Cancer is.the second leading cause of death among Americans with breast cancer being the most common site in women. Social support is needed by patients with cancer as they learn to cope with thetr disease and its treatment. Coping behaviors are the specific techniques a person selects to manage stress. A descriptive correlational research design was used to determine the nature and quality of social support, to examine the coping strategies, and to describe the relationship between social support and coping behaviors in women with breast cancer. The sample.consisted of 43 women ages 25 to 77 years who acknowledged their diagnosis of breast cancer, were 3 months to 21 years since the diagnosis, and received treatment in three ambulatory care clinics in a medical center in the Southeastern in the United States. An investigator-developed Demographic Form, the Norbeck Social Support Questionnaire, and the Jalowiec Coping Scale were completed by each subject. Descriptive statistics were used to describe the study sample, the components of social support, and coping behaviors. Pearson's prdduct-moment cor~elations were calcul~ted to determine the direction and strength of the relationship between social support and coping behaviors. Family members were listed more frequently than any other source of support category. Only 4.7% of the subjects identified a health care provider in her support network. The subjects identified problem-oriented coping methods more frequently than affective-oriented coping methods. The most often indicated coping methods in this sample were prayer, maintaining hope, accepting the situation, and u~e of sleep. The research hypothesis that there is a positive .relationship between social support and coping behaviors in women with breast cancer was supported by the-findings. ·statistically significant correlations were identified between affectiveoriented and problem-oriented coping behaviors and the social support components of Total Functional Support and Total_Network.Support. For the purpose of increasing a patient's coping ability, a professional nurse should identify the amount and quality of support a patient receives, encourage family members and friends to visit and· communicate with the patient, and offer to serve as one of the patient's support network. These findings also suggest that it is ne~essary to introduce the concepts of social support and coping behaviors to nursing students early in their nursing education program.

The purpose of this-descriptive field study was to determine if differences exist in levels of burnout in rural nurs~s working: full-time and part~time; in full-time nurses staying in the same area versus changing·work areas; differing amounts of time- in direct face-to face contact with patients; with: nurses- having g·reat·er· amounts of· ·time in contact with the same patients versus those having less amounts of. time in contact with the same patients; with var.ying scheduled work interruptions. This study also compared levels of burnout of nurses in rural Georgia in 1987 and rural Idaho in 1982. A convenience sample of ·98 registered nurses voluntarily participated in the study. The Human Services survey instrument developed by Christina Maslach and Susan Jackson was used to measure levels of burnout~ A demographic survey accompanied the Maslach-Jackson tool. . Results of the t-tests and one-way analyses of variance revealed significant differences at the .05 level in the MBI subscale mean scores for emotional exhaustion in hypothesis one, and in one section of the fourth hypothesis. No significant differences were· demonstrated in either the depersonalization or personal accomplishment subscales. These findings resulted in the rejection ·of the research hypotheses. The findings of this investigation as well as other extensive studies of national healthcare workers indicate the need to take different directions in the study of burnout. Future studies could study burnout in connection with other variables such as turnover, hardiness, decision making, and self actualization.

The foc~s of this study was the· female's ret~rn to school and her petception of its effect·on the family system. A tota~ of ·twenty females, selected through a snowball effect,· were interviewed ·in their homes. An interview technique· with demographic questionnaire 'Was utilized. The results of the st.udy indicated that the return to school had various similarities for the female. The suppoit 6f . . ·. spouse and f~mily was viewe~ as crucial. Di.~ision.of · labor d-id not change drastically nor did. t'ime spent with families. Quality of time with family.became more important and.the most positive effect of the return to school was seen as the increased interqction between husband and children. The study has implications for educators, counselors, health car~ providers and the families~ The greatest implication of the. study is the fact that the return to school. was viewed by most women in this study as being positive.

A study of value· orientation in Ufe goals and activity interests was conducted to explore how culture influences thes_e two variables. The relationship between value· orientation and activity interests was also investigated to explore the theoretical framework of human occupation. The human occupation model borrowed the general system theory and assumed that t Man as an open system, interacted with the environment through a process of input, throughput , output and feedback. The environment is physical, social and cultural phenomena. Output information results in purposeful occupation or human occupation. A descriptive survey was designed using two questionnaires to measure the value orientation and activity interests in two cultural g~oups, American occupational therapy students at the Medical College of Georgia, Augusta, GA, U. S. A. and Chinese occupational therapy students at the National Taiwan University, Taipei, Taiwan,· R. 0. C .. The questionnaires were translated into Chinese for the Chinese subjects. The California Life Goals Evaluation Schedules was administered to measure the value orientation in life goals. It included 150 statements categorized into 10 categories: esteem, profit, power, fame, leadership, security, social service, interesting experiences, self expression and independence. Matsutsuyu's Neuropsychiatric Institution Interest Checklist was used to measure activity interests which were categorized with the assistance of occupational therapy faculty at the Medical College of Georgia. The 80 activity items were categorized as active, passive, cooperative, competitive, creative, structured, solitary and group activities. A total.of 35 questionnaires was sent out for the Chinese subjects. All of them were returned , but one of them was not completed. A total of 50 questionnaires was distributed for the American subjects. Thirty·questionnaires were returned, 20 of them were completed. ·Data were analyzed using "STATGRAPHICS" computer package. The statistical tests utilized were_ Student's t-test and Pearson product moment Correlations. Findings indicated that the value orientation in these two groups had .statistically significant differences in fame, power, leadership, security, interesting experiences, and independence. But, there were no significant differences in the activity interests except-in the category of structured activities. A further finding was that the American group in this study tended to prefer passive, cooperative, creative and group activities. The Chinese group tended to prefer passive, and cooperative activities and had no significant preferences in creative versus structured and solitary versus group activities. Considering the correlation of value and activity interests in each cultural group, the results showed that there existed some correlations of value and activity interests. These findings did not supp·ort all the hypotheses, but did provide clues of relationship in value and activity interests.

The purpose of this study was to ascertain if perception of control was effective in reducing noise annoyance in the Intensive Coronary Care Unit (ICCU) setting. The sample consisted of 30 adult subjects admitted to a 16"!"'bed ICCU in a rural 275 b.ed hospital in the southeastern United States. A Noise Annoyance Questionnaire (NAQ) was the instrument utilized to measure noise annoyance. The randomized post-test only experimental design tested the following hypothesis: Patients who are issued earplugs as a means' to control noise will score lower on a scale measuring annoyance to noise in the ICCU than will patients who are not issued earplugs. Subjects were randomly assigned to either the experimental group (n=15) or control group (n=15). Experimental group participants were issued earplugs with instructions for their use and applicati.on. At 24 hours post-ICCU discharge, all patients were asked to complete the NAQ. The t-test for independent means revealed no significant difference (R =.06). in the mean noise annoyance scores between the groups; therefore, the hypothesis was rejected. This finding indicates that in this study, the total noise annoyance scores from participants receiving earplugs did not differ from the scores of participants who did not receive earplugs. S.ince the nursing intervention (offering earplugs to ICCU patients) was not effective in this sample of patients, other nursing interventions need to be explored as a measures of control of noise annoyance.

The purpose of this study was to utilize Herzbe~g's approach to deter~ine the factors within a nursers job and.work environment ·that are most important to the registered. nurse. A convenience sample of 107 registered nurses from two acute care hospitals in the southeast United States participated in this survey and answered questions on the Longest (1974) questionnaire. This instrument is a 6-point Likert type tool designed to.1determine the nurses' pe~ception of the importance of Herzberg's ten motivation/hygiene factors to job satisfaction. A pilot study indicated that the instrument was understandable and easily com~leted. Face and content validity of the instrument were established by a review panel of three experts. A reliability coefficient of 0.5 was obtained. Dat~ analysis showed that these nurses rated both the motivation and hygiene factors as moderately important to very important in terms of job satisfaction. Using the paired t-test to compare mean· ratings of each subject on each factor, there was no significant difference between the means of the hygiene and motivation factors. A comparison of overall .job satisfaction .between medical/surgical nurses and those employed in other clinical areas of practice was conducted. A chi square test produced significant findings between the two practice groups. Nurses in medical/surgical areas reported more dissatisfaction in their jobs than did nurses working non-medical/surgical areas. Recommendations for further resea~ch include ./ further testing and refinement of the Longest questionnaire so that reliability is enhanced and further terminology/vocabulary·specific to the nursing profes~ion can be incorporated.,~ . Results of this study . should be utilized proactively by nurse executives in developing incentives and programs that create an attraction to the nursing field an~ an appealing image of the nurse and her work. Finally, a similar study in other geographical areas with a comparatively larger sample of nurses is suggested.

Maternal-Fetal Bonding and a Previous Spontaneous Abortion. Sharon Sue Elkins. The purpose of this study was to investigate the relationship between the occurrence of a spontaneous abortion in a prior pregnancy and maternal-fetal bonding· in a. current pregnancy. Cranley•s Maternal;;;Fetal Attachment Sca'le and a demographic questionnaire were completed by 236 pregnant women attending either Lamaze classes or a prenatal clinic .. There was no significant difference found in maternal-fetal bonding, measured by the total score on Cranley•s Maternal-Fetal Attachment Sea 1 e, between wome·n who had experienced a spontaneous abortion .in the previous_ pregnancy and women who had not experienced· a spontaneous abortion in the previous pregnancy. However, on ·subscale (2) 11 interaction with the fetus 11 the scores of the spontaneous abortion group. were significantly lower than the scores of the lnonspontaneous abortion group. A1 s o, the spontaneous abortion group had a significantly greater variance than the nonspontaneous abortion group. No relationship was found between the number of weeks pregnant at the time of the spontaneous abortion and maternal~fetal bonding. -. Social class was found to have the greatest effect on maternal-fetal bonding of all the observed variables. Women in higher social classes had significantly higher total scores on the Maternal-Fetal Attachment Scale. Also-, Caucasian women and younger women had significantly \higher total scores on the Maternal-Fetal Attachment Scale. Women who were the greater number of weeks pregnant also had significantly higher scores ·on two of the subscales, 11 i·nteraction with the fetus" and 11 giving of self ...

A comparative correlational design was used to examine the relationship between self-esteem and goal-ririentation ahd contraceptive behavior among four gr_oups of· -adolescent females. The four groups included those· who were compliant J ' with contraceptives, those who were not sexually active, those who were sexually act'ive without contraceptives, and thqse who were pregnant. The 47 adolescent females were administered the Coopersmith Self-Esteem.Inventory as a measure,of self-esteem and the Offer_Self-Image Questionnaire for Adoles_cents as a measure of goalorientation. Three hypotheses were tested. The first, which stated there would be-· a positive relationship between , se·lf-esteem and goal-orientation. was no't supported using Pearsonian Correlational_Statistics. The second hypothesis stated there would be significant differences in the selfesteem scores among the four -groups. This hypothesis was . ' tested.and not supported. using one-way.analysis of variance techniques. The third hypothesis _stated there would be significant ·differences in the goal-or~entation scores· among the four groups. This hypothesis· was also not supported using one-way· analysis.of·variance techriiqu~s. Although .none of the. three hypotheses were supported, two interesting findings did emerge related to contraceptive usage and trends in the self_.esteem scores among the_four groups. Those adolescents who stated they were using_ contraceptiyes had significantly higher_selfesteem and goal-orientation scores than those who were not using contraception. The n;tean.score of those adolescents who were compliant with contraceptives was higher than that of the other. three groups of adolescents. Recommendations t·o be considered in the future -by those working with adolescent pregnancy are included.

The purpose of this study .was to systematic·ally examine the needs and emotional distress of family members when an adult relative is hospitalized in an intensive care unit. A modified version of McCubbin and Patterson's (1983) Family Stress Framework provided the theoretical basis for t~e investigation. Using questionnaire/survey· technique~,:data was collected from 32 family members 36 to 96 hours following the admission of an adult relative to an intensive care unit. Two_research questions were po~ed related to need importance as perceiv~d by family members and the perceived degree to which these needs -were met. Using an adapted version of Molter and·Leske's (1983) er~tical Care Family Needs Inventory, family members reported ma:r;1y ·needs·· as very important. These needs. ·appeared to have· constancy in content when visually com~ared to findingi from previous family need-studies.· There were needs which family members perceived as not always met, although, many of the needs perceived as most important were reported by family members as having been met. Employing Pearson's Product Moment Correlation, six research.hypotheses were used to test a theoretical proposition; as the demands of unmet needs .. · increase, distress ·increases in family members within the context of an actual or potential crisis-inducing event. Significant (P_i· os·) pos'itive· correlations· were f·ound between. the demands of unmet needs and emot·ional distress in family . members as mea.sured by Hopkins ··Symptom Checklist ( HSCL) · total-item symptom distress (r=.36) and four HSCL·symptom dimensions to include somatization (r=.33) 1 anxiety (r=.30) 1 depression (r=.40) 1 and interpersonal-sensitivity (r=.37). While there was a positive relationship of c6mparable strength between unmet needs and HSCL symptom dimension· obsessive-compulsive (r=.30) 1 the relationship-was-not statistically sign·ificant.. These findings suggested that family members· of critically .i}l pat·ients were able to ,mobilize resources in meetin'g'·. the needs 'th,ey perceived as ' most important 1 and that' nurses in ·critical care 'settings may be intervening to·· meet ina.riy of .the needs of: family members. Since distres·s was significantly related to unmet -~ ·-· ' ' . ' . . . . . . . . . . . needs I it· may be :,pos.sibl~ .that the :~dapt.iye resources .of .- family members were consumed or depleted in satisfying the needs they perceived as most important. Further, ·the ability .of fa~ily ~embers· to .. mobilize additional resources . ' .. in order to ~eet the ;emaining ·unmet rieed~ was exceeded and distress emerged. Other possib.le explanat·ions may exist since a cause-and-effect relationship bet~een unmet needs and distress cannot be_established based'on the .findings of this descriptive-corr~lational study. It was recommended that nursing interventions in reducing distress and maxi~izing·coping ef:f;ectiveness in· family members when-an adult relative is hospitalized-in an ·intensiva care ·unit~

A ·study of nurses' . attitudes ~award continuing ~ducation w~s ' . conducted to de~ennine .if nurses .t:hink. ~t .participatiOn_ is nece.ssary ' ' - . . . for responsible professio~l practicer. the influence of ~datocy cori-: ·, . ·_ tinuing education requirements on attitUd~s·; the reia~i.onship· b~twe~·" higher acaderriic e~ation · and attitudes; and. to id~ti~ pe~soruil ~d. employrreilt facto~s that influence attitudes toward and __ partic-ipation in- continl,ling education . activities-. 1 · ... - ----~--.-- ----- A descriptive ~ey de~ii?;n usi.Tig a 45·. item -~strurnent sampled · opinions of·registered nurse subjects practicing in 2 selected hos- . ·I· , pitals in 2 southern states; one state . requires mar:tdatory Gohtinuing education for relicensure, one state do~s not. ·A total of .. 200 questionnaires were distributed; 104 completed· questi~r-es, ~er~--.~ eturned by U.S. Mail. Data were analyzed uslnK Sta~istical. ]?ackage for Social Sciences. ·'!he statistical ·tests utilized. were ~lysls· of variance and Pearson Product Moment Correlations. . . Fin~gs indicated that these-registered nurses ·expressed·positive -. . . ~ attitudes toward continuing education· and value participation in order to maintain professional knowledge· and compet~ce. . Negative _attitudes were eXpressed t~ard the ANA. ~f~tion of con~inw_ng· _eduCation, which excludes learning activities for which academic credit is given. No . . ' significant relationship . was found between . attitudes toward _c_?1:1tinulpg · education and mandatory requirements~ Subjects ··frOm. both states eXpressed positive attitudes toward continuing ·education, but negative _at:~ituc1es toward mandatory requirements. . Positive. attitudes were· express~d toward iii. shared responsibility of the nurse and the employer for time and costs of continuing education activities for nurses. Attitude toward continuing education was not shown to be. related to basic educational preparation for nursing . or highest level of educational atta.irnn:mt . . Significant relationships were found between attitude toward continuing education and ·age, position title, and .membership it+ a professional nursing associat~on. .