Research in Nursing & Health, 1992, 15, 139 - 146
The Effect of Clients’ Family Structure on Nursing Students’ Cognitive Schemas and Verbal Behavior Lawrence H. Ganong and Marilyn Coleman
The primary purpose of this study was to investigate if nursing students stereotype clients on the basis of family status. In addition, the influence of information about the client’s family status on students’ predictions about the client’s behavior, information sought from the client, recalled information, and verbal responses directed toward the client were examined. The participants were 83 nursing students from a large Midwestern university. They were randomly assigned to one of two groups. Brief written information about a female adult client with a vaginal discharge was provided and, after listening to an audiotaped interview between a nurse and the client, students completed a battery of questionnaires. They also responded verbally to questions asked by the audiotaped client. All information given to both groups was identical except for the client’s family status. Results indicated that the client who was a married mother was perceived somewhat more positively than the unmarried mother client. Participants’ perceptions were only somewhat consistent with cultural stereotypes about these family statuses. Information sought and information remembered about the client were greater when she was an unmarried mother. There were no differences in predictions of patients’ behaviors and verbal responses.
People are exposed to a tremendous amount of information every day. Fortunately, the human brain processes information in a manner that permits a manageable interpretation of a complex environment by clustering associated facts and thoughts together into cognitive categories or schemas (Ashmore & Del Boca, 1981). These schemas direct attention, encode information, and retrieve information from memory. If one feature of a schema is recalled, then other parts of the schema also are activated into memory. A stereotype is a special kind of schema (Fiske & Taylor, 1984), in which the central concept is a group of people who share a common characteristic (Blalock & DeVellis, 1986). A stereotype is a set of beliefs about the personal attributes of a group of people (Ashmore & Del Boca, 1981). When stereotyping, a person: (a) categorizes other individuals; (b) attributes a set of characteristics to all members of that category; and (c) attributes those characteristics to any member of that category
(Blalock & DeVellis, 1986). A stereotype exists when there is an identified category of people about whom there are generalized, widely-held beliefs. Stereotyping is a normative cognitive process that is engaged in by everyone (McCauley, Stitt, & Segal, 1980). The process of stereotyping can be useful in organizing information about groups of people. Stereotypes provide a set of hypotheses about a target group’s behaviors, attitudes, and traits. The problem associated with stereotyping is that a stereotype may be oversimplified, overgeneralized, and uncritically accepted (Snyder, 1981). A rigidly held stereotype that contains incorrect attributions or one that consists entirely of negative characteristics may cause problems for both the holder of the stereotype and members of the social group being stereotyped (DeVellis, Wallston, & Wallston, 1980). For example, only data that “fit” the stereotype may be perceived; data that do not fit may be either ignored or distorted
Lawrence H. Ganong, PhD, is a professor in the School of Nursing, University of Missouri-Columbia. Marilyn Coleman, EdD, is a professor in the Department of Human Development and Family Studies, University of Missouri-Columbia. This article was received on March 18, 1991, was revised, and accepted for publication September 19, 1991. Requests for reprints can be addressed to Dr. Ganong, S313 School of Nursing, University of Missouri-Columbia, Columbia, MO 6521 1.
0 I992 John Wiley & Sons, Inc. CCC 0160-6891/92/020139-08 $04.00
140
RESEARCH IN NURSING 8 HEALTH
so that it can be assimilated into the existing set of beliefs (Snyder & Cantor, 1979; Snyder & Swann, 1978). Incoming perceptions also can be distorted (Darley & Gross, 1983), and the interpretation of previously known information can be reconstructed to fit the stereotypes (Snyder & Uranowitz, 1978). Finally, behavion directed toward members of the group may be affected (Snyder & Swann, 1978).
Nurses and Stereotyping The concept of stereotyping has relevance for nursing (DeVellis et al., 1980). Quality patient care requires that nurses be aware of and respond to individual differences among patients, evaluate information about them in an objective manner, and develop relationships that promote communication (Blalock & DeVellis, 1986). Yet, the ability of nurses to accept patients and care for them is affected by a number of factors: age, gender, developmental state, relevant life experiences, health state, sociocultural orientation, and available resources (Orem, 1985). If a nurse holds stereotypes about certain groups represented by a patient’s characteristics, the nurse’s cognitive processing of information about the patient and the nurse’s behavior toward the patient may be negatively affected. Therefore, the concept of stereotyping becomes crucial to the delivery of quality patient care (Blalock & DeVellis, 1986; DeVellis et al., 1980). Nurses and nursing students have been found to stereotype patients according to age, race, gender, personal appearance, socioeconomic status, and acceptability of the illness (DeVellis et al., 1980; Ganong, Bzdek, & Manderino, 1987). In most research on stereotyping in nursing, the presence or absence of stereotypes, rather than the effects of stereotyping on the cognitive processing of information and on nurses’ behavior, has been examined (Ganong et al., 1987). One patient characteristic that has received little investigation is family structure. In studies on nursing students’ perceptions of children from different family structures, children from nuclear families were viewed more positively than children from other family structures (Glanz, Ganong, & Coleman, 1989; Siebert, Ganong, Hagemann, & Coleman, 1986). There is some evidence that patients’ marital status is a cue for stereotyping by nurses. Morgan and Barden (1985) found that practicing nurses held significantly more favorable attitudes toward married mothers than toward unwed mothers. Pregnant clients’ marital status
affected the nursing students’ perceptions, also (Ganong, Coleman, & Riley, 1988). These results correspond to those from nonnursing samples (Ganong, Coleman, & Mapes, 1990). The purpose of this study was to determine if nursing students stereotype patients on the basis of marital status. The study also was designed to investigate the potential effects of marital status stereotypes on the cognitive processing of information about patients. Specifically, expectations about client behavior, information sought from the client, and information remembered about the client were examined. Expectations represent the use of cognitive categories to make judgments about the patient, information sought should indicate if stereotyped assumptions affect assessments of the patient, and information recalled should vary if only sterotype-consistent behavior is remembered. A final objective was to determine if verbal behaviors directed toward a client are influenced by information about marital status. It was expected that nursing students would perceive and respond to a never-married mother with vaginitis more negatively than to a married mother with vaginitis.
METHOD
Sample The sample consisted of 83 female undergraduate nursing students enrolled in a baccalaureate nursing program in the Midwestern United States. The age of the subjects ranged from 20 to 36, with a mean age of 22 (SD = 2.3). All subjects volunteered for the study. Most were single (88% of the sample). Of the remaining subjects, 11 % were married and one was divorced. Most of the subjects (85.6%)had parents who were still married, 8.4% had divorced parents, 2.4% were widowed, and 3.6%were remarried. The majority of the sample (98%)were Caucasian.
Procedure Nursing students were recruited in classes to participate in a study in which they would listen to a taped interview between a nurse and client, respond to some questions, and complete several questionnaires. They were assured of confidentiality and were offered $5 for participating. Data collection was done with one participant at a time in an office equipped with two chairs, a desk, and
FAMILY STRUCTURE STEREOTYPES / GANONG AND COLEMAN
two tape recorders. One of three female researchers conducted the data collection interview. The nursing students were randomly assigned to one of two experimental conditions: married client or never-manied client. They were given two written sources of information that described the client and her problem. The first source was a brief chronological description of the physical, social, and emotional development of a 26-yearold client. The participants also were given a sheet entitled “Client History” that briefly described the client’s presenting problem, which was a vaginal discharge. In both conditions, students received the same background and health history regarding the client. However, in the Married group, “Mary” was described as a married mother of a 5-year-old daughter. The client history sheet listed her marital status as married and her husband, Scott, as the person to notify in case of emergency. In the Never-Married group, “Mary” was presented as an unmanied mother. Her marital status was single on the client history sheet and her mother was listed as the next of kin. The “Background’ sheet on the client was identical in both conditions except for Mary’s relationship to Scott. The Manied group read of her marriage to Scott and the birth of the child following the marriage. The Never-Married group read of her living with and eventually separating from Scott, the father of the child. Little in the written background and nothing in the audiotaped interview indicated any information about socioeconomicstatus, except that Mary was described as “employed full-time as a secretary for a large corporation . . . Although [Scott and Mary’s]/her salary is modest, [they]/she is able to earn enough to provide the basic needs for [themselves]/herself and [their]/her child.” This information was provided to remove socioeconomic status as a potentially confounding variable. After the participant read the client history, a 5-min audiotape of a nurse interviewing “Mary” was played. The scripts for both groups were identical except for the client’s response to one question about marital status. The audiotape presented was a simulated interview between a nurse practitioner and a client seeking assistance for vaginitis. The same women played Mary and the nurse in both versions of the tape. The script was written by a certified nurse practitioner. Three registered nmes reviewed the scripts for relevance and realism, and for face validity. After the participants had read the background material and listened to the interview, they were asked to respond to two questionnaires measuring perceptions of the client. Following this, students
141
were told: “Now I’m going to play a question or comment made by this client. Instead of listening to the nurse’s responses, however, I am asking you to respond to the client just as if you were the nurse she was talking to. In other words, I will play one of the client’s statements, then I will stop the tape and ask you to respond.” The interviewer then played the tape in which the client made six statementdquestions. After each question was asked by the client, the tape was turned off while the nursing student orally responded. These responses were recorded on a second cassette recorder for later coding. At the completion of the interview, participants were paid and debriefed. The interviews took approximately 35 min.
Instrumentation Both self-report questionnaires and verbal responses were used as dependent measures in this study. Brief descriptions follow.
The First Impression Questionnaire (FIQ). The FIQ is a &item semantic differential designed to measure perceptions of an individual. The FIQ consists of six empirically-derived scales, Evaluation, Potency, Activity, SatisfactionlSecurity, Personal Character, and Stability (Bryan, Coleman, Ganong, & Bryan, 1986). Each item on the FIQ is a pair of contrasting adjectives with 7 spaces between them. The spaces are assigned a value from 1 to 7, with 7 the most positive and 1 the most negative. Item scores are added to create scale scores, with higher scores indicating more positive perceptions. The Evaluative scale represents a judgment regarding the relative positiveness of the adult female patient (e.g., good-bad, moral-immoral). The Potency scale measures perceptions of the target’s power and ability (e.g., competent-incompetent, successful-unsuccessful, independent-dependent). The Activity scale assesses perceptions of target action (e.g., active-passive, eager-indifferent). The SatisfactiodSecurity scale is a measure of views about a target’s sense of well-being (e.g., secure-insecure, satisfied-dissatisfied). The final two scales are both short (two items each) and measure perceptions of a target’s personality (Personal Character: predictable-unpredictable) and stability (Stability: stable-changeable). Coefficient alphas for the Evaluative, Potency, Activity, SatisfactiodSecurity, Personal Character, and Stability scales respectively were .94, .8 1, .66, .8 1, .7 1, .77.
The Family Role Stereotypes Instrument (FRSI). The FRSI consists of 25 stereotyped
142
RESEARCH IN NURSING 8 HEALTH
descriptors about married mothers (e.g., loving, responsible), and 29 stereotyped descriptors of never-married mothers (e.g., promiscuous, troubled). The items originally were derived from lists generated by 35 graduate students who were asked to “identify what you believe are widely held cultural beliefs’ about certain family roles’’ (Ganong & Coleman, 1991). This list then was administered to five other samples. Only those items that were seen as characteristic of a majority of people in a particular family role were included on the final version of the FSRI. The retained items, therefore, have high content validity as widely held beliefs about family roles. For each item on the FRSI, respondents were instructed to indicate whether it was an accurate or inaccurate descriptor of the client, or whether they needed more information before making a judgment. The most appropriate response for each item was “need more information,” since none of the FRSI items represented data presented to the participants. Two scores were derived from the FRSI. The Attribution score measured the proportion of stereotype-consistent items for the patient’s family role that were seen as attributes of the patient. For each group, the number of stereotype-consistent items indicated as accurately describing the patient was divided by the total number of stereotypeconsistent items for that marital status condition. The Adherence score assessed how closely the respondents’ perceptions of the patient matched cultural stereotypes. This score was the number of stereotype-consistent items that were perceived to be accurate descriptors of the patient divided by the rota1 number of items checked as accurate. For example, if half of the items the respondent thought were characteristic of the patient were stereotypes that were consistent with the patient’s family role, then the Adherence score was S O . Predicted Behavior of a Hospitalized Adult Questionnaire. The PBHAQ was designed to measure predictions of the clients’ behavior should she be hospitalized. It consists of eight items that predict patients’ cooperation with nursing staff, coping abilities, knowledge about their problem, receptivity to teaching compliance, support from family, tolerance of hospital procedures, and pain tolerance. A 7-point semantic differential format is utilized to measure these items. Item scores are summed to create the PBHAQ scale score. Higher scores represent more positive predictions for the patient’s behavior. Coefficient Alpha for the scale was .91. Assessment Checklist (AC). The AC is a 25item checklist that consists of a broad range of
topics a nurse may want to ask a client complaining of vaginal discharge. The items were compiled by three nurse practitioners. Face validity was estimated by asking a second group of experts to verify the appropriateness of the items. Participants were asked “What would you want to know about this client if you were interviewing her?’ They responded by checking as many items as they deemed appropriate. The AC contains three scales: Psychosocial Information (e.g., self-esteem, relationship with family), General Health (e.g., daily health care practices), and Sexual Health (e.g., sexual practices, number of partners). Coefficient Alpha for these scales was .72, .84, and .77, respectively. Patient Recollection Instrument (PRI). To determine if participants differed in their recollections about a client from different family structures, eight multiple choice questions developed by the researchers were asked about the client. For example, one question asked “Mary’s discharge (a) is gray and odorous; (b) is yellow and has an odor; (c) is colorless and odorless; (d) is red and odorless; and (e) this information was not given.” Each question had only one c o m t answer. Scores reflected the number of questions correctly answered. Low correlations between the PRI and both the FIQ and PBHAQ (.21 and .15, respectively) provided evidence of divergent validity and showed that the PRI is not redundant but assessed a different cognitive area than either the FIQ or PBHAQ. Verbal Response Measure. In this study, verbal responses by the nursing students were coded by one of three researchers with a coding scheme developed by Matthews (1962) and modified by DeVellis, Adams, and DeVellis (1984) that was designed to measure the person-centered quality of nurse responses to patients. Verbal responses were divided into individual utterances that were rated for person-centerednesson a scale from 1 to 5, with more person-centeredresponses receiving lower ratings. For each question, level of person-centeredness was calculated by summing the responses and dividing by the number of utterances in order to compute a mean. Interrater reliability was computed on the coding of taped verbal responses for 21 randomly selected subjects. After the initial audiotape coding, a second coder independently coded the tape again. Interrater reliabilities were generally high, ranging from .69 to .88 (Cohen’s kappa). The questions raised by the “client” were: “You don’t think it’s one of those ‘bad’ diseases, do you?’; “I just don’t know what I’d do if it was!”; “I know that 1’11 be really angry if it was something contagious.”;
143
FAMILY STRUCTURE STEREOTYPES / GANONG AND COLEMAN
indicated that differences were found in adherence to the cultural stereotype, and in stereotyped attributions for both client conditions (see Table 1). The reliance on stereotypes was not clear-cut, however. For both client conditions, less than half of the items believed to be characteristic of the patient fit the patients’ family role stemtype (44% for the married mother and 27% to the unmarried), and in the unmarried mother condition less than half (43%) of the culturally stereotyped items were considered to be descriptive of the patient. The more general tendency was for respondents to indicate that positive traits were characteristic of the patient, regardless of the marital status of the patient.
“Condoms should provide protection, shouldn’t they?’; “Is another type of contraception more effective in controlling this problem?’; and “Are there a lot of women who get symptoms like mine?’
RESULTS
Stereotypes For the FIQ analysis, the dependent variables were the six scales of the FIQ and the independent variable was marital status (married and unmarried). The married client was viewed as being more stable; there were no significant differences on the other five scales (see Table 1). On the FRSI, Adherence and Attribution scores for both groups were analyzed to see if they differed from 0, the scores expected if participants did not make stereotyped judgments. These comparisons
Predicted Behavior There were no differencesin the predicted behavior of the unmarried and married patient (seeTable 1).
Table 1. Means and Standard Devlatlons of First lmpresslons Questlonnalre Scales, Stereotype Attrlbutlon and Adherence Scorea, Predlcted Behavior of a Horpltallzed Adult Scale, Assessment Checklist Scales, Patient Recollectlon Score, and Verbal Response8 to Cllenta Married n = 39
FIQ scales Evaluation Secure Potency Activity Character Stability Family role stereotype Attribution Adherence Predicted behavior Patient recollection Verbal responses Bad disease Know Angry Condoms Contraceptives Women Assessment checklist Psychosocial General health Sexual health
Unmarried n = 44
M
SO
M
so
4.91 4.23 4.60 3.95 4.69 4.29
0.71 1.03 0.71 0.81 0.80 0.98
4.85 3.86 4.81 4.21 4.64 3.80
0.56 0.86 0.79 0.83
.44 .65 4.63 6.52
.24 .24 1.03 1.47
3.53 3.34 1.92 3.73 3.70 5.10 2.62 6.82 5.18
t 0.38 1.74 -1.30 - 1.44
0.80
- .05
1.13
2.10’
.27 .44 4.62 7.18
.18 .23 .84 1.08
a”’ b”’ .04 -2.27’
3.45 3.48 2.78 1.72 1.73 2.57
4.09 3.91 1.73 3.57 4.18 5.18
3.57 4.09 2.96 2.17 2.81 3.17
0.73 0.50 0.30 0.36 0.94 0.12
1.83 2.35 1.14
3.86 7.66 5.61
1.59 2.12 0.84
-3.31” -1.70 - 1.98’
Note. a.bttests for attribution and adherence scores are for comparisons of the values reported on the table to zero, rather than comparisons between groups. t for attribution scores are 11.60 (married) and 9.75 (unmarried); for adherence scores are 16.49 (married) and 12.56 (unmarried). ‘ p < .05. “ p < .01. “ ‘ p < .001.
RESEARCH IN NURSING 8 HEALTH
144
Information Sought Differences were found on the Psychosocial Information and Sexual Health scales. Nursing students who listened to the tape of the unmarried mother would seek more information than those who listened to the interview of a married mother (see Table 1).
Recalled Information The PRI was analyzed with a t test of the mean number of correctly recalled responses. Those in the never-married group remembered significantly more about the client than those in the married group (See Table 1). The PRI also contained a manipulation check, in that one question asked the participantsto identify Mary’s marital status. Nearly all of the participants correctly remembered the marital status, and there were no differences between groups in the number of correct responses to this question.
Verbal Behavior Level of person-centeredness was compared between the two stimulus conditions with a series of r tests. The data indicated that family structure does not influence the person-centered responses of the nursing students (see Table 1).
DISCUSSION Do nursing students stereotype patients on the basis of family structure? Individual perceptions in this study do not show stereotyping effects as clearly as other studies (Bryan et al., 1986; Morgan & Barden, 1985), but this may be due to methodological differences. In previous investigations, family status was one of only a few characteristics presented, while in this study, family status was patt of a larger body of data. When little information is given, each characteristic may have a comparatively greater impact on first impressions. The students did not rely heavily upon stereotypes of married and unmarried mothers. None of the presented information about the patient fit cultural stereotypes, and there was little tendency to construct attributions that were consistent with these stereotypes. The respondents did not rely solely on stereotypes to make judgments about the patients, obviously, but also used information from the audiotaped interviews and from the background information sheet. This illustratesthe
importance of multiple methods of assessing stereotypes, and should serve as a warning to researchers that stereotyping is difficult to measure when study designs become more complex and closer to “real life” simulations. Is cognitive processing about a patient affected by family status information? Information that would be sought is clearly affected by such information. The fact that those in the unmarried mother group wanted to know more about the client’s psychosocial characteristics and sexual behavior than those in the married mother condition may be due to a belief that unmarried mothers are “at risk” for psychological, interpersonal, and sexual problems. If these beliefs are part of the student’s cognitive schema of unmarried mothers, then additional questioning of such a client would follow. An unmarried mother may elicit a greater sense of concern, leading to questions about coping techniques, stressors, h d the client’s self-esteem. Predictions about client behavior were not influenced by information about clients’ family status, however. These findings are not congruent with either those of Glanz et al. (1989), who found that predictions for the family support of a hospitalized child were affected by information about the child’s family structure, or those of Ganong and colleagues (1988), who found that predictions about a pregnant client were af€ected by her marital status. Finally, cognitive recall of data also was influenced by the family status information. Those exposed to the never-married group remembered more than those exposed to the married group. Hamilton (198 1) contended that unusual information is more likely to be remembered. Since never-married mothers are statistically more unusual in our society, students may have viewed that marital status as unique and thus remembered more information about her. Are nursing students’ verbal behaviors influenced by information about clients’ family status? Verbal responses to married and unmarried mothers did not differ in warmth and person-centeredness. In fact, the mean response scores showed that the students were generally empathic to the client in both stimulus groups. The education of nursing students teaches objective assessment and treatment of patients; such lessons might have been foremost in the minds of the participants. Therefore, although they may have held stereotypes, the stereotypes did not effect their verbal behaviors. A factor not investigated in this study is the impact of other client characteristics on students’ schemas related to family status. For example, the never-married client was portrayed as having
FAMILY STRUCTURE STEREOTYPES I GANONG AND COLEMAN
a significant relationship with the father of her child. Would the results have been different if the client was unsure of the identity of the father of her child? Further research is needed to examine the impact of a combination of client characteristics on nurses’ cognitions and behaviors to determine if there are interactions between variables. The methods used in this study could have affected the results. First, extensive informationabout the client, including a social and medical history, was presented. Family information regarding the client was mentioned, but not emphasized, on the social and health history forms. The family status of the client was one piece of a great deal of information, perhaps lowering the probability that family status would be a salient cue for cognitive organization. Second, the presenting problem of vaginitis could create some of its own biases. For example, the students could have focused on the negative social implications and connotations of a sexually-transmitted disease and ignored other data. Finally, the audiotape utilized in this study allowed for only one method of sensory input and a one-way flow of information. A videotape would stimulate both auditory and visual senses and allow for increased realism of the nurse-client interaction. Increasing the sensory input and providing a two-way interaction may increase the reality of a nurse-client interaction for the nursing students. Perhaps having a group of nursing students view an interview through a one-way mirror would increase the reality of the stimulus. In conclusion, it appears that nursing students hold stemtypes of married and unmarried mothers that are consistent with cultural stemtypes. Family status information about a client serves as one of the ways data about the client are cognitively organized. No evidence exists, however, that communication was influenced by the stemtypes. Further research on the influence of family role schemas on practicing nurses seems necessary. The effects of greater experience with clients, the interaction of family status with other client variables, and the use of various methods of presenting the client stimuli are important issues that should be studied.
REFERENCES Ashmore, R.D., & Del Boca, F.K. (1981). Conceptual approaches to stereotypes and stereotyping. In D.L. Hamilton (Ed.), Cognitive processes in stereotyping and intergroup behavior ( pp. 1 35). Hillsdale, NJ: Erlbaum. Blalock, S.J., & DeVellis, B.M.(1986). Stereo-
145
typing: The link between theory and practice. Patient Education and Counseling, 8 , 11-25. Bryan, L., Coleman, M., Ganong, L., & Bryan, H. (1986). Person perception: Family structure as a cue for stereotyping. Journal of Marriage and the Family, 48, 161-114. Darley, J . , & Gross, P.H. (1983). A hypothesis confirming bias in labeling effects. Journal of Personality and Social Psychology, 44, 20-33. DeVellis, B . , Adams, J., & DeVellis, R. (1984). Effects of information on patient stereotyping. Research in Nursing & Health, 7 , 231-244. DeVellis, B., Wallston, B., & Wallston, K. (1980). Stereotyping: A threat to individualized patient care. In B. Flynn & M. Kerler (Eds.), Current perspectives in nursing: Social issues and trends (pp. 252-264). St. Louis, MO: C.V. Mosby. Fiske, S .T., & Taylor, S .E. ( 1984). Social cognition. Reading, MA: Addison- Wesley. Ganong, L.H., Bzdek, V., & Manderino, M.A. ( 1 987). Stereotyping by nurses and nursing students: A critical review of research. Research in Nursing & Health, 10, 49-70. Ganong, L., Coleman, M . , & Mapes, D. (1990). A meta-analytic review of family structure stereotypes. Journal of Marriage and the Family, 52, 281-297. Ganong, L., Coleman, M., & Riley, C. (1988). Nursing students’ stereotypes of married and unmarried pregnant clients. Research in Nursing & Health, 1 1 , 333-342. Glanz, D.L., Ganong, L . , & Coleman, M. (1989). Effects of client gender, diagnosis, and family structure on perceptions. Western Journal of Nursing Research, 1 1 , 126-135. Hamilton, D.L. (1981). Illusory correlation as a basis for stereotyping. In D.L. Hamilton (Ed.), Cognitive processes in stereotyping and intergroup behavior (pp. 115- 144). Hillsdale, NJ: Lawrence Erlbaum. Matthews, B. (1962). Measurement of psychological aspects of the nurse-patient relationship. Nursing Research, 1 1 , 154-162. McCauley, C., Stitt, C . L . , & Segal, M. (1980). Stereotyping: From prejudice to prediction. Psychological Bulletin, 87, 195-208. Morgan,B.S.,&Barden,M.E. (1985). Unwedand pregnant: Nurses’ attitudes towards unwed mothers. MCN: American Journal of Maternal Child Nursing, 10, 114- 117. Orem, D. (1985). Nursing: Concepts of practice (3rd ed.). New York, NY: McGraw-Hill. Rothbart, M. (1981). Memory processes and social beliefs. In D. Hamilton (Ed.), Cognitive processes in stereotyping and intergroup behavior ( pp. 145- 181). Hillsdale, NJ: Erlbaum. Siebert, K . , Ganong, L., Hagemann, V., & Coleman, M. (1986). Nursing students’ perceptions of a child: Influence of information on family structure. Journal of Advanced Nursing, 1 1 , 333- 337.
146
RESEARCH IN NURSING 8 HEALTH
Snyder, M.(1981). On the self-perpetuating nature of social stereotypes. In D.L. Hamilton (Ed.), Cognitive processes in stereotyping and intergroup behavior (pp. 183-212). Hillsdale, NJ: Lawrence Erlbaum. Snyder, M.,& Cantor, N . (1979). Testing hypotheses about other people: The use of historical knowledge. Journal of Experimental Social Psychology, 15, 330-342.
Snyder, M.,& Swann, W. (1978). Behavioral confirmation in social interaction: From social perception to social reality. Journal of Experimental Social Psychology, 14, 148- 162. Snyder, M.,& Uranowitz, S.W. (1978). Reconstructing the past: Some cognitive consequences of person perception. Journal of Personality and Social Psychology, 36, 941-950.
The Effect of Clients’ Family Structure on Nursing Students’ Cognitive Schemas and Verbal Behavior Lawrence H. Ganong and Marilyn Coleman
The primary purpose of this study was to investigate if nursing students stereotype clients on the basis of family status. In addition, the influence of information about the client’s family status on students’ predictions about the client’s behavior, information sought from the client, recalled information, and verbal responses directed toward the client were examined. The participants were 83 nursing students from a large Midwestern university. They were randomly assigned to one of two groups. Brief written information about a female adult client with a vaginal discharge was provided and, after listening to an audiotaped interview between a nurse and the client, students completed a battery of questionnaires. They also responded verbally to questions asked by the audiotaped client. All information given to both groups was identical except for the client’s family status. Results indicated that the client who was a married mother was perceived somewhat more positively than the unmarried mother client. Participants’ perceptions were only somewhat consistent with cultural stereotypes about these family statuses. Information sought and information remembered about the client were greater when she was an unmarried mother. There were no differences in predictions of patients’ behaviors and verbal responses.
People are exposed to a tremendous amount of information every day. Fortunately, the human brain processes information in a manner that permits a manageable interpretation of a complex environment by clustering associated facts and thoughts together into cognitive categories or schemas (Ashmore & Del Boca, 1981). These schemas direct attention, encode information, and retrieve information from memory. If one feature of a schema is recalled, then other parts of the schema also are activated into memory. A stereotype is a special kind of schema (Fiske & Taylor, 1984), in which the central concept is a group of people who share a common characteristic (Blalock & DeVellis, 1986). A stereotype is a set of beliefs about the personal attributes of a group of people (Ashmore & Del Boca, 1981). When stereotyping, a person: (a) categorizes other individuals; (b) attributes a set of characteristics to all members of that category; and (c) attributes those characteristics to any member of that category
(Blalock & DeVellis, 1986). A stereotype exists when there is an identified category of people about whom there are generalized, widely-held beliefs. Stereotyping is a normative cognitive process that is engaged in by everyone (McCauley, Stitt, & Segal, 1980). The process of stereotyping can be useful in organizing information about groups of people. Stereotypes provide a set of hypotheses about a target group’s behaviors, attitudes, and traits. The problem associated with stereotyping is that a stereotype may be oversimplified, overgeneralized, and uncritically accepted (Snyder, 1981). A rigidly held stereotype that contains incorrect attributions or one that consists entirely of negative characteristics may cause problems for both the holder of the stereotype and members of the social group being stereotyped (DeVellis, Wallston, & Wallston, 1980). For example, only data that “fit” the stereotype may be perceived; data that do not fit may be either ignored or distorted
Lawrence H. Ganong, PhD, is a professor in the School of Nursing, University of Missouri-Columbia. Marilyn Coleman, EdD, is a professor in the Department of Human Development and Family Studies, University of Missouri-Columbia. This article was received on March 18, 1991, was revised, and accepted for publication September 19, 1991. Requests for reprints can be addressed to Dr. Ganong, S313 School of Nursing, University of Missouri-Columbia, Columbia, MO 6521 1.
0 I992 John Wiley & Sons, Inc. CCC 0160-6891/92/020139-08 $04.00
140
RESEARCH IN NURSING 8 HEALTH
so that it can be assimilated into the existing set of beliefs (Snyder & Cantor, 1979; Snyder & Swann, 1978). Incoming perceptions also can be distorted (Darley & Gross, 1983), and the interpretation of previously known information can be reconstructed to fit the stereotypes (Snyder & Uranowitz, 1978). Finally, behavion directed toward members of the group may be affected (Snyder & Swann, 1978).
Nurses and Stereotyping The concept of stereotyping has relevance for nursing (DeVellis et al., 1980). Quality patient care requires that nurses be aware of and respond to individual differences among patients, evaluate information about them in an objective manner, and develop relationships that promote communication (Blalock & DeVellis, 1986). Yet, the ability of nurses to accept patients and care for them is affected by a number of factors: age, gender, developmental state, relevant life experiences, health state, sociocultural orientation, and available resources (Orem, 1985). If a nurse holds stereotypes about certain groups represented by a patient’s characteristics, the nurse’s cognitive processing of information about the patient and the nurse’s behavior toward the patient may be negatively affected. Therefore, the concept of stereotyping becomes crucial to the delivery of quality patient care (Blalock & DeVellis, 1986; DeVellis et al., 1980). Nurses and nursing students have been found to stereotype patients according to age, race, gender, personal appearance, socioeconomic status, and acceptability of the illness (DeVellis et al., 1980; Ganong, Bzdek, & Manderino, 1987). In most research on stereotyping in nursing, the presence or absence of stereotypes, rather than the effects of stereotyping on the cognitive processing of information and on nurses’ behavior, has been examined (Ganong et al., 1987). One patient characteristic that has received little investigation is family structure. In studies on nursing students’ perceptions of children from different family structures, children from nuclear families were viewed more positively than children from other family structures (Glanz, Ganong, & Coleman, 1989; Siebert, Ganong, Hagemann, & Coleman, 1986). There is some evidence that patients’ marital status is a cue for stereotyping by nurses. Morgan and Barden (1985) found that practicing nurses held significantly more favorable attitudes toward married mothers than toward unwed mothers. Pregnant clients’ marital status
affected the nursing students’ perceptions, also (Ganong, Coleman, & Riley, 1988). These results correspond to those from nonnursing samples (Ganong, Coleman, & Mapes, 1990). The purpose of this study was to determine if nursing students stereotype patients on the basis of marital status. The study also was designed to investigate the potential effects of marital status stereotypes on the cognitive processing of information about patients. Specifically, expectations about client behavior, information sought from the client, and information remembered about the client were examined. Expectations represent the use of cognitive categories to make judgments about the patient, information sought should indicate if stereotyped assumptions affect assessments of the patient, and information recalled should vary if only sterotype-consistent behavior is remembered. A final objective was to determine if verbal behaviors directed toward a client are influenced by information about marital status. It was expected that nursing students would perceive and respond to a never-married mother with vaginitis more negatively than to a married mother with vaginitis.
METHOD
Sample The sample consisted of 83 female undergraduate nursing students enrolled in a baccalaureate nursing program in the Midwestern United States. The age of the subjects ranged from 20 to 36, with a mean age of 22 (SD = 2.3). All subjects volunteered for the study. Most were single (88% of the sample). Of the remaining subjects, 11 % were married and one was divorced. Most of the subjects (85.6%)had parents who were still married, 8.4% had divorced parents, 2.4% were widowed, and 3.6%were remarried. The majority of the sample (98%)were Caucasian.
Procedure Nursing students were recruited in classes to participate in a study in which they would listen to a taped interview between a nurse and client, respond to some questions, and complete several questionnaires. They were assured of confidentiality and were offered $5 for participating. Data collection was done with one participant at a time in an office equipped with two chairs, a desk, and
FAMILY STRUCTURE STEREOTYPES / GANONG AND COLEMAN
two tape recorders. One of three female researchers conducted the data collection interview. The nursing students were randomly assigned to one of two experimental conditions: married client or never-manied client. They were given two written sources of information that described the client and her problem. The first source was a brief chronological description of the physical, social, and emotional development of a 26-yearold client. The participants also were given a sheet entitled “Client History” that briefly described the client’s presenting problem, which was a vaginal discharge. In both conditions, students received the same background and health history regarding the client. However, in the Married group, “Mary” was described as a married mother of a 5-year-old daughter. The client history sheet listed her marital status as married and her husband, Scott, as the person to notify in case of emergency. In the Never-Married group, “Mary” was presented as an unmanied mother. Her marital status was single on the client history sheet and her mother was listed as the next of kin. The “Background’ sheet on the client was identical in both conditions except for Mary’s relationship to Scott. The Manied group read of her marriage to Scott and the birth of the child following the marriage. The Never-Married group read of her living with and eventually separating from Scott, the father of the child. Little in the written background and nothing in the audiotaped interview indicated any information about socioeconomicstatus, except that Mary was described as “employed full-time as a secretary for a large corporation . . . Although [Scott and Mary’s]/her salary is modest, [they]/she is able to earn enough to provide the basic needs for [themselves]/herself and [their]/her child.” This information was provided to remove socioeconomic status as a potentially confounding variable. After the participant read the client history, a 5-min audiotape of a nurse interviewing “Mary” was played. The scripts for both groups were identical except for the client’s response to one question about marital status. The audiotape presented was a simulated interview between a nurse practitioner and a client seeking assistance for vaginitis. The same women played Mary and the nurse in both versions of the tape. The script was written by a certified nurse practitioner. Three registered nmes reviewed the scripts for relevance and realism, and for face validity. After the participants had read the background material and listened to the interview, they were asked to respond to two questionnaires measuring perceptions of the client. Following this, students
141
were told: “Now I’m going to play a question or comment made by this client. Instead of listening to the nurse’s responses, however, I am asking you to respond to the client just as if you were the nurse she was talking to. In other words, I will play one of the client’s statements, then I will stop the tape and ask you to respond.” The interviewer then played the tape in which the client made six statementdquestions. After each question was asked by the client, the tape was turned off while the nursing student orally responded. These responses were recorded on a second cassette recorder for later coding. At the completion of the interview, participants were paid and debriefed. The interviews took approximately 35 min.
Instrumentation Both self-report questionnaires and verbal responses were used as dependent measures in this study. Brief descriptions follow.
The First Impression Questionnaire (FIQ). The FIQ is a &item semantic differential designed to measure perceptions of an individual. The FIQ consists of six empirically-derived scales, Evaluation, Potency, Activity, SatisfactionlSecurity, Personal Character, and Stability (Bryan, Coleman, Ganong, & Bryan, 1986). Each item on the FIQ is a pair of contrasting adjectives with 7 spaces between them. The spaces are assigned a value from 1 to 7, with 7 the most positive and 1 the most negative. Item scores are added to create scale scores, with higher scores indicating more positive perceptions. The Evaluative scale represents a judgment regarding the relative positiveness of the adult female patient (e.g., good-bad, moral-immoral). The Potency scale measures perceptions of the target’s power and ability (e.g., competent-incompetent, successful-unsuccessful, independent-dependent). The Activity scale assesses perceptions of target action (e.g., active-passive, eager-indifferent). The SatisfactiodSecurity scale is a measure of views about a target’s sense of well-being (e.g., secure-insecure, satisfied-dissatisfied). The final two scales are both short (two items each) and measure perceptions of a target’s personality (Personal Character: predictable-unpredictable) and stability (Stability: stable-changeable). Coefficient alphas for the Evaluative, Potency, Activity, SatisfactiodSecurity, Personal Character, and Stability scales respectively were .94, .8 1, .66, .8 1, .7 1, .77.
The Family Role Stereotypes Instrument (FRSI). The FRSI consists of 25 stereotyped
142
RESEARCH IN NURSING 8 HEALTH
descriptors about married mothers (e.g., loving, responsible), and 29 stereotyped descriptors of never-married mothers (e.g., promiscuous, troubled). The items originally were derived from lists generated by 35 graduate students who were asked to “identify what you believe are widely held cultural beliefs’ about certain family roles’’ (Ganong & Coleman, 1991). This list then was administered to five other samples. Only those items that were seen as characteristic of a majority of people in a particular family role were included on the final version of the FSRI. The retained items, therefore, have high content validity as widely held beliefs about family roles. For each item on the FRSI, respondents were instructed to indicate whether it was an accurate or inaccurate descriptor of the client, or whether they needed more information before making a judgment. The most appropriate response for each item was “need more information,” since none of the FRSI items represented data presented to the participants. Two scores were derived from the FRSI. The Attribution score measured the proportion of stereotype-consistent items for the patient’s family role that were seen as attributes of the patient. For each group, the number of stereotype-consistent items indicated as accurately describing the patient was divided by the total number of stereotypeconsistent items for that marital status condition. The Adherence score assessed how closely the respondents’ perceptions of the patient matched cultural stereotypes. This score was the number of stereotype-consistent items that were perceived to be accurate descriptors of the patient divided by the rota1 number of items checked as accurate. For example, if half of the items the respondent thought were characteristic of the patient were stereotypes that were consistent with the patient’s family role, then the Adherence score was S O . Predicted Behavior of a Hospitalized Adult Questionnaire. The PBHAQ was designed to measure predictions of the clients’ behavior should she be hospitalized. It consists of eight items that predict patients’ cooperation with nursing staff, coping abilities, knowledge about their problem, receptivity to teaching compliance, support from family, tolerance of hospital procedures, and pain tolerance. A 7-point semantic differential format is utilized to measure these items. Item scores are summed to create the PBHAQ scale score. Higher scores represent more positive predictions for the patient’s behavior. Coefficient Alpha for the scale was .91. Assessment Checklist (AC). The AC is a 25item checklist that consists of a broad range of
topics a nurse may want to ask a client complaining of vaginal discharge. The items were compiled by three nurse practitioners. Face validity was estimated by asking a second group of experts to verify the appropriateness of the items. Participants were asked “What would you want to know about this client if you were interviewing her?’ They responded by checking as many items as they deemed appropriate. The AC contains three scales: Psychosocial Information (e.g., self-esteem, relationship with family), General Health (e.g., daily health care practices), and Sexual Health (e.g., sexual practices, number of partners). Coefficient Alpha for these scales was .72, .84, and .77, respectively. Patient Recollection Instrument (PRI). To determine if participants differed in their recollections about a client from different family structures, eight multiple choice questions developed by the researchers were asked about the client. For example, one question asked “Mary’s discharge (a) is gray and odorous; (b) is yellow and has an odor; (c) is colorless and odorless; (d) is red and odorless; and (e) this information was not given.” Each question had only one c o m t answer. Scores reflected the number of questions correctly answered. Low correlations between the PRI and both the FIQ and PBHAQ (.21 and .15, respectively) provided evidence of divergent validity and showed that the PRI is not redundant but assessed a different cognitive area than either the FIQ or PBHAQ. Verbal Response Measure. In this study, verbal responses by the nursing students were coded by one of three researchers with a coding scheme developed by Matthews (1962) and modified by DeVellis, Adams, and DeVellis (1984) that was designed to measure the person-centered quality of nurse responses to patients. Verbal responses were divided into individual utterances that were rated for person-centerednesson a scale from 1 to 5, with more person-centeredresponses receiving lower ratings. For each question, level of person-centeredness was calculated by summing the responses and dividing by the number of utterances in order to compute a mean. Interrater reliability was computed on the coding of taped verbal responses for 21 randomly selected subjects. After the initial audiotape coding, a second coder independently coded the tape again. Interrater reliabilities were generally high, ranging from .69 to .88 (Cohen’s kappa). The questions raised by the “client” were: “You don’t think it’s one of those ‘bad’ diseases, do you?’; “I just don’t know what I’d do if it was!”; “I know that 1’11 be really angry if it was something contagious.”;
143
FAMILY STRUCTURE STEREOTYPES / GANONG AND COLEMAN
indicated that differences were found in adherence to the cultural stereotype, and in stereotyped attributions for both client conditions (see Table 1). The reliance on stereotypes was not clear-cut, however. For both client conditions, less than half of the items believed to be characteristic of the patient fit the patients’ family role stemtype (44% for the married mother and 27% to the unmarried), and in the unmarried mother condition less than half (43%) of the culturally stereotyped items were considered to be descriptive of the patient. The more general tendency was for respondents to indicate that positive traits were characteristic of the patient, regardless of the marital status of the patient.
“Condoms should provide protection, shouldn’t they?’; “Is another type of contraception more effective in controlling this problem?’; and “Are there a lot of women who get symptoms like mine?’
RESULTS
Stereotypes For the FIQ analysis, the dependent variables were the six scales of the FIQ and the independent variable was marital status (married and unmarried). The married client was viewed as being more stable; there were no significant differences on the other five scales (see Table 1). On the FRSI, Adherence and Attribution scores for both groups were analyzed to see if they differed from 0, the scores expected if participants did not make stereotyped judgments. These comparisons
Predicted Behavior There were no differencesin the predicted behavior of the unmarried and married patient (seeTable 1).
Table 1. Means and Standard Devlatlons of First lmpresslons Questlonnalre Scales, Stereotype Attrlbutlon and Adherence Scorea, Predlcted Behavior of a Horpltallzed Adult Scale, Assessment Checklist Scales, Patient Recollectlon Score, and Verbal Response8 to Cllenta Married n = 39
FIQ scales Evaluation Secure Potency Activity Character Stability Family role stereotype Attribution Adherence Predicted behavior Patient recollection Verbal responses Bad disease Know Angry Condoms Contraceptives Women Assessment checklist Psychosocial General health Sexual health
Unmarried n = 44
M
SO
M
so
4.91 4.23 4.60 3.95 4.69 4.29
0.71 1.03 0.71 0.81 0.80 0.98
4.85 3.86 4.81 4.21 4.64 3.80
0.56 0.86 0.79 0.83
.44 .65 4.63 6.52
.24 .24 1.03 1.47
3.53 3.34 1.92 3.73 3.70 5.10 2.62 6.82 5.18
t 0.38 1.74 -1.30 - 1.44
0.80
- .05
1.13
2.10’
.27 .44 4.62 7.18
.18 .23 .84 1.08
a”’ b”’ .04 -2.27’
3.45 3.48 2.78 1.72 1.73 2.57
4.09 3.91 1.73 3.57 4.18 5.18
3.57 4.09 2.96 2.17 2.81 3.17
0.73 0.50 0.30 0.36 0.94 0.12
1.83 2.35 1.14
3.86 7.66 5.61
1.59 2.12 0.84
-3.31” -1.70 - 1.98’
Note. a.bttests for attribution and adherence scores are for comparisons of the values reported on the table to zero, rather than comparisons between groups. t for attribution scores are 11.60 (married) and 9.75 (unmarried); for adherence scores are 16.49 (married) and 12.56 (unmarried). ‘ p < .05. “ p < .01. “ ‘ p < .001.
RESEARCH IN NURSING 8 HEALTH
144
Information Sought Differences were found on the Psychosocial Information and Sexual Health scales. Nursing students who listened to the tape of the unmarried mother would seek more information than those who listened to the interview of a married mother (see Table 1).
Recalled Information The PRI was analyzed with a t test of the mean number of correctly recalled responses. Those in the never-married group remembered significantly more about the client than those in the married group (See Table 1). The PRI also contained a manipulation check, in that one question asked the participantsto identify Mary’s marital status. Nearly all of the participants correctly remembered the marital status, and there were no differences between groups in the number of correct responses to this question.
Verbal Behavior Level of person-centeredness was compared between the two stimulus conditions with a series of r tests. The data indicated that family structure does not influence the person-centered responses of the nursing students (see Table 1).
DISCUSSION Do nursing students stereotype patients on the basis of family structure? Individual perceptions in this study do not show stereotyping effects as clearly as other studies (Bryan et al., 1986; Morgan & Barden, 1985), but this may be due to methodological differences. In previous investigations, family status was one of only a few characteristics presented, while in this study, family status was patt of a larger body of data. When little information is given, each characteristic may have a comparatively greater impact on first impressions. The students did not rely heavily upon stereotypes of married and unmarried mothers. None of the presented information about the patient fit cultural stereotypes, and there was little tendency to construct attributions that were consistent with these stereotypes. The respondents did not rely solely on stereotypes to make judgments about the patients, obviously, but also used information from the audiotaped interviews and from the background information sheet. This illustratesthe
importance of multiple methods of assessing stereotypes, and should serve as a warning to researchers that stereotyping is difficult to measure when study designs become more complex and closer to “real life” simulations. Is cognitive processing about a patient affected by family status information? Information that would be sought is clearly affected by such information. The fact that those in the unmarried mother group wanted to know more about the client’s psychosocial characteristics and sexual behavior than those in the married mother condition may be due to a belief that unmarried mothers are “at risk” for psychological, interpersonal, and sexual problems. If these beliefs are part of the student’s cognitive schema of unmarried mothers, then additional questioning of such a client would follow. An unmarried mother may elicit a greater sense of concern, leading to questions about coping techniques, stressors, h d the client’s self-esteem. Predictions about client behavior were not influenced by information about clients’ family status, however. These findings are not congruent with either those of Glanz et al. (1989), who found that predictions for the family support of a hospitalized child were affected by information about the child’s family structure, or those of Ganong and colleagues (1988), who found that predictions about a pregnant client were af€ected by her marital status. Finally, cognitive recall of data also was influenced by the family status information. Those exposed to the never-married group remembered more than those exposed to the married group. Hamilton (198 1) contended that unusual information is more likely to be remembered. Since never-married mothers are statistically more unusual in our society, students may have viewed that marital status as unique and thus remembered more information about her. Are nursing students’ verbal behaviors influenced by information about clients’ family status? Verbal responses to married and unmarried mothers did not differ in warmth and person-centeredness. In fact, the mean response scores showed that the students were generally empathic to the client in both stimulus groups. The education of nursing students teaches objective assessment and treatment of patients; such lessons might have been foremost in the minds of the participants. Therefore, although they may have held stereotypes, the stereotypes did not effect their verbal behaviors. A factor not investigated in this study is the impact of other client characteristics on students’ schemas related to family status. For example, the never-married client was portrayed as having
FAMILY STRUCTURE STEREOTYPES I GANONG AND COLEMAN
a significant relationship with the father of her child. Would the results have been different if the client was unsure of the identity of the father of her child? Further research is needed to examine the impact of a combination of client characteristics on nurses’ cognitions and behaviors to determine if there are interactions between variables. The methods used in this study could have affected the results. First, extensive informationabout the client, including a social and medical history, was presented. Family information regarding the client was mentioned, but not emphasized, on the social and health history forms. The family status of the client was one piece of a great deal of information, perhaps lowering the probability that family status would be a salient cue for cognitive organization. Second, the presenting problem of vaginitis could create some of its own biases. For example, the students could have focused on the negative social implications and connotations of a sexually-transmitted disease and ignored other data. Finally, the audiotape utilized in this study allowed for only one method of sensory input and a one-way flow of information. A videotape would stimulate both auditory and visual senses and allow for increased realism of the nurse-client interaction. Increasing the sensory input and providing a two-way interaction may increase the reality of a nurse-client interaction for the nursing students. Perhaps having a group of nursing students view an interview through a one-way mirror would increase the reality of the stimulus. In conclusion, it appears that nursing students hold stemtypes of married and unmarried mothers that are consistent with cultural stemtypes. Family status information about a client serves as one of the ways data about the client are cognitively organized. No evidence exists, however, that communication was influenced by the stemtypes. Further research on the influence of family role schemas on practicing nurses seems necessary. The effects of greater experience with clients, the interaction of family status with other client variables, and the use of various methods of presenting the client stimuli are important issues that should be studied.
REFERENCES Ashmore, R.D., & Del Boca, F.K. (1981). Conceptual approaches to stereotypes and stereotyping. In D.L. Hamilton (Ed.), Cognitive processes in stereotyping and intergroup behavior ( pp. 1 35). Hillsdale, NJ: Erlbaum. Blalock, S.J., & DeVellis, B.M.(1986). Stereo-
145
typing: The link between theory and practice. Patient Education and Counseling, 8 , 11-25. Bryan, L., Coleman, M., Ganong, L., & Bryan, H. (1986). Person perception: Family structure as a cue for stereotyping. Journal of Marriage and the Family, 48, 161-114. Darley, J . , & Gross, P.H. (1983). A hypothesis confirming bias in labeling effects. Journal of Personality and Social Psychology, 44, 20-33. DeVellis, B . , Adams, J., & DeVellis, R. (1984). Effects of information on patient stereotyping. Research in Nursing & Health, 7 , 231-244. DeVellis, B., Wallston, B., & Wallston, K. (1980). Stereotyping: A threat to individualized patient care. In B. Flynn & M. Kerler (Eds.), Current perspectives in nursing: Social issues and trends (pp. 252-264). St. Louis, MO: C.V. Mosby. Fiske, S .T., & Taylor, S .E. ( 1984). Social cognition. Reading, MA: Addison- Wesley. Ganong, L.H., Bzdek, V., & Manderino, M.A. ( 1 987). Stereotyping by nurses and nursing students: A critical review of research. Research in Nursing & Health, 10, 49-70. Ganong, L., Coleman, M . , & Mapes, D. (1990). A meta-analytic review of family structure stereotypes. Journal of Marriage and the Family, 52, 281-297. Ganong, L., Coleman, M., & Riley, C. (1988). Nursing students’ stereotypes of married and unmarried pregnant clients. Research in Nursing & Health, 1 1 , 333-342. Glanz, D.L., Ganong, L . , & Coleman, M. (1989). Effects of client gender, diagnosis, and family structure on perceptions. Western Journal of Nursing Research, 1 1 , 126-135. Hamilton, D.L. (1981). Illusory correlation as a basis for stereotyping. In D.L. Hamilton (Ed.), Cognitive processes in stereotyping and intergroup behavior (pp. 115- 144). Hillsdale, NJ: Lawrence Erlbaum. Matthews, B. (1962). Measurement of psychological aspects of the nurse-patient relationship. Nursing Research, 1 1 , 154-162. McCauley, C., Stitt, C . L . , & Segal, M. (1980). Stereotyping: From prejudice to prediction. Psychological Bulletin, 87, 195-208. Morgan,B.S.,&Barden,M.E. (1985). Unwedand pregnant: Nurses’ attitudes towards unwed mothers. MCN: American Journal of Maternal Child Nursing, 10, 114- 117. Orem, D. (1985). Nursing: Concepts of practice (3rd ed.). New York, NY: McGraw-Hill. Rothbart, M. (1981). Memory processes and social beliefs. In D. Hamilton (Ed.), Cognitive processes in stereotyping and intergroup behavior ( pp. 145- 181). Hillsdale, NJ: Erlbaum. Siebert, K . , Ganong, L., Hagemann, V., & Coleman, M. (1986). Nursing students’ perceptions of a child: Influence of information on family structure. Journal of Advanced Nursing, 1 1 , 333- 337.
146
RESEARCH IN NURSING 8 HEALTH
Snyder, M.(1981). On the self-perpetuating nature of social stereotypes. In D.L. Hamilton (Ed.), Cognitive processes in stereotyping and intergroup behavior (pp. 183-212). Hillsdale, NJ: Lawrence Erlbaum. Snyder, M.,& Cantor, N . (1979). Testing hypotheses about other people: The use of historical knowledge. Journal of Experimental Social Psychology, 15, 330-342.
Snyder, M.,& Swann, W. (1978). Behavioral confirmation in social interaction: From social perception to social reality. Journal of Experimental Social Psychology, 14, 148- 162. Snyder, M.,& Uranowitz, S.W. (1978). Reconstructing the past: Some cognitive consequences of person perception. Journal of Personality and Social Psychology, 36, 941-950.
