at home with the support of female family members, friends, and a traditional birth attendant. In Israel, the women delivered in a hospital alone and unsupported. In Ethiopia, the pregnant woman's modesty was considered important and was protected, but, in Israel, no regard was given to issues of modesty. In Ethiopia, the women had more control over their labor and the position in which they gave birth. In order to avoid restrictions to their activities while in labor, the women stayed at home as long as possible in Israel before rushing to the hospital. While hospital delivery was associated with loneliness, a lack of support, a lack of personal control, and invasions of privacy, these negative experiences were accepted in order to obtain the clean, safe, and "clever" care available in the hospitals. These findings indicate that culturally competent care for this group would involve respecting the need for modesty during prenatal care, increasing access to nutritional foods instead of routinely prescribing iron and vitamin supplementation, allowing a support group to accompany the woman during labor and delivery, and delaying the use of the lithotomy position and other restrictions on mobility until the last possible moment.

This study examined the moderating effect of age on the relations between symptom severity, self-care and others'care, patients'perception of the extent of problem solution, theirsatisfaction with the solution, and their perception of control over their health. Participating in the study were 121 female and 167 male chronically ill patients. Results indicated that age did play a major role in the relations between self-care and others'care and self-care outcomes. The young population sought maximum relief of symptoms with minimum effortfrom the self: The elderly, in contrast, could be said to maximize control because what was importantfor them was not to depend on others but to be self-sufficient in solving their health problems.

In spite of the theoretical recognition regarding the role of coping as a moderator, empirical findings indicate that it has only a modest effect as such. This study was designed, therefore, to examine the moderating effect of demographic variables (DV) on coping effectiveness, i.e. active cognitive coping, avoidance coping and active behavioural coping. The study sample was comprised of 12 male and 65 female patients with rheumatoid arthritis who were treated in three outpatient clinics of large hospitals in Israel. Findings suggest that demographic variables do play an important, and somewhat surprising, role in the effectiveness of coping strategies to temper psychological distress. Of the various demographic variables studied, marital status was found to have a significant effect on active cognitive coping and avoidance coping, and adherence to a religious belief system was found to have a significant effect on avoidance coping. The implications of the results for coping effectiveness are discussed.

The purpose of this study was to describe how school-age children perceive mental illness. The specific aims of this study were to describe the impact of age and sex on children's ability to identify and classify deviant behavior, and to identify how school-age children perceive mental illness by looking at how they define the concept, characterize the mentally ill, and understand causality and treatment. The random sample consisted of 90 school-age children. Thirty children were in grade 1, 30 in grade 4, and 30 in grade 7. A multimethods approach combining qualitative and quantitative techniques was used to analyze data Major studyfindings indicated that age was not a significant factor in children's ability to classify deviant behavior; however; there was a sex main effect: Boys were able to better identify deviant behaviors than girls. A developmental trend was noted in children 's ability to be aware of what mental illness is, to acknowledge characteristics of people who are mentally ill, to differentiate between mental illness and mental retardation, to identify various etiologies of mental illness, and to choose appropriate treatment modalities.

This paper takes another look at coping as a moderator of the stress—strain relationship by assessing the extent of correspondence between subjects' use of various coping behaviours and their perception of their helpfulness (coping effectiveness). The use of four coping strategies and the perception of their helpfulness, as well as the stress and psychological distress of 79 subjects whose spouses were hospitalized, were assessed by questionnaires. The results show that when applying coping effectiveness scores, problem-focused coping and avoidance coping moderate the stress—strain relationship. Coping use scales revealed that only positiveappraisal coping reduced psychological distress.

The purpose of this research was to document how children with hemophilia describe their experiences with pain in relation to their understanding of their unique illness and treatment experiences. Subjects were 20 children with hemophilia who were between the age of 6 years and 13 years and had no evidence of cognitive problems. Following the principles of grounded theory, data about children's experiences of hemophilia were obtained through a semi-structured interview using five pictorial stimuli representing illness and treatment domains. Data analysis was conducted using the constant comparative method. Findings indicated that pain experiences had a major role in children's perceptions of their illness and treatment experiences and in the meaning attached to these experiences.

Approximately two thirds of all children re- of conduct-problem chilldren typically lack certain ferred to mental health agencies are labeled con- fundamental parenting skills. For example, reports duct disordered or oppositional (IKazdin, 1985). have indicated that parents of aggressive: children Moreover, the prevalence of such disorders is in- exhibit fewer positive behaviors, are more violent creasing, creating a need for service that far ex- and critical in their discipline, are more permissive, ceeds available personnel and resources. Specific and often fail to monitor their children's behaviors diagnostic criteria have been developed: such chil- (Kazdin, 1985; Loebelr ik Dishion, 1983; Patterson dren typically exhibit antisocial behavior-that is & Stouthamer-Loeber, 1984). Consequently, parent lying, cheating, stealing, firesetting, fighting, oppo- training programs have been developed that focus sitional behaviors, and noncomplia~ice to parental on teaching parents to use specific reinforcement requests-at abnormal rates. The need to help fam- and nonviolent punishment skills (Forehand & ilies of conduct-problelm children is particularly ur- McMahon, 1981; Kazdin, 1985; Patterson, 1984). gent, for these aggressive children are at increased Reviews of such parent itraining programs based on risk for being abused by their parents (Reid, Ta- one-to-one therapy have g~enerally supported their plin, & Loeber, 1981), as well as for school drop- effectiveness (Kazdin, 1985). In a series of studies out, alcoholism, drug abuse, juvenile delinquency, (Webster-Stratton, 1981, 1984; Webster-Stratton, adult crime, antisocial personality, marital disrup- Hollinsworth, & Kolpacoflr, 1989) we have shown tion, interpersonal problems, and poor physical that therapist-led parenit group discussion training health (Kazdin, 1985; Loeber, 19185; Loeber & based on videotape modeling (GDVM) was both Dishion, 1983; Robins, 1981). Thus, in the absence cost-efficient and effective in improving parenting of treatment, the long-term outlook for conduct- attitudes and behaviors, and in reducing child conproblem children is poor. In response tab the large duct problems. Even an individually self-adminisnumbers of children with conduct problems and tered videotape parent traiining program (IVM) rethe shortage of professional manpower, there has sulted in significant improvements im parent been increasing emphasis on training parents to be reports and parent-cElld interactions ~(Webstertherapists for their own children. An additional, Stratton, in press; Webster-Stratton, Kolpacoff, & less circumstantial rationale for such an approach Hollinsworth, 1988). Irk spite of the documented is provided by research indicating tlhat the parents effectiveness of various types of parent training programs, the literature coi~tains little discussion of A more complete description of the parent training program the actual process of charnge brought about by such that was the subject of this research, includiing another paper intervention programs. h large body of research to describing the therapist role, is available from1 Carolyn Webster- date has been quantitative in nature, focusing on

The Nurse Stress Checklist was developed to measure stress in clinical nursing as a multidimensional construct. The instrument was formulated within a transactional model of stress. The items were derived from five domains thought to contribute to nurse stress in clinical settings and were organized into a questionnaire. Holmes Schedule of Recent Events was included as a validity measure. The instrument was tested on 104 staff nurses working in three institutions in an urban community. Exploratory factor analysis was applied to the 74 items presented to subjects in Likert-type format. Five factors were derived and subjected to psychometric evaluation. Internal consistency reliability for the five factors was good, ranging from 0.80 to 0.91. Means and measures of dispersion supported the potential of the five subscales to discriminate among respondents on the attributes being measured. Intercorrelations of the factors provided evidence of the distinctiveness of the five components of stress, although factor loadings showed some overlap between Personal Reactions and Work Concerns and Work Concerns and Work Completion Concerns. Validity of the factors also was supported by correlations with Holmes' Schedule of Recent Events. Content validity was supported by comparison of these results with findings of other investigators. Limitations of the results are discussed, and recommendations for future work on the instrument are offered.

Background Western Europe has been swept in the last three decades by ongoing reforms within the nurse education systems. Within the Western European region, Switzerland is one of the last countries initiating the integration of nursing programs into higher education institutions. Objectives This article examines the nurse education reforms recently enacted in Switzerland. The specific aims of the analysis were to: (a) examine modes of reform implementation and the current status of the Swiss nurse education system; (b) compare between two new Swiss nurse education models developed in the various linguistic regions. Method A documentary search for policy documents, reports and studies related to the implementation processes of reforms was conducted through websites of various legal institutions and the Swiss university library system. Findings The analysis indicated that although a fit between environmental pressures and the reform agenda exists, the implementation of the nursing reform varied considerably between the various Swiss linguistic regions. This variation resulted in two newly created models of nurse education programs revealing a high level of variability and inconsistency. As such, the development of a unified system of nurse education, which was set as the primary goal of the reformed system, was not achieved. Conclusions Overall, Switzerland is contributing to the widening heterogeneity rather than to the aspired homogeneity across Western European countries.

Many countries reorganizing their health services are drawn toward similar reform programs and tend to experience what seem to be similar problems relating to implementation outcomes. One such problem is the major crisis within the nursing profession relating to the labor market, working conditions and level of autonomy. This research examines the thesis that the profile of nursing problems is global (the 'convergence' thesis) by comparing the changing hospital contexts nursing has been confronting in 20 Western European countries between 1990 and 2001. The analysis indicates that in spite of growing convergence, the divergence in patient care processes, workforce composition and resources allocated for care is still rather remarkable and that similarity or divergence between countries changes over time. This contextual variability highlights why problems such as the crisis of the nursing profession must be analysed from a divergent rather than a convergent perspective.

Israeli nurses’ knowledge of health care reforms Objectives. This study examines health care reforms’ implementation processes from the perspective of nurses’ knowledge regarding the reforms. The research has been carried out in the Israeli context, where health care reforms were initiated in 1995. Three specific research questions were formulated: (a) What is the level of nurses’ knowledge regarding the recommendations of the Netanyahu committee? (b) What is the level of nurses’ knowledge concerning the basic principals of the National Insurance Law? and (c) Are there knowledge differences relating to employment setting (hospital, community, and educational settings), nurses’ roles (managerial vs. staff nurses), years of experience, and level and type of education? Method. The stratified nonproportional random sample consisted of a total of 468 nurses. Of these nurses, 206 were employed in community settings (136 in curative care, and 70 in preventive care), 137 were employed in hospital settings, and 125 worked in schools and departments of nursing. Research tools, developed for the purpose of this study, included the nurses’ knowledge questionnaire comprised of five subscales, and the knowledge relevancy questionnaire. Results. Overall, data demonstrated a low to moderate level of knowledge on all knowledge scales. Knowledge level on the criteria questions was particularly low. Contrary to the low level of knowledge, nurses regarded health care reforms’ knowledge as highly relevant to their work life. Curative setting, an extensive work experience, managerial position, and non-nursing academic degree were all positively related to higher levels of reforms’ knowledge. Conclusion. These findings should encourage both policy makers and managers in various health care organizations to develop programs for informing health care providers on central aspects of health care reforms considered most relevant to the practice setting.

Evaluation of an innovative curriculum: nursing education in the next century The present research focused on an interim evaluation of a new nursing curriculum made by first- and second-year undergraduates. Study 1 examined the assessments made by 90 students of the new, actual programme of their studies, as well as an ideal one, on 21 bipolar criteria reflecting the developing changes in health care practices and higher educational processes in western society. The results of study 1 indicated that students perceived the actual programme as compatible with health care changes, but lacking in terms of the learning process. Study 2 investigated the same assessments among 105 registered nurses who evaluated the traditional nursing programme under which they were trained as well as an ideal one. The results of study 2 showed that registered nurses perceived past curricula as lower than the ideal on both health care and process of learning. The results of this interim evaluation imply that the new nursing curriculum follows health care trends, but a shift in the educational process is required.

The effects of monitoring and blunting on individuals' choices of coping strategies and their effectiveness were examined. In addition, the authors explored the effect of the ability to achieve cognitive structure (AACS), defined as either or both of the following: (a) the ability to avoid information that either cannot be categorized or clashes with the individual's existing knowledge; (b) the ability to organize knowledge to fit an already existing cognitive structure. The results showed that in addition to the main effects of monitoring on problem-focused coping and social support seeking behaviors and of blunting on the use of wishful thinking, AACS was found to moderate blunting's influence on problem-focused coping as well as the effectiveness of distancing and avoidance coping. Finally, the results showed that the combination of high monitoring and high blunting sometimes contributes to coping effectiveness.

The transition into the information era is characterized by society's passage through three crossroads representing a change from: (a) technology to post-technology; (b) rigid jobs and hierarchies to dejobbing and vanishing hierarchies; and (c) limited competition to competition dominating all markets. These transitions have caused dramatic changes in the health care system at large and escalating problems that cannot be solved within the current paradigm of nursing. Among the nursing problems that were identified are those including difficulties in: (a) defining the relative contribution of nursing vis a vis other health professions; (b) the scope and dimensions of nursing authority; (c) implementing all aspects of the nursing intervention; (d) actualizing caring in nursing intervention; and (f) implementing the nursing process as a major thinking process in the profession. The analysis of the state of nursing suggests that the current clinical paradigm fails to consolidate the economic and quality issues into the core of nursing. It is not capable of solving central professional problems and emerging dilemmas. Considering that under the current paradigm, nursing has difficulties in highlighting to clients and the system alike where nursing can make a difference, it is questionable whether such a paradigm can ensure the existence of nursing in the future.

Neuropathic pain is often severe, persistent, and responds poorly to analgesic medications. Recent evidence suggests that N-methyl-D-aspartate (NMDA) receptor antagonists may be effective in the treatment of neuropathic pain. The present trial was designed to test the efficacy of acute administration of the NMDA receptor antagonist amantadine in relieving surgical neuropathic pain in patients with cancer. The study sample consisted of 15 cancer patients with the diagnosis of surgical neuropathic pain. Two 500 ml infusions of either 200 mg amantadine or placebo were administered over a 3 h period, in a randomized order, 1 week apart from each other. Spontaneous and evoked pain were measured for 48 h before treatment, during treatment, and for 48 h following treatment. An average pain reduction of 85% was recorded at the end of amantadine infusion vs. 45% following placebo administration. The difference in pain relief between the two treatments was statistically significant (P = 0.009). Mean pain intensity remained significantly lower during the 48 h following amantadine treatment as compared with the 48 h prior to treatment (31% reduction; P = 0.006), whereas no such effect was found with the placebo (6% reduction; P = 0.40). Amantadine, but not the placebo, also reduced 'wind up' like pain (caused by repeated pinpricking) in four patients. We conclude that amantadine infusion is a safe and effective acute treatment for surgical neuropathic pain in cancer patients. Further trials with long-term oral or parenteral amantadine treatment should be conducted.

The Resilience Scale (RS) was developed by Wagnild and Young (1993) to measure a personality characteristic or coping resource that facilitates adaptation. The RS, however, has not been evaluated with foreign-born populations. Therefore, the purpose of this study was to report the factor structure, internal consistency, and concurrent validity of a Russian language version of the RS in a sample of 450 recent former Soviet immigrants. The 25-item 2-factor solution obtained by Wagnild and Young (1993) was not supported by the Russian data. However, a modified 12-item Russian language version of the RS was, for the most part, reliable and valid: The standardized factor loadings and goodness of fit indices obtained from confirmatory factor analysis were acceptable, the internal consistency of one of the two subscales was very good, and the correlations between scores from the RS subscales and various measures of constructs that are theoretically linked with adaptation were in the expected direction and statistically significant.

Over the past two years, an innovative collaborative project in the care of Ethiopian Jews who immigrated to Israel has been carried out. In this project, both students and faculty joined in activities of research and practice through a clinic at a trailer court that houses 96 Ethiopian immigrant families. This project brought about several favorable changes: a) Health of the underprivileged and underserved was enhanced through bi-weekly services provided to the poor and sick trailer court inhabitants; b) An educational program for learning in a crosscultural community setting was developed. This curricula advanced recognition of the growing cultural and racial diversity of both individual and family lifestyles, as well as allowed for learning events that are based on substantive contact with, or participation by, persons at health risk; c) An educational milieu that fosters the use of research-based interventions was developed. This article describes the cross-cultural educational project which was designed as a pilot for a new baccalaureate program in nursing, and critiques it based on the criteria of the five major concepts- primacy of the teacher-student relationship, social responsibility, centrality of caring, interpretive stance and theoretical pluralism, proposed by the promoters of the "curriculum revolution."

What is qualitative research? Why should we do it? After all, isn’t quantitative research the only “legitimate” method of scientific research— objective, verifiable, and methodologically rigorous? Does qualitative research have scientific integrity? Is it reliable? Valid? Generalizable? Can it add anything new to the findings of quantitative research? Is it publishable? After all, haven’t psychology journals adhered almost exclusively to quantitative models of research? Why have they published so little qualitative research?

Previous research regarding knowledge about internal organs among school-age children tied this knowledge to the development of cognitive capabilities. Studies have rarely considered the impact of culture on this knowledge. The purpose of this study was to examine internal body perceptions among Ethiopian Jews who emigrated to Israel. A total of 65 children (stratified according to age) and 19 adults were interviewed. Findings indicated that Ethiopian children reported fewer body organs than did Western children. Further, Ethiopian children and adults, unlike peoplefrom Western societies, did notthinkabout the body in terms of different biophysical functions. Rather, they perceived the body as a holistic system in which a divine providence was responsible for body organs working together harmoniously. Implications of the differing perceptions about internal body organs, health, illness, and treatment are discussed.

This study examines social support effect on stress and adaptation through the mediating effect of control. Participants in the study were 12 male and 65 female rheumatoid arthritis patients who were being treated in the outpatient clinics of three large hospitals in Israel. Findings suggest that social support did have a significant effect on stress and adaptation, though this effect was through the mediating effect of control and not as a buffer as was suggested previously. Implications of the results for nursing science are discussed.

This research examined the behaviors children reported to be linked to their asthma flare-ups, the extent to which reported links were in the theoretically expected direction, explanatory models children gave for linkages they espoused, and the extent to which reporting a greater number of theoretically appropriate linkages was associated with a variety of asthma-related beliefs and behaviors. Most children reported that their behavior had an affect on their breathing and most often the reported impact was in theoretically expected directions (73%-100%). The ability of children to provide substantive explanatory models was more limited. Significant relationships were found between the child's number of theoretically appropriate affirmitive responses and several subsequent measures of asthma knowledge, extent of child's responsibility to implement daily asthma management by both parent and child report, child's self-efficacy rating on his or her ability to perform asthma self-management activities, and the child's report of frequency with which routine asthma management behaviors were performed.

The purposes of this study was to describe patterns characterizing appraisal processes of chronically ill and healthy school-age boys regarding illness and treatment situations. The specific aims were to describe (a) the domains representing the process of appraisal, (b) the relationships among the domains, and (c) the patterns of appraisal based on the interplay among the various domains. The sample included 18 healthy boys and 18 hemophilic boys. The two groups were matched on the basis of child's age and family socioeconomic level. A qualitative methodology was used to understand the ways in which boys appraise illness- and treatment-related stimuli. Findings showed that appraisal processes of school-age boys were comprised of four interacting domains: delineation of the context, fears related to the stimuli, the emotional response to the stimuli, and the final decision. The characteristics of these domains and the relationships among them resulted in two patterns of appraisal: amplification and minimization.

Gaining self-confidence as a nurse is an essential aspect of the nursing student's professional development. The purpose of this study was to determine clinical instruction behaviors that students perceived as important in promoting their self-confidence. One hundred thirty-nine baccalaureate students rated 16 clinical teaching behaviors as to the degree each helped or hindered their self-confidence as nurses. Factor analysis of these behaviors revealed five dimensions of clinical teaching that characterized the instructor as: resource, evaluator, encourager, promoter of patient care, and benevolent presence. Behaviors contributing to the dimensions of clinical instruction other than evaluation were rated by students as helpful in the development of their self confidence as nurses. Students' responses to open-ended questions provided further evidence of the importance of the nonevaluation dimensions. Focusing on evaluation to the exclusion of other aspects of clinical teaching may impede nursing students' professional development.