The views of Montana State legislators on nurses, nursing, and health care
by Linda Kay Adkins
A thesis submitted in partial fulfillment of the requirements for the degree of Master of Nursing
Montana State University
© Copyright by Linda Kay Adkins (1985)
Abstract:
The initial problem identified for this study was the lack of power among nurses and in the nursing
profession when dealing with health care issues in this country. One method of acquiring more power,
as identified in the literature review, is to build grass roots political support for nursing and health care
issues, especially health care promotion. The goal in this process is to bring about, by planned change,
increased support from local legislators. The conceptual framework for this study was Rappsilber's
persuasion-change model for nurses. The initial step in utilizing this model requires an assessment of
the target audience, which in this study was the 1983 Montana State Legislature. A questionnaire was
developed to assess the attitudes and opinions of the 150 legislators on the issues of nurses, nursing,
and health care. The questionnaire was administered and the 98 that were returned were tabulated
according to frequency and cross tabulated with the demographic data. The results identified a strong
support base for nurses and nursing issues, especially baccalaureate level of entry into nursing. The
other significant outcome was a frequent lack of knowledge among those legislators of the roles of
nurses and current problems and issues in nursing and health care. Related to the conceptual
framework, one significant conclusion was that nurses should use the informational method of
persuasion strategy with the legislature in order to bring about planned change and support for nursing
issues. The other major outcome showed the need for nursing to increase its networking and public
awareness of modern day nursing's place in the health care system. THE VIEWS OF MONTANA STATE LEGISLATORS
ON NURSES, NURSING, AND
HEALTH CARE
by
LINDA KAY ADKINS
A th e sis submitted in p a rtia l f u lf illm e n t
o f the requirements f o r the degree
of
Master o f Nursing
MONTANA STATE UNIVERSITY
Bozeman, Montana
August 1985
W A IN U B .
CI
APPROVAL
o f a th e sis submitted by
Linda Kay Adkins
This th e sis has been read by each member o f the the sis committee
and has been found to be s a tis fa c to ry regarding content, English usage,
form at, c ita tio n s , b ib lio g ra p h ic s ty le , and consistency, and is ready
fo r submission to the College o f Graduate Studies.
C
Date
La,-
Chairperson, Graduate Committee
Approved fo r the Major Department
Head, Major Department
Approved fo r the College o f Graduate Studies
Date
Graduate Dean
■Hi
STATEMENT OF PERMISSION TO USE
In presenting th is
th e sis
in p a r tia l
f u lf illm e n t o f the re q u ire ­
ments fo r a m aster's degree a t Montana State U n iv e rs ity ,
the L ib ra ry s h a ll
L ib ra ry .
B rie f
make i t
quotations
a v a ila b le
from
to
th is
I agree th a t
borrowers under ru le s o f the
th e sis
are
allow able
w itho ut
special perm ission, provided th a t accurate acknowledgment o f source is
made.
Permission fo r extensive quotation
from or reproduction
o f th is
th e sis may be granted by my major pro fe sso r, on in her absence, by the
D ire c to r o f L ib ra rie s when, in the opinion o f e ith e r , the proposed use
o f the m a teria l
is fo r s c h o la rly purposes.
Any copying or use o f the
m a teria l in th is th e sis fo r fin a n c ia l gain sh a ll not be allowed w itho ut
my w ritte n perm ission.
^
6/
'
iv
TABLE OF CONTENTS
Page
1.
2.
3.
4.
OVERVIEW........................................................... ■ ........................................
I
Id e n tific a tio n and Discussion o f the Problem ........................
Purpose ..............................................................................................
D e fin itio n o f T e r m s ..........................................................
S ig n ifica n ce o f the Study ...........................................................
Assumptions ......................................................................................
I
2
2
3
4
LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK ...................................
5
In tro d u c tio n ......................................................................................
L ite ra tu re Review .......................
S um m ary......................................................
Conceptual Framework ......................................................................
5
5
13
13
METHODOLOGY..............................................................................................
18
Overview ..............................................................................................
Research Design ..............................................................................
P rotection o f Human Rights ...........................................................
Population and S ettin g ..................................................................
Development o f Research T o o l.......................................................
V a lid ity and R e lia b ilit y ...............................................................
Data C o lle ctio n Method ..................................................................
Data Analysis M e th o d s .......................................................
. .
S um m ary..............................................................................................
18
18
19
19
19
29
29
30
30
RESULTS..............................................................
O ve rvie w ...................................................
P o p u la tio n ..........................................................................................
Demographic D a ta ..............................................................................
Age and S e x ............................'..................................................
P o litic a l Background........................... ... . . ....................
E d u c a tio n ..................................................................................
Geographical Background .......................................................
Primary Occupation ..........................................
Health Related B a c k g ro u n d ...................................................•
Knowledge o f Health Care Resources ...................................
A ttitu d e s and Opinions/Data Results .......................................
31
31
31
32
32
32
33
33
34
34
35
35
V
TABLE OF CONTENTS — Continued
Page
5.
C o rre la tio n s . . . . . . . .
........................ . . . . . . . .
O v e rv ie w ................................................... ........................... ... .
Age and S e x ......................................................................
P o litic a l P arty, Philosophy, and Years in O ffic e . . .
Education and Occupation .....................................................
Montana Natives and Rural Background ................................
A ssociation w ith N u r s e s ...................................
S um m ary...........................
43
43
44
46
47
49
51
52
DISCUSSION ........................................................'..........................................
53
* ...........................
O v e rv ie w ...............................................
In te rp re ta tio n o f D a ta ...............................
Demographics..................................................................
A ttitu d e s and O p in io n s .......................................
The Image o f the N u rs e ................ ... ......................................
The Economics o f Nursing . . . . . ......................................
S p e cia lty Areas in N u rs in g ...........................
Nursing Education . . ...........................................
Professional ism in Nursing ....................................................
Nursing and P o l i t i c s ........................... ....................... ... . .
Consumer Health C a re ...........................
The Role o f the Nurse ............................................................
R elationship to Conceptual Framework . . . . . . . . . . .
Im p lic a tio n s fo r Nursing . . . ....................................................
L i m i t a t i o n s .......................................................................................
Suggestions f o r Future Research . . . . . .
........................
S um m ary...............................................................................................
53
54
54
55
55
56
56
56
57
58
58
59
59
60
62
63
64
REFERENCES CITED.......................................................
65
APPENDIX
67
......................................................................................
Sample o f Q u e s tio n n a ir e ...........................
. .
....................
68
vi
LIST OF TABLES
Page
1. OCCUPATIONS................................................... ...
. ........................ ...
.
34
2. HOME COUNTY HEALTH CARE RESOURCES...................................................
35
3. ATTITUDES AND OPINIONS........................................... ............................
- Part I
........................................................... . . . .
Part I I
........................................................... ........................... .... .
36
36
37
. 4. RANKING OF NURSING R O L E ........................... ............................... ...
5. RANKING OF STRIKE CAUSES . . . . . . . . .
38
....................................
6. CAUSES OF A NURSING SHORTAGE . . . . . . . .
................ ...
7. ROLES OF NURSES..................................................................................
38
39
.
39
8. ENTRY INTO PRACTICE...............................................................................
40
9. FUNDING
. ...............................................................
10. ISSUES IN HEALTH CARE
........................ ...
11. TEACHING WELLNESS PROMOTION
. . . . . . . . .
I . . . . . .
40
.
41
...............................................................
41
v ii
LIST OF FIGURES
Page
I.
RAPPSILBER'S PERSUASION - CHANGE MODEL FOR NURSES
17
v iii
A bstra ct
The i n i t i a l problem id e n tifie d fo r th is study was the lack o f power
among nurses and in the nursing profession when dealing w ith health care
issues in th is country.
One method o f a cq u irin g more power, as iden­
t i f i e d in the lit e r a t u r e review , is to b u ild grass roots p o lit ic a l
support fo r nursing and health care issue s, e s p e c ia lly health care
promotion.
The goal in th is process is to brin g about, by planned
change, increased support from lo ca l le g is la to r s .
The conceptual
framework fo r th is study was RappsiI b e r's persuasion-change model fo r
nurses. The i n i t i a l step in u t i l i z i n g th is model re q u ire s .an assessment
o f the ta rg e t audience, which in th is study was the 1983 Montana State
L e g is la tu re . A questionnaire was developed to assess the a ttitu d e s and
opinions o f the 150 le g is la to rs on the issues o f nurses, nursing , and
health care. The questionnaire was adm inistered and the 98 th a t were
returned were tabulated according to frequency and,cross tabulated w ith
the demographic data. The re s u lts id e n tifie d a strong support base fo r
nurses and nursing issues, e s p e c ia lly baccalaureate le v e l o f e n try in to
nursing. The other s ig n ific a n t outcome was a frequent lack o f knowledge
among those le g is la to rs o f the ro le s o f nurses and c u rre n t problems and
issues in nursing and health care. Related to the conceptual framework,
one s ig n ific a n t conclusion was th a t nurses should use the info rm a tiona l
method o f persuasion stra te g y w ith the le g is la tu re in order to bring
about planned change and support fo r nursing issues. The oth er major
outcome showed the need f o r nursing to increase it s networking and
p u b lic awareness o f modern day n u rs in g 's place in the health care
system.
I
CHAPTER I
OVERVIEW
Id e n tific a tio n and Discussion o f . the Problem
Professional nurses today are being c o n tin u a lly encouraged to u n ite
to become a more powerful fo rce in .th e area o f health care p o lic y in
th is country (A iken, 1981).
As the la rg e s t group o f health care pro vid ­
e rs, one would expect them to have the g reate st in flu e n c e , but th is has
not been the case.
U n til re c e n tly , nurses have, f o r the most p a rt, ignored th is aspect
o f t h e ir professional ism, i f they even viewed nursing as a profession.
But the increasing number who do view i t as a profession are re a liz in g
th a t
one way to
increase
t h e ir
power is
through
v is ib ility
in
the
p o lit ic a l workings o f our cou ntry, in c lu d in g lo c a l, s ta te , and national
le v e ls .
One o f Messer's goals in th is area is to s o l i c i t and influ ence
le g is la to r s '
views
on
n u rsin g 's
c u rre n t
and p o te n tia l
place
in
the
health care d e liv e ry system (1980).
In order to learn what the le g is la to r s ' views a c tu a lly were a t the
s ta te
le v e l,
s ta te
le g is la tu re
nursing is
baseline data on the views and opinions o f the cu rre n t
were needed.
How the
le g is la to rs
view nurses and
im portant fo r the nursing profession because i t
influences
the p ro fe s s io n 's a b i l i t y to intervene in the le g is la tiv e process and to
2
u tiliz e
it s
power to b rin g about change.
In the fie ld s o f nursing and
health care, th is power would be c la s s ifie d as expert power (O'Rourke,
1980).
Whatever changes
nursing
would
see as
necessary could
best be
brought about by planned change, which Willman said would give nursing
the most c o n tro l
over a given
s itu a tio n
(1983).
Assessment o f the
c u rre n t s itu a tio n is a necessary step in planned change.
For th is type
o f study, a questionnaire on the to p ic s o f nurses, n u rsin g , and health
care, developed to e l i c i t the le g is la to r s '
views on c u rre n t issues in
these areas, was considered to be the best research to o l.
The re s u ltin g
data could give nurses in Montana an idea o f t h e ir c u rre n t image and
status among le g is la to r s .
A lso, since le g is la to rs are themselves health
care consumers„ th is image might also be s im ila r to the one held by the
general
p o pula tion.
With th is
in fo rm a tio n , nursing could attempt to
in flu e n ce consumers toward a more p o s itiv e as w ell as a more knowledge­
able view point on health care.
Purpose
The purpose o f th is study was to id e n tify the c u rre n t a ttitu d e s o f
Montana State L e g is la to rs on the to p ic s o f nurses, n u rsin g , and health
care.
D e fin itio n o f Terms
Id e n tify
-
to put oneself in another's place so as to
understand and share the o th e r's thoughts and
fe e lin g s (Webster, 1974).
Current
-
occurring in the present (Merriam-Webster,
1974).
3
A ttitu d e s
one's d is p o s itio n , o p in io n , or mental set
(Webster, 1974).
Montana State
L e g is la to rs
the 1983 session o f 100 Representatives and 50
Senators.
Nurses
members o f the profession o f nursing and
re g iste re d by the s ta te as such.
Nursing
the diagnosis and treatm ent o f human responses
to actual o r p o te n tia l health problems (Ameri­
can Nurses' A ssociation (ANA), 1980).
Health Care
Maintenance o f the s ta te o f health which is a
dynamic s ta te o f being in which the development
and behavior p o te n tia l o f an in d iv id u a l is
re a liz e d to the f u lle s t exte nt possible (ANA,
1980).
S ig n ifica n c e o f the Study
The fin d in g s o f th is
study provide inform ation to be used by the
nursing profession regarding the opinions o f the s ta te 's le g is la to rs and
health consumers on to p ics in v o lv in g nurses, nursing, and health care.
This basic info rm a tion could then be used by professional
lo b b y is ts
groups and
to assess n u rs in g 's status and then plan fo r change.
change might
in vo lve
such areas
as
health
care
fu n d in g ,
This
education,
government re g u la tio n o f the health care system, or even the professio n­
al image o f the re g iste re d nurse.
One o f
audience.
the
key fa c to rs
in
implementing
change
is
knowing
the
Nurses could create b e tte r fe e lin g s between le g is la to rs and
themselves i f they understood the possible prejudices and misconceptions
lik e ly to be present in th a t p o lit ic a l group.
Conversely, i f th a t group
were knowledgeable, one would not want to repeat known fa c ts .
In te r ­
vention th a t avoids d ir e c t c o n fro n ta tio n and h o s t ilit y would be fostered
by a knowledgeable ra th e r than an ignorant change agent.
When planning
4
an in fo rm a tion presentation to a busy group o f people, fa c to rs such as
c a re fu l e d itin g , b r e v ity , and the d e lib e ra te re p e titio n o f only the most
im portant po ints must be considered.
The data from th is study w i l l be
a v a ila b le to those involved in promoting nursing and improving health
care in th is s ta te .
Assumptions
The fo llo w in g assumptions were p e rtin e n t to th is study:
1.
State le g is la to rs have a s ig n ific a n t influ ence on the profes­
sion o f nursing and the f i e l d o f health care in Montana because o f th e ir
le g is la tiv e power in passing laws and funding p ro je c ts .
2.
State le g is la to rs could be considered to be a group o f Montana
health care consumers who hold opinions on nursing and health care.
3.
The consumers o f health care in Montana have o r could have a
great in flu e n ce on the f i e l d
o f health care, depending on t h e ir per­
ceived needs, knowledge, and biases.
5
CHAPTER TWO
LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK
In tro d u c tio n
The re la tio n s h ip s between p o lit ic s ,
power, and nursing have been
major to p ic s in nursing lite r a tu r e over the past decade, but there has
been
little
to p ic s .
research
d ir e c tly
Most o f the w ritin g s
re la te d
to
the
in te ra c tio n
of
these
have been o f a d e s c rip tiv e -e x p lo ra to ry
nature and concern those re la tio n s h ip s which should be im portant fo r
nursing , since they have been fo r other groups.
The key would be fo r
nursing to u t i l i z e the various concepts and philosophies in coordinated
and advantageous ways.
L ite ra tu re Review
N ursing's re la tio n s h ip to the p o lit ic a l
repeatedly in nursing lit e r a t u r e
o f la te .
process has been stressed
Knowledge o f the p o lit ic a l
system and how to use i t to fu r th e r the p ra c tic e o f professional nursing
are
considered
e sse n tia l
aspects o f nursing.
P o licy
Statement"
components
fo r
promoting
the
professional
The American Nurses' A ssociatio n, in th e ir "Social
(1980),
id e n tifie d
the
p o lit ic a l
process
as
the
expression o f p u b lic w i l l in determ ining the d ire c tio n health care w ill
take in the fu tu re .
N ursing's in p u t was seen as e s s e n tia l, w ith the
p u b lic good demanding n u rsin g 's o v e rrid in g concern.
Humphrey (1979) saw
nursing as having a key knowledge o f the health care system and as being
6
the em inently ap propriate group a v a ila b le as a resource to le g is la to rs
on health care issues.
One element necessary to
p o lit ic a l in te ra c tio n is power.
the
nursing
profession
fo r
meaningful
Nurses have been exhorted to u n ite w ith
one voice and become a group w ith in flu e n ce p ro p o rtio n a l to it s numbers.
Grissum1s (1976) goal was f o r nursing to s ta r t a sse rtin g it s
power to
b e n e fit the image o f n u rsin g , ra th e r than the image o f m edicine, and to
work toward changing p u b lic a ttitu d e s about nursing.
power stated th a t i t
is
the many ways in which groups o r in d iv id u a ls
in flu e n ce the behavior and decisions o f o th e rs .
the
promotion or p ro te c tio n
(L e in in g e r, 1977).
based on the
(McFarland,
o f p a r tic u la r
S im ila rly , p o lit ic s is
vested
in te re s ts
or goals
More s p e c ific a lly , there is expert power, which is
possession
1982).
One d e fin itio n o f
o f v a lid
O'Rourke
knowledge,
(1980)
nurses as the basis fo r p o lit ic a l
saw the
strength
s k ills ,
and inform ation
use o f expert power by
in
three areas:
(I)
the
services which nurses could provide; (2) how these services were d i f f e r ­
ent from the services provided by o th e rs ; and (3) the impact o f these
services on p u b lic h e a lth .
Essential to the use o f expert power* or any
oth er kind o f power, is planning.
Rappsilber (1982) saw th is power as
p a rt o f a method o f persuasion used to brin g about change.
process
consisted
of
id e n tify in g
e x is tin g
behaviors,
This change
knowledge,
and
a ttitu d e s in o th e rs, and then changing them to the ones needed to brin g
about more h e a lth fu l behavior.
The e ffe c t o f organized power and planned change by nursing on the
in flu e n ce government has on health care was another to p ic fre q u e n tly
discussed by various authors
(A iken, 1982; KaliSch and K a lisch, 1982;
7
Stevens, 1983).
Willman (1983) pointed out th a t p u b lic pressure fo r the
fo rm u la tio n o f a national health p o lic y had given- nursing an opportunity
and re s p o n s ib ility to f u l l y u t i l i z e it s a b ilit ie s and ta le n ts to support
th is p u b lic need, and co n currently improve the p u b lic image o f nursing.
E sp e cia lly in the area o f r is in g health care costs, the nursing p ro fe s ­
sion has the knowledge and resources to implement and influ ence p o lic ie s
th a t would bring
down these
costs.
Such methods
as
less
expensive
health care from nurse p r a c titio n e rs , health promotion, and improved and
increased home health care were but a few o f the ways to reduce these
c o s ts .
Messer (1980) suggested th a t one o b je c tiv e in developing a grass
roots le g is la tiv e in flu e n ce was to f a c i l i t a t e the development o f mutual­
ly h e lp fu l
re la tio n s h ip s between nurses and le g is la to rs .
These in t e r ­
actions would include s o lic it in g and in flu e n c in g le g is la to r s ' views on
n u rsin g 's
system.
current
and
p o te n tia l
place
in
the
health
care
d e liv e ry
Consequently, the le g is la to rs would become in cre a sin g ly aware
o f the many p o s s ib ilitie s fo r p o s itiv e change, and also increase th e ir
u t iliz a t io n
of nurses
as key informants
and resource persons.
This
process would lead to a co n siste n t n u rs e -le g is la to r re la tio n s h ip th a t
could
help
increase
n u rsin g 's
influ ence
on
the
p o lit ic a l
process.
Messer also stressed the need fo r continued input in to th is process and
the establishm ent of a c re d ib le re la tio n s h ip , whether through lobbying
or in d iv id u a l inp ut on s p e c ific issues.
lik e ly
federal
to occur over le ve l
monies,
there
is
o f e n try
With major confrontations soon,
in to
even more o f
p ra ctice
a need fo r
and a llo c a tio n
nursing
to
of
have
8
developed
a
s o lid
groundwork
fo r
e ffe c tiv e
in te ra c tio n
w ith
lo ca l
le g is la to r s .
N ursing's
recent
push toward
professional
major fa c to r in i t s need fo r p o lit ic a l power.
remains divide d on several key issues.
awareness has been a
But in th is push, nursing
One o f the major d iv is iv e issues
is associated w ith educational standards and level o f e n try in to prac­
t ic e .
The attem pt to d iv id e nursing in to both professional and te c h n i­
cal areas has caused heated c o n f lic t , which has a ffe c te d the professio n­
al cohesiveness needed to gain power.
The ANA has proposed a baccalau­
reate degree as the only le ve l o f e n try in to professional nursing w hile
oth er authors have also recommended th a t the graduate o f the associate
degree program be considered a tech nical nurse as opposed to a profes­
sional
nurse.
Hassenplug,
National
Many authors held
1978;
Kohnke,
League f o r
1978).
these view points
Although
Nursing have favored
(A y d e lo tte ,
c e rta in councils
1983;
of
the
the view o f two le v e ls
of
nursing , w ith the baccalaureate p re re q u is ite fo r the professional le v e l,
the o rgan ization
as a whole was s t i l l
faced w ith heated debate from
supporters o f associate and diploma programs who have wished to m aintain
the c u rre n t three le v e ls
1983).
p u b lic
Since th is
debate
and le g is la to rs
professio n.
o f e n try in to
Regardless
professional
could e v e n tu a lly
might be
o f the
p ra c tic e
(Burge,
lead to le g is la tio n ,
the
forced to make the decision fo r
outcome,
the
image o f
nursing
the
as
a
profession would be tarnished i f in te rn a l problems were a ire d before the
p u b lic .
H is to r ic a lly , many other fa c to rs have influenced the p u b lic image
o f n u rsing , p rim a rily because i t
has f o r the most p a rt been a women's
9
professio n.
Biases regarding the woman's place being in the home, about
her p a s s iv ity and dependence and about her lack o f need fo r education
(Grissum, 1976) were prominent u n til the recent women's movement.
These
biases g re a tly influenced the status o f nursing, keeping i t a ty p ic a lly
woman-oriented occupation.
Caring f o r the sick was an extension o f a.
woman's work in the home.
She was dependent on the physician fo r her
jo b , and her education consisted o f tra in in g in m edically and adminis­
t r a t iv e ly
run
h o s p ita ls .
Kalisch
and
Kalisch
sex-stereotyping and pointed out th a t a ll
(1982)'
expounded
on
the c h a ra c te ris tic s seen as
p o s itiv e and valuable q u a litie s fo r success in men were seen as harmful
and detrim ental in women.
w ith
a c u ltu re
o f denial
Brown (1978) associated th is sex-stereotyping
pervasive
in
many nurses,
characterized by
professional impotence, denial o f the a b i l i t y and re s p o n s ib ility of the
profession to
influ ence health care s e rvice s, and also the denial
s e lf-w o rth as a p ro fe ssio n a l.
of
Both Brown and the Kalisches have studied
the image o f nursing e xte n sive ly over the la s t decade, p a r tic u la r ly as
re la te d to c u ltu ra l influences and power.
Brown (1978) also id e n tifie d m edicine's e ffo rts to continue nurs­
in g 's dependence upon i t
(1976)
saw n u rsin g 's
co n sistin g
of
as a cause o f the denial
attempt
ro le -b re a k in g ,
to
improve
which
it s
caused
syndrome.
professional
physicians
and
Grissum
image
as
hospital
a d m in istra to rs to fee l threatened by the increased independence o f the _
ro le o f the nurse.
The c o n flic t caused by the d iffe re n c e between how
nurses saw th e ir ro le compared to how physicians saw th a t ro le coincided
w ith
the s itu a tio n s
o v e rq u a lific a tio n .
Hardy (1978)
defined
as ro le
ambiguity and ro le
Hardy, who has examined in depth the ro le theory in
10
re la tio n to health p ro fe s s io n a ls , defined ro le am biguity as the s itu a ­
tio n
occurring when there
is
a disagreement about ro le
because o f a lack o f c l a r i t y in those e xp e cta tio n s.
expectations
The am biguity could
occur when, because o f the changing knowledge base and increased profes­
sional m a tu rity in n u rsing , n e ith e r the physician nor the nurse would be
sure
of
n u rs in g 's
appropriate
boundaries.
Role
o v e rq u a lific a tio n ,
defined as the s itu a tio n where the nurse's q u a lific a tio n s are in excess
o f these required fo r the p o s itio n , might occur when a nurse w ith a
baccalaureate degree desires to fu n c tio n as a professional nurse, but
the h o sp ita l and the physicians only recognize the te ch n ica l aspects o f
nursing.
Ashley (1976), whose book was based on her doctoral d is s e rta tio n ,
fu r th e r re la te d these biases about n u rs in g 's subjugation to medicine to
the
p u b lic 's
image o f
nursing.
As
re c e n tly
as
1970,
the
American
Medical A ssociation id e n tifie d the p o s itio n o f the nurse as being under
the supervision o f the p h ysicia n , although much o f nursing was done in
s e ttin g s
o th e r than
h o s p ita ls
or when a physician was not
present.
Brown (1981) recommended increased independent c lin ic a l decision-making
by nurses and a c o lla b o ra tiv e p ra c tic e between nurses and physicians.
She believed th a t the end product would then be improved p a tie n t care
and lower health care costs fo r consumers.
Aiken
(1981), whose research background
-'
includes
a s ta t is t ic a l,
lo n g itu d in a l study o f nurses, saw nursing as having a unique c o n trib u ­
tio n to make to nationa l h e a lth , but did not see th is ro le as being well
understood by consumers o r other health p ro fe ssio n a ls.
The need then
was fo r nursing to demonstrate to the p u b lic the outcomes o f nursing
11
p ra c tic e as w ell as to develop s tra te g ie s fo r fin a n cin g improvements in
nursing and health care d e liv e ry .
consumers as nursing advocates.
Nursing would then be able to r e c r u it
This move would be necessary fo r power­
b u ild in g and implementation o f a health care d e liv e ry system th a t would
meet the needs o f the
consumer and not ju s t
those o f the
d e liv e ry
system.
Ashley (1976) saw the need to improve n u rsin g 's consumer image as
re la te d
to
consumer education and the d is p e llin g
biases about nursing.
o f oth er myths and
She id e n tifie d re co g n itio n o f higher education,
both m oneta rily and through the a b i l i t y to p ra c tic e as a p ro fe s s io n a l,
ra th e r than a se m i-p ro fe ssio n a l, as improving n u rs in g 's status and the
q u a lity
o f p a tie n t care.
n u rsin g ,
In order to
nurses would have to make the
dispel
p u b lic
the
"bedpan"
image o f
aware o f what nurses
a c tu a lly do, as opposed to the view the p u b lic receives from the h ig h ly
in flu e n tia l te le v is io n networks.
One area o f n u rsin g 's fu n c tio n in g th a t was e s p e c ia lly im portant to
the consumer was the f i e l d
tifie d
o f health promotion.
Grissum (1976) iden­
the increased need fo r th is health promotion, as opposed to the
illn e s s treatm ent o rie n ta tio n , and stated th a t the consumer, along w ith
the nurse, would have to be involved in planning and implementation.
If
nursing could v is u a liz e i t s e l f as accountable and respon sible, i t could
develop goals fo r leadership in health promotion, and through an expand­
ed ro le could improve health care and lower costs (Ashley, 1976).
A ll o f these recommendations presented nursing and nurses as change
agents.
More s p e c ific a lly ,
volved in planned change.
professional
nurses would have to be in ­
This type o f system atic involvement should
12
then b rin g about cohesiveness in the p ro fe ssio n , improved s ta tu s , and an
improved health care system (W illman, 1983).
would give the nurse power and c o n tro l
In tu r n , planned change
over events,
nurse having to re act to change in it ia t e d by oth ers.
ra th e r than the
Ehrenreich (1979)
expanded th is view somewhat when she id e n tifie d the nurse as a profes­
sional agent o f change who should use p o lit ic a l
f o r change.
She also regarded th is
a ctivism as the arena
a c tiv is m as an o b lig a tio n o f the
professional nurse to o th e r nurses and consumers.
One stra te g y f o r change th a t Grissum (1976)
id e n tifie d
as being
p a r tic u la r ly a p p lica b le to nursing was th a t o f a ttitu d e change.
This
s tra te g y involved developing a le v e l o f a ttra c tio n and t r u s t between the
change agent and the involved groups, such as s ta te le g is la to r s .
goal
was to
cooperation.
minimize
perceived, d iffe re n c e s
and to
stress
The
peace and
The promotion o f empathy w ith respect to m otives, expec­
ta tio n s , and a ttitu d e s was seen as e s s e n tia l.
any kind o f change, a problem -solving model
In order to brin g about
should be involved.
The
i n i t i a l stage o f planned change is the assessment phase, which involves
id e n tify in g in te re s t in and m otivation fo r change and also the environ­
ment in which i t would take place (Wilim an, 1983).
The need fo r planned
change led to the s e le c tio n o f a p a r tic u la r conceptual model to be used
as the framework fo r th is study.
In s p ite o f a ll the opinions th a t have been w ritte n re la tin g to the
need fo r increased involvement by nurses in health care policy-m aking,
very T i t t le
research has been done e ith e r to v e r ify the need fo r th is
involvement or to examine the outcomes o f such involvement.
13
Summary
Various
aspects o f the c u rre n t status
and ro le
o f nursing were
discussed in th is lit e r a t u r e
review.
involvement in the p o lit ic a l
process, the re la tio n s h ip between nursing
and governmental
nursing.
These aspects included nu rsin g 's
influ ence s on health care, and also the p ra c tic e o f
N ursing's own professional awareness was examined in re la tio n
to h is to r ic a l in flu e n c e s , present c o n flic ts , and n u rs in g 's influ ence on
consumer health and the health care d e liv e ry system.
a means f o r accomplishing
id e n tifie d
goals, was also discussed as a
basis fo r a conceptual framework f o r th is study.
ing a ll
o f these to p ics was to
Planned change, as
e s ta b lis h
The o b je c t o f examin­
a basis f o r
the use o f a
d e s c rip tiv e survey to evaluate the views o f s ta te le g is la to rs on those
various issues.
Conceptual Framework
The conceptual
framework fo r
th is
study re la te d
to
the general
theory o f planned change and s p e c ific a lly to RappsiI b e r's (1982) persua­
sion-change model
fo r
nurses.
This
researcher
in itia lly
became ac­
quainted w ith the model in re la tio n s h ip to a graduate study p ro je c t on
change theory and i t s a p p lic a tio n to the work s e ttin g .
RappsiIb e r, who
is the Dean o f Nursing a t West Texas State U n iv e rs ity , had w ritte n a
chapter on persuasion as a mechanism f o r change in the book The Nurse as
a Change Agent,
edited
persuasion-change model
model.
by
Lancaster
and
Lancaster.
She
included
a
fo r nurses th a t was based on Kar' s diagnosis
The model (F igure I , page 17) s ta rte d w ith the id e n tific a tio n o f
the ta rg e t audience and in te rv e n tio n design va ria b le s and then concluded
14
w ith successful change.
model, m ainly the
This study d e a lt w ith only a p o rtio n o f th a t
ta rg e t audience v a ria b le s .
That section
could
be
likened to the assessment phase o f the problem -solving model (W illman,
1983).
In order to brin g about successful change, planning o f s tra te g ie s
would have to be s p e c ific a lly
re la te d to the needs, m o tiv a tio n s , and
biases o f the ta rg e t audience.
The persuasion-change model id e n tifie d
such
va ria b le s
as: '
( I ) p o l it ic a l ,
tu ra l-p s y c h o lo g ic a l,
(2) socia l
s tru c tu re ,
(4) e n v iro n m e n ta l-s itu a tio n a l,
c a l- b io lo g ic a l, and (6) e d u c a tio n a l-in te lle c tu a l.
(3) c u l­
(5) p h y s io lo g i­
In th is stu d y, which
d e a lt w ith the Montana State L e g is la tu re as the ta rg e t audience, a ll s ix
o f these va ria b le s were a p p lica b le in determ ining the le g is la to r s ' views
on nurses, n u rsing , and health care.
The f i r s t
v a ria b le ,
the
in flu e n ce re la te d to p o lit ic a l
p o lit ic a l
determ inant,
p a rty and philosophy.
had
an obvious
P o litic a l
back­
ground is e s p e c ia lly re le va n t when examining p r o b a b ility fo r approval of
health care funding.
ence,
could
The second v a ria b le , the social s tru c tu re i n f l u ­
be evaluated
by examining
backgrounds and occupations.
such
aspects
as
le g is la to r s '
C u ltu ra l-p s y c h o lo g ic a l aspects might also
have an e ffe c t on le g is la to r s ' views because o f c u ltu ra l biases re la te d
to health care and the ro le o f women.
A lso , previous in te ra c tio n s w ith
the health care system might in flu e n ce psychological
th a t system.
a ttitu d e s
toward
The e n v iro n m e n ta l-s itu a tio n a l varia bles re la te d to present
problems and issues in v o lv in g health care in the s p e c ific environment o f
the
s ta te
include
of
Montana.
such fa c to rs
The p h y s io lo g ic a l-b io lo g ic a l
as age and sex.
And la s t ly ,
va ria b le s
the
would
le g is la to r s '
15
e d u c a tio n a l-in te lle c tu a l
background
could
in flu e n ce
t h e ir
views
on
p ro fessio nalism , education, and the ro le s o f nurses.
By assessing these s ix
areas,
the change agent could develop a
b e tte r p ic tu re o f the ta rg e t audience, and then, w ith a knowledge o f
in te rv e n tio n -d e s ig n va ria b le s as re la te d to persuasion th e o rie s , could
determine
the
appropriate
p a r tic u la r ta rg e t audience.
change
in
behavior.
in te rv e n tio n
model
to
be used w ith
th a t
The goal would be to b rin g about a desired
The fiv e
in te rv e n tio n
persuasion-change framework consisted o f:
models
included
in
th is
( I ) the in fo rm a tio n a l model,
where, although m o tiva tio n and a c c e s s ib ility were present, the ta rg e t
population might lack the necessary info rm a tion or s k i l l
to accomplish
the changes; (2) the in s tru c tio n a l model, which was lik e
the previous
model but involved more depth in developing complex s k i l l s
te n c ie s ;
(3)
the environmental
and s itu a tio n a l
and compe­
model, in which there
would be audience nonacceptance secondary to a lack o f environmental
support; (4) the m o tiva tio n a l model, which involved a lack o f p o s itiv e
m o tivation or a strong negative m otive; and, f i n a l ly (5) the consonance
model, which would be used when resistance to change was a re s u lt o f
c o n flic tin g m otives, values, a ttitu d e s or b e lie fs .
R appsiIber1s conceptual framework was then the basis fo r the types
o f questions th a t were developed fo r use in the le g is la tiv e question­
n a ire .
The re s u lts would then id e a lly be organized w ith in the persua­
sion-change
model
and
u tiliz e d
by
the
change-agent
nurse.
In
the
s e ttin g o f th is study, the desired change would be fo r the le g is la to rs
to
vote
fo r
le g is la tio n
th a t
would
b e n e fit
the
consumers'
16
u t iliz a t io n
of
the
health
care
system.
Another
goal
would
be the
promotion o f nursing as a profession and as a v ia b le p a rt o f the health
care team.
17
Reassessment
Drive Motive
Cognitive
Intervention
design
variables
Stimulus
response
Social
Personality
Information
No change
Perceptual
behavior
Instruction
Political
Social
structure
Environment
Motivation
Persuasion
strategy
Change
behavior
Consonance
Cultural
psychological
Target
audience
variables
Environmental
situational
Physiological
biological
Educational
intellectual
Successful
change
Figure I
R appsilber1s persuasion-change model fo r nurses
Adoption
18
CHAPTER THREE
METHODOLOGY
Overview
The purpose o f th is study was to id e n tify the c u rre n t a ttitu d e s o f
Montana State L e g is la to rs on the to p ic s o f nurses, n u rsing , and health
care in the framework o f u t i l i z i n g the accumulated info rm a tion to brin g
about change.
This chapter describes the method used to develop a to o l
by which to survey the Montana State L e g is la tu re on those to p ic s .
It
fu r th e r describes the methods u t iliz e d to adm inister the questionnaire
and analyze the data.
Research Design
Although th is
study was designed as e x p lo ra to ry , a search o f the
lit e r a t u r e was made to discover a p re v io u s ly developed to o l which could
have been used in data c o lle c tio n .
questions o f a to p ic a l
No to o l was found th a t would ask
nature on the c u rre n t problems o f nursing and
health care in Montana, or th a t was s p e c ific a lly d ire c te d toward le g is ­
la to r s .
Tool development was then undertaken based on the lite r a tu r e
about c u rre n t problems in nursing and health care n a tio n a lly .
development
of
these
to p ics
nursing leaders, in Montana.
was
accomplished
through
Further
inte rview s
Tool development is discussed la te r .
of
19
P rote ction o f Human Rights
Montana State U n iv e rs ity 's requirements on human rig h ts were met in
th is study.
Since the ta rg e t population was the 150 s ta te le g is la to rs
in the 1983 session, the category f e l l
being elected o f f ic i a l s .
under those exempt because o f
Therefore, the request form and questionnaire
were submitted to and approved by the Human Rights Committee w ith o u t
exception.
Anonymity was also assured in
the cover l e t t e r w ith
the
questionnaire (Appendix).
Population and S e ttin g
The study u tiliz e d
an e n tire population - a ll
150 members o f the
1983 Montana State L e g isla tu re - which consisted o f 100 representatives
and
50
senators,
both
male
s p e c ific a lly targeted th is
have been used.
le g is la tio n ,
A lso,
any
re p re se n ta tive .
and female.
le g is la tiv e
The
purpose
group.
of
No la rg e r sample could
since each le g is la to r had one vote on any given
sm aller
sample would
have
made
the
re s u lts
adm inistered
o rig in a l
th a t
w ith
the
help o f
a
c u rre n t
The to o l
re p re se n ta tive whose
profession had been nursing and who had been h e lp fu l
session
less
The s e ttin g f o r the study was the Montana State C apitol
B u ild in g during the la s t week o f the 1983 le g is la tiv e session.
was
the study
to
the
lobbying
u n it
of
the
professional
during
nursing
o rgan ization ip th is s ta te .
Development o f the Research Tool
Two methods o f data c o lle c tio n would have been appropriate in th is
study.
The f i r s t was the anonymous questionnaire and the second was the
20
d ir e c t in te rv ie w .
Because o f the increased time involved and the lack
of
a d ir e c t
anonymity w ith
chosen.
in te rv ie w ,
the
questionnaire
method was
This type o f da ta-gathering was viewed as being more lik e ly to
re s u lt in honest, less biased responses than w ith the in te rv ie w , since
during an in te rv ie w the le g is la to rs would more lik e ly fe e l the need to
t e l l the in te rv ie w e r the answers they thought were expected.
In
order
to
develop
nursing and health
care
questions
p e rtin e n t
to
Montana,
in te n s iv e
p re lim in a ry
in
c u rre n t
issues
in
interview s
were c a rrie d out w ith ten o f the leading nurses in the s ta te to fin d out
th e ir views on n u rsin g 's problems.
Such to p ic s as the power o f nursing,
i t s ro le in health care p o lic y , the consumer's views o f the ro le o f the
nurse,
nursing
education,
and economic
status
were explored.
Those
nurses were also asked what questions they would put to s ta te le g is la ­
to rs
about nurses, n u rsin g ,
and health
care
to
fin d
out about the
c u rre n t knowledge and opinions o f le g is la to rs th a t might be useful
dealing w ith the group on upcoming le g is la tio n or funding issues.
in itia l
These
in te rvie w s were p a rt o f an independent study on the power o f
nurses in Montana.
r o le s ,
in
such
as
The ten nurses were involved in a v a rie ty o f nursing
education,
community
and
home
h e a lth ,
p o lit ic s ,
c o n s u lta tio n , a d m in is tra tio n , and c lin ic a l p ra c tic e .
The
questions
presented
to
these
nurses
in
the
developing the survey to o l were very broad and open-ended.
process
of
The ques­
tio n s most a p p lica b le to the survey were ( I ) do nurses in th is s ta te
have power, and i f
n o t,
why not?
nursing profession in Montana?
in
Montana?
(4) is
the
(2) what are the
problems o f the
(3) what are the major health problems
re la tio n s h ip
betweeri
nurses
and
the
s ta te
21
le g is la tu re good or bad?
(5) are nurses equipped to cope w ith lobbying
and co n tra ct negotia tion?
and (6) how can nurses increase th e ir power?
On the
to p ic
of
power,
c u rre n t power was w ith in
group
nursing
was
not
the
responses
in d iv id u a l
as
were g e nerally
th a t
the
nurses and th a t as a c o lle c tiv e
powerful
as
it s
numbers
would
suggest.
Increased power was seen as being required through cohesiveness,
creased
increased
general
p ro fe s s io n a lism,
increased
s e lf-c o n fid e n c e ,
consensus
in d iv id u a lly
th a t
and
the
and c o lle c tiv e ly
involvements
increased
c r e d ib ilit y .
re la tio n s h ip
through
between
v is ib ility ,
There
was
nursing,
a
both
the Montana Nurses Association
(MNA), and the s ta te le g is la tu re was a p o s itiv e one.
doing a good job w ith lobbying.
and
in ­
They saw nurses as
The c o lle c tiv e bargaining process was
viewed as going w e ll, but there was s t i l l
a s p l i t p h ilo s o p h ic a lly about
whether or not the MNA should be involved in th a t area.
■ The nursing
problems.
profession
The c o n f lic t
in
Montana was
over the MNA being
seen as
having m u ltip le
involved w ith
c o lle c tiv e
bargaining and possibly a lie n a tin g the management sector of the member­
ship was d iv id in g the nursing population.
The issue o f the baccalau­
reate degree as the leve l o f e n try in to nursing p ra ctice s t i l l
did not
have statewide support and s p e c ia lity p ra c tic e was causing fragmentation
o f nurses' in te re s ts .
A lso, there seemed to be a lack o f public know­
ledge about the v a rie ty o f nursing ro le s .
( I ) in - fig h tin g
and
je a lo u s y ,
Other problem areas included
(2) problems
associated
w ith
being
a
predominately women's profession (m in o rity group a c tio n s ), (3) lack of
lea dership, (4) com petition and c o n flic t between nurses, physicians, and
h o sp ita l
a d m in is tra to rs ,
(5) nurses'
lack
o f a professional
view o f
22
themselves, (6) lack o f th ir d -p a rty reimbursement, (7) lack o f p o lit ic a l
power and status
in the sta te in both nursing and non-nursing areas,
(8) lack o f fin a n c ia l
power, and (9) poor communication among nurses.
The major health problems were viewed as being re la te d to health care in
the ru ra l
s e ttin g
(p ro x im ity to health f a c i l i t i e s ) ,
q u a lity o f health
f a c i l i t i e s and s ta ffin g , funding o f health care., w ellness-prom otion, and
reimbursement.
In response to what they would want to know from le g is la to rs , the
nurses'
answers
centered
on
the
le g is la to r s '
views
on
health
care
fin a n c in g ; th e ir d e fin itio n o f nursing and health care; th e ir views on
independent
p ra c tic e ,
nurse
p r a c titio n e rs ,
and
reimbursement; and from whom they sought inform ation
le g is la tio n .
th ird -p a rty
on health
care
The answers given were co n siste n t from one nurse to the
next.
A fte r the previous data were analyzed, the answers were separated
in to e ig h t major to p ic s , which were:
1.
The image o f the nurse
2.
The economics o f nursing
3.
S pecia lty areas in nursing
4.
Nursing education
5.
Professional ism in nursing
6.
Nursing and p o lit ic s
7.
Consumer health care
8.
The ro le o f the nurse
The s p e c ific questions fo r the survey were developed in re la tio n s h ip to
these ca te g o rie s.
23
in deciding what type o f questions were most appropriate fo r th is
group o f people, several aspects were examined.
F ir s t , considering the
tim in g o f the survey, there was a need to make the questions as easy to
answer as possible and the questionnaire sh o rt enough to not discourage
the le g is la to rs from attem pting to complete i t .
Second,
most
of
the
to p ic s
le n t
themselves
w ell
to
p o si­
tiv e -n e g a tiv e answers, regardless o f whether they were o f the opinion
type
or the
knowledge type.
form at was chosen fo r
a n tic ip a te d
Therefore,
the m a jo rity
a yes/no and agree/disagree
o f the questions.
th a t more choices were necessary fo r
Where i t
was
adequate data c o l­
le c tio n , e ith e r ranking or a choice o f one or more options was given.
The two open-ended questions th a t completed the questionnaire were used
to a llo w a v a rie ty
o f responses, since the possible options were so
d iv e r s ifie d as to make forced choices too lim ite d in scope.
A copy o f
the questionnaire is included (Appendix).
In choosing the wording fo r each question, an attem pt was made to
use term inology th a t was considered to be g e n e ra lly understood, w ith the
expectation th a t am biguities would be elim in ated a fte r review by several
experts and peers.
The i n i t i a l questionnaire consisted o f 54 questions,
in c lu d in g demographics.
The demographics th a t were selected were p a r t ia lly those common to
most
questionnaires
of
th is
type ,
education, and p o lit ic a l background.
such
as
age,
sex,
occupation,
These demographics also re la te d to
the ta rg e t audience va ria b le s in the conceptual model.
An e f f o r t was
made to obtain background d e ta ils w ith o u t a c tu a lly id e n tify in g s p e c ific
in d iv id u a ls .
The oth er
demographic
questions were chosen to
re la te
24
s p e c ific a lly
c la s s ifie d
to
as
Montana.
r u r a l,
Since
w ith
th is
s ta te
a s ig n ific a n t
can,
in
population
general,
liv in g
in
be
areas
c la s s ifie d as ru ra l in the questionnaire (population o f 2,500 or low er),
questions p e rta in in g to r u r a li t y were a p pro pria te.
The curriculum study
being done in the Montana State U n iv e rs ity School o f Nursing m aster’ s
program
had,
d iffe re n c e s
aligned
w ith
questions
the
years,
pointed
out
some co n sistent
between those people q u a lify in g
p a r tic u la r ly
contact
over
the
la rg e r
evident
population
w ith
re la tio n
as ru ra l
centers.
to
c u ltu ra l
and those more
D ifferences
health
care.
were
Demographic
11 and 12 were included as determinants o f whether previous
w ith
nurses
a ffe cte d
knowledge
and
opinions.
Question
13
addressed the le g is la to r s ’ perceived awareness o f health care services
in
t h e ir
home
counties,
mainly
to
determine
whether
they
viewed
the
thesis
themselves as knowledgeable on the to p ic .
The
in itia l
committee,
involved
c la r ity
questionnaire
the members o f the
in s tru c to rs .
and
content
Each
was
then
researcher's
question
v a lid it y .
was
submitted
to
nursing
c la s s ,
examined
Recommendations
and other
in d iv id u a l Iy
were
made
fo r
regarding
changes in wording or options g iv e n , and the possible d e le tio n o f some
questions.
The
of
the
recommendations by the other nurses and those were implemented.
The
recommendations
re la tin g
to
the
question naires,
questions.
researcher
was
in
agreement
w ith
most
from a professor who was. a former sta te
habits
were
The tool
and id io syn cra sie s
also
u t iliz e d .
was again
c l a r it y and content v a lid it y .
The
of
le g is la to rs
in itia l
le g is la to r.,
completing
revisions
reviewed by the the sis
le ft
53
committee fo r
25
When the questionnaire was revised the th ir d tim e, more questions
were deleted , and the arrangement o f the questions was also a lte re d .
Those questions in the demographic section were rearranged s lig h t ly so
as to be grouped according to to p ic .
rearranged so th a t a ll
were a ll
the yes/no
The body o f the questionnaire was
the agree/disagree questions were together, as
questions
and the
open-ended questions were placed la s t.
ranking
questions.
The two
The reasoning behind th is was to
enhance the flo w o f the questionnaire and thereby increase the ease o f
completion by the le g is la to rs .
Opinion questions were s p e c ific a lly not
grouped as to to p ic , where p o ssib le , in order not to d ir e c tly influence
le g is la to r s ' responses.
M u ltip le questions re la ted to a s p e c ific to p ic
were included as a cross-check o f opinions given.
The fin a l question­
naire consisted o f 49 questions th a t covered ju s t over fo u r pages.
The
questionnaire was typed on both sides o f the page so as to appear as
short as possible to the respondents.
In t r i a l s ,
the time taken to
complete the questionnaire was between 10 and 15 minutes.
The s p e c ific questions re la tin g to the previou sly mentioned e ig h t
to p ic s ,
as they appeared on the fin a l
questionnaire, were as fo llo w s
(w ith some overlap between ca te g o rie s):
The Image o f the Nurse
14.
In general, nurses today have a good p u b lic image.
Agree - Disagree
16a. Nursing is
an appropriate career fo r men.
16b. Nursing is
an appropriate career fo r women.
Agree - Disagree
Agree - Disagree
22.
There is a shortage o f nurses in the U.S.
Agree - Disagree
23.
There is a shortage o f nurses in Montana.
Agree - Disagree
26
42.
I f you belie ve there is a shortage o f nurses in Montana, do
you th in k i t is due to (check one o r more)
___ Lack o f enough nurses
___ Rapid turnove r o f nursing personnel
___ D is s a tis fa c tio n w ith working conditions
___ Irr e g u la r d is tr ib u tio n o f nurses throughout the sta te
___ Low s a la rie s
The Economics o f Nursing
15.
Most nurses who work in Montana h o s p ita ls are being paid what
th e ir services are w orth. Agree - Disagree
27.
Nurses should be e lig ib le fo r th ir d - p a r ty reimbursement.
Agree - Disagree
29.
The money th a t most nurses earn is a supplemental income fo r
the fa m ily (th e husband is the prim ary breadw inner).
Agree - Disagree
S p e cia lty Areas in Nursing
17.
P hysicians' a ssista n ts and nurse p ra c titio n e rs are the same in
what they have to o ffe r the consumer in the way o f health
care. Agree - Disagree
34.
Do you know what a nurse p r a c titio n e r does?
Yes - No - Uncertain
36.
Would you approve o f a fa m ily member going to a nurse p r a c ti­
tio n e r fo r health care? Yes - No - Uncertain what a nurse
p r a c titio n e r does
39.
Would you go to see a nurse p r a c titio n e r f o r a physical
examination? Yes - No - Do not know what a nurse p r a c titio n e r
does
Nursing Education
18.
Nursing is a profession ra th e r
occupation. Agree - Disagree
than
a te c h n ic a lly
s k ille d
'
35.
Are you aware th a t there are three basic programs by which a
person can study to be a re g is te re d nurse? Yes - No
44.
I be lie ve the basic education f o r le ve l o f e n try in to profes­
sional nursing should be (check one or more)
■__ 2-year associate degree in nursing
___ 3-year diploma
___ 4-5 year ba chelo r's degree in nursing
not aware o f the d iffe re n c e s between the three
27
P rofessionalism in Nursing
18.
Nursing is a profession ra th e r
occupation. Agree - Disagree
than
a te c h n ic a lly
19.
Nurses should fu n c tio n only under the supervision o f physi­
cians. Agree - Disagree
21.
Physicians and nurses should have equal
policym aking. Agree - Disagree
24.
The re la tio n s h ip between nurses and physicians
c o lle g ia l one. Agree - Disagree
30.
Nurses should be
employing agencies.
41.
Nurses s tr ik e most often f o r (rank in order or importance w ith
I being the most im portant)
___ more money
___ b e tte r working conditions
___ improved q u a lity o f p a tie n t care
allowed to organize
Agree - Disagree
ro le s
and
in
s k ille d
hospital
should be a
bargain
w ith
Nursing in P o litic s
20.
Nurses as a group are powerful
p o lic ie s . Agree - Disagree
in
in flu e n c in g health
care
28.
Governmental monies should be used to finance m a te rn a l-c h ild
health programs ( w e ll- c h ild c lin ic s , n u tr itio n a l programs,
e tc .) Agree - Disagree
31.
Nurses should provide in p u t to
issues. Agree - Disagree
33.
P ublic funds should be used to finance some health care.
Agree - Disagree
\
le g is la to rs
on health
care
45. S elect the fo llo w in g statement
w ith which you most agree,
re la te d to a llo c a tio n o f funds fo r health care.___ Health promotion is more im portant than illn e s s
treatm ent.
Illn e s s treatm ent is more im portant than health promotion.
___ The two are o f equal importance.
49.
As a le g is la to r , from whom (category o f persons) do you seek
info rm a tion on le g is la tiv e health care issues?
28
Consumer Health Care
26.
I f Montana c itiz e n s are given inform ation on good health
ha bits and health promotion, the m a jo rity w i l l fo llo w the
suggestions to improve th e ir h e a lth . Agree - Disagree
32.
The p u b lic needs to be b e tte r educated in health promotion and
disease p reven tion, so they can be more p r o fic ie n t in
s e lf-c a re . Agree - Disagree
37.
I would fe e l co n fid e n t in
nurse. Yes - No
40.
Rank the fo llo w in g nursing ro le s in order o f importance to the
consumer (w ith I being the most im p o rta n t).
___ Caring fo r the sick (bedside nursing)
___ Health promotion through education and research
___ Disease prevention through education and research
45.
S elect the fo llo w in g statement w ith which you most agree
re la te d to a llo c a tio n o f funds f o r health care.
___ Health
promotion
is
more
im portant
than
illn e s s
treatm ent.
___ Illn e s s
treatm ent
is
more
im portant
than
health
promotion.
___ The two are o f equal importance.
46.
Rank in order o f importance these major issues in health care
in Montana today ( I is most im po rta nt, 9 is le a s t).
___ Cost o f health care
___ Lack o f f a c i l i t i e s in ru ra l area (access to care)
___ Lack o f q u a lifie d health professionals
___A llo c a tio n o f resources f o r treatm ent o f interpersonal
abuse (spouse, c h ild )
___ A llo c a tio n o f resources f o r dealing w ith accident victim s
___ D u p lica tio n o f services
Other
47.
Wellness promotion should be taught by (check a ll a p p lic a b le ).
Parents
___ Health professionals
___ Teachers in preschools
___ Teachers in grade schools
___Teachers in high schools
48.
The major reason fo r the ra p id ly increasing cost o f health
care i s ______._____ _
__________.
re c e iv in g health
teaching from a
The Role o f the Nurse
25.
Because o f th e ir experience in management^ some nurses make
good executives. Agree - Disagree
29
37.
I would fe e l co n fid e n t in
nurse. Yes - No
re c e iv in g health teaching from a
38.
Do you th in k c e rta in nurses are q u a lifie d to p ra c tic e indepen­
dently?
Yes - No - Uncertain what independent p ra c tic e
e n ta ils
40.
Rank the fo llo w in g nursing ro le s in order o f importance to the
consumer (w ith I being the most im p o rta n t).
___Caring f o r the s ick (bedside
nursing)
___ Health promotion through education and research
___ Disease prevention through education and research
43.
In the fu tu re , the ro le s o f
fo llo w in g (check one o r more)
___ Health Promotion
___ Disease prevention
___ Independent p ra c tic e
__ L Bedside nursing
___ Nursing research
- Nursing a d m in is tra tio n
___ H ospital a d m in is tra tio n
nurses
should
include
the
V a lid ity and R e lia b ilit y
The content was tested f o r v a lid it y
ment.
ions
throughout the to o l develop­
The to o l was self-designed to determine the a ttitu d e s and opin­
of
in itia l
le g is la to rs
on nurses,
n u rsing ,
in p u t from ten prominent nurses
and health
care,
w ith
the
in Montana and the repeated
evaluation o f the questions by fa c u lty , students, and le g is la to r s .
The
to o l was r e lia b le because i t provided Montana le g is la to rs an op p o rtu n ity
to express t h e ir a ttitu d e s and opinions on nurses, n u rsing , and health
care, and the same type o f data could be obtained i f the questions were
adm inistered to another s im ila r group.
Data C o lle c tio n Method
The assistance o f a 1983 s ta te
re p re se n ta tive was s o lic ite d .
A
cover l e t t e r which requested completion o f the survey was d rafte d to
30
inform the le g is la to rs
o f the reason fo r the survey and th a t
supported by one o f them.
it
was
A s tip u la tio n was added to id e n tify th a t in
th is q u e stio n n a ire , the term nurse re fe rre d to a re g is te re d nurse, as
opposed to a licensed p ra c tic a l nurse (Appendix).
The a s s is tin g le g is ­
la to r was given the forms and had one placed in each le g is la to r 's box.
The completed questionnaires were then returned to
box.
th a t le g is la to r 's
Al I questionnaires returned to the researcher p r io r to the s t a t is ­
t ic a l computation o f frequencies were included.
Data A nalysis Methods
Because o f the type o f survey and the data re turn ed, computations
were
in itia lly
ta b u la tio n s
lim ite d
to
raw
frequencies
between p a r tic u la r to p ic a l
and
percentages.
Cross
areas and re la te d demographics
were la te r compiled a t the d is c re tio n o f the researcher.
Summary
This chapter on methodology described the development o f a survey
to o l th a t would obtain a ttitu d e s and opinions o f the 150 Montana State
L e g is la to rs
nurses
in
in the 1983 session.
the
s ta te
and the
Input was gathered from ten leading
re s u ltin g
questions
were
repeated analysis by other nurses and a past le g is la to r .
subjected
to
A 49-question
to o l, dealing w ith the to p ics o f the image o f the nurse, the economics
of
n u rsing ,
s p e c ia lty
areas
in
nursing ,
nursing
education,
professionalism in n u rsin g , nursing and p o lit ic s , consumer health care,
and the ro le o f the nurse, was the r e s u lt.
The questionnaire was then
adm inistered to the 1983 L e g is la tu re , and the data were compiled and
analyzed w ith the use o f a computer.
31
CHAPTER FOUR
RESULTS
Overview
The purpose o f th is study was to id e n tify the cu rre n t a ttitu d e s o f
Montana State L e g isla to rs on the to p ics o f nurses, nursing, and health
care.
A research tool was designed to ascertain these a ttitu d e s in the
areas o f the image o f the nurse, the economics o f nursing, s p e c ia lity
areas in nursing, nursing education, professionalism in nursing, nursing
and p o lit ic s ,
chapter
consumer health care, and the ro le o f the nurse.
reports
the
s t a t is t ic a l
fin d in g s
as
to
the
frequency
This
of
responses, and gives some c o rre la tio n s between the demographics and the
responses.
Population
A ll
150 of the 1983 sta te le g is la to rs received the questionnaire,
and 98 questionnaires were returned in time fo r use in th is study.
The
response
the
rate
was
65%.
Of
those
98,
two
did
not
complete
demographic data, but the re s t of th e ir responses were u tiliz e d in the
to ta l frequencies.
32
Demographic Data
Age -and Sex
Knowledge o f the respondents' ages was considered s ig n ific a n t in
th a t some o f the re s u lts might be re la te d to the changing image o f the
nurse over the past few generations.
These generational
d iffe re n ce s
accounted fo r the age choice groupings o f 18-35, 36-50, 51-65, and over
65.
Of the 96 responses, 15 were in the 18-35 group, 32 in the 36-50
group, 38 in the 51-65 group, and 11 in the over-65 group.
The
respondent's
knowing whether there
sex
was
considered
was a s ig n ific a n t
im portant
a ttitu d e
in
re la tio n
d iffe re n c e
to
between
males and females regarding a career f i e l d th a t has been predominantly
female.
Of the 96 respondents, 16 were female and 80 were male.
P o litic a l Background
Party a f f i l i a t i o n
trends
in
responses
and p o lit ic a l
philosophy were included so th a t
re la te d to these influences
could be id e n tifie d .
Data were also requested on the number o f years' the respondents had held
p o lit ic a l
o ffic e
experience.
to
Party
see
i f there
choices were
was an a ttitu d e
Republican,
trend re la te d
Democrat, and
to
o th e r.
F o rty -fiv e responded as Republicans, 51 as Democrats and none as o th e r.
As to
p o lit ic a l
philosophy,
o f 92
respondents, 20 were L ib e ra l, 43
Conservative, 27 Moderate, one P o p u lis t, and one Progressive.
In order
to analyze the number o f years in p o lit ic a l o ff ic e , the responses were
grouped in to three ca te g o rie s:
those w ith less than two years, between
two and up to 11 yea rs, and 11 years and over.
Of the 96 responses, 27
were in the f i r s t category, 51 in the second, and 18 in the t h ir d .
groupings were an a r b itr a r y choice o f the researcher.
The
33
Education
Respondents were asked to
s ta te
the
highest le v e l
o f education
completed, again to see i f increased education co rre la te d w ith increased
knowledge
issues.
or
Of the
12th-grade
completed
more
p o s itiv e
to ta l
education,
some
of
a ttitu d e s
96 responses,
17 were
colleg e
about
but
high
had
not
nursing
2 persons
school
or
had
graduates
obtained
a
health
less
than
o n ly ,
degree,
care
27
28
a
had
had
a
ba chelo r's degree, 15 a m aster's degree, and seven possessed a doctoral
degree.
(Some lawyers
lis te d
themselves
as having
a doctoral
education and some lis te d themselves a t the m aster's le v e l.
leve l
The re s t a t
the doctoral le ve l were e d u ca to rs.)
Geographical Background
Previous studies done as p a rt o f the M aster's in Nursing program at
Montana State U n iv e rs ity have pointed out a ttitu d e
and philosophical
d iffe re n ce s about health and health care between people who have ru ra l
backgrounds and those who do no t.
life
Networking and the philosophies o f
o f Montana natives also seem to vary from those people who are
tra n s p la n ts .
These areas were explored through questions asking whether
the respondents were born in Montana, how many years they had liv e d in
the s ta te , and whether most o f th e ir liv e s
s e ttin g .
town
of
had been spent in a ru ra l
Rural was defined as e ith e r a sparsely populated area or a
2500
people
or
le ss .
Of
the
96 who
responded
to
these
q u estion s, 55 were Montana n a tiv e s , 41 were n o t; 54 had liv e d in Montana
t h e ir e n tire liv e s , 11 more than h a lf, and 31 less than h a lf; and 42 had
spent most o f th e ir liv e s in ru ra l areas, w h ile 54;had n o t.
34
Primary Occupation
These data were e lic it e d to see i f there was a c o rre la tio n between
the le g is la to r s '
occupations and th e ir a ttitu d e s
nurses,
and health
n u rsing ,
care.
Table
I
and knowledge about
shows
the. breakdown
of
occupations.
Health Related Background
In order to
in flu e n ce
asked.
see i f
f a m ilia r it y w ith
on the respondents'
nurses or h o s p ita ls
a ttitu d e s 9l two s p e c ific
had an
questions were
One was whether the respondents had ever been h o s p ita liz e d , and
the oth er was whether they had a close frie n d or r e la tiv e who was a
re g iste re d nurse.
Of the 96 le g is la to rs who responded to the question
o f whether they had ever been h o s p ita liz e d , 84 had and 12 had not.
As
to having a close frie n d or r e la tiv e who was a re g is te re d nurse, o f 95
responses, 73 were a ffir m a tiv e , and 22 were negative.
Table I . OCCUPATIONS (n=96)
Category ■
Absolute Frequency
28
Rancher or Farmer
22
Business
.
11
Education
9
R etired
6
Lawyer
5
Laborer
4
Management
2
Consultant
2
F ir e fig h te r
C le ric a l
2
2
Housewife
I
A rc h ite c t *
I
Lobbyist *
Student
*
I
*Thoughout the remainder o f the th e s is , these three occupations w ill be
included together under the category o f "o th e r" in order to maintain
anonymity.
35
Knowledge o f Health Care Resources
The
la s t
perceived
county.
demographic
knowledge
of
The o b je ct
of
question
health
th is
care
asked
services
question
about
the
a v a ila b le
was not to
respondents'
in
fin d
th e ir
home
out what was
a v a ila b le in the s ta te but to id e n tify how many le g is la to rs thought they
knew about the services a v a ila b le .
th e ir
home county
They were asked to id e n tify whether
had a community health
nurse,
w e ll- c h ild
c lin ic s ,
blood pressure screenings f o r sen ior c itiz e n s , independently p ra c tic in g
nurse p r a c titio n e rs , and independently p ra c tic in g nurse midwives.
were given
the
option
of
answering yes,
no,
or u n c e rta in .
They
Table 2
describes the re s u lts .
Table 2.
Home County Health Care Resources
Category
Yes
No
Uncertain
(n=)
Community Health Nurse?
89
2
4
(95)
WelI -C h ild C lin ic s ?
46
22
23
(91)
Blood Pressure Checks?
85
I
9
(95)
Nurse P ra c titio n e rs ?
43
13
36
(92)
Nurse Midwives?
22
26
43
(91)
.
A ttitu d e s and Opinions/Data Results
The re s t o f the questionnaire consisted o f 34 questions e lic it in g
a ttitu d e s
and
opinions
on
nurses,
nursing ,
and
health
fo llo w in g tab les show the re s u lts o f questions 14 through 47.
48 and 49 were open-ended questions,
discussed la te r .
answers
to
The
Questions
which w ill
be
In questions 14 through 33, any uncertain answers were
added by the respondents.
the questions.
the
care.
See the Appendix fo r the exact phrasings o f
36
Table 3.
A ttitu d e s and O pinions, Part I________ _________________ .
___________Question_________________
14.
Nurses have a good
p u b lic image?
15.
Nurses are paid what
they are worth?
16a.
Nursing is appropriate
f o r men?
Nursing is appropriate
f o r women?
16b.
Agree
Disagree
Uncertain (n=)
96
2
0
(98)
. 44
42
9
(95)
79
15
3
(97)
97
I
0
(98)
,
17.
PA's and Nurse
P ra c titio n e rs o ffe r
the same health care?
24
55
11
(90)
18.
Nursing is a profession
ra th e r than a s k ille d
occupation?
76
17
4
(97)
19.
Nurses always need MD
supervision?
36
56
3
(95)
20.
Nurses are powerful in
in flu e n c in g health care
p o lic ie s ?
77
20
0
(97)
21.
MD's and nurses should
a ffe c t h o sp ita l p o lic ie s
equally?
57
34
6
(97)
22.
Shortage o f nurses in
the U.S?
69
15
11
(95)
23.
Shortage o f nurses in
Montana?
61
23
12
(96)
24.
Nurses and MD's should
have a c o lle g ia l
re la tio n s h ip ?
74
16
5
(95)
25.
Some nurses make good
executives?
91
3
4
(98)
26. .
Montanans are in te re s te d
in pursuing good health
habits?
59
31
7
(97)
27.
Nurses should be e lig ib le f o r
th ir d - p a r ty reimbursement?
55
20
14
(8 9 )
37
Table 3.
A ttitu d e s and O pinions, Part I
Question
- (Continued)
Agree
Disagree
Uncertain (n=)
28.
Government monies should
be used fo r m aternalc h ild programs?
61
28
6
(95)
29.
Nurse's income is
only im portant as
supplemental income in
a fam ily?
28
62
8
(98)
30.
Nurses should be able to
organize and bargain?
68
25
3
(96)
31.
Nurses should provide
in p u t to le g is la to rs on
health care issues?
96
I
0
(97)
32.
The p u b lic needs b e tte r
health promotion and
disease prevention
education?
94
4
0
(98)
33.
Use p u b lic funds fo r
health care?
82
12
2
(96)
Yes
No
Do you know what a
nurse p r a c titio n e r
does?
45
9
41
35.
Aware th a t there are
3 basic education ■
programs in nursing? •
23
74
0
(97)
36.
Would you approve o f
a fa m ily member going
to a,nurse p ra c titio n e r?
60
7
27
(94)
37.
Nurses are good a t health
care teaching?
92
3
I
(96)
38.
Nurses are q u a lifie d
to p ra c tic e independently?
56
10
30
(96)
39.
Would you go to a nurse
p r a c titio n e r fo r a p h y s ic a l?
40
39
14/3*
(96)
Part I I
Question
34.
.
Uncertain
(n=)
(95)
38
* In Question 39, three respondents were uncertain i f they would go
to a nurse p r a c titio n e r , which was an added answer, w h ile 14 were
uncertain what a nurse p r a c titio n e r does, which was the th ir d option.
In Questions 40 and 41, the respondents were asked to rank th e ir
answers.
Question 40 asked fo r a ranking o f the
importance to the
consumer o f three aspects o f health care in which nurses were involved.
The options were bedside n u rsing , h e a lth promotion, and disease-preven­
tio n .
Question 41 concerned why nurses
s tr ik e .
More money,
b e tte r
working c o n d itio n s , and improved q u a lity o f p a tie n t care were the three
choices.
Tables 4 & 5 show the breakdown o f the responses.
Table 4.
Ranking o f Nursing Roles
40.
Rank the fo llo w in g
consumer (n=97).
nursing ro le s
in
order o f importance to
1st
87
2nd
3
3rd
7
Health promotion through education and research
7
54
32
Disease prevention through education and research
(Some respondents om itted 2nd or 3rd ra n k in g s .)
3
. 36
54
1st
2nd
3rd.
More money
50
20
17
B e tte r working con dition s
28
52
5
Improved q u a lity o f p a tie n t care
11
12
62
Caring f o r the s ick (bedside nursing)
Table 5.
41.
the
Ranking o f S trik e Causes
Nurses s tr ik e most often fo r (n=89):
(Some respondents om itted 2nd or 3rd ra n k in g s .)
In Questions 42, 43, 44 and 47, the le g is la to rs
were given the
o p p o rtu n ity to s e le c t a m u ltip le number o f answers to c e rta in questions.
Question 42 asked fo r possible reasons fo r a shortage o f nurses, and the
re s u lts are shown in Table 6.
39
Table 6.
42.
Causes o f a Nursing Shortage_______
___________________
I f you be lie ve there is a shortage o f nurses in Montana, do you
th in k i t is due to (check one or more)
(n=80)
29 Lack o f enough nurses
19 Rapid turnove r o f nursing personnel
36 D is s a tis fa c tio n w ith working conditions
41 Irre g u la r d is tr ib u tio n o f nurses throughout the s ta te
48 Low s a la rie s
Question 43 asked what le g is la to rs thought should make up the roles
o f nurses in the fu tu re .
Table 7.
43.
The breakdown is shown in Table 7.
Roles o f Nurses_____________________________________________ _
In the fu t u r e , the ro le s o f nurses should include the fo llo w in g
(check one or more)
(n=98)
__72 Health promotion
57 Disease prevention
38 Independent p ra c tic e
76 Bedside nursing
45 Nursing research
67 Nursing a d m in is tra tio n
52 H ospital a d m in is tra tio n
In Question 44, the le g is la to rs were asked to give t h e ir opinions
on the le ve l
answers.
o f e n try
in to
p ra c tic e
f o r nurses.
Table 8 shows the
40
Table 8.
44.
Entry in to P ractice_________________________
I belie ve the basic education fo r le v e l o f e n try in to professional
nursing should be (check one or more)
(n=98)
22
2-ye ar associate degree in nursing
22
3-year diploma
47
4-5-year ba chelo r's degree in nursing
12
not aware o f the d iffe re n c e s between the three
There were other in te re s tin g data from th is question.
More than
one choice was allow ed, but o f those who selected only one o f the fo u r
possible choices, 14 persons picked the associate degree o n ly , .15 picked
the diploma program o n ly , and 39 selected the bachelor's degree only.
Only fo u r persons picked a ll three choices as op tions.
Question 45 d e a lt w ith p r io r it iz in g
treatm ent
in
regard
to
a llo c a tio n
of
health promotion and illn e s s
he a lth
care
funds.
Table
9
delineates the re s u lts .
Table 9.
45.
Funding____________ ________________________________
S elect the fo llo w in g statement w ith which you most agree, re la te d
to a llo c a tio n s o f funds fo r health care.
__17
Health
promotion
is
(n=93)
more
im portant
than
illn e s s
treatm ent.
22
Illn e s s
treatm ent
is
more
im portant
promotion.
54
The two are o f equal importance.
than
health
41
In question 46, the le g is la to r s ' opinions on some major health care
issues in Montana were e lic it e d .
Table 10.
46.
The re s u lts are lis te d in Table 10.
Issues in Health Care_______________________________________
Rank in order o f importance these major issues in health care in
Montana today ( f i r s t through th ir d place ra tin g on ly)
1st
2nd
(n=89)
3rd
_72
_10 _3
Cost o f health care
_4
23 28
Lack o f f a c i l i t i e s in ru ra l areas (access to care)
_A
12 A l
Lack o f q u a lifie d health professionals
_3
22 i§ .
Lack o f home health care s e ttin g s
_2
_j8
11_
A llo c a tio n o f resources fo r treatm ent o f alcohol
and drug abuse
_0
_6
__4
A llo c a tio n o f resources fo r treatm ent o f
inte rpe rson al abuse (spouse, c h ild )
_1
_2
_3
A llo c a tio n o f resources fo r dealing w ith accident
■ victim s
__0 _5
__5
D u p lica tio n o f Services
_3
_0
Other - Lack o f preventive philosophy in health
_0
care - Q u a lity o f services - Uncertain
The le g is la to r s '
opinions on who should teach wellness promotion
were addressed in Question 47.
Table 11.
47.
The re s u lts are shown in Table 11.
Teaching Wellness P r o m o t i o n _____
Wellness
promotion
should
be
taught
(n=98)
88
Parents
80
Health professionals
66
Teachers in
preschools
76
Teachers in
grade schools
69
Teachers in high schools
by
(check
a ll
a p p lica b le )
42
In an open-ended q u e stio n , number 48, the le g is la to rs were asked
fo r th e ir opinions on the major reason f o r the ra p id ly increasing cost
of
health
care.
Of those
who answered,
negative reason fo r the increasing c o s t.
the
m a jo rity
id e n tifie d
a
The main causes were excessive
la b o r costs and greed. These seemed to overlap some, because the lab or
costs
were fre q u e n tly
described
e s p e c ia lly e a rly in p ra c tic e .
as doctors
wanting
too
much money,
One respondent said he did not know any
doctors in the middle income bracket.
A few persons s p e c ific a lly stated
th a t nurses' incomes were ob viously not one o f the causes.
Increased technology, w ith it s accompanying increase in co sts, was
the next most popular answer.
I t was u s u a lly lis te d as a negative cause
(excessive cost and use o f equipment), but a few le g is la to rs mentioned
th is as an in e v ita b le outcome o f improved health care.
Another major
cause given was excessive governmental
re g u la tio n , w ith
medicare
Many
included
under
th is
to p ic .
answers
medicaid and
mentioned
th a t
h o s p ita ls and doctors had taken advantage o f these payment systems to
increase t h e ir p r o f it s .
S im ila r ly , insurance rates were seen as being
excessive and a llo w in g h o s p ita ls to ra is e t h e ir ra te s , because the costs
would be paid fo r by the insurance companies and not d ir e c tly by the
p a tie n ts .
Cost containment was not seen as being p racticed a t the tim e.
A few people mentioned unpaid b i l l s as being a problem.
H ospitals
would th e re fo re ra ise t h e ir rates to cover the unpaid b i l l s .
In fla tio n
was also lis te d as a problem, or a t le a s t an excuse when th is question­
n a ire was completed in 1983.
43
Other
causes
mentioned
law suits and m alpractice
were
d u p lic a tio n
of
s e rv ic e s ,
excessive
insurance, and poor management o f h o s p ita ls .
A lso, a few le g is la to rs were o f the opinion th a t consumers were in d is ­
crim in a te
in th e ir use o f health care f a c i l i t i e s
and th a t they could
save money by more ju d ic io u s shopping fo r health care.
The le g is la to rs were asked, in question 49, where they usually went
fo r
inform ation
swered th a t
sources.
on le g is la tiv e
persons
in
the
health
health
care issues.
care
The m a jo rity an­
professions were th e ir main
Nurses and doctors ranked about the same as resources, w ith
a d m in istra to rs next.
Other answers were fe llo w le g is la to r s , the Depart­
ment o f Social and R e h a b ilita tio n
S e rv ic e s ,th e Department o f Health,
teachers, p a tie n ts , consumers and themselves.
The other major category
was lo b b y is ts , which included some o f the above groups.
comments
s p e c ific a lly
on
nurses
and
the
nursing
A ll
lobby
o f the
were
very
fa vo ra b le .
C o rre lations
Overview
Demographical data were included in the questionnaire to enable the
researcher
to
demographics.
id e n tify
s p e c ific
c o rre la tio n s
The p a rtic u la r re la tio n s h ip s
the most s ig n ific a n c e were delineated
demographics.
Therefore,
computer re la tin g
to
cross
in
between
responses
and
th a t were thought to hold
the previous
ta b u la tio n s
were
discussion
obtained
from
those demographics and selected questions.
on
the
The
re la tio n s h ip s th a t the researcher found most revealing w ill be discussed
in th is section.
44
Age and Sex
As mentioned e a r lie r , the researcher was in te re ste d in determining
whether
the
various
generations
of
le g is la to rs
making
up the
state
le g is la tu re could be id e n tifie d as holding d iffe r e n t opinions on nurses,
nursing , and health care.
The changing image o f women was thought to be
re la te d to a changing image o f nurses and nursing.
respondents
was
seen
as
having
a
p o te n tia l
Also, the sex o f the
influence
on
how the
respondents viewed the career o f nursing and how they would u t iliz e the
services nurses provide.
Question 16, both sections (a) and (b ), were c o rre la te d w ith both
age and sex demographics.
p ria te career fo r men.
Part (a) stated th a t nursing is an appro­
As to age d iffe re n c e s , a ll 15 respondents (100%)
o f the 18 to 35 age group agreed th a t the. career was appropriate.
the 32 in
Of
the 36 to 50 age group, 87.5% agreed, 6.3% disagreed and
another 6.3% were u n certa in.
There were 38 respondents in the 51 - 65-
age group, and 81.6% agreed, 15.8% disagreed, and 2.6% were un certain.
Of the 10 respondents in the la s t group, which included those over 65,
40% agreed,
60% disagreed,
and none were uncertain.
section was co rre la te d w ith
the
respondents'
When th a t same
sex, o f the 16 females
responding, 15, or 93.8% agreed, w h ile I , or 6.3% disagreed.
Of the 79
male respondents, 63 (79.7%) agreed, 14 (17.7%) disagreed, and 2 (2.5%)
were u n ce rta in .
In part B, a ll the respondents agreed th a t nursing was
an appropriate career fo r women, th e re fo re no ta b u la tio n s were done.
Another question re la te d to the professional ism of nursing (number
18),
stated
th a t
s k ille d occupation.
nursing
is
a profession
ra th e r than
a te c h n ic a lly
That question was tabulated against the age and sex
45
o f the respondents.
In the age cross ta b u la tio n , over 50% in each age
category agreed th a t nursing is a profession.
fo r the sex o f the respondents.
disagreed,
w hile
21.3% o f
the
That fa c t was also tru e
Also in te re s tin g was th a t no females
male
respondents
disagreed
w ith
the
statement.
The responses to the question th a t stated th a t the money th a t most
nurses
earn
compared to
is
supplemental
the
sex o f
the
income fo r
respondents.
the
fa m ily ,
number 29, were
Only 2 females
out o f
16
responding (12.5%) agreed w ith the statement, 3 (81.3%) disagreed, and I
(6.3%) was u n certa in.
Of the 80 males responding, 26 (32.5%) agreed, 48
(60%) disagreed, and 6 (7.5%) were u n ce rta in .
The sex o f the le g is la ­
to rs was viewed as s ig n ific a n t because o f possible sexual
held by some people.
supplemental
bias s t i l l
I f the respondents viewed nurses' incomes as only
they might be less
sympathetic to nurses'
requests
fo r
increased pay and tend to a lly themselves w ith a d m in is tra tiv e fa c tio n s
on other issues also.
The le g is la to rs were asked i f they would go to see a nurse p r a c ti­
tio n e r fo r a physical examination (question 39), and the responses were
co rre la te d again w ith sex and age demographics.
Over 50% o f each o f the
two younger groups stated they would see a nurse p r a c titio n e r , w hile
over
50% o f
the
two o ld e r groups
said
they would not.
As to
sex
c o rre la tio n s , 53.3% (8) o f the females said ye s, 26.7% (4) said no, 6.7%
( I ) said she was u n ce rta in , and 13.3% (2) said they did not know what.a
nurse p r a c titio n e r does.
Of the males, 38% (30) said yes, 44.3% (35)
said no, 2.5% (2) said they were u n c e rta in , and 15.2% (12) did not know
what a nurse p r a c titio n e r does.
46
P o litic a l P a rty, Philosophy, and Years in O ffic e
Demographic questions th re e , fo u r, and nine addressed these to p ic s .
Since le g is la to r s ' p o lit ic a l philosophies in flu e n ce t h e ir votes on many
issues, the researcher was in te re s te d in id e n tify in g any re la te d trends.
Question 28, which stated th a t governmental monies should be used
to finance m a te rn a l-c h ild health programs, was p a r tic u la r ly s ig n ific a n t.
When compared w ith the p o lit ic a l
p a rty , 34.1% (15) o f the Republicans
agreed, w h ile 54.5% (24) disagreed.
ta in .
Five persons, or 11.4% were uncer­
Comparatively, o f the 49 Democrats, 91.8% (45) agreed w ith the
statem ent, w h ile 6.1% (3) disagreed, and 2% ( I ) were u n ce rta in .
looking a t the p o lit ic a l
philosophy o f the 26 who disagreed w ith the
statement and who declared a philosophy, one was a lib e r a l,
conservatives
and
fo u r
When
were
moderates.
Only
in
the
21 were
conservative
category did those disagreeing outnumber those agreeing.
When the
question
stated
th a t
nurses
should
provide
in p u t
to
le g is la to rs on health care issues (number 31), only a moderate Democrat
w ith over s ix terms in o ffic e disagreed.
Another question on the to p ic o f funding was number 33.
I t stated
th a t p u b lic funds should be used to finance some health pare.
Of the 51
Democrats, one was uncertain and the re s t agreed.
Republicans,
u n ce rta in .
31
(72%)
agreed,
11 (26%)
disagreed,
However, o f the 43
and one (2%) was
Of those 11 disagreeing, ten were conservatives and one was
a moderate, w h ile one o f them was a fir s t- te r m e r ,
second to f i f t h
th e ir
terms, and fo u r Were in a t le a s t th e ir s ix th term.
Another p o lit ic a l
in question 27.
s ix were in
issue, th ir d
p a rty reimbursement, was addressed
I t stated th a t nurses should be e lig ib le fo r th ir d
47
p a rty reimbursement.
In the p o lit ic a l
agreed,
16 (38.1%)
p a rty breakdown, 18 o f the 42
Republicans
(42.9%)
disagreed,
and 8
(19%)
were
u n ce rta in .
There was more agreement among the 46 Democrats, w ith 36
(78.3%) agreeing, 4 (8.7%) disagreeing, and 6 (13%) being u n certa in.
Of
the 19 who disagreed, 14 were conservatives and 5 were moderates.
The la s t
p o l it ic a l l y
orie nte d
question
examined was number 45,
which asked the respondents to s e le c t the statement w ith which they most
agreed,
re la tin g
choices
were
tre atm e nt,
equal.
to
the
health
illn e s s
a llo c a tio n
promotion
of
being
funds
more
fo r
health
im portant
treatm ent being more im portant,
The m a jo rity
care.
than
The
illn e s s
or the two being
o f both Democrats and Republicans
selected
the
th ir d choice o f both being eq ual, but o f the remaining Democrats, 10 out
o f the 16 chose health promotion, w h ile o f the Republicans, only fiv e
out o f the 21 made th a t same choice.
Education and Occupation
These two demographics could be s ig n ific a n t in re la tin g views on
professional issues to the respondent's professional background.
In question 18, which stated th a t nursing is a profession ra th e r
than
a te c h n ic a lly
agreed,
s k ille d
occupation,
of
the
97 responding,
17.9% disagreed, and 4.2% were u n ce rta in .
77.9%
Those disagreeing
included one o f the two respondents w ith less than a 12th grade educa­
tio n (50%), e ig h t o f the 16 w ith tw e lfth grade educations (50%), one o f
the 27 who had some higher education (3.7% ), fiv e o f the 28 who had a
bachelor degree (17.9%), and two o f the seven who had a doctoral degree
(28.6%).
In
the
occupation
category,
the
d isa gre eing, seven, were farmers or ranchers.
la rg e s t
number o f
those
48
The statement th a t nurses should fu n c tio n
only under the super­
v is io n o f p h ysicia ns, question 19, had 35 agreeing and 55 disagreeing.
Three were u n ce rta in .
Those agreeing f e l l
under a ll
education
egories except the category o f less than a 12th grade education.
35 agreeing;
the
g re a te st
numbers
were
ranchers
and
c a t­
Of the
farmers
(1 1 ),
business persons (9 ), educators (5 ), and re tire d persons (3 ).
Another question ,
number 21,
stated
should have equal ro le s in h o sp ita l
th a t
physicians
p o lic y making.
and nurses,
T h irty -fo u r o f 95
respondents disagreed.
Tw enty-five percent o f those w ith a 12th grade
education,
some higher education,
29.6% w ith
46.4% w ith
a bachelor
degree, 26.7% w ith a m aster's degree, and 71.4% w ith a doctoral degree
a ll disagreed.
The occupations o f those disagreeing were 54.5% o f the
educators, 66.7% o f the lawyers, 100% o f the co n su lta n ts, 50% o f the
managers,
31,8% o f the
business
persons,
33.3% o f the
ranchers
and
farm ers, and 44.4% o f the re tire d persons.
Another re la te d question, number 24, stated th a t the re la tio n s h ip
between nurses and physicians should be a c o lle g ia l
the
respondents
disagreed,
which
included
fo u r
one.
o f the
Only 16% o f
26 w ith
some
higher education, e ig h t o f the 27 w ith a bachelor degree, one o f the 15
w ith a m aster's degree, and three o f the seven w ith a doctoral degree.
The professions o f those disagreeing were law yers^ educators, managers,
business persons, ranchers and farm ers, and re tire d persons.
None o f
the occupation categories had more than 50% disagreeing.
Question 30 stated th a t nurses should be allowed to organize and
bargain w ith
disagreed.
employing agencies.
N in e ty -fo u r responded, o f which 24
One o f the respondents (50%) w ith less than a 12th grade
49
ed ucation, fo u r o f the respondents (26.7%) w ith a 12th grade education,
10 (37%) o f those w ith some higher education, seven (25%) o f those w ith
a bachelor degree, and two (28.6%) o f those w ith
responded n e g a tive ly.
F if t y
a doctoral
degree,
percent o f those in management, 27.3% of
those in business, 46.2% o f the ranchers and farm ers, and 33.3% o f the
re tire d respondents made up the group th a t disagreed.
In two questions, numbers 36 and 39, re la tin g to u t iliz in g
p r a c titio n e rs , the c o rre la tio n s w ith education are as fo llo w s :
nurse
o f the
92 respondents to the statement th a t the le g is la to rs would approve o f a
fa m ily member going to a nurse p r a c titio n e r fo r health care, 58 said
yes, seven said no, and 27 were uncerta in.
Of the seven who said no,
one had less than a 12th grade education, 3 had a 12th grade education,
2 had some higher education, and one had a doctoral degree.
if
When asked
they would go to a nurse p r a c titio n e r fo r a physical exam, 38 said
yes, 39 said no, three were u n ce rta in , and 14 were uncertain what a
nurse p r a c titio n e r does.
Each leve l
o f education was divided almost
evenly between those who said yes versus those who said no.
Montana Natives and Rural Background
Questions 6, 7, and 8, which covered whether the le g is la to rs were
born in Montana, how many years they had liv e d here, and whether they
had spent most o f th e ir liv e s in a ru ra l environment, were compared w ith
several consumer type questions.
Question 26 stated th a t i f Montana c itiz e n s were given inform ation
on good health habits and health promotion, the m a jo rity would fo llo w
the suggestions to improve th e ir he alth.
Of the 55 respondents who were
na tive Montanans, 60% agreed, 32.7% disagreed and 7.3% were uncertain.
50
These percentages were s im ila r to the 40 non-natives o f whom 60% agreed,
32.5% disagreed, and 7.5% were u n c e rta in .
The percentages were also
s im ila r when the question was compared to years liv e d in Montana.
Next,
background.
the question
on improving health was compared w ith
ru ra l
Of the 42 respondents from ru ra l backgrounds, 54.8% said
they agreed, 33.3% disagreed, and 11.9% were u n c e rta in .
There were 53
le g is la to rs , from non-rural backgrounds, and 64.2% o f them agreed, 32.1%
disagreed, and 3.8% were u n certa in.
The next set o f comparisons d e a lt w ith question 32, which stated
th a t the p u b lic needs to be b e tte r educated in
health
promotion and
disease preven tion, so they can be more p r o fic ie n t in s e lf care.
Of the
55 who were Montana n a tiv e s , 54 agreed (98.2%) and one (1.8%) disagreed.
Of the 41 non-natives, 38 agreed (92.7%) and 3 disagreed (7.3%).
Of the
fo u r respondents who disagreed w ith the statem ent, one had liv e d here
less than h a lf his l i f e , two had liv e d here most o f t h e ir liv e s , and one
his whole l i f e .
A lso, three o f the fo u r were from ru ra l backgrounds.
Question 40 gave the respondents three choices o f the nursing ro le
most im portant to consumers.
caring
fo r
the
s ic k .
The overwhelming number one choice was
But o f the
IQ persons choosing e ith e r health
promotion or disease preven tion, nine o f them had non-rural backgrounds.
In number 46, which asked the respondent to rank in order o f importance
e ig h t d iffe r e n t major issues on health care in Montana today, no s ig n if ­
ic a n t d iffe re n ce s were noted between n a tiv e Montanans and non-natives,
or according to d u ratio n o f liv in g in th is s ta te .
Only a s lig h t d i f f e r ­
ence was noted between ru ra l dw ellers and non-rural ones, w ith 71.1% o f
V
51
the ru ra l in h a b ita n ts s e le c tin g cost o f health care as the major issue
and 87.8% o f the non-rural members also s e le c tin g th a t f i r s t choice.
A ssociation w ith Nurses
This la s t section o f demographics was seen as re la tin g to consum­
e rs ' views on the ro le s o f nurses.
Three questions were cross tabulated
w ith demographic questions 11 and 12.
In
question
25,
the
statement was made th a t
because o f
experience in management, some nurses make good executives.
th e ir
Of the 95
respondents, 88 agreed, three disagreed and fo u r were u n ce rta in .
Al I
seven in the la s t two categories answered yes to the question o f whether
they had a close frie n d or r e la tiv e who was a re g is te re d nurse.
Of the
three who disagreed, two answered yes to having been h o s p ita liz e d and
one answered no.
Question
37 stated
th a t the
respondent would fe e l
re ce ivin g health teachings from a nurse.
three said no and another was u n ce rta in .
co n fiden t
in
Of the 94 respondents, only
Again a ll fo u r stated they had
a frie n d or r e la tiv e who was a nurse and a ll had been h o s p ita liz e d .
Next, the question which asked i f the le g is la to rs thought c e rta in
nurses
were
examined.
q u a lifie d
to
p ra c tic e
independently
(question
38)
was
Of the 94 respondents, 54 said yes, 10 said no, and 30 were
uncertain what independent p ra c tic e
e n ta ile d .
seven
did
had nurse
h o s p ita liz e d .
frie n d s
and three
n o t,
Of the
w hile
a ll
10 saying
no,
10 had been
Of the 30 uncertain respondents, 22 had an RN fr ie n d , and
28 had been h o s p ita liz e d .
52
Summary
This chapter has presented the s t a t is t ic a l data c o lle c te d from the
questionnaire adm inistered to the 1983 Montana State L e g is la tu re about
th e ir views on nurses, n u rsing , and health care.
The re s u lts o f the 13
demographic questions were given as were the absolute frequencies fo r
questions
re s u lts
14 through 49.
were
summarized.
For the la s t two open ended questions, the
The
second
p a rt
of
the
chapter
included
c o rre la tio n s between the demographics and s p e c ific questions selected by
the researcher th a t might id e n tify p re d ic ta b le trends in the opinions o f
these le g is la to rs and which might also be applied to fu tu re le g is la to r s .
In the fin a l
chapter, the s ig n ific a n c e o f the trends and c o rre la tio n s
w i l l be discussed.
53
Chapter 5
DISCUSSION
■
Overview
The purpose o f th is study was to examine the a ttitu d e s and opinions
o f the 1983 Montana State L e g is la tu re on the to p ics o f nurses, nursing,
and health care.
The lite r a tu r e
review discussed p e rs is te n t problems
f o r the nursing profession in achieving power, professional s ta tu s , and
re co g n itio n
o f e q u a lity
as
a member o f
the
health
care
team.
The
opinions o f various leading nursing professio nals in Montana were c ite d
about how to promote power among nurses.
both nationa l
and lo c a l
One o f the key ways favored by
nurse leaders was to obtain
p o lit ic a l
power
through in te ra c tio n w ith le g is la to rs a t a ll le v e ls , e s p e c ia lly the.grass
roots
le v e l.
In
th is
nurses could s o l i c i t
study,
a survey
to o l
was developed by which
info rm a tion from Montana State le g is la to rs
t h e ir views on nurses, n u rsing , and health care.
about
With th is in fo rm a tio n ,
nurses could become more fa m ilia r w ith the a ttitu d e s o f the people w ith
whom they would be working to
brin g about changes in
nursing and health care in the s ta te .
the fie ld s
of
The conceptual framework fo r the
study was based on planned change using RappsiI b e r's persuasion - change
model fo r nurses.
was e sse n tia l
in
An evaluation o f the ta rg e t audience (le g is la to r s )
determ ining
the s tra te g y
to
be used by the change
agents (nurses) to b rin g about changes in a ttitu d e s and behaviors in the
ta rg e t audience.
54
In te rp re ta tio n o f Data
Many o f
the
p e rtin e n t
fin d in g s
in
th is
study were
expectations versus the actual re s u lts o f the survey.
re la te d
to
The m a jo rity o f
the answers given were expected by the researcher a fte r having reviewed
the lit e r a t u r e on the c u rre n t status o f the nursing profession and a fte r
having interview ed ten prominent nurse leaders in Montana.
of
c e rta in
oth er
questions
pointed
out
some negative
The re s u lts
aspects
about
nursing th a t could be s ig n ific a n t in ' pursuing fu tu re le g is la tio n .
In
th is chapter, the re s u lts o f s p e c ific questions w ill be discussed, then
the
im p lic a tio n s
of
th is
study
w ill
be
d e lin ea ted.
Next,
the
lim ita tio n s o f the study w i l l be presented, along w ith suggestions fo r
fu tu re research.
Demographics
In
the
in te re s tin g
demographic
since
the
se c tio n ,
the
responses
re s u lts
showed
th a t
to
question
13 were
le g is la to r s ,
probably
because o f th e ir ages and socia l s ta tu s , were much less c e rta in about
th e ir
county
p r a c titio n e rs ,
nurses
resources
dealing
w ith
w e ll-c h ild
c lin ic s ,
nurse
and nurse midwives than they were about p u b lic health
and blood pressure c lin ic s .
These re s u lts
could be expected
because these services are h is t o r ic a lly fewer in number and less w ell
known.
As to the other demographics, trends in age and sex showed women
and
younger
men
to
be
the
most
Conservative Republicans led the l i s t
e s p e c ia lly in areas o f fin a n c in g .
supportive
of
nursing
issues.
o f those on the negative sid e ,
Education and occupation did not
55
c o n s is te n tly determine s p e c ific
a ttitu d e s
and opinions
and would not
seem to be good p re d ic to rs o f them, although farmers and ranchers seemed
to have c o n s is te n tly conservative a ttitu d e s .
If
anything, those w ith
doctoral degrees seemed the le a s t sympathetic to nursing issues.
did r u r a li t y or being a n a tive Montanan show co n siste n t tre nds.
Nor
L a s tly ,
those w ith the more r e s t r ic t iv e views o f nursing ro le s were frie n d s or
re la tiv e s o f nurses or had come in to contact w ith them in h o s p ita ls .
A ttitu d e s and Opinions
The Image o f the Nurse
Six questions were included under th is se c tio n .
o f nurses compiled from the re s u lts was p o s itiv e .
the
p u b lic
image was
p o s itiv e
and
profession fo r both men and women.
th a t
nursing
The o v e ra ll image
The m a jo rity thought
was
an
acceptable
The fa c t th a t the negative re p lie s
about male nurses were from o ld e r men may have been re la te d to the more
conservative a ttitu d e s regarding appropriate careers f o r men and women
which were prevalent p r io r to the women's lib e r a tio n movement in the
1970's.
The respondents also believed th a t there is a nursing shortage,,
both n a tio n a lly and in Montana.
In a c tu a lity , there are more nurses in
Montana than there are nursing p o s itio n s , but the d is tr ib u tio n does not
always match the a v a ila b le p o s itio n s .
In the other re la te d question,
number 42, the le g is la to rs did choose " ir r e g u la r d is tr ib u tio n o f nurses
throughout the s ta te " as a close second to low s a la rie s as the cause o f
the shortage in Montana.
This choice seems to show th a t the respondents
are aware o f the d is tr ib u tio n problem indigenous to Montana.
56
The Economics, o f Nursing
The le g is la to rs were about evenly s p l i t on whether nurses are paid
what they are w orth.
About tw o -th ird s
o f the respondents said th a t
nurses should be e lig ib le fo r th ir d p a rty reimbursement.
One could be
o p tim is tic regarding le g is la tio n on th a t issue, since th a t le g is la tu re
had
already
passed
reimbursement.
a
b ill
g iv in g
nurse
To the o th e r question
s p e c ia lis ts
re la tin g
th ir d
party
to money, number 29,
which stated th a t the money most nurses earn is supplemental income fo r
the fa m ily , 63% o f the le g is la to rs
responded n e g a tiv e ly .
The o v e ra ll
economic a ttitu d e appears p o s itiv e f o r nurses.
S p e cia lty Areas in Nursing
With 37% o f the le g is la to rs e ith e r o f the opinion th a t physician
a ssista n ts and nurse p ra c titio n e rs o ffe r the same service to consumers
o r are uncertain i f they do, nurse p ra c titio n e rs might see the need to
improve the consumer p o p u la tio n 's knowledge o f th e ir ro le .
a nurse p r a c titio n e r f o r
responses
were
more
health
lik e ly
from
care,
o ld e r
questions
males,
As to using
36 and 39, negative
and
in
general,
the
le g is la to rs were more lik e ly to approve o f th e ir fa m ilie s u t iliz in g the
services o f a nurse p r a c titio n e r than they were fo r themselves.
a ttitu d e
could
be
re la te d
to
the
p ra c titio n e rs are female and to i t s t i l l
fie ld
(20 y e a rs ).
impression
th a t
most
This
nurse
being a r e la tiv e ly new career
Increased education did
not increase the ra te
of
p o s itiv e responses to those questions.
Nursing Education
The three questions p e rta in in g to the to p ic were 18, 35, and 44.
The respondents' overwhelming view th a t nursing is a profession ra th e r
57
than a s k ille d occupation is a promising aspect fo r nursing.
s ig n ific a n t
p ra c tic e
fin d in g
issues
to
came
nurses
from
involved
question
in
35.
the
le ve l
of
Approximately
A h ig h ly
e n try
in to
73% o f
the
respondents were not aware th a t nursing has three educational le v e ls o f
e n try in to p ra c tic e .
Since, in question
Again, consumer education would seem appro pria te.
44, the le g is la to rs were overwhelmingly in fa v o r o f
the baccalaureate degree being the on ly le v e l o f e n try in to p ra c tic e ,
the
nursing
community
might
view
le g is la tiv e
change as
being
more
appropriate than attem pting a change through the State Board o f Nursing.
Professionalism in Nursing
Several trends can be seen from the s ix questions re la te d to th is
to p ic .
There was support fo r nursing having an equal ro le w ith medicine
in h o sp ita l
p o lic y making and fo r nurses to not always need physician
su p ervision .
between nurses
background in
There
was
also
and physicians.
the
le g is la to rs
support
fo r
a
c o lle g ia l
Increased education
did
not seem to
re la tio n s h ip
and professional
coincide w ith
a more
p o s itiv e a ttitu d e toward nursing as a profession ra th e r than a s k ille d
occupation.
Organizing and bargaining were oth er professional issues w ith which
the m a jo rity agreed, and both o f these p ra ctice s
Montana fo r several years.
have been legal
in
But the le g is la to rs were o f the opinion th a t
nurses s tr ik e m ostly fo r more money.
According to the nurse in charge
o f bargaining f o r the Montana Nurses A sso cia tio n , improved q u a lity o f
care is as often a major issue in bargaining as is money.
lack o f in fo rm a tion would seem to be a to p ic
Again, th is
in need o f more p u b lic
awareness to help nursing acquire a stronger support network.
58
Nursing and P o litic s
Six questions were included in th is category.
P o s itiv e trends were
v is ib le on the to p ic o f health care fundings (question 45) w ith illn e s s
treatm ent and disease prevention both being viewed as e q u a lly im portant
by
the
m a jo rity ,
experience.
p o lic ie s .
lobbying
regardless
of
p o lit ic a l
Nurses were seen as a powerful
That
e ffo r ts
p o s itiv e
of
the
a ttitu d e
was
MNA during
p a rty ,
or
in flu e n ce on health care
probably
the
philosophy,
1983
influenced
session.
by
the
A lso,
the
le g is la to rs were overwhelmingly in fa v o r o f having in p u t from nurses on
health care issu e s, as stated in both questions 31 and 49.
p a rty and philosophy a ffe c te d
m a te rn a l-c h ild
p o lic y opinions
health programs w ith
lik e ly to be against the funding.
re la te d
P o litic a l
to funding fo r
the conservative Republicans more
At the same tim e , many o f those same
conservatives were in fa v o r o f health care funding in general.
group would
change
if
be one toward which
m a te rn a l-c h ild
nurses
programs
come
should d ir e c t
under
a tta ck
This
t h e ir
planned
w ith
funding
cutbacks.
Consumer Health Care
The summary o f the re s u lts o f the consumer re la te d questions showed
th a t a m a jo rity o f respondents saw a need f o r increased consumer health
teaching, thought th a t Montanans would use health promotion inform ation
w is e ly , and saw nurses as being good resource persons fo r th is health
teaching.
Parents, teachers, and other health professio nals were also
viewed as ap propriate teachers.
f o r the s ick was s t i l l
consumers.
The tr a d itio n a l nursing ro le o f caring
seen as the prim ary nursing ro le o f b e n e fit to
Much o f nursing education today stresses health promotion, .
59
and again, increased p u b lic awareness o f the various ro le s involved innursing would be b e n e fic ia l to the professio n.
When the le g is la to rs were asked to id e n tify the major reason fo r
ra p id ly increasing health care c o sts, the overwhelming m a jo rity chose a
negative reason.
They blamed doctors and lawyers fo r t h e ir greed and
consumers f o r th e ir apathy and ignorance.
th a t
something needed to
should be h e lp fu l
They conveyed the fe e lin g
be done about the
problem.
This
to nurses promoting new endeavors i f
a ttitu d e
they use cost
containment in a sso ciation w ith improved health care as p o s itiv e aspects
o f t h e ir p ra c tic e .
The Role o f the Nurse
Responses to questions on th is to p ic showed an o v e ra ll p ic tu re o f
nurses having a v a lid place in higher management and as having a ro le in
health teaching.
As to the s p e c ific
ro le s mentioned in
bedside nursing and health promotion ranked about equal.
question 43,
Other areas o f
less v i s i b i l i t y , lik e research and h o sp ita l a d m in is tra tio n , were, chosen
about
50% o f
the
tim e.
The one ro le
th a t
was received
the
le a s t
e n th u s ia s tic a lly was independent p ra c tic e f o r nurses.
One lik e ly reason
would
by
be
p o pula tion.
the
lack
of
f a m ilia r it y
w ith
th is
ro le
the
consumer
Here again, improved consumer education on various nursing
ro le s should help to increase understanding o f the ro le s and acceptance
o f nurses in those ro le s .
R elationship to Conceptual Framework
Throughout
th is
study,
the
data
c o lle c tio n
,
was
geared
toward
accumulating info rm a tion about a ta rg e t audience, the 1983 Montana State
60
L e g is la tu re .
le g is la to rs
opinions
In summary, th is study gave some s p e c ific data about the
re la te d
to
t h e ir
demographics,
o f the group as a whole.
nurse change agent,
This
and
the
a ttitu d e s
and
inform ation would allow the
p a r tic u la r ly where baccalaureate degree le v e l
of
e n try in to professional nursing is the g o a l, to determine which model o f
in te rv e n tio n
would be most appropriate
in fo rm a tio n a l
model
to
use w ith
th is
group.
The
appears to be the best choice since there is
an
o v e ra ll p o s itiv e m o tiva tio n and a c c e s s ib ility o f audience along w ith a
lack
of
some
basic
info rm a tion
about
nursing
upon
which
to
base
decisions.
Im p lica tio n s For Nursing
Throughout th is stud y, re s u lts from the data analysis have pointed
toward
the
need
fo r
increased
consumer
education
profession o f nursing and improved health care.
about
both
the
For nurses dealing w ith
le v e l o f e n try , these re s u lts should p o in t out a need fo r education o f
the le g is la tu re e a rly in the session about c u rre n t ro le s in nursing and
then fo r reinforcem ent o f the need fo r a baccalaureate degree to give
re g iste re d nurses the necessary educational background to achieve tru e
professional
s ta tu s .
Since the m a jo rity o f le g is la to rs
already fa v o r
the baccalaureate f o r le v e l o f e n try , the e ffo r ts o f lo b b y is ts should be
d ire cte d toward re la tin g less c o s tly health care and improved consumer
health to higher standards o f education.
As stated in the lite r a tu r e
review , nurses need to e s ta b lis h a c o a litio n w ith the p o lit ic a l forces
a t the s ta te and lo ca l
w ith these people.
le v e ls , and then m aintain a constant dialogue
A hard s e ll s tra te g y would not be needed w ith th is
61
audience,
actions
but a constant su b tle
fo s te rin g
promotion o f the
consumer wellness
would
profession
be a p p ro p ria te .
through
The end
product o f th is process should also be the establishm ent o f a power base
on which nurses can b u ild
by continuing to
increase the support fo r
nursing.
S im ila r ly ,
the
education
of
consumers
through
p u b lic
re la tio n s
methods and networking would help to improve knowledge o f nursing ro le s
and provide a support system fo r nursing.
This support is needed fo r
wellness promotion and improved health care.
the need f o r planned change is
Throughout th is process,
paramount, both to give d ire c tio n
to
nursing in Montana, and to m aintain a p o s itio n o f. a ctio n ra th e r than
re a c tio n .
One fu r th e r
pointed out in
p o l it ic a l l y
nursing is
consideration
the lit e r a t u r e
is
re la te d
nursing
education.
As
review , the need fo r nurses to become
knowledgeable and a c tiv e
im portant.
to
in
supporting the profession o f
Professional power is acquired not only through
improved fin a n c ia l s ta tu s , but also through increased p o lit ic a l support
from
vo tin g
increased
le g is la to r s .
support
u su a lly
Again,
the
involves
method
planned
to
brin g
change.
about
th is
Baccalaureate
programs th a t include a t le a s t an in tro d u c to ry course on these top ics
provide some o f the in ce n tive s f o r nurses to u t i l i z e these concepts from
the beginning o f th e ir careers.
Masters programs need to focus h e a vily
on these professional issues in n u rsing , since increased education and
experience u s u a lly r e s u lt in increased se lf-c o n fid e n c e in nurses, making
them more lik e l y to fo llo w through w ith needed plans o f a c tio n .
62
L im ita tio n s
The
lim ita tio n s
a d m in is tra tio n
questions.
of
o f the
th is
study
questionnaire
basis fo r planned change, i t
week o f
le g is la to rs
on
the
tim in g
of
the
and the wording o f the s p e c ific
In th is study, the questionnaire was not adm inistered u n til
the end o f the le g is la tiv e session.
fir s t
center
the
s till
should have been administered during the
session.
This
tim in g
is
b e n e fic ia l
because the
have a l ig h t schedule during th a t week since b i l l s
have not y e t been subm itted.
questionnaire i f
Id e a lly , to make i t a p re d ic to r and
More le g is la to rs might have completed the
they had been under less pressure from other sources
during th a t fin a l week.
As to the v a lid it y o f the questions in th is study, c o lle c tio n and
analysis o f the data from the questionnaire showed th a t several o f the
questions
were
ambiguous
or
too
general.
A lso,
feedback
from
the
le g is la to rs on the questionnaire showed the need fo r an uncertain option
on each question.
executives.
One example is question 25, about nurses making good
The researcher was looking fo r biases against nurses who
might in the fu tu re view h o sp ita l a d m in is tra tio n as being id e a lly under
the auspices o f nurses.
the
responses
to
The wording o f the question is too vague fo r
adequately
id e n tify
any o f
those
biases.
Another
problem question was number 15, which stated th a t nurses in Montana are
being paid what they are w orth.
The in te n t o f the question was to fin d
out i f le g is la to rs thought nurses were being underpaid, but the wording
also
le ft
open the
p o s s ib ility
nurses are paid too much.
o f a "disagree"
answer meaning th a t
63
Another lim ita tio n o f th is study re la te s to the m o d ific a tio n o f the
questionnaire th a t would probably be needed each time i t would be used.
Some o f the cu rre n t issues in nursing are time s p e c ific , so additions
and d e le tio n s would be appropriate each tim e. A lso, the fa c t th a t the
questionnaire was self-developed allows fo r many biases in the wording
o f the questions re la te d to expected outcomes.
A
fo u rth
questionnaire
consideration
was
adm inistered
re la te s
at
to
the
the
fir s t
beginning
of
one.
the
If
the
le g is la tiv e
session and planned change was in it ia t e d , then the questionnaire should
be repeated a t the end o f the session to see i f there were any concrete
changes in a ttitu d e s
and opinions.
Some feedback would already have
been obtained by passage o f re la te d nursing or health care le g is la tio n .
O v e ra ll, tim ing and refinem ent o f the questionnaire would be areas o f
concern fo r anyone re p lic a tin g th is study or u t iliz in g the re s u lts fo r
change purposes.
Suggestions For Future Research
Suggestions fo r fu tu re research would be re p lic a tio n o f the study
w ith each le g is la tiv e
change a t the session.
groups in the s ta te .
session p r io r to in it ia t in g
lobbying or planned
A revised version might also be used w ith other
C oncurrently, a lo n g itu d in a l study could be done
to examine changing a ttitu d e s over time to see i f the planned change was
e ffe c tiv e .
Another option would be the extension o f th is type of study
to other states s im ila r to Montana and eve n tu a lly to any s ta te .
concept o f planned change should be used by nurses whenever a goal
set th a t would necessitate change.
The
is
P ublica tion o f some o f the fin d in g s
64
o f th is
th e sis w ith background data could help oth er nurses use th is
process fo r accomplishing le ve l o f e n try and other major change p ro je cts
throughout the country.
Summary
- This
opinions
nurses,
ta rg e t
study was done to
o f the
s o lic it
1983 Montana State
n u rsing , and health care.
audience
in
order
involved in planned change.
to
and evaluate
le g is la to rs
the
a ttitu d e s
on issues
re la te d
and
to
The goal was the evaluation o f a
determine
needed modes o f
in te rv e n tio n
One s p e c ific goal was to obtain inform ation
re la te d to fu tu re le g is la tio n supporting, the baccalaureate degree as the
le ve l o f e n try in to professional nursing p ra c tic e .
The study showed th a t in Montana in 1983, the nursing profession .
had a favo rab le image w ith the le g is la to r s , but th a t increased education
was needed fo r both le g is la to rs and other consumers on the various ro le s
th a t
are
p a rt
of
the
nursing
profession
and
profession has to o ffe r the health care system.
on
the
b e n e fits
the
65
REFERENCES CITED
Aiken, L. H. (E d .). Health p o lic y and nursing p ra c tic e . New York:
McGraw-Hill Book Company, 1981.
American Nurses A sso cia tio n . Nursing, a socia l p o lic y statem ent.
Kansas C ity : American Nurses' A sso cia tio n , 1980.
Ashley, J. A. H o s p ita ls , paternalism , and the ro le o f the nurse.
York: Teachers College Press, 1976.
New
A y d e lo tte , M. K. Professional nursing: The d riv e fo r governance. In ■
N. L. Chaska (E d .). The nursing p rofessio n: A time to speak. New
York: McGraw-Hill Book Company, 1983.
Brown, B. J. Reorganizing hospital-based nursing p ra c tic e : An analysis
o f p a tie n t outcomes, provide s a tis fa c tio n , and costs.
In U H.
Aiken
(E d .).
Health p o lic y and nursing p ra c tic e .
New York:
McGraw-Hill Book Company, 1981.
Brown, E. L. External so cia l pressures and the c u ltu re o f d e n ia l. In
One step beyond: Shock or r e a lity ? New York: National League fo r
Nursing, 1978.
Burge, J. M. The power o f o rg a n iz a tio n s . In K. R. Stevens (E d .).
Power & in flu e n c e , a source book f o r nurses. New York: John Wiley
& Sons, 1983.
E hrenreich, B. The purview o f p o lit ic a l a c tio n .
nursing as a p o lit ic a l fo rc e .
New York:
N ursing, 1979.
In The emergence o f
National League fo r
Grissum, M. P o litic s o f power. In M. Grissum & C. Spengler (E d s.),
Womanpower and health care.
Boston:
L i t t l e , Brown and Company,
1976.
Hardy, M. E. Role stre ss and ro le s tr a in . In M. E. Conway & M. E.
Hardy (E d s.).
Role theory perspectives fo r health p ro fe s s io n a ls .
New York: Apple to n -C e n tu ry -C ra fts , 1978.
Hassenplug, L. W. 2001 is here. In One step beyond:
New York: National League fo r Nursing, 1978.
Shock or re a lity ?
Humphrey, C. In tro d u c tio n : Mandate fo r nurses: Involvement in health
p o lic y .
In The emergence o f nursing as a p o lit ic a l fo rc e .
New
York: National League fo r Nursing, 1979.
66
REFERENCES CITED
K a lisch , B. J . , & K a lis c h 9 C. A. P o litic s o f n u rs in g .
J. B. L ip p in c o tt Company9 1982.
P h ila d e lp h ia :
Kohnke9 M. F. The case fo r co n s u lta tio n in nursing; designs
fo r professional p ra c tic e . New York: John Wiley & Sons, 1978.
L e in in g e r9 M. T e r r i t o r i a l T ty 9 power, and c re a tiv e leadership in
a d m in is tra tiv e nursing contexts. In Power9 use i t or lose i t .
York: National League fo r N ursing9 1977.
New
McFarland, D. E. Power as a change s tra te g y . In J. Lancaster & W.
Lancaster (E d s.).
The nurse as a change agent.
S t. Louis:
C. V. Mosby Company9 1982.
The
Messer9 S. S. P o litic s , f o r nursing: T h re a t.o r opportunity?
National League fo r N ursing9 1980.
New York:
O'Rourke, M. W. Expert power: The basis f o r p o lit ic a l s tre n g th . In
Raising your p o lit ic a l blood pressure. New York: National League
fo r N ursing9 1980.
R appsilber9 C. Persuasion as a mechanism f o r change. In J. Lancaster
& W. Lancaster (E d s.).
The nurse as a change agent.
S t. Louis:
The C. V. Mosby Company9 1982.
Stevens9 K. R. (E d .). Power & in flu e n c e , a source book f o r nurses.
New York: John Wiley & Sons, 1983.
The Merriam-Webster d ic tio n a r y .
New York:
Pocket Books, 1974.
Webster's 7th new c o lle g ia te d ic tio n a r y . S p rin g fie ld , Massachusetts:
C. & C. Merriam Company, P u b lish e rs, 1963.
W illm an, M. D. Change and power. In K. R. Stevens (E d .).
Power & in flu e n c e , a source book fo r nurses. New York:
& Sons, 1983.
John Wiley
67
APPENDIX
A p ril 14, 1983
Dear L e g is la to r:
The accompanying questionnaire is p a rt o f the research I am doing
f o r my th e sis toward my Masters in Nursing a t Montana State U n iv e rs ity .
The o b je c t o f the th e sis is to survey the opinions o f the curren t
Montana State L e g isla tu re on the subjects o f nurses, nursing , and health,
care.
I selected the le g is la tiv e body as i t is a repre senta tive group
o f consumers in Montana and one th a t would h o p e fu lly be in te re s te d in
the to p ic and w illin g to complete th is sho rt q u estion naire.
take only about 10 minutes to do so.
I t w ill
Please respond w ith the f i r s t
answer th a t comes to mind.
I have discussed th is survey w ith Representative Toni Bergene and
she supports the research and requests your cooperation in completing
the form.
A ll questionnaires w i l l be com pletely anonymous and summary
re s u lts only w i l l be published in my th e s is .
Again, I am looking fo r
your opinions and th e re fo re there are no r ig h t o r wrong answ ers.. Al I
references to nurses should be taken to mean re g is te re d professional
nurses, as opposed to licensed p ra c tic a l nurses.
I would very much appreciate your cooperation.
Please complete the
questionnaire and re tu rn i t , v ia a page, to Desk 80 by the end o f the
day on Monday, A p ril 18, 1983.
Thank You
Montana State U n iv e rs ity
School o f Nursing
68
L e g is la tiv e Questionnaire
Demographics - Please c ir c le your answer or f i l l
1.
2.
3.
4.
Age
18-35
36-50
51-65 .
Sex
Female
Male
P o litic a l p a rty
Republican
Democrat
in the blank.
Over 65
O th e r________________
P o litic a l philosophy
L ib e ra l
Conservative
Other ________________
5.
Highest le ve l o f education completed
Less than 12th grade
12th grade
Higher education w ith o u t degree
Bachelors degree
Masters degree
Doctoral degree
6.
Were you born in Montana?
Yes
No
7.
How many years have you liv e d
8.
Have you spent most o f your l i f e
or less?
Yes
No
9.
How many years have you held p o lit ic a l o ffic e ?
10.
Your primary occupation
11.
Do you have any close frie n d s or re la tiv e s who are re g iste re d nurses?
Yes
No
12.
Have you ever been h o spitalize d?
Yes
No
13.
Does your home county have
A community (p u b lic ) health nurse?
Well c h ild c lin ic s ?
Blood pressure check c lin ic s f o r senior c itiz e n s ?
Independently p ra c tic in g nurse p ra c titio n e rs ?
Independently p ra c tic in g re g iste re d nurse midwives?
in Montana?
in a ru ra l area or a town o f 2500 people
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Uncertain
Uncertain
Uncertain
Uncertain
Uncertain
69
The fo llo w in g statements are re la te d to your personal a ttitu d e s on
health care to p ics - - please respond w ith your f i r s t impression.
14.
In g e n e ra l, nurses today have a good p u b lic image.
Agree
Disagree
15.
Most nurses who work in Montana h o s p ita ls are being paid fo r what t h e ir
services are w o rth .
Agree
Disagree
16a. Nursing is an appropriate career fo r men.
Agree
Disagree
b. Nursing is an appropriate career fo r women.
Agree
Disagree
17.
P hysicians' a ssista n ts and nurse p ra c titio n e rs are the same in what they
have to o ffe r the consumer in the way o f health care.
Agree
Disagree
18.
Nursing is a profession ra th e r than a te c h n ic a lly s k ille d occupation.
Agree
Disagree
19.
Nurses should fu n c tio n only under the supervision o f physicians.
Agree
Disagree
20.
Nurses as a group are powerful in in flu e n c in g health care p o lic ie s .
Agree
Disagree
21.
Physicians and nurses should have equal ro le s in h o sp ita l p o lic y making.
Agree
Disagree
22.
There is a shortage o f nurses in the U.S.
Agree
Disagree
23.
There is a shortage o f nurses in Montana.
Agree
Disagree
24.
The re la tio n s h ip between nurses and physicians should be a c o lle g ia l one.
Agree
Disagree
25.
Because o f th e ir experience in management, some nurses make good
executives. .
Agree
Disagree
26.
I f Montana c itiz e n s are given in fo rm a tion on good health habits and
health care promotion, the m a jo rity w i l l fo llo w the suggestions to
improve th e ir h e a lth .
Agree
Disagree
27.
Nurse should be e lig ib le f o r th ir d p a rty reimbursement.
Agree
Disagree
70
28.
Governmental monies should be used to finance m a te rn a l-c h ild health
programs ( w e ll- c h ild c lin ic s , n u tr itio n a l programs, e t c . ) .
Agree
Disagree
29.
The money th a t most nurses earn is a supplemental income fo r the fa m ily
(the husband is the prim ary breadw inner).
Agree
Disagree
30.
Nurses should be allowed to organize and bargain w ith employing agencies.
Agree
Disagree
31.
Nurses should provide in p u t to le g is la to rs on health care issues.
Agree
Disagree
32.
The p u b lic needs to be b e tte r educated in health promotion and disease
. prevention, so they can be more p r o fic ie n t in s e lf care.
Agree
Disagree
33.
P ublic funds should be used to finance some health care.
Agree
Disagree
34.
Do you know what a nurse p r a c titio n e r does?
Yes
No
Uncertain
35.
Are you aware th a t there are three basic programs by which a person can
study to be a re g iste re d nurse?
Yes
No
36.
Would you approve o f a fa m ily member going to a nurse p r a c titio n e r fo r
health care?
Yes
No
Uncertain what a nurse p r a c titio n e r does
37.
I would fe e l co n fid e n t in re c e iv in g health teaching from a nurse.
Yes
No
38.
Do you th in k c e rta in nurses are q u a lifie d to p ra c tic e independently?
Yes
No
Uncertain whatindependent
p ra c tic e e n ta ils
39.
Would you go to see a nurse p r a c titio n e r fo r a physical examination?
Yes
No
Do not know what a nursep r a c titio n e r does
40.
Rank the fo llo w in g nursing ro le s in order o f importance to the consumer
(w ith I being the most im p o rta n t).
_______
Caring f o r the sick (bedside nursing)
Health promotion through education and research
_______
Disease prevention through education and research
41.
Nurses s tr ik e most often f o r (rank in order o f importance w ith I
being the most im p o rta n t).
_______
More money
_______
B e tte r working conditions
_______
Improved q u a lity o f p a tie n t care
71
42.
I f you be lie ve there is a shortage o f nurses in Montana, do you
th in k i t is due to (check one or more)
_______
Lack o f enough nurses
.
Rapid turnove r o f nursing personnel
_______
D is s a tis fa c tio n w ith working conditions
_______
Irre g u la r d is tr ib u tio n o f nurses throughout the sta te
Low s a la rie s
43.
In the fu tu re , the ro le s o f nurses should include the fo llo w in g (check
one o r more)
_______
Health promotion
_______
Disease prevention
_______
Independent p ra c tic e
_______
Bedside nursing
_______
Nursing research
_
Nursing a d m in is tra tio n
_______
H ospital a d m in is tra tio n
44.
I be lie ve the basic education f o r le v e l o f e n try in to professional
nursing should be (check one o r more)
_______
2 year associate degree in nursing
_______
3 year diploma
_______
4-5 year bachelor degree in nursing
not aware o f the d iffe re n c e between the three
45.
S elect the fo llo w in g statement w ith which you most agree, re la te d to
a llo c a tio n s o f funds fo r health care.
Health promotion is more im portant than illn e s s treatm ent
Illn e s s treatm ent is more im portant than health promotion
_______
The two are o f equal importance
46.
Rank in order o f importance these major issues in health care in Montana
today ( I is most im portant, 9 is the le a s t ) .
______ _
Cost o f health care
Lack o f f a c i l i t i e s in ru ra l areas (access to care)
_______
lack o f q u a lifie d health professionals
Lack o f home h e a lth care s e ttin g s
A llo c a tio n o f resources fo r treatm ent o f alcohol and drug abuse
_______
A llo c a tio n o f resources f o r treatm ent o f interpersonal abuse
(spouse, c h ild )
_______
A llo c a tio n o f resources f o r dealing w ith accident victim s
_______
D u p lica tio n o f services
Other
-________________
47.
Wellness promotion should be taught by (check a ll a p p lic a b le )
_______
Parents
_______
Health professionals
_______
Teachers in preschools
_______
Teachers in grade schools
_______
Teachers in high schools
72'
48.
The major reason fo r the ra p id ly increasing cost o f health care is
49.
As a le g is la to r , from whom (category o f persons) do you seek inform ation
on le g is la tiv e health care issues?
Comments:
MONTANA STATE UNIVERSITY LIBRARIES
762 1003861 7 4
MAIN L:
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