The "Readers Respond" column is designed to give you, our readers, a chance to respond to a particular article, ask a question of an author or Editorial Board member, or speak out about the Journal and care of the elderly in general. We will offer authors the opportunity to respond to criticism and/or questions that may be generated by their articles. Both the response and the original letter will be published in the same issue. If you wish to share your comments with our readers, please send your letter to the JOURNAL OF GERONTOLOGICAL NURSING, Charles B. Slack, Inc., 6900 Grove Road, Thorofare, New Jersey 08086.
To The Editor:
I am both distressed and intrigued by Margaret Lewis's article "Personal Space Boundary Needs of Elderly Persons: An Empirical Study" in the July issue.
My distress focuses on three issues. First, the approach method of measuring personal space has certain pitfalls. In particular, whose boundary, the researcher's or the subject's, is being measured? Is the subject reacting to the intrusion of the researcher's own variable boundary?
Second, there are numerous variables that influence personal space needs. Research has demonstrated that variance is related to time of day, culture, self-esteem, age, and anxiety. Were any of these variables controlled for in this study?
Third, it is always disappointing to find someone doing research related to one's own who appears to be unaware of the work previously done and reported in both the Journal of Gerontological Nursing (January 1978) and the American Journal of Nursing (May 1980). In my own research on personal space in the elderly I found a significant correlation with age of the subject.
My own findings led to my interest in the article. Did Dr. Lewis analyze the data for correlation with age? Given the range of the age of the subjects, I would be very interested to know if personal space needs increased with age of the subject?
Evelynn C. Gioiella, RN, PhD.
Dean, The City College
of the City University
of New York
Margaret Louis responds:
Thank you for the opportunity to respond to Dr. Gioiella's comments. I will speak to them in the order she has made them.
First: A direct measurement of personal space was chosen because stuthes reported before this project was implemented indicated that less than 5% of the variance between direct and projective measurement could be accounted for. In addition, these stuthes using projective measurement had children and young adults as participants. The direct measurement used asked the elder participant to respond to their actual experiencing of discomfort/uneasiness in relation to the situation as it was occurring (approaching or being approached by a nurse stimulus). The participants did not have to remember or project answers. Support can be of fered that the distances measured in this study were those of the participants and not the stimulus and can be found in the fact that the participant controlled the distance measured - by either moving or not moving closer and by telling the stimulus when to stop in the approach. The variance in the scores obtained, from participant to participant, and the lack of significant difference in scores test to re-test also supports the measures being those of the participant and not the stimulus. In addition, the stimulus made a deliberate effort (after pre-test training) to make the same presentation to each participant.
Second: Control for extraneous variables included testing proedure - same time of day, same room, lighting, temperature and use of a room familiar to all participants. Socio-cultural-economic controls were in essence effected through participant selection from residents of a low-income seniors' housing project. They were of similar ages, cultures, and race. Controls for anxiety and self-esteem were not directly made. However, it could be assumed all participants were under similar levels of stress - a new experience (participating in a study). All were functioning independently and had been screened to have been living in the same housing for at least the last six months. This was done to indicate some degree of satisfaction with their life situation, which may or may not reflect their self-esteem level. Elders in that particular city had multiple choices for low cost housing and consequently could and did move to find one to their liking. Also, all of the participants were active in at least their housing community and could not be classified as socially isolated.
Third: The reference list included with the article reflects only stuthes cited and not the total literature reviewed. Also, Dr. Gioiella's article in JGN was not available when this study was being implemented.
Correlation of subsets of the participants by age was not made as visual evaluation of the data did not suggest such a difference. Also, further interpretation of my data by age alone would not have been appropriate as sex was suggested to be a factor and would have required a further split of the already small sample size, and lack of weight would have made such a finding misleading.
Dr. Gioiella's finding of an age difference with her female sample adds weight to the recommendation of further study before absolute statements are made about p.s.d. of elders.
Findings do support the need to consider personal space when working with elders, but remember that there are no absolutes and each situation and person needs to be assessed on an individual basis.
Margaret A. Louis, RN, PhD
Department of Nursing
University of Nevada
The article in the September, 1981, issue of the Journal of Gerontological Nursing concerning "Navajo Nursing Homes: A Fusion of Philosophies" was most interesting. Being on the edge of the Navajo reservation, our nursing home also deals with Navajo families and provides care for 58 to 60 Navajo patients.
We have found that while there are many families who do interact with the patient-resident, the Navajos are not greatly different from any other groups of people. Some families are devoted and attentive; others visit only when summoned because of critical illness. Many are placed in nursing homes and totally abandoned - we have had people who have been here for five and six years without any visitors. There are also those who have sufficient self-help skills that they could be cared for in their home with minimal attention from their children or "extended families." They do not want nursing home placement; they do not actually need it but the families will not assume the responsibility of providing necessary food and shelter, even with the patient's own income.
It is much to be hoped that one day the families of our patients become as benevolent and concerned as those at Chinle and Toyei. We would certainly welcome the conern and the respect for the elderly patients, although I anticipate more anglo values as the Navajo learn to be more like the Bilagana (nonIndian). Unfortunately, it's going to be rather difficult to tell the difference.
Marian L. Macrorie, RN, NHA
Marcella Chavez, RN
Director of Nurses