The importance of familycentered care is well-recognized in nursing,1"3 and nurses have been at die forefront of assisting lamilies to be more resourceful.4'5 However, one aspect of fantily research, the relationship between adult children and their aged family, has been largely ignored in nursing. Most nursing research has tended to focus almost exclusively on data gathered from die aged parents and neglected die viewpoints of die adult children. Research needs to focus on dus area as die middle-aged and aged populations continue to grow due to die rapid lengthening of the hfe span. Particular attention should be given to form families who are experiencing financial strain and form foreclosures.
Because of these environmental stressors, role strain, increased withdrawal of family members, and breakdown of intergenerational relationships may occur. The goal of the present investigation was to provide data that will assist die nurse in better understanding intergenerational relationships.
The purpose of the study was to investigate two questions: How is filial responsibility and affection perceived by rural adults for their aged parents? Does financial strain experienced by rural adult children affect their perception of filial responsibility and affectional bonds with their aged parents?
Questionnaires were completed by 296 farmers over die age of 45 who had at least one living parent over the age of 65 who was not residing in the same house as the subjects. The questionnaire examined die concepts of filial responsibility and affectional bonds with aged parents. Items related to filial responsibility included responsibilities that subjects perceived as important in their relationships with parents. Affectional dimensions of understanding, trust, fairness, respect, and quality of communication were also measured. The reliability coefficient for 15 items that measured filial responsibility was .82 and die alpha for 15 items measuring affection was .91 .
This study relied on die accuracy of participant self-administration of a questionnaire rather than direct observation by the researcher and, hence, is a study of subjective perceptions and beliefs rather than of objective behaviors. This study is also only representative of farm families living in die state of Iowa.
The sample (N = 296) was equally divided among men and women with a mean age of 45 years; 291 subjects were white and 5 were black. The majority of the sample (51%) described their families as belonging to the working class, whereas the remaining subjects stated that they belonged to the upper (2%), professional (1%), lower (6%), and middle (40%) classes.
Years of schooling ranged from 5 years to 19 years with a mean of 12.9 years. Three percent of the subjects were single and 97% married. The range of years married were from 1 to 49 years with a mean of 23 years. The mean number of children living in the home was 3.2.
The mean score for level of affection was 30.74, with men having a higher mean (31.70) than women (29.72). Results of a one-way ANOVA showed the sex of the subjects was significantly related to affection (F = 3.80, P < .05). Affection and filial responsibility were related significantly (r = .44, P < .001). Adequate income was positively correlated with affection (r = .16, P < .01), and negative correlations were found between financial worry and affection (r = .12, P < .05). A negative correlation was also found between the likelihood of foreclosure (r = .13, P < .055), financial worries (r = . 13, P < .05), and affection. The majority of subjects were concerned about adequacy of income, financial worries, and the possibility of foreclosure (Table 1).
The mean score for filial responsibility was 29.88, with a lower mean for women (30.37) than for men (32.77). Results of the one-way ANOVA suggested that sex of the subjects was significantly related to filial responsibility (F = 10.54, P < .001). A negative correlation (r = . 13, P < .05) was found between adequacy, income, and filial responsibility. Subjects who perceived they had adequate incomes had lower filial responsibility scores.
Subjects had frequent contact with their parents either through daily (16%) or weekly (47%) visits. Letter writing was rare. Eighty percent of the subjects were very satisfied or satisfied with these contacts (Table 2).
The majority of the subjects (53%) resided 1 to 10 miles from their parents and visited them at least once a week (63%). This regular physical bonding promotes greater affection between the two generations.6 Heller et al report that kin relationships form the basis of emotional and physical support for rural residents.7 The nuclear family's identity and sense of worth is defined by the kinship system. The outside community is only secondarily considered as a positive reference group and may be considered hostile to family cohesion.
DESCRIPTION OF ADEQUACY OF INCOME, FINANCIAL WORRIES AND POSSIBILITY OF FORECLOSURE
Most of the subjects had inadequate incomes (55%) and financial worries (68%). fourteen percent of the sample predicted foreclosure and 31% were undecided whether they would lose their farms. These sobering financial concerns have affected intergenerational relationships; these subjects had lower levels of affection for their parents than subjects who did not share the same concerns. Previous research has reported that higher reciprocity relationships displayed greater positive attachments than other aid patterns.8 In this study, the children's inability to reciprocate may have resulted in decreased affectional bonds with their parents.
Interestingly, financial strain did not affect filial responsibility scores; subjects with higher incomes had lower scores. Previous research supports this finding. The study by Kleugel et al found that farmers and factory workers had the highest rate of contact with parents, whereas business people were about average and professionals had the lowest contact.9 In fact, farmers and factory workers had twice the contact rate of professionals. The data in this investigation suggests that the perceptions of filial responsibility remain strong even when individuals' resources decrease. Existing studies demonstrate that the extent of adult children's help in times of crisis and the length of time such help is offered depend on patterns of socialization and mutual aid that existed prior to the crisis.10
The women in this study had lower levels of affection and filial responsibility than men, which was surprising because no previous studies have reported similar results. This finding might be explained by the differences in life stage tasks and concerns. During middle age, men and women display a need to commit themselves in areas other than those based on sex roles: men turn to their families for increased affiliation and nurturance; women, often expressing a desire for personal growth and self-expression, begin to add new roles to that of wife, mother, and daughter.11 Consequently, the trajectory of women may be away from die family at the very time men turn toward die family with increased interest.
DESCRIPTION OF CONTACT WITH PARENTS
IMPLICATIONS FOR NURSING PRACTICE
The direat or even fear of losing a farm can tear away at individuals and tiireaten to destroy die entire family unit. Nurses can be at the forefront of preventing this possible breakdown by helping chUdren and aged parents to be more resourceful. However, several points must be kept in mind when working wim this population. First, nurses must recognize that the efficacy of nursing interventions is dependent on an understanding of rural kinship systems. This study suggests that acceptance of filial responsibility and affectional bonds are pervasive in rural families. Intervention outside the kinship system has the potential to be considered intrusive. For nurses to be seen as advocates rather than adversaries, they should familiarize themselves with successful models of health care for the rural population.
For example, Buckwalter et al have implemented a rural elderly outreach program.12 An interdisciplinary team composed of a physician, social worker, and two nurses coordinates its activities to provide services to families. This approach reflects the idea that problems presented by an aged client cannot be adequately treated in isolation, but must be viewed within the context of intergenerational relationships. The interdisciplinary team supervises the famdy's caregiving efforts, provides ongoing counseling, ensures frequent phone contacts or home visits, implements appropriate support services, and relieves the family's burden through appropriate use of respite care.
Controversy persists as to whether financial benefits will be derived by implementing interdisciplinary health teams in the home care setting. Stuthes show that attempts to preserve a family's independence in the community is of considerable benefit both in terms of quality of life to the family and cost to the community. 13
Secondly, the nurse must be cognizant of crisis intervention with this population. Depression, suicide, and chemical dependency have risen dramatically (Krach P. 1989. Unpublished data). The nurse must be aware of and use all available resources. Buckwalter et al have implemented an innovative approach through the use of "gatekeepers," who live and work in the community.11 They are in the best position to recognize early changes in the behavior of local residents. Mail carriers, grocery store clerks, home delivery clerks, among otiiers, complete a training program and then link people needing help to sources of help in the community. This intervention has resulted in a decrease of fragmentation and a lack of coordination of health-care services.
Finally, to provide the most therapeutic and cost-effective care, nurses must be aware of the inherent strengths in intergenerational relationships. Nurses can then assist adult children and aged parents to precisely delineate the strengtiis that will help them to meet the demands of their lives.
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- 12. Buckwalter K, McDonald T, Smith M, Stewart-Dedmon MN. Gatekeeper Training Manual. Iowa City: The University of Iowa; 1986.
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DESCRIPTION OF ADEQUACY OF INCOME, FINANCIAL WORRIES AND POSSIBILITY OF FORECLOSURE
DESCRIPTION OF CONTACT WITH PARENTS