PERSONAL SPACE AND THE DYSPNEIC PATIENT.
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GITTINS, LAVEENA ANNE
PERSONAL SPACE AND THE DYSPNEIC PATIENT
THE UNIVERSITY OF ARIZONA
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PERSONAL SPACE AND THE DYSPNEIC PATIENT
by
Laveena Anne G i t t i n s
A Thesis Submitted to the Faculty o f the
COLLEGE OF NURSING
I n P a r t i a l F u l f i l l m e n t o f the Requirements
For the Degree o f
MASTER OF SCIENCE
I n the Graduate College
THE UNIVERSITY OF ARIZONA
19 8 4
STATEMENT BY AUTHOR
This thesis has been submitted i n p a r t i a l f u l f i l l m e n t o f r e ­
quirements f o r an advanced degree a t The University o f Arizona and i s
deposited i n the University L i b r a r y t o be made a v a i l a b l e t o borrowers
under rules o f the L i b r a r y .
B r i e f quotations from t h i s thesis a r e allowable without special
permission, provided that accurate acknowledgment o f source i s made.
Requests f o r permission f o r extended quotation from o r reproduction o f
t h i s manuscript i n whole o r i n p a r t may be granted by the head o f the
major department o r the Dean o f the Graduate College when i n h i s judg­
ment the proposed use o f the material i s i n the i n t e r e s t s o f scholar­
ship.
In a l l other instances, however, permission must be obtained
from the author.
SIGNED
APPROVAL OF THESIS DIRECTOR
This thesis has been approved on the date shown below:
G-
A. TRAVER
Associate Professor o f Nursing
^ ^ /f&
U
Date
ACKNOWLEDGMENTS
Many people made t h i s study possible.
The investigator i s
g r a t e f u l f o r t h e i r continued help and encouragement.
The investigator i s deeply indebted t o her thesis committee:
Gayle Traver, Chairman, Dr. Joyce Verron and D r . A l i c e Longman.
Their guidance and counsel was invaluable.
Sincere thanks i s extended t o the s t a f f and c l i e n t s o f the
outpatient r e s p i r a t o r y c l i n i c .
Their genuine i n t e r e s t and cooperation
was g r e a t l y appreciated.
F i n a l l y , the investigator wishes t o acknowledge the encourage­
ment and i n s p i r a t i o n received from her husband, Wyn.
TABLE OF CONTENTS
Page
LIST OF TABLES
vi
ABSTRACT
1.
vii
INTRODUCTION
1
Purpose of the Study
Significance of the Problem
Conceptual Framework
Study Questions
D e f i n i t i o n of Terms
2.
REVIEW OF THE LITERATURE
8
Shape and Size o f Personal Space
E f f e c t s of Sex, Age, Culture and Environment
Invasion o f Personal Space
Personal Space and the Dyspneic P a t i e n t
Methods of Studying Personal Space
Summary
3.
RESEARCH METHODOLOGY
9
11
13
14
16
19
20
Protection of Human Subjects
Setting and Sample
Data Collection Tools
Data Collection Protocol
Analysis o f Data
4.
2
3
k
6
7
PRESENTATION AND ANALYSIS OF DATA
Characteristics of the Sample
Analysis o f Findings
Findings Related t o Study Questions
R e l i a b i l i t y and V a l i d i t y Testing o f Form A and
Form B o f Reaction t o Nursing Care
iv
20
20
21
22
25
25
26
27
31
TABLE OF CONTENTS—Continued
Page
5.
CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS
FOR FURTHER STUDY
Findings i n R e l a t i o n t o Conceptual Framework
Findings i n Relation t o the L i t e r a t u r e
Implications f o r Nursing
Limitations
Areas f o r Further Study
34
34
36
37
39
40
APPENDIX A:
COMFORTABLE INTERPERSONAL DISTANCE SCALE . . .
42
APPENDIX B:
HUMAN SUBJECTS APPROVAL
43
APPENDIX C:
DISCLAIMER
44
APPENDIX D:
SUBJECT PROFILE
45
APPENDIX E:
REACTION TO NURSING CARE--F0RM A
46
APPENDIX F:
REACTION TO NURSING CARE—FORM B . . . . . . .
47
APPENDIX G:
AUTHOR'S PERMISSION TO USE THE CID
48
APPENDIX H:
MARLOWE-CROWNE SOCIAL DESIRABILITY SCALE
M-CI (10)
49
APPENDIX I :
COVARIANCE MATRIX—FORM A
50
APPENDIX J:
COVARIANCE MATRIX—FORM B
52
REFERENCES
54
LIST OF TABLES
Table
Page
1.
Characteristics and D i s t r i b u t i o n o f Subjects by Sex . . .
26
2.
Two Way Analysis o f Approaches t o Dyspneic and
Nondyspneic Subjects
29
Paired T - t e s t s o f Approaches during Nondyspneic
and Dyspneic States
30
k.
Form A and Form B Paired T - t e s t
31
5.
Summary Item t o Item Correlations f o r R e l i a b i l i t y
Analysis o f Form A and Form B
32
3.
vi
ABSTRACT
The conceptual framework f o r t h i s study was based on theories
o f personal space.
The study's purpose was t o determine some o f the
e f f e c t s o f dyspnea on personal space o f chronic respiratory disease
patients.
I n addition reaction t o intrusion o f personal space by
nurses when subjects were nondyspneic and dyspneic was studied.
T h i r t y subjects p a r t i c i p a t e d i n the study.
Interpersonal Distance Tool
The Comfortable
(CIO) was used t o measure personal space.
Subjects responded t o two s t i m u l i on the CID; a close family member
and an unknown nurse.
Responses to these stimuli were measured f o r
dyspneic and nondyspneic s t a t e s .
A Reaction t o Nursing Care tool was
developed t o measure responses t o intrusion o f personal space by
nurses.
The findings concluded that subjects preferred close family
members t o approach nearer than the nurse during states o f dyspnea
and nondyspnea.
During periods o f dyspnea, subjects preferred both
family members and nurses to stay f u r t h e r away than during nondyspneic
states.
Nurses' intrusion o f personal space was perceived as necessary
i n order t o a s s i s t subjects a l l e v i a t e symptoms.
CHAPTER 1
INTRODUCTION
Han's use of space as a means o f communication has been the
focus o f study f o r many social s c i e n t i s t s .
H a l l (1966) coined the term
proximics to describe the study o f man's s o c i a l - s p a t i a l behavior.
He
used the term personal space t o describe the space peripheral t o the
body that an individual considers as h i s own.
Personal space i s the
distance an individual maintains between himself and others.
The boun­
daries a r e i n v i s i b l e but personal space i s the area immediately sur­
rounding an i n d i v i d u a l .
This space acts as a buf fer zone i n
interpersonal i n t e r a c t i o n (Horowitz, D u f f , and Statton, 196*0.
Personal space a l t e r s under various conditions.
When an i n ­
dividual interacts with a well-known f r i e n d , personal space contracts.
I n t e r a c t i o n with strangers causes personal space t o expand ( L i t t l e ,
1965)-
Personal space i s a f f e c t e d by the sex, age and status of the
individual with whom one i s i n t e r a c t i n g .
Socio-cultural rules govern the maintenance and invasion of
personal space.
An individual attempts t o maintain control o f invasion
o f personal space.
I f one i s unable to control the invasion o f one's
personal space, feelings of discomfort a r i s e .
When socio-cultural
rules governing personal space a r e not adhered t o , the individual
begins to f e e l uncomfortable.
1
2
Health care settings a f f e c t personal space.
Health care work­
ers frequently encroach upon an i n d i v i d u a l ' s personal space i n order t o
assess and care f o r an i n d i v i d u a l .
Therapeutic invasion o f personal
space may be perceived by the p a t i e n t as h e l p f u l or threatening depend­
ing on the p a t i e n t ' s expectations.
The stress o f the i l l n e s s i t s e l f
o f t e n a l t e r s an i n d i v i d u a l ' s personal space.
Dosey and Meisels (1969)
found that s t r e s s f u l , threatening situations expand an i n d i v i d u a l ' s
personal space.
Individuals with chronic r e s p i r a t o r y disease experience i n ­
creased stress when they develop dyspnea.
Kent and Smith (1977) noted
that the p a t i e n t always experienced f e e l i n g s o f panic during episodes
o f dyspnea.
The dyspneic p a t i e n t ' s perception o f personal space may be
indicated by h i s expression of claustrophia as described by Kent and
Smith (1977)-
T r a v e r ' s (1983) anecdotal notes from a c l i n i c a l s e t t i n g
indicated t h a t the dyspneic p a t i e n t f e l t that people who come too close
blocked the p a t i e n t ' s access t o a i r .
Physical measures undertaken by nurses t o a s s i s t the dyspneic
p a t i e n t breathe more e a s i l y o f t e n require close body contact with the
patient.
Nurses a l s o use physical closeness, touch and eye contact t o
reassure and support the p a t i e n t .
A l l o f these actions may encroach
upon the p a t i e n t ' s personal space.
Purpose o f the Study
The purpose o f t h i s study was t o compare the respiratory
p a t i e n t ' s perception o f personal space during periods o f normal breath­
ing and during periods o f dyspneic breathing.
Responses o f the
3
subjects t o Invasion of personal space by nurses during normal breath­
ing and during dyspnea were a l s o studied.
Significance o f the Problem
Nurses caring f o r dyspneic patients g i v e emotional support t o
the p a t i e n t with nonverbal methods o f communication.
Actions such as
taking the p a t i e n t ' s hand, making eye contact and placing an arm
around the p a t i e n t a r e some o f the methods used t o convey the nurse's
concern and support.
Nurses also a s s i s t p a t i e n t s t o control t h e i r
breathing patterns by placing t h e i r hands on the p a t i e n t ' s chest or
sides.
Such actions may encroach upon the p a t i e n t ' s personal space.
Stillman (1978) stated t h a t how one f e e l s about one's personal
space determines how muph intrusion by others one finds acceptable.
How the p a t i e n t f e e l s about the invasion o f personal space necessitated
by the nurse's care i s d i f f i c u l t t o assess.
The p a t i e n t with dyspnea
i s concentrating on c o n t r o l l i n g h i s r e s p i r a t i o n s .
He has l i t t l e energy
l e f t to convey the discomfort he may feel when the nurse's actions a r e
perceived as unacceptable invasion o f personal space.
Ricci (1981) noted that invasion o f personal space can pose a
t h r e a t t o a person's security and e l i c i t a n x i e t y .
a compounding f a c t o r f o r the dyspneic p a t i e n t .
Anxiety i s already
Kent and Smith (1977)
stated that f e a r was endemic to the psychology o f the respiratory
patient.
Increasing the anxiety o f the dyspneic patients exacerbated
t h e i r symptoms (Dudley e t a l . , 1980).
Therefore, the nurse who cared
f o r the dyspneic p a t i e n t needed t o be aware that encroachment upon
the p a t i e n t ' s personal space may have been threatening t o him.
The
k
nurse needed t o be aware o f how the dyspneic p a t i e n t responded t o
invasion o f personal space i n order t o avoid actions which would i n ­
crease the p a t i e n t ' s a n x i e t y .
Two investigators suggested t h a t nurses needed t o conduct
research i n t o aspects o f personal space.
A l l e k i a n (1973) suggested
that studies be conducted to establish those behaviors o r treatments
that a r e most anxiety producing when personal space i s invaded.
Ricci
(1981) pointed out t h a t feelings experienced by p a t i e n t s during i n t e r ­
actions with nurses needed t o be investigated.
This study proposes t o
answer some o f these questions which required f u r t h e r i n v e s t i g a t i o n .
Conceptual Framework
Personal space i s the area immediately surrounding every i n d i ­
vidual.
This space functions as a b u f f e r zone to protect one from per­
ceived threats t o emotional well being (Dosey and Meisels, 1969;
Horowitz e t a l . , 1964).
H a l l (1966) measured and defined four major divisions of per­
sonal space.
They were:
1.
Public distance--twelve f e e t or more from the body.
2.
Social distance—two t o twelve f e e t from the body.
3.
Personal distance—eighteen inches t o twelve f e e t from the
body.
k.
Intimate distance—zero to eighteen inches from the body.
For the purposes o f t h i s study, the areas involved were those Hall
(1966) c a l l e d personal distance and intimate distance.
5
The s i z e , shape and p e n e t r a b i l i t y o f personal space depends on
immediate interpersonal events, as well as ego and motivational states
o f the individual
(Horowitz e t a l . , 1964).
Kuethe (1962) found t h a t
personal space was a function o f r e l a t i o n s h i p .
I n h i s experiments, a
c h i l d moved closer to the mother than t o the f a t h e r .
Geden and
Begeman (1981) found t h a t h o s p i t a l i z e d adults had d i f f e r e n t sizes o f
personal space i n the hospital than i n t h e i r homes.
Personal space
was also a f f e c t e d by c u l t u r e ( H a l l , 1966), age (Louis, 1981), emotions
(Meisels and Dosey, 1971) and sex (Guardo, 1976).
Individuals responded t o invasion o f personal space i n a v a r i e t y
o f ways, designed to increase interpersonal distance and reduce discom­
f o r t (Altman, 1976).
Intrusion o f personal space may be threatening or
may be pleasing t o the i n d i v i d u a l .
Invasion over which the individual
has no control i s o f t e n perceived as threatening (Maagdenberg, 1983).
Invasion which the individual has i n v i t e d o r occurs i n a manner
acceptable to the individual i s perceived as nonthreatening and h e l p f u l .
The r o l e o f the nurse i s t o a s s i s t others meet t h e i r needs t o
a t t a i n and maintain optimum l e v e l s o f h e a l t h .
The assistance given by
nurses has t o be acceptable t o patients i n order t o be e f f e c t i v e .
Individuals with chronic respiratory disease require emotional support
t o a l l e v i a t e some o f the distress experienced during dyspneic episodes.
The methods nurses use t o convey support a r e frequently nonverbal
actions.
Nonverbal communication o f t e n encroaches upon the p a t i e n t ' s
personal space.
The nurse needs t o be aware o f the p a t i e n t ' s response
t o therapeutic interventions.
How the p a t i e n t f e e l s about h i s personal
space i s an important aspect t o consider when evaluating the p a t i e n t ' s
6
response t o nursing actions.
Acceptance o r r e j e c t i o n o f nursing
actions may be predicated on whether o r not the p a t i e n t f e e l s h i s p e r ­
sonal space has been respected.
Sommer (1959) found that approaching
subjects too closely increased t h e i r l e v e l o f a n x i e t y .
When patients
perceived invasion of personal space as threatening, d i s t r e s s was i n ­
creased.
Emotional d i s t r e s s increased the chronic respiratory p a t i e n t ' s
dyspnea.
Study Questions
1.
Does the personal space o f a chronic respiratory p a t i e n t change
i n s i z e during periods o f dyspnea?
2.
I s the shape o f personal space i n the chronic respiratory
p a t i e n t a l t e r e d by dyspnea?
3.
Does the personal space o f the chronic respiratory p a t i e n t
d i f f e r when approached by a close family member and by an un­
known nurse when the subject i s breathing normally o r experi­
encing dyspnea?
k.
Does personal space change due to an i n t e r a c t i o n between the
type of person approaching the subject and the dyspneic or
nondyspneic s t a t e of the subject?
5.
Are actions o f the nurse perceived as invasions o f personal
space by chronic respiratory p a t i e n t s when dyspneic or non­
dyspneic?
D e f i n i t i o n o f Terms
Personal space—the space an individual maintains between s e l f
and others during social i n t e r a c t i o n s .
The space was measured
by the Comfortable Interpersonal Distance Scale (Duke and
Nowicki, 1972).
Invasion—unsolicited entrance a c t i v i t y or contact w i t h i n
personal space ( A l l e k i a n , 1973).
CHAPTER 2
REVIEW OF THE LITERATURE
The term personal space was f i r s t coined by the b i o l o g i s t
Katz (1937)•
He used the term to describe the distance birds main­
tained between themselves during f l i g h t and landing.
Sociologists
began to apply the term personal space t o people i n the 1950s.
Much
of the e a r l y work on personal space i n health care settings was done
in psychiatric i n s t i t u t i o n s .
Sommer (1959) observed the spatial
behavior of people i n the dining and l i v i n g rooms o f a large psychi­
atric hospital.
Horowitz (1965) mapped the use o f space by inmates
in a large m i l i t a r y h o s p i t a l .
Felipe and Sommer (1966) studied
personal space responses of residents i n a l a r g e s t a t e mental
in­
stitution.
Currently there i s some controversy over the use o f the term
personal space.
Levy-Leboyer (1983) states the term personal space
i s questioned on a conceptual basis.
She quotes L'Ecuyer (1976) who
emphasized that there i s always a social dimension involved, there­
f o r e personal space i s a misnomer.
What one i s a c t u a l l y observing
i s the interpersonal distance maintained between people w i t h i n a
given communication context.
I n t h i s study the term personal space
is viewed as synonymous with the term interpersonal distance.
8
9
Shape and Size o f Personal Space
Several
investigators have attempted t o measure and describe
the shape o f personal space.
Although the terms used t o describe the
various aspects of personal space d i f f e r , the r e s u l t s o f t h e i r e x p e r i ­
ments were comparable.
Lyman and Scott (1967) postulated that people
have four distances which were used during i n t e r a c t i o n s .
They labeled
these four areas p u b l i c , home, interactional and body t e r r i t o r i e s .
Body t e r r i t o r i e s were those immediately surrounding an individual and
were i n v i o l a t e .
Hall
(1966) described the spatial behavior o f white middle
class Americans.
He defined and measured four major d i v i s i o n s .
They
were:
1.
Intimate distance which was zero to eighteen inches from the
body,
2.
Personal distance eighteen inches t o two f e e t from the body,
3.
Social distance two f e e t t o twelve f e e t from the body, and
k.
Public distance twelve f e e t and over from the body.
There was a near and f a r phase f o r each distance.
The f a r phase of
intimate distance was reserved f o r family and close f r i e n d s .
The near
phase of personal space allowed persons t o touch one another and was
used f o r f r i e n d l y i n t e r a c t i o n s .
The f a r phase o f H a l l ' s personal d i s ­
tance was the l i m i t two people can separate and s t i l l touch.
Hall's
intimate distance was comparable t o Lyman and S c o t t ' s (1967) body
territories.
Ricci (1981) noted that i n t e r a c t i o n i n public w i t h i n
intimate d i v i s i o n o f space was not considered proper f o r adult middle
class Americans.
Hall conceptualized the shape o f personal space t o be a series
of concentric c i r c l e s .
F e l i p e and Sommer (1966) presented evidence
that personal space did not conform t o regular spheres, but resembled
f l u c t u a t i n g globes.
The concentric c i r c l e notion was a l s o negated by
McBride, King,and James (1965).
I n t h e i r experiments using galvanic
skin response t o measure the e f f e c t o f invasion on personal space, they
found personal space t o be greater i n f r o n t than a t the sides of the
body.
Personal space to the rear was the shortest distance from the
body.
Horowitz e t a l . (1964) a l s o found t h a t people described a greater
personal distance i n f r o n t .
Louis (1981) found that e l d e r l y residents
i n a housing complex had smaller face to face personal space than i n
l a t e r a l positions.
She postulated that these measures were due t o a
loss o f acuity i n s i g h t .
Kinzel
(1970) compared the personal space
needs o f v i o l e n t prisoners with non-violent prisoners.
He found that
the rear zones were l a r g e r than f r o n t a l zones i n v i o l e n t prisoners.
In contrast the non-violent prisoners had l a r g e r f r o n t a l zones than
rear zones.
He concluded that prisoners with aggressive tendencies
had disturbed personal space needs.
These studies indicated that personal space was a phenomenon
that fluctuated around an i n d i v i d u a l .
S p e c i f i c types o f interactions
were permissible w i t h i n d e f i n i t e prescribed distances from the body.
The shape and s i z e o f personal space was determined by s o c i a l , psycho­
l o g i c a l , and physiological f a c t o r s .
11
E f f e c t s o f Sex, Age, Culture and Environment
Sex, age, and c u l t u r e a f f e c t personal space perception.
McBride
e t a l . (1965) found t h a t heterosexual p a i r s had l a r g e r personal space
areas than same sex p a i r s .
Sommer (1969) found t h a t male p a i r s r e ­
quired s i g n i f i c a n t l y l a r g e r personal space areas than female p a i r s .
He
a l s o noted t h a t male p a i r s required greater space between the p a i r mem­
bers than d i d female p a i r s .
Nesbitt and Stevens (197^) found t h a t male
subjects approached female models more closely than female subjects
approached male models.
Evans and Howard (1973) stated that hetero­
sexual p a i r s require less space than female p a i r s which i n turn require
less space than male p a i r s .
Fisher and Byrne (1975) found t h a t s o l i t a r y
males i n l i b r a r i e s erected b a r r i e r s against f a c e - t o - f a c e invasion,
whereas females erected b a r r i e r s against side-by-side invasion.
Peterson (1973) studied the personal space needs o f elementary
school c h i l d r e n .
needs.
I n f i r s t grade boys and g i r l s had s i m i l a r spatial
By the t h i r d grade boys had l a r g e r space needs than g i r l s , and
approached a p a t t e r n s i m i l a r t o a d u l t s .
Mishra (197^) studied i n t e r -
generational spatial behaviors i n young and o l d women.
He found that
longer intrusion o f personal space was t o l e r a t e d by persons w i t h i n the
same age range than by persons o f d i f f e r e n t age ranges.
Engebretson (1973) indicated that personal space was c u l t u r a l l y
determined.
The function of personal space was to f a c i l i t a t e social
behavior w i t h i n the c u l t u r e .
Hall
(1966) compared the use o f space by
American and English u n i v e r s i t y students.
He concluded that these two
cultures communicated spatial needs d i f f e r e n t l y .
An American requiring
more space r e t i r e d to h i s own room and closed the door.
The English
12
s i g n i f i e d the need f o r more personal space by decreasing verbal commu­
nication.
H a l l also noted t h a t the French used smaller personal space
areas than North Europeans and Americans.
Watson and Graves (1966)
observed t h a t Arabs confront each other and use smaller personal space
areas than Americans.
Watson (1970), i n a cross c u l t u r a l study o f
proxemic behavior concluded t h a t people do not recognize t h e i r own
spatial behaviors.
tural pattern.
They therefore do not understand a d i f f e r e n t c u l ­
Friendly approaches may be misconstrued as aggressive
threats.
I n s t i t u t i o n a l i z a t i o n o f an individual a l t e r s h i s personal space.
The i d e n t i t y o f the individual with whom one i n t e r a c t s also a f f e c t s an
i n d i v i d u a l ' s personal space.
Allekian (1973) and Baur (1979) studied
t e r r i t o r i a l i t y and personal space i n nursing home residents.
They found
that the longer an individual had been a resident the smaller were h i s
personal space needs.
Geden and Begeman (1981) studied personal space
preferences o f 30 male and 30 female medical surgical p a t i e n t s .
They
used f i g u r e placement techniques t o measure personal space preferences.
Their findings indicated that personal space preferences were smaller
i n hospitals than a t home.
I n both settings figures representing
family members were placed closest to figures representing the subjects.
The f i g u r e representing the doctor was placed next closest t o the s e l f
figure.
The nurse f i g u r e was placed f u r t h e r away than the doctor
f i g u r e and a f i g u r e representing a stranger was placed the f u r t h e s t
away from the s e l f f i g u r e .
The above studies showed that age, sex, and environment affected
personal space.
I n t e r p r e t a t i o n o f another's approaches was c u l t u r a l l y
13
determined.
Problems i n interpersonal interactions occurred when one
person misinterpreted another's personal space behavior.
Invasion o f Personal Space
Our understanding o f personal space has been gained by study­
ing responses e l i c i t e d by invasion i n t o that space.
Ricci (1981) stated
that invasion was intrusion i n t o a person's self-boundaries.
(1970) studied sex and race norms of personal space.
types o f personal space invasion.
They were:
Liebman
He found three
overly close physical
distance, inappropriate body position and inappropriate behaviors that
r e s u l t i n excessive symbolic intimacy.
F e l i p e and Sommer (1966) observed psychiatric p a t i e n t s ' r e ­
sponses t o invasion by s i t t i n g too close t o p a t i e n t s .
t h a t s p a t i a l invasion had a d i sruptive e f f e c t .
f l i g h t t o antagonistic d i s p l a y .
Responses showed
Reactions ranged from
Too close stimulation of v i s u a l , tac­
t i l e , and o l f a c t o r y senses was also perceived as invasive.
Argyle and Dean ( I 9 6 5 ) studied eye contact changes i n response
t o invasion o f personal space.
They observed that the closer people
were standing t o each other the less frequent was eye contact.
When
eye contact did occur, i t lasted f o r a shorter period o f time than
when people stood f u r t h e r a p a r t .
A l l e k i a n (1973), i n a review of personal space studies, r e ­
ported that people tend t o avoid invasion o f personal space.
Avoidance
behaviors included moving away, p u l l i n g oneself i n or scowling a t the
intruder.
When avoidance o f intrusion was not possible, people experi­
enced embarrassment o r unease.
]
k
Maagdenberg (1983) conducted a survey o f e l d e r l y nursing home
residents to discover reasons f o r abusive behavior toward s t a f f .
The
residents indicated they f e l t anger t o the point o f assault when nurses
touched them without asking permission.
Such a c t i v i t i e s as taking
temperatures, feeding, or t r a n s f e r r i n g them from beds t o wheelchairs
e l i c i t e d the anger.
The residents also stated they were uncomfortable
and f e l t threatened when doctors or nurses poked a t t h e i r incision
without providing privacy.
McBride e t a l . (1965) studied responses to personal space i n ­
vasion.
They found that a galvanic skin response was e l i c i t e d when
subjects perceived invasion o f t h e i r personal space.
This study i n d i ­
cated that involuntary physiological reactions occurred i n response to
invasion o f personal space.
The studies quoted indicated that invasion o f personal space
e l i c i t e d physiological, physical and psychosocial responses.
Unsolic­
i t e d invasion that was not controlled by the individual was d i s r u p t i v e .
Invasion produced feelings o f discomfort, t h r e a t and anxiety i n i n d i v i d ­
uals.
Individuals attempted to a l l e v i a t e these feelings by withdrawing
from the s i t u a t i o n or exhibited aggressive behavior towards the invader.
Personal Space and the Dyspneic Patient
The individual with pulmonary disease becomes anxious when he
develops dyspnea.
Dyspnea i s a subjective f e e l i n g o f breathlessness
associated with v e n t i l a t o r y inadequacy (Luckman and Sorenson, 1980).
Agle and Baum (1977) stated that the anxiety resulted from the dyspnea
i t s e l f and a closely associated fear o f suffocation and death.
Traver
15
(1982) stated that the p a t i e n t experiencing shortness of breath fears
death even though he had experienced the same symptoms before and had
survived.
Anecdotal notes from a p a t i e n t i n intensive care f o r respiratory
distress g r a p h i c a l l y describe the f e a r o f dying (Traver, 1983)f e l t her heart would stop.
She
She found t h a t having l a r g e numbers o f
u n f a m i l i a r people close t o her increased her d i s t r e s s .
People who moved
too close and talked too loudly appeared t o have d i s t o r t e d faces.
f e l t these people were going t o "do her i n . "
She
S t a f f who spoke s o f t l y to
her before g e t t i n g too close were people she could t r u s t .
Kent and
Smith (1977) noted that dyspneic p a t i e n t s f e l t claustrophic and made
comments such as " i t f e e l s as i f the walls a r e closing i n on me."
Barstow (197^), i n a study o f coping mechanisms used by chronic
respiratory p a t i e n t s , found that subjects engaged i n techniques to
decrease the impact o f t h e i r symptoms on others.
These included w i t h ­
drawal from others during bouts o f coughing or wheezing.
The study
demonstrated the awareness chronic respiratory patients had o f how
t h e i r symptoms could invade the personal space o f others.
Concern with
how others were a f f e c t e d by respiratory symptomatology increased the
respiratory p a t i e n t ' s a n x i e t y .
Attending t o the pulmonary p a t i e n t ' s psychological fears and
r e l i e v i n g t h e i r anxiety i s an important modality o f t h e i r c a r e .
Agle
and Baum (1977) noted a close r e l a t i o n s h i p between respiratory function
and psychological outlook.
They studied 23 pulmonary patients and
found that those whose psychological outlook improved had fewer hospi­
t a l izations and reported an increase i n useful l i f e a c t i v i t i e s .
16
Schraa and Dirks (1982) studied the e f f e c t o f anxiety i n
respiratory p a t i e n t s .
They looked a t r e c a l l o f , and compliance with
instructions given t o p a t i e n t s .
They found that patients with high
l e v e l s o f anxiety were less able t o r e c a l l or respond t o medical
instruction.
cesses.
The dyspneic p a t i e n t was anxious due t o disease pro­
Invasion o f personal space also increased anxiety and de­
creased the i n d i v i d u a l ' s a b i l i t y t o process information.
Evans and
Howard (1973) reported that reduced interpersonal distance decreased
performance when individuals were working on information processing
tasks.
Meisenhelder (1982) stated that i t was the nurse's r o l e t o pro­
vide an environment which preserved the c l i e n t ' s personal space.
sonal space was an integral p a r t o f each i n d i v i d u a l .
Per­
Physicians,
nurses, and students presumed ready access t o any area o f the p a t i e n t ' s
body.
This presumption invaded the p a t i e n t ' s personal space.
Invasion
o f personal space increased anxiety f o r everyone but compounded the
anxiety experienced by the dyspneic p a t i e n t .
Anxiety increased the
dyspneic p a t i e n t ' s symptoms, reduced h i s r e c a l l o f instructions and
prevented h i s compliance with medical protocol.
Some o f the anxiety
expressed by the dyspneic p a t i e n t could be avoided i f the patient p e r ­
ceived personal space invasion as h e l p f u l .
Methods o f Studying Personal Space
Methods of studying personal space varied from f i e l d studies
t o paper and pencil t e s t s .
Duke and Nowicki (1972) developed a tool
which they c a l l e d the Comfortable Interpersonal Distance Scale (CID)
(Appendix A ) .
This was a paper and pencil t e s t .
The scale had a
c i r c l e with e i g h t l i n e s emanating from a common p o i n t .
meter radius was numbered randomly.
could be measured i n m i l l i m e t e r s .
Each 80 m i l l i ­
Any l o c a t i o n on a given radius
Typical instructions asked the sub­
j e c t s to imagine themselves a t the center o f the diagram.
Subjects
were then asked t o respond t o imaginary persons approaching them along
a p a r t i c u l a r radius by marking on the l i n e where they would l i k e t h a t
p a r t i c u l a r person t o stop.
The subjects were asked t o have the person
stop when the subjects thought they might begin to f e e l uncomfortable
with that person's closeness.
Duke and Nowicki (1972) conducted t e s t - r e t e s t r e l i a b i l i t y using
23 male and 21 female a d u l t s , 61 male and 41 female high school stu­
dents and 67 male and 84 female elementary school students.
The sub­
j e c t s were asked t o respond t o the CID two weeks a f t e r i n i t i a l
administration.
The correlations ranged from 168 t o . 8 6 f o r the a d u l t
and high school subjects and from .39 t o . 5 0 f o r the elementary subjects.
Correlations o f the CID with the Marlowe-Crowne Social D e s i r a b i l i t y Test
ranged from .03 t o .18 indicating that subjects were not responding i n a
way deemed s o c i a l l y d e s i r a b l e .
Veitch, Getsinger, and Arkelian (1976)
performed a t e s t - r e t e s t r e l i a b i l i t y study o f the CID with 15 male and
14 female college students.
A c o r r e l a t i o n of . 9 5 was found a f t e r an
i n t e r v a l o f 16 months.
Construct v a l i d i t y o f the CID was measured by. comparing the
responses to stimuli with actual preferred distances i n response t o
p a r a l l e l real l i f e s t i m u l i .
Martin (1972) found correlations o f .65
to .71 i n 26 male and 27 female college students.
Johnson (1972)
18
reported correlations o f .83 t o .84 between CID responses and actual
approaches i n a sample o f black college students.
Duke and Kiebach
(1974) used the CID and real l i f e s t i m u l i with 10 male and 10 female
college students and these correlations ranged from .52 t o . 7 6 .
Veitch e t a l . (1976) assessed the v a l i d i t y o f the CID by com­
paring responses t o the CID with responses t o other measures.
The
l i t e r a t u r e suggested t o Veitch e t a l . that females preferred smaller
personal space zones than males.
Responses t o the CID a l s o demon­
strated smaller personal space preferences by females.
Significant
p o s i t i v e correlations were found between authoritarianism and i n t e r ­
personal distancing which was consistent with previous findings.
White and L i r a (1978) assessed concurrent v a l i d i t y by comparing
the CID with the Peterson Personal Space Measure (PPSM).
were 26 male and 17 female adolescents.
The subjects
They found that both t e s t s
demonstrated acceptable l e v e l s o f r e l i a b i l i t y , p r e d i c t i v e v a l i d i t y , and
concurrent v a l i d i t y .
The CID was found to be quicker t o administer,
more e a s i l y understood and did not present incongruence between stimulus
appearance and subject imagery.
The above suggested that the CID was an
appropriate scale t o use i n research on interpersonal distance.
Evans
and Howard (1973) noted that the CID consistently demonstrated accuracy
i n measuring relationships between interpersonal distance and ( a ) race
o f the i n t e r a c t a n t s , (b) developmental and sex v a r i a b l e s , (c) a f f i n i t y ,
and (d) personality v a r i a b l e s .
19
Summary
Personal space i s a highly individual phenomenon a f f e c t e d by
c u l t u r e , age, sex, social p o s i t i o n , and circumstances.
The s t a t e of
an i n d i v i d u a l ' s health may a f f e c t perception o f personal space.
Invasion o f personal space increases anxiety i n people who a r e
i n mental i n s t i t u t i o n s , residents o f nursing homes, o r who a r e c l i e n t s
in libraries.
Health care workers have observed that respiratory
patients appear to require more personal space during dyspneic periods.
No studies have been conducted to v e r i f y such observations.
Several tools have been developed t o measure personal space.
The Comfortable Interpersonal Distance Scale (CID) developed by Duke
and Nowicki (1972) has been found t o be psychometrically sound.
The
CID i s a v a l i d and r e l i a b l e tool when used with a wide age range i n
varied settings and with c u l t u r a l l y diverse subjects.
CHAPTER 3
RESEARCH METHODOLOGY
This chapter o u t l i n e s the design, sample s e t t i n g , t o o l s , and
s t a t i s t i c a l analyses used.
The study was conducted i n an attempt t o
describe the perceptions o f personal space of chronic respiratory
patients.
The e f f e c t o f family members on personal space was compared
t o the e f f e c t o f nurses on personal space when subjects were breathing
comfortably and when subjects were experiencing dyspnea.
Protection o f Human Subjects
Permission t o use human subjects f o r the study was granted by
the College o f Nursing Ethical Review Subcommittee (Appendix B ) .
A
disclaimer (Appendix C) was used t o obtain consent from the subjects.
Setting and Sample
An ambulatory pulmonary care u n i t was used t o obtain subjects.
The f a c i l i t y was located a t a u n i v e r s i t y i n an urban southwestern commu­
nity.
The f a c i l i t y served c l i e n t s regardless of race, r e l i g i o n , or
national o r i g i n .
Verbal permission t o approach c l i n i c c l i e n t s was
granted by the medical d i r e c t o r .
The t a r g e t population included c l i e n t s from selected c l i n i c
who met the following c r i t e r i a :
1.
F i f t y - f i v e years o f age and o l d e r ,
20
2.
Able t o communicate i n oral and w r i t t e n English,
3.
Had chronic respiratory disease confirmed by a physician,
k.
Had experienced episodes o f dyspnea r e l a t e d t o t h e i r
respiratory disease.
A convenience sample of 30 subjects was used f o r t h i s study.
Data Collection Tools
Demographic information describing each subject was c o l l a t e d
on the subject's p r o f i l e sheet (Appendix D ) .
The information included
age, sex, ethnic o r i g i n , how long the subject had lung disease, when
the subject l a s t experienced a dyspneic episode, and how close subjects
preferred others to approach when the subject was dyspneic.
P a r a l l e l questionnaires, Reaction to Nursing Care Form A
(Appendix E) and Form B (Appendix F) were developed by the i n v e s t i g a t o r .
These were designed t o c o l l e c t data about f e e l i n g s subjects experienced
when a nurse approached the subject's personal space.
The question-
4
naires contained 11 forced choice L i k e r t type statements.
Items f o r
the questionnaires were obtained from the l i t e r a t u r e , observation o f
c l i e n t s i n the pulmonary c l i n i c , and from health care workers i n the
clinic.
Several health care workers from the pulmonary c l i n i c were
asked t o review the questionnaires f o r content and r e a d a b i l i t y .
P a r a l l e l forms were developed to compare responses made when subjects
were breathing normally with responses made when subjects were experi­
encing dyspnea.
The Comfortable Interpersonal Distance Scale (CID) was used
t o measure personal space.
Permission to use the CID was granted by
22
Dr. M. P. Duke (Appendix G ) .
The CID was a paper and pencil t e s t .
Eight l i n e s r a d i a t e from a central p o i n t .
was numbered randomly.
Each 80 m i l l i m e t e r radius
Any l o c a t i o n on a given radius could be mea­
sured.
The Marlowe-Crowne Social D e s i r a b i l i t y Scale M-C (10)
(Appendix H) adapted by Strahan and Gerbosi (1978) i s also a paper and
pencil t e s t .
The responses t o the Marlowe-Crowne scale w i l l be corre­
l a t e d with responses t o the Reaction t o Nursing Care instrument t o
assess whether social d e s i r a b i l i t y was a f actor influencing responses.
Data C o l l e c t i o n Protocol
The subjects read the disclaimer, completed the subject p r o f i l e
sheet, and Form A o f the Reaction t o Nursing Care.
administered to the subjects four times.
The CID was then
The following instructions
were given to subjects regarding the CID.
Imagine the drawing you have been given i s a round room
with eight doors, represented by the numbered boxes.
Two people w i l l be described t o you who w i l l enter the
room and walk towards you.
Indicate the point on the
l i n e a t which you f e e l uncomfortable with the closeness
o f the person described. F i r s t imagine that you a r e
facing the door number four and a close family member
enters through door number four and walks toward you.
Mark a spot on the l i n e leading from number four t o
indicate the point a t which you would feel uncomfortable
with that person's closeness.
Imagine that you are s t i l l
facing door number four and the same family member
approaches you from each o f the doorways. Mark on each
l i n e the point you would begin t o f e e l uncomfortable with
that person's closeness.
The instructions are repeated using a nurse unknown to the
subject as the stimulus.
Subjects were asked to respond t o the CID
f o r a close family member and then the nurse when breathing normally.
23
The subjects were then asked t o think about how they f e l t when they
were dyspneic when responding t o the CID.
The close family member and
an unknown nurse were again used as the s t i m u l i .
Subjects were asked
to continue thinking about being short o f breath while they responded
to Form B o f the Reaction t o Nursing Care.
L a s t l y , subjects were
asked t o respond t o the Marl owe-Crowne Social D e s i r a b i l i t y Scale.
They
were t o l d that comfortable breathing or shortness o f breath were not
factors t o consider while they responded t o t h i s l a s t questionnaire.
Analysis o f Data
Each radius was measured i n m i l l i m e t e r s and the mean of the
sums o f the eight measures was used t o a r r i v e a t a single measure f o r
each response t o the CID.
question:
A comparison of the numbers would answer the
Does the personal space o f a chronic respiratory patient
change i n s i z e during periods of dyspnea?
Observation o f the shape o f the drawings made on the CID were
used t o answer the question:
I s the shape o f personal space i n the
chronic respiratory p a t i e n t a l t e r e d by dyspnea?
Comparisons were made
of the distance marked on each radius during normal breathing and the
percentage o f increase o r decrease marked on a l l r a d i i during periods
of dyspnea.
A two way analysis o f variance was I'snd t o compare the r e ­
sponses o f subjects t o the approach of a close family member and an
unknown nurse during normal breathing and periods o f dyspnea.
Responses during nondyspneic and dyspneic states were recorded i n
rows.
Responses t o close family members and t o the unknown nurse were
recorded i n columns.
Paired t - t e s t s described the sources o f variance.
The p a i r s were fami1y/nondyspneic with fami1y/dyspneic, nurse/nondyspneic
with nurse/dyspneic, family/nondyspneic with nurse/nondyspneic, and
family/dyspneic with nurse/dyspneic.
Responses given on Form A and Form B o f the Reaction t o Nursing
Care instrument (Appendices E and F) were assigned values.
answers to each statement were:
f e r e n t , agree and strongly agree.
valued 5 , A, 3 , 2 , 1 .
3 , b , 5-
Possible
strongly disagree, disagree, i n d i f ­
Answers t o p o s i t i v e statements were
Answers t o negative statements were valued 1 , 2 ,
The negative statements on Form A were statements 2 , 5 , 11,
and the negative statements on Form B were statements 2 , k , 5 , 7 , 8 ,
and 11.
A score of 33 indicated that the subject f e l t i n d i f f e r e n t t o
a l l the nursing actions described as there were eleven items on each
form and the i n d i f f e r e n t choice was valued as t h r e e .
Scores greater
than 33 indicated that subjects perceived the nursing actions as i n ­
vasive.
Scores less than 33 indicated that subjects perceived nursing
actions described as p o s i t i v e rather than invasive.
Pearson Product
Moment correlations were calculated between scores o f the MarloweCrowne Social D e s i r a b i l i t y Scale and Forms A and B o f the Reaction t o
Nursing Care.
This analysis was c a r r i e d out t o determine i f perceived
social a c c e p t a b i l i t y o f responses a f f e c t e d the subject's choice o f
answers to each statement on Forms A and B.
Alpha c o e f f i c i e n t s were
completed on responses t o Form A and Form B to determine the r e l i ­
a b i l i t y of these two t e s t s .
CHAPTER k
PRESENTATION AND ANALYSIS OF DATA
This chapter describes the c h a r a c t e r i s t i c s o f the sample.
The findings and s t a t i s t i c a l analysis o f data a r e presented.
The
r e l i a b i l i t y and v a l i d i t y of new instruments used i n t h i s study a r e
also discussed.
Characteristics o f the Sample
Seventeen male and seventeen female Caucasian subjects met the
stated c r i t e r i a and were asked to p a r t i c i p a t e i n the study.
male and fourteen females p a r t i c i p a t e d .
Sixteen
The average age o f the sub­
j e c t s was 68 .2 years with a range o f 55 t o 87 years.
The mean age f o r
men was 68 years and the mean age f o r women was 68.3 years.
The
h i s t o r y o f stated lung disease f o r each subject ranged from one year
to 72 years, with a mean of 19 -6 years.
The subjects experienced
t h e i r l a s t period of dyspnea the day of data c o l l e c t i o n t o a period
o f 730 days with a mean o f 101 days.
by sex are presented i n Table 1 .
25
The c h a r a c t e r i s t i c s of the sample
26
Table 1 .
Characteristics and D i s t r i b u t i o n of Subjects by Sex
Range
Age
Male (N16)
Mean
SD*
68.06
55-87
Number o f years
o f lung disease
3-40
13.8
Number o f days
when l a s t e x p e r i ­
enced dyspnea
0-730
81
Range
Female (N14)
Mean
SD
8.5
59-81
68.3
6.7
13.1
1-72
26.2
26.6
1 82.A
0-730
123
241
"Standard deviation
Analysis of Findings
The m a j o r i t y of subjects marked symmetrical distances on each
radius of the CID.
Therefore the mean sum o f the eight measures on
each CID was used t o obtain a single reading.
Two way analysis of
variance was used t o determine i f s i g n i f i c a n t differences existed be­
tween responses t o family members and nurses when the subject was nondyspneic and dyspneic.
variance.
Paired t - t e s t s determined the source of
Responses to Form A and Form B of the Reaction t o Nursing
Care instrument were recorded on L i k e r t type scales.
considered to be i n t e r v a l d a t a .
The scores were
Correlations were calculated between
r e s u l t s of the Marl owe-Crowne Social D e s i r a b i l i t y Scale and both forms
of the Reaction t o Nursing Care Instrument.
27
Findings Related t o Study Questions
The findings i n r e l a t i o n t o each o f the f i v e questions were
as follows:
1.
Does the personal space o f the chronic respiratory p a t i e n t
change i n s i z e during dyspnea?
Twenty subjects o r 66.6% o f the sample
showed an increase i n s i z e o f personal space when responses made t o
the CID during nondyspneic periods were compared t o responses t o the
CID during periods o f dyspnea.
Six subjects o r 20% o f the sample
showed a decrease i n s i z e o f personal space during periods o f dyspnea
when compared t o periods o f nondyspnea.
Four subjects o r 13.3% o f the
sample indicated no change i n the s i z e o f personal space between p e r i ­
ods of dyspnea and nondyspnea.
2.
I s the shape o f personal space a l t e r e d by dyspnea?
Analysis
o f the shapes was not done as subjects drew symmetrical shapes during
dyspneic and nondyspneic s t a t e s .
Twenty-three of the subjects or
76.6% of the sample drew c i r c u l a r shapes on the CID indicating an
equal amount o f space was required i n a l l directions around the body.
None o f the subjects indicated a l a r g e r space was required in f r o n t .
Seven subjects or 23.3% o f the sample indicated a l a r g e r space was
required t o the rear than was required t o the sides o r i n f r o n t .
o f these subjects were women.
All
Two subjects stated t h a t t h e i r f a m i l i e s
were trained t o speak t o the subject before approaching from the rear
t o avoid s t a r t l i n g the subject.
3.
Does the personal space of the chronic respiratory p a t i e n t
d i f f e r when approached by a close family member and by an unknown nurse
when the subject i s breathing normally or experiencing dyspnea?
28
k.
Does personal space change due t o an i n t e r a c t i o n between the
type of person approaching the subject and the dyspneic: o r nondyspneic
s t a t e o f the subject?
A s i g n i f i c a n t d i f f e r e n c e a t the .04 l e v e l was found when sub­
j e c t responses during dyspnea and nondyspnea were compared between
family members and nurses.
This difference indicated t h a t the subjects
preferred people to stay a s i g n i f i c a n t l y greater distance away when
they were dyspneic than when nondyspneic.
A s i g n i f i c a n t difference a t
the .01 l e v e l was found when the responses t o the approach o f the
family member were compared with responses to the approach o f the un­
known nurse.
This indicated that the subjects preferred having the
family member closer than the nurse.
There was no i n t e r a c t i o n between
the type o f person approaching the p a t i e n t and the dyspneic o r non­
dyspneic s t a t e of the subject.
This lack o f i n t e r a c t i o n indicated
that most explained variance i n CID scores can be accounted f o r by the
main e f f e c t s o f dyspnea/nondyspnea and family/nurse.
Table 2 presents
the r e s u l t s o f the analysis of variance between the type of person
approaching the subject, i . e . , close family member or unknown nurse
and the subject's physical s t a t e , i . e . , nondyspneic or dyspneic.
29
Table 2 .
Two Way Analysis o f Approaches t o Dyspneic
and Nondyspneic Subjects
Source
df
SS
119
35508.99167
Dyspnea/Nondyspnea
1
Fami1y/Nurse
Interaction
Total
Error
F
Significance
1197.00833
4.24524
.041
1
1591.40833
5.64400
.019
1
12.67500
0.04495
1.000
116
32707.90000
Paired t - t e s t s were also performed on the d a t a .
were:
-
-
The p a i r s
(1) family/subject dyspneic with fami1y/subject nondyspneic,
(2) nurse/subject nondyspneic with nurse/subject dyspneic, ( 3 ) nurse/
subject nondyspneic with family/subject nondyspneic, (*0 nurse/subject
dyspneic with fami1y/subject dyspneic.
Significance was found with each o f the p a i r s .
The result s
of the paired t - t e s t s confirmed the r e s u l t s obtained from the two way
analysis o f variance, when dyspneic subjects preferred a l l people t o
stay f u r t h e r away than when the subject was nondyspneic.
Subjects
preferred the family member closer than the nurse whether the subject
was nondyspneic or dyspneic.
pai red t - t e s t s .
Table 3 shows the r e s u l t s o f the
30
Table 3•
Paired T - t e s t s o f Approaches during Nondyspneic
and Dyspneic States
Variable
Mean
Standard
Deviation
Fam i1y/Nondyspne i c
9-47
13.64
Fami1y/Dyspneic
17-40
17.55
Nurse/Nondyspneic
16.A3
15.05
Nurse/Dyspnei c
23.07
20.18
9.47
13.64
Nu rse/Nondyspne i c
16.43
15-05
Fami1y/Dyspne i c
17.40
17.55
Nurse/Dyspneic
23.07
20.18
Fami1y/Nondyspneic
5.
df
Significance
Level
29
.001
29
.039
29
.002
29
.039
Are actions o f the nurse perceived as invasions o f personal
space by chronic respi ratory patients when dyspneic or nondyspneic?
The p a r a l l e l Forms A and B o f the Reaction t o Nursing Care (Appen­
dices E and F) were used t o answer t h i s question.
tered when subjects were breathing normally.
Form A was adminis­
Form B was answered by
the subjects as i f they were experiencing dyspnea.
The range o f scores obtained on Form A was 24-44.
score was 33 and a standard deviation of 4 . 6 0 .
The mean
Scores less than 33
indicate t h a t subjects perceive nursing actions as p o s i t i v e rather
than invasive.
Scores o f 33 indicate that subjects f e e l i n d i f f e r e n t
to nursing actions and scores greater than 33 indicate that subjects
perceived nursing actions as negative or invasive.
On Form A eleven
subjects scored less than 33» four scored 33 and 15 scored more than
33.
The range o f scores on Form B was 20-36 with a mean o f 31-16 and
a standard deviation o f 3•71•
There was a s l i g h t l y more p o s i t i v e
response t o nursing actions when subjects were dyspneic than when
nondyspneic.
A paired t - t e s t was done between Form A and Form B.
Although the mean scores appeared t o be s i m i l a r , there was a s t a t i s ­
t i c a l d i f f e r e n c e between them.
Table
presents the result s of the
paired t - t e s t between Form A and Form B.
Table 4 .
Form A and Form B Paired T - t e s t
Standard
Deviation
Variable
Range
Mean
Form A
24-W
33-00
A.60
Form B
20-36
31.16
3-71
df
Significance
Level
29
.026
R e l i a b i l i t y and V a l i d i t y Testing o f Form A
and Form B o f Reaction t o Nursing Care
Forms A and B o f the Reaction t o Nursing Care were developed by
the i n v e s t i g a t o r .
The purpose o f these instruments was t o measure r e ­
sponses t o nursing actions which intrude on personal space.
Parallel
forms were used t o compare nondyspneic responses with dyspneic responses.
R e l i a b i l i t y testing f o r internal consistency o f the two forms
was performed using alpha c o e f f i c i e n t s .
Nunnally (1978) stated that
alpha c o e f f i c i e n t s o f . 7 0 or higher are preferred f o r new t o o l s .
t o item c o r r e l a t i o n analysis was calculated.
Item
The c r i t e r i o n f o r item
32
t o item analysis was set a t correlations between . 3 0 t o . 7 0 .
This
c r i t e r i o n indicated that items a r e from the same domain y e t were nonredundant.
Form A Reaction t o Nursing Care showed a range o f - . 0 7 t o . 7 0
between the items.
Forty percent o f the items were found t o c o r r e l a t e .
The standardized alpha c o e f f i c i e n t was found t o be . 6 0 7 .
Reaction t o Nursing Care showed a range o f - . 0 1 t o . 9 2 .
percent of the items were found t o c o r r e l a t e .
was found t o be . 3 9 6 .
correlations.
Form B
Twenty-three
The standardized alpha
Table 5 provides a summary o f the item t o item
I n addition Appendices I and J provide complete item t o
item c o r r e l a t i o n matrices f o r reaction t o nursing care which intrudes
on personal space.
Table 5-
Summary Item t o Item Correlations f o r R e l i a b i l i t y
Analysis o f Form A and Form B
Range Item t o
Item Correlation
Tool s
Number of
Items Correlated
Form A
-.07 to .70
22 o f 55
Form B
- . 0 1 t o .92
13 o f 55
0%
23.6%
Standardized Alpha
Coefficient
.607
• 396
Review of the c o r r e l a t i o n matrices indicated that deleting
e i t h e r items 2 or 5 from Form A would elevate the alpha t o .7^ i n each
instance.
Deleting e i t h e r items 3 , 8 , or 9 from Form B would increase
the alpha to . ^5.
statements.
Item 5 on Form A and item 3 on Form B a r e p a r a l l e l
The alpha values indicated a moderate c o r r e l a t i o n between
the items used.
Alpha values a l s o indicated that items may have
functioned d i f f e r e n t l y on Form B when the subject was dyspneic than
they functioned on Form A when the subject was nondyspneic.
Pearson product moment correlations were performed between the
Marlowe Crowne Social D e s i r a b i l i t y Scale and Forms A and B o f the
Reaction to Nursing Care instrument.
The V measured f o r Form A was
.004 (p >.98) and f o r Form B was - . 1 6 (p > . k ) .
These result s i n d i ­
cated t h a t social d e s i r a b i l i t y had a n e g l i g i b l e e f f e c t on subjects'
responses t o the instrument.
CHAPTER 5
CONCLUSIONS, IMPLICATIONS AND
RECOMMENDATIONS FOR FURTHER STUDY
This chapter presents the conclusions o f the study.
tions o f the conclusions f o r nursing care are o u t l i n e d .
Implica­
Recommendations
f o r f u r t h e r study are l i s t e d .
Findings i n Relation to Conceptual Framework
The conceptual framework of t h i s study was based on theories
o f personal space.
Personal space i s a moveable t e r r i t o r y surrounding
an i n d i v i d u a l , over which the individual attempts to maintain c o n t r o l .
Lyman and Scott (1967) stated that maintaining control o f personal
space was a fundamental human a c t i v i t y .
Sommer (1959) described p e r ­
sonal space as an i n v i s i b l e boundary surrounding a person's body, into
which others may not intrude.
Several researchers (Altman, 1976;
Fisher and Byrne, 1975; Geden and Begeman, 1981) have found that the
size of personal space i s a f f e c t e d by the i n d i v i d u a l ' s view o f s e l f
w i t h i n the s p e c i f i c environment.
How the individual viewed the person
approaching him also a f f e c t e d the size o f personal space ( G o t t h e i l ,
Cory, and Parades, 1968; Guardo, 1976; O'Neal e t a l . , 1979)•
In t h i s study the shape and size o f personal space o f the
chronic respiratory p a t i e n t was measured using the Comfortable I n t e r ­
personal Distance Scale (Duke and Nowicki, 1972).
3*4
Responses o f the
subjects indicated t h a t greater personal space was needed during
periods o f dyspnea than was needed during nondyspneic breathing.
The
subjects indicated a smaller personal space when approached by a family
member than when approached by an unknown nurse.
The observation t h a t
the family members could approach closer than the nurse was seen
whether the subject was nondyspneic or dyspneic.
A small percentage
o f subjects indicated that the nurse could approach closer than the
family member could during periods o f dyspnea.
The subjects who allowed
the nurse t o be closer also indicated that the nurse would help a l l e ­
v i a t e the dyspnea.
The shape o f personal space i s r e l a t i v e l y constant (Sommer,
1959)•
In t h i s study the shape o f personal space o f a l l subjects r e ­
mained constant whether the subject was dyspneic o r nondyspneic.
The
s i z e of the personal space increased o r decreased depending on i n d i v i d ­
ual changes w i t h i n the subject.
The s i z e also changed depending on the
i d e n t i t y o f the individual approaching the subject.
Behavioral changes r e s u l t from invasion o f personal space
(Dosey and Meisels, 1969; F e l i p e and Sommer, 1966).
Reactions t o i n ­
vasion may cause the subject to f e e l comfortable o r uncomfortable.
Invasion o f personal space frequently occurs when nurses administer
care t o p a t i e n t s .
P a r a l l e l forms o f a Reaction t o Nursing Care were
used to investigate the chronic respiratory p a t i e n t ' s response t o i n ­
vasive nursing actions.
Trends i n the data suggest that nursing
actions which invade personal space a r e viewed with indifference or
as nonsupportive when the subject was breathing comfortably.
Similar
actions a r e viewed with less indifference and as more supportive when
the subject was dyspneic.
The low alpha and lack o f consistency
w i t h i n the questionnaires necessitates caution when considering these
conclus ions.
Findings i n Relation t o the L i t e r a t u r e
Geden and Begemen (1981) i n t h e i r study o f personal space found
that adults preferred t o have family members closer t o them.
Their
subjects placed nurses' figures a t a distance f a r t h e r away from s e l f
than they placed family member f i g u r e s .
the present study.
This finding was r e f l e c t e d i n
Subjects indicated they preferred the nurse t o stay
s i g n i f i c a n t l y f u r t h e r away than a close family member.
This preference
occurred when the subject was dyspneic and when the subject was
breathing comfortably.
Dyspnea a l t e r e d personal
space by increasing the amount o f
space subjects wanted around them when they were dyspneic.
The need
f o r g r e a t e r personal space during dyspnea may be r e f l e c t e d i n Kent and
Smith's (1977) description o f the claustrophia experienced by r e s p i r a ­
tory patients in acute d i s t r e s s .
Traver's (1983) anecdotal observa­
tions indicated t h a t during dyspneic episodes having strangers too
close increased the p a t i e n t ' s anxiety and respiratory discomfort.
The m a j o r i t y o f the subjects i n t h i s study required an equal
amount of space i n a l l d i r e c t i o n s .
This finding varies with what Louis
(1981) found with a s i m i l a r age group o f subjects i n a residence f o r
the e l d e r l y .
She found that her subjects desired a smaller face t o
face distance than was desired along other parameters.
Louis hypoth­
esized that smaller face t o face distance was due t o decreased
perceptual acuity o f her population.
The subjects i n the present study
were c l i n i c outpatients l i v i n g i n t h e i r own homes.
Perceptual a c u i t y
may be reduced i n the present subjects, but having r e s p i r a t o r y disease
may i n t e r f e r e with allowing a closer approach t o accommodate perceptual
deficits.
Therefore these subjects indicated a desire t o have others
approach an equal distance on a l l parameters, rather than allowing a
closer approach on the face t o face radius.
The d i f f e r e n t l i f e s t y l e s
o f the subjects may account f o r the v a r i a t i o n i n personal space between
the two groups.
Barstow (197^0 found t h a t chronic r e s p i r a t o r y patients engaged
i n attempts t o decrease the impact o f t h e i r symptoms on o t h e r ' s personal
space.
One technique used by her subjects was t o withdraw from others.
The need t o have greater space between s e l f and others during dyspneic
periods may r e f l e c t a withdrawal from others.
Several subjects when
completing the Comfortable Interpersonal Distance Scale stated they
removed themselves from others so others would not be disturbed by
t h e i r symptoms.
Implications f o r Nursing
Chronic respiratory patients preferred t o have family members
closer than unknown nurses during dyspneic and nondyspneic s i t u a t i o n s .
Nursing actions which brought the nurse closer t o the p a t i e n t were
t o l e r a t e d because the action a l l e v i a t e d d i s t r e s s .
Several subjects
commented that as long as the nurse helped the subject t o breathe
b e t t e r i t d i d n ' t matter how close she was.
Nursing actions which did
not a l l e v i a t e respiratory d i s t r e s s during dyspnea were viewed nega­
tively.
38
Subjects were asked t o react t o the p o s i t i o n a nurse assumed
during an interview when the subject was dyspneic.
The subjects
focused on the idea o f " i n t e r v i e w" rather than on the nurse's p o s i t i o n .
Many stated that they d i d n ' t want someone interviewing them when they
were short o f breath.
The nurse caring f o r respiratory patients needs
t o be able t o quickly and e f f e c t i v e l y assess the p a t i e n t and i n s t i t u t e
measures t o a l l e v i a t e respiratory d i s t r e s s .
The chronic respiratory
p a t i e n t w i l l allow the nurse who i s perceived t o be h e l p f u l t o come
closer.
The nurse who i s thoroughly p r o f i c i e n t i n techniques t o r e ­
l i e v e distress and who works a t developing the p a t i e n t ' s t r u s t w i l l be
welcomed.
The p a t i e n t ' s perception o f which nurse i s most h e l p f u l to
the p a t i e n t should be considered when assignments a r e made.
A skillful
nurse who i s assigned t o a p a t i e n t who perceives that nurse as nonhelpf u l w i l l increase the p a t i e n t ' s d i s t r e s s .
The p a t i e n t has not developed
t r u s t i n that nurse, therefore h i s anxiety w i l l not be relieved and h i s
dyspnea continues due t o a n x i e t y .
The respiratory p a t i e n t prefers having the family member c l o s e r ,
therefore nurses need t o support family members' attempts t o help the
chronic respiratory p a t i e n t .
Incorporating the family member i n p a t i e n t
teaching promotes the family member as h e l p e r .
Teaching family members
those a c t i v i t i e s which a l l e v i a t e symptoms, and which the family a r e
w i l l i n g t o implement recognizes the subject's need f o r closeness from
family members.
The tendency to maintain distance between s e l f and others i n
order to decrease the e f f e c t symptoms have on others i s a p a t i e n t
behavior nurses need to recognize.
Providing adequate privacy so that
the p a t i e n t i s not aware o f the presence o f others during dyspneic
episodes i s h e l p f u l to the p a t i e n t .
Discrete disposal o f sputum cups
and paper tissues a f t e r the p a t i e n t i s finished with them also m i n i ­
mizes a t t e n t i o n t o the p a t i e n t ' s symptoms.
The d i f f e r e n t responses t o the p a r a l l e l forms o f Reaction t o
Nursing Care may indicate t h a t chronic respiratory patients respond
d i f f e r e n t l y t o nursing actions when they a r e dyspneic.
Nurses who
develop a r e l a t i o n s h i p with a nondyspneic p a t i e n t may have t o reassess
that r e l a t i o n s h i p when the p a t i e n t i s dyspneic.
A nursing action which
the p a t i e n t accepted when nondyspneic may be t o t a l l y unacceptable when
the p a t i e n t i s dyspneic.
L imi t a t ions
Most o f the subjects were breathing comfortably so that the
questionnaire and the Comfortable Interpersonal Distance Scale were
completed r e t r o s p e c t i v e l y .
The few who were experiencing dyspnea
f i l l e d i n the f i r s t questionnaire and the CID r e l a t i n g t o nondyspneic
state retrospectively.
The majority of the interviews were conducted i n examining
rooms o f the outpatient c l i n i c .
member was frequently present.
The spouse o r another close family
The presence o f the spouse may have
a f f e c t e d the subject's willingness t o accurately s t a t e how close he
wanted family members t o approach when he was dyspneic.
R e l i a b i l i t y o f both Form A and Form B o f the Reaction t o
Nursing Care was a t a moderate l e v e l .
Similar items function d i f f e r ­
e n t l y on the two forms o f the instrument.
For example:
item six on
Form A states:
"During an interview I f e e l comfortable when the nurse
s i t s d i r e c t l y i n f r o n t o f me so that our knees a r e only a couple o f
inches a p a r t . "
The p a r a l l e l statement on Form B, item ten states:
"I
f e e l comfortable i f the nurse s i t s i n a chair beside me when she i n t e r ­
views me."
When responding to the statement on Form A, the subjects
reacted t o the nurse's p o s i t i o n .
Several subjects stated i t d i d n ' t
matter where the nurse sat during the interview.
On Form B the sub­
j e c t s responded t o the idea of the nurse doing an interview when the
subject was dyspneic.
Several stated they d i d n ' t want t o be asked
questions when they were short o f breath.
The position assumed by the
nurse was not commented upon.
Areas f o r Further Study
1.
Replication o f the design of the study using a l a r g e r sample
o f subjects.
2.
P a r t i a l r e p l i c a t i o n of the study with younger people who ex­
perience episodes o f acute dyspnea with no respiratory symptoms
between dyspneic episodes.
3.
Replication o f the study using subjects from an acute care
s e t t i ng.
4.
Replication o f the study using a nurse known to the subject as
one o f the stimul i on the CID.
5-
Exploration o f what chronic respiratory patients consider an
intrusion o f space during dyspneic and nondyspneic s t a t e s .
6.
Revision o f Form A and Form B of the Reaction t o Nursing Care
tools t o improve v a l i d i t y and r e l i a b i l i t y .
Replication o f the study when subjects a r e a c t u a l l y dyspneic
and nondyspneic.
Exploration o f s e r i a l responses t o the CID when subjects
experience d i f f e r e n t degrees o f dyspnea.
APPENDIX A
COMFORTABLE INTERPERSONAL DISTANCE SCALE
Number
Duke, M. P . and N o w i c k i , S. A . , "A New Measure and Social Learning Model f o r
Interpersonal D i s t a n c e , " Journal o f Experimental Research i n P e r s o n a l i t y ,
6 : 1 9 7 2 , p p . 119-132.
k2
APPENDIX B
HUMAN SUBJECTS APPROVAL
THE UNIVERSITY OF ARIZONA COLLEGE OF
N~
SING
MEMORANDUH
TO:
Laveena Gittins
College of Nursing
PhD ,1~
FRaq :
Ada Sue Hinshaw, RN,
Director of Research
DATE:
October 31, 1983
RE:
Human Subjects Review:
~rv
Katherine J. Young, RN, PhD
Chairman, Research Committee
Personal Space and the Dyspneic Patient
Your project has been reviewed and approved as exempt from University review by
the College of Nursing Ethical Review Sub-committee of the Research Committee
and the Director of Research. A consent form with subject sianature is not
required for projects exempt from full University review. Please use only a
disclaimer format for subjects to read before givinq their oral consent to the
research. The Human Subjects Project Approval Form is filed in the office of
the Director of Research if you need access to it.
We wish you a valuable and stimulating experience with your research.
ASH/fp
43
APPENDIX C
DISCLAIMER
PERSONAL SPACE AND THE DYSPNEIC PATIENT
The purpose o f t h i s study i s to c o l l e c t information about how
shortness o f breath a f f e c t s personal space and how people with short­
ness o f breath f e e l about invasion o f personal space. The information
may help nurses b e t t e r understand respiratory p a t i e n t s and improve
patient care.
You a r e being asked to p a r t i c i p a t e v o l u n t a r i l y i n t h i s study.
Completion o f the three questionnaires and the comfortable i n t e r ­
personal distance tool indicates your consent and willingness t o p a r t i ­
c i p a t e in the study. There a r e no costs o r r i s k s t o you i n your
p a r t i c i p a t i o n . The investigator w i l l be a v a i l a b l e t o answer any
questions you may have while you are completing the instrument. Ans­
wering the questionnaires and f i l l i n g i n the Comfortable Interpersonal
Distance Scale w i l l take approximately 15 minutes. You may withdraw
from the study a t any time.
A l l information c o l l e c t e d during t h i s study w i l l be kept
c o n f i d e n t i a l . Your name w i l l be known only to the investigator and
w i l l not appear on the information gathering sheets. Whether you
decide to p a r t i c i p a t e or not w i l l not a f f e c t your c a r e . A l l r e s u l t s
w i l l be grouped.
I f the r e s u l t s o f t h i s study are published, you can
be assured that you w i l l not be i d e n t i f i e d by name. A summary o f
r e s u l t s o f t h i s study w i l l be provided upon request.
I f you have any questions regarding t h i s study, please feel
f r e e t o contact the investigator a t the address below. Thank you
f o r your p a r t i c i p a t i o n i n t h i s study.
Laveena A. G i t t i n s , B.S.N.
1553 E. Prince Road
Tucson, AZ 85719
325-9584
APPENDIX D
SUBJECT PROFILE
Subject number
Age
Ethnic o r i g i n
Sex
Number o f years have had lung disease
How long ago did you have your l a s t period o f shortness of breath?
How close do you feel comfortable having people approach you when
you are short o f breath?
45
APPENDIX E
REACTION TO NURSING CARE—FORM A
After each of the following statements, indicate if you strongly disagree (SO),
diagree (0), are indifferent (I), agree (A), or strongly agree (SA) with the
statement by marking the appropriate box.
SO
I FEEL COMFORTABLE' WHEN THE NURSE STANDS BESIDE
HE AND PLACES HER ARM ACROSS MY SHOULDERS WHEN
TALKING TO ME.
2. I FEEL UNCOMFORTABLE WHEN I'H ON THE EXAMINING
TABLE ANO THE NURSE LEANS ACROSS ME TO REACH THE
BLOOD PRESSURE APPARATUS ON THE OPPOSITE SIDE
OF THE EXAM I NING TABLE.
3- I FEEL COMFORTABLE WHEN THE NURSE STANDS IN FRONT
OF ME AND PLACES HER HANOS ON EITHER SIDE OF MY
CHEST TO HELP ME CONTROL MY BREATHING.
<1. WHEN I'M SHORT OF BREATH ANO LYING ON THE
EXAMINING TABLE, I FEEL COMFORTABLE WITH THE
CURTAINS DRAWN AROUND ME.
5. WHEN I'M SHORT OF BREATH, I FEEL UNCOMFORTABLE
IF THE NURSE STANDS DIRECTLY IN FRONT OF ME
WHEN SHE USES A STETHOSCOPE TO LISTEN TO MY
CHEST.
6. DURING AN INTERVIEW I FEEL COMFORTABLE WHEN THE
NURSE SITS DIRECTLY IN FRONT OF ME SO THAT OUR
KNEES ARE ONLY A COUPLE OF INCHES APART.
7. I FEEL COMFORTABLE IF THE NURSE STANDS BEHIND
ME AND PLACES HER HANDS ON EITHER SIDE OF MY
CHEST TO HELP ME CONTROL MY BREATHING.
8. WHEN I AM SHORT OF BREATH, I FEEL C0MF0RTA8LE
IF THE NURSE STANDS BESIDE ME TO LISTEN TO MY
CHEST WITH A STETHOSCOPE.
9. WHEN I AM SHORT OF BREATH, IT DOESN'T BOTHER ME
IF THE NURSE LEANS CLOSE TO ME AND I FEEL HER
BREATH ON MY FACE WHEN SHE ASKS A QUESTION.
10. WHEN I AH SHORT OF BREATH, I FEEL COMFORTABLE
IF THE NURSE LEANS TOWARDS ME ANO PLACES BOTH
HANOS ON MY ARMS WHILE SHE EXPLAINS SOMETHING
TO ME.
II. I FEEL UNCOMFORTABLE IF THE NURSE SITS BESIOE
ME AND ACCIOENTLY TOUCHES MY ARM OR LEG WHILE
WE ARE TALKING.
46
SA
APPENDIX F
REACTION TO NURSING CARE—FORM B
In the following situations, when you are feeling short of breath indicate
whether you strongly agree (SA), agree (A), are indifferent (I), disagree (D),
or strongly disagree (SD) with the statement.
SD
1 FEEL COMFORTED WHEN THE NURSE APPROACHES ME
FROM THE SIDE AND PLACES AN ARM AROUND MY
SHOULDERS WHILE SPEAKING TO ME.
1 FEEL UNCOMFORTABLE WHEN THE NURSE STANDS
CLOSE TO ME AND 1 FEEL HER BREATH ON MY
FACE WHEN SHE TALKS TO ME.
1 FEEL COMFORTABLE I F THE NURSE STOPS ABOUT
A FOOT IN FRONT OF ME AND THEN ASKS
QUESTIONS OF ME.
1 FEEL MORE SHORT OF BREATH I F THE NURSE
STANDS DIRECTLY IN FRONT OF ME WHILE
LISTENING TO MY CHEST WITH A STETHOSCOPE.
1 FEEL UNEASY IF THE NURSE PLACES HER CHAIR
SO CLOSE TO ME HER KNEES ARE ONLY A COUPLE
OF INCHES FROM MY KNEES.
1 FEEL COMFORTABLE I F THE NURSE STANDS
BESIOE ME WHILE LISTENING TO MY CHEST WITH
A STETHOSCOPE.
1 FEEL UNEASY I F THE NURSE STANDS IN FRONT
OF ME AND PLACES HER HANDS ON MY RIB CAGE
TO HELP ME LEARN A NEW BREATHING PATTERN,
1 FEEL MORE SHORT OF BREATH WHEN THE
CURTAINS ARE DRAWN AROUND ME WHILE I ' M ON
THE EXAMINING TABLE.
1 FEEL COMFORTABLE I F THE NURSE STANDS
BEHIND ME AND PLACES HER HANDS ON MY RIB
CAGE TO HELP ME LEARN NEW BREATHING PATTERNS.
1 FEEL COMFORTABLE I F THE NURSE SITS I N A
CHAIR BESIDE ME WHEN SHE INTERVIEWS ME.
1 FEEL UNEASY WHEN THE NURSE REACHES ACROSS
MY CHEST TO OBTAIN THE BLOOD PRESSURE CUFF
WHEN I ' M LYING ON THE EXAMINING TABLE.
47
D
1
A
SA
APPENDIX G
AUTHOR'S PERMISSION TO USE THE CID
EMORY UNIVERSITY
ATLANTA. GIORCIA 30322
TMC PSYCHOLOGICAL CENTCR
OF THL
DEPARTMENT OF PSYCHOLOGY
September 23, 1983
Dear Ms. G i t t i n s :
Thank you f o r your i n t e r e s t
in the CID.
i n s t r u c t i o n s f o r a d m i n i s t e r i n g and s c o r i n g .
use t h e CID and reproduce i t as needed.
I ' v e enclosed some
Please feel
free to
Your h y p o t h e s i s r e g a r d i n g
space as a f u n c t i o n o f b r e a t h i n g d i f f i c u l t y i s i n t r i g u i n g .
l o v e t o know how i t comes o u t .
I'm sorry but
I'd
I have no i n f o r m a t i o n
regarding r e l i a b i l i t y and v a l i d i t y o f CID i n s i t u a t i o n s o f a l t e r e d
conditions.
I would assume, however, t h a t t h i s could be seen
as another type o f
s t r u c t i o n a l v a r i a b l e which can have an e f f e c t
on d i s t a n c e s c o r e s .
Good l u c k i n your research
P r o f e s s o r o f Psychology
A8
APPENDIX H
MARLOWE-CROWNE SOCIAL DESIRABILITY SCALE M-C1 ( 1 0 ) *
Listed below are statements concerning personal a t t i t u d e s and t r a i t s .
Indicate i n the space provided whether the statement i s T ( t r u e ) or
F ( f a l s e ) as i t pertains t o you personally.
1.
I HAVE NEVER BEEN IRKED WHEN PEOPLE EXPRESSED
IDEAS VERY DIFFERENT FROM MY OWN.
2.
I SOMETIMES TRY TO GET EVEN RATHER THAN FORGIVE
AND FORGET.
3.
THERE HAVE BEEN OCCASIONS WHEN I TOOK ADVANTAGE
OF SOMEONE.
k.
I HAVE NEVER DELIBERATELY SAID SOMETHING THAT
HURT SOMEONE'S FEELINGS.
5.
I AM ALWAYS WILLING TO ADMIT I T WHEN I MAKE
A MISTAKE.
6.
THERE HAVE BEEN OCCASIONS WHEN I FELT LIKE
SMASHING THINGS.
7.
I NEVER RESENT BEING ASKED TO RETURN A FAVOR.
8.
I ALWAYS TRY TO PRACTICE WHAT I PREACH.
9.
I LIKE TO GOSSIP AT TIMES.
10.
AT TIMES I HAVE REALLY INSISTED ON HAVING THINGS
MY OWN WAY.
"Adapted from Strahan, R. and Gerbosi, K. C. Short homogeneous versions
o f the Marlowe Crowne Social D e s i r a b i l i t y Scale. Journal of C I i n i c a l
Psychology, 28, 1978, p . 192.
49
APPENDIX I
COVARIANCE MATRIX—FORM A
50
Covariance Matrix o f Form A o f the Reaction t o Nursing Care Instrument
It e m
Item
1
Item
2
Item
3
Item
4
Item
5
Item
6
Item
7
Item
8
Item
9
1
1.2368
2
-.1356
.5161
3
• 3103
.0690
.8276
4
.2713
-.2046
.2414
.6161
5
-.0598
.1333
-.1379
-.1977
.4644
6
.3356
-.3057
.2414
.2667
-.2230
.5333
7
.2690
-.1630
.5517
.3379
-.3310
.4000
.8517
8
.0874
-.2161
• 3103
.2943
-.3126
.2782
.5448
.7540
9
.2437
-.0529
• 3103
.0713
-.0736
.1770
.2621
.1287
1.0161
10
.4368
-.2356
.4138
.3333
-.3563
.5287
.5690
.4253
.4713
11
.2621
.1276
.0690
-.0828
.1310
-.0621
-.0724
-.1862
.1103
1
Item
0
vn
APPENDIX J
COVARIANCE MATRIX—FORM B
52
Covariance Matrix o f Form B o f the Reaction t o Nursing Care Instrument
1 tem
2
1 tem
3
1 tem
4
1 tem
5
1 tem
6
1 tem
7
1 tem
8
1 tem
9
1 tem
10
1 tem
1 tem
1
1
1.172*»
2
-.2759
1 .1034
3
.1724
-.2069
• 9207
4
-.0345
.3448
0.2172
.6448
5
-.0345
.5862
0.0483
.4345
.7402
6
.6552
0.3448
• 0759
-.0966
-.1747
.6851
7
-.1724
.4483
-.1310
.2483
.4115
-.1770
.9609
8
-.3793
• 3103
0
.1034
.1954
-.3333
.2529
• 9885
9
.4483
-.2759
.2448
-.2034
-.3172
.5034
-.4966
-.4833
.9759
10
.4138
0
-.0724
-.0379
-.0161
.3126
-.1356
-.2644
.4724
.6540
11
.1724
.1724
.1172
.0828
.3517
-.1241
.2552
.3448
-.3379
-.2138
VI
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