A descriptive study of the public image of the nurse
by Ellen Marie Leahy
A thesis submitted in partial fulfillment of the requirements for the degree of MASTER OF NURSING
Montana State University
© Copyright by Ellen Marie Leahy (1981)
Abstract:
The purpose of this study was to describe the public image of the nurse. The exploratory-descriptive
design of this study was based on three related concepts of image determination theorized by Leo W.
Simmons (Simmons 1964). These three concepts, social position, attributes and expectations, and
reference groups of the nurse were operationalized and offered as forced-choice items on a
questionnaire. The questionnaire was a tool developed by the researched.
Tool development was based on interviews using the operationalized concepts of Simmons. Content
analysis of interview data was used to formulate forced choice questions which were assembled into a
questionnaire. The sample consisted of 200 randomly chosen residents of Missoula County, Montana.
Findings indicated that the nurse was explicitly described by the public as "a cheerful woman in a white
uniform who assists the doctor." This description is supported by the findings implicit in the data that
indicate that the public perceived the nurse in relation to traditional and female sex-role stereotypes and
in a dichotomous and static manner. As the image of the nurse holds serious implications for the
profession of nursing, it was recommended in this study that the findings be utilized to generate further
research aimed at identifying the effects of the image. This study may also be utilized to provide an
impetus to change aspects of the image which are contrary to the image nurses wish to project. STATEMENT OF PERMISSION TO COPY
In p re s e n tin g t h i s th e s is in p a r t ia l f u l f i l l m e n t o f th e r e q u ir e ­
ments f o r an advanced degree a t Montana S ta te U n iv e r s it y , I agree t h a t
th e L ib r a r y s h a ll make i t f r e e ly a v a ila b le f o r in s p e c tio n .
I fu rth e r
agree t h a t p e rm is s io n f o r e x te n s iv e co p ying o f t h is th e s is f o r s c h o la r ly
purposes may be g ra n te d by my m ajor p ro fe s s o r o r , in h is absence, by
th e D ir e c to r o f L ib r a r ie s .
I t is understood t h a t any co p yin g o r p u b li­
c a tio n o f t h is th e s is f o r f in a n c ia l g ain s h a ll n o t be a llo w e d w ith o u t
my w r it t e n p e rm is s io n .
S ig n a tu re ;
A DESCRIPTIVE STUDY OF THE PUBLIC IMAGE OF THE NURSE
by
E lle n M arie Leahy
A th e s is s u b m itte d in p a r t ia l f u l f i l l m e n t
o f th e re q u ire m e n ts f o r th e degree
of
MASTER OF NURSING
Approved:
rson
GraduaW Committee
Head, M a jo r Departm ent
Graduate Dean
MONTANA STATE UNIVERSITY
Bozeman, Montana
May, 1981
iii
ACKNOWLEDGEMENTS
The a u th o r w ishes to express her a p p re c ia tio n t o :
D r. J a c q u e lin e T a y lo r , com m ittee c h a irp e rs o n , f o r her wisdom in
th e se m a tte rs .
- Ms. Karen S tin g e r and Ms. K a ri P e te rs o n , com m ittee members, f o r
t h e i r a s s is ta n c e , s u p p o rt and tim e .
D r. R andall Washburn and Dr. James T u rle y f o r t h e i r rescue from
th e com puter.
My f r ie n d s who lis te n e d and lis t e n e d .
My p a re n ts , Mr. Joseph Leahy and M rs. Ruth Leahy, f o r t h e i r s tro n g
and c o n s ta n t s u p p o rt.
TABLE QF CONTENTS
' Chapter
Page
V I T A ..........................................................................
ACKNOWLEDGEMENTS
ii
. ........................................................................................ i i i
TABLE OF CONTENTS.......................................................................................
iv
LIST OF T A B L E S ................................................................................................. v i i
1.
A B S TR A C T.........................................................................................................
i* .
O VER VIEW .........................................................................................................
I
I d e n t if ic a t io n and D iscu ssio n o f th e Problem ..................
I
PURPOSE
2
DEFINITION OF TERMS
......................................................................
2
.................................................................
3
.......................................................................................
4
SIGNIFICANCE OF STUDY
ASSUMPTIONS
2.
3.
REVIEW OF THE LIT E R A T U R E ........................................................
5
I n t r o d u c t i o n ..................................
.5
Review o f th e L it e r a t u r e
5
CONCEPTUAL FRAMEWORK
.............................................................
. . • ...............................
16
S u m m a ry ................................................................................................
20
4:
METHODOLOGY............................................................................................
21
5.
ANALYSIS AND INTERPRETATION OF FINDINGS .........................................
36
OVERVIEW...........................................................
36
SAMPLE
36
................................................................................................
V
C hapter
Page
•
DEMOGRAPHIC DATA . ...........................................................................
36
Age and S e x ...............................................................................
36
Income and O c c u p a t io n .....................................................\
37
R e l i g i o n .......................................................................................
39
R e s id e n c e ...................................................................................
39
Summary o f th e Demographic Data
...................................
40
...............................................................................
41
P ro fe s s io n a l i s m ......................................................................
41
Changes in L e ve ls o f Knowledge,
R e s p o n s ib ilit y and A u th o r ity .......................................
42
SOCIAL POSITION
S u p e rv is io n and L i a b i l i t y
•
................................................
.4 5
Sexual R e p u ta tio n .....................................................................
47
Compensation and E d u c a tio n a l Q u a lif ic a t io n s
. . .
T r u s t ..............................
ATTRIBUTES AND EXPECTATIONS
52
54
.....................................................
56
F u n c t io n s .............................................................................................56
S a t is f a c t io n
...............................................................................
T r a d itio n a l Female Sex-R ole E x p e c ta tio n s
..................
59
61
A t t r i b u t e s ................................... ■.................... * ..................... 64
Dichotom y o f th e I m a g e .............................................................. 66
M ental P i c t u r e ......................................................... .« . . .
67
vi
C hapter
Page
REFERENCE GROUPS . ..
Male and Female
6.
. ' ................................... ..............................'
..........................
68
69
A g e ..............................................................................
71
E x p o s u r e .......................................
71
COMPOSITE IM A G E .......................................
72
SUMMARY................................................................................................
76
DISCUSSION
....................................................
78
SUMMARY AND CONCLUSIONS...................... : ..................... - . . .
78
L IM IT A T IO N S .......................................................................................
80
IMPLICATIONS ANDRECOMMENDATIONS ..............................................
82
LIST OF REFERENCES...................................................................................
APPENDICES
88
LIST OF TABLES
T ab le
Page
1.
OCCUPATION ( n - 9 1 ) .........................................................................
38
2.
INCOME (n=91)
39
3.
Response to th e S ta te m e n t:
"NURSES HAVE MORE KNOWLEDGE THAN THEY DID TEN YEARS AGO"
(n=91)
......... ................................................... ■........................
4.
Response to the S ta te m e n t:
NURSES HAVE MORE RESPONSIBILITY THAN THEY DID TEN YEARS AGO
(n=91)
............................................................................................ .... . . .
43
Response to th e S ta te m e n t:
"NURSES HAVE MORE AUTHORITY THAN THEY DID TEN YEARS AGO"
(n=91)
.............................................................................................................
44
Response to th e S ta te m e n t:
NURSES SHOULD ALWAYS WORK UNDER THE SUPERVISION OF A DOCTOR"'
(n=91)
................................................................................... ' .......................
45
Response to th e S ta te m e n t:
"NURSES ARE CAPABLE OF WORKING INDEPENDENTLY IN HEALTH CARE"
(n=91)
........................................................................................................
46
Response to th e S ta te m e n t:
"FEMALE NURSES ARE GENERALLY MORE PROMISCUOUS THAN FEMALES
IN GENERAL" ( n = 9 1 ) ...................................................................................
48
Response to th e S ta te m e n t:
"MALES THAT ARE NURSES HAVE A TENDENCY TOWARD HOMOSEXUALITY"
(n=91)
........................................................................................................
48
5.
6.
7.
8.
9.
10.
Response to th e S tatem ent c o n ce rn in g a n u rs e 's OFF-DUTY h o u rs :
"A FEMALE NURSE NEEDS TO BE MORE CAREFUL ABOUT HER REPUTATION
THAN DOWOMEN INGENERAL" ( n = 9 1 ) ..........................................................
49
11.
V IS IB IL IT Y OF THE MEMBERSHIP OF THE NURSING PROFESSION (n=91)
50
v iii
Table
Page
12.
COMPENSATION (b=91) .............................................................................
.
52
13.
EDUCATIONAL CRITERIA (n=91) ..................................................................
53
14.
TRUST (n=91)
55
15.
MOST IMPORTANT FUNCTIONS (n = 9 l)
.........................................................
57
16.
MOST TIME-CONSUMING FUNCTION(n=91) . . . . : .............................
57
17.
MOST IMPORTANT IMPROVEMENTS (n = 9 1 ).
. . ........................................'
5g
18.
In Response to th e S tatem ent:
"NURSES SEEN ON TELEVISION SHOWS ARE VERY SIMILAR TO NURSES
IN REAL LIFE " (n = 9 1 )..................................
60
Response to th e S ta te m e n t:
"NURSES IN REAL LIFE ARE FAR MORE INTELLIGENT THAN THOSE
PORTRAYED ON TELEVISION (n=91)
60
Response to th e S tatem ent:
"NURSES SEEN ON TELEVISION SHOWS ARE MORE SEXUAL THAN THOSE
IN REAL LIFE"
(n=91)
61
Response to th e S tatem ent:
"WOMEN HAVE A KNACK FOR NURSING THAT MEN DO NOT HAVE" (N=91)
62
Response to th e S tatem ent:
" I PREFER TO HAVE A FEMALE NURSE RATHER THAN A MALE NURSE"
( n = 9 1 ) .............................................................................................................
63
23.
ASSESSMENT OF GENTLENESS (n=91) .........................................................
64
24.
ASSESSMENT OF WARMTH (n=91) ..................................................................
65
25.
Response to th e S ta te m e n t:
" I FEEL VERY SAFE UNDER A NURSE'S CARE" ( n - 9 1 ) ......................
65
Response to th e S tatem ent:
"NURSES BECOME HARDENED BY THE KINDS OF THINGS THEY SEE IN
THEIR WORK" (n=91)
,,
19.
20.
21.
' 22.
26.
ix
ABSTRACT
The purpose o f t h is s tu d y was to d e s c rib e the p u b lic image o f the
n u rs e . The e x p lo r a t o r y - d e s c r ip tiv e design o f t h is s tu d y was based
on th re e r e la te d concepts o f image d e te rm in a tio n th e o riz e d by Leo
W. Simmons (Simmons 1964). These th re e c o n c e p ts , s o c ia l p o s itio n ,
a t t r ib u t e s and e x p e c ta tio n s , and re fe re n c e groups o f th e nurse were
o p e r a tio n a liz e d and o ffe r e d as fo rc e d -c h o ic e item s on a q u e s tio n ­
n a ir e .
The q u e s tio n n a ire was a to o l developed by th e rese a rch e d .
Tool developm ent was based on in te r v ie w s u s in g th e o p e ra tio n a liz e d
concepts o f Simmons. C ontent a n a ly s is o f in te r v ie w d a ta was used
to fo rm u la te fo rc e d ch o ice q u e s tio n s w h ich were assembled in t o a
q u e s tio n n a ir e . The sample c o n s is te d o f 200 random ly chosen re s id e n ts
o f M isso u la C ounty, Montana.
F in d in g s in d ic a te d th a t th e nurse was
e x p l i c i t l y d e s c rib e d by th e p u b lic as "a c h e e rfu l woman in a w h ite
u n ifo rm who a s s is ts th e d o c to r ." T h is d e s c r ip tio n is s u p p o rte d by
th e f in d in g s i m p l i c i t in th e data t h a t in d ic a te t h a t th e p u b lic p e r­
ce iv e d th e nurse in r e la t io n to t r a d i t i o n a l and fem ale s e x - r o le
s te re o ty p e s and in a dichotom ous and s t a t i c manner. As th e image o f
th e nurse h o ld s s e rio u s im p lic a tio n s f o r th e p ro fe s s io n o f n u rs in g ,
i t was recommended in t h is s tu d y t h a t th e fin d in g s be u t i l i z e d to
ge n e ra te f u r t h e r re se a rch aimed a t id e n t if y in g th e e f f e c t s o f the
image. T h is s tu d y may a ls o be u t i l i z e d to p ro v id e an im petus .to
change a spe cts o f th e image which are c o n tr a ry to th e image nurses
w ish to p r o je c t.
CHAPTER ONE
OVERVIEW
I d e n t if ic a t io n and D iscu ssio n o f th e Problem
"The p u b lic 's o p in io n o f a p ro fe s s io n is o f g re a t im portance to
i t s m em bership"
(Simmons. 1 9 6 2 ),
The im pact o f t h is s ta te m e n t on
th e n u rs in g p ro fe s s io n cannot be r e a liz e d un le ss one responds to an
im p lie d charge o f th e s ta te m e n t; t h a t i s , to d e te rm in e th e p u b lic 's
o p in io n .
T h is re s e a rc h e r began to q u e s tio n w hether th e p u b lic had a
r e a lis tic
co n c e p tio n o f th e p ro fe s s io n o f n u rs in g .
T h is q u e s tio n
was r a is e d , in p a r t , by members o f th e p u b lic bombarding her w ith
e x c la m a tio n s such a s, "Y o u 're a nurse?
I co uld never be a n u r s e !" "
Each exclam ant u s u a lly fo llo w e d t h i s s ta te m e n t w ith a s in g u la r , y e t
s e e m in g ly , o m n is c ie n t r a tio n a le such as* " I c a n 't stand th e s ig h t o f
b lo o d ," o r " I t ' s
a woman's jo b , " o r " I f I were going to go in to m edi­
c in e a t a l l , I ' d j u s t go on to c o lle g e and become a d o c t o r ."
Such s ta te m e n ts , ta ke n by t h is re s e a rc h e r as cues to th e p u b lic '
image o f th e n u rs e , were in d ic a t iv e o f a narrowed and in a c c u ra te
image.
The w e ig h t o f an in a c c u ra te image is n o t to be d is c o u n te d ;
however, f o r an image is re a l to th o se who p e rc e iv e i t .
H erein l i e s
th e power o f th e image.
What typ e s o f l i m i t s co u ld such an image p la ce on th e n u rs in g
p ro fe s s io n ?
How g re a t a degree o f r o le d is c re p a n c y can r e s u lt ?
The
2
im p lic a tio n s o f th e answers to these q u e s tio n s are q u ite s e r io u s .
D r. C arol L indeman, in her re c e n t s tu d y f o r the Am erican Academy o f
N u rs in g , c it e d th e image o f th e nurse as th e n u rs in g p r o fe s s io n 's
most c r i t i c a l
is s u e
(Lindeman-
1 9 7 9 ).
In o rd e r f o r th e n u rs in g p ro fe s s io n to respond to t h is ch a rg e ,
it
is f i r s t necessary to de te rm in e th e n a tu re o f th e n u rs e 's image.
I f one assumes t h a t a s te re o ty p e e x is t s , th e q u e stio n , becomes,
w hich one?
Which nurse is v i s i b l e
to th e m in d 's eye o f th e p u b lic ;
th e angel in w h ite ,W o rld War I I n u rs e ,
th e soap operas?
o r , p a r a d o x ic a lly , th e nurse in
Does th e la d y w ith th e lam p, i f she e v e r d id , s t i l l
e x is t f o r th e p u b lic ?
Which image does p r e v a il?
power o f th e image does have p o te n tia l
o f n u rs in g , then i t
If,
in d e e d , the
in flu e n c e o ve r th e p ro fe s s io n
is e s s e n tia l t h a t th e e x is t in g image o f the
nurse be d e s c rib e d .
PURPOSE
The purpose o f t h i s s tu d y is to d e s c rib e th e p u b lic image o f th e
n u rse .
DEFINITION OF TERMS
D e scribe
- t o . re p re s e n t
th e o u t lin e o f
P u b lic
-
o r g iv e an account o f in w o rds; to tra c e
(W e bste r, 1970.)
th e people as a whole
(W ebster, 1970)
f o r purposes o f t h is s tu d y th e term 'p u b li c ' w i l l r e f e r
to and in c lu d e o n ly th o se persons c u r r e n t ly r e s id in g
3
w it h in th e g e o g ra p h ic a l bou ndarie s o f M isso u la C ounty,
Montana '
Image
-
a m ental co n c e p tio n h e ld in common by members o f a
group and sym b o lic o f b a s ic a t t it u d e s and o r ie n ta tio n
(W e bste r, 1970.)
a p ro fe s s io n a l s te re o ty p e (Simmons.
Nurse
-
1962.)
a p ro fe s s io n a l n u rs e , r e g is te r e d by th e Montana S ta te
Board o f N u rsing to p r a c tic e p r o fe s s io n a l n u rs in g
th e incum bent o r occupant o f th e image as d e fin e d by
. Simmons
SIGNIFICANCE OF STUDY
The fin d in g s o f t h i s s tu d y w i l l
c u r r e n t image o f n u rs in g .
p ro v id e a knowledge base f o r th e
T h is in fo r m a tio n , once d is s e m in a te d , can
be u s e fu l tow ard in c re a s in g th e a w a re n e ss.o f th e p ro fe s s io n a l nurse
to the l i g h t in which th e y are b e in g "p e rc e iv e d .
I t may f a c i l i t a t e
th e n u rs e 's a b i l i t y to a n t ic ip a t e and understand th e p u b lic 's r e s ­
ponse to th e n u rs e 's r o le .
Such a knowledge base can f u r t h e r respond to th e s ta te d p ro b ­
lem as i t
can c o n tr ib u te to th e c o n s tr u c tio n o f a to o l f o r use in
co m p a ra tive s tu d ie s co n ce rn in g n u rs in g r o le s .
Such a to o l would
p ro v id e th e n u rs in g p ro fe s s io n w ith a means to i d e n t i f y fa c to r s t h a t
need to be communicated to th e p u b lic in an a tte m p t tow ard r o le
r e c o n c ilia t io n .
"P u b lic
r e d e f in it io n o f th e n u rs in g image is o f
4
paramount im p o rta n ce f o r th e p r o fe s s io n 's grow th and scope o f p ra c ­
t ic e "
( B e le tz
1974 ) .
U ltim a te ly , th e knowledge r e s u lt in g from t h is s tu d y can be
employed in th e fo rm u la tio n o f p r e d ic t iv e p r in c ip le s f o r change by
r e ly in g on th e n u rs e 's image as th e ba ro m e te r.
"E x p e rt knowledge
on th e c u r r e n t im agery as r e la te d to n u rs in g and broad tre n d s in th e
s h ifts
in image concepts can be v e ry u s e fu l to le a d e rs in n u rs in g ,
e s p e c ia lly i f th e y w i l l
ta k e advantage o f t h is
in fo r m a tio n to a n t ic i
pa te changes and ada pt t h e i r programs to such image f lu c t u a t io n s " ■
(Simmons.
1964.)..
ASSUMPTIONS
The fo llo w in g assum ptions were b a s ic to th e p u r s u it o f t h is
s tu d y :
1.
The p u b lic does possess an image o f th e n u rse .
2.
The p u b lic image o f th e nurse has im pact on th e p r o fe s ­
s io n o f n u rs in g .
CHAPTER TWO
REVIEW OF THE LITERATURE
In tr o d u c tio n
There e x is ts a tremendous amount o f l i t e r a t u r e on th e n u rs e 's
s e l f im age, b u t th e re are few er s tu d ie s re g a rd in g th e c u r r e n t p u b lic
image o f th e nurse per se.
Recent s tu d ie s on th e t o p ic draw from a
few m a jo r s tu d ie s conducted d u rin g th e la t e 1940's and e a r ly 1 9 5 0 's .
T h is l i t e r a t u r e
is . in c lu d e d i n . t h i s
re v ie w .
Most c u r r e n t l i t e r a t u r e d iscu sse s th e n u rs e 's image in r e la t io n
to fem ale s te re o ty p in g and t r a d it io n a l v ie w p o in ts , c it e s th e s i g n i f i ­
cance o f the r e s u lt in g images to n u r s in g , and charges th e n u rs in g
p ro fe s s io n to ta k e a c tio n .
T h is l i t e r a t u r e
is v e ry s ig n if ic a n t as
i t responds to and is a p p lic a b le to th e c u r re n t s ta te o f n u rs in g .
For t h is re a so n , and w ith th e o b je c tiv e o f p ro v id in g o p e ra tio n a l
d e f in it io n s o f th e term s t h a t compose t h i s s tu d y , such l i t e r a t u r e
is a ls o d iscu sse d in th e fo llo w in g .
Review o f th e L it e r a t u r e
The p ro fe s s io n o f n u rs in g is changing
b u t th e image is n o t,
a c c o rd in g to th e r e s u lt s o f a re c e n t s tu d y conducted to determ ine
"how th e p u b lic sees n u rs in g "
( B e le tz . 1974).
The sample f o r t h is
s tu d y in c lu d e d o n ly in - h o s p it a l p a tie n ts and th e r e s u lt s are n o t
g e n e r a liz a b le .
The responses to open-ended q u e s tio n s such as "What
6
are t h e " f i r s t th o u g h ts and images t h a t come to mind when I m ention ■
th e word nu rse ? "
and "What do you see a nurse do?" c o n s is t ly "p r e ­
sented th e image o f a t e c h n ic a l, fu n c tio n a l d o e r."
In B e le t z 1s
a n a ly s is , th e com posite p ic tu r e pre se n te d was o f "fe m a le n u r t u r e r ,
m e d ic a to r, p h y s ic ia n 's a s s is ta n t, maid and a d m in is tr a to r " ( B e le tz
1974).
B e le t z 's im age, as d e s c rib e d in 1974, shows l i t t l e
th e image p re se n te d by B ir d w h is te ll in 1947.
v a ria n c e from
B ir d w h is te ll d e s c rib e d
th e nurse from th e th re e v ie w p o in ts o f u p p e r, m id d le and lo w e r s o c io ­
economic c la s s e s and found t h a t th e upper c la s s viewed th e nurse as
a " s k i l l e d m e n ia l, someone e ls e ' s m a id ."
Her jo b was viewed as an
"u n p le a s a n t" one, and th e a s s o c ia tiv e term chosen to r e f e r to her
was "c o u s in " o r "p o o r r e l a t i v e . "
The m id d le c la s s re garded th e nurse as someone who was "se m i­
s k i l l e d to s k i l l e d " and whose e d u c a tio n a l p re p a ra tio n was r e fe r r e d
to as " t r a i n i n g . "
An a s s o c ia tio n t e s t a d m in is te re d to t h is
produced th e term s "m other,, s i s t e r , a u n t, o r no r e l a t i v e . "
lo w e r c la s s viewed n u rs in g as "one o f th e n o b le s t o f a l l
group
The
p r o fe s s io n s ."
In an a s s o c ia tio n t e s t f o r t h is g roup , th e nurse was r e fe r r e d to
as a " te c h n ic a l e x p e rt"
( B ir d w h is t e ll 1947).
D e u ts c h e r's f in d in g s in 1955 are c o n s is te n t w ith B i r d w h i s t e ll's
as evidenced by h is s ta te m e n t, "As we move from h ig h e r to lo w e r
so cio -e co n o m ic groups th e e v a lu a tio n o f nurses becomes c o n s is te n tly
7
more f a v o r a b le ."
D e u ts c h e r's upper c la s s sample s ta te d t h a t the
nurse may "become c a llo u s e d , c y n ic a l, and c o a rs e ."
sample c o n tr a d ic te d t h i s e v a lu a tio n th ro u g h i t s
His lo w e r c la s s
s ta te m e n t t h a t "nurses
are k in d , th e y are s y m p a th e tic , and th e y are v e ry u n d e rs ta n d in g .
j u s t t h in k th e y are t o p s . "
I
The lo w e r c la s s group a ls o commented th a t
nurses are " c le a n , s a n ita r y and n e a t."
The f a c t t h a t p u b lic respondents are each members o f d i f f e r e n t
so cio -e co n o m ic c la s s e s may p a r t i a l l y acco u n t f o r th e dichotom ous
image o f th e nurse t h a t "A t one p o le is th e image o f a h u m a n ita ria n
and a l t r u i s t i c
in d i v i d u a l , more o r le s s com petent, and endowed w ith
sym pathy, com passion, and e x c e p tio n a l c a p a c ity f o r e s ta b lis h in g
r a p p o r t, one who g iv e s o f h e r s e lf.
A t th e o th e r p o le is th e image
o f a p r o fe s s io n a l, th o ro u g h ly t r a in e d , t e c h n ic a lly e f f i c i e n t and
co ol-h eade d e x p e rt who can be r e lie d upon f o r an a b le perform ance
w it h in her s p e c ia lt y , and r e l a t i v e l y in depe nden t o f e m o tio n a l compo­
n e n ts , one who a tte m p ts to keep h e r s e lf o u t o f her work (Simmons
1964).
A n o th e r fa c e t o f th e n u rs e 's image t h a t e x h ib it s a dichotom y is
t h a t c o n ce rn in g h e r sexual m o ra ls .
The men in D e u ts c h e r's m iddle
c la s s sample r e fe r r e d to nurses as "easy m a rk s ," y e t he s ta te d th a t
th e y seemed to have re s p e c t f o r th e m ."
w it h in a s in g u la r v ie w p o in t.
Here e x is ts a d is p a r it y
The women in the upper c la s s sample
d id " n o t re g a rd these women (n u rs e s ) as a t h r e a t " as any casual
a f f a i r " c o u ld n 't come to a n y th in g ."
T h is im p lie s p ro m is c u ity o f a
8
s i g n i f i c a n t degree.
The men in th e lo w e r c la s s sample th o u g h t t h a t
th e d o c to rs "p ro b a b ly had a l o t o f fu n w ith them ( n u r s e s ) " y e t a ls o .
s ta te d t h a t th e " g i r l s were 'lo o k e d a f t e r 1 by th e head n u rs e s ."
A lth o u g h a l l th re e c la s s e s r e fe r r e d to th e nurse w ith term s d e n o tin g
p r o m is c u ity , a l l
b u t th e upper c la s s p re se n te d a c o n tr a d ic tio n w ith in
t h e i r vie w .
The l i t e r a t u r e
suggests t h a t th e d is p a r it y c o n c e rn in g th e n u rs e 's
sexual m orals may have an h is t o r ic a l o r ig i n .
B e fo re N ig h tin g a le ,
"n u rse s were c o n s id e re d a drunke n, immoral l o t .
N ig h tin g a le , an
a r is t o c r a t h e r s e lf , tu rn e d nurses in t o re s p e c ta b le la d ie s "(C o re a 1977).
W ith N ig h tin g a le 's s tim u lu s , th e pendulum began i t s
s ite
d ir e c t io n b u t, i t
does n o t appear t h a t i t
swing in th e oppo­
stopped .m id p o in t.
The
a n g e lic , c e lib a te image o f th e nurse was p e rp e tra te d th ro u g h th e
n u rs in g e d u c a tio n l i t e r a t u r e o f th e ye a rs fo llo w in g N ig h tin g a le ,
The
c e lib a te image is i l l u s t r a t e d by sta te m e n ts found in a n u rs in g t e x t ,
c ir c a 1937, such a s,
"Two th in g s need to be remembered, man can l i v e
h a p p ily and s a t i s f a c t o r i l y in a s ta te o f c e lib a c y and, on th e o th e r hand,
a happy w e ll- c o n t r o lle d sex l i f e
liv in g .
makes fo r.p o w e r and contentm ent in
E xperience and o b s e rv a tio n teach t h a t th e sexual energy o f a
normal person can be d iv e r te d in t o o th e r channels and t h a t c h a s t it y
and c e lib a c y are c o m p a tib le , w ith happy, serene and p ro d u c tiv e l i v i n g "
(G ladw in 1937).
T h is t e x t a ls o c o n ta in s an essay to d is p u te a n u rs in g
s tu d e n t's s ta te m e n t t h a t "My p r iv a t e l i f e
is nobody's b u s in e s s ."
9
The e v o lu tio n o f
an
extrem e image did. n o t re p la c e th e o r ig in a l
im age, b u t m e re ly appeared as a c o u n te r-im a g e .
T h is p o la riz e d
image e x is t s to d a y in "com ic s t r i p s , n o ve ls and o th e r f i c t i o n , and
t e le v is io n
( t h a t ) tend to p o r tr a y th e nurse ( s t i l l
a v e ry sweet a n d /o r sexy young g i r l ,
fe m a le ) e it h e r as
p la y in g o b e d ie n t handmaiden to
th e d o c to r s , o r as a to u g h , s ta rc h e d o ld e r woman, e f f i c i e n t and
b ru s q u e "
(Young
1975), such as Nurse Hatched in Kesey1s One Flew
Over th e C uckoo's Nest
C u rre n t l i t e r a t u r e
( Kesey
1962).
s ta te s t h a t th e n u rs e 's image is f u r t h e r con­
t r iv e d beyond th e dichotom y o f "p ro m is c u o u s /c o ld " to f i t
th e d ic h o ­
tomous images o f " m o th e r ly /a lo o f, " e f f i c i e n t and h a r d , " and "dumb/
sw eet"
(Benton
1979).
Miss N ig h tin g a le had been assigned her own
p e rso n a l dichotom y by many in London who r e fe re d to her as "th e dove
o f mercy who had claw s o f ir o n "
(Elms & Moorehead
1977).
Simmons'
e v a lu a tio n f u r t h e r c o n firm s th e p o in t t h a t " In many s tu d ie s o f nurse
images c e r ta in themes predom inate and appear in c o m p a tib le o r even in
c o n f lict"(S im m ons 1962).
The p re ce d in g themes appear re p e a te d ly in re c e n t l i t e r a t u r e .
The predom inate theme o f c u r r e n t l i t e r a t u r e , however, speaks w ith a
s tro n g b ia s t h a t th e image o f th e n u rs e , i n - f a c t th e im pedim ent o f
th e n u rs in g p r o fe s s io n , is r e la te d to fem ale s e x - r o le s te re o ty p e s .
Peeples and F ra n c is (1968) s ta te t h a t one o f th e a t t it u d e s and
b e lie f s t h a t "te n d to r e ta r d th e f u l l
acceptance o f n u rs in g as. a
10
p ro fe s s io n " is t h a t n u rs in g has been, c h a ra c te riz e d as th e "work o f
fe m a le s ."
T h is b e l i e f h o ld s t h a t n u rs in g is fe m in in e in c h a ra c te r w h ile
m e d ic in e , d e n t is t r y , and pharmacy have a m a sculine c h a ra c te r.
T h is tends to enhance sex s e g re g a tio n w h ic h , in t u r n , l i k e o th e r
form s o f s e g re g a tio n , c re a te s b a r r ie r s to com m unication and
th e r e fo r e to th e u n d e rs ta n d in g and f u l l a p p re c ia tio n o f th e ■
problem s o f th e o u t-g ro u p .
The l i t e r a t u r e , w h eth er f e m in is t o r ie n te d o r n o t, is s a tu ra te d w ith
sta te m e n ts li n k i n g n u rs in g to th e t r a d i t i o n a l fem ale r o le s and
e x p e c ta tio n s o f n u rtu ra n c e , o b e d ie n ce , d ru d g e ry and dependence.
few examples w i l l
A
s u f f ic e :
"N u rs in g as i t s
v e ry t i t l e
s u g g e s ts , is a n u r tu r in g process and
th e m o th e rin g asp e ct o f n u rtu ra n c e is s t r o n g ly e n fo rc e d .
T h is is to
say t h a t o v e r a v e ry lo n g p e rio d o f n u r s in g 's h is t o r y , th e nurse has
been viewed as a s e lf le s s m o t h e r - s u b s t i t u t e ( Schoen 1 1 9 7 1 ).
Simmons c it e d a g e n e r a lly - h e ld vie w o f th e e a r ly 1900's t h a t "women
are by n a tu re le s s in d e p e n d e n t, le s s capable o f i n i t i a t i v e
and le s s
c r e a tiv e than are men and, f o r t h is re a so n , stand in need o f mascu­
l i n e gu id a n ce .
C o n se q u e n tly, modern n u rs in g g o t i t s
f ix e d in a s e x - lin k e d v o c a tio n "
(Simmons
s t a r t f ir m l y
1962;).
The p ro fe s s io n o f n u rs in g so c lo s e ly p a r a lle le d th e o c cu p a tio n
o f w ife and m other t h a t i t was g e n e r a lly th o u g h t unnecessary o r
in a p p r o p r ia te f o r a woman to f i l l
both r o le s .
T h is accounts f o r the
f a c t t h a t th ro u g h o u t th e h is t o r y o f modern n u rs in g , a b a t t le o f
o p in io n s on th e id e a l m a r ita l s ta tu s o f th e nurse has been ra g in g .
11
B ird w h is te H ' s m id d le c la s s sample im p lie d t h a t th e nurse is a
woman "who c a n 't g e t a husband o r who is a n e g le c tfu l w ife "
( B ir d w h is te H .
1947 )•
The lo w e r c la s s th o u g h t the p ro fe s s io n would
p u t th e nurse " in a p o s itio n in w hich she w i l l be a b le to make a
good m a rria g e . "
th is
The p o s t-w a r and c u r r e n t f i c t i o n
o fte n i d e n t if ie s
"good" m a rria g e as th e in e v it a b le m a rria g e to a d o c to r (R ic h te r,
1 9 7 4 ).
Upon achievem ent o f t h is g o a l, however, th e nurse was not
expected to work u n le ss she became bored and wanted to go o u t and
work a l i t t l e
(Lamb
1973 ),.
A cco rd in g to Corea, th e nurse was,
in f a c t , d is c rim in a te d a g a in s t once m a rrie d , as evidenced by th e man­
d a to ry r e s ig n a tio n o f newly-wedded U.S. Army and Navy n u rs e s , c ir c a
1945
(Corea.
1977 )..
The n u rs in g le a d e r . N ig h tin g a le h e r s e lf , when
faced w ith th e se em in gly m u tu a lly e x c lu s iv e choices o f m a rria g e o r
c a re e r, chose c a re e r.
The fem ale a t t r ib u t e s thus f a r d e s c rib e d , i f
n o t p ra c tic e d in m a rria g e , were d i r e c t l y a p p lic a b le to n u r s in g , y e t
i t was co n sid e re d in c o m p a tib le to p r a c tic e b o th .
Corea speaks o u t th e lo u d e s t in lin k in g th e fem ale s e x -ro le
s te re o ty p e to n u rs in g :
"S e rv in g and n u r tu r in g were th e r o le s o f a l l
women so n u rs in g was fe m in in e "
(Corea
1 9 7 7 )-
Corea i d e n t if ie d
th e V ic to r ia n im pact o f th e N ig h tin g a le era on n u rs in g .
Statem ents
from th e c o n te x t o f N ig h tin g a le 's t e x ts are c ite d th ro u g h o u t C orea's
essay.
Not o n ly is i t
s tr o n g ly suggested t h a t N ig h tin g a le 's p h ilo s o ­
ph ie s are re s p o n s ib le f o r much o f to d a y 's im age, b u t Corea a ls o accused
th e n u rs in g le a d e r o f n o t w a n tin g nurses to govern th e m se lve s,
if
12
N ig h tin g a le d id indeed h o ld such a p h ilo s o p h y , th e im p lic a tio n s may
be v i s i b l e to d a y as th e y may a cco u n t f o r th e c u r r e n t autonomy
d e f ic i e n t image o f th e n u rse .
A n o th e r a u th o r r e fe rre d v e rb a tim to N ig h tin g a le 's
" r ig id "
re q u ire m e n ts f o r a nurse in an e f f o r t to p ro v id e an e x p la n a tio n , n o t
a cause, f o r th e c u r r e n t s ta te o f th e n u rs in g image'
(Benton
1 9 7 9 ).
The in t e r p r e t a t io n o f N ig h tin g a le 's p h ilo s o p h ie s and t h e i r im pact
on n u rs in g is spoken to in th e m a jo r it y o f c u r r e n t l i t e r a t u r e
con­
c e rn in g th e image o f n u rs in g as r e la te d to fem ale s e x - r o le s te re o ­
ty p e s .
Two m a jo r sch o o ls o f th o u g h t e x is t in th e l i t e r a t u r e
in g th e N ig h tin g a le f a c t o r .
co n ce rn ­
One blames th e n u rs in g le a d e r f o r her
r i g i d d e f in it io n s and e x p e c ta tio n s , th e o th e r in t e r p r e t s N ig h tin g a le 's
stand as a nece ssary extrem e o f th e tim e s .
Proponents o f e it h e r
in t e r p r e t a t io n , how ever, agree t h a t remnants o f th e p h ilo s o p h ie s o f
th e N ig h tin g a le era e x is t and a c c o u n t, a t le a s t in p a r t , f o r th e c u r ­
r e n t image o f th e n u rs e .
As evidenced by t h i s re v ie w th u s f a r , one o f th e m ajor themes
o f th e c u r r e n t l i t e r a t u r e
onal
r e la te s th e image o f th e nurse to
and fem ale s e x - r o le s te re o ty p e s .
emphasis
e x is t
th ro u g h o u t
th e
t r a d it i­
Two o th e r m a jo r p o in ts o f
lite r a tu r e .-
The f i r s t speaks to
th e s ig n if ic a n c e o f th e c u r re n t image to n u r s in g .
The f i n a l p o in t
r e s u lt s from a d is c u s s io n o f th e s ig n if ic a n c e o f th e image and is a
s tro n g charge to change th e image.
13
R egardless o f th e main fa c to r s c it e d in d e te rm in in g th e image
o f th e n u rs e , th e m a jo r it y . o f th e l i t e r a t u r e judged th e c u r re n t
im agery to be a h in d ra n ce to th e p ro g re s s io n o f n u rs in g .
a r tic le
A re c e n t
in a h e a lth care jo u rn a l c it e s th e image o f th e nurse as
one o f th e th re e m a jo r issu e s u n d e rly in g th e c h ro n ic nurse shortage,.
( P e rs o n e tt; 1980.) .
P e rs o n e tt s ta te d t h a t th e t r a d it io n a l
image o f
th e nurse "as a handmaiden to th e p h y s ic ia n is outmoded and i l l e g a l "
to d a y , th e re b y im p ly in g th e developm ent o f a r o le d is c re p a n c y .
Corea, in s u p p o rt f o r her argument a g a in s t th e t r a d it io n a l d o c to r nurse r e la t io n s h ip r e s u lt in g from th e n u rs e 's image, a ls o commented
on th e le g a l l i a b i l i t i e s
o f such a r e la t io n s h ip .
" I n e v e ry s ta te in
th e c o u n tr y , a nurse is le g a l ly l i a b l e f o r her a c tio n s even i f she
is fo llo w in g a d o c t o r 's o r d e r ."
Elms and Moorehead (1 9 7 7 ), in o u t lin in g the dangers o f s te re o ty p e s
•'to n u rs in g ,
q u e s tio n e d
w hether th e p u b lic and p ro s p e c tiv e nurses
can be in fo rm e d t h a t th e re " is more to n u rs in g than w ip in g th e p e rs ­
p ir a t io n from th e d o c to r 's -forehead.whiTe he proceeds w ith th e s u r g e r y . "
T h e ir essay in c lu d e d an o p e ra tio n a l d e f i n i t i o n o f s te re o ty p in g :
Why w o rry about s te re o ty p in g ? Because s te re o ty p e s are harm­
fu l.
U n fo r tu n a te ly , th e harm engendered by s te re o ty p e s is n o t
d i r e c t o r im m ediate and cannot be e a s ily p in p o in te d , b u t i t does
e x is t.
What s te re o ty p in g does is c a tc h people up in t h e i r own
m yth o lo g y. They begin to b e lie v e th e s te re o ty p e and n o t see the
r e a lity .
T h e ir e x p e c ta tio n s and e x p la n a tio n s no lo n g e r r e la t e
to what is r e a l l y happening in th e w o rld , b u t to what th e y
b e lie v e is happening based on th e m ythology p o rtra y e d in the
s te re o ty p e . What you are a ble to accom plish is based, in p a r t ,
on what people t h in k you can do.
14
The p re s e n t day s te re o ty p e is d e trim e n ta l to th e image o f
nurses and h in d e rs th e s e rio u s e f f o r t s in n u rs in g to improve
h e a lth care d e liv e r y .
Benton (1 9 7 9 )b ro u g h t o u t th e im p o rta n t c o n s id e ra tio n th a t
"image o f n u rs in g issu e s are in t im a t e ly r e la te d to th e re c ru itm e n t
and r e te n tio n o f q u a lif ie d c a n d id a te s and, t h e r e fo r e , th e ve ry
f u tu r e o f n u r s in g . "
In a DHEW s tu d y on th e n u rs in g p ro fe s s io n as a
c a re e r as p e rc e iv e d by h ig h school s e n io r s , th e most common reasons
f o r r e je c t in g n u rs in g as a c a re e r w ere: "squeam ishness" on th e p a r t
o f th e fem ales su rve ye d .
The males reasoned t h a t n u rs in g was a
" fe m a le - r e la te d " c a re e r
( Rudov
1976)•
In emphasis on th e s ig n if ic a n c e o f th e n u rs e 's image to th e
p r o fe s s io n , one a u th o r s ta te d t h a t th e l i m i t s o f n u r s in g 's expand­
in g p r a c tic e w i l l
be s tr o n g ly in flu e n c e d by th e o p in io n s and expec­
t a t io n s o f th e p u b lic .
te d
th a t
( B e le tz z 1974).
in co n g ru e n cy in images and, s u b s e q u e n tly , in r o le s , w i l l
p ro v id e an im petus f o r change.
handmaiden"
The l i t e r a t u r e f u r t h e r sugges­
( Tim e. 1979)•
"N urses are no lo n g e r c o n te n t to be th e
The f i n a l and most em phatic theme con­
s is t e n t th ro u g h o u t th e l i t e r a t u r e
is a charge f o r change.
The -
charge f o r change is b e s t summarized and id e n t if ie d by one a u th o r 's .
s u c c in c t s ta te m e n t:
p e c ta b le s e lf-im a g e "
"To s u r v iv e , th e nurse must e s t a b lis h a r e s ­
( P e rso n e tt,. 1980).
15
Summary
Discussed in t h i s
re v ie w were p e r t in e n t r e s u lt s o f m a jo r s tu d ie s
o f nurses conducted d u rin g th e p a s t t h i r t y y e a rs .
o u t lin e s a t r a d i t i o n a l
lite r a t u r e ,
The d is c u s s io n
image o f th e n u rs e , t h a t when compared t o re c e n t
is q u ite s im ila r t o th e image d e s c rib e d to d a y .
The m a jo r
p o r tio n o f th e re v ie w d iscu sse d re c e n t l i t e r a t u r e w h ich p re se n te d con­
s is t e n t themes r e la t in g th e n u rs e 's image t o t r a d i t i o n a l and fem ale
s e x - r o le s te re o ty p e s .
The l i t e r a t u r e a ls o d e s c rib e d th e c u r r e n t image
o f th e nurse in" a dichotom ous and s t a t i c manner.
The l i t e r a t u r e
e m p h a tic a lly charged th e n u rs in g p ro fe s s io n to change th e image as i t
was ju d g e d t o be an im pedim ent to th e p ro fe s s io n .
CHAPTER THREE
CONCEPTUAL FRAMEWORK
The co n ce p tu a l fram ew ork o f t h is s tu d y was d e riv e d from th e th e o ry
o f Leo W. Simmons re g a rd in g images o f th e n u rs e .
A predom inant theme
o f Simmons' th e o ry is t h a t images "o p e ra te as fo rc e s in th e s o c ia l
m ilie u to prom ote o r impede p ro g re ss in an o c c u p a tio n
1964 ) .
(Simmons
D e f in it io n o f th e term s o p e ra tin g in Simmons' th e o ry t h a t a p p ly
to t h is s tu d y precede p re s e n ta tio n o f th e th e o ry .
" fo c a l p o s it io n "
- th e p o s itio n o f s tu d y , as is o la te d from th e
m u lt ip le p o s itio n s one person o c c u p ie s .
In t h is
s tu d y , th e nurse is th e fo c a l p o s itio n o f th e s tu d y .
" s i g n i f i c a n t re fe re n c e g ro u p s"
-
groups o f people "a s s o c ia te d
around th e in d iv id u a l occup ying th e fo c a l p o s itio n ,
. .
s in g le d o u t f o r . . . ( th e ) s p e c ia l re le v a n c e to th e
( f o c a l ) p o s it io n . "
In t h is
s tu d y , groups o f people t h a t may h old a d i f f e r e n t percep­
t io n o f th e nurse than t h a t o f th e gen eral p u b lic are id e n t i f i e d ,
" image c o n s tr u c ts "
-
"fo lk - d e te r m in e d arid u n iv e r s a lly p re v a le n t
a p p ra is a ls o f s p e c ifie d c a te g o rie s o f p e o p le ."
T h is s tu d y d e te rm in e s th e image c o n s tr u c t o f th e n u rs e .
For p u r­
poses o f t h is s tu d y th e image c o n s tru c t is r e fe r r e d to as th e image o f
th e n u rse .
17
" r e a lis tic
image"
a lly
-
"th e . . . image (th e incum bent as he a c tu ­
is ) as conceived by e it h e r " th e re fe re n c e groups
o r th e incum bent.
By t h i s d e f i n i t i o n , th e p u b lic 's p e rc e p tio n o f th e nurse c o n s titu te s
a r e a lis tic
image o f th e n u rse .
T h is s tu d y d e a ls w ith th e nurse as p e r­
ce ive d by th e p u b lic , n o t th e nurse as i t
is p e rc e iv e d th e nurse should
be, nor th e nurse as p e rc e iv e d by th e nurse..
(Simmons
196 4).
In accordance w ith Simmons' te rm s , t h is s tu d y d e s c rib e s th e r e a l i s ­
t ic
image o f th e fo c a l p o s itio n o f nurse as p e rce ive d by th e p u b lic and
s ig n if ic a n t re fe re n c e group s.
I t is im p o rta n t to note t h a t th e charac^
t e r i s t i c s o f th e " r e a l i s t i c " image may n o t e x is t in r e a l i t y b u t are p e r­
ce ive d to e x is t and th e re b y are v a lid in term s o f th e " in flu e n c e t h a t
(th e y ) e x e r t on b e h a v io r"
(Simmons. 1964)•
P e r tin e n t to t h is stu d y is th e im p o rta n t p o in t t h a t " v a r ia b le
images" o f th e fo c a l p o s itio n are " r e f le c t e d by d i f f e r e n t re fe re n c e
g ro u p s ."
A d is c r im in a t in g vie w o f a fo c a l p o s it io n , th e r e fo r e , is
dependent upon a s tu d y t h a t re co g n ize s th e m a jo r re fe re n c e groups.
From t h i s ,
"a com posite image" o f th e occupant o f th e fo c a l p o s itio n
can be drawn'.'
(Simmons; 1964).
The elem ents o f Simmons' th e o ry c o n s is ts o f s ix
r e la te d
co n ce p ts:
1.
The id e n t i f i a b l e and d e fin a b le s o c ia l p o s itio n s o f an incum­
b e n t w it h in a s p e c ifie d o c c u p a tio n a l c a te g o ry .
2.
The re c o g n iz e d re fe re n c e groups o r p u b lic s c le a r l y a s s o c ia te d
w ith th e above s p e c ifie d p o s i t i o n .
18
3.
The r o le images o r c o n c e p ts , c o n s is tin g o f a t t r ib u t e s acorded
to and e x p e c ta tio n s h e ld tow ard occupants o f such p o s itio n s
by th e p e r t in e n t ly r e la te d re fe re n c e groups.
4 ..
The id e n t i f i a b l e d is c re p a n c ie s t h a t e x is t between th e a c tu a l
b e h a v io r o r s e rv ic e s o f th e occupant o f a v o c a tio n a l r o le p o s i­
t io n and th e e x p e c ta tio n s o f such b e h a v io r by members o f the
re fe re n c e . groups on th e one hand o r by th e incum bent on th e
•
o th e r hand.
5.
The s tre s s e s ( c o n f lic t u a l and o th e rw is e ) t h a t are experienced
by th e ro le -im a g e d p r a c t it io n e r s as a consequence o f th e
re co g n ize d d is c re p a n c ie s between e x p e c ta tio n s f o r perform ance
and th e a c tu a l b e h a v io r and
6.
The coping p a tte rn s a c q u ire d by ro le -im a g e d p r a c t it io n e r s in
coming to term s w ith o r making a d a p ta tio n s to th e above s t r e s ­
ses.
(Simmons, 1964.)
The con ce p tu a l fram ew ork o f t h is s tu d y is based on th e concepts o f
s o c ia l p o s it io n , re fe re n c e g ro u p s, and a t t r ib u t e s and e x p e c ta tio n s as
d e s c rib e d by Simmons.
The e x p lo r a to r y d e sig n o f t h is s tu d y does n o t
accommodate Simmons' concepts o f d is c re p a n c ie s , s tre s s e s , and coping
p a tte r n s , as th e se elem ents are b e s t de te rm in e d th ro u g h co m parative and
h y p o th e tic a l s tu d ie s .
The s o c ia l p o s itio n o f an o c c u p a tio n is
i d e n t if ia b le by sym bols.
"The more p r o fe s s io n a liz e d an o c c u p a tio n becomes, th e more d i s t i n c t i v e
appear i t s
id e n t if y in g symbols and tra d e m a rk s . "
A p o in t t h a t in te r e s t s
t h i s a u th o r is t h a t symbols can be " im p r in te d so in d e l ib l y
th e p ro fe s s io n shows t h r o u g h , , .
. . . th a t
. . even when in d iv id u a ls n o t on d u ty
a t th e tim e m ig h t p r e f e r to rem ain o c c u p a tio n a lly anonymous."
s ta te m e n t is b e s t e x e m p lifie d by d e s c r ib in g a s it u a t io n
T h is
in which a mem­
ber o f th e p u b lic , upon h e a rin g t h a t person he is speaking w ith is a
19
n u rs e , may sa y, " I thought you looked l i k e
a nurse."
The conce pt o f re fe re n c e groups as d e te rm in a n ts o f th e image is
e x tre m e ly s ig n if ic a n t to t h is s tu d y as i t
is th e "p o p u la r a p p r a is a l"
o f th e se groups t h a t " in flu e n c e th e g en eral acceptance o r r e je c t io n "
o f th e n u rs in g p r o fe s s io n 's c a p a b ilit ie s
(simmons 1964, p . 168).
In t h i s
s tu d y , re fe re n c e groups are those groups o f people t h a t have been
id e n t if ie d to h o ld a s i g n i f i c a n t l y d i f f e r e n t p e rc e p tio n o f th e nurse
than th e gen eral p u b lic .
The e x is te n c e o f a com posite image o f th e nurse is a d e te rm in in g
f a c t o r o f th e " a t t r ib u t e s accorded t o , and e x p e c ta tio n s h e ld to w a rd "
each nurse by th e p u b lic .
The re v ie w o f th e l i t e r a t u r e c it e d many
e x p e c ta tio n s and a t t r ib u t e s t h a t th e p u b lic holds f o r th e n u rse .
exam ple, i t may be t h a t the. p u b lic does h o ld e x p e c ta tio n s
t h a t are d e riv e d from a t r a d it io n a l
image o f the n u rs e .
of
For
the nurse
T h is is im por­
t a n t to th e nurse as a com posite image based on t r a d it io n s
is
"s u r- ■
p r is i n g l y tough and d u ra b le and (may) o u t la s t any r e a l i t i e s on which
( it )
may have been based." As th e conce pt o f a t t r ib u t e s and e x p e c ta tio n s
is im p o rta n t in d e te rm in in g an image, t h is s tu d y e x p lo re s th e p u b lic
to i d e n t i f y any a t t r ib u t e s and e x p e c ta tio n s th e p u b lic h o ld s f o r th e
nurse (Simmons 1964,..p. 169).
T h is
s tu d y
was
s tru c tu r e d by and
responded d i r e c t l y to th e
in t e r r e la t e d concepts o f s o c ia l p o s it io n , re fe re n c e groups and a t t r i ­
butes and e x p e c ta tio n s as d e te rm in a n ts Of th e n u rs e 's im age.
C onclu­
s iv e id e n t i f i c a t i o n o f r e s u lt in g r o le d is c re p a n c ie s , s tre s s e s , and
_
20
coping p a tte rn s o f th e nurse is beyond th e scope o f t h is s tu d y .
Summary
The co n ce p tu a l fra m e w o rk -s u p p o rtin g t h is stu d y is d e riv e d on th e o ry
o f nurse im agery p o s tu la te d by Simmons
(Simmons. 1 9 6 4 The th e o ry
o u t lin e s r e la te d elem ents o f v o c a tio n a l image th e o ry and s u p p lie s o p e r­
a tio n a l d e f in it io n s o f th e te rm s .
The concepts d i r e c t l y p e r tin e n t to
t h is s tu d y in c lu d e th e id e n t i f i c a t i o n o f s o c ia l p o s it io n s , th e re co g ­
n i t i o n o f v a rio u s re fe re n c e g ro u p s, th e im p lie d a t t r ib u t e s and expec­
t a t io n s o f th e n u rs e 's im age, and th e assum ption t h a t th e p e rce ive d
image is v a lid in term s o f th e in flu e n c e i t e x e rts on th e n u rs in g p ro ­
fe s s io n .
CHAPTER FOUR
METHODOLOGY
OVERVIEW
P resented in t h is c h a p te r are th e methods by which th e problem o f
d e s c r ib in g th e p u b lic image o f the nurse were o p e r a tio n a liz e d .
The
re se a rch d e s ig n , developm ent o f th e re se a rch t o o l, sample and s e t t in g ,
da ta c o lle c t io n m ethods, and data a n a ly s is methods are d is c u s s e d .
RESEARCH DESIGN
T h is s tu d y is e x p lo r a t o r y - d e s c r ip tiv e in d e s ig n .
The design o f t h is
s tu d y employs o n ly e x p lo r a to r y methods in response to Simmons' concepts
o f s o c ia l p o s it io n , re fe re n c e group s, and a t t r ib u t e s and e x p e c ta tio n s as
image d e te rm in a n ts .
(Simmons
1964.)... These concepts are o p e ra tio n a liz e d
and s ta te d as q u e s tio n s w hich were pre se n te d in an e x p lo r a to r y su rv e y .
For purposes o f t h is s tu d y , these th re e afo re m e n tio n e d components o f
Simmons' th e o ry w i l l be r e fe r r e d to as "im age d e te rm in a n t com ponents."
The design o f t h is s tu d y does n o t accommodate those components o f
Simmons' th e o ry t h a t are o p e ra tio n a l o n ly thro ugh com p a ra tive measures
between th e n u rs e 's p u b lic image and th e n u rs e 's s e lf-im a g e .
The re se a rch design c a lls f o r a re s e a rc h to o l t h a t can be u t i l i z e d
to e x p lo re th e th re e image d e te rm in a n t com ponents.
n o t p ro v id e such a t o o l.
Simmons' work does
For t h is re a so n , th e m ethodology o f t h is stu d y
in c lu d e s both th e developm ent and u t i l i z a t i o n
o f the re se a rch t o o l.
22
PROTECTION OF HUMAN RIGHTS
The human r ig h t s re q u ire m e n ts o f Montana S ta te U n iv e r s it y were m et.
In te rv ie w e e s were in fo rm e d th ro u g h an in tr o d u c to r y l e t t e r (Appendix A)
and q u e s tio n n a ire r e c ip ie n t s were in fo rm e d th ro u g h a co v e r l e t t e r
(Appendix C) t h a t p a r t ic ip a t io n was v o l u n t a r y c o n f i d e n t i a l i t y would be
m a in ta in e d , i d e n t i t i e s would n o t be re v e a le d , and t h a t t h e i r d e c is io n
re g a rd in g p a r t ic ip a t io n would have no b e a rin g on any f u tu r e p ro fe s s io n a l
r e la t io n s h ip w ith th e re s e a rc h e r.
P e rm ission was re q u e ste d and g ranted
by th e managers o f th e business e s ta b lis h m e n ts a t w hich in te r v ie w s were
conducted.
SETTING
The s e t t in g f o r t h is s tu d y was M isso u la C ounty, Montana which is a
w estern co u n ty in Montana.
As d e fin e d in t h is s tu d y , w e ste rn Montana
in c lu d e s th e area w est o f th e c o n tin e n ta l d iv id e to th e w e ste rn boun­
d a ry o f th e s ta te o f Montana.
c it y
The c i t y o f M is s o u la , w hich is th e la r g e s t
in w e stern M o n ta n a ,is a lm o st c e n t r a lly lo c a te d w it h in M issoula
C ounty.
The c i t y o f M isso u la is th e home o f th e U n iv e r s it y o f Montana
and a ls o has many sm all com mercial business e s ta b lis h m e n ts and produc­
t io n m ill s o f th e wood p ro d u c ts in d u s tr y .
s u rro u n d in g
. th e
c it y
The rem ainder o f th e county
■ o f M isso u la c o n s is ts o f ra n c h !ands, fo r e s tla n d s ,
r e c r e a tio n a l a re a s , and sm all tow ns.
The p o p u la tio n o f th e c i t y o f
M isso u la is 33,000 and th e p o p u la tio n o f th e county o f M is s o u la is 75,400
(C ounty C le r k 's O f f ic e , M is s o u la , Montana, May 6 , 1981.)
23
DEVELOPMENT OF THE RESEARCH TOOL
The q u e s tio n n a ire method o f data c o lle c t io n was chosen by the
re s e a r c h e r •because o f th e ease in a d m in is tr a tio n and a n a ly s is and the
a c c e s s i b i lit y to th e sample t h a t is p ro v id e d .
In o rd e r to decrease the
in tr o d u c tio n o f b ia s in the developm ent o f a q u e s tio n n a ir e , a p r e lim i­
n a ry p h a s e 'o f d a ta c o lle c t io n was u n d e rta ke n .
The purpose o f the p re ­
lim in a r y phase o f data c o lle c t io n was to e x p lo re the p u b lic f o r common
o p in io n s and te rm in o lo g y used by th e p u b lic in r e la t io n to th e n u rs e 's
image.
The a n a ly s is o f the data c o lle c te d in t h is p r e lim in a r y phase was
used in th e developm ent o f th e q u e s tio n n a ire th e re b y c o n t r ib u tin g face
v a l i d i t y to th e te rm in o lo g y and c o n te n t o f th e q u e s tio n n a ir e .
T h is
phase o f d a ta c o lle c t io n is more f u l l y e x p la in e d in th e fo llo w in g d is c u s
s io n o f th e methods by w hich th e p r e lim in a r y da ta were c o lle c te d and th e
manner in w hich th e data were used in th e developm ent o f th e q u e s tio n ­
n a ir e .
The P r e lim in a ry Phase o f Data C o lle c tio n :
The In te rv ie w s
The method o f in te r v ie w in g was employed d u rin g th e p r e lim in a r y phase
o f d a ta c o lle c t io n .
The in te r v ie w schedule was designed to id e n t if y com
mon te rm in o lo g y and o p in io n s o ffe r e d by members o f th e p u b lic in p ro ­
v id in g a d e s c r ip tio n o f th e n u rs e .
The in te r v ie w schedule (Appendix B)
was based on th e th re e image d e te rm in a n t components o f s o c ia l p o s it io n ,
re fe re n c e g ro u p s , and a t t r ib u t e s and e x p e c ta tio n s .
24
The image d e te rm in a n t component o f re fe re n c e group s, as d e s crib e d
by Simmons, c a l l s f o r th e r e s e a rc h e r t o d i f f e r e n t i a t e among th e p u b lic
those groups t h a t may h o ld a d i f f e r e n t p e r s p e c tiv e o f th e nurse
(Simmons
1 96 4)i
This component was e x p lo re d p r i m a r i l y through the
c o l l e c t i o n o f demographic data and a ls o by i d e n t i f y i n g those i n t e r v i e w ­
ees who had v a r y in g degrees o f exposure t o nurses e i t h e r as k in o r as
r e c i p i e n t s o f n u r s in g c a re .
The image d e te rm in a n t component o f s o c ia l p o s i t i o n r e f e r s to the
symbols th e p u b li c may a s s o c ia te w i t h th e nurse and th e p u b li c assigned
rank o f the n u rse .
T h is component was e x p lo re d through open-ended ques­
t i o n s designed t o e l i c i t o p in io n s o f th e nurse in regards t o symbols,
pay, e d u c a tio n , p r o f e s s io n a lis m , sexual r e p u t a t i o n ,
p o n s i b i l i t y and a u t h o r i t y .
independence, r e s ­
The q u e s tio n , "What do you t h i n k about the
e d u c a tio n a nurse must go th ro u g h ? "
p ro v id e s an example o f th e type
and s t r u c t u r e o f th e q u e s tio n s in t h i s c a te g o r y .
Due t o th e p o t e n t i a l l y numerous a t t r i b u t e s and e x p e c ta tio n s in
a s s o c ia t io n w i t h th e n u rs e , th e g r e a t e r p o r t io n o f the i n t e r v i e w sche­
d u le responded t o t h i s
image d e te rm in a n t component.
This component
was e x p lo re d thro ugh q u e s tio n s t h a t were designed t o prompt the i n t e r ­
viewee t o d e s c rib e mental p i c t u r e s .
Examples i n c lu d e ,
"What i s the
f i r s t th in g , t h a t comes t o y o u r mind when I say the word nurse?"
( B e le tz 1974) and "What do nurses do?"
The q u e s tio n n a ir e item s were d e r iv e d from th e q u e s tio n s on the
i n t e r v i e w sched ule .
The c o n te n t o f the q u e s tio n s remained s u b s t a n t i a l l y
25
unchanged in. t h e i r use as item s on th e q u e s tio n n a ire ,.
For t h i s reason,
the s p e c i f i c item s are presented w i t h i n th e d is c u s s io n o f the q u e s tio n ­
n a ir e which appears l a t e r in t h i s c h a p te r.
Conduction o f the In te r v ie w s
The sample o f in te r v ie w e e s c o n s is te d o f key in fo rm a n ts chosen from
the p u b li c s e t t i n g .
C r i t e r i a f o r sample s e l e c t i o n were a w i l l i n g n e s s
t o p a r t i c i p a t e , th e a b i l i t y t o speak th e E n g lis h language, a c u r r e n t
r e s id e n c y s t a t u s o f a t l e a s t s i x months d u r a t io n w i t h i n th e le g a l
boundaries o f M issoula County, Montana, and presence in one o f the pub­
lic
s e t t i n g s a t the tim e th e in t e r v ie w s were being conducted.
The pub­
lic
s e t t i n g c o n s is te d o f v a r io u s p u b li c places and businesses in c lu d in g
r e s t a u r a n t s , shopping a re a s , th e u n i v e r s i t y a re a , a community c e n t e r ,
a beauty sa lo n and a bar in M issoula County.
As the purpose o f th e in t e r v i e w was t o i d e n t i f y common uses o f t e r ­
m inology and common o p in io n s o f f e r e d by members o f the p u b li c d e s c r ib ­
in g th e n u rs e , th e sample s iz e was determ ined by the numbers o f i n t e r ­
views conducted in o r d e r f o r such com m o n a litie s t o emerge.
Commonali­
t i e s were e v id e n t by th e tim e tw enty-one persons had been approached
and f i f t e e n
in t e r v ie w s had been com pleted.
Of the tw e n ty-o n e people
approached, f o u r re fu s e d to p a r t i c i p a t e , two were d i s q u a l i f i e d due to
r e s id e n c y s t a t u s , and f i f t e e n completed the i n t e r v i e w .
recorded v e r b a tim .
Responses were
T h is p a r t i c u l a r method o f sampling was dependent
upon ongoing data a n a ly s is which i s d e s c rib e d in the f o l l o w i n g d is c u s ­
s io n .
26
A n a ly s is and A p p l i c a t i o n o f I n t e r v i e w Data t o Q u e s tio n n a ire
Development
Data a n a ly s is o f in t e r v i e w responses was ongoing th ro u g h o u t the
i n t e r v i e w i n g process and p r i m a r i l y c o n s is te d o f i d e n t i f y i n g commonly
used t e r m in o lo g y and o p in io n s among th e a ccu m u la tin g responses.
The
most commonly used te r m in o lo g y in c lu d e d pronouns o f th e female gender
and th e words, " w h i t e , "
s io n a l,"
"h e lp ,"
"d o c to r,"
" s e n s i t i v e , " and " p a t i e n t s . "
" m e d ic a t io n s , "
"p ro fe s ­
Common o p in io n s such as those
d e s c r ib in g th e nurse as w e l l - I ik e d , com petent, p r o f e s s io n a l were a ls o
q u i t e e v id e n t i n th e d a ta .
The c o n t e x t was a ls o analyzed t o determ ine i f ,
in deed , a t t r i b u t e s
and e x p e c ta t io n s and i n d i c a t o r s o f s o c ia l p o s i t i o n and a t t r i b u t e s
and e x p e c ta tio n s were g e n e r a ll y e x p lo re d by th e item s o f the in t e r v i e w
sch e d u le .
The most commonly assigned a t r r i b u t e s and e x p e c ta tio n s were"
i d e n t i f i e d f o r i n c o r p o r a t i o n on th e q u e s t io n n a ir e .
I n t e r v i e w schedule
item s t h a t s u c c e s s f u l ly c o l l e c t e d data u s e fu l in d e te r m in in g s o c ia l
p o s i t i o n were a ls o i d e n t i f i e d f o r i n c o r p o r a t i o n on th e q u e s t io n n a ir e .
The manner in which i n t e r v i e w c o n te n t was a p p lie d t o q u e s tio n n a ir e
development i s b e st i l l u s t r a t e d by th e f o l l o w i n g example.
Of f i f t e e n responses t o the q u e s tio n ,
"What i s th e f i r s t t h in g
t h a t comes t o y o u r mind when I say th e word “ n urse? " the word " w h it e "
was used e i g h t tim e s , th e word " h e l p " was used f o u r tim e s , pronouns o f
27
the fe m in in e gender were used c o n s i s t e n t l y th ro u g h o u t a l l
responses,
and a s s o c ia t io n s between th e nurse and th e d o c to r and th e nurse and
th e p a t i e n t were f r e q u e n t .
The a n a ly s is o f these d ata was a p p lie d t o the c o n s t r u c t i o n o f the
■ q u e stio n n a ire in th e f o l l o w i n g way.
The q u e s tio n was adapted t o f i t
th e q u e s tio n n a ir e medium, w h ile p r e s e r v in g th e c o n t e n t .
The r e s u l t :
"PICTURE A NURSE. Which ONE o f th e f o l l o w i n g item s most c l o s e l y resembles
th e v e r y FIRST p i c t u r e t h a t you saw i n y o u r mind?"
The response choices
o f f e r e d c o n s is te d o f v a r io u s com bin a tio n s o f the words d e r iv e d from con­
t e n t a n a ly s is o f th e i n t e r v ie w s .
Examples in c lu d e , " w h i t e , " " h e l p , "
fe m in in e and n e u te r gender pronouns',;
" d o c t o r " and " p a t i e n t . "
"a
"a
"a
"a
and a s s o c ia t io n s w i t h th e words
Thus, th e f o l l o w i n g response choices r e s u lt e d :
woman in a w h ite u n ifo rm "
person h e lp in g a p a t i e n t "
woman h e lp in g a p a t i e n t "
woman h e lp in g a d o c t o r "
T h is p a r t i c u l a r q u e s tio n n a ir e ite m was used t o e x p lo r e a mental
p i c t u r e , n o t in tr o d u c e one, and was t h e r e f o r e h i g h l y dependent upon t e r ­
m in o lo g y .
Many q u e s tio n n a ir e item s were used to e x p lo re o p in io n s and
were n o t q u i t e as dependent upon choice o f te r m in o lo g y .
When t h i s was
th e case, th e i n t e r v i e w data were analyzed t o i d e n t i f y c a te g o r ie s o f
o p in io n s and the response choices were composed a c c o r d i n g l y .
An
example i l l u s t r a t e s :
One in t e r v i e w q u e s tio n
asks, "What k in d o f nurses do men make?"
A n a ly s is o f the response data showed t h a t the data separated i n t o
28
c a te g o r ie s t h a t in v o lv e d a comparison o f male nurses t o fem ale nurses
in r a t i n g s o f e i t h e r b e t t e r , equal t o , n o t as good as, o r c l i n i c a l l y
equal b u t p o s s i b l y la c k in g in terms o f compassion as in d ic a t e d by r e s ­
ponses such as "may be a p a t h e t i c , " o f " le s s c a r i n g . "
The q u e s tio n n a ir e
ite m t h a t r e s u lt e d based on t h i s p r e l i m i n a r y data i s : Which ONE o f the
f o l l o w i n g i s most t r u e f o r you?
(
(
(
(
) Male n u rs e s , in g e n e r a l, are b e t t e r than female nurses.
) Male n u rs e s , in g e n e r a l, are e q u a ll y as good as female n urses.
) Male nurses are
as good c l i n i c a l l y b u t are n o t as compas­
s io n a te as female nurses.
) Male n u rs e s , in g e n e r a l, are n o t as good as fem ale n urses.
One f i n a l way in which th e a n a ly s is o f th e in t e r v i e w data was
a p p lie d t o th e c o n s t r u c t i o n o f the q u e s tio n n a ir e was in th e development
o f new item s t h a t had n o t been in c lu d e d on th e in t e r v i e w schedule.
These item s were developed in response t o the high fre q u e n c y o f c e r t a i n
responses t h a t d e s c r ib e a t t r i b u t e s and o p in io n s o f the nurse such as
in d ic a t e d in th e f r e q u e n t use o f the words "warm ," " h a rd e n e d ," " m o t h e r l y , "
"knack" and " s a f e . "
Such item s were in c lu d e d on the q u e s tio n n a ir e in a
form t h a t e x p lo re d th e s t r e n g th o f th e a t t r i b u t e o r o p in io n as i t e x i s t s
among th e p u b l i c .
Examples in c lu d e :
NURSES BECOME HARDENED BY THE KINDS OF THINGS THEY SEE IN THEIR
WORK.
STRONGLY
AGREE
5
4
3
2
I
STRONGLY
DISAGREE
and
C i r c l e th e number on th e s c a le t h a t b e s t in d ic a t e s y o u r f e e li n g s
re g a r d in g th e manner o f a nurse.
WARM
5
4
3
2
1
COLD
29
The L i k e r t s c a le was employed on a l l q u e s tio n n a ir e item s designed
t o assess th e s t r e n g t h o f common o p in io n s and a t t r i b u t e s o f th e nurse
t h a t were i d e n t i f i e d by c o n te n t a n a ly s is o f th e i n t e r v i e w .
The rank
o r d e r method was u t i l i z e d on c e r t a i n q u e s tio n n a ir e item s t o enable th e
r e s e a rc h e r t o i d e n t i f y p u b li c p r i o r i t i e s o f e x p e c ta tio n s o f the nurse.
The f o r c e d - c h o ic e method was employed on most o f the q u e s tio n n a ir e
item s t o enable th e re s e a rc h e r t o analyze data by com putation o f f r e ­
q u e ncie s.
Summary
In summary, th e development o f th e research t o o l was based on the
a n a ly s is o f p r e l i m i n a r y data t h a t was c o l l e c t e d u sin g th e c o l le c t e d
in te r v ie w s ._
The i n t e r v i e w schedule o f t h i s p r e l i m i n a r y phase o f
data c o l l e c t i o n was e x p l o r a t o r y in design and based on th e image d e t e r ­
m inant components o f s o c ia l p o s i t i o n , r e f e r e n t groups, and a t t r i b u t e s
and e x p e c ta t io n s .
Content a n a ly s is o f th e in t e r v i e w data was in terms
o f i d e n t i f y i n g commonly used te rm in o lo g y and common o p in io n s o f fe r e d
by members o f th e p u b l i c in d e s c r i p t i o n o f th e n u rse .
T h is a n a ly s is
c o n t r ib u t e d t o th e c o n s t r u c t i o n o f th e q u e s tio n n a ir e by p r o v id in g fa ce
v a l i d i t y t o th e c o n te n t and te rm in o lo g y o f th e q u e s t io n n a ir e .
The
f o l l o w i n g i s a d is c u s s io n o f th e r e s u l t i n g q u e s tio n n a ir e in terms o f
i t s use as th e re se a rch t o o l .
THE RESEARCH TOOL
The development o f th e research t o o l
th e p re ce d in g s e c t io n .
is
d e s c rib e d
At t h is p o in t th e re fo re i t w i l l
in
s u f f i c e to
30
s t a t e t h a t th e re s e a rc h t o o l was in th e form o f a q u e s tio n n a ir e
(Appendix D) t h a t was designed by th e re s e a rc h e r t o e x p lo r e th e th re e
image d e te r m in a n t components o f s o c ia l p o s i t i o n , r e f e r e n t group s, and
a t t r i b u t e s and e x p e c ta tio n s o f t h e . n u r s e .
The q u e s tio n n a ir e i s now
s p e c i f i c a l l y presented and discussed i n terms o f i t s
use as th e research
to o l.
The Q u e s tio n n a ire
The q u e s tio n n a ir e i s presented in t h i s s e c t io n .
The p r e s e n ta t io n
o f th e item s i s o rg a n iz e d in terms o f th e image d e te rm in a n t components
t o which th e y respond.
Reference Groups
The image d e te rm in a n t component o f re fe re n c e group s, as d e s c rib e d
by Simmons, c a l l s f o r th e re s e a rc h e r t o d i f f e r e n t i a t e from th e p u b lic
as a whole those groups whose members may h o ld a d i f f e r e n t image o f th e
nurse in response t o t h e i r vantage p o i n t
(Simmons
196 4).
This com­
ponent was e x p lo re d p r i m a r i l y thro ugh th e c o l l e c t i o n o f th e f o ll o w i n g
demographic d a ta :
age, sex, o c c u p a tio n , income, r e l i g i o n , d u r a t io n o f
re s id e n c e in Montana, r u r a l o r urban re s id e n c e d u r in g c h ild h o o d , ( f o r
purposes o f t h i s s tu d y , c h ild h o o d was d e fin e d as the f i r s t tw e lv e years
of life ,
and r u r a l was d e fin e d as a town w i t h a p o p u la tio n o f le s s than
2,500 o r o u t in th e open c o u n t r y ) "(M a ssin g e r 1976).
I t was a ls o noted
whether o r n o t th e respondent l i v e d w i t h i n th e c i t y l i m i t s o f M issoula
o r elsewhere in M isso u la County.
31
The image d e te rm in e n t component was f u r t h e r e x p lo re d by i d e n t i f y i n g
those groups who have had v a r y in g degrees o f exposure t o th e nurse
e i t h e r as k in
(m o th e r, s i s t e r o r w i f e ) o r are nurses them se lve s, o r
by having been r e c i p i e n t s o f n u r s in g c a re .
Those who had re c e iv e d
n u r s in g care were asked t o i n d i c a t e th e s e t t i n g and the circum stances
o f th e care and t h e i r general f e e l i n g s about th e c a re .
S o c ia l P o s it io n
The image d e te rm in a n t component o f s o c ia l p o s i t i o n r e f e r s t o those
symbols such as a u t h o r i t y , p r o f e s s io n a lis m , income, knowledge, respon­
s ib ility ,
e d u c a tio n a l c r i t e r i a ,
independence, and r e p u t a t io n t h a t the
p u b li c may a s s ig n to th e nurse and use t o determ ine the rank o f the
nurse in t h i s s o c i e t y .
These symbols as a p p lie d t o the nurse are
e x p lo re d by th e f o l l o w i n g groups o f q u e s tio n n a ir e ite m s .
The assessment o f w h eth er o r n o t th e p u b li c assigns th e nurse to
th e rank o f p r o f e s s io n a l and the s u b j e c t iv e d e f i n i t i o n o f th e term
p r o f e s s io n a l are d e a l t w i t h by q u e s tio n n a ir e item s numbered 16 and
17 (Appendix D ).
Q u e s tio n n a ir e item s numbered 18 thro ugh 23 were used
to determ ine changes in the le v e l o f a u t h o r i t y , r e s p o n s i b i l i t y and
independence a t t r i b u t e d t o th e nurse by th e p u b l i c .
Q u e s tio n n a ire
item s 15, 47, 48 and 49 were u t i l i z e d t o determ ine the p u b l i c ' s o p in io n
r e g a r d in g l i a b i l i t y
o f th e nurse and th e le v e l o f s u p e r v is io n a t which
th e nurse i s expected t o f u n c t i o n .
O pin io n s re g a r d in g th e sexual
r e p u t a t io n t h a t may c o n t r i b u t e t o th e image o f th e nurse were i n v e s t i ­
gated th ro u g h item s numbered 25, 26 and 42.
32
Q u e s tio n n a ire item s t h a t served the purpose o f e x p l o r in g th e
b e l i e f o f f e r e d by Simmons t h a t some symbols, o f a p r o fe s s io n a r e " im p r in ­
te d so i n d e l i b l y on th e membership t h a t th e p r o fe s s io n shows thro ugh .. .
even when i n d i v i d u a l s
( a re ) n o t on duty a t th e tim e "
are numbered 24, 42 and 43.
(Simmons 1964)
Through th e use o f q u e s tio n n a ir e items
numbered 32 and 33, the re s e a rc h e r assessed p u b li c knowledge and
o p in io n re g a r d in g the average monetary compensation o f th e nurse.
Q u e s tio n n a ire ite m number 44 was u t i l i z e d t o determ ine p u b li c know­
ledge re g a r d in g th e n u r s e 's e d u c a tio n a l q u a l i f i c a t i o n s and w hether o r
n o t the p u b li c p e rc e iv e d d i f f e r e n t ranks w i t h i n the n u r s in g p r o f e s s io n .
The f i n a l group o f q u e s tio n n a ir e item s used to e x p lo r e the image
d e te rm in a n t component o f s o c ia l p o s i t i o n s are item s numbered 7 through
9.
These item s assessed th e s t r e n g th o f th e p u b l i c ' s t r u s t in n urses,
d o c t o r s , and nurses t h a t are males.
A t t r i b u t e s and E x p e c ta tio n s
The image d e te rm in a n t component o f a t t r i b u t e s a n d 'e x p e c ta tio n s o f
th e nurse in v o lv e d s tu d y in g th e p u b li c f o r o p in io n s in terms o f p e r ­
c e iv e d f u n c t io n s o f th e n u rs e , s a t i s f a c t i o n w i t h th e n u rs e ,
and the
e x is te n c e o f t r a d i t i o n a l and s e x - r e la t e d a t t r i b u t e s and e x p e c ta t io n s .
I t a ls o in v o lv e d asse ssin g th e s t r e n g th o f commonly assigned t r a i t s
as warmth and conveying a f e e l i n g o f s a f e t y . .
such
An im p o r ta n t p a r t o f t h i s
image d e te rm in a n t component in v o lv e d th e d e s c r ip t i o n o f mental p i c t u r e s .
33
Q u e s tio n n a ire item s numbered I th ro u g h 3 and 45 are designed t o
r e f l e c t mental p i c t u r e s o f th e nurse as p e rc e iv e d by members o f the
p u b lic .
P e rc e p tio n s o f what the nurse d o e s, should do, th e most im por­
t a n t and l e a s t im p o r ta n t t h in g s th e nurse does, and th e most tim e -c o n ­
suming t h in g s a nurse does are ranked in q u e s tio n n a ir e item s numbered
5, 6 , 10, 11, 12, 13 and 14.
General s a t i s f a c t i o n w i t h th e nurse i s
assessed th ro u g h q u e s tio n n a ir e item s numbered 37 and 38.
Comparison o f
th e p u b li c image t o th e image p o r tra y e d by th e mass media i s explo re d
th ro u g h q u e s tio n n a ir e item s 34, 35 and 36.
E x p lo r a t io n o f th e n u r s e 's image in terms o f t r a d i t i o n a l and
fe m a le -se x r o l e s te re o ty p e s and dichotomous a t t r i b u t e s i s achieved
th ro u g h q u e s tio n n a ir e item s numbered 27 th ro u g h 31 and 41.
The s t r e n g th
o f th e a t t r i b u t e s o f s a f e t y , warmth, hardness and g e n tle n e s s are assessed
by q u e s tio n n a ir e item s numbered 39, 40, 46 and 4.
The methods by which
th e data were c o l l e c t e d and analyzed are d iscussed in th e n e x t s e c t io n .
SAMPLE
C r i t e r i a f o r sample s e l e c t i o n in c lu d e d randomness, a w i l l i n g n e s s t o
p a r t i c i p a t e , th e a b i l i t y to read and w r i t e th e E n g lis h language and a
c u r r e n t r e s id e n c y s t a t u s o f a t l e a s t s i x months d u r a t io n w i t h i n th e le g a l
boundaries o f M issoula County, Montana.
Sample s iz e was 200 and.was
determ ined i n r e l a t i o n t o th e number o f groups o f q u e s tio n n a ir e ite m s .
The q u e s tio n n a ir e c o n ta in s t h i r t e e n groups o f ite m s ; each group deals
w ith a s p e c ific s u b je c t.
I t was a r b i t r a r i l y designed by t h i s re s e a rc h e r
34
t h a t a t l e a s t ten people would be sampled f o r each o f th e groups in
o r d e r t o p r o v id e an ample response t o th e s u rv e y .
Sample s iz e was n o t
determ ined in r e l a t i o n t o th e s iz e o f th e p o p u la tio n under s tu d y as
t h i s s tu d y was n o t in te n d e d t o be g e n e r a liz a b le .
RELIABILITY AND VALIDITY
The method o f t o o l development as discussed e a r l i e r i n t h i s c h a p te r
c o n t r ib u t e s fa ce v a l i d i t y t o th e t o o l .
The t o o l has n o t been t e s te d f o r
r e l i a b i l i t y , t h e r e f o r e does n o t p ro v id e r e l i a b i l i t y .
The sample i s not
o f a s u f f i c i e n t s iz e t o produce r e s u l t s t h a t are g e n e r a li z a b l e .
PILOT STUDY
A p i l o t s tu d y was conducted to. screen the q u e s tio n n a ir e medium and
c o n te n t.
surveyed.
Ten per c e n t o f the sample s i z e , tw e n ty pe o p le , were randomly
Feedback on the t o o l was re q u e s te d .
were r e t u r n e d , each a p p r o p r i a t e l y com pleted.
Eighteen q u e s tio n n a ir e s
From t h e . p i l o t study i t
was determ ined t h a t th e q u e s tio n n a ir e was ready f o r use.
DATA COLLECTION METHODS
Data c o l l e c t i o n was conducted in th e f o l l o w i n g manner.
A random
sample o f 200 was chosen from the M issoula te lep hone d i r e c t o r y . Ques­
t i o n n a i r e s were m ailed
.to .
th e households chosen in t h i s manner.
In c lu d e d w i t h th e q u e s tio n n a ir e were a c o ve r l e t t e r (Appendix C) and a
s e lf- a d d re s s e d stamped envelope.
A l l q u e s tio n n a ir e s r e tu rn e d w i t h i n two
and a h a l f weeks o f th e m a il in g date and whose respondents f i t
t e r i a f o r sample, s e l e c t i o n were in c lu d e d in th e s tu d y .
the c r i ­
Q u e s tio n n a ire s
r e tu r n e d a f t e r th e d e a d lin e were n o t in c lu d e d in the s tu d y .
35
DATA ANALYSIS METHODS
Data .were analyzed by computing fre q u e n c ie s and percentages on a l l
ite m s .
Cross t a b u l a t i o n s were computed between data t h a t responded to
th e components o f r e f e r e n t groups and a t t r i b u t e s and e x p e c ta t io n s .
c h i-s q u a r e t e s t was computed on a l l
s ta tis tic a l
c ro s s -ta b u la tio n s .
A
The le v e l o f
s i g n i f i c a n c e f o r t h i s s tu d y was s e t a t 0.10 i n response to
th e e x p l o r a t o r y - d e s c r i p t i v e design o f th e s tu d y as t h i s le v e l o f s i g ­
n i f i c a n c e was s t r o n g l y i n d i c a t i v e o f a t r e n d .
Data a n a ly s is was f a c i ­
l i t a t e d th ro u g h th e use o f th e S t a t i s t i c a l Package f o r th e S o c ia l S c i­
ences (SPSS) . (N ie 1975).
' SUMMARY
T h is c h a p te r o u t l i n e d th e e x p l o r a t o r y - d e s c r i p t i v e design o f t h i s
s tu d y .
The use o f in t e r v ie w s in th e development o f th e research to o l
was d is c u s s e d .
The re se a rch t o o l , a q u e s t i o n n a ir e , was presented in
r e l a t i o n t o th e conceptual framework.
and v a l i d i t y ,
methods.
A ls o discussed were r e l i a b i l i t y
sample s e l e c t i o n , data c o l l e c t i o n and data a n a ly s is
CHAPTER FIVE
ANALYSIS AND INTERPRETATION OF FINDINGS
OVERVIEW
The purpose o f t h i s s tu d y w a s ;to d e s c rib e the p u b li c image o f
th e nurse.
The concepts o f t h i s s tu d y were o p e r a t i o n a l iz e d through
the use o f a re se a rch t o o l designed t o e x p lo r e the p u b li c image o f
the nurse in r e l a t i o n to Simmons' image d e te rm in a n t components o f
re fe re n ce group s, s o c ia l p o s i t i o n , and a t t r i b u t e s and e x p e c ta t io n s .
T h is c h a p te r r e p o r t s th e data a n a ly s is and i n t e r p r e t s th e f in d i n g s
in response t o each image d e te rm in a n t component.
The c h a p te r con­
clu d e s w i t h a com posite d e s c r i p t i o n o f th e p u b li c image o f th e nurse
SAMPLE
• Of th e 200 q u e s tio n n a ir e s m ailed t o M issoula County r e s id e n t s ,
14 were u n d e li v e r a b l e , 8 were re tu rn e d beyond the d e a d lin e f o r use
in the s tu d y , and 91 were used f o r data a n a ly s i s .
The 91 used f o r
data a n a ly s is c o n s t i t u t e a 47 per c e n t response.
DEMOGRAPHIC DATA
Age and Sex
The m a j o r i t y o f respondents were between the ages o f 21 and 50,
(67 per ce n t o f a l l
re s p o n d e n ts ).
pondents were age 51 and o l d e r .
younger than 20 years o f age.
T h i r t y - t h r e e per c e n t o f a l l r e s ­
None o f the respondents were
A lth o u g h t h i s s tu d y was n o t designed
. 37
to i n t e n t i o n a l l y o m it t h i s younger age group, the methods o f sampling
and data c o l l e c t i o n may have c o n t r ib u t e d t o t h i s om ission sin ce
q u e s tio n n a ir e s were w r i t t e n a t an a d u l t re a d in g le v e l and se n t to
heads o f households.
per c e n t o f a l l
Both sexes were f a i r l y w e ll re p re s e n te d as 53
respondents were females and 42 per c e n t were males.
Five per c e n t d id n o t i n d i c a t e sex.
Income and O ccupation
For purposes o f t h i s s tu d y , th e c a te g o ry o f " p r o f e s s i o n a l "
in c lu d e d t e a c h e r s , d e n t i s t s , p h y s ic ia n s and la w y e rs ; " w h it e c o l l a r
w o rk e rs " in c lu d e d o f f i c e personnel and e x e c u tiv e s ; and "b lu e c o l l a r
w o rke rs" in c lu d e d i n d u s t r i a l w orkers and la b o r e r s .
Table I ,
As in d ic a te d by
th e m a j o r i t y , 57 per ce n t o f a l l respondents was comprised
o f p r o f e s s io n a ls (29 per c e n t) and w h ite c o l l a r w o rkers (28 per c e n t ) .
Blue c o l l a r w orkers comprised o n ly 12 per ce n t o f a l l
respondents..
In re g a rd t o th e prominence o f the wood h a r v e s t in g and wood products
i n d u s t r y o f th e M issoula r e g io n , the r e s e a rc h e r had n o t expected to
f i n d such a la r g e v a r ia n c e between th e percentage o f b lu e c o l l a r r e s ­
pondents in comparison t o the percentage o f w h ite c o l l a r and p r o f e s ­
s io n a l respondents in a random sample.
The low percentage o f blue
c o l l a r respondents may be a t t r i b u t e d t o th e response b e h a v io r
o f t h i s group t o t h i s method o f survey:.
Four per c e n t o f a l l
respondents were n urses.
As t h i s percen­
tage i s to o low to s i g n i f i c a n t l y a l t e r data a n a ly s i s , b u t more
38
i m p o r t a n t l y , as t h i s group i s co n sidered by t h i s r e s e a rc h e r t o be a
p a r t o f the p u b l i c , th e data from t h i s group is in c lu d e d in t h i s
•
a n a ly s i s .
Table I
OCCUPATION ( n = 9 1 ) ......................................................................... ..............................
Percentage
Occupation
H e a lth care Worker
Nurse
R e tire d
Stude nt
I
4
. 5
: 5
O ccupation
Percentage
Blue c o l l a r
Homemaker
White C o ll a r
P r o fe s s io n a l
12
16
28
29
In terms o f annual income, th e data i l l u s t r a t e d i n Table 2 i n d i C
ca te s t h a t th e m a j o r i t y o f respondents were in th e m id d le - c la s s
range .
For purposes o f t h i s s tu d y , lo w e r c la s s i s d e fin e d as those
e a rn in g le s s than $ 10,000 a n n u a lly , m id d le c la s s , $ 10,000 t o $25,000
a n n u a lly , and upper c la s s as those e a rn in g more than $25,000 per y e a r
T h is d e f i n i t i o n . i s based on c u r r e n t U n ite d S tates Government income
g u i deles as issued t o th e Community S e rv ic e A d m i n i s t r a t i o n .
By t h i s
d e f i n i t i o n , th e m a j o r i t y Of respondents (54 per c e n t) are o f the
m id d le c la s s .
The curve s h i f t s t o th e l e f t as 30 per c e n t o f the
respondents correspond to the lo w e r c la s s c a te g o ry and o n ly 16 per
ce n t correspond t o the h ig h e r c la s s c a te g o r y .
These are n o t in con­
t r a d i c t i o n t o th e economic c o n d it io n o f the re g io n sampled.
I t is
common knowledge t h a t th e economic c o n d it io n o f t h i s re g io n i s such
39
Table 2
INCOME (n=91)
Income Class
Percentage
Lower Class
M iddle Class
Upper Class
30
54
16
t h a t th e r e are a g r e a t e r number o f th e p o p u la tio n in th e lo w e r than
in the upper c la s s .
R e lig io n
Data c o l l e c t e d re g a r d in g th e r e l i g i o u s p re fe re n ce s o f th e r e s ­
pondents shows 87 per c e n t are o f th e C h r i s t i a n f a i t h .
Of the t o t a l ,
19 per c e n t are P r o t e s t a n t and 40 per c e n t are C a t h o li c .
Eleven
per c e n t r e p l i e d t h a t th e y had no r e l i g i o u s p re fe re n c e and two per
c e n t in d ic a t e d t h a t th e y are n o n - C h r is t ia n .
Residence
N a tiv e Montanans comprised 56 per c e n t o f th e sample.
Of the
groups t h a t are n o t n a t iv e to Montana, 90 per ce n t in d ic a t e d t h a t
th e y had spent th e f i r s t tw e lv e y e a rs o f t h e i r l i f e
and c e n t r a l s t a t e s .
in th e western
S i x t y - n i n e per c e n t o f a l l respondents have
l i v e d in Montana f o r a t l e a s t te n y e a r s .
In terms o f r u r a l and urban d a t a , 56 per c e n t in d ic a t e d t h a t
th e y had re s id e d in a r u r a l area f o r most o f th e f i r s t tw e lv e years
40
o f th e ir l i f e .
Rural
is
d e fin e d f o r purposes o f t h i s s tu d y as a
town w i t h a p o p u la tio n o f le s s than 2 ,5 0 0 ; o r , as l i v i n g in the open
c o u n tr y
(M assin g e r, 1976)•
The l a r g e r p o r t i o n , 56 per c e n t o f the
respondents c u r r e n t l y . l i v e s o u ts id e th e l i m i t s o f the C i t y o f M issoula
in an area t h a t i s regarded as r u r a l
in terms o f t h i s s tu d y .
Summary o f th e Demographic Data
I n t e r p r e t a t i o n o f th e demographic data in d ic a t e s t h a t the
sample o f respondents i s composed o f persons from ages 20 and o l d e r ,
th e m a j o r i t y being between the ages o f 21 and 50,
The f a c t t h a t the
age group o f persons le s s than 20 y e a rs o ld i s n o t re p re se n te d in
t h i s data is p o s s i b l y due t o sam pling methods.
T h is sample re p re s e n ts a v a r i e t y o f o c c u p a tio n a l group s, the
m a j o r i t y being of. the w h ite c o l l a r and p r o f e s s io n a l g ro u p s .
r e p r e s e n t a t io n o f b lu e c o l l a r respondents was e xpe cted .
A la rg e r
The cause
o f t h i s v a ria n c e i s p o s s ib ly due t o th e response b e h a v io r o f blue
c o l l a r w orkers to t h i s method o f d ata c o l l e c t i o n .
Data re g a r d in g annual income i n d i c a t e t h a t the m a j o r i t y o f the
respondents are. o f th e m id d le c la s s .
The d a ta a ls o i n d i c a t e t h a t the
second l a r g e s t r e p r e s e n t a t io n i s o f th e lo w e r c la s s , a f i n d i n g t h a t
corresponds t o th e economic le v e l o f t h i s r e g io n .
In te rp re ta tio n o f
th e data in re g a rd t o re sid e n ce i n d ic a t e s t h a t more than h a l f o f the
respondents show re s id e n c e e xp e rie n ce s t h a t are western and r u r a l
n a tu r e .
in
41
SOCIAL POSITION
A n a ly s is and i n t e r p r e t a t i o n o f th e data in regard, t o the image
d e te rm in a n t component o f s o c ia l
p o s i t i o n are re p o rte d in t h i s s e c t io n .
Image d e te rm in a n ts are those sym bols, such as a u t h o r i t y , p r o f e s s io n ­
a lis m ,
income, knowledge, r e s p o n s i b i l i t y , e d u c a tio n a l c r i t e r i a ,
independence, and r e p u t a t io n t h a t th e p u b li c may a s s ig n t o th e nurse
in v a r y in g degrees th e r e b y d e te r m in in g th e rank o f th e nurse in t h i s
s o c ie ty .
T h is component was e x p lo re d thro ugh groups o f q u e s tio n ­
n a ir e item s (see Methodology) and w i l l
be r e p o r te d a cc o rd in g to
these groups.
P r o fe s s io n a lis m
The q u e s tio n as t o w hether o r n o t th e p u b li c a ssigns th e nurse
t o the rank o f p r o f e s s io n a l was f i r s t e x p lo re d thro ugh a d i r e c t ques­
tio n ,
"Do you f e e l t h a t nurses are p r o f e s s io n a ls ? "
The response was
a s tro n g a f f i r m a t i v e ; 98 per ce n t o f th e respondents in d ic a t e d " y e s . "
In o r d e r t o b e t t e r understand th e meaning o f th e word p r o f e s ­
s io n a l as i t
i s s u b j e c t i v e l y a p p lie d , th e respondent was asked to
i n d i c a t e the response t h a t b e s t d e fin e d th e term
(Appendix D, Item 1 7 ).
p ro fe s s io n a l,
Of seven p o s s ib le responses, 24 per cent
chose th e response o f "com petent" and an equal number chose the r e s ­
ponse " s p e c i a l iz e d in t h e i r w o r k . "
Responses t h a t r e f e r r e d to e i t h e r
e d u c a tio n a l o r li c e n s u r e c r i t e r i a were th e l e a s t chosen responses.
42
I n t e r p r e t a t i o n o f these data i n d i c a t e
t h a t th e p u b l i c , w ith
s tro n g concensus, does assign t h e . r a n k o f p r o f e s s io n a l t o the
n u rs e .
The data a ls o suggest t h a t s u b j e c t iv e assignment o f the rank
o f p r o f e s s io n a l
i s based on the idea t h a t nurses are competent o r
s p e c i a l iz e d in t h e i r work r a t h e r than on more o b j e c t i v e l y a p p lie d
e d u c a tio n a l o r I i censure c r i t e r i a .
Changes in L e ve ls o f Knowledge, R e s p o n s i b i l i t y and A u t h o r i t y
'
In o r d e r t o e x p lo re p u b lic o p in io n s t h a t may i n d i c a t e changes
in t h e i r p e r c e p tio n o f the n u rse , th e respondent was asked t o r e s ­
pond t o q u e s tio n n a ir e item s (Appendix D, Items 18-23) designed to
assess th e s t r e n g th o f o p in io n s re g a r d in g p e rc e iv e d changes in l e v e ls
o f knowledge, r e s p o n s i b i l i t y and a u t h o r i t y o f th e n u r s e .
The r e s ­
pondent was f i r s t asked t o i n d i c a t e w hether o r n o t nurses were " d i f ­
fe re n t
to d a y than th e y were ten years a g o ;" t o which 67 per cent
responded " y e s . "
Respondents were then asked t o r a t e on a sca le
from " s t r o n g l y d is a g r e e " w i t h the v a lu e o f " I " t o " s t r o n g l y agree"
w i t h a v a lu e o f "5 " w hether o r n o t th e y b e lie v e d nurses had "more
knowledge than th e y d id ten years a g o . "
The same method was used to
assess o p in io n s re g a r d in g changes in l e v e l s o f r e s p o n s i b i l i t y and
a u th o rity .
The r e s u l t s were a l l on th e a f f i r m a t i v e end o f the s c a le .
The mean f o r knowledge was th e h ig h e s t a t 4 . IT
The mean f o r r e s ­
p o n s i b i l i t y f o llo w e d w it h 3.9 and th e mean f o r a u t h o r i t y was 3.4.'
43
Table 3
Response t o th e S tatem ent:
"NURSES HAVE MORE KNOWLEDGE.THAN THEY DID TEN YEARS AGg1
Value Category
Percentage
5
S t r o n g ly agree
43
4
Agree
34
3
M id p o in t
18
2
Disagree
3
I
S t r o n g l y d is a g re e
2
MEAN VALUE
(n=91)
4 •I
Agree
Table 4.
Response t o th e S tatem ent:
NURSES.HAVE MORE RESPONSIBILITY THAN THEY DID TEN YEARS AGO". (n=91)
Value Category
Percentage
5
S t r o n g ly agree
44
4
Agree
20
3
M id p o in t'
24
2
Disagree
9
I
S t r o n g ly d is a g re e
3
MEAN VALUE
3.9 Agree
44
Table 5
Response t o th e Statem ent:
"NURSES HAVE MORE AUTHORITY .THAN THEY DID TEN YEARS AGO"
Value Category
' Percentage
5
S t r o n g ly Agree
19
4
Agree
23
3
M id p o in t
44
2
Disagree
9
I
S t r o n g ly d is a g re e
5
MEAN VALUE
3.4 M id p o in t
F u r t h e r e x p l o r a t i o n in terms o f p e rc e iv e d changes i n th e image
o f th e nurse was und ertaken th ro u g h s i m i l a r l y c o n s tr u c te d q u e s tio n s
re g a r d in g th e e f f e c t o f th e Women's R ig h ts Movement on th e nurse.
S ix ty - s e v e n per c e n t responded t h a t th e movement has had an e f f e c t
on n u r s in g .
On a s c a le o f " I " t o "5 " w i t h "5 " c o rre sp o n d in g to
" s t r o n g l y a g r e e ," th e mean in response t o th e s ta te m e n t "The
Women's R ig h ts Movement has a f f e c t e d n u r s in g in a p o s i t i v e way,"
was 3 . 5 , which i s s l i g h t l y toward th e agree end o f th e s c a le .
I n t e r p r e t a t i o n o f th e data r e g a r d in g th e p e rc e iv e d changes in
th e image o f th e nurse in d i c a t e
t h a t th e p u b lic does p e rc e iv e o f
p o s i t i v e changes in terms o f in c re a s e d l e v e l s o f knowledge, respon­
s i b i l i t y , and a u t h o r i t y .
improved th e most.
The le v e l o f knowledge i s p e rc e iv e d t o have
I t must be noted t h a t the data show t h a t the
in c re a s e s in th e p e rc e iv e d le v e l o f a u t h o r i t y are n o t equal to the
45
p e rce ive d changes in the le v e l o f r e s p o n s i b i l i t y o f th e n urse.
The
data re g a r d in g th e e f f e c t o f the Women's R ig h ts Movement on the
nurse suggest t h a t i t
i s perce ive d t o have some im pact on th e image
and t h a t t h i s im pact may be a t l e a s t one c o n t r i b u t o r t o th e p o s i t i v e
changes o f th e n u r s e 's image.
S u p e rv is io n and L i a b i l i t y
Four q u e s tio n n a ir e items (Appendix D, Items 15, 47, 48 and 49)
were used t o determ ine p u b li c o p in io n s r e g a r d in g the le v e l o f su p e r­
v i s i o n a t which th e nurse should work and th e amount o f l i a b i l i t y
th e p u b li c a ssigns th e n urse.
Two q u e s tio n s (Appendix D, Items 47,
and 48) employ th e L i k e r t s c a le t o assess th e p u b li c response to
state m en ts about th e s u p e r v is o r y le v e l o f the d o c to r in r e l a t i o n to
th e nurse and th e n u r s e 's c a p a b i l i t i e s f o r independent w ork.
r e s u l t s are l i s t e d
The
in Tables 6 and 7
Table 6
Response t o the S tatem ent:
. "NURSES SHOULD ALWAYS WORK.UNDER THE SUPERVISION OF A DOCTOR" (n=91)
Value Category
Percentage
5
S t r o n g ly agree
14
4
Agree
18
3
• M id p o in t
26
2
Disagree
25
I
S t r o n g ly d is a g re e
17
MEAN VALUE
2 .9
M id p o in t
46
Table 7
Response t o Statem ent:
"NURSES ARE CAPABLE OF WORKING INDEPENDENTLY IN HEALTH CARE"(n=91)
Value Category
Percentage
5
S t r o n g l y agree
38
4
Agree
33
3
M id p o in t
16
2
Disagree
11
I
S t r o n g ly d is a g re e
MEAN VALUE
2
■
4 .0 Agree
In response t o a q u e s tio n (Appendix D, Item 1 5 ),
th e nurse f i r s t r e s p o n s ib le ? "
"To whom is
th e l a r g e s t group o f respondents (49
per c e n t) in d ic a t e d the. " p a t i e n t and d o c t o r , e q u a l l y . "
In response
t o a q u e s tio n (Appendix D, Item 49) t h a t asked, "Who should be held
r e s p o n s ib le i f a p a t i e n t i s harmed as a r e s u l t o f a nurse c a r r y i n g
o u t a d o c t o r 's o r d e r ? " , th e m a j o r i t y (66 per c e n t) o f respondents
in d ic a t e d th e " d o c t o r . "
I n t e r p r e t a t i o n o f th e data i n d ic a t e s t h a t the p u b l i c s t r o n g ly
a s s o c ia te s th e nurse w i t h th e d o c t o r and p e rce ive s th e d o c to r as th e
s u p e r v is o r y and l i a b l e
p a rty .
A lth o u g h th e p u b li c does n o t s t a te
t h a t th e nurse i s in c a p a b le o f w o rkin g in d e p e n d e n tly , i t
p e rc e iv e t h a t th e nurse i s w o rking in d e p e n d e n tly .
does n o t
T h is i s evidenced
in p a r t by th e f i n d i n g t h a t th e p u b li c b e lie v e s th e nurse i s respon­
s i b l e t o th e p a t i e n t and t o th e d o c t o r e q u a ll y .
A lth ough th e p u b lic
does n o t s t r o n g l y f e e l t h a t th e nurse should always work under the
47
s u p e r v is io n o f a d o c t o r , th e f i n d i n g t h a t the nurse i s r e s p o n s ib le
t o both th e p a t i e n t and the d o c to r e q u a ll y im p lie s t h a t the d o c to r
is i n a s u p e r v is o r y p o s i t i o n t o the n u rs e .
The f i n d i n g t h a t the d o c t o r i s l i a b l e f o r the n u r s e 's a c t io n s
has m ajor i m p l i c a t i o n s re g a r d in g th e p u b li c p e rc e p tio n o f the
n u r s e 's autonomy and r e s p o n s i b i l i t y .
T h is f i n d i n g im p lie s t h a t the
d o c t o r i s r e s p o n s ib le f o r making th e judgements and th e nurse i s res
p o n s ib le f o r a d m in is t e r in g the t e c h n ic a l component t o th e d o c t o r 's
judgem ent.
Such a b e l i e f a c t u a l l y " r e le a s e s " the nurse from p ro ­
f e s s io n a l l i a b i l i t y .
I n t e r p r e t a t i o n o f these data i n d i c a t e , t h a t the
nurse i s n o t p e rc e iv e d t o be autonomous.
Sexual R e p u ta tio n
In o r d e r t o d is c o v e r th e p u b li c o p in io n re g a r d in g th e sexual
r e p u t a t io n o f th e n u rs e , respondents were asked t o r a t e t h e i r r e s ­
ponses t o th r e e state m e n ts (Appendix D, Items 25, 26 and 4 2 ) .
Two
o f these item s s t a t e common myths r e g a r d in g th e sexual p r a c t ic e s o f
both male and female n u rse s.
The t h i r d
ite m a tte m p ts t o d i f f e r e n ­
t i a t e th e sexual r e p u t a t io n o f females t h a t are nurses from t h a t o f
females in g e n e r a l.
illu s tra te d
The state m en ts and th e responses t o each are
in Tables 8 , 9 and 10.
48
Table 8
In Response t o th e S tatem ent:
"FEMALE NURSES ARE GENERALLY MORE PROMISCUOUS THAN FEMALES
IN GENERAL"
(n=91)
Value Category
Percentage
5
S t r o n g ly agree
4
4
Agree
8
3
M id p o in t
13
2
Disagree
14
I
S t r o n g ly d is a g re e
61
MEAN VALUE
1.8 Disagree
Table 9
In Response t o th e Statem ent:
"MALES THAT ARE NURSES HAVE A TENDENCY TOWARD HOMOSEXUALTY"
Value C a te g o rie s
Percentages
5
S t r o n g ly agree
I
4
Agree
2
3
M id p o in t
4
Disagree
■13
I
S t r o n g ly d is a g re e
72
MEAN VALUE
.
11
1.5 Disagree
(n=91)
49
Table 10
In Response t o the Statem ent conce rn ing a n u r s e 's OFF-DUTY hours:
"A FEMALE NURSE NEEDS TO BE MORE CAREFUL ABOUT HER REPUTATION THAN
DO WOMEN IN GENERAL"
(n=91)
Value C a te g o rie s
Percentages
5
S t r o n g l y agree
9
4
Agree
5
3
M id p o in t
22
2
Disagree
21
I
S t r o n g ly d is a g re e
43
2.2 Disagree
MEAN VALUE
I n t e r p r e t a t i o n o f t h i s group o f data a t face v a lu e would i n d i ­
c a te t h a t a c c o rd in g t o the s t a t i s t i c a l
a n a ly s i s , th e p u b li c does n o t
hold th e o p in io n t h a t the o f f - d u t y female nurse should be more c a re ­
f u l about her r e p u t a t io n than females in g e n e r a l; d is a g re e s t h a t
female nurses are more a p t to be promiscuous than females in g e n e r a l;
and d is a g re e s t o a s t r o n g e r degree t h a t male nurses tend to be homo­
sexual .
S u b s ta n tiv e i n t e r p r e t a t i o n o f t h i s data must ta ke i n t o c o n s id e r - .
a t io n th e p r o b a b i l i t y t h a t respondents would respond t o th e c o n te n t
o f th e item s in a s o c i a l l y a c c e p ta b le manner.
T h e r e fo r e , th e data
may n o t a c c u r a t e ly r e f l e c t th e s t r e n g th o f th e p u b l i c ' s p e r c e p tio n o f
th e n u r s e 's sexual r e p u t a t i o n .
A le s s o v e r t method o f e x p lo r in g t h i s
p e r c e p tio n o r an open-ended r a t h e r than fo rc e d choice q u e s tio n may
have p ro vid e d f o r in cre a se d accuracy in d e s c r ib in g th e sexual r e p u t a ­
t i o n o f th e n u rse .
50
A group o f t h r e e q u e s tio n n a ir e item s (Appendix D, Items 24, 42
and 43) served th e purpose o f e x p l o r in g th e b e l i e f t h a t some symbols
o f a p r o f e s s io n are " im p r in t e d so i n d e l i b l y on the membership t h a t
th e p r o f e s s io n shows thro ugh . . . even when i n d i v i d u a l s ( a re ) not on
d u ty a t th e t im e .
(Simmons
1 9 6 2 ).
The f i r s t item o v e r t l y surveys
th e p u b li c t o d e te rm in e whether o r n o t th e " p r o f e s s io n shows th ro u g h "
by o f f e r i n g th e respondent choices d e s c r ib in g d i f f e r e n t degrees o f
v is ib ility
o f th e n u rs e .
The ite m and th e responses are l i s t e d in
Table 11 below.
Table 11
V IS IB ILIT Y OF THE MEMBERSHIP OF THE NURSING PROFESSION (n=91)
Percentage
Response
0
A.
I can t e l l i f someone i s a nurse j u s t by lo o k in g
a t h im /h e r , even w i t h o u t a u n i f o r m .
10
B.
Sometimes a f t e r t a l k i n g t o o r w a tch in g someone, I
can t e l l t h a t t h a t person i s a nurse
18
C.
When someone t e l l s me t h a t he/she i s a n u rse , I
f i n d I am n o t s u r p r is e d .
57
D.
I do n o t f e e l t h a t you can t e l l i f
nurse by th e way th e y lo o k o r a c t
4
E.
I can o n ly t e l l
i s in u n ifo rm
11
F.
Even in a w h ite u n ifo rm some people do n o t lo o k
l i k e nurses t o me.
if
'
someone i s a
someone i s a nurse i f
he/she
The m a j o r i t y o f the respondents (61 per c e n t) in d ic a t e d by
choosing responses "D" and "E" t h a t th e p r o fe s s io n does n o t necessa­
r ily
show th ro u g h .
A s i g n i f i c a n t number (39 per c e n t) however, chose
51
state m en ts t h a t i n d i c a t e t h a t the p r o f e s s io n does show th ro u g h , a t
l e a s t under c e r t a i n circ u m s ta n c e s .
Of t h i s 39 per c e n t , choices "B"
and "C" d e s c r ib e v i s i b i l i t y o f d i f f e r e n t degrees; c h o ic e "F" im p lie s
thro ugh th e phrase "does n o t lo o k l i k e a n u rs e " t h a t th e nurse does
indeed possess an i d e n t i f i a b l e lo o k re g a rd le s s o f u n ifo rm .
The second item i n t h i s group (Appendix D, Item 43) r e s u l t s from
c o n te n t a n a ly s is o f th e in t e r v i e w data which co n ta in e d numerous r e f ­
erences t o th e " t y p e " o f person t h a t e n te r s the p r o f e s s io n .
Data
a n a ly s is i n d ic a t e s t h a t th e l a r g e s t p o r t i o n o f q u e s tio n n a ir e respon­
den ts (48 per c e n t) chose the response "wants t o h e lp peo p le " from
f i v e p o s s ib le choices as th e b e s t d e s c r i p t i o n o f the typ e o f person
t h a t e n te r s th e n u r s in g p r o f e s s io n .
o n ly one per p e rc e n t o f a l l
In c o n t r a s t , i t
i s noted t h a t
respondents chose th e response " m o t h e r l y . "
I n t e r p r e t a t i o n o f these data d e s ig n a te s th e " h e lp e r " as a symbol o f
th e membership o f th e n u rs in g p r o f e s s io n .
I t does n o t , however, d i s ­
count t h a t th e p u b li c may a t t r i b u t e m o th e rly q u a l i t i e s t o . t h e n urse.
The t h i r d
ite m in t h i s group was p r e v io u s ly discussed in r e l a ­
t i o n t o d e te r m in in g th e sexual r e p u t a t io n o f the n u rse .
D, Item 4 2 .)
(Appendix
The response to the s ta te m e n t "A female nurse needs t o be
more c a r e f u l about her r e p u t a t io n than do females in g e n e r a l" was
n e g a tiv e .
Had th e response been p o s i t i v e ,
i t could be im p lie d t h a t
i f th e nurse does need t o guard her r e p u t a t io n more than females in
g e n e r a l, female nurses must be i d e n t i f i a b l e
in p u b l i c .
As th e r e s ­
ponse t o th e sta te m e n t had a mean va lu e o f 2.2 on a s c a le o f one to
52
f i v e w i t h one e q u a lin g " s t r o n g l y d i s a g r e e , " the ite m does n o t c o n t r i -
■
b ute t o th e d e t e r m in a t io n o f symbols and v i s i b i l i t y o f the n urse.
Based on i n t e r p r e t a t i o n o f th e d a ta , i t
i s in d ic a t e d t h a t the
p u b li c does, t o some degree, i d e n t i f y th e n u rs in g p r o f e s s io n 's mem­
b e r s h ip by symbols.
T h is is evidenced by the f a c t ' t h a t o n e - h a lf o f
th e p u b li c f e e l s th e membership i s comprised o f a c e r t a i n i d e n t i f i a b l e
typ e o f person, i . e . ,
the " h e l p e r . "
The m a j o r i t y o f th e p u b li c does
n o t b e lie v e t h a t th e "p ro fe s s io n , shows t h r o u g h . "
A s ig n if ic a n t por­
t i o n , however, does f i n d the membership o f the n u r s in g p r o fe s s io n to
be re c o g n iz a b le by lo o k o r b e h a v io r.
Compensation and E d u ca tio n a l Q u a l i f i c a t i o n s
Through th e use of- q u e s tio n n a ir e item s (Appendix D, Items 32
and 33) th e re s e a rc h e r assessed p u b li c awareness and o p in io n o f the
average monetary compensation th e nurse r e c e iv e s .
Table 12 i l l u s ­
t r a t e s the responses.
Table 12
COMPENSATION (n=91)
Category o f
Pay per Hour
$3.00 an hour
$4.00 an hour
$5.00 an hour
$ 6.00 an hour .
$7.00 an hour
$ 8.00 an hour
$9.00 an hour
$ 10.00 an hour-
Percentage
I
10
30
28
.17
8
3
3
O pinion Regarding
Compensation
Underpaid
Paid as should be
Percentage
82
■18
53
As i l l u s t r a t e d by Table 12, a Targe m a j o r i t y o f the p u b lic holds
the o p in io n t h a t th e nurse i s u n d e rp a id .
T h is o p in io n may be based
in p a r t on th e p u b l i c ' s im pression t h a t the nurse re c e iv e s monetary
compensation a t a r a t e o f f i v e t o s i x d o l l a r s an h o u r, when in f a c t
the nurse in th e re g io n o f t h i s s tu d y re c e iv e s a s l i g h t l y h ig h e r
wage than t h a t p e rc e iv e d by the p u b l i c .
T h is small v a r ia n c e between,
th e p e rc e iv e d wage and th e a c tu a l wage p ro b a b ly d e t r a c t s l i t t l e ,
if
any, from th e s t r e n g th o f th e o p in io n t h a t nurses are u n d e rp a id .
T h is i n t e r p r e t a t i o n i s made because th e v a r ia n c e i s o f a small degree,
the s t r e n g t h o f the o p in io n i s o f a g r e a t degree, and because the
data does n o t i n d i c a t e what the o p in io n t h a t nurses are underpaid i s
based upon.
Table 13
EDUCATIONAL CRITERIA
(ri=91)
Perceived Rank
T itle
F irs t
R e g iste re d Nurse,
Ph.D.
Second
R e g is te re d Nurse,
M a s te r's Degree
T h ir d
R e g is te re d Nurse,
B a c h e lo r's Degree
Fourth
R e g is te re d Nurse,
A s s o c ia te Degree
F ifth
R e g iste re d Nurse,
Diploma
S ix th
Licensed P r a c t ic a l
As i l l u s t r a t e d
Nurse,no degree
in Table 13, th e m a j o r i t y o f th e p u b li c reversed
th e o r d e r o f th e A s s o c ia te Degree nurse w it h the diplom a n u rse ,
th e re b y a s s ig n in g the. a s s o c ia te degree nurse th e h ig h e r ra n k in terms
54
o f amount o f e d u c a tio n r e q u ir e d t o o b t a in the t i t l e .
The remainder
o f th e l i s t was c o n s i s t e n t l y found t o be in c o r r e c t o r d e r .
I n t e r p r e t a t i o n o f th e data r e g a r d in g th e p u b l i c ' s p e rc e p tio n o f
th e d i f f e r e n t l e v e l s Of e d u c a tio n a l q u a l i f i c a t i o n s a nurse may pos­
sess must ta k e i n t o account th e method by which th e data were c o l ­
le c te d .
The q u e s tio n n a ir e ite m was s t r u c t u r e d ^so t h a t h t h e ! d i f f e r e n t
l e v e l s were l i s t e d by name and th e respondent had o n ly t o rank the
ch o ice s p r o v id e d .
Had th e respondent been asked to l i t e r a l l y w r i t e
in th e d i f f e r e n t ranks o f e d u c a tio n q u a l i f i c a t i o n s , th e r e s u l t s may
have c o n t r ib u t e d t o a more a c c u ra te p i c t u r e o f th e p u b l i c ' s percep­
t i o n re g a r d in g t h i s s u b j e c t .
T h is method o f data c o l l e c t i o n , how­
e v e r , d id n o t accommodate such an ite m .
I n t e r p r e t a t i o n o f the data
a t fa c e v a lu e in d i c a t e s t h a t th e p u b li c possesses a s l i g h t l y in a c ­
c u r a te u n d e rs ta n d in g o f th e d i f f e r e n t l e v e l s o f e d u c a tio n a l q u a l i f i ­
c a t io n s a nurse may possess.
No f u r t h e r c o n c lu s io n s can be drawn.
T rust
The f i n a l
group o f q u e s tio n n a ir e ite m s used t o e x p lo r e the image
d e te rm in a n t component o f s o c ia l
p o s i t i o n (.Appendix D, Ite m s, 7, 8 and
9) assess th e s t r e n g t h o f the p u b l i c ' s t r u s t in n u rs e s , d o c to rs and
male nurses in r e l a t i o n t o each o t h e r .
The respondents were asked t o
r a t e on a continuum o f t r u s t t o d i s t r u s t t h e i r f e e l i n g s o f t r u s t
toward n u rs e s , d o c t o r s , and male n u r s e s .
Table 14.
The r e s u l t s are l i s t e d in
55
Table 14
TRUST (n=91)
NURSES
Percentages
DOCTORS
Percentages
28
24
14
4
49
48
42
3
18
17
- 28
2
4
8
14
I
3
2
4 .0
3 .8
3.5
Value Category
5
I
T rust
D is tru s t
MEAN VALUE
Based on data a n a ly s i s ,
•
MALE NURSES
Percentages
i t can be determ ined t h a t th e p u b lic
holds a high degree o f t r u s t in n u rs e s , in g e n e r a l; a s l i g h t l y lo w er
degree o f t r u s t i s a t t r i b u t e d to d o c t o r s ; and the lo w e s t s c o re , y e t
s till
i n d i c a t i v e of. t r u s t ,
i s assigned t o male, n urses.
The chance
t h a t th e p u b li c may respond in a s o c i a l l y a c c e p ta b le manner, th e re b y
a s s ig n in g scores i n d i c a t i v e o f a h ig h e r than a c tu a l o p in io n t o a l l
th re e c a te g o r ie s a n d /o r nurses in p a r t i c u l a r , may decrease th e s t r e n g th
o f th e d a ta .
In summary, i t
can be concluded t h a t th e p u b li c holds a high
degree o f t r u s t in th e nurse and t h a t nurses rank s l i g h t l y h ig h e r
than d o c to r s in terms o f t r u s t w o r t h in e s s .
56
' ATTRIBUTES AND EXPECTATIONS
D e s c rib in g th e nurse in terms o f th e image d e te rm in a n t component
o f a t t r i b u t e s and e x p e c ta tio n s in v o lv e d s tu d y in g the p u b li c t o d is c o v e r
th e expected f u n c t io n s o f th e n u rs e , s a t i s f a c t i o n l e v e l s w i t h th e n u rs e ,
and th e e x is te n c e o f p o s s ib le h i s t o r i c a l , t r a d i t i o n a l and s e x - r e la t e d
a t t r i b u t e s and e x p e c ta t io n s .
E x p lo r a t io n in terms o f t h i s
image d e t e r ­
m inan t component a ls o in v o lv e d assessment o f th e s t r e n g t h o f p u b lic
o p in io n re g a r d in g commonly assigned t r a i t s
th e f e e l i n g o f s a f e t y .
such as warmth and conveying
Most im p o r t a n t , th e stu d y o f t h i s image d e t e r ­
m inant component in v o lv e d th e d e s c r i p t i o n o f mental p i c t u r e s o f th e nurse
as p e rc e iv e d by th e p u b l i c .
F un ctions
P u b lic p e r c e p tio n s o f th e f u n c t io n s o f th e nurse c o n s t i t u t e p u b lic
e x p e c ta tio n s o f th e n u rs e .
These p e r c e p tio n s were e x p lo re d thro ugh
q u e s tio n n a ir e item s (Appendix D, Items 5, 6, 10, 11 13 and 1 4 ), t h a t
surve y th e p u b li c to d is c o v e r what im p re ssio n s e x i s t re g a r d in g what
th e nurse does, should do, spends th e most tim e d o in g , and the
im portance o f what i s done.
From a l i s t o f t h i r t e e n v a r io u s f u n c t io n s o f th e n u rs e , respondents
were asked t o rank item s in terms o f im portance (Appendix D, Items 5
and 6 ) .
Table 15 i n d ic a t e s th e f i r s t th ro u g h t h i r d ranked ite m and th e
ite m p e rc e iv e d to be th e l e a s t im p o r ta n t.
57
Table 15
MOST IMPORTANT FUNCTIONS (n=91)
Rank
F un ction
F i r s t most im p o r ta n t
"ta k e care o f th e whole person"
Second most im p o r ta n t
"make the p a t i e n t c o m fo rta b le "
T h ir d most im p o r ta n t
" f o l l o w d o c t o r 's o r d e r s "
L ea st im p o r ta n t
"change bedpans, l i n e n and cle an up"
S i m i l a r l y s t r u c t u r e d q u e s tio n n a ir e item s (Appendix D, Items 10
and 11) d e a l t w i t h d is c o v e r in g which f u n c t i o n s , in th e p u b l i c ' s
o p i n i o n , were considered I t o be th e most tim e consuming.
are l i s t e d
The r e s u l t s
in Table 16.
•
Table 16
MOST TIME-CONSUMING FUNCTION
(n=91)
Rank
F un ction
F irs t
"Checking on t h e i r p a t i e n t s "
Second
" A d m in is t e r in g m e d ic a tio n s "
T h ir d
"H e lp in g the d o c to r w it h exams and tr e a tm e n ts '
Least
"Teaching p a t ie n t s and p a t i e n t s ' f a m i l i e s "
The p u b li c was then asked to respond d i r e c t l y to i n d i c a t e
w hether o r n o t th e y were s a t i s f i e d t h a t the nurse was spending the
most tim e doing what should be done.
c e n t) responded in th e a f f i r m a t i v e .
To t h i s , the m a j o r i t y (66 p e r ­
58
The s u b je c t o f what nurses should do was e x p lo re d thro ugh ques­
t i o n n a i r e item s (Appendix D,. Items 13. and 14) t h a t ask th e respon­
dent t o rank item s a c c o rd in g t o the "most im p o r ta n t improvement
nurses should make."
The r e s u l t s are l i s t e d in Table 17.
Table 17
MOST IMPORTANT IMPROVEMENTS
(n=91)
Rank
F u n ctio n
F irs t
"H o n e s tly e x p l a i n a l l p roced ure s, m e d ic a tio n s ,
and terms t o th e p a t i e n t "
:
iii
■
Second ( t i e )
"Stand up f o r those t h in g s t h a t are in th e
b e s t i n t e r e s t o f th e p a t i e n t ' s h e a lt h "
Second ( t i e )
"In c re a s e t h e i r knowledge"
Least
"Be more p r o f e s s io n a l in t h e i r manner"
P u b lic e x p e c ta tio n s o f th e nurse are im p lie d th ro u g h i n t e r p r e t a ­
t i o n o f th e data re g a r d in g th e p e rc e iv e d f u n c t io n s o f the n urse.
I n t e r p r e t a t i o n o f these data i d e n t i f i e s two predom inant p u b li c expec­
t a t i o n s o f th e n u rs e .
The most s t r o n g l y e v id e n t e x p e c ta tio n i s t h a t
th e nurse i s th e d e l i v e r e r o f d i r e c t care t o the p a t i e n t .
The p u b li c
expects t h a t most o f th e n u r s e 's tim e i s and should be spen t checking
on p a t i e n t s .
Most im p o r t a n t , the nurse w i l l take care o f the whole
person and make th e p a t i e n t c o m fo rta b le .
The second most predominant p u b li c e x p e c ta tio n i s t h a t the
n u r s e 's care i s dependent upon th e p h y s i c i a n 's d i r e c t i v e s .
T h is i s
evidenced th ro u g h th e responses t h a t i n d i c a t e t h a t one o f the most
59
im p o r ta n t f u n c t io n s o f the nurse i s t o f o l l o w d o c t o r 's o r d e r s , and
by th e p u b li c im p re ssio n t h a t th e nurse spends a g r e a t deal o f time
a d m in is t e r in g m e d ic a tio n s and h e lp in g th e d o c to r w i t h exam in ations
and t r e a tm e n ts .
The p u b li c b e l i e f t h a t th e nurse spends th e l e a s t amount o f
tim e te a c h in g p a t i e n t s and p a t i e n t s ' f a m i l i e s i s c o n s i s t e n t w ith the
p u b li c response t h a t th e most im p o r ta n t improvement th e nurse should
make i s t o h o n e s tly e x p la in a l l
th e p a t i e n t .
p ro ce d u re s, m e d ic a tio n s and terms t o
The p u b li c o p in io n t h a t th e l e a s t im p o r ta n t im prove­
ment f o r the nurse would be t o be more p r o f e s s io n a l in manner i s con­
s i s t e n t w i t h th e s tro n g b e l i e f t h a t th e nurse i s p r o f e s s i o n a l , as
re p o r te d under th e heading "S o c ia l P o s i t i o n . "
S a tis fa c tio n
The general le v e l o f p u b li c s a t i s f a c t i o n w it h o r f e e l i n g toward
the nurse was assessed thro ugh two p a r a l l e l q u e s tio n n a ir e items
(Appendix D, Items 37 and 38) t h a t d e a l t w i t h b a s ic l i k e s and d i s ­
l i k e s th e p u b li c may h o ld in regard to. th e n u rse .
In response to
th e ite m re g a r d in g p o s s ib le reasons f o r d i s l i k i n g th e n u rs e , the
m a j o r i t y o f respondents (67 per c e n t) chose the s ta te m e n t, " I cannot
t h i n k o f a n y th in g I d i s l i k e about n u r s e s . "
The p a r a l l e l q u e s tio n
e x p l o r in g what th e p u b li c m ig h t l i k e about nurses was responded to
most f r e q u e n t l y (34 per c e n t) w i t h "Nurses are s e n s i t i v e t o p a t i e n t s '
n e e d s ."
These data i n d i c a t e t h a t th e p u b li c g e n e r a lly l i k e s th e nurse
60
and -that a s i g n i f i c a n t p a r t o f th e p u b l i c bases t h i s f e e l i n g o f
s a t i s f a c t i o n on th e o p in io n t h a t nurses are s e n s i t i v e .
Table 18
In Response to th e Statem ent:
"NURSES SEEN ON TELEVISION SHOWS ARE VERY SIMILAR TO NURSES IN
REAL LIFE"
(n=91)
Value
Percentage
S t r o n g ly agree
4
4
Agree
7
3
M id p o in t,
26
2
Disagree
29
I
S t r o n g ly d is a g re e
34
5
.
MEAN VALUE
2 .2 Disagree
Table 19
Response t o th e Statem ent :
"NURSES IN REAL LIFE ARE FAR MORE INTELLIGENT THAN THOSE PORTRAYED
ON TELEVISION" (n=91)
Percentage
Value
5
S t r o n g ly agree
33
4
Agree
33
3
M id p o in t
22
2
Disagree
3
I
S t r o n g ly d is a g re e
9
MEAN VALUE
3 .8
Agree
61
Table 20
Response t o th e S tatem ent:
"NURSES SEEN ON TELEVISION SHOWS ARE MORE SEXUAL THAN THOSE IN
REAL LIFE "
(n=91)
Value
5
4
. Percentage
■ S t r o n g l y agree
. Agree
33
33
M id p o in t
2
Disagree
3
I
S t r o n g ly d is a g re e
9 .
MEAN VALUE
, ■
22
3
3 .8 Agree
I n t e r p r e t a t i o n o f th e data in d ic a t e ,
fe e l
it
media.
t h a t th e p u b li c does not
shares th e image o f the nurse as p o r tra y e d by th e t e l e v i s i o n
The p u b li c f e e l s t h a t the nurse i s more i n t e l l i g e n t and n o t •
as sexual as th e nurse p o rtra y e d by th e t e l e v i s i o n media.
Although
the p u b li c i s aware o f a d i f f e r e n c e between the re a l nurse as p e r­
c e iv e d by th e p u b l i c and th e t e l e v i s i o n nurse as p o r tra y e d by. the
m edia, th e data does n o t w a rra n t th e c o n c lu s io n t h a t th e t e l e v i s i o n
media has no i n f l u e n c e on the p u b l i c ' s p e rc e p tio n o f th e nurse.
T ra d itio n a l
Female Sex-Role E xp e c ta tio n s
V a rious types o f q u e s tio n n a ir e item s (Appendix D, Items 27
thro ugh 31) were u t i l i z e d t o e x p lo r e th e p u b li c f o r e x p e c ta tio n s o f
the nurse t h a t may be a t t r i b u t a b l e t o t r a d i t i o n a l
s te r e o ty p e s .
female s e x - r o le
A p a i r o f q u e s tio n s (Appendix D, Items 30 and 31) were
designed t o i d e n t i f y th e b e s t and l e a s t e x p la n a t io n s f o r fhe f a c t t h a t
62
most nurses are women.
n if ic a n t m a jo rity ,
" tra d itio n ."
From a l i s t o f ten p o s s ib le c h o ic e s , a v e ry s i g ­
(50 per c e n t) o f respondents chose th e response
T h is response was chosen o ver responses t h a t o f fe r e d
reasons why men d id n o t e n t e r n u r s in g as w e ll as o th e r reasons why women
d id
e n te r
n u r s in g .
The l e a s t b e st e x p la n a t io n , as chosen by 24 per
ce n t o f th e re s p o n d e n ts , was t h a t " o t h e r o p tio n s are n o t o f f e r e d to
young g i r l s
choosing c a r e e r s . "
The r e s u l t s o f a L i k e r t s c a le ques­
t i o n n a i r e ite m (Appendix D, Item 29) used t o assess th e s t r e n g th o f the
p u b li c b e l i e f in th e s ta te m e n t, "Women have a knack f o r n u r s in g t h a t
men do n o t have" are l i s t e d i n Table 21.
T ab le 21
Response t o the S tatem ent:
"WOMEN HAVE
A
KNACK FOR NURSING THAT MEN DO NOT HAVE"
Value
(n=91)
Percentage
5
S t r o n g ly agree
20
4
Agree
21
3
M id p o in t
25
2
D isagree
13
I
S t r o n g ly d is a g re e
21
MEAN VALUE
•
3 .1 M id p o in t
A n oth er q u e s tio n n a ir e ite m (Appendix D, Item 29) was u t i l i z e d to
f u r t h e r e x p lo r e th e p u b li c f o r a b e l i e f t h a t women may have some in h e r e n t
• q u a li t y , t h a t c o n t r ib u t e s t o n u r s in g a b i l i t i e s .
T h is was i n d i r e c t l y
e x p lo re d by comparing o p in io n s about male nurses t o o p in io n s about
63
female n u rse s.
Respondents had the ch o ice o f i n d i c a t i n g t h a t e i t h e r
male nurses were b e t t e r t h a n , equal t o , n o t as good a s , o r e q u a lly
good c l i n i c a l l y b u t n o t as compassionate as fem ale n u rs e s .
The
m a j o r i t y (67 per c e n t) o f th e respondents chose the sta te m e n t "Male
n u rs e s , in g e n e r a l, are e q u a ll y as good as female n u r s e s ."
One f i n a l
ite m in t h i s group (Appendix D, I t e m . 27) employed the
L i k e r t s c a le t o assess th e p u b l i c ' s p r e fe re n c e r e g a rd in g th e sex o f
t h e i r n u rse .
The r e s u l t s are l i s t e d in Table 22.
T a b !e 22
Response t o th e S tatem ent:
" I PREFER TO HAVE A FEMALE NURSE RATHER THAN A MALE NURSE" (h=91)
Value .
Percentage
S t r o n g l y agree ■
32
4
Agree
23
3
M id p o in t
21
2
Disagree
.10
I
S t r o n g ly d is a g re e
5
'
MEAN VALUE
14
3 .5 Agree
I n t e r p r e t a t i o n o f t h i s group o f d ata i n d ic a t e s t h a t th e p u b lic
does hold general e x p e c ta tio n s o f the nurse t h a t are r e l a t e d t o t r a ­
d i t i o n a l fem ale s e x - r o le e x p e c t a t io n s .
T h is i s evidenced by the a f f i r ­
m a tiv e , however n o t s t r o n g , response t o th e state m en t t h a t women have a
knack f o r n u r s in g .
The p u b li c d i r e c t l y c i t e d t r a d i t i o n as th e reason
t h a t n u r s in g i s p re d o m in a n tly a female p r o f e s s io n .
A lth o u g h the p u b li c
s ta te d t h a t male nurses in general are e q u a ll y as good as female n u rs e s .
64
th e general p re fe re n c e was f o r a female n u rse .
an e x p e c ta tio n t h a t the nurse w i l l
This im p lie s n o t o n ly
be female b u t t h a t t h i s female nurse
has something e x t r a t h a t causes the p u b li c to p r e f e r her t o an " e q u a lly
as good" male n urse.
A ttrib u te s
A group o f q u e s tio n n a ir e item s (Appendix D, Items 4 , 39, 40 and
46) were s t r u c t u r e d u s in g th e L i k e r t s c a le method t o assess the
s t r e n g t h o f a t t r i b u t e s t h a t are commonly assigned t o th e n u rs e .
These
p a r t i c u l a r a t t r i b u t e s were chosen by th e h ig h fre q u e n c y a t which th e y
appeared in th e i n t e r v i e w d a ta .
ness and warmth are i l l u s t r a t e d
Table 23
The s t r e n g th o f th e a t t r i b u t e s o f g e n t l e ­
in Tables 23 and 24.
.
ASSESSMENT OF GENTLENESS (n=91)
Value Category
Percentage
5
Very g e n tle
39
4
G entle
38
3
M id p o in t,
22
2
Rough
I
I
Very hough
0
MEAN VALUE
4 .1 G entle
65
Table 24
ASSESSMENT.OF WARMTH (n=91).
Value Category
Percentage
5
Very warm
22
4
Warm
51
3
M id p o in t
23
2
Cold
3
I
Very c o ld
I
MEAN VALUE
3 .9 Warm
Response t o state m en ts (Appendix D, Items 39 and 46) concerning
the general f e e l i n g o f s a f e t y w h ile in th e care o f a nurse and the
o p in io n t h a t nurses may become hardened in t h e i r work are i l l u s t r a t e d
in Tables 25 and 26.
Table 25
Response t o th e Statem ent:
" I FEEL VERY SAFE UNDER A NURSE'S CARE" (n=91)
Value
Category
Percentage
5
S t r o n g ly agree
23
4
Agree
36
3
M id p o in t
31
2
Disagree
8
I
S t r o n g ly d is a g re e
2
MEAN VALUE
3 .7 Agree
-
66
Table 26
R esponse'to th e Statem ent:
"NURSES BECOME HARDENED BY THE KINDS OF THINGS THEY SEE IN THEIR
WORK" (n'=91)
' '
Value
Percentage
5 ■
S t r o n g ly agree
,
4
Agree
32
3
M id p o in t
22
2
Disagree
24
I
S t r o n g ly d is a g re e
14
.
8
MEAN VALUE
3 .2 M id p o in t
I n t e r p r e t a t i o n o f t h i s group o f data i n d ic a t e s t h a t th e p u b lic
a ssig n s t o th e nurse th e a t t r i b u t e s o f warmth, conveyance o f a f e e l i n g
o f s a f e t y , g e n tle n e s s , and hardness.
I t f o ll o w s t h a t th e p u b li c expects
t h a t th e nurse does possess these a t t r i b u t e s .
A b r i e f d is c u s s io n o f
these a t t r i b u t e s . p o i n t s o u t th e dichotomous aspe ct o f th e n u r s e 's image.
The nurse i s warm, an a t t r i b u t e which r e q u ir e s an em otional e l e ­
ment.
Most i n t e r e s t i n g l y , th e nurse i s both g e n tle and hard.
The
dichotomous a spe ct o f th e n u r s e 's image i s f u r t h e r assessed by i n t e r p r e ­
t a t i o n o f th e f o l l o w i n g q u e s tio n n a ir e ite m .
Dichotomy o f th e Image
.
The e x is te n c e o f a dichotomous a sp e ct o f th e n u r s e 's image was
f u r t h e r e x p lo re d th ro u g h .a q u e s tio n n a ir e ite m (Appendix D, Item 4). t h a t
was designed and analyzed in such a manner t h a t . a n y e x i s t i n g dichotom y
- X
67
c o u ld be d is c o v e re d .
The ite m asked th e respondent to choose the two
b e st q u a l i t i e s o f
a good nurse from a l i s t t h a t l i s t e d s i x p o s s ib le
a t t r i b u t e s o f the
n urse.
t e c h n ic a l element
o f th e image and t h r e e o th e rs c o n s t i t u t e d an
em otional element
o f th e image.
on th e l i s t ;
Three o f th e p o s s ib le choices c o n s t i t u t e d a
The item s were n o t o v e r t l y c a te g o riz e d
th e y were l i s t e d a l p h a b e t i c a l l y .
The m a j o r i t y o f respondents (68 per c e n t) chose a p a i r o f items
t h a t c o n s t i t u t e d a dichotom y.
pe te n cy" and " s e n s i t i v i t y . "
The most f r e q u e n t l y chosen p a i r was "com­
T h is data f u r t h e r in d i c a t e t h a t some o f
the e x p e c ta tio n s t h a t compose the n u r s e 's image are dichotomous in
n a tu re in t h a t th e y r e p r e s e n t a t e c h n ic a l e x p e c ta tio n and an em otional
e x p e c ta tio n o f the n u rse .
Mental P ic t u r e
One f i n a l
group o f q u e s tio n n a ir e item s (Appendix D5 Items I , 2, 3
■
and 45) were designed and a d m in is te re d t o r e f l e c t mental p i c t u r e s o f
th e nurse as d e s c rib e d by th e p u b l i c .
I t i s im p o r ta n t t o emphasize a t
t h i s p o i n t t h a t these item s were v e ry c a r e f u l l y composed from the v e r ­
batim responses r e c e iv e d d u r in g the i n t e r v i e w phase.
I t i s a ls o im p o r­
t a n t t o note t h a t t h r e e o f these item s appeared as th e f i r s t th re e
item s on th e q u e s tio n n a ir e in o r d e r t h a t the respondent c o u ld record
f i r s t im p re ssio n s n o t in flu e n c e d by the rem ainder o f th e q u e s tio n n a ir e .
The respondent was f i r s t asked t o " P i c t u r e a n u rs e " (Appendix D,
Item I ) .
Of s i x c h o ic e s , th e m a j o r i t y (57 per c e n t) chose th e response "a
woman in a w h ite u n i f o r m . "
The respondent was then asked t o " P i c t u r e
68
th e nurse doing s o m e th in g ."
(Appendix Da Item 2 . )
Of e i g h t p o s s ib le
c h o ic e s , the most f r e q u e n t l y chosen response was " a d m in is t e r in g medica­
t i o n " (31 per c e n t ) .
The t h i r d
item (Appendix D, Item 3) asked the r e s ­
pondent t o re c o rd th e e x p re s s io n he o r she m e n t a lly p i c t u r e d on the
n u r s e 's fa c e .
A s i g n i f i c a n t m a j o r i t y (42 per c e n t) chose th e response
" c h e e r f u l " from e i g h t p o s s ib le c h o ic e s .
One f i n a l q u e s tio n n a ir e ite m (Appendix D, Item 45) was used to
d e s c r ib e th e mental p i c t u r e th e p u b li c has o f the n urse.
The respon­
den ts were asked t o choose from a l i s t o f 14 item s the two items t h a t
b e st d e s c rib e d th e n u rse .
The most f r e q u e n t l y chosen (38 per c e n t)
d e s c r i p t i o n o f th e nurse was " a s s i s t a n t t o a d o c t o r . "
In te rp r e ta tio n
o f t h i s group o f data d e s c rib e s th e nurse as a c h e e rfu l woman in a
w h ite u n ifo rm a d m in is t e r in g m e d ic a tio n and a s s i s t i n g th e d o c t o r .
REFERENCE GROUPS.
The image d e te rm in a n t component o f re fe re n c e groups was s tu d ie d by
d i f f e r e n t i a t i n g from th e p u b l i c , as a w h o le , those groups whose members
may hold a d i f f e r e n t image o f th e nurse i n response t o t h e i r vantage
p o in t.
T h is component was e x p lo re d p r i m a r i l y through th e c o l l e c t i o n o f
demographic d a ta .
T h is component was f u r t h e r e x p lo re d by i d e n t i f y i n g
those groups who have had v a r y in g degrees o f exposure t o th e nurse as
k in o f nurses o r who are nurses them selve s, o r by having been r e c i p i e n t s
o f n u rs in g c a re .
'69
In o r d e r t o determ ine whether o r n o t an i d e n t i f i e d group o f the
p u b li c c o n s t it u t e d , a r e f e r e n t group, each was compared t o th e p u b lic as
a whole in t h e i r responses t o q u e s tio n n a ir e ite m s .
T h is was accomplished
thro ugh th e data a n a ly s is method o f c r o s s - t a b u l a t i o n d e s c rib e d in the
prece d in g c h a p te r .
A group was accepted as a r e fe re n c e group when a
s i g n i f i c a n t d i f f e r e n c e was demonstrated between th e g ro u p s' response t o
a p a r t i c u l a r q u e s tio n n a ir e item and th e response Of the p u b li c as a
whole.
The le v e l o f co n fid e n c e t h a t was accepted as s i g n i f i c a n t f o r
t h i s stu d y was th e 0.10 co n fid e n c e le v e l because t h i s v a lu e was s t r o n g ly
in d ic a tiv e o f a tre n d .
The g r e a t m a j o r i t y o f comparisons were i n s i g n i f i c a n t .
The d is c u s ­
sio n o f r e fe re n c e groups i d e n t i f i e s those groups t h a t d id e x h i b i t a s i g ­
n i f i c a n t d i f f e r e n c e o f response from th e p u b li c as a w hole.
Male and Female
The d i v i s i o n o f th e sexes formed two re fe re n c e groups t h a t e x h ib it e d
a g r e a t e r number o f d i f f e r e n t p e r c e p tio n s from the p u b li c and each o t h e r
than any o t h e r re fe re n c e groups. D iff e r e n c e s were noted in o p in io n s r e g a r ­
ding th e degrees o f t r u s t and g e n tle n e s s a t t r i b u t e d t o th e nurse and
among o p in io n s re g a r d in g sexual r e p u t a t io n and t r a d i t i o n a l fem ale-sex
r o l e e x p e c ta tio n s o f th e nurse.
The s t r e n g th o f the a t t r i b u t e o f g e n tle n e ss was h ig h e r among females
than males.
More than tw ic e as many fem ales (70 per c e n t) than males
(30 per c e n t) assigned th e score o f " 5 " , e q u a ll in g " v e r y g e n t l e " w h ile
70
39 per c e n t o f th e p u b li c assigned th e same s c o re .
T h is f i n d i n g is
s t a t i s t i c a l l y s i g n i f i c a n t a t a c o n fid e n c e le v e l o f '0.0026.
Females a ls o assigned a h ig h e r score o f t r u s t t o th e nurse than
d id males.
The m a j o r i t y o f fem ale respondents (70 per c e n t) assigned
scores o f " 4 " and " 5 " .
The m a j o r i t y o f males
(60 per c e n t)
assigned scores o f "3 " and " 4 " , which d e s ig n a te scores more toward the
m id p o in t:
T h is f i n d i n g i s s i g n i f i c a n t a t a con fid e n ce le v e l o f
0.0816.
A lth o u g h both males and females d is a g re e t h a t nurses who are female
need t o be more c a r e f u l about t h e i r r e p u t a t io n than do females in gen­
e r a l , t h i s o p in io n i s s t r o n g e r among fem ales than males.
T h is i s e v i ­
denced by th e f i n d i n g t h a t th e m a j o r i t y o f females (75 per c e n t) ranked
t h e i r le v e l o f disagreem ent a t " I " and "2 " which d e s ig n a te d is a g re e and
s t r o n g l y d is a g r e e .
"2"
The m a j o r i t y o f males (60 per c e n t) had .scores o f
and " 3 " , which are more toward th e m id - p o i n t .
\ There e x i s t s a s i g n i f i c a n t d i f f e r e n c e between th e s t r e n g th o f o p in io n
h e ld by th e m a j o r i t y o f th e females (80 p e r c e n t) and t h a t o f the m a jo r ­
i t y o f th e males (80 per c e n t) re g a r d in g t h e s ta te m e n t, "Women have a
knack f o r n u r s in g t h a t men do n o t have.
The m a j o r i t y o f females chose
th e v a lu e o f " I " which d e sig n a te s t h a t th e y s t r o n g ly d is a g r e e .
The
m a j o r i t y o f males chose th e va lu e o f "2 " which d e s ig n a te s t h a t th e y d i s ­
agree.
T h is f i n d i n g was s i g n i f i c a n t a t th e 0.0148 l e v e l .
71
Age
The age group o f those age f i f t y
and o l d e r was i d e n t i f i e d as a
r e fe re n c e group based on th e s i g n i f i c a n t d i f f e r e n c e s noted in t h e i r
o p in io n s r e g a r d in g th e le v e l a t which th e nurse should be s u p e rv is e d .
The m a j o r i t y o f those age f i f t y
and o l d e r (70 per c e n t) agree t h a t the
nurse "sh o u ld always work under th e s u p e r v is io n o f a d o c t o r . "
This
v a r ie s from th e o p in io n o f th e general p u b li c as 67 per c e n t disagreed
w i t h th e sta te m e n t o r ra te d t h e i r response a t m id p o in t .
T h is f i n d i n g
i s s i g n i f i c a n t a t a c o n fid e n c e le v e l o f 0.0497.
Exposure
The o n ly o t h e r s i g n i f i c a n t r e fe re n c e group d isco ve re d was t h a t
composed o f k in o f n u rs e s .
In response t o a q u e s tio n n a ir e ite m (Appen­
d i x D, Item I ) t h a t d e s c rib e d mental p i c t u r e s o f th e n u rs e , those who
were k in o f nurses were more e ve n ly d iv id e d in t h e i r mental p i c t u r e o f
th e nurse as 35 per c e n t chose the response "a person h e lp in g a p a t i e n t "
and 45 per c e n t chose th e response "a woman in a w h ite u n i f o r m . "
Those
who were n o t exposed t o nurses th ro u g h r e l a t i o n possessed a s tro n g men­
t a l p i c t u r e o f a nurse as "a woman in a w h it e u n ifo rm " as evidenced by
th e f i n d i n g t h a t 64 per c e n t chose t h i s response.
The general p u b lic
chose t h i s response by a m a j o r i t y o f 57 per c e n t.
In te rp re ta tio n o f
these data in d ic a t e s t h a t those w i t h l i t t l e
nurse tend t o p e rc e iv e th e t r a d i t i o n a l
personal exposure t o the
"woman in a w h it e u n ifo rm " as the
image o f th e nurse more than does th e general p u b li c and much more than
those who have personal exposure t o th e n urse.
.72 '
COMPOSITE IMAGE
A com posite p i c t u r e o f . t h e p u b li c image o f the nurse i s describ e d
in t h i s s e c t io n .
T h is composite p i c t u r e i s drawn by a comprehensive
summary o f th e th r e e image d e te rm in a n t components o f s o c ia l p o s i t i o n ,
a t t r i b u t e s and e x p e c t a t io n s , and r e fe r e n c e groups as i n t e r p r e t e d e a r l i e r
in t h i s c h a p te r .
The n u rs e , as e x p l i c i t l y d e s c rib e d by th e p u b l i c , i s a c h e e rfu l
woman in a w h ite u n ifo rm who a s s i s t s th e d o c t o r .
T h is d e s c r i p t i o n i s
c o n s i s t e n t w i t h th e image t h a t i s i m p l i c i t in th e o v e r a l l f i n d i n g s o f
t h i s s tu d y in which th e nurse i s d e p ic te d in r e l a t i o n t o t r a d i t i o n a l
and female s e x - r o le s te re o ty p e s and in a dichotomous and s t a t i c manner.
The d is c u s s io n which f o l l o w s i l l u s t r a t e s th e image o f th e nurse as
determ ined by th e
com piled f i n d i n g s o f th e image d e te rm in a n t components.
There i s s tro n g concensus among th e p u b li c re g a r d in g th e s o c ia l
p o s i t i o n o r rank o f th e nurse in t h i s s o c i e t y .
The nurse i s a w e l l -
l i k e d , h i g h l y t r u s t e d , underpaid p r o f e s s io n a l.
The s u b j e c t iv e a s s ig n ­
ment o f th e nurse t o th e rank o f p r o f e s s io n a l i s based upon th e im pres­
sio n t h a t th e nurse i s competent o r s p e c ia liz e d r a t h e r than on l i c e n s u r e
o r e d u c a tio n a l c r i t e r i a .
The p u b l i c ' s p e r c e p tio n o f th e e d u c a tio n a l
c r i t e r i a o f th e nurse i s , a t l e a s t , s l i g h t l y in a c c u r a t e .
A lth o u g h co n sid e re d t o be a p r o f e s s i o n a l , the nurse i s n o t p e r ­
ce ive d t o be autonomous.
T h is i s e v id e n t in th e s tro n g a s s o c ia t io n
th e p u b li c draws between the nurse and th e d o c t o r .
The p u b li c c o n s is ­
t e n t l y a s s o c ia te s th e nurse w i t h th e d o c t o r and p e rc e iv e s th e d o c to r as
73
th e s u p e r v is o r y and l i a b l e p a r t y o f th e r e l a t i o n s h i p .
c a te
Data t h a t i n d i ­
t h a t th e p u b li c b e lie v e s th e n u r s e 's f i r s t r e s p o n s i b i l i t y to be
to th e p a t i e n t and th e d o c t o r , e q u a l l y , has m ajor i m p l i c a t i o n s r e g a r d ­
in g th e p e rc e iv e d autonomy o f th e n u rse .
T h is f i n d i n g i s compounded by
data i d e n t i f y i n g th e p u b li c b e l i e f t h a t th e d o c to r i s l i a b l e f o r the
n u r s e 's a c t io n s .
T h is b e l i e f lends w e ig h t t o P e r s o n e t t 's state m en t
t h a t th e t r a d i t i o n a l
image o f th e nurse "as a handmaiden t o the p h y s i­
c ia n i s outmoded and i l l e g a l " today
( P e r s o n e tt , 1 9 8 0 ).
The dependent p o s i t i o n o f th e nurse in r e l a t i o n t o th e d o c to r i s
e x p l i c i t l y d e s c rib e d by th e p u b li c in t h e i r choice o f " a s s i s t a n t t o th e
d o c t o r " as th e b e s t d e s c r i p t i o n o f th e n u rse .
T h is d e s c r i p t i o n i s con­
s i s t e n t w i t h th e d e s c r i p t i o n o f th e nurse as "handmaiden" and " p h y s i c ia n 's
a s s i s t a n t " t h a t i s p r e v a le n t in the c u r r e n t l i t e r a t u r e
( B e le tz
1974,).
(Time, 1 9 7 9 ),
The p u b li c b e l i e f t h a t th e nurse has changed in terms
o f in cre a se d l e v e l s o f knowledge, r e s p o n s i b i l i t y and a u t h o r i t y has n o t
eroded th e predom inant image o f th e nurse as an a s s i s t a n t t o th e d o c t o r .
There i s l i t t l e
evidence t h a t any im p o r ta n t change i n th e image o f th e
nurse has e v o lv e d .
The p e r s i s t e n t use o f th e word " w h it e " in d e s c r ip ­
t i o n o f th e nurse i s s t r o n g l y e v id e n t o f an unchanging image.
The f u n c t io n s th e p u b li c p e rc e iv e s ,a n d th e re b y expects th e nurse t o
p e rfo rm , f u r t h e r s u p p o rt th e r e s i l i e n t image o f th e nurse as "handm aiden."
The nurse i s expected t o help the d o c to r and f o l l o w th e d o c t o r 's o r d e r s .
The im p re ssio n o f th e female nurse respon ding t o the male d o c t o r 's o rd e rs
i s i n d i c a t i v e o f a theme t h a t i s dominant i n th e f i n d i n g s o f t h i s s tu d y ;
th e image o f th e nurse as determ ined by fem ale s e x - r o le s te r e o ty p e s .
74
Data t h a t in d i c a t e d t h a t nurses are expected t o " ta k e c a re " and "make,
th e p a t i e n t c o m fo r ta b le "
are in accordance w i t h th e fem ale s te re o ty p e
e x p e c ta tio n s t h a t " s e r v in g and n u r t u r i n g ( a re ) th e r o le s o f a l l women
so n u r s in g ( i s ) f e m in in e "
(Corea
nurse as a "fem a le n u r t u r e r "
1977).
( B e le tz
B e le tz a ls o d e s c rib e d the
1974).
The fe m in in e n a tu re o f
th e n u r s e 's image i s f u r t h e r su pp orted by the f i n d i n g s o f t h i s study
t h a t , a lth o u g h th e p u b li c f i n d s male nurses to be e q u a ll y as good as
fem ale n u rs e s , t h e r e i s a s tro n g p r e fe re n c e among th e p u b li c f o r female
n u rs e s .
There i s , t o some degree, a b e l i e f among members o f th e p u b li c
t h a t women have a knack f o r n u r s in g .
T h is f u r t h e r i d e n t i f i e s n u rs in g
as a t r a i t in h e r e n t t o women.
E a r l i e r s t u d ie s on th e image o f th e nurse p la c e much emphasis on
th e p e rc e iv e d sexual r e p u t a t io n o f th e n u rse .
■
U n lik e B i r d w h i s t e l l 's
f i n d i n g s in which th e p u b li c d e s c rib e d th e n u r s e 's sexual r e p u t a t io n in
comparison t o t h a t o f females in g e n e r a l, th e f i n d i n g s o f t h i s s tu d y
i n d i c a t e t h a t th e p u b li c does n o t d i s t i n g u i s h th e n u r s e 's sexual re p u ­
t a t i o n from t h a t o f fem ales in g e n e r a l.
The p r o b a b i l i t y t h a t th e p u b li c
responded in a s o c i a l l y a c c e p ta b le manner a l t e r s th e s u b s t a n t iv e i n t e r ­
p r e t a t i o n o f these d a ta .
B a s i c a l l y , the f i n d i n g s o f t h i s s tu d y assign fem ale t r a i t s
t o th e
n u r s in g p r o f e s s io n b u t do n o t d i f f e r e n t i a t e nurses from th e female popu­
l a t i o n as a whole.
Many o f th e a t t r i b u t e s t h a t th e p u b li c n o rm a lly
a ssig n s t o females are a ls o a t t r i b u t e d t o th e n u rse .
nurse t o be g e n t l e , warm, and s e n s i t i v e .
The p u b li c f i n d s
Id e n tific a tio n o f a ttrib u te s
the
75
le d t o d is c o v e r y o f th e dichotomous n a tu re o f th e n u r s e 's image.
Con­
s i s t e n t l y th ro u g h o u t th e d a ta , the nurse was d e s c rib e d in a dichotomous
manner.
Not o n ly d id th e nurse possess th e a t t r i b u t e o f g e n tle n e s s ,
b u t was a ls o co n sidered t o be hardened.
The e x p e c ta tio n s o f the nurse
t h a t c o n s is te d o f an em otional elem ent, such as warmth and c h e e rfu ln e s s ,
were u s u a ll y matched w i t h e x p e c ta tio n s t h a t c o n s is te d o f a t e c h n ic a l
e lem e nt, such as th e conveyance o f a f e e l i n g o f s a f e t y , and s p e c i a l i z a ­
tio n .
The dichotomous n a tu re o f th e n u r s e 's image i s p a r t i c u l a r l y e v i ­
d e n t i n th e p u b l i c ' s c h o ic e o f competency and s e n s i t i v i t y as th e b e st
p a i r o f q u a l i t i e s a good nurse possesses. T h is f i n d i n g i s c o n s is te n t
w i t h B e n to n 's i d e n t i f i c a t i o n o f th e dichotomous n a tu re o f th e n u r s e 's
image in which th e nurse i s expected t o possess both "sympathy and
u n d e rs ta n d in g " and "common sense and an a l e r t mind
(Benton
1979).'
Simmons, whose th e o r y pro vid e d th e conceptual framework o f t h i s
s tu d y , n o t o n ly d e s c rib e d a dichotomous image, b u t a ls o th e o r iz e d t h a t
th e p r o fe s s io n "shows th ro u g h " on i t s membership by way o f symbols.
A cco rding t o t h i s s tu d y , th e p u b li c does, t o some degree, f e e l t h a t th e
members o f th e p r o f e s s io n are r e c o g n iz a b le .
The data suggest,
t h a t one
symbol by which th e n u r s in g p r o fe s s io n i s r e c o g n iz a b le i s t h a t i t s mem­
b e rs h ip i s t y p i f i e d as h e lp e r s .
Simmons' concept o f r e fe re n c e groups p ro vid e d a s i g n i f i c a n t v a r i a ­
t i o n o f th e n u r s e 's image as p e rce ive d by th e i d e n t i f i e d r e fe re n c e
groups o f m ales, fe m a le s , k in o f n u rs e s , and i n d i v i d u a l s o l d e r than age
fifty .
I d e n t i f i c a t i o n o f a group as a r e fe re n c e group was accepted a t
76
th e 0 .10 le v e l o f s i g n i f i c a n c e .
Kin o f nurses held a s l i g h t l y d i f f e r ­
e n t image o f th e nurse than th e p u b l i c as a whole i n t h a t th e y were ■
le s s a p t t o d e s c r ib e th e nurse as woman in a w h ite u n ifo rm than was. th e •
general p u b l i c .
fifty
The re fe re n c e groups composed o f people o l d e r than age
h e ld a s tro n g vie w t h a t th e nurse should always work under the
s u p e r v is io n o f a d o c t o r .
T h is o p in io n was in disagreeance w it h t h a t o f
th e general p u b l i c .
The r e fe r e n c e groups composed o f males and fem ales e x h i b i t e d th e
g r e a t e s t number o f d i f f e r e n c e s from each o t h e r and th e p u b li c as a
w hole. ' Females ra te d nurses h ig h e r in terms o f t r u s t and gen tle n e ss
than d id m ales.
Females a ls o more s t r o n g l y d is a g re e d than d id males
and -the general p u b l i c . w i t h th e s ta te m e n t,"F e m a le nurses need t o be
more c a r e f u l about t h e i r r e p u t a t io n than do females in g e n e r a l. "
O ther than th e d i f f e r e n t p e r c e p tio n s c i t e d in r e l a t i o n t o i d e n t i f i e d
r e fe r e n c e groups, th e image o f th e nurse as d e s c rib e d in t h i s stu d y
s u p p o rts th e themes o f th e l i t e r a t u r e r e v ie w .
image i s n o t changing.
( B e le tz
nurse and d o c to r remains and
rem ains.
197 4.)
As B e le tz s t a t e s , th e ■
The s tro n g a s s o c ia t io n between .
th e r e s u l t i n g low degree o f nurse autonomy
The i n t e r e s t i n g dichotom y o f both t e c h n ic a l and em otional
elements e x i s t s .
Most im p o r t a n t l y , th e r e i s s tro n g evidence t h a t the
image o f th e nurse p a r a l l e l s th e image o f the fe m a le .
SUMMARY
T h is c h a p te r r e p o r te d a n a ly s is and i n t e r p r e t a t i o n o f the d a ta .
Data were r e p o r te d in terms o f th e image d e te rm in a n t components
77
t o which th e y corresponded.
The c h a p te r concluded w it h a summary o f
th e i n t e r p r e t a t i o n o f th e image d e te rm in a n t components in which a com­
p o s it e image o f the nurse was d e s c rib e d .
CHAPTER SIX
DISCUSSION
SUMMARY AND CONCLUSIONS
The purpose o f t h i s s tu d y was t o d e s c r ib e the p u b li c image o f the
n u rse .
The research problem i s s i g n i f i c a n t t o th e n u r s in g p r o fe s s io n
as i t responds t o th e c u r r e n t p r o t e s t o f th e p o r t r a y a l o f th e nurse as
c i t e d by th e l i t e r a t u r e .
Review o f th e l i t e r a t u r e i d e n t i f i e s m ajor f a c ­
t o r s composing th e n u r s e 's image.
Most prom inent in th e l i t e r a t u r e i s
th e d is c u s s io n o f th e image o f th e nurse in r e l a t i o n t o t r a d i t i o n a l and
fem ale s e x - r o le s te r e o ty p e s .
Emphatic in th e c u r r e n t l i t e r a t u r e i s a
charge t o th e n u r s in g p r o f e s s io n t o change th e image.
T h is stu d y des­
c r ib e s th e e x i s t i n g image, th e re b y p r o v id in g a knowledge base from which
f u r t h e r re se a rch and change can be ge n e ra te d .
T h is s tu d y was e x p l o r a t o r y - d e s c r i p t i v e in d e s ig n .
The conceptual
framework o f t h i s s tu d y was based upon a t h e o r y o f image d e te r m in a tio n
developed by Leo Simmons.
image d e t e r m in a t io n .
Simmons presen ted s i x r e l a t e d concepts o f
Three o f these co nce pts, s o c ia l p o s i t i o n , a t t r i ­
butes and e x p e c t a t io n s , and r e fe re n c e groups, were the image d e te r m i- .
nant components upon which th e s tu d y was based.
These concepts were opera
t i o n a l iz e d and s ta te d as q u e s tio n s which were presented i n an e x p lo r a ­
t o r y surve y.
The m ethodology o f t h i s s tu d y in c lu d e d th e necessary stage o f t o o l
development.
Tool development was.accom plished thro ugh th e u s e .o f the
79
i n t e r v ie w i n g method o f data c o l l e c t i o n .
Key in fo rm a n ts o f th e general
p u b li c were in te r v ie w e d f o r the purpose o f i d e n t i f y i n g common o p in io n s
and p u b li c usage o f te rm in o lo g y f o r in c o r p o r a t i o n on th e r e s u l t i n g
re se a rch t o o l .
The research t o o l was a q u e s tio n n a ir e developed by the
re s e a rc h e r and designed t o e x p lo re a sample o f the p u b li c in terms o f
th e th r e e image d e te rm in a n t components.
Data were c o l l e c t e d by random
su rvey o f r e s id e n t s o f M issoula County, Montana.
Data were f i r s t i n t e r ­
p re te d in terms o f th e th r e e image d e te rm in a n t components.
The f i n d ­
ings were then drawn t o g e t h e r t o form a composite d e s c r i p t i o n o f the
image o f th e n urse.
The com posite image o f the nurse was found to be c o n s i s t e n t w it h
th e m a jo r themes o f th e re v ie w o f th e l i t e r a t u r e in t h a t th e nurse was
d e s c rib e d in r e l a t i o n t o t r a d i t i o n a l and female s e x - r o le s te re o ty p e s
and in a dichotomous and s t a t i c manner.
The p u b li c (random survey)
d e s c rib e s th e nurse as a w e l l - I ik e d , h i g h l y - t r u s t e d , y e t underpaid
p ro fe s s io n a l.
autonomous..
Q u ite
i m p o r t a n t ly ,
th e nurse i s n o t p e rc e iv e d to be
T h is f i n d i n g i s based on data t h a t s t r o n g l y p o r t r a y s th e
nurse i n a p o s i t i o n dependent to th e d o c t o r .
nurse i s t r a d i t i o n a l
Such a p o r t r a y a l o f the
i n n a tu re and i s evidence o f r e s is t a n c e o f the
image to change.
D e s c r ip t io n o f th e nurse in a dichotomous manner i s p e r s i s t e n t
th ro u g h o u t th e d a ta .
The nurse i s expected to s im u lta n e o u s ly e x h i b i t
em otional elements such as s e n s i t i v i t y and t e c h n ic a l elements such as
competency.
C e r ta in aspects o f th e image o f the nurse a c t u a l l y
80
c o n s t i t u t e a double b in d in which th e nurse m u s V e x i s t .
T h is i s e v i ­
dent in th e e x p e c ta tio n s t h a t the nurse possess th e a t t r i b u t e s o f both
g e n tle n e ss and h a rd n e ss, and most e s p e c i a l l y e v id e n t in th e im pression
t h a t th e nurse i s a p r o f e s s i o n a l , y e t possesses l i t t l e
autonomy.
The most p r e v a le n t f i n d i n g o f th e s tu d y i s th e p u b l i c ' s d e s c r ip ­
t i o n o f the nurse in a manner t h a t p a r a l l e l s th e female image.
The
p u b li c c o n s i s t e n t l y r e f e r r e d t o th e nurse as female and assigned t o th e
nurse a t t r i b u t e s such as warmth, g e n tle n e s s , and s e n s i t i v i t y , t h a t are
g e n e r a ll y assigned to fem ales in t h i s s o c i e t y .
The dependent p o s i t i o n
t h e p u b li c a s s ig n s th e nurse in r e l a t i o n . t o the d o c to r r e f l e c t s the
tra d itio n a l
r o l e o f the female in t h i s s o c i e t y .
The p re fe re n c e o f the
p u b li c toward having a female nurse i s s u g g e s tiv e o f e x p e c ta tio n s t h a t
are r e l a t e d t o female s e x - r o le s t e r e o ty p e s .
The f i n d i n g s o f t h i s s tu d y
are b e s t summarized by th e c o n c lu s io n t h a t th e p u b li c d e s c rib e s the
nurse as a " c h e e r fu l woman in a w h ite u n ifo rm who a s s i s t s the d o c t o r . "
LIMITATIONS
The r e s u l t s o f t h i s s tu d y are n o t g e n e r a li z a b l e .
A lth o u g h the
research t o o l p ro v id e s f o r fa c e v a l i d i t y and a p i l o t s tu d y was conduc­
t e d , the t o o l
has n o t been t e s te d f o r r e l i a b i l i t y .
A l s o , th e sample
was n o t o f a s iz e s u f f i c i e n t t o produce g e n e r a liz a b le r e s u l t s .
The c o n c lu s io n s o f th e s tu d y are l i m i t e d in t h a t th e s tu d y r e s ­
ponds o n ly t o th e th r e e image d e te rm in a n t components o f Simmons'
th e o r y t h a t were o p e r a t i o n a l iz e d and s t a te d as fo rc e d c h o ic e q u e s tio n s
81
in an e x p l o r a t o r y s u rve y.
The s tu d y d id n o t accommodate r e la t e d e l e ­
ments o f Simmons' th e o r y t h a t could be determ ined o n ly th ro u g h compara­
t i v e s t u d ie s between the n u r s e 's p e r c e p tio n and th e p u b l i c ' s p e rc e p tio n
o f th e n urse.
A lth o u g h th e sample was randomly s e le c te d , the method o f data c o l ­
le c tio n ,
in which q u e s tio n n a ir e s were m a ile d t o M issoula households,
d id n o t a llo w f o r r e p r e s e n t a t io n o f a d o le s c e n ts and c h i l d r e n o r people
w i t h o u t te le p h o n e s .
The q u e s tio n n a ir e medium may a ls o have i n h i b i t e d
p a r t i c i p a t i o n o f persons whose i n t e r e s t i s n o t r a is e d by t h i s form o f
survey and those who do n o t have adequate l i t e r a c y s k i l l s .
There e x i s t s th e p o s s i b i l i t y t h a t tho se who r e tu rn e d the ques­
t i o n n a i r e may have responded in a s o c i a l l y a c c e p ta b le manner t o some
o f th e q u e s tio n n a ir e c o n te n t.
T h is p o s s i b i l i t y ,
in a d d i t i o n t o the
f a c t t h a t th e i n t e r v i e w e r and r e s e a rc h e r was i d e n t i f i e d t o the p u b lic
as a n u rs e , may have i n h i b i t e d candid responses th e re b y in t r o d u c in g
b ia s i n t o th e d a ta .
The m a j o r i t y o f th e data were analyzed by com putation o f fre q u e n ­
c ie s o f responses.
The data used t o i d e n t i f y r e fe re n c e group s, how­
e v e r , were analyzed th ro u g h c r o s s - t a b u l a t i o n and com putation o f a c h i square t e s t .
The le v e l o f s i g n i f i c a n c e chosen f o r t h i s s t u d y , 0 .1 0 ,
was a p p r o p r ia t e t o th e e x p l o r a t o r y design o f the s tu d y as i t was used
t o i d e n t i f y t r e n d s , and should be in t e r p r e t e d o n ly as a b a s is f o r gen­
e r a t i n g h y p o th e s is t e s t i n g s t u d ie s .
82
IMPLICATIONS AND' RECOMMENDATIONS
The i m p l i c a t i o n s o f th e p u b li c image o f th e nurse f o r th e n u rs in g
p r o f e s s io n are g r e a t .
those who p e rc e iv e i t "
I t must be emphasized t h a t th e "image i s re a l t o
(Simmons
1 96 2).
The serio u sn e ss o f t h i s
sta te m e n t i s a p p a re n t when a p p lie d t o th e f i n d i n g o f t h i s s tu d y t h a t
th e nurse i s
to r."
"a c h e e r fu l woman in a w h ite u n ifo rm who a s s i s t s the doc­
I t i s c l e a r t h a t th e p r o f e s s io n o f n u r s in g cannot w ith s ta n d the
r o l e d is c re p a n c ie s t h a t can r e s u l t from such an image.
The p u b li c image o f th e nurse i n j u r e s the p r o f e s s io n in many
ways.
I t decreases u t i l i z a t i o n o f th e nurse in p r o v id in g comprehensive
h e a lt h care as i t
c a re .
p o r t r a y s th e nurse as in c a p a b le o f p r o v id in g such
The image places the nurses in a double bind s i t u a t i o n by a s s ig n ­
in g th e r e s p o n s i b i l i t i e s o f a p r o f e s s i o n a l , y e t denying th e autonomy
and a u t h o r i t y needed t o meet th e r e s p o n s i b i l i t i e s .
The nurse cannot
s u c c e s s f u l ly f u n c t i o n in a r o l e t h a t has in c o m p a tib le e x p e c t a t io n s .
The
p r o f e s s io n cannot change t o meet th e changing h e a lth care needs o f the
consumer i f
th e image remains s t a t i c . ■ The p r o fe s s io n cannot r e c r u i t
and o b t a in " i n t e l l i g e n t and a r t i c u l a t e males and fe m a le s ; i n t o the p r o ­
f e s s io n " w i t h th e u n a t t r a c t i v e image t h a t now p r e v a i l s .
(,NLN, 1981).
The image o f th e nurse i s s e r i o u s l y impeding th e p r o f e s s io n o f n u r s in g .
I t i s recommended t h a t th e knowledge base p ro vid e d by t h i s study
be used t o g en erate f u r t h e r s tu d ie s aimed a t changing th e image o f the
n u rse .
The f i n d i n g s o f t h i s stu d y may be u t i l i z e d in com parative s t u d ie s
used t o dete rm in e the degree o f impediment th e image has on th e
83
p r o f e s s io n .
The r e s u l t s o f t h i s s tu d y may a ls o be u t i l i z e d t o i d e n t i f y
those f a c t o r s t h a t preserve the image, th e re b y i d e n t i f y i n g t a r g e t s f o r
change.
Most i m p o r t a n t l y , th e c o n c lu s io n s o f t h i s s tu d y should be
u t i l i z e d t o add w e ig h t to a r e c e n t l y proposed r e s o l u t i o n o f th e N a tio n a l
League f o r N ursing t o "la u n c h a campaign t o improve th e p u b li c image
o f th e n u r s in g p r o fe s s io n " (NLN 1981).
LIST OF REFERENCES
LIST OF REFERENCES
A s h le y , Jo Ann.
H o s p it a l s , P a te r n a lis m , and th e Role o f th e Nurse.
Teachers C o lle g e P ress, Columbia U n i v e r s i t y , New Y ork, New York,
1976.
B e le t z , E la in e .
" I s N u r s in g 's P u b lic Image Up To Date?"
O u tlo o k , J u l y , 1974, 22:432,435.
N ursing
Benton, Denise.
"You Want To Be A W hat?"' N u rsing O u tlo o k , June,
1979, pp. 388-393.
B i r d w h i s t e l l ,R. S o c ia l Science and N ursing E d u c a tio n , Some T e n t a t iv e
S u ggestio ns.
F i f t y - N i n t h Annual Report o f N a tio n a l League f o r
N ursing E d u c a tio n , New Y ork, N . L . N . E . , 1947.
Community S e rv ic e s A d m i n is t r a t i o n Human Resources O f f i c e , M is s o u la , Mon­
ta n a .
P e rs o n a l. com munication. May 13, 1981.
Corea, Gena. The Hidden M a lp r a c t ic e , How American M edicine M is t r e a ts
Women. W illia m Morrow and Company, In c .
Chapter 3,
"Female
H e a lth W o rk e rs ," pp. 6 4-82 , 1977.
County C l e r k 's O f f i c e , M is s o u la , Montana.
6 , 1981.
Personal com m unication. May
D e u ts c h e r, I r w i n .
A Study o f th e R e g is te re d Nurse in a M e tr o p o lita n
Community.
Kansas C i t y , M i s s o u r i , Community S t u d ie s , I n c . , as
re p o r te d by Simmons and Henderson, 1957, p. 179.
Elms, Rdslyn R. and Jean M. Moorehead. " W i l l th e ' R e a l ' Nurse Please
Stand Up; th e S te re o ty p e v s. R e a l i t y . "
N ursing Forum, XVI,
No. 2, 1977.
F a g in , C l a i r e M.
"N u rses' R i g h t s . "
Janu a ry, 1975, p. 82.
American Journal o f N u rs in g ,
G ladw in, Mary E.
E t h ic s : A Textbook f o r N urses.
W.B. Saunders Company, 1937.
2nd E d . , P h ila d e lp h ia
H a s s in g e r, Edward W. and L a r r y W h it in g , Eds.
Rural H e a lth S e r v ic e s :
O r g a n iz a tio n , D e liv e r y and Use. Ames, Iowa: Iowa S ta te U n iv e r s it y
P ress, 1976.
H o s p it a l s .
p. 72.
" T e l e v is i o n i s Used in Nurse R e c ru itm e n t,"
J u ly I ,
1980,
86
K e lle y , Lucy Young.
D im e n s io n s -o f P r o fe s s io n a l N u r s in g .
York: M a c m illa n , 1975.
=
T
Kesey, Ken.
1962.
One Flew OVef th e Cuckoo's N est.
3rd Ed.
New
New York: V ik in g Press,
Kramer, M arlene.
R e a l i t y Shock, Why Nurses Leave N u rs in g .
C.V. Mosby Company, 1974.
S t. L o u is :
Lindeman, C a ro l.
D e lph i Survey, P r i o r i t i e s w i t h i n th e H e a lth Care
System. American Academy o f N u rs in g , D r a f t R e p o rt, 1979.
Unpublished Study.
Muhlenkamp, A . F. and J . L . Parsons.
" C h a r a c t e r i s t i c s o f N u rses: An
Overview o f Recent Research P u b lis h e d in a N ursing Research
P e r i o d i c a l , 1972." Journal o f V o c a tio n a l B e h a v io r , J u l . '7 2 , 2 : 2 6 1 - 2 7 3 .
N a tio n a l League f o r N u rs in g . R e s o lu tio n s o f May, 1981 C onvention.
N ie , Norman, H a dla i C. H u l l , Jean G. J e n k in s , K a rin S te in b re n n e r
and Dale H. Bent.
SPSS, S t a t i s t i c a l Package f o r th e S o c ia l
S c ie n c e s . 2nd Ed. New York: McGraw H i l l Book Company, 1975.
N i g h t in g a le , F lo re n c e .
Notes on N u r s in g . Branden Systems Press, I n c . ,
1970.
1860 V e rte x , P r in c e to n , New Y o rk, London.
H o t t e r , L u c i l l e , E . , Eugenia Kennedy S p a ld in g .
P ro fe s s io n a l N u r s in g :
F o u n d a tio n s, 1976 P e rs p e c tiv e s and R e la t io n s h ip s .
9 th Ed.
P h ila d e l p h i a :
J .B . L ip p e n c o tt Company, 1976.
Peeples and F r a n c is .
" S o c ia l- P s y c h o lo g ic a l O bsta cles t o E f f e c t i v e
H e a lt h . " Team P r a c t ic e .
N ursing Forum, 7 ( 1 ) , 1968, pp. 28-37.
P e r s o n e tt , J u d i t h D.
"Abuse, Poor Image Causes S h o r ta g e ."
H e a lth C a re , J u l y , 1980, pp. 92 and 99.
Modern
R i c h t e r , L a u r e lt o n and E liz a b e t h R i c h t e r .
"Nurses i n F i c t i o n . "
' American Jo u rn a l o f N u r s in g , J u l y , 1974, pp. 1280-1281.
R o b e rts , Joan I . and T h e tis M. Group.
"The Women's Movement and
N u r s i n g . " N u r s i n g ' Forum, V o l. X l I , No. 33, 1973, pp. 303-327.
Rudov, M .H ., ,M.T. W ilson and K.F. T r o c h i . "High School S e n io r s ' A t t i ­
tudes o f 1976 and Concepts o f N u rsin g as a P r o f e s s io n , " U.S.
Dept, o f HEW, January 1976,' DHEW Pub. # (HRA) 76-35.
■87
Simmons, Leo W. "P a s t and P o t e n t ia l Images o f th e N u rs e ."
Forum. Summer, 1962, pp. 16-33.
Nursing
'
and V i r g i n i a H e n d e rs o n .' N u rsing R e s e a rc h :' A Survey and
' Assessment. New York: M e re d ith P u b lis h in g Company, pp. 167-223,
1964.
S p ra d ley, James P. The E t h n o g ra p h ic ' I n t e r v i e w .
W inston, 1979.
H o l t , R in e h a rt and
Strom b erg, M a r i ly n .
" R e la t io n s h ip s o f Sex Role I d e n t i t y t o Occupa­
t i o n a l Image o f Female Nursing S t u d e n t s . " N ursing Research,
S e ptem ber-O ctober, 1976, V o l . 25, No. 5 , pp. 363-369.
S u lliv a n , J u d ith A ., C h ris ty
"Overcoming B a r r i e r s t o
N u rsin g P r a c t i t i o n e r . "
b e r , 1978, V o l. 68, No.Time Magazine.
62-63.
A. Dachele t , H a rry A. S u it s and M arie Henry.
th e Employment and U t i l i z a t i o n o f the
American Journa l o f P u b lic H e a lt h , Novem­
11, pp. 1097-1102.
" R e b e llio n Among th e A n g e ls ."
August 27, 1979, pp.
Webster and Merriam.
W ebster's Seventh New C o ll e g ia t e D i c t i o n a r y .
G.& C. S p r i n g f i e l d , Mass.: Merriam Company, 1970.
APPENDICES
89
APPENDIX A
December 17, 1980
Dear S ir o r Madam:
I am a r e g is te r e d nurse on the Montana S ta te U n iv e r s ity School o f
N u rsin g F a c u lty , M isso u la Campus.
I am c u r r e n t ly c o n d u c tin g a survey
as p a r t o f my th e s is work and am a skin g you to p a r t ic ip a t e in t h is survey
by a llo w in g me to in te r v ie w you.
The purpose, o f t h is s tu d y is to des­
c r ib e th e p u b lic image o f th e n u rse .
In o rd e r to o b ta in in fo r m a tio n from w hich to c o n s tr u c t a q u e s tio n ­
n a ir e f o r use in t h is s tu d y , I am f i r s t c o n d u c tin g random in te rv ie w s
w ith M isso u la r e s id e n ts .
I chose to speak to you s im p ly because you are
in one o f th e d e s ig n a te d areas in which I planned to in te r v ie w people.
T h is in te r v ie w , sh o u ld you decide to p a r t ic ip a t e , w i l l
tw e n ty m inutes o f y o u r tim e .
Your p a r t ic ip a t io n
ta k e about
is c o m p le te ly v o lu n ta r y .
Your d e c is io n on w h eth er o r n o t to p a r t ic ip a t e and y o u r sta te m e n ts made
d u rin g t h is in te r v ie w w i l l have a b s o lu te ly no b e a rin g on any f u tu r e p ro ­
fe s s io n a l r e la t io n s h ip between you and m y s e lf.
I s in c e r e ly want y o u r
honest o p in io n s on t h is s u b je c t.
A lth o u g h I w i l l ask q u e s tio n s about you and y o u r o p in io n s , I w i l l n o t
a t any tim e , need to know n o r want to know y o u r name.
I w i l l ask t h a t you
keep a copy o f t h is , l e t t e r which in c lu d e s my name and a number where I
can be reached shou ld you w ish to c o n ta c t me in reg a rd to t h is s tu d y .
Your tim e is g r e a t ly a p p re c ia te d .
S in c e r e ly ,
E lle n Leahy, R .N ., I n s t r u c t o r
Montana S ta te U n iv e r s ity School o f N u rsin g
616 Eddy A v e ., M is s o u la , Mt.
90
APPENDIX B
In te rv ie w e e P r o f ile
I.
male
fem ale
2.
O ccupation ____________________________________________________ ;
3.
Are you or. are you r e la te d to a nurse o r p h y s ic ia n ? ________
4.
Age
5.
Area o f re s id e n c e in town (must be a M isso u la r e s id e n t f o r
_____
s ix m o n th s ).
6.
Range o f Income ( c i r c l e o n e ):
le s s than $7,000 per y e a r
7.000 to 10,000 per y e a r
10.000 to 15,000 per y e a r
15.000 to ZO3OOOvper y e a r
20.000 to 25,000 p e r y e a r
g re a te r than 25,000 per y e a r
7. ■ R e lig io u s a f f i l i a t i o n ________________________________
8.
N a t i o n a l i t y ______________________ ____________________
9.
Have you e v e r re c e iv e d n u rs in g care? _________ .
I f y e s , e x p la in w here, d u r a tio n and c irc u m s ta n c e s :
10.
How do you fe e l about th e n u rs in g care you re c e iv e d ?
11.
H ig h e s t le v e l o f e d u c a tio n com ple te d. _______________
91
In te rv ie w Schedule
I..
What is th e f i r s t th in g t h a t comes to mind when I say the word
nurse?
2.
What do nurses do? (Prom pt: What k in d o f th in g s do you th in k
th e y do?)
3.
What o th e r th in g s do nurses do?
4.
What is th e most im p o rta n t th in g .n u rs e s do?
5.
, What is th e le a s t im p o rta n t th in g nurses do?
6.
What do nurses do most o f?
7.
What do nurses do le a s t o f?
8.
What k in d s o f th in g s sh o u ld nurses do?
9.
What k in d s o f th in g s should nurses n o t
do?
10.
What o th e r th o u g h ts come to y o u r mind when you t h in k o f a nurse?
11.
Can you id e n t i f y a nurse?
12.
Do you t h in k t h a t c e r ta in types o f people go in t o n u rsin g ?
Who? Why?
13.
What do you l i k e about nurses?
14.
What do you d i s l i k e about nurses?
15.
Are th e re d i f f e r e n t kin d s o f nurses o r d i f f e r e n t le v e ls o f
n u rs in g ? What are they?
16.
Why do you t h in k most nurses are women?
How?
i
17.
What k in d o f nurses do men make?
18.
What is a "good" nurse?
19.
D e scrib e th e nurse p o rtra y e d on t e le v is io n .
20.
Do you t h in k nurses are r e a l l y l i k e those on t e le v is io n ?
are th e y th e same o r d i f f e r e n t .
21.
Do you t h in k nurses are much d i f f e r e n t to d a y than th e y were ten
ye a rs ago?
Why n o t o r in what ways?
22.
Who is th e nurse re s p o n s ib le to
23.
Do you t r u s t nurses?
24.
Are nurses p ro fe s s io n a ls ?
25.
What does th e term p r o fe s s io n a l mean to you?
26.
What do you t h in k about th e e d u c a tio n a nurse must go through?
27.
What do you t h in k about what nurses re c e iv e as w a g e s/h o u rs/
b e n e fits ?
28.
P ic k one word o r phrase t h a t b e s t d e s c rib e s th e n u rse .
29.
Is th e re a n y th in g e ls e you care to comment on o r ask a t t h is
tim e?
How
(fo r) f ir s t?
Why o r why not?
93
APPENDIX C
Montana S ta te U n iv e r s ity
School o f N u rsing
M isso u la E xte n sio n
616 Eddy Avenue
M is s o u la , Montana 59812
January 22, 1981
Dear S ir o r Madame:
As a gra d u a te s tu d e n t in n u r s in g , I am c u r r e n t ly c o n d u c tin g a stu d y
re g a rd in g th e p u b lic image o f th e n u rs e .
I have a s in c e re in t e r e s t
in y o u r o p in io n s re g a rd in g t h is s u b je c t.
T h e re fo re , I am a s k in g you
to please spend about 15 to 20 m inutes to f i l l o u t th e enclosed
q u e s tio n n a ir e .
Your name was chosen a t random from th e M isso u la te le p h o n e d ir e c t o r y ,
and has been used o n ly to m ail you t h i s l e t t e r .
Your name w i l l n o t
be used f u r t h e r in any way in t h is s tu d y .
I w i l l have no way o f
knowing who re tu rn e d w hich q u e s tio n n a ir e .
Al I q u e s tio n n a ire s re tu rn e d by F ebruary 6 , 1981, w i l l be used in t h is
s tu d y .
Should you have any q u e s tio n s o r comments w ith re g a rd to the
s tu d y o r i f you care to re c e iv e a copy o f th e r e s u lt s o f t h is s tu d y ,
please e n clo se a s e p a ra te note when you r e tu r n the q u e s tio n n a ir e .
I w i l l a p p re c ia te i t v e ry much i f you would f i l l o u t t h is q u e s tio n ­
n a ire and r e tu r n i t in th e s e lf-a d d re s s e d , stamped envelope t h a t is
e n clo se d .
Thank you v e ry much f o r y o u r c o o p e ra tio n .
S in c e r e ly ,
\
E lle n Leahy
Telephone:
243-6515
94
APPENDIX D
PLEASE FILL OUT THE FOLLOWING INFORMATION SHEET.
1.
How lo n g have you liv e d in Montana?
(
(
(
2.
)
)
Yes
No
)
)
)
)
)
)
)
N orthw e st
Southwest
C e n tra l
New England
S outheast
N o rth e a s t
I f u n c e rta in o f above b o u n d a rie s , please s p e c ify th e
s t a te :
Mark th e ite m below t h a t d e s c rib e s th e area in which you
re s id e d f o r most o f th e f i r s t 12 y e a rs o f y o u r l i f e .
. (
(
5.
Less th a n f i v e ye a rs
' Five to te n ye a rs
More than te n ye a rs
I f n o t, in what p a r t o f th e c o u n try d id you spend most o f th e
f i r s t 12 y e a rs o f y o u r l i f e ?
(
(
(
(
(
(
(
4.
)
)
)
Are you a n a tiv e Montanan?
(
(
3.
THANK YOU.
)
)
Urban
Rural (a town w ith a p o p u la tio n o f le s s than 2,500 OR
o u t in open c o u n try )
Mark ONE o f th e fo llo w in g item s t h a t a p p lie s to y o u r re s id e n c y .
(R e sid e n cy, f o r t h is s tu d y , in c lu d e s o n ly c u r r e n t r e s id e n ts who
have liv e d in MISSOULA COUNTY f o r a t le a s t s ix m onths.
(
(
(
)
)
)
W ith in M isso u la c i t y l i m i t s
O u tsid e M isso u la c i t y l i m i t s , BUT w it h in M isso u la County
I am n o t a r e s id e n t o f M isso u la County
95
6.
AGE:
(
)
(
)
(
)
( )
(
)
(
)
(
)
(
)
Less th a n
21 to 30
31 to 40
41 to 50
51 to 60
61 to 70
71 to 80
More than
7.
(
(
Female
Male
8.
OCCUPATION:
)
)
20 ye a rs o ld
80 ye a rs o ld
Please s p e c ify :
9.
RANGE OF ANNUAL INCOME:
(
(
(
(
(
(
(
10.
)
)
)
)
)
)
)
Less than $5,000 per y e a r
■ $5,000 to $10,000 per y e a r
$10,000 to $15,000 p e r y e a r
$15,000 to $20,000 per y e a r
$20,000 to $25,000 per y e a r
$25,000 to $30,000 per y e a r
More than $30,000 per y e a r.
RELIGIOUS PREFERENCE:
Please s p e c ify : ___________________
11.
Are you a n u rs e , o r are you r e la te d to a nurse?
( , )
(
)
Yes
No
12.
I f y e s , please s p e c ify th e r e la t io n o f t h is nurse to you.
13.
Have you e v e r been taken care o f by a nurse?
(
(
)
)
Yes
No
96
14.
I f y e s , p lease s p e c ify th e s e t t in g ( s ) which a p p ly :
(
(
(
(
(
(
(
(
(
15.
)
)
)
)
)
)
)
)
)
___
Mark w ith an X ALL o f th e ite m s below t h a t a p p ly to y o u r s it u a ­
t io n a t th e tim e ( s ) t h a t you re c e iv e d n u rs in g c a re .
( )
( )
( )
( )'
( j
( )
( ')
( )
( )
( )
( )
16.
H o s p ita liz e d
Emergency room
O u tp a tie n t
D o c to r's o f f i c e
Home
Community agency
Independent nurse c l i n i c
Place o f o ccu p a tio n
O th e r:
' _______________________
L ife - t h r e a te n in g c o n d itio n
S e rio u s il ln e s s
S e rio u s in ju r y
M ajor s u rg e ry
M inor s u rg e ry
M in o r i n ju r y o r illn e s s
M ental h e a lth concerns
Tests
D e liv e ry o f baby
R o utine h e a lth m aintenance
I have c lo s e ly accompanied my c h ild o r c lo s e f r ie n d o r
r e la t iv e d u rin g th e s it u a t io n s th a t I have in d ic a te d
above.
In g e n e r a l, how do you fe e l abo ut th e n u rs in g ca re you
re c e iv e d ?
( C ir c le one)
GOOD
5
.
4
3
2
I
BAD
I t is VERY IMPORTANT to th e r e s u lt s o f t h i s stu d y t h a t you read th e
q u e s tio n s in th e o rd e r t h a t th e y are p r in t e d .
I t is a ls o v e ry im p o rta n t t h a t you read th e q u e s tio n FIRST and RESPOND
TO IT IN YOUR OWN MIND BEFORE re a d in g th e responses g iv e n to choose
fro m .
PLEASE RECORD YOUR FIRST IMPRESSION.
THANK YOU FOR YOUR COOPERATION!
/
97
1.
PICTURE A NURSE
Which ONE o f th e fo llo w in g item s most c lo s e ly resem bles th e
v e ry FIRST p ic tu r e t h a t you saw in y o u r mind?
(
(
(
(
(
(
2.
)
)
)
)
)
)
A woman in a w h ite u n ifo rm
, A person h e lp in g a d o c to r
A person h e lp in g a p a t ie n t
A woman h e lp in g a d o c to r
A woman h e lp in g a p a t ie n t
O th e r:
PICTURE THE NURSE DOING SOMETHING
W ith t h is p ic tu r e in y o u r m ind, f in d ONE ite m on th e l i s t th a t
BEST d e s c rib e s what the nurse is d o in g .
(The item s are in
a lp h a b e tica l o r d e r . )
(
(
(
(
(
(
(
(
3.
)
)
)
)
)
)
)
)
A d m in is te rin g m e d ic a tio n
Changing lin e n o r bedpan
C o m fo rtin g someone
C ounseling someone
H e lp in g a d o c to r
H e lp in g a p a tie n t
T aking someone's p u lse and te m p e ra tu re
O th e r:
~______________________________________________
PICTURE THE EXPRESSION ON THE NURSE'S FACE
The EXPRESSION on th e face o f th e nurse in y o u r mind is BEST
d e s c rib e d by w hich ONE o f th e f o llo w in g :
(
(
(
(
(
(
(
(
)
)
)
)
)
)
)
)
A lo o f
C h e e rfu l
C o n c e n tra tin g
Concerned
Harsh
Im p a tie n t
S te rn
S ym pathetic
98
4.
IMAGINE THAT YOU ARE THE NURSE'S PATIENT
C ir c le th e number on th e continuum t h a t b e s t in d ic a te s how you
■ im agine th e n u rs e 's MANNER to be tow ard you w h ile w o rkin g ,
w ith you.
GENTLE
5.
4
3
2
1
ROUGH
Of th e f o llo w in g ite m s , p lease choose th e one t h a t you fe e l is
th e MOST IMPORTANT th in g t h a t a nurse does and w r it e the number
I in th e b ra c k e ts n e x t to t h a t ite m ; w r it e a 2 in th e second
most im p o rta n t ite m , and c o n tin u e l i k e t h i s u n t i l you have
chosen th e f i f t h (5 ) most im p o rta n t ite m .
(
(
(
(
(
(
(
(
(
(
(
(
(
6.
5
)
)
)
)
)
)
)
)
)
)
)
)
)
A c t as an advocate f o r th e p a t ie n t
A d m in is te r m e d ic a tio n s
. Always be th e re
Change bedpans, change lin e n s , and cle an up
C o n tin u a lly assess th e p a t ie n t 's s ta tu s
C ontinue t h e i r n u rs in g e d u c a tio n
F o llo w d o c t o r 's o rd e rs
Give in fo r m a tio n to p a tie n ts
Handle em ergencies
Help p re v e n t illn e s s
Make th e p a t ie n t c o m fo rta b le
R e lie v e pain
Take ca re o f th e whole person
Now, r e f e r back to th e above l i s t and mark an X n e x t to the
LEAST im p o rta n t ite m .
C ir c le th e ONE number on each continuum in th e fo llo w in g s e rie s t h a t
BEST in d ic a te s y o u r fe e lin g s in response to the fo llo w in g q u e s tio n s .
How much do you t r u s t NURSES in g e n e ra l?
TRUST
5
4
3
2
I
DISTRUST
2
I
DISTRUST
How much do you t r u s t DOCTORS?
TRUST
5
. 4
3
99
'9.
How much do you t r u s t MALE NURSES?
• TRUST
10.
5
4
3
2
1
DISTRUST
On th e fo llo w in g l i s t , place a I n e x t to th e ite m t h a t you fe e l
TAKES UP MOST OF THE NURSE'S TIME, and c o n tin u e r a t in g t h is l i s t
by number, a c c o r d in g ly , u n t i l you have placed a 5 n e x t to y o u r
f i f t h c h o ic e .
(
(
(
(
(
(
(
)
)
)
)
)
)
)
(
(
(
(
)
)
)
)
(
(
)
)
A d m in is te rin g m e d ic a tio n s
A nsw ering p a t ie n ts ' and p a t ie n t s ' f a m ilie s ' q u e s tio n s
A sse ssing th e p a t ie n t 's s ta tu s
Checking on t h e i r p a tie n ts
C heering up p a tie n ts
H e lp in g th e d o c to r w ith e xa m in a tio n s and tre a tm e n ts
Making d e c is io n s t h a t are d i r e c t l y concerned w ith p a t ie n t
ca re
S u p e rv is in g o th e r nurses
T a lk in g to p a t ie n ts , o n e -to -o n e
Teaching p a tie n ts and p a t ie n t s ' f a m ilie s
Tending to th e m achinery o r p a ra p h e rn a lia in v o lv e d
w ith c a r in g f o r p a tie n ts
W orking d i r e c t l y w ith th e p a tie n ts
W r itin g on c h a rts
11.
REFER BACK TO THE ABOVE LIST AND MARK AN X NEXT TO THE ITEM
THAT TAKES THE LEAST PORTION OF THE NURSE'S TIME.
12.
LOOK AGAIN AT THE ITEM ABOVE THAT YOU CHOSE AS NUMBER ONE.
-Do you t h in k t h is ite m
(
(
13.
)
)
SHOULDta k e
up most
o f a n u rs e 's tim e?
Yes
No
You now have an o p p o r tu n ity to make some su g g e s tio n s to nurses
co n c e rn in g th in g s th e y should im prove upon.
Please p la ce a I n e x t to th e MOST IMPORTANT IMPROVEMENT nurses
sh o u ld make, from th e l i s t below . C ontinue to ra n k th e item s
u n t i l you mark a 5 n e x t to y o u r f i f t h c h o ic e .
(
(
)
)
Be more p ro fe s s io n a l in t h e i r manner
Be k in d e r andf r i e n d l i e r
to t h e i r p a tie n ts
100
(
)
(
(
(
(
)
)
)
)
(
)
Stand up f o r those th in g s t h a t are in th e b e s t in te r e s t s
o f th e p a t ie n t 's h e a lth
In cre a se t h e i r knowledge
In cre a se t h e i r s k i l l
Pay more a t te n tio n to th e p a t ie n t
Make more d e c is io n s t h a t d i r e c t l y in v o lv e th e care o f
th e p a t ie n t
H o n e s tly e x p la in a l l p ro c e d u re s , m e d ic a tio n s , and terms
to th e p a t ie n t .
14.
REFER BACK TO THE ABOVE LIST AND MARK AN X NEXT TO THE LEAST
IMPORTANT ITEM.
15.
To whom is th e nurse FIRST RESPONSIBLE?
Choose o n ly ONE from th e l i s t below .
(
(
(
(
(
16.
■
17.
P a tie n t
D o ctor
Head nurse
N u rs e 's e m p lo ye r, whomever i t may be
P a tie n t and d o c to r , e q u a lly .
Do
you
( )
( )
Yes
No
t h in k t h a t nurses are p ro fe s s io n a ls ?
Choose ONE o f th e fo llo w in g t h a t BEST d e fin e s what th e word
" p r o f e s s io n a l" means to you.
(
(
(
(
(
(
(
18,
)
)
)
)
)
)
)
)
)
)
)
)
H ig h ly tr a in e d
Competent
D edicated
Passed exams necessary to re c e iv e a lic e n s e to p r a c tic e
S p e c ia liz e d in t h e i r work
Educated in t h e i r f i e l d o f work
A c o lle g e graduate
Do you t h in k t h a t nurses are DIFFERENT today than th e y were te n
y e a rs ago?'
( )
Yes
(
)
No
101
19.
NURSES HAVE MORE KNOWLEDGE TODAY THAN THEY DID TEN YEARS AGO.
( C ir c le one)
STRONGLY
AGREE
20.
5
5
STRONGLY
DISAGREE
1
4
3
2
I
STRONGLY
DISAGREE
5
4
3
2
I
STRONGLY
DISAGREE
Has th e Women's R ig h ts Movement had any e f f e c t on n u rs in g ?
(
(
23.
2
NURSES HAVE MORE AUTHORITY TODAY THAN THEY DID TEN YEARS AGO.
STRONGLY
AGREE
22.
3
NURSES HAVE MORE RESPONSIBILITY TODAY THAN THEY DID TEN YEARS
AGO.
STRONGLY
AGREE
21.
4
)
)
Yes
No
I f you answered YES to th e p re v io u s q u e s tio n , please c i r c l e th e
number t h a t BEST in d ic a te s y o u r o p in io n o f th e fo llo w in g
s ta te m e n t.
THE WOMEN'S RIGHTS MOVEMENT HAS AFFECTED NURSING IN A POSITIVE
WAY.
STRONGLY
AGREE
24.
5
4
3
2
I
STRONGLY
DISAGREE
Which ONE o f th e fo llo w in g is most tr u e f o r you?
(
)
(
)
(
)
(
)
I can t e l l i f someone is a nurse ju s t by lo o k in g a t him /
h e r , even w ith o u t a u n ifo rm .
Sometimes a f t e r t a lk in g to o r w a tch in g someone, I can
t e l l t h a t t h a t person is a n u rse .
When someone t e l l s me t h a t he/she is a. n u rs e , I f in d
t h a t I am n o t s u r p r is e d .
I do n o t fe e l t h a t you can t e l l
th e way th e y lo o k o r a c t.
i f someone is a nurse by
102
(
)
Even in a w h ite u n ifo rm , some people do n o t lo o k l i k e
nurses', to me.
The f o llo w in g s ta te m e n ts may r e f l e c t p o s s ib le sexual t r a i t s
r e la t io n t o th e image o f n u rs e s .
in
C ir c le th e number t h a t BEST in d ic a te s y o u r o p in io n o f th e fo llo w in g
s ta te m e n ts .
Please be as honest as you can; I s in c e r e ly want y o u r
o p in io n .
25.
FEMALE NURSES ARE GENERALLY MORE PROMISCUOUS THAN FEMALES, IN
GENERAL
STRONGLY
AGREE
26•
5
I
STRONGLY
DISAGREE
5
4
3
2
STRONGLY
DISAGREE
, 1
5
4
3
2
I
STRONGLY
DISAGREE
Which ONE o f th e fo llo w in g is most tr u e f o r you?
(
(
)
)
(
(
29.
2
I PREFER TO HAVE A FEMALE NURSE RATHER THAN A MALE NURSE
STRONGLY
AGREE
28.
3
MALES THAT ARE NURSES' HAVE A TENDENCY TOWARD HOMOSEXUALITY
STRONGLY
AGREE
27.
, 4
)
)
Male n u rs e s ,
in g e n e ra l, a re b e t t e r
Male n u rs e s ,
in g e n e ra l, are e q u a lly
nurses
Male nurses are as good c l i n i c a l l y com passionate as fem ale n u r s e s .
Male n u rs e s , in g e n e ra l, are n o t as
C ir c le th e number t h a t
in g s ta te m e n t.
than fem ale nurses
as good as fem ale
b u t are n o t as
good as fem ale nurses
BEST in d ic a te s y o u r o p in io n o f th e f o llo w
WOMEN HAVE A KNACK FOR NURSING THAT MEN DO NOT HAVE
STRONGLY
AGREE
5
4
3
2
I
STRONGLY
DISAGREE
103
30.
Mark a I n e x t to th e ite m t h a t BEST EXPLAINS WHY MOST NURSES ARE
WOMEN. Place a 2 n e x t to th e n e x t b e s t reason, and so on, u n t il
you have p la ce d a 5 n e x t to th e ite m t h a t is the f i f t h b e s t
e x p la n a tio n .
(
)
(
(
(
(
)
)
)
)
(
)
(
(
)
)
(
(
)
)
Men may be a f r a id to e n te r n u rs in g because th e y may be
c o n s id e re d e ffe m in a te
Men cann ot make i t on a n u rs e 's s a la ry
N u rsin g f i t s th e fem ale s te re o ty p e
Women have m o th e rly i n s t i n c t s
Women have taken care o f c h ild r e n , and t h is t r a in s them
f o r n u rs in g
Women need a jo b th e y can go back to a f t e r r a is in g a
f a m ily
Women are n a t u r a lTy more com passionate than men
Women cannot g e t in t o m edical school as e a s ily as males
can
T r a d itio n
O the r o p tio n s are n o t o ffe r e d to young g i r l s choosing
c a re e rs
31.
REFER BACK TO THE ABOVE LIST AND MARK AN X NEXT TO THE ITEM
THAT IS THE LEAST BEST EXPLANATION.
32.
Choose ONE c a te g o ry t h a t you t h in k is c lo s e s t to th e h o u rly
wage earned by th e average nurse w o rk in g in M isso u la County
( )
( )
( )
( )
( )
( )
( )
(■ (
$3.00 an hour
$4.00 an hour
$5.00 an hour
$6.00 an hour
$7.00 an hour
$8.00, an hour
$9.00 an hour
$10.00 an hour
Do you t h in k t h a t nurses a re :
(
(
(
)
)
)
(Choose one)
U nderpaid
Paid as much as th e y sh o u ld be paid
O verpaid
104
C ir c le th e number in each o f th e f o llo w in g sta te m e n ts t h a t BEST
in d ic a te s y o u r o p in io n o f each s ta te m e n t.
34.
NURSES SEEN ON-TELEVISION SHOWS ARE VERY SIMILAR TO NURSES IN
REAL-LIFE,
STRONGLY
AGREE
35.
4
3
2
I
STRONGLY
DISAGREE
NURSES IN REAL-LIFE ARE FAR MORE INTELLIGENT THAN THOSE POR­
TRAYED ON TELEVISION,
STRONGLY
AGREE
36.
5
5
4
3
2
I
STRONGLY
DISAGREE
NURSES SEEN ON TELEVISION SHOWS ARE MORE SEXUAL THAN THOSE IN
REAL-LIFE
STRONGLY
AGREE
5
4
3
2
1
STRONGLY
DISAGREE
37. ' Which ONE o f th e fo llo w in g BEST s ta te s what you LIKE about
nurses?
(
(
(
(
(
(
38.
)
)
)
)
)
)
I fe e l sa fe under th e care o f a nurse
Nurses a re th e re when you need them
Nurses are e a s ie r to t a l k to than d o c to rs
Nurses are f r i e n d l y
Nurses are s e n s itiv e to p a t ie n t s ' needs
I do n o t l i k e nurses
Which ONE o f th e f o llo w in g BEST s ta te s what you DISLIKE about
nurses?
(
(
(
(
(
(
)
)
)
)
)
)
I do n o t fe e l sa fe under th e care o f a n u r s e .
Nurses a re n o t always th e re when you need them
Nurses are o fte n in t im id a t in g - - n o t easy to t a l k to
Nurses are u n f r ie n d ly
Nurses are in s e n s itiv e
I cann ot t h in k o f a n y th in g t h a t I d i s l i k e about nurses
105
39.
C ir c le th e number t h a t BEST in d ic a te s y o u r o p in io n in re g a rd to
th e fo llo w in g sta te m e n t
I FEEL VERY SAFE UNDER A NURSE'S CARE
STRONGLY
AGREE
40.
3
2
STRONGLY
DISAGREE
1
5
4
3
2
1
COLD
Place X 's b e sid e TWO o f th e f o llo w in g item s t h a t you fe e l are
th e TWO BEST QUALITIES o f a GOOD Nurse.
(
(
(
(
(
(
42.
4
C ir c le th e number on th e s c a le t h a t BEST in d ic a te s y o u r f e e l ­
in g s re g a rd in g th e manner o f a nurse
WARM
41.
5
)
)
)
)
)
)
Competency
E f f ic ie n c y
I n te llig e n c e
P a tie n ce
S e n s it iv i t y
U n dersta ndin g
C ir c le th e number t h a t b e s t in d ic a te s y o u r o p in io n about the
f o llo w in g s ta te m e n t co n ce rn in g a n u rs e 's OFF-DUTY HOURS.
A FEMALE NURSE NEEDS TO BE MORE CAREFUL ABOUT HER REPUTATION
THAN DO WOMEN IN GENERAL
STRONGLY
AGREE
43.
5
4
3
2
I
STRONGLY
DISAGREE
Of th e f o llo w in g , which ONE BEST d e s c rib e s th e TYPE o f person
t h a t d e cides to e n te r th e n u rs in g p ro fe s s io n ?
(
(
(
(
(
)
)
)
)
)
Compassionate
In te re s te d in h e a lth care
M o th e rly
Wants to h e lp people
Unable to go th ro ugh m edical school
106
44.
Rank th e fo llo w in g nurses a c c o rd in g to th e amount o f e d u ca tio n
re q u ire d to o b ta in t h e i r t i t l e s .
Place a I n e x t to the one
r e q u ir in g th e MOST amount o f e d u c a tio n .
(
(
(
(
(
(
45.
)
)
)
)
)
)
R e g is te re d N urse, M a s te r's Degree
R e g is te re d N urse, B a c h e lo r's Degree
Licensed P r a c tic a l N urse, no degree
R e g is te re d N urse, A s s o c ia te Degree
R e g is te re d N urse, diplom a
R e g is te re d N urse, Ph.D.
Of th e fo llo w in g words and p h ra se s, p la ce X 's b eside th e TWO
ite m s th a t BEST DESCRIBE A NURSE.
(
(:
(
(
(
(
(
)
)
)
)
)
)
)
Angel o f mercy
. A s s is ta n t to a d o c to r
Competent
D edicated
F rie n d
Hardened
Hel per
(
(
(
(
(
(
(
.
H ig h ly s k i l l e d
M o th e rly
P ro fe s s io n a l
R e lia b le
S trong
S ym pathetic
U n derstanding
)
)
)
)
)
)
)
C ir c le th e number t h a t b e s t in d ic a te s y o u r o p in io n o f each o f the
f o llo w in g s ta te m e n ts .
46.
NURSES BECOME HARDENED BY THE KINDS OF THINGS THEY SEE IN
THEIR WORK
STRONGLY
AGREE
47.
4
3
2
STRONGLY
DISAGREE
1
NURSES SHOULD ALWAYS WORK UNDER THE SUPERVISION OF A DOCTOR
STRONGLY
AGREE
48.
5
5
4
3
2
STRONGLY
DISAGREE
1
NURSES ARE CAPABLE OF WORKING INDEPENDENTLY IN HEALTH CARE .
STRONGLY
AGREE
5
4
3
2
I
STRONGLY
DISAGREE
107
49.
Who sh o u ld be h e ld re s p o n s ib le i f a p a tie n t is harmed as a
r e s u lt o f a n u rs e 's c a r ry in g o u t a d o c to r 's o rd e r?
(Choose
ONLY ONE)
(
(
(
(
50.
)
)
)
)
D o ctor
Nurse
Both
O th e r:
I f you have any q u e s tio n s o r comments, please w r it e them below ,
o r c o n ta c t me as in d ic a te d in th e accompanying l e t t e r .
THANK YOU VERY MUCH FOR YOUR COOPERATION
,1.dS^Ptive Studv n f, . . . .......
RL
1762 OOl694iTo
N378
LU72
cop.2
Leahy, Ellen M
Mescriptive study of
the public image of the
nurse
DATE
IS S U E D
TO
/ £ A i v'
-
/
Y
Z
S
k'
^ V . .i, V "
H ^ y w ^ v r ,
NSM
I
iH X
-iJ ^