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Perceptions of privacy among residents in a long term care facility : a phenomenological approach Stanbury, Janice Lillian 1989

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P E R C E P T I O N S O F P R I V A C Y A M O N G R E S I D E N T S I N A L O N G T E R M C A R E F A C I L I T Y : A P H E N O M E N O L O G I C A L A P P R O A C H B y J A N I C E L I L L I A N S T A N BURY B . S . N . , T h e U n i v e r s i t y o f S a s k a t c h e w a n , 1980 A T H E S I S S U B M I T T E D I N P A R T I A L F U L F I L L M E N T O F T H E R E Q U I R E M E N T S F O R T H E D E G R E E O F M A S T E R O F S C I E N C E I N N U R S I N G i n T H E F A C U L T Y O F G R A D U A T E S T U D I E S ( S c h o o l o f N u r s i n g ) W e accep t th is thes is as c o n f o r m i n g t o the r e q u i r e d s t a n d a r d T H E U N I V E R S I T Y O F B R I T I S H C O L U M B I A A U G U S T 1989 © J A N I C E L I L L I A N S T A N B U R Y , 1989 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of K| 1 1 y ^ ^ q The University of British Columbia Vancouver, Canada Date ®,h„hh<J(. SI , /9 9<f DE-6 (2/88) i i Abstract T h i s s tudy w a s des i gned to exp lo re a n d desc r i be e l de r l y res iden ts ' p e r c e p t i o n s o f p r i vacy i n a l o n g t e r m ca re fac i l i t y set t ing. Spec i f i ca l l y , the r e s e a r c h e r sought to iden t i f y a n d desc r i be e l de r l y res iden ts ' de f i n i t i ons o f p r i vacy , to iden t i f y the func t i ons o f p r i vacy fo r the res iden ts a n d to desc r i be p e r s o n a l a n d p h y s i c a l fac tors i n the i ns t i t u t i ona l e n v i r o n m e n t a f fec t ing p r i vacy . A p h e n o m e n o l o g i c a l m e t h o d o l o g y was c h o s e n to g u i d e the s tudy i n v o l v i n g f o u r w o m e n a n d two m e n cu r ren t l y r es i d i ng i n a l o n g t e r m ca re fac i l i t y . D a t a w e r e o b t a i n e d t h r o u g h u n s t r u c t u r e d in te rv iews that w e r e a u d i o -t a p e d a n d t r a n s c r i b e d a n d t h e n a n a l y z e d u s i n g the m e t h o d o f constant c o m p a r a t i v e ana lys is . D a t a ana lys is r e v e a l e d that the res iden ts w e r e ab le to desc r i be the i r p e r c e p t i o n s o f p r i vacy i n a l o n g t e r m ca re fac i l i t y se t t ing a n d iden t i f y the i r fee l ings a n d responses to p e r c e i v e d v i o l a t i o n o f d e s i r e d p r i vacy . W i t h i n the f r a m e w o r k o f the study 's th ree m a j o r p u r p o s e s , i t was f o u n d that res iden ts ' de f i n i t i ons o f p r i vacy i n c l u d e d the f o l l o w i n g t hemes : so l i t ude , c o n t r o l o f i n f o r m a t i o n access a n d d i sc losu re a n d b o u n d a r y c o n t r o l . T h e f u n c t i o n c o m p o n e n t o f p r i vacy r e v e a l e d a m a j o r t h e m e o f p r o t e c t e d exp ress ion o f se l f w h i c h e n c o m p a s s e d the oppo r tun i t y f o r exp ress ion o f e m o t i o n s , se l f - eva lua t i on a n d i n t i m a c y i n p e r s o n a l re la t i ons . W i t h i n the fac tors a f fec t ing the res iden ts ' ab i l i t y to c o n t r o l p r i vacy , res iden ts p e r c e i v e d nu rs i ng ca re s t a f f s a t t i tudes a n d b e h a v i o u r s a n d ava i l ab i l i t y o f a n d access to p r i va te r o o m a c c o m m o d a t i o n as h a v i n g s ign i f i can t impac t . T h r o u g h o u t the pa r t i c i pan ts ' accoun ts , the e t h i c a l p r i n c i p l e o f a u t o n o m y was a cen t ra l focus fo r the res iden ts ' p e r c e p t i o n s o f p r i vacy i n a l o n g t e r m ca re fac i l i t y set t ing. T h e f i nd ings i n d i c a t e d that p r i vacy is v a l u e d , p r o t e c t e d a n d sought by l o n g t e r m ca re res iden ts . T h e y a lso suggested that nurses n e e d to b e aware o f a n i n d i v i d u a l c l ien t ' s n e e d fo r p r i vacy a n d u n d e r s t a n d that the i r b e h a v i o u r a n d a t t i tudes i m p a c t u p o n a c l ien t ' s ab i l i t y to secu re a n d m a i n t a i n p r i vacy . B a s e d o n these f i nd ings , i m p l i c a t i o n s fo r nu r s i ng p rac t i ce , n u r s i n g e d u c a t i o n a n d n u r s i n g r e s e a r c h a re p resen ted . iv T a b l e o f C o n t e n t s A b s t r a c t i i T a b l e o f C o n t e n t s iv A c k n o w l e d g e m e n t s v i C H A P T E R O N E I n t r o d u c t i o n 1 B a c k g r o u n d 1 P r o b l e m S ta temen t 3 P u r p o s e 4 C o n c e p t u a l F r a m e w o r k 4 S i g n i f i c a n c e • 7 D e f i n i t i o n o f T e r m s 8 A s s u m p t i o n s 8 L i m i t a t i o n s r 9 S u m m a r y 9 C H A P T E R T W O L i t e r a t u r e R e v i e w 10 I n t r o d u c t i o n 10 N a t u r e a n d D e f i n i t i o n o f P r i v a c y 10 F u n c t i o n s o f P r i v a c y 15 Se l f - Iden t i t y F u n c t i o n s 15 I n t e r p e r s o n a l F u n c t i o n s 17 R e s e a r c h S tud ies R e l a t e d to P r i v a c y 19 S u m m a r y 27 C H A P T E R T H R E E R e s e a r c h D e s i g n 28 I n t r o d u c t i o n 28 Se t t i ng 29 Sub jec t S e l e c t i o n 29 E t h i c a l C o n s i d e r a t i o n s 31 D a t a C o l l e c t i o n P r o c e d u r e 32 D a t a A n a l y s i s 33 C H A P T E R F O U R P r e s e n t a t i o n a n d D i s c u s s i o n o f A c c o u n t s 35 I n t r o d u c t i o n 35 C h a r a c t e r i s t i c s o f Pa r t i c i pan t s 35 C o n s t r u c t i o n o f A c c o u n t s 37 I n t e r p r e t a t i o n a n d D i s c u s s i o n o f A c c o u n t s 39 D e f i n i t i o n s o f the T e r m P r i v a c y 39 S o l i t u d e 39 C o n t r o l o f I n f o r m a t i o n A c c e s s a n d D i s c l o s u r e 42 ) v B o u n d a r y C o n t r o l 45 F u n c t i o n s o f P r i v a c y 49 P r o t e c t e d E x p r e s s i o n o f S e l f 50 F a c t o r s A f f e c t i n g P r i v a c y 55 N u r s i n g S ta f f A t t i t u d e s a n d B e h a v i o u r s 55 A v a i l a b i l i t y o f a n d A c c e s s to P r i v a t e R o o m A c c o m o d a t i o n 58 T h e C e n t r a l T h e m e o f A u t o n o m y 60 S u m m a r y 63 C H A P T E R F I V E S u m m a r y , C o n c l u s i o n s a n d N u r s i n g I m p l i c a t i o n s 65 S u m m a r y 65 F i n d i n g s 67 C o n c l u s i o n s 69 I m p l i c a t i o n s fo r N u r s i n g P r a c t i c e 70 I m p l i c a t i o n s fo r N u r s i n g E d u c a t i o n 72 I m p l i c a t i o n s f o r N u r s i n g R e s e a r c h 73 C o n c l u d i n g R e m a r k s 75 R e f e r e n c e s 76 A p p e n d i c e s 81 A . I n f o r m a t i o n L e t t e r f o r R e s i d e n t s 81 B . S a m p l e Q u e s t i o n s 83 C . C o n s e n t F o r m 84 D . L e t t e r o f P e r m i s s i o n f r o m M a n a g e r o f L T C F a c i l i t y 85 vi A c k n o w l e d g e m e n t s I w o u l d l i k e to ex tend m y s ince re a p p r e c i a t i o n to m y thesis c o m m i t t e e , C a r o l J i l l i ngs a n d J a n e t E r i c k s e n fo r the i r g u i d a n c e , suppo r t a n d w i se c o u n s e l d u r i n g th is r e s e a r c h e n d e a v o r . I a m a lso g ra te fu l to J o A n n P e r r y a n d M a u r e e n M u r p h y w h o w e r e i n v o l v e d d u r i n g the i n i t i a l p h a s e o f th is r e s e a r c h p rocess . I a m i n d e b t e d to the six res iden ts w h o gene rous l y a n d w i l l i ng l y p a r t i c i p a t e d i n th is study. A s p e c i a l t h a n k - y o u is e x t e n d e d to M r s . T . P a s u t , the A d m i n i s t r a t o r a n d M s . A . B a r n e s , the D i r e c t o r o f N u r s i n g w h o w e l c o m e d m e to C e n t r a l P a r k L o d g e a n d p r o v e d i n v a l u a b l e by f ac i l i t a t i ng access to the res iden ts w h o s e expe r i ences f o r m the bas is o f th is study. F i n a l l y , a n d m o s t impo r tan t l y , I ex tend m y l o v e a n d g ra t i t ude to m y f a m i l y a n d f r i ends , a sou rce o f suppor t , h u m o u r a n d e n c o u r a g m e n t t h roughou t th is l eng thy e n d e a v o r . CHAPTER ONE 1 Introduction Background to the Problem T h e e x p e r i e n c e o f ag ing i n C a n a d a occurs w i t h i n a p o p u l a t i o n w h i c h it i t se l f ag ing . U n t i l recen t l y , C a n a d a has b e e n a d e m o g r a p h i c a l l y y o u n g coun t r y as e v i d e n c e d by h i ghe r b i r t h ra tes a n d h i g h e r dea th ra tes, w i t h c o m p a r a t i v e l y shor t l i f e expec tanc ies . H o w e v e r , m o r e p e o p l e a re su rv i v ing c h i l d b i r t h , i n f ancy a n d c h i l d h o o d to l i ve l o n g e r l i ves a n d l i fe expec tancy i n g e n e r a l is a lso l eng then ing . S i n c e the t u r n o f the century , as the abso lu te n u m b e r s o f o l d p e o p l e a n d the i r p r o p o r t i o n i n c r e a s e d w i t h the dec l i nes i n b i r t h ra te a n d i m m i g r a t i o n , the age s t ruc tu re has b e c o m e o l d e r a n d is c o n t i n u i n g to d o so. I n 1901 the pe rcen tage o f p e o p l e aged s ixty- f ive a n d ove r i n C a n a d a was f ive pe rcen t . B y 1981, the p r o p o r t i o n o f e l d e r l y p e o p l e rose to o v e r n i n e p e r c e n t o f the to ta l p o p u l a t i o n (Stat is t ics C a n a d a , 1982). T h e i m p l i c a t i o n s o f the chang ing age s t ruc tu re have on ly recen t l y b e g u n to b e e x a m i n e d i n a sys temat ic way , bu t the n e e d to focus o n these i m p l i c a t i o n s is w i d e l y r e c o g n i z e d . E v i d e n t i n the ge ron to l ogy l i t e ra tu re is a n i n c r e a s i n g in te res t i n the e x p e r i e n c e o f i n s t i t u t i o n a l i z a t i o n fo r the aged . I n p a r t i c u l a r , m o r e r esea rch re l a t i ng to qua l i t y o f l i f e , l i f e sa t i s fac t i on and m o r a l e a m o n g the i n s t i t u t i o n a l i z e d e l de r l y is b e i n g c o n d u c t e d . M u c h resea rch n o w focusses o n cu r ren t a l te rna t i ves to ins t i tu t ions w h i c h p r o v i d e a cus tod i a l , i l l ness -o r i en ted e n v i r o n m e n t f o r the e lde r l y . O n e such a l te rna t i ve e m p h a s i z e s the w e l l aspects o f the i n d i v i d u a l a n d desc r ibes the o l d e r adu l t i n t e rms o f capac i t i es a n d p o t e n t i a l ( C o o n s , 1983). T h e a i m is to p r o v i d e a qua l i t y o f l i f e w h i c h enab les the e lde r l y to m a i n t a i n the i r d ign i ty a n d to h a v e the r igh t to m a k e dec i s i ons abou t issues w h i c h af fect t h e m . H o w e v e r , m a n y gaps s t i l l exist i n the k n o w l e d g e base o f i n s t i t u t i o n a l i z a t i o n fo r the e lde r l y . O n e such gap re la tes to the ways i n w h i c h i ns t i t u t i ona l e n v i r o n m e n t s af fect e l de r l y res iden ts ' needs fo r p r i vacy . A t t e m p t s to e x p l o r e p r i vacy as o n e aspect o f i n s t i t u t i o n a l i z e d l i v i ng mus t b e m a d e i n o r d e r to c rea te a phys i ca l a n d p s y c h o l o g i c a l e n v i r o n m e n t w h i c h enhances the i m a g e o f the e l de r l y p e r s o n as a n i n d i v i d u a l r a t he r t h a n a n e n v i r o n m e n t p r i m a r i l y des i gned a n d m a n a g e d to focus o n g roups o f i n d i v i d u a l s . T o da te , r esea rche rs i n ge ron to logy have fo r a l l p r a c t i c a l p u r p o s e s neg lec ted the n o t i o n o f p r i vacy . W h i l e s tud ies exist i n w h i c h p r i vacy is o n e o f m a n y va r i ab l es that w e r e inves t iga ted o r n o t e d , w i t h on l y r a re excep t ions there have b e e n n o a t tempts at a sys temat ic e x p l o r a t i o n o f the concep t o f p r i vacy . O u r soc ie ty has p l a c e d i nc reas i ng a t t en t i on o n the c o n c e p t o f p r i vacy i n r ecen t years ( B l o c h , 1970). C o n t e m p o r a r y soc ie ty 's i n c r e a s i n g c o n c e r n , deba te a n d d i s c u s s i o n r e g a r d i n g the concep t is r e f l ec ted i n the m e d i a w h i c h have s e r v e d to i n c r e a s e g e n e r a l p u b l i c awareness r e g a r d i n g the p o t e n t i a l a n d r e a l i z e d th reats to p r i vacy i n eve ryday l i v i ng . P r i v a c y is a lso a "sa l ient c o n c e r n f o r h e a l t h p ro fess iona l s , s ince mat te rs o f p r i vacy a re i nhe ren t i n the i n te rac t i ons b e t w e e n t h e m a n d the i r c l ien ts " ( R a w n s l e y , 1980, p. 26) . A l t h o u g h f r equen t re fe rences to a pa t ien t ' s n e e d fo r p r i v a c y a re m a d e by nurses , a p a u c i t y o f nu r s i ng l i t e ra tu re re l a t i ng to the concep t o f p r i vacy a n d its a p p l i c a t i o n to nu r s i ng p rac t i ce is ev iden t ( B l o c h , 1970). I n pa r t i cu la r , p r i vacy i n r e l a t i o n to the e l de r l y r e s i d i n g i n l o n g t e r m care fac i l i t i es is ra re ly a d d r e s s e d . T h u s , i t appea rs that there is a n e e d fo r e m p i r i c a l r e s e a r c h that exp lo res the c o n c e p t o f p r i vacy a n d " h o w the pa t ien t ' s n e e d fo r p r i vacy is s u p p o r t e d , e n c o u r a g e d , m e t o r i n h i b i t e d i n the p r o v i s i o n o f h e a l t h serv ices a n d espec ia l l y n u r s i n g " ( B l o c h , 1970, p. 251) . T h i s s tudy focuses o n the e l d e r l y res iden t ' s p e r c e p t i o n s o f p r i vacy i n a l o n g t e r m care fac i l i t y set t ing. P r o b l e m S t a t e m e n t I n c l i n i c a l e x p e r i e n c e as a c o m m u n i t y h e a l t h nu rse , the au tho r has e n c o u n t e r e d m a n y e l de r l y res iden ts i n l o n g t e r m ca re fac i l i t i es c o n c e r n e d a b o u t the c o n c e p t o f p r i vacy . Q u e s t i o n s a n d conce rns r e g a r d i n g the i m p o r t a n c e o f p r i va te r o o m s , the ab i l i t y to l o c k one 's d o o r , b a t h e unass i s ted a n d e x c l u d e o n e s e l f f r o m fac i l i t y ac t iv i t ies r e c u r f r equen t l y i n i n te rv iews w i t h e l d e r l y c l ien ts o f l o n g t e r m ca re fac i l i t i es . T h e l i t e ra tu re has i n d i c a t e d that p r i vacy is i m p o r t a n t to the e lde r l y res iden t i n a n i ns t i t u t i on ( F e l t o n a n d K a h a n a , 1974; F i r e s t o n e , L i c h t m a n and E v a n s , 1980). H o w e v e r , t he re is a l a c k o f e m p i r i c a l r esea rch d e s c r i b i n g h o w e lde r l y res iden ts de f i ne p r i vacy i n l o n g t e r m ca re fac i l i t i es . T h e r e f o r e , this s tudy a s k e d the r e s e a r c h q u e s t i o n : W h a t does "p r i vacy" m e a n to the e lde r l y res iden t o f a l o n g t e r m ca re fac i l i t y? 4 P u r p o s e T h e p u r p o s e o f th is s tudy was to e x p l o r e a n d desc r i be the e lde r l y res iden ts ' p e r c e p t i o n s o f p r i vacy i n a l o n g t e r m ca re fac i l i t y set t ing. Spec i f i ca l l y , the r e s e a r c h e r sought : 1) to iden t i f y a n d desc r i be e l de r l y res iden ts ' de f i n i t i ons o f p r i vacy , 2 ) to iden t i f y the func t ions o f p r i vacy fo r the res iden ts , a n d 3) to d e s c r i b e p e r s o n a l a n d p h y s i c a l fac tors i n the i ns t i t u t i ona l e n v i r o n m e n t a f fec t ing p r i vacy . C o n c e p t u a l F r a m e w o r k P e r s o n a l c o n t r o l p r o v i d e s a c o n c e p t u a l bas is fo r e x p l o r i n g the c o n c e p t o f p r i v a c y as p e r c e i v e d a n d e x p e r i e n c e d by the e l de r l y r e s i d i n g i n l o n g t e r m care fac i l i t i es . L o c u s o f c o n t r o l , the m o s t w i d e l y c i t ed d i m e n s i o n o f p e r s o n a l c o n t r o l , is c o n c e p t u a l i z e d by R o t t e r (1966) as a g e n e r a l expec tancy that p red i c t s the extent to w h i c h i n d i v i d u a l s b e l i e v e that they have o r do no t have the p o w e r to c o n t r o l w h a t h a p p e n s to t h e m . T h i s cons t ruc t desc r ibes i n d i v i d u a l s a c c o r d i n g to the deg ree to w h i c h they accep t o r c l a i m p e r s o n a l r espons ib i l i t y f o r w h a t h a p p e n s to t h e m ( L e f c o u r t , 1966). S o c i a l l e a r n i n g theo ry is the bas is o f the c o n c e p t o f l o cus o f c o n t r o l . T h i s t heo ry i m p l i e s that i n d i v i d u a l s have a c h o i c e i n h o w they w i l l b e h a v e , a n d b e f o r e d e c i d i n g o n a p a r t i c u l a r a c t i o n they f i rst mus t c o n s i d e r b o t h the i r v a l u a t i o n o f the o u t c o m e ( r e i n f o r c e m e n t va l ue ) a n d the i r e s t i m a t i o n o f the p r o b a b i l i t y o f i ts o c c u r r i n g (expec tancy) ( P e r l m u t t e r a n d M o n t y , 1979). It b e c o m e s a p p a r e n t that w h e n a r e i n f o r c e m e n t is s e e n as no t d e p e n d e n t u p o n a n i n d i v i d u a l ' s b e h a v i o u r that i ts o c c u r r e n c e w i l l no t i nc rease a n expec tancy as m u c h as w h e n it is s e e n as d e p e n d e n t . D e p e n d i n g u p o n a pe rson ' s h is to ry o f r e i n f o r c e m e n t , i n d i v i d u a l s w o u l d l i k e l y d i f fe r i n the deg ree to w h i c h they a t t r i bu ted r e i n f o r c e m e n t s to the i r o w n b e h a v i o u r s . A s a g e n e r a l i z e d expec tancy i n s o c i a l l e a r n i n g theory , l ocus o f c o n t r o l is a " re la t i ve ly s tab le pe rsona l i t y fac to r d e v e l o p e d ove r t i m e a n d a c q u i r e d t h r o u g h a ser ies o f m a n y s o c i a l l e a r n i n g expe r i ences ( A r a k e l i a n , 1980). H o w e v e r , b e c a u s e changes i n expec tanc ies c a n b e b r o u g h t abou t by i n t r o d u c i n g n e w expe r iences that a l te r p r e v i o u s pa t te rns o f success a n d f a i l u re , the p o t e n t i a l a lways exists f o r c h a n g i n g a pe rson ' s c o n t r o l o r i e n t a t i o n . A s h a r e d co re d e f i n i t i o n is ev iden t i n a n e x a m i n a t i o n o f the m e a n i n g s a n d d i m e n s i o n s o f the concep t o f p r i vacy . "P r i vacy , as a w h o l e o r i n par t , rep resen ts the c o n t r o l o f t ransac t ions b e t w e e n pe rson (s ) , a n d o ther (s ) , the u l t i m a t e a i m o f w h i c h is to e n h a n c e a u t o n o m y , a n d / o r to m i n i m i z e v u l n e r a b i l i t y " ( M a r g u l i s , 1974). P e r s o n a l c o n t r o l as a c o n c e p t c e n t r a l to that o f p r i v a c y mer i t s s p e c i a l c o n s i d e r a t i o n . P r i v a c y a n d i n v a s i o n o f p r i vacy a lways i n c l u d e the o p p o s i n g i n f l uences o f soc ie ta l a n d i n d i v i d u a l in terests . T h e ab i l i t y to exerc ise c o n t r o l is e x p e r i e n c e d i n any p r i vacy s i t u a t i o n as the ab i l i t y to c h o o s e h o w , u n d e r wha t c i r cums tances a n d to wha t extent i n d i v i d u a l s a re to re la te to o thers o r separa te t hemse lves f r o m o thers ( L a u f e r a n d W o l f e , 1977). C h o i c e deve lops ou t o f a r e l a t i onsh ip b e t w e e n the se l f a n d the e n v i r o n m e n t t h r o u g h e x p e r i e n c e i n spec i f i c s i tua t ions . T h e ab i l i t y to p e r c e i v e op t i ons a n d to exerc ise c o n t r o l a m o n g op t i ons is r e l a t e d to one 's stage i n the l i fe cyc le ( L a u f e r a n d W o l f e , 1977). A s a c o n s e q u e n c e , eve ryday l i f e c rea tes expe r i ences w i t h p r i vacy that change the w a y a n i n d i v i d u a l p e r c e i v e s the cho i ces a v a i l a b l e . A t leas t t h ree aspects o f c o n t r o l a re re levan t to a n e x a m i n a t i o n o f the c o n c e p t o f p r i v a c y ( M a r g u l i s , 1974). F i r s t l y , p r i vacy i n c o r p o r a t e s c o n t r o l ove r w h e n , w h e r e a n d h o w to have a sense o f p r i vacy . S e c o n d l y , c o n t r o l ove r access to a n i n d i v i d u a l is b a s e d o n i n d i v i d u a l s l i m i t i n g o the rs ' ab i l i t y to k n o w o r i n t r u d e u p o n t h e m . A t h i r d aspect re fers to c o n t r o l o v e r the type a n d in tens i ty o f s t i m u l a t i o n o n e rece ives . J o h n s o n (1974) argues that p r i v a c y can b e v i e w e d as " those b e h a v i o u r s w h i c h e n h a n c e a n d m a i n t a i n one 's c o n t r o l ove r o u t c o m e s i nd i r ec t l y by c o n t r o l l i n g i n te rac t i ons w i t h o thers" (p. 90) . F u r t h e r , these b e h a v i o u r s w h i c h set cond i t i ons fo r o u t c o m e a t t a i n m e n t c rea te w h a t is r e g a r d e d as seconda ry c o n t r o l . S e c o n d a r y o r i nd i r ec t c o n t r o l a r ises f r o m b e h a v i o u r s w h i c h c rea te e n v i r o n m e n t a l a n d p e r s o n a l cond i t i ons w h i c h fac i l i ta te d i rec t o r p r i m a r y c o n t r o l l i n g b e h a v i o u r s (p. 89) . A n u m b e r o f o the r b e h a v i o u r a l sc ient is ts p r o c l a i m p e r s o n a l c o n t r o l as a n i n teg ra l p a r t o f any e x a m i n a t i o n o f the concep t o f p r i vacy . F o r e x a m p l e , W o l f e a n d L a u f e r (1974) w r i t e that the n e e d a n d ab i l i t y to exer t c o n t r o l ove r self , ob jec ts , spaces , i n f o r m a t i o n a n d b e h a v i o u r is a c r i t i ca l e l e m e n t i n any c o n c e p t o f p r i vacy . A l t a i a n (1977) de f ines p r i vacy as " a b o u n d a r y c o n t r o l p rocess w h e r e b y p e o p l e s o m e t i m e s m a k e s themse lves o p e n a n d access ib le to o thers a n d s o m e t i m e s c lose themse lves o f f f r o m o thers " (p. 67) . A t h i r d au tho r , W e s t i n (1968) e m p h a s i z e s the c o n t r o l that p r i v a c y a l l ows ove r d i s s e m i n a t i o n o f i n f o r m a t i o n abou t onese l f . T h e s e au tho rs d e m o n s t r a t e that 7 d i f fe ren t express ions o f p r i vacy m a y b e u n d e r s t o o d as m a n i f e s t i n g d i f fe ren t c o n c e r n s a b o u t a n d a p p r o a c h e s to p e r s o n a l c o n t r o l . Significance T h i s s tudy p r o p o s e d to focus o n e lde r l y res iden ts o f a l o n g t e r m care fac i l i t y a n d to so l i c i t t he i r v i ews a n d p e r c e p t i o n s r e g a r d i n g the c o n c e p t o f p r i vacy . T h i s i n f o r m a t i o n w o u l d b e v a l u a b l e to nurses i n p l a n n i n g a n d p r o v i d i n g ca re . N u r s e s n e e d to k n o w a n d u n d e r s t a n d w h a t p r i v a c y m e a n s to the i r pa t ien ts . N u r s e s c o n c e r n e d w i t h the p r o m o t i o n a n d m a i n t e n a n c e o f p r i v a c y f o r e l d e r l y pa t ien ts mus t b e awa re o f wha t k i n d o f p r i vacy the pa t ien ts des i r e a n d the reasons fo r it. T h e e n v i r o n m e n t m u s t b e c o n s i d e r e d b y nu rses as o n e i m p o r t a n t v a r i a b l e that c a n b e m a n i p u l a t e d o r a l t e r e d so that i n d i v i d u a l p r i v a c y goa ls a n d needs a re a c h i e v e d . S i n c e c o n t r o l o f p e r s o n a l b o u n d a r y has b e e n i d e n t i f i e d i n the l i t e ra tu re as a n i n teg ra l pa r t o f p r i vacy , those g i v ing ca re , i f they have k n o w l e d g e a n d sens i t i v i ty r e g a r d i n g the c o n c e p t o f p r i vacy , " c a n p r o v i d e the n e e d e d l i n k b e t w e e n the pa t ien t ' s des i re to c o n t r o l h is b o u n d a r i e s a n d h is ab i l i t y to d o so " (Schus te r , 1972, p. 97) . T h i s s tudy o f p r i vacy f o r l o n g t e r m ca re fac i l i t y res iden ts a lso has p r a c t i c a l a p p l i c a t i o n f o r des igners o f fac i l i t i es s ince n u r s i n g h o m e s a re h o m e s fo r m a n y e l d e r l y res iden ts a n d the i n d i v i d u a l ' s p r i vacy i n th is se t t ing wa r ran ts s p e c i a l a t ten t i on . T h e i m p o r t a n c e o f p l a n n i n g , e v a l u a t i n g a n d a l t e r i ng pa t i en t e n v i r o n m e n t s to p r o m o t e pa t i en t p r i vacy is c lea r . 8 Definition of Terms 1) R e s i d e n t s - those i n d i v i d u a l s w h o have l i v e d i n a l o n g t e r m ca re fac i l i t y f o r at least s ix m o n t h s . 2 ) P e r c e p t i o n s - u n d e r s t a n d i n g o f a n d fee l ings abou t a n e x p e r i e n c e o r s i t ua t i on . T h e s e w i l l b e i n f l u e n c e d b y the contex t i n w h i c h the s i t ua t i on is v i e w e d , a n d the res iden t ' s p e r s o n a l va lues a n d be l i e f s . 3 ) L o n g T e r m C a r e F a c i l i t y - a r es i dence l i c e n s e d by the B r i t i s h C o l u m b i a M i n i s t r y o f H e a l t h to p r o v i d e i n t e r m e d i a t e ca re . 4 ) P r i v a c y - is the c l a i m o f i n d i v i d u a l s to d e t e r m i n e f o r themse lves w h e n , h o w a n d to w h a t extent i n f o r m a t i o n abou t t h e m is c o m m u n i c a t e d to o thers . It is the v o l u n t a r y a n d t e m p o r a r y w i t h d r a w a l o f the p e r s o n f r o m the g e n e r a l soc ie ty t h r o u g h p h y s i c a l o r p s y c h o l o g i c a l m e a n s ( W e s t i n , 1968, p. 7 ) . Assumptions 1) R e s i d e n t s i n a l o n g t e r m ca re fac i l i t y a re a b l e to desc r i be a n d de f i ne p r i v a c y a c c o r d i n g to the contex t i n w h i c h they v i e w the i r s i tua t ions a n d the i r p e r s o n a l va lues a n d be l i e f s . 2) R e s i d e n t s a re w i l l i n g to ta l k abou t the i r p e r c e p t i o n s o f p r i vacy . 3 ) R e s i d e n t s w h o have l i v e d i n a l o n g t e r m ca re fac i l i t y f o r s ix m o n t h s o r l o n g e r n o l o n g e r e x p e r i e n c e r e l o c a t i o n ad jus tment . 4) P r i v a c y is a s ign i f i can t concep t f o r res iden ts i n a l o n g t e r m ca re fac i l i t y . Limitations A l i m i t to the gene ra l i zab i l i t y o f the study's resu l ts was that the l o c a t i o n o f the s tudy w a s res t r i c ted to o n e l o n g t e r m ca re fac i l i t y i n V a n c o u v e r . T h e r e f o r e , spec i f i c charac te r i s t i cs o f th is se t t ing m a y i n f l u e n c e the w a y that the e l de r l y res iden t de f ines the c o n c e p t o f p r i vacy . Summary T h i s s tudy has b e e n des i gned to e x p l o r e the c o n c e p t o f p r i vacy as e x p e r i e n c e d a n d u n d e r s t o o d by the res iden ts o f a l o n g t e r m ca re fac i l i ty . C h a p t e r o n e has i n t r o d u c e d the p r o b l e m a n d p u r p o s e o f th is s tudy. A r e v i e w o f l i t e ra tu re re l evan t to the s tudy o f p r i vacy is p r e s e n t e d i n c h a p t e r two . CHAPTER TWO Literature Review Introduction T h e p u r p o s e o f th is chap te r is to r e v i e w l i t e ra tu re r e l a t e d to the th ree ob jec t i ves o f th is study. A n e x a m i n a t i o n o f the wr i t i ngs o n p r i vacy revea l s a l a c k o f pe r t i nen t l i t e ra tu re re l a t i ng d i rec t l y to the p r o b l e m s ta tement . H o w e v e r , m u c h l i t e ra tu re exists c o n c e r n i n g r e l a t e d a reas o f the p r o b l e m focuss ing o n such concep ts as te r r i to r ia l i t y , i n t e r p e r s o n a l space a n d exposu re . A l t h o u g h r e s e a r c h p e r t a i n i n g d i rec t l y to the p r o b l e m s ta tement is scarce a n d i n c o n c l u s i v e , i t is never the less i m p o r t a n t to d iscuss th is r esea rch i n r e l a t i o n to the p u r p o s e o f th is study. T h i s l i t e ra tu re r e v i e w w i l l b e o r g a n i z e d i n t o th ree a reas : a n o v e r v i e w o f the na tu re a n d d e f i n i t i o n o f p r i vacy , the func t i ons o f p r i vacy a n d r e s e a r c h s tud ies c o n c e r n e d d i rec t l y w i t h the c o n c e p t o f p r i vacy . Nature and Definition of Privacy P r i v a c y as a c o n c e p t appea rs i n the l i t e ra tu re o f m a n y d i sc ip l i nes -psycho logy , soc io logy , an th ropo logy , nu r s i ng , p h i l o s o p h y , l a w a n d a rch i t ec tu re . H o w e v e r , th is c o n c e p t has no t b e e n e x a m i n e d i n a sys temat ic way necessary to gene ra te t h e o r e t i c a l a n d e m p i r i c a l da ta . T o da te , the ma jo r i t y o f l i t e ra tu re d e a l i n g w i t h p r i vacy is b a s e d u p o n i n d i v i d u a l wr i te r ' s expe r i ences a n d o p i n i o n s ra the r t h a n o n t h e o r e t i c a l f o r m u l a t i o n s a m e n a b l e to r esea rch . A s a resu l t , p r i vacy ' s m e a n i n g va r ies w ide l y . T h i s o b s e r v a t i o n re f lec ts the c o m p l e x i t y o f the t e r m , f o r p r i vacy is gene ra l l y c o n s i d e r e d to b e no t o n e t h i ng bu t m a n y th ings. P r i v a c y , as i t is cu r ren t l y t r ea ted i n the l i t e ra tu re , is no t a s i m p l e u n i d i m e n s i o n a l concep t w i t h a n eas i l y i d e n t i f i a b l e class o f e m p i r i c a l re fe ren ts . It c a n b e d e s c r i b e d as a " p s y c h o l o g i c a l p h e n o m e n o n , a p o l i t i c a l p h e n o m e n o n a n d , i nd i rec t l y , e v e n as a n e c o n o m i c p h e n o m e n o n " ( L a u f e r , P r o s h a n s k y a n d W o l f e , 1976, p. 206) . I n a d d i t i o n , the t e r m m a y b e d e f i n e d i n r e f e r e n c e to s o m e k i n d o f n e e d o r d r i ve state o f a n i n d i v i d u a l , to f o r m s o f b e h a v i o u r , to a f fec t ive expe r i ences o r to s o m e c o m b i n a t i o n o f these. D e f i n i t i o n s m a k i n g re fe rence to p h y s i c a l l o ca t i ons such as "pr iva te p l aces , p r i va te apa r tmen ts o r a secret p l a c e , a n d those i n c l u d i n g aspects o f con f i den t i a l i t y o r secrecy" a re n o w ra re l y u s e d a n d obso le te ( R o o s a , 1979, p. 2 ) . L i k e w i s e , the t e c h n o l o g i c a l m e a n s a v a i l a b l e i n o u r c o n t e m p o r a r y soc ie ty that serve to t h r e a t e n p r i vacy s u c h as e l e c t r o n i c su r ve i l l ance a n d c o m p u t e r i z e d i n f o r m a t i o n s torage a re c lea r l y on l y o n e ve ry s m a l l aspect o f a c o m p r e h e n s i v e d e f i n i t i o n o f the concep t o f p r i vacy . A b r o a d e r d e f i n i t i o n o f the c o n c e p t n o w focusses o n cond i t i ons o f w i t h d r a w a l f r o m s o c i a l i n t e r a c t i o n a n d c o n t r o l o v e r the d i sc losu re o f p e r s o n a l i n f o r m a t i o n ( R o o s a , 1979, p. 3 ) . O n e g r o u p o f wr i te rs uses de f i n i t i ons o f p r i vacy e n c o m p a s s i n g s e c l u s i o n , w i t h d r a w a l o r a v o i d a n c e o f i n t e r a c t i o n . F o r e x a m p l e : P r i v a c y is a "pe rson 's f e e l i n g that o thers s h o u l d b e e x c l u d e d f r o m s o m e t h i n g w h i c h is o f c o n c e r n to h i m , a n d a lso r e c o g n i t i o n that o thers have a r igh t to d o th is" (Ba tes , 1964, p. 429) . J o u r a r d (1966) e m p h a s i z e s the n o t i o n that p r i vacy is a n o u t c o m e o f a pe rson ' s w i s h to w i t h h o l d c e r t a i n k n o w l e d g e as to h is pas t a n d p resen t expe r i ences a n d a c t i o n a n d h is i n ten t i ons fo r the fu tu re . S i m i l a r l y , p r i v a c y c a n b e d e s c r i b e d i n " te rms o f the v o l i t i o n o f f r e e d o m o f the i n d i v i d u a l to c h o o s e h is m o v e m e n t across the b o u n d a r y w h i c h d is t ingu ishes h i m as b e i n g a l o n e versus h i m as a separa te i n d i v i d u a l i n te rac t i ng w i t h o the rs " ( L a u f e r , P r o s h a n s k y a n d W o l f e , p. 206) . A s e c o n d ser ies o f de f i n i t i ons e m p h a s i z e s the c o m p o n e n t o f c o n t r o l -o p e n i n g a n d c l os i ng the se l f to o thers a n d f r e e d o m o f c h o i c e r e g a r d i n g p e r s o n a l access ib i l i t y . A c c o r d i n g to S i m m e l : p r i v a c y is a c o n c e p t r e l a t e d to so l i t ude , sec recy a n d a u t o n o m y bu t i t is no t s ynonymous w i t h these te rms , f o r b e y o n d the p u r e l y desc r ip t i ve aspects o f p r i vacy a n d i s o l a t i o n f r o m the c o m p a n y , the cur ios i t y a n d the i n f l u e n c e o f o the rs , p r i v a c y i m p l i e s a n o r m a t i v e e l e m e n t : the r ights o f exc lus ive c o n t r o l o f access to p r i va te r e a l m s . (1968, p. 480) . A s e c o n d a u t h o r e m p h a s i z i n g c o n t r o l , K e l v i n (1973) , rega rds p r i vacy "as a c o n d i t i o n o f ' separa teness ' de l i be ra te l y c h o s e n a n d p r o t e c t e d by a n i n d i v i d u a l (o r g r o u p ) , a separa teness w h i c h the i n d i v i d u a l c a n , i n p r i n c i p l e , a b a n d o n o r b r e a k d o w n i f h e so chooses " (p. 253) . T h e n o t i o n o f v o l u n t a r y a n d p e r s o n a l c o n t r o l is i m p l i e d i n th is d e f i n i t i o n . S i m i l a r l y , F r i e d (1968) con tends that p r i v a c y is no t s i m p l y a n absence o f i n f o r m a t i o n abou t us i n the m i n d s o f o the rs ; " ra ther it is the c o n t r o l w e have o v e r i n f o r m a t i o n a b o u t ou rse l ves " (p. 482) a n d a f e e l i n g o f secur i t y i n c o n t r o l ove r that i n f o r m a t i o n . O t h e r w r i t e rs have c o n s i d e r e d the respons ib i l i t y o f soc ie ty fo r p r o t e c t i o n o f the i n d i v i d u a l ' s p r i vacy ( R o o s a , 1979). M a r s h a l l (1970) ho lds that p r i v a c y is c o n c e r n e d w i t h c o n t r o l l i n g the deg ree to w h i c h ins t i tu t ions a n d o t h e r i n d i v i d u a l s e n c r o a c h u p o n one 's l i f e . P r i v a c y is v i e w e d "as a d i m e n s i o n fo r d e s c r i b i n g b e h a v i o u r that dea ls w i t h c o n t r o l o v e r i n t e r a c t i o n w i t h o the rs , the d o m a i n o f p r i vacy i n c l u d i n g (a) b e h a v i o r that is o r i e n t e d away f r o m o thers a n d (b) the p r e s e n t a t i o n o f b a r r i e r s to the b e h a v i o r o f o thers o r i e n t e d t o w a r d o n e s e l f ( M a r s h a l l , 1970, p. 1). A con t ras t i ng d e f i n i t i o n o f p r i vacy is p r o v i d e d b y W a r r e n a n d B r a n d e i s (1890) a n d E r n s t a n d S c h w a r t z (1962) w h o have a r g u e d that p r i vacy is the r igh t to b e le t a l o n e . T h e i r pos i t i ons o n p r i vacy , h o w e v e r , s e e m to r e fe r to a h u m a n i t a r i a n c o n c e r n ra the r t h a n a l e g a l r igh t s ince the re is n o g e n e r a l s a n c t i o n o f p r i v a c y as a r igh t i n the l e g a l l i t e ra tu re . I n the U n i t e d Sta tes , the F o u r t e e n t h A m e n d m e n t p r o v i d e s l i m i t e d p r o v i s i o n fo r the p r o t e c t i o n o f p r i va te p r o p e r t y a n d fo r the secur i t y o f the p e r s o n a n d it spec i f i es tha t n o p e r s o n sha l l b e c o m p e l l e d to b e a w i tness aga ins t h imse l f . I n C a n a d a , t he re is , as yet, n o u n i f o r m i t y i n c o m m o n l a w that de f ines p r i vacy o r dea l s w i t h the r igh t to p r i vacy a n d the re is n o separa te tor t that p ro tec ts th is r ight . C a n a d i a n s re l y o n d e f a m a t i o n , b r e a c h o f con t rac t o r o the r t heo r i es o f l a w w h e n they f e e l t he i r p r i vacy has b e e n i n v a d e d ( S m i t h , 1979, p. 103). B y a n d l a rge , the l a w has dea l t m o r e w i t h the s u r r e n d e r o f p r i vacy t h a n its p r o t e c t i o n . A m o r e c o m p r e h e n s i v e d e f i n i t i o n that regards p r i vacy as a p rocess is p r o v i d e d b y W e s t i n (1968) w h o states that p r i vacy is the c l a i m o f i n d i v i d u a l s , g roups , o r ins t i tu t ions , to d e t e r m i n e f o r t hemse l ves w h e n , h o w , a n d to w h a t extent i n f o r m a t i o n a b o u t t h e m is c o m m u n i c a t e d to o the rs . . .P r i vacy is the v o l u n t a r y a n d t e m p o r a r y w i t h d r a w a l o f the p e r s o n f r o m the g e n e r a l soc ie ty t h r o u g h p h y s i c a l o r p s y c h o l o g i c a l m e a n s . . . T h u s e a c h i n d i v i d u a l is con t i nua l l y engaged i n a p e r s o n a l ad jus tmen t p rocess i n w h i c h h e b a l a n c e s the des i re f o r p r i v a c y w i t h the des i re f o r d i sc losu re a n d c o m m u n i c a t i o n a b o u t h i m s e l f to others. . . (p . 7 ) . W e s t i n (1968) p r o v i d e s a sys temat ic ana lys is o f the c o n c e p t o f p r i v a c y w h i c h is u s e f u l i n o u t l i n i n g its na tu re . T h e m a i n focus o f h is t h e o r e t i c a l a p p r o a c h is i n t e rms o f f o u r i n d i v i d u a l states o r types o f p r i vacy . T h e f i rst state o f p r i vacy , so l i t ude , is the m o s t ex t reme c o n d i t i o n o f p r i vacy w h e r e a p e r s o n is a l o n e a n d f ree f r o m the sc ru t iny o f o thers . I n t imacy is a state o f p r i vacy i n v o l v i n g s e c l u s i o n o f a s m a l l g r o u p o f two o r m o r e i n d i v i d u a l s . T h e th i rd state, a n o n y m i t y , occu rs w h e n a n i n d i v i d u a l is i n a p u b l i c p l a c e bu t seeks ar id f inds f r e e d o m f r o m i d e n t i f i c a t i o n a n d su rve i l l ance . T h e last a n d m o s t sub t le state, rese rve , occu rs w h e n the i n d i v i d u a l ' s n e e d to l i m i t c o m m u n i c a t i o n abou t h i m s e l f is p r o t e c t e d by the w i l l i n g d i s c r e t i o n o f those s u r r o u n d i n g h i m (pp. 31-32) . W e s t i n ' s ana lys is is i m p o r t a n t to a n e x a m i n a t i o n o f the concep t o f p r i v a c y b e c a u s e i t i nd i ca tes h o w i n d i v i d u a l s a n d g roups a re i n v o l v e d i n p r i v a c y p h e n o m e n a , h o w sett ings af fect p r i v a c y a n d b e c a u s e i t suggests the o p e r a t i o n o f c e r t a i n m e c h a n i s m s to a c h i e v e v a r i o u s leve ls o f p r i v a c y ( A l t a i a n , 1974, p. 6) . M o r e recen t l y , Schus te r has d e v e l o p e d a d e f i n i t i o n o f p r i vacy b a s e d o n p h e n o m e n o l o g i c a l r esea rch e x a m i n i n g pa t i en ts ' p e r c e p t i o n s o f p r i v a c y i n a n acu te c a r e h o s p i t a l . T h i s au tho r de f i nes p r i vacy as a c o m f o r t a b l e c o n d i t i o n re f l ec t i ng a d e s i r e d deg ree o f s o c i a l re t rea t o n the pa r t o f the p e r s o n s e e k i n g i t . . .may b e s p o k e n o f i n a n i n f o r m a t i o n a l m o d e w h e r e b y the i n d i v i d u a l is f r ee to d i sc lose on l y that i n f o r m a t i o n abou t h i m s e l f cons is ten t w i t h h is c i r cums tances a n d des i res . A l s o i t is r e m o v e d f r o m the necess i ty o f t a k i n g i n u n w a n t e d i n f o r m a t i o n f r o m ou ts i de sources. . . (1972, p. 51 ) . T h e m e s o f p e r s o n a l c o n t r o l o v e r the deg ree to w h i c h p e o p l e a n d ins t i tu t ions i m p i n g e u p o n one ' s l i f e e m e r g e f r o m the l i t e ra tu re . O n e senses that i t is a c o n d i t i o n to b e en joyed by a n i n d i v i d u a l w h o is f ree to c h o o s e w h e n , a n d u n d e r w h a t c i r cums tances he w i l l have i t ( R o o s a , 1979). Functions of Privacy A r e v i e w o f the l i t e ra tu re revea ls that p r i vacy fo r the i n d i v i d u a l serves a va r ie t y o f func t ions that focus o n b o t h i n d i v i d u a l a n d i n t e r p e r s o n a l needs . Se l f - Iden t i t y F u n c t i o n s A l l i n d i v i d u a l s r e q u i r e the oppo r t un i t y to pu t as ide p u b l i c r o l es a n d ven t fee l i ngs that m igh t b e supp ressed i f i n the p r e s e n c e o f o thers ( R o o s a , 1979). T h i s is w h a t has b e e n t e r m e d " b e i n g of f s tage" ( G o f f m a n , 1959) - the exh ib i t i ng a n d p r o t e c t i n g o f v u l n e r a b l e aspects o f b e h a v i o u r (Ba tes , 1964; S c h w a r t z , 1968) a n d e m o t i o n a l re lease ( W e s t i n , 1968) a n d the g e n e r a l l ay i ng as ide o f s o c i a l r o l es . T h e c o n c e p t o f "backs tage" rep resen ts a p l a c e w h e r e aspects o f one ' s b e h a v i o u r m a y b e p r e s e n t e d that a re n o r m a l l y supp ressed w h e n f a c i n g a n a u d i e n c e o r o thers . It is a p l a c e w h e r e the i n d i v i d u a l c a n r e l a x a n d d r o p h is f ron t g i v e n the e x p e c t a t i o n that n o i n t r u s i o n by o thers w i l l occu r . T o G o f f m a n , p r i vacy a l l ows o n e to b e h a v e m o r e f ree l y a n d o p e n l y w h e n a l o n e a n d away f r o m the e m o t i o n a l s t i m u l a t i o n o f da i l y l i fe . P r i v a c y a l so re l i eves o the r sources o f e m o t i o n a l t e n s i o n such as m i n o r n o n - c o m p l i a n c e w i t h s o c i a l n o r m s , anger , sexua l a n d exc re to ry func t i ons a n d events i n v o l v i n g the e x p r e s s i o n o f s t rong fee l ings . S e l f - e v a l u a t i o n ( W e s t i n , 1968) is a n o t h e r f u n c t i o n o f p r i v a c y a n d p r o v i d e s o n e w i t h the o p p o r t u n i t y f o r assessment o f expe r i ences t h r o u g h p r o c e s s i n g , p l a n n i n g , c rea t i ng a n d an t i c i pa t i ng events . It serves i n t e l l e c t u a l o r m o r a l ends a n d a l l ows o n e to eva lua te the responses o f o thers to one 's ac t ions o r though ts a n d the reby he lps o n e to regu la te a n d c o n t r o l the re lease o f i n f o r m a t i o n to o thers . P r i v a c y a n d se l f - ident i t y a p p e a r i n the wr i t i ngs o f m a n y p e o p l e . P e n n o c k (1971) , B e a r d s l e y (1971) , a n d G r o s s (1971) s p e a k o f i nvas ions o f p r i v a c y as espec ia l l y h a r m f u l s ince they des t roy i n d i v i d u a l a u t o n o m y , sel f-respec t a n d d ign i t y ; b y t a k i n g c o n t r o l o f a pe rson ' s l i f e away f r o m the p e r s o n a n d i n a sense d e m e a n i n g the w o r t h o f the p e r s o n . T h u s i t is a loss o f c o n t r o l to o the rs that is se r ious , no t so m u c h the m e r e exposu re o f i n f o r m a t i o n ( A l t m a n , 1975). P e r s o n a l c o n t r o l i n p r i vacy s i tua t ions as a p r i m a r y m e a n s f o r d e v e l o p i n g p e r s o n a l a u t o n o m y is f o u n d i n the w o r k by L a u f e r , P r o s h a n s k y a n d W o l f e (1976) . T h r e e aspects o f c o n t r o l : c h o i c e c o n t r o l , access c o n t r o l a n d s t i m u l a t i o n c o n t r o l a re i d e n t i f i e d as ways o f a c h i e v i n g p r i vacy a n d p e r s o n a l a u t o n o m y . T h e y state that i n d i v i d u a l s m u s t b e f ree to d e c i d e w h e n , w h e r e a n d u n d e r w h a t c i r cums tances they w i l l have p r i vacy , e i t he r phys i ca l l y o r psycho log i ca l l y a n d u n d e r wha t cond i t i ons i n t rus ions u p o n th is c o n d i t i o n w i l l b e a l l o w e d . T h i s f r e e d o m o f c h o i c e f u n c t i o n m a y b e s ign i f i can t w h e n c o n s i d e r i n g the b e h a v i o u r o f the e l de r l y i n ins t i tu t ions . It has b e e n t h e o r i z e d that " i n any s i t ua t i ona l contex t , the i n d i v i d u a l a t tempts to o r g a n i z e h is p h y s i c a l e n v i r o n m e n t so that i t m a x i m i z e s h is f r e e d o m o f c h o i c e " ( T a t e , 1980, p. 441) . P r i v a c y a c c o m p l i s h e s this by a l l o w i n g p e o p l e to f ee l f ree to act i n a p a r t i c u l a r m a n n e r by r e m o v i n g c e r t a i n aspects o f s o c i a l cons t ra in ts . T h e essence o f p r i vacy a n d se l f - ident i t y is a r t i c u l a t e d b y S i m m e l (1971) : W e n e e d to b e a pa r t o f o thers , o f i n t i m a t e c i rc les , f a m i l i e s , c o m m u n i t i e s , na t ions , pa r t o f human i t y , a n d w e n e e d to b e r e c o g n i z e d by o thers , to b e s u p p o r t e d by the i r a p p r o v a l f o r o u r a f f i l i a t i o n a n d o u r l i keness to t h e m . B u t w e a l so n e e d to c o n f i r m o u r d is t inc tness f r o m o thers , to asser t o u r i nd i v i dua l i t y , to p r o c l a i m o u r capac i t y to en joy, o r e v e n suf fer , the con f l i c ts that resu l t f r o m s u c h asser t ions o f i n d i v i d u a l i t y (p. 73) . I n t e r p e r s o n a l F u n c t i o n s A m a j o r f u n c t i o n o f p r i vacy is the r e g u l a t i o n o f i n t e r a c t i o n w i t h the s o c i a l e n v i r o n m e n t . S c h w a r t z (1968) ou t l i nes f o u r soc i e ta l f unc t i ons of p r i vacy . F i r s t , h e con tends that p r i vacy is i n s t i t u t i o n a l i z e d as a m e a n s o f m a i n t a i n i n g a n d p r e s e r v i n g the g r o u p o r the s o c i a l r e l a t i onsh ip . T h i s f u n c t i o n is l a b e l l e d as l i m i t e d a n d p r o t e c t e d c o m m u n i c a t i o n b y W e s t i n (1968) . P r o t e c t e d c o m m u n i c a t i o n p r o v i d e s oppo r tun i t i es to exchange c o n f i d e n c e s a n d i n t i m a c i e s o r o b t a i n p r o f e s s i o n a l c o u n s e l b e c a u s e a b r e a c h o f c o n f i d e n c e v i o l a tes s o c i a l n o r m s o r laws. I n this way , p r i vacy fosters the d e v e l o p m e n t o f i n t i m a c y b e t w e e n p e o p l e . A d d i t i o n a l l y , p r i vacy fac i l i ta tes spon tane i t y . F o r e x a m p l e , i n the t h e r a p e u t i c p r o f e s s i o n a l - c l i e n t ' r e l a t i o n s h i p con f i den t i a l i t y i m p l i e s that the c l i en t w i l l b e p r o t e c t e d f r o m ex te rna l sanc t ions b u t a lso that the p r o f e s s i o n a l w i l l no t exer t the u s u a l sanc t ions fo r d e v i a n c e ( S i m m e l , 1968). F r i e d (1968) c o n c l u d e s that p r i vacy is necessary f o r d e v e l o p m e n t o f the l o v e , respec t , f r i e n d s h i p a n d t rust that p r o v i d e the c o r e fo r c lose re l a t i onsh ips . L i m i t e d c o m m u n i c a t i o n serves to es tab l i sh " b o u n d a r i e s o f m e n t a l d i s tance i n i n t e r p e r s o n a l s i tua t ions" ( W e s t i n , 1968, (p.38) i n c l u d i n g the m o s t i n t i m a t e to the m o s t p u b l i c . T h i s p s y c h o l o g i c a l d i s tance is ev iden t i n c r o w d e d u r b a n set t ings w h e r e a c o m p l e x bu t u n d e r s t o o d e t ique t te o f p r i vacy is pa r t o f o u r s o c i a l l i f e . P r i v a c y a lso he lps m a i n t a i n soc i e ta l status d i v i s i ons b e c a u s e pe rsons o f h i g h r a n k usua l l y have m a n y m o r e m e a n s o f a t t a i n i ng s t ruc tu ra l i n s u l a t i o n f r o m o thers , a n d a lso m o r e p o w e r to i n v a d e the p r i v a c y o f o thers ( M a r s h a l l , 1970) . S c h w a r t z (1968) cons ide rs th is f u n c t i o n o f p r i vacy as o n e m e a n s o f p r e s e r v i n g o r g a n i z a t i o n a l s t ruc tures b y m a i n t a i n i n g r e q u i r e d status d i v i s ions . It a l so fos ters g r o u p f u n c t i o n i n g by p e r m i t t i n g i n d i v i d u a l s to o r g a n i z e a n d p e r f o r m w i t h s o m e degree o f secrecy a n d f r e e d o m . T h e f r e e d o m to res t r ic t c o m m u n i c a t i o n o f dec i s i ons a n d fu tu re p l ans m a y p r o m o t e the i n n o v a t i o n a n d r i sk t a k i n g c o n s i d e r e d i n teg ra l par ts o f p r i va te en te rp r i se ( R o o s a , 1979, p. 19). P r i v a c y , i n th is contex t , m a y a l so b e v i e w e d as a r e w a r d f o r respons ib i l i t y . It w a s f o u n d , i n a s tudy o f i ndus t r i a l w o r k e n v i r o n m e n t s , that the i n te r va l b e t w e e n supe rv i so ry contac ts was a n exce l l en t m e a s u r e o f the respons ib i l i t y e x e r c i s e d b y a w o r k e r a n d c o u l d b e u s e d fo r a l t e r i ng w a g e sca les ( Jacques , 1956). P r i v a c y t h e n is c o n s i d e r e d as b o t h s y n o n y m o u s w i t h a n d a p re - requ i s i t e to f r e e d o m i n a h i e r a r c h y o f p o w e r i m b a l a n c e . T h i r d , p r i vacy a l l ows f o r m s o f dev ian t b e h a v i o u r that i f o b s e r v e d m i g h t o the rw i se t h r e a t e n the f o u n d a t i o n o f soc ie ty . I n th is way , p r i vacy e n a b l e s "secre t c o n s u m p t i o n " (Schwar t z , 1968, p. 745) . F i n a l l y , S c h w a r t z states that p r i v a c y p ro tec ts the ego f r o m iden t i f y i ng i t se l f t oo i n t i m a t e l y w i t h o r l o s i n g i tse l f i n p u b l i c ro les . A c c o r d i n g to S c h w a r t z , da i l y l i f e is r i fe w i t h t e n s i o n b e t w e e n s incer i t y a n d d e c e p t i o n , b e t w e e n openness a n d sel f-c o n t a i n m e n t a n d b e t w e e n i n v o l v e m e n t i n w h a t is p u b l i c a n d the d r i ve to a v o i d g r o u p d e m a n d s . I n d i v i d u a l ident i ty , t hen , is v i e w e d as b e i n g m a i n t a i n e d by the ab i l i t y to h o l d b a c k f r o m o thers as w e l l as to a f f i l i a te . T h r o u g h p r i vacy , p e o p l e a re p r o t e c t e d f r o m s o c i a l p ressures to c o m p l y a n d f r o m the n e e d to act i n ways tha t a re l i k e l y to g a i n o thers ' a p p r o v a l . c R e s e a r c h S tud ies R e l a t e d to P r i v a c y T h e f o l l o w i n g r e s e a r c h ef for ts rep resen t a s a m p l i n g o f s tud ies p resen t i n the l i t e ra tu re w h i c h a t tempt to p r o v i d e c l a r i f i c a t i o n r e g a r d i n g the concep t o f p r i vacy . S c h w a r t z a n d P r o p p e (1969) assessed o n e h u n d r e d a n d twen ty -n ine m a l e i n s t i t u t i o n a l i z e d e l de r l y res iden ts ' p e r c e p t i o n s o f p h y s i c a l space a n d ef fect o n p r i v a c y t h r o u g h in te rv iews u t i l i z i n g a q u e s t i o n n a i r e c o v e r i n g l i fe c o n c e r n s . T h e resu l ts i n d i c a t e d that e a c h subject was ab le to d e l i n e a t e a n d d e s c r i b e the p h y s i c a l a reas h e c o n s i d e r e d h is o w n te r r i t o ry w i t h i n the b e d r o o m s o f the fac i l i ty , a n d e a c h c o u l d desc r i be a p r e f e r r e d deg ree o f p r i vacy . A s d i scussed ea r l i e r , p r i vacy is no t u n i d i m e n s i o n a l a n d its m e a n i n g va r ies w i d e l y . O b v i o u s l y , o n e m e a n i n g focusses o n the ava i l ab i l i t y a n d use o f space . H o w e v e r , a n o t h e r d i m e n s i o n , c o m m u n i c a t i o n o f i n f o r m a t i o n , b e c a m e ev iden t i n th is s tudy 's f ind ings . O v e r t i m e , the e x p e r i e n c e o f the subjects r e v e a l e d a c o n c e r n fo r a b r e a c h o f con f i den t i a l i t y t h r o u g h r e p e a t e d i n te rv iews , inves t iga t ions a n d e x a m i n a t i o n s w h i c h c o u l d b e r e c o r d e d o n the ins t i tu t ion 's w r i t t e n reco rds . A s these reco rds b e c a m e a v a i l a b l e to m o r e staff, res iden ts b e c a m e cogn i zan t that m o r e i n te rac t i ons i nc rease the l i k e l i h o o d o f c o m p r o m i s i n g con f i den t i a l i t y a n d , as a resu l t , w e r e m o r e l i k e l y to r e p o r t tha t p r i vacy is i m p o r t a n t a n d i nc reas ing l y h a r d to o b t a i n . It is s ign i f i can t to no te that th is s tudy c lea r l y i n d i c a t e d that e a c h sub jec t h a d a p e r c e p t i o n o f w h a t "p r i vacy" m e a n t to h i m a n d that the re w e r e two aspects o f p r i v a c y - i n f o r m a t i o n f l o w a n d i n t e r p e r s o n a l d i s t anc ing (Schus te r , 1972, p. 23) . Inves t iga t ions focuss ing o n res iden t sa t i s fac t ion w i t h a n d des i re fo r p r i v a t e r o o m s exist bu t to da te have b e e n i n c o n c l u s i v e . W h i l e s o c i a l theor is ts ag ree that m o r a l e a n d sa t i s fac t i on a re r e l a t e d to p r i vacy , no t a l l res iden ts p a r t i c i p a t i n g i n r e s e a r c h s tud ies have d e c l a r e d a p r e f e r e n c e f o r p r i va te o r s ing le r o o m a c c o m m o d a t i o n . I n o n e study, L a w t o n a n d B a d e r (1970) i n t e r v i e w e d a t o ta l o f e igh t h u n d r e d a n d th i r t y -n ine subjects o f d i f f e r i ng ages, i ns t i t u t i ona l status, r o o m m a t e status a n d h e a l t h status to d e t e r m i n e des i rab i l i t y o f p r i va te a c c o m m o d a t i o n s w h e n l i v i ng i n a n i ns t i t u t i on fo r the a g e d . T h e y h y p o t h e s i z e d that the i n s t i t u t i o n a l i z e d e l d e r l y w o u l d have a c l e a r e r i d e a o f the pos i t i ve a n d nega t i ve aspects o f sha r i ng a r o o m a n d w o u l d b e m o r e l i k e l y to c h o o s e p r i va te a c c o m m o d a t i o n s t h a n w o u l d n o n -i n s t i t u t i o n a l i z e d p e o p l e o f s i m i l a r ages. T h e f ind ings i n d i c a t e d that y o u n g e r p e o p l e w e r e m o r e l i k e l y to share r o o m s t h a n o l d e r p e o p l e . T h e f i nd ings a lso r e v e a l e d the d r a m a t i c i n f l u e n c e o n p resen t r o o m m a t e status. A l m o s t n o i ns t i t u t i ona l res iden t w h o r e s i d e d i n a s ing le r o o m w i s h e d to share o n e . H o w e v e r , a m o n g those w i t h a r o o m m a t e , a l m o s t o n e h a l f d e s i r e d a s ing le r o o m . T h e au tho rs c o n c l u d e d that a l t h o u g h a s i zab le p o r t i o n o f res iden ts d i d no t a p p e a r to w a n t p r i vacy , this d i d no t suggest a l a c k o f n e e d fo r p r i vacy . T h e y h y p o t h e s i z e d that o l d e r p e o p l e w o u l d t e n d to c h o o s e w h a t is m o s t p r o b a b l e . T h e r e was ev iden t a k n o w l e d g e o f the shor tage o f p r i v a t e r o o m s a n d responden t s w e r e l i k e l y r eac t i ng to this rea l i t y b y a l t e r i n g the i r p r e f e r e n c e s i n th is d i r e c t i o n . O n e c o u l d a lso specu la te that res iden ts o f s h a r e d r o o m s m a y have b e e n c o n c e r n e d r e g a r d i n g the cost o f p r i vacy r o o m s . I n a l a te r s tudy o f res iden ts i n a n i ns t i t u t i on that was b u i l d i n g a n e w s t ruc tu re w i t h a ma jo r i t y o f p r i va te r o o m s , L a w t o n (1972) f o u n d a n o v e r w h e l m i n g p r e f e r e n c e f o r a s ing le r o o m b o t h p r e c e d i n g a n d f o l l o w i n g the m o v e . L a w t o n c o n c l u d e d that " the ex is tence o f a r e a l a l t e rna t i ve m a y a l l o w the c l e a r e r e m e r g e n c e o f w h a t appea rs to b e a la ten t n e e d f o r p r i vacy " (p. 119). T h i s s ta temen t is s u p p o r t e d by the w o r k o f F i r e s t o n e , L i c h t m a n a n d E v a n s (1980) w h o d e t e r m i n e d that res iden ts ' p r i vacy -soc iab i l i t y p r e f e r e n c e s w e r e p r i m a r i l y d e t e r m i n e d by the i r cu r ren t type o f a c c o m m o d a t i o n w i t h i n the n u r s i n g h o m e . A c c e p t a n c e a n d a d a p t a t i o n was a m a j o r t h e m e i n the d a t a b a s e d o n the a s s u m p t i o n that the i n s t i t u t i o n a l i z e d e l de r l y c o n s i d e r the rea l i t i es o f t he i r l i v i n g cond i t i ons as u n c h a n g e a b l e facts. A n o t h e r s tudy c o n d u c t e d by F e l t o n a n d K a h a n a (1974) e x a m i n e d the r e l a t i o n s h i p b e t w e e n p e r c e i v e d l ocus o f c o n t r o l a n d ad jus tmen t u s i n g i n s t i t u t i o n a l i z e d a g e d res iden ts ' so lu t i ons to h y p o t h e t i c a l p r o b l e m s as the m e a s u r e o f p e r c e i v e d c o n t r o l . O n e such p r o b l e m c o n c e r n e d a n i n d i v i d u a l ' s fe l t l a c k o f p r i vacy a n d p r o v e d to b e s ign i f i can t l y r e l a t e d to se l f - ra ted l i fe sa t i s fac t ion . G i v e n the p r o b l e m o f i nsu f f i c ien t p r i vacy , those i n d i v i d u a l s w h o p e r c e i v e d staf f to b e the l ocus o f c o n t r o l h a d h i g h e r l i f e sa t i s fac t i on scores a n d w e r e s ign i f i can t l y be t te r ad jus ted . T h e au tho rs s p e c u l a t e d that s ince a g e d res iden ts gene ra l l y expe r i ence a dec rease i n capac i t y f o r c o n t r o l l i n g the i r e n v i r o n m e n t s , p e r c e p t i o n o f b e i n g c o n t r o l l e d ex te rna l l y m a y i n d i c a t e a hea l thy , r ea l i s t i c a d a p t a t i o n to i ns t i t u t i ona l l i f e . T h e r e l a t i o n s h i p b e t w e e n p r i vacy a n d l i f e sa t i s fac t i on a n d pos i t i ve m o r a l e has b e e n assessed b y o the r inves t iga tors . P r i v a c y was i d e n t i f i e d as o n e o f f i f t een fac to rs c o n t r i b u t i n g to sa t i s fac t i on i n a n i ns t i t u t i on ( K a n e et a l . , 1983) a n d o n e o f two s ta t is t ica l ly s ign i f i can t fac tors p r e d i c t i v e o f pos i t i ve m o r a l e a m o n g the e l de r l y i n a l o n g t e r m ca re fac i l i t y ( T e r e s i et a l . , 1982). A t h i r d s tudy c o n d u c t e d by J o h n s o n (1979) was d e s i g n e d to d e t e r m i n e fac to rs that i n f l u e n c e the response o f the e l d e r l y i n s t i t u t i o n a l i z e d c l i en t to t e r r i t o r i a l i n t r u s i o n , o n e aspec t o f p r i vacy i n v a s i o n . V a r i a b l e s i n c l u d e d i n the s tudy i n c l u d e d : sex, type o f r o o m a c c o m m o d a t i o n , l eng th o f r e s i d e n c e a n d p h y s i c a l l im i t a t i ons . T h e resu l ts i n d i c a t e d that the ma jo r i t y o f subjects exp ressed anx ie ty t o w a r d t e r r i t o r i a l i n t r u s i o n regard less o f the o the r v a r i a b l e s . T h e a u t h o r con tends that nu r s i ng h o m e staf f s h o u l d c o n s i d e r th is sou rce o f stress w h e n p l a n n i n g a n d p r o v i d i n g ca re s ince unnecessa ry i n t rus ions i n to p e r s o n a l te r r i to ry c a n r e a d i l y b e d e t e r m i n e d a n d a v o i d e d . O n e study was f o u n d that f ocussed o n ch i l d ren ' s a n d ado lescen ts ' p e r c e p t i o n s o f p r i vacy . L a u f e r a n d W o l f e (1974) c o n d u c t e d a survey o f two h u n d r e d a n d e igh ty -seven c h i l d r e n a g e d f i ve to s e v e n t e e n years i n w h i c h the m e a n i n g o f the w o r d p r i vacy was e x p l o r e d . T h e i r s tudy was b a s e d o n the a s s u m p t i o n s that p r i vacy is d y n a m i c a n d i ts m e a n i n g is a f u n c t i o n o f age a n d age - re l a t ed expe r i ences . It is no tewo r thy that m o r e t h a n o n e h a l f o f the f ive y e a r o l d c h i l d r e n c o u l d o f fe r s o m e d e f i n i t i o n o f p r i vacy . R e s u l t s a lso i n d i c a t e d that the concep t b e c a m e m o r e c o m p l e x w i t h age a n d that the re w e r e f o u r c o m m o n m e a n i n g s re f l ec t i ng those f o u n d i n the l i t e ra tu re . T h e s e w e r e : c o n t r o l l i n g access to i n f o r m a t i o n , a loneness , no t b e i n g b o t h e r e d a n d c o n t r o l l i n g access to space . E v i d e n t i n the resu l ts was a n a s s o c i a t i o n w i t h aspects o f the e n v i r o n m e n t , a n assoc ia t i on w h i c h con t i nues to a p p e a r at la te r ages a n d is ev iden t i n seve ra l o the r s tud ies . P r i v a c y w a s a l so v i e w e d as a n i n t e r p e r s o n a l c o n c e p t because it p resupposes the ex is tence o f o thers a n d the poss ib i l i t y o f a r e l a t i o n s h i p w i t h t h e m . M a r s h a l l (1971) a n a l y z e d the r e l a t i o n s h i p b e t w e e n p r i vacy a n d p e r s o n a l i t y as w e l l as e l e m e n t s o f the p h y s i c a l a n d s o c i a l e n v i r o n m e n t . A "p r i vacy p r o f i l e " was cons t ruc ted fo r a s a m p l e o f j u n i o r co l l ege subjects a n d the i r pa ren t s w h i c h cons i s ted o f the f o l l o w i n g six fac to rs : n e i g h b o u r i n g , s e c l u s i o n , so l i t ude , anonym i t y , se l f -d i sc losu re a n d i n t imacy . S ign i f i can t l y , th is r e s e a r c h e r d e t e r m i n e d that f e m a l e s s h o w e d a gene ra l l y h i g h e r p r e f e r e n c e fo r p r i v a c y t h a n m a l e s b y p r e f e r e n c e fo r m o r e so l i t ude , less se l f -d i sc losu re a n d m o r e p r i v a c y fo r i n t imacy . T h e s e f i nd ings , p a r t i c u l a r l y the f e m a l e p re fe rences fo r l o w se l f -d i sc losu re , do no t suppo r t the c o m m o n s te reo type a b o u t sex d i f f e rences i n th is a r e a . T h i s s tudy a lso i n d i c a t e d that p e o p l e d o have a n o r i e n t a t i o n to p r i v a c y that i n f l uences the i r ef for ts to es tab l i sh o r p ro tec t it (Schus te r , 1972, p. 24 ) . H o w e v e r , s ince n o e l de r l y o r i n s t i t u t i o n a l i z e d subjects w e r e i n c l u d e d i n the study, n o c o m p a r i s o n o f o r i en ta t i ons to p r i vacy w e r e p r o v i d e d fo r the age g r o u p se lec ted fo r th is au tho r ' s s tudy a n d i t has b e e n s p e c u l a t e d that a pe rson ' s p h y s i c a l a n d m e n t a l capab i l i t i e s m a y af fect access to p r i v a c y ( R o o s a , 1979). K e r r ' s o b s e r v a t i o n a l s tudy (1985) w a s u n i q u e i n that i ts a i m was to e x a m i n e h o s p i t a l space use i n te rms o f staff te r r i to ry a n d oppo r t un i t i e s fo r p r i vacy . T h e resu l ts i n d i c a t e d that type o f space a l l o c a t e d a n d f r e e d o m o f c h o i c e a v a i l a b l e r e f l ec ted status a n d / o r r o l e d i f fe rences . T h i s suppor t s the p o w e r f u n c t i o n o f p r i vacy o u t l i n e d p r e v i o u s l y i n th is chap te r . I n th is study, i n g e n e r a l , t he h i g h e r the staf f m e m b e r ' s status, the g rea te r the oppo r t un i t i e s f o r p r i vacy . F r y ' s (1984) p h i l o s o p h i c a l ana lys is o f e ight l e g a l cases rep resen ts the c o n t i n u i n g s t rugg le to a r t i cu la te the na tu re a n d d e f i n i t i o n o f p r i vacy . T h i s s tudy f ocussed o n the r o l e o f the v a l u e o f p r i vacy a n d the ro l es o f o the r va lues i n t r ea tmen t dec i s ions i n v o l v i n g i n c o m p e t e n t pa t ien ts . T h e f ind ings i n d i c a t e d that i n e a c h case s i t ua t i on , the r o l e o f p r i vacy , v is -a -v is the r o l e o f s e l f - d e t e r m i n a t i o n a n d h u m a n w e l f a r e has b e e n r e n d e r e d a m b i g u o u s b y the d e c i s i o n - m a k i n g p rocess a n d that the v a l u e o f p r i vacy is no t the a p p r o p r i a t e v a l u e to p ro tec t i n these c i r cums tances . O n e c a n specu la te that the c o m p l e x i t y a n d a m b i g u i t y o f the c o n c e p t o f p r i vacy m a y b e p r i m a r y reasons fo r the cour t ' s v a r i e d i n te rp re ta t i ons o f the t e r m . I n the f i e l d o f nu r s i ng , Schus te r (1972) i n t e r v i e w e d twen ty -one h o s p i t a l i z e d adu l ts i n a n acu te ca re set t ing to g a i n ins ight i n to the na tu re o f p r i vacy . O n c e a g a i n , h o w e v e r , n o e l de r l y subjects w e r e i n c l u d e d i n the study. T h e r e s e a r c h d a t a e n a b l e d the inves t iga to r to syn thes ize a d e f i n i t i o n a n d d e s c r i p t i o n o f p r i vacy , i den t i f y a n d d e s c r i b e the ef fects o f h o s p i t a l i z a t i o n o n p r i v a c y a n d re la te aspects o f p r i vacy to pa t i en t ca re . Schus te r i d e n t i f i e d th ree d is t inc t aspects o f p r i vacy w h i c h w e r e l a b e l l e d as p r i v a c y o f l i f e sty le, even t a n d pe rsona l i t y . I n o r d e r , they re fe r to a n i n d i v i d u a l ' s p r i vacy p r e f e r e n c e i n da i l y l i f e , p r e f e r e n c e fo r a spec i f i c ac t iv i ty a n d a non - t rans ien t aspec t o f p r i v a c y w h i c h rep resen ts a c e n t r a l c o r e o f se l f u n d e r the d o m a i n o f a u t o n o m o u s act iv i ty . A l t h o u g h p r i vacy a p p l i e d to any o n e o f the th ree o u t l i n e d aspects , the ma jo r i t y o f p r i vacy de f i n i t i ons p r o v i d e d by the h o s p i t a l i z e d subjects r e l a t e d to p r i vacy o f event . A c c o r d i n g to Schus te r ' s f i nd ings , p r i v a c y a lways i n c o r p o r a t e s s o m e f o r m o f d i s t a n c i n g w h i c h m a y a s s u m e v a r i o u s f o r m s a n d w h i c h m a y b e p s y c h o l o g i c a l a n d / o r p h y s i c a l i n n a t u r e . T h e n o t i o n o f d i s tanc ing is s u p p o r t e d b y B o e t t c h e r (1985) w h o d e t e r m i n e d that w h e n p r i vacy needs o f e l de r l y res iden ts i n ins t i tu t ions a re u n m e t , t he re is w i t h d r a w n a n d apa the t i c b e h a v i o u r o b s e r v e d that is a n a d a p t i v e a t t emp t to t u r n i n w a r d a n d tune ou t p s y c h o l o g i c a l l y i n o r d e r to sat is fy the n e e d fo r p r i vacy . T h e study resu l ts f u r t he r i n d i c a t e d that f ou r m a j o r v a r i a b l e s i n f l u e n c e the pa t ien ts ' ab i l i t y to c o n t r o l o r p ro tec t the i r p r i vacy . T h e s e v a r i a b l e s a r e : m o b i l i t y , l e v e l o f consc iousness a n d awareness , the spec i f i c charac te r i s t i cs o f pa t ien t - to -pa t ien t r e l a t i o n s h i p s a n d p e r c e p t i o n o f r o l e . O f s i gn i f i cance to nurses a re the resu l ts w h i c h i n d i c a t e that h e a l t h ca re p r o v i d e r s h a v e cons tan t oppo r t un i t y to i n f l u e n c e the qua l i t y a n d quan t i t y o f the pa t ien t ' s p r i vacy , e i the r by acts o f o m i s s i o n o r acts o f c o m m i s s i o n . A n o t h e r nu rse resea rche r , R o o s a (1979) c o n d u c t e d a survey o f sixty n u r s i n g h o m e res iden ts , the a ims o f w h i c h w e r e to a s c e r t a i n w h a t subjects d e f i n e d as p r i vacy , w h a t bene f i t s i t p r o v i d e s a n d w h a t ac t iv i t ies necess i ta ted p r i vacy . S h e f o u n d that res iden ts u n a n i m o u s l y se lec ted so l i t ude o r a l oneness as t he i r d e f i n i t i o n o f p r i vacy . A m o n g the responses , subjects v e r b a l i z e d h a v i n g a s ing le r o o m o r " be ing b y m y s e l f as pa r t o f th is d e f i n i t i o n . T h e a u t h o r s p e c u l a t e d that sha r i ng l i v i ng quar te rs i n n u r s i n g h o m e s p r o b a b l y m a k e s b e i n g a l o n e the res iden ts ' greatest c o n c e r n . S o m e responden ts p r o v i d e d a d d i t i o n a l de f i n i t i ons such as p e r s o n a l c o n t r o l , f r e e d o m o f c h o i c e a n d m a i n t a i n i n g sec recy o r l i m i t i n g se l f -d i sc losu re . I n th is survey, a l m o s t every r e s p o n d e n t i n d i c a t e d that h is o r h e r r o o m was the best p l a c e to h a v e p r i vacy a n d a ma jo r i t y o f those w h o h a d sem i -p r i va te r o o m s s a i d they w o u l d l i k e a p r i va te r o o m . T h e bene f i t s o f p r i vacy i d e n t i f i e d by R o o s a i n c l u d e d e m o t i o n a l r e l ease f o r a b o u t o n e - h a l f o f the subjects. O t h e r bene f i t s n o t e d w e r e self-e v a l u a t i o n s u c h as r e f l ec t i ng o n pas t events , a n d p e r s o n a l c o n t r o l . C l e a r l y , these bene f i t s re l a te d i rec t l y to the func t i ons o u t l i n e d i n the p r e v i o u s sec t i on o f th is chap te r . A c t i v i t i e s w h i c h necess i ta ted p r i v a c y w e r e those i d e n t i f i e d ^ b y res iden ts as b e i n g ex t r ins ic to the da i l y r o u t i n e o f the fac i l i t y a n d i n c l u d e d i n v o l v e m e n t i n h o b b i e s such as r e a d i n g a n d l i s t en ing to m u s i c a n d p e r s o n a l bus iness respons ib i l i t i es . It is s ign i f i can t to no te that R o o s a , l i k e p r e v i o u s au tho rs , specu la ted u p o n the ef fect o f a res iden t ' s p h y s i c a l a n d m e n t a l capab i l i t i e s o n access ib i l i t y to p r i vacy by r e l a t i n g the i nab i l i t y to secu re so l i t ude a n d p r i v a c y to the l i k e l i h o o d o f p s y c h o l o g i c a l w i t h d r a w a l . S u m m a r y A r e v i e w o f l i t e ra tu re shows that p r i vacy , as a concep t , appea rs r egu la r l y i n the l i t e ra tu re o f m a n y f i e lds . O b v i o u s l y , h o w e v e r , it is m u l t i d i m e n s i o n a l i n na tu re a n d has v a r i o u s m e a n i n g s f o r d i f f e ren t p e o p l e . C e r t a i n l y , o n e m e a n i n g has to d o w i t h the ava i l ab i l i t y a n d use o f space , w h i l e a n o t h e r face t o f p r i v a c y re la tes to c o m m u n i c a t i o n o f i n f o r m a t i o n abou t o n e s e l f to o thers . W i t h r a re excep t ions , r e s e a r c h ef for ts to da te h a v e no t f ocussed p r i m a r i l y o n p r i vacy . M o r e f requen t l y , i t has r e m a i n e d p e r i p h e r a l o r i n c i d e n t a l i n r e l a t i o n to o the r issues u n d e r i nves t i ga t i on . A s a resu l t , ex is t ing l i t e ra tu re is f ragmen ta ry , i ncons is ten t a n d i n c o n c l u s i v e . It is , t he re fo re , i m p o r t a n t to e x a m i n e e m p i r i c a l l y the na tu re o f p r i v a c y i n o r d e r to a d d to the b o d y o f k n o w l e d g e r e g a r d i n g the concep t . CHAPTER T H R E E Research Design Introduction A n exp lo ra to ry , desc r ip t i ve r e s e a r c h m e t h o d o l o g y ~ spec i f i ca l l y , p h e n o m e n o l o g y ~ was c h o s e n to c o n d u c t this study. T h i s pe rspec t i ve focusses o n the q u e s t i o n o f h o w the w o r l d is e x p e r i e n c e d f r o m the i n d i v i d u a l ' s f r a m e o f r e f e rence . T h e au tho r se lec ted th is m e t h o d o l o g y as the m o s t a p p r o p r i a t e to e x p l o r e the i ns t i t u t i ona l i zed e l d e r l y p e r s o n ' s p e r c e p t i o n s o f p r i v a c y s ince p h e n o m e n o l o g y focusses o n the c o n s t r u c t i o n o f m e a n i n g w i t h i n a n in te rsub jec t i ve rea l i t y . " T h e p h e n o m e n o l o g i c a l m e t h o d is a p p r o a c h i n g the p h e n o m e n o n w i t h n o p r e c o n c e i v e d expec ta t i ons o r ca tegor ies . . .and t h e n e x p l o r i n g the m e a n i n g o f the e x p e r i e n c e as it u n f o l d s f o r the pa r t i c i pan t s " ( O m e r y , 1983, p. 54) . T h e resea rche r ' s p r e c o n c e p t i o n s o r assump t i ons a re s u s p e n d e d o r " b r a c k e t e d " so that a p u r e a p p r e h e n s i o n o f the e x p e r i e n c e is o b t a i n e d ( D a v i s , 1978). T h e inves t iga to r was d i r e c t e d by p h e n o m e n o l o g y to exp lo re the c o n c e p t o f p r i vacy as p e r c e i v e d a n d d e s c r i b e d b y the e l d e r l y res iden ts o f a l o n g t e r m ca re fac i l i t y . T h i s chap te r w i l l o u t l i n e the r e l e v a n c e o f the p h e n o m e n o l o g i c a l m e t h o d f o r th is r e s e a r c h study. Setting T h e s i te c h o s e n f o r this s tudy was a l o n g t e r m ca re fac i l i t y i n V a n c o u v e r , B . C . i n w h i c h two h u n d r e d a n d , f i f ty-eight p e o p l e assessed as r e q u i r i n g p e r s o n a l o r i n t e r m e d i a t e ca re res ide . P e r s o n a l ca re l e v e l deno tes i n d i v i d u a l s w h o a re i n d e p e n d e n t l y m o b i l e w i t h o r w i t h o u t m e c h a n i c a l a ids , m e n t a l l y in tac t , o r su f fe r ing on l y m i n o r m e n t a l i m p a i r m e n t ( K a n e a n d K a n e , 1985, p. 144). T w e n t y - f o u r h o u r a day s u p e r v i s i o n is r e q u i r e d b y n o n -p r o f e s s i o n a l p e r s o n n e l . T h e i n t e r m e d i a t e ca re l e v e l desc r i bes i n d i v i d u a l s w h o are i n d e p e n d e n t l y m o b i l e w i t h o r w i t h o u t m e c h a n i c a l a ids , r e q u i r e ass is tance w i t h ac t iv i t ies o f da i l y l i v i ng , r e q u i r e da i l y p r o f e s s i o n a l ca re a n d / o r s u p e r v i s i o n as w e l l as a p r o t e c t e d e n v i r o n m e n t a n d a s o c i a l a n d / o r r e c r e a t i o n a l p r o g r a m . T h e th ree leve ls o f i n t e r m e d i a t e ca re d e n o t e v a r y i n g degrees o f p h y s i c a l a n d m e n t a l d i sab i l i t y r e q u i r i n g a d d i t i o n a l ca re a n d s u p e r v i s i o n t i m e b y p r o f e s s i o n a l h e a l t h ca re staff ( M i n i s t r y o f H e a l t h , 1984). Subject Selection G i v e n that i n p h e n o m e n o l o g y m e a n i n g is sought f r o m a n in te rsub jec t i ve rea l i t y , the r e s e a r c h e r sought to o b t a i n i n f o r m a n t s w h o w e r e r ecep t i ve a n d k n o w l e d g e a b l e abou t p r i vacy "to fac i l i t a te u n d e r s t a n d i n g f o r d e s c r i p t i o n a n d to e l i c i t m e a n i n g " ( M o r s e , 1986, p. 184). F o r the p u r p o s e o f th is thes is , q u a l i f i e d subjects w e r e those e l de r l y res iden ts w h o w e r e w i l l i n g to pa r t i c i pa te , h a d l i v e d i n a l o n g t e r m ca re fac i l i t y f o r at leas t s ix m o n t h s a n d w e r e phys i ca l l y a n d m e n t a l l y c a p a b l e o f u n d e r s t a n d i n g a n d r e s p o n d i n g to ques t i ons i n E n g l i s h . T h e c r i t e r i o n fo r l eng th o f r es i dency was se lec ted to d e a l w i t h the fac to r o f r e l o c a t i o n stress a n d the last c r i t e r i o n was necessary to fac i l i t a te the i n t e r v i e w i n g p rocess . F r o m the c h o s e n fac i l i t y , subjects i d e n t i f i e d b y the D i r e c t o r o f N u r s i n g as m e e t i n g subject s e l e c t i o n c r i t e r i a w e r e c o l l e c t e d a n d r e c o r d e d . T h i s n o m i n a t e d m e t h o d o f s a m p l i n g was d e e m e d a n a p p r o p r i a t e n o n p r o b a b i l i t y t e c h n i q u e fo r th is p h e n o m e n o l o g i c a l r e s e a r c h s ince it m e t the c r i t e r i o n o f a p p l i c a b i l i t y o r f i t t ingness o u t l i n e d by S a n d e l o w s k i (1986) . A n y subject b e l o n g i n g to a s p e c i f i e d g r o u p is c o n s i d e r e d to r ep resen t that g roup . T h e r e f o r e , anyone ' s d e s c r i b e d e x p e r i e n c e rep resen ts a "s l i ce f r o m the l i fe w o r l d " a n d is t he re fo re a p p r o p r i a t e subject m a t t e r f o r qua l i t a t i ve i n q u i r y ( D e n z i n , 1978, p. 134). T h i s s a m p l i n g t e c h n i q u e a l so dea l t w i t h recep t i v i t y p r o b l e m s , s ince the subject was i n t r o d u c e d i nd i r ec t l y to the r e s e a r c h e r by the D i r e c t o r o f N u r s i n g w h o was k n o w n to a l l res iden ts . In i t ia l l y , s ix subjects w e r e i d e n t i f i e d b y the D i r e c t o r . A l l six res iden ts a p p r o a c h e d b y the D i r e c t o r o f N u r s i n g v o l u n t e e r e d to pa r t i c i pa te i n the s tudy. T h i s s m a l l s a m p l e s ize is t yp i ca l i n qua l i t a t i ve r e s e a r c h m e t h o d s s u c h as p h e n o m e n o l o g y s ince d a t a sought a re " c o m p r e h e n s i v e , r e l evan t a n d d e t a i l e d " i n n a t u r e ( M o r s e , 1986, p. 183). I n d e p t h i n te rv iews gene ra te a l a rge v o l u m e o f v e r b a l d a t a that r equ i r es ana lys is a n d p h e n o m e n o l o g y tends to e m p h a s i z e i n tens i ve a n d p r o l o n g e d con tac t w i t h subjects. S a m p l e s ize i n qua l i t a t i ve s tud ies , h o w e v e r , c a n n o t b e p r e d e t e r m i n e d b e c a u s e i t is d e p e n d e n t o n the na tu re o f the d a t a c o l l e c t e d a n d w h e r e those d a t a t a k e the inves t iga to r ( S a n d e l o w s k i , 1986). T h e a u t h o r was a w a r e that a d d i t i o n a l subjects m a y have b e e n r e q u i r e d s ince ana lys is o f f i nd ings e m e r g i n g f r o m the in te rv iews m a y h a v e r e v e a l e d a n e e d f o r a d d i t i o n a l d a t a b a s e d o n the c r i t e r i o n o f c red ib i l i t y . G u b a a n d L i n c o l n (1981) suggest that a qua l i t a t i ve s tudy is c r e d i b l e w h e n i f p resen ts such f a i t h fu l desc r i p t i ons o r i n te rp re ta t i ons o f a p h e n o m e n o n o r h u m a n e x p e r i e n c e that p e o p l e l i v i ng the e x p e r i e n c e w o u l d i m m e d i a t e l y r e c o g n i z e i t f r o m the i r o w n desc r i p t i ons o r i n te rp re ta t i ons . Ethical Considerations T h e r e s e a r c h e r o b t a i n e d p e r m i s s i o n to conduc t th is s tudy f r o m the U n i v e r s i t y o f B r i t i s h C o l u m b i a B e h a v i o u r a l Sc i ences S c r e e n i n g C o m m i t t e e f o r R e s e a r c h a n d O t h e r S tud ies I nvo l v i ng H u m a n Sub jec ts a n d f r o m the m a n a g e r o f a l o n g t e r m ca re fac i l i t y i n V a n c o u v e r (see A p p e n d i x D ) . Sub jec ts w h o m e t the s e l e c t i o n c r i t e r i a a n d w h o h a d exp ressed a w i l l i n g n e s s to p a r t i c i p a t e i n this s tudy w e r e p r o v i d e d w i t h a n i n f o r m a t i o n le t te r ( A p p e n d i x A ) a n d w e r e c o n t a c t e d b y the r e s e a r c h e r w h o m e t w i t h t h e m i n d i v i d u a l l y , at the l o n g t e r m ca re fac i l i t y at des igna ted p rese t t imes . D u r i n g th is m e e t i n g , the e t h i c a l conce rns o f con f iden t ia l i t y , the r igh t to re fuse to a n s w e r any ques t ions a n d the r igh t to w i t h d r a w f r o m the s tudy at any t i m e w i t h o u t j e o p a r d i z i n g ca re at the fac i l i t y w e r e e x p l a i n e d by the resea rche r . Sub jec ts w e r e i n f o r m e d that the i r p a r t i c i p a t i o n w o u l d i n v o l v e o n e to th ree t a p e r e c o r d e d i n te rv iews las t i ng a p p r o x i m a t e l y th i r ty to sixty m i n u t e s . A consen t f o r m ( A p p e n d i x C ) w i t h th is i n f o r m a t i o n was g i v e n to e a c h p a r t i c i p a n t a n d s i gned i n the p r e s e n c e o f the r e s e a r c h e r a f ter a l l ques t ions a b o u t the s tudy h a d b e e n a n s w e r e d . Sub jec ts a l l r e c e i v e d a copy o f the consen t f o r m . C o n f i d e n t i a l i t y o f resu l ts was m a i n t a i n e d by c o d i n g the p a r t i c i p a n t s ' n a m e s fo r the pu rposes o f the t ranscr ip ts , a n d pa r t i c i pan t s w e r e a s k e d no t to m e n t i o n n a m e s d u r i n g the in te rv iews . A n y n a m e s acc iden ta l l y m e n t i o n e d w e r e d e l e t e d f r o m the t ranscr ip ts . Data Collection Procedure D a t a c o l l e c t i o n f o r th is thesis i n v o l v e d the use o f u n s t r u c t u r e d i n te rv iews w i t h t r igger ques t ions ( A p p e n d i x B ) as a n o u t l i n e o f con ten t a reas . E a c h i n t e r v i e w was t a p e r e c o r d e d a n d t r ansc r i bed f o r the p u r p o s e o f ana lys is . T h e i n i t i a l i n te rv iews sought to p r o v i d e the r e s e a r c h e r w i t h a b r o a d scope o f concep ts a n d ideas . S u b s e q u e n t i n te rv iews w i t h the pa r t i c i pan t s w e r e necessary to v a l i d a t e a n d e x p a n d o n u n d e r l y i n g fac to rs a n d concep ts resu l t i ng f r o m d a t a o b t a i n e d d u r i n g i n i t i a l i n te rv iews . In i t i a l i n te rv iews l as ted f r o m for ty to sixty m i n u t e s a m o n g six pa r t i c i pan ts . S e c o n d i n te r v i ews las t i ng f r o m th i r ty to fo r ty m i n u t e s w e r e c o n d u c t e d w i t h six subjects . D a t a c o l l e c t i o n c o n t i n u e d u n t i l the d a t a w a s d e e m e d c o m p l e t e , w i t h o u t gaps, m a d e sense a n d h a d b e e n c o n f i r m e d ( M o r s e , 1986, p. 184). S i n c e the r e s e a r c h e r a c c o m p l i s h e d these c r i t e r i a u p o n c o m p l e t i o n o f s e c o n d r o u n d in te rv iews , n o fu r the r i n te rv iews w e r e c o n d u c t e d a n d n o n e w subjects w e r e a d d e d to the study. A l l o f the res iden ts h a d b e e n o f f e red the i r p r e f e r e n c e r e g a r d i n g w h e r e the i n te rv iews w o u l d t ake p l a c e . I n e a c h case, the pa r t i c i pan t s chose the i r o w n r o o m i n the fac i l i t y as the p r e f e r r e d s i te f o r i n t e r v i e w i n g . E a c h res iden t w a s e n c o u r a g e d to f ree ly p resen t t he i r thoughts a n d fee l ings abou t p r i vacy , w a s i n f o r m e d that n o response was co r rec t o r i n c o r r e c t a n d w a s t o l d tha t the i n te rv iews c o u l d b e s t o p p e d a n d r e s u m e d b y the p a r t i c i p a n t as necessary . Data Analysis G i o r g i (1975) of fers the f o l l o w i n g p r o c e d u r e f o r qua l i t a t i ve ana lys is w h i c h was u t i l i z e d by the r e s e a r c h e r i n e x p l o r i n g the c o n c e p t o f p r i v a c y as p e r c e i v e d a n d e x p e r i e n c e d b y the e lde r l y res iden ts o f a l o n g t e r m ca re fac i l i t y : 1. T h e r e s e a r c h e r reads the en t i re d e s c r i p t i o n to get a sense o f the w h o l e . 2. T h e resea rche r reads the s a m e d e s c r i p t i o n m o r e s low ly a n d de l i nea tes e a c h t i m e that a t r ans i t i on i n m e a n i n g is pe rce i ved . . . and ob ta ins a ser ies o f m e a n i n g un i t s o r cons t i tuents . 3 . T h e r e s e a r c h e r t h e n e l i m i n a t e s r e d u n d a n c i e s , bu t o the rw i se k e e p s a l l un i t s . H e t h e n re la tes the m e a n i n g un i t s to e a c h o the r a n d to the sense o f t he w h o l e . 4 . T h e r e s e a r c h e r re f lec ts o n the g i v e n cons t i tuen ts , s t i l l exp ressed essen t ia l l y i n the conc re te l anguage o f the subject , a n d t r ans fo rms the m e a n i n g o f e a c h u n i t f r o m the everyday na i ve l anguage o f the sub jec t i n to the l a n g u a g e o f p s y c h o l o g i c a l sc ience . 5 . T h e r e s e a r c h e r t h e n synthes izes a n d in tegra tes the ins ights a c h i e v e d i n t o a cons is ten t d e s c r i p t i o n (pp . 74-75) . T h e p r i n c i p l e s o f cons tan t c o m p a r a t i v e ana lys is f o r m e d the bas is f o r d a t a ana lys is . U s i n g th is t e c h n i q u e , the inves t iga to r is d i r e c t e d to e x p l o r e d a t a c o l l e c t e d fo r bas i c t hemes a n d pa t te rns a n d to v a l i d a t e these by o b t a i n i n g c l a r i f i c a t i o n f r o m the subject g r o u p . I n i t i a l i n te rv iews a l l o w e d the a u t h o r to i den t i f y a n d ana l yze " m e a n i n g un i ts " . S u b s e q u e n t i n te rv iews w e r e s c h e d u l e d as necessary to c la r i fy a n d e x p a n d o n the m e a n i n g un i t s . A s a resu l t , e a c h p a r t i c i p a n t was i n t e r v i e w e d o n two occas ions . I f m o r e d a t a h a d b e e n r e q u i r e d fo r c l a r i f i c a t i o n a n d e x p a n s i o n , n e w pa r t i c i pan t s w o u l d have b e e n i n c l u d e d i n the study. U p o n c o m p l e t i o n o f i n t e r v i ew ing , the a u t h o r f u r t he r e x p l o r e d the i d e n t i f i e d m e a n i n g un i ts by r e t u r n i n g to the l i t e ra tu re . A s u m m a r y o f the m e a n i n g un i t s that w e r e syn thes i zed a n d i n teg ra ted w a s p r e p a r e d w i t h i l l us t ra t i ng t ranscr ip ts . T h e m e a n i n g un i ts w e r e t h e n p r e s e n t e d e m p i r i c a l l y f r o m the pe rspec t i ve o f the pa r t i c i pan ts i n the study. CHAPTER FOUR Presentation and Discussion of Accounts Introduction T h i s c h a p t e r ou t l i nes a n d desc r ibes the r e s e a r c h p rocess f r o m the i n i t i a l stage o f d a t a c o l l e c t i o n to the i n t e r p r e t a t i o n a n d d i s c u s s i o n o f the accoun ts o f t he p a r t i c i p a n t s ' p e r c e p t i o n s o f p r i vacy i n a l o n g t e r m ca re se t t ing . T h e f i rs t s e c t i o n o f th is chap te r w i l l i n c l u d e d e m o g r a p h i c a n d desc r ip t i ve i n f o r m a t i o n a b o u t the subjects w h o p a r t i c i p a t e d i n the study. T h e s e c o n d t o p i c is the c o n s t r u c t i o n o f accoun ts . T h e last a n d m a j o r pa r t o f the chap te r p resen ts a d e s c r i p t i o n a n d d i scuss i on o f the f i nd ings g e n e r a t e d t h r o u g h the i n t e r t w i n e d p rocesses o f d a t a c o l l e c t i o n a n d ana lys is . T h e f i nd ings o f th is s tudy a re p r e s e n t e d i n r e l a t i o n to the s tudy ques t ions o u t l i n e d i n chap te r o n e . P r e s e n t a t i o n a n d d i scuss i on o f the f ind ings a re o r g a n i z e d , t he re fo re , i n to the f o l l o w i n g sec t ions : (a) the res iden ts ' de f i n i t i ons o f the t e r m p r i vacy , (b) the func t i ons o f p r i v a c y f o r the res iden ts , a n d (c) p e r s o n a l a n d p h y s i c a l fac tors i n the i ns t i t u t i ona l e n v i r o n m e n t a f fec t ing p r i vacy . Characteristics of the Participants A to ta l o f s ix res iden ts w h o m e t the s a m p l i n g c r i t e r i a w e r e a p p r o a c h e d b y the D i r e c t o r o f N u r s i n g to pa r t i c i pa te i n th is study. A l l s ix i n d i v i d u a l s a g r e e d to b e i n t e r v i e w e d by the resea rche r . T h e study s a m p l e was c o m p r i s e d o f f o u r w o m e n a n d two m e n . T h e i r ages r a n g e d f r o m seventy - two to n ine ty -o n e yea rs . T h e m e a n age was e igh ty - th ree a n d a h a l f yea rs . T h e subjects ' ages w e r e t y p i c a l o f the ages o f res iden ts l i v i n g i n o the r l o n g t e r m ca re fac i l i t i es ( R e i z e n s t e i n , 1977). E a c h o f the pa r t i c i pan t s was assessed as I n t e r m e d i a t e C a r e I a n d e a c h r e p o r t e d at least o n e c h r o n i c m e d i c a l c o n d i t i o n . I n e a c h case , these cond i t i ons w e r e assoc ia ted w i t h a d m i s s i o n to fac i l i t y ca re s ince they i m p a i r e d e a c h i n d i v i d u a l ' s ab i l i t y f o r se l f -ca re i n o n e o r m o r e ways . E a c h p a r t i c i p a n t p r o v i d e d the r e a s o n o f " cou ldn ' t c o p e a l o n e " as the p r i m a r y r e a s o n fo r en t ry i n t o fac i l i t y ca re . T h e s e f i nd ings r e f l e c t e d the c r i t e r i a f o r e l i g ib i l i t y f o r ca re u n d e r the B r i t i s h C o l u m b i a l o n g t e r m ca re p r o g r a m w h i c h s t ipu la te that c l ien ts i n fac i l i t y ca re n e e d to h a v e a c h r o n i c m e d i c a l c o n d i t i o n ( M i n i s t r y o f H e a l t h , 1984). A m o n g the pa r t i c i pan ts , seve ra l h e a l t h p r o b l e m s w e r e ev iden t : v i s u a l a n d h e a r i n g i m p a i r m e n t , c a r d i o v a s c u l a r d i sease , a r th r i t i s a n d o the r m u s c u l o s k e l e t a l d iseases. D e s p i t e the p r e s e n c e o f c h r o n i c h e a l t h conce rns , e a c h res iden t c o u l d a m b u l a t e i n d e p e n d e n t l y . T w o i n d i v i d u a l s u s e d w a l k e r s a n d o n e u s e d a c a n e to a i d a m b u l a t i o n . F o u r o f the res iden ts s ta ted that they regu la r l y l e f t the fac i l i t y to pa r t i c i pa te i n r e c r e a t i o n a l a n d s o c i a l ou t ings a r r a n g e d b y the fac i l i t y , to a t t end a p p o i n t m e n t s , to v is i t w i t h f a m i l y o r f r i ends , a n d to w a l k i n the g a r d e n a r e a ad jacen t to the fac i l i t y . M a r i t a l status v a r i e d . O n e p a r t i c i p a n t was s ing le , o n e was m a r r i e d w i t h a spouse l i v i n g i n the s a m e fac i l i t y a n d f o u r w e r e w i d o w e d . A l l o f the pa r t i c i pan t s w e r e C a u c a s i a n a n d h a d r e s i d e d i n B r i t i s h C o l u m b i a fo r m o s t o f t he i r a d u l t l i ves . T h e l eng th o f stay o f subjects r a n g e d f r o m t e n m o n t h s to o n e h u n d r e d m o n t h s (e ight years , f o u r m o n t h s ) . T h e m e a n l e n g t h o f stay was twen ty -seven m o n t h s . O n e o f the assump t i ons o f th is s tudy con tends that s ince the res iden ts have l i v e d i n the l o n g t e r m ca re fac i l i t y f o r m o r e t h a n six m o n t h s , they s h o u l d n o l o n g e r b e e x p e r i e n c i n g the stress o f r e l o c a t i o n ad jus tment . T i m e fo r i n i t i a l ad jus tmen t to the fac i l i t y was ev iden t i n the i n t e r v i e w t ranscr ip ts . P r i o r to en t ry i n to the res i dence w h e r e this s tudy w a s c o n d u c t e d , m o s t o f t he res iden ts h a d l i v e d i n a p r i va te h o m e (house o r a p a r t m e n t ) . O n e res iden t was a d m i t t e d f r o m a r e h a b i l i t a t i o n h o s p i t a l a n d h a d p r e v i o u s l y l i v e d i n the p resen t fac i l i t y . A n o t h e r res iden t was a d m i t t e d f r o m a n acu te ca re se t t ing f o l l o w i n g a h o s p i t a l i z a t i o n o f seve ra l m o n t h s . A t the t i m e o f this s tudy, e a c h res iden t o c c u p i e d a p r i va te r o o m i n the twe lve s tory fac i l i t y a n d e a c h r o o m h a d a p r i va te b a t h r o o m . T h e s e a c c o m m o d a t i o n s r e f l e c t e d those f o u n d i n the rest o f the fac i l i t y . Construction of Accounts T h e p r o g r e s s i o n o f d a t a ana lys is o c c u r r e d t h roughou t the i n t e r v i e w p rocess as the r e s e a r c h e r sought to e l i c i t a n d u n d e r s t a n d the pa r t i c i pan t s ' p e r c e p t i o n s o f p r i vacy i n a l o n g t e r m ca re fac i l i t y . In i t ia l l y , the r e s e a r c h e r u s e d o p e n - e n d e d ques t ions a n d re f l ec t i ve responses as t e c h n i q u e s to o b t a i n c o n c r e t e m e a n i n g un i t s . A l t h o u g h a l l pa r t i c i pan ts exp ressed c o n c e r n at the outse t r e g a r d i n g the i r "exper t i se" as subjects , e a c h p a r t i c i p a n t was in te res ted i n the study a n d cu r i ous to k n o w h o w the resu l ts m i g h t b e u s e f u l to nurses . L a t e r , s e v e r a l sought v a l i d a t i o n f r o m the r e s e a r c h e r that they h a d c o n t r i b u t e d "adequa te l y " to the study. T h e f i rs t ser ies o f i n te rv iews g e n e r a t e d a b r o a d scope o f p e r c e p t i o n s , i deas a n d fee l ings . T h e resu l tan t t ranscr ip ts w e r e t h e n a n a l y z e d a n d i n f e r e n c e s w e r e m a d e w h i c h w e r e e x p l o r e d a n d e v a l u a t e d w i t h the pa r t i c i pan t s i n subsequen t i n te rv iews . C o n s t a n t c o m p a r a t i v e ana lys is was a n i n t e g r a l pa r t o f the en t i re d a t a ana lys is p rocess as the r e s e a r c h e r w o r k e d w i t h the m e a n i n g un i t s p r e s e n t e d i n the t ranscr ip ts . It was d u r i n g the s e c o n d r o u n d o f i n te rv iews that the p rocess o f v a l i d a t i o n b e c a m e p a r t i c u l a r l y s ign i f i can t s ince the resea rche r ' s u n d e r s t a n d i n g o f the v a r i o u s m e a n i n g un i t s c o u l d t h e n b e c h a l l e n g e d , r e f u t e d o r s u p p o r t e d . T h e p r o g r e s s i o n f r o m the i n i t i a l conc re te m e a n i n g un i t s t owards m o r e abst rac t i n te rp re ta t i ons w a s f ac i l i t a t ed t h r o u g h v a l i d a t i o n w i t h the pa r t i c i pan ts . I n m o s t cases, the t e c h n i q u e o f f e e d b a c k p r o v e d u s e f u l i n e x a m i n i n g p r e s e n t e d desc r ip t i ons o f p r i vacy . A t o t h e r t imes , a n e x p l o r a t i o n o f the use o f spec i f i c t e rms b y the pa r t i c i pan t s i n a c e r t a i n con tex t was necessa ry to fu r the r c la r i f y e v o l v i n g m e a n i n g un i ts . T h e accoun ts that f o l l o w w i l l b e p r e s e n t e d as desc r i p t i ons o f the pa r t i c i pan t s ' p e r c e p t i o n s o f p r i vacy i n a l o n g t e r m ca re fac i l i t y . V e r b a t i m t ransc r ip t excerp ts w i l l b e i n c o r p o r a t e d i n o r d e r to i l l us t ra te the study's f i nd ings . A d i s cuss i on o f the accoun ts w i l l b e p r e s e n t e d i n r e l a t i o n to p e r t i n e n t l i t e ra tu re p r e s e n t e d e a r l i e r i n chap te r two . T h i s l i t e ra tu re w i l l b e u t i l i z e d i n o r d e r to focus o n the s ign i f i can t t hemes p r e s e n t e d i n the accoun ts . T o assist i n t e r p r e t a t i o n o f the f i nd ings , a d d i t i o n a l s tud ies a n d t h e o r e t i c a l w o r k s w i l l b e i n c l u d e d as r e q u i r e d . Interpretation and Discussion of Accounts Definitions of the Term Privacy T h e f o l l o w i n g sec t i on focusses o n th ree s ign i f i can t t h e m e s r e l a t e d to the res iden ts ' de f i n i t i ons o f the t e r m p r i vacy . T h e s e a r e : so l i t ude , c o n t r o l o f i n f o r m a t i o n access a n d d i sc losu re a n d b o u n d a r y c o n t r o l . S o l i t u d e E a c h pa r t i c i pan t ' s a c c o u n t o f the e x p e r i e n c e o f p r i v a c y was u n i q u e , h o w e v e r , c o m m o n themes w e r e r e a d i l y d i s c e r n i b l e a n d p r e v a i l e d i n a l l the accoun ts . T h e f i rs t t h e m e , so l i t ude , was d e s c r i b e d by res iden ts i n te rms such as " b e i n g a l o n e " , " to ta l ly by m y s e l f a n d "get t ing away f r o m the c r o w d " . T h e f o l l o w i n g t ransc r ip t excerpts i l l us t ra te the d i m e n s i o n o f so l i t ude as a n i n t e g r a l p a r t o f p r i vacy : P r i v a c y to m e m e a n s that y o u have a p l a c e w h e r e y o u c o u l d b e abso lu te l y o n y o u r o w n w i t h o u t i n te r rup t i ons o f any k i n d . I w o u l d say that it is a s ign o f a pe rson ' s i nd i v i dua l i t y o r d is t inc t i veness w h e n o n e speaks o f p r i vacy . . .peop le a re a l l , w e l l , d i f f e ren t a n d i f o n e fee ls they can ' t b e a l o n e w h e n they n e e d to d o so , tha t w o u l d b e a de f i n i t e i n v a s i o n o f one 's sense o f p r i vacy a n d e v e n one ' s sense o f self . S o m e t i m e s p e o p l e h a v e the i r r o o m a n d i f p e o p l e a re a lways c o m i n g to y o u r r o o m , w e l l , p e r h a p s y o u don ' t w a n t t h e m to c o m e a l l the t i m e . F r o m t i m e to t i m e y o u n e e d to b e ab le to get away phys i ca l l y f r o m o the r f o l ks ~ y o u just w a n t to b e , w e l l , a l o n e . Y e s , a l o n e , w i t h m y o w n thoughts a n d fee l ings . A s c a n b e s e e n f r o m the p r e c e d i n g t ranscr ip ts , p r i vacy was v i e w e d as v a l u e d , sought a n d p r o t e c t e d a n d these pos i t i ve aspec ts ; o f the c o n c e p t h e l p e d to c la r i f y so l i t ude f r o m o the r concep ts such as i s o l a t i o n . A t h i r d t ranscr ip t d i f f e ren t ia tes p r i v a c y as so l i t ude f r o m i s o l a t i o n . F o r m e , b e i n g a b l e to c h o o s e to b e by o n e s e l f doesn ' t m e a n that I f e e l i s o l a t e d . I n m y l i fe , w h e n I've fe l t , y o u k n o w , i s o l a t e d o r l one l y , i t wasn ' t s o m e t h i n g I w a n t e d . U s u a l l y , w h e n I t h i n k o f b e i n g i s o l a t e d , I r e g a r d it as s o m e t h i n g y o u m i g h t d o to d i s c i p l i n e a c h i l d f o r m i s b e h a v i n g - pu t t i ng a c h i l d i n a r o o m as a p u n i s h m e n t o r pu t t i ng a p r i s o n e r i n a so l i ta ry c o n f i n e m e n t c e l l . N o , p r i v a c y o r b e i n g a l o n e m e a n s I chose i t b e c a u s e I n e e d e d it. N o b o d y is f o r c i n g m e to b e a l o n e a n d I ce r ta in l y don ' t resent it. P e r c e p t i o n s o f p r i vacy as p l e a s u r a b l e , sought , p r o t e c t e d a n d v a l u e d have b e e n r e a f f i r m e d by ex is t ing r esea rch . Schus te r ' s p h e n o m e n o l o g i c a l s tudy (1972) o f p r i v a c y d e s c r i b e d the c o n c e p t "as a c o m f o r t a b l e c o n d i t i o n re f l ec t i ng a d e s i r e d deg ree o f s o c i a l re t rea t o n the pa r t o f the p e r s o n s e e k i n g it" (p. 51 ) . L i k e w i s e , a s o c i a l p s y c h o l o g i c a l e x a m i n a t i o n o f p r i vacy by K e l v i n (1973) d e t e r m i n e d that p r i vacy d e n o t e d the pos i t i ve aspects o f separa teness o r so l i t ude . " P r i v a c y m a y b e r e g a r d e d as a c o n d i t i o n o f separa teness de l i be ra te l y c h o s e n a n d p r o t e c t e d b y a n i n d i v i d u a l (o r g r o u p ) , a separa teness w h i c h the i n d i v i d u a l c a n , i n p r i n c i p l e , a b a n d o n o r b r e a k d o w n i f h e so chooses " (p. 253) . I s o l a t i o n , i n cont ras t , is no t assoc ia ted w i t h c h o i c e bu t is i m p o s e d . I n a p s y c h o l o g i c a l sense, the i n d i v i d u a l does no t have the p o w e r to c h o o s e o r does no t v i e w h i m s e l f i n a p o s i t i o n to choose . I n p r i vacy , h o w e v e r , so l i t ude rep resen ts c h o s e n w i t h d r a w a l o r d i s tanc ing f r o m o thers a n d p r o v i d e s a n i n d i v i d u a l w i t h c h o i c e ove r h is b e h a v i o u r w h i c h c o u l d b e c o n s t r a i n e d o r l i m i t e d by the p resen t o r p o w e r o f o thers (p. 253) . P h y s i c a l so l i t ude as a n i m p o r t a n t d i m e n s i o n o f p r i v a c y was ev iden t i n the res iden ts ' desc r i p t i ons . B u t so l i t ude was a lso p e r c e i v e d as a p s y c h o l o g i c a l p h e n o m e n o n . T h e f o l l o w i n g t ranscr ip t i l l us t ra tes the p s y c h o l o g i c a l c o m p o n e n t o f s o l i t u d e : I was t h i n k i n g a m i n u t e ago o f wha t w o u l d b e c o m e o f m y p r i v a c y i f I c o u l d n ' t c o m e u p h e r e to m y r o o m a n d I t h i n k i t w o u l d b e h a r d . I 've w a t c h e d o the r fo l ks h e r e - i n v o l v e d i n s o m e o n e ' s i d l e cha t te r - u n i n v i t e d I m igh t a d d , a n d y o u see t h e m sor t o f p u l l away , t he i r eyes l o o k away o r c lose , they f idget o r jus t s e e m to s top l i s t en ing b e f o r e they get away to ta l ly . I f p e o p l e h a d b e e n sens i t i ve to h e r t u rn i ng away men ta l l y , y o u k n o w , h a d rea l l y c o m m u n i c a t e d , they w o u l d h a v e b e e n respec t i ng h e r n e e d fo r p r i vacy . A s w i t h p h y s i c a l so l i t ude , the a b o v e desc r ip t i ons o f p s y c h o l o g i c a l s o l i t u d e i n c o r p o r a t e d aspects o f v o l i t i o n a n d c h o i c e o n the pa r t o f the p e r s o n s e e k i n g p r i vacy . M a r s h a l l ' s s tudy o n p r i vacy o r i en ta t i ons (1970) suppor ts the i m p o r t a n c e o f b e i n g a l o n e men ta l l y , w i t h o thers p resen t bu t no t i m p i n g i n g u p o n one ' s thoughts . L a w t o n (1970) has suggested that i n ins t i tu t ions fo r the e l d e r l y w h e r e the re is a loss o f p h y s i c a l p r i vacy , p s y c h o l o g i c a l w i t h d r a w a l m a y b e the on l y subst i tu te a v a i l a b l e to a res iden t . It c a n b e s p e c u l a t e d that the use o f s o c i a l w i t h d r a w a l b e h a v i o u r s p e r m i t s a n i n d i v i d u a l to o b t a i n p s y c h o l o g i c a l i f no t p h y s i c a l resp i te f r o m the cons tan t p r e s e n c e o f o the rs . C o n t r o l o f I n f o r m a t i o n A c c e s s a n d D i s c l o s u r e A s e c o n d m a j o r t h e m e i n the d i s cuss i on r e g a r d i n g the d e f i n i t i o n o f p r i v a c y r e l a t e d to the c o m m u n i c a t i o n o f i n f o r m a t i o n . O n c e a g a i n , a l l pa r t i c i pan t s r e l a t e d at least o n e e x a m p l e o f the i m p o r t a n c e o f p e r s o n a l c o n t r o l o v e r w h a t i n f o r m a t i o n abou t t h e m w o u l d b e d i s s e m i n a t e d to o the r p e o p l e w i t h i n the fac i l i t y set t ing. A l l res iden ts i n t e r v i e w e d exp ressed c o n c e r n that they no t b e p r e s s u r e d i n to p r o v i d i n g i n f o r m a t i o n to staf f o r o the r res iden ts . T h e r e w a s a lso c o n c e r n exp ressed d u r i n g the two i n te r v i ews that o the r i n d i v i d u a l s h a d the s a m e r ight to res t r ic t the f l o w o f i n f o r m a t i o n i n d i c a t i n g the b i - d i r e c t i o n a l na tu re o f res t r i c ted i n f o r m a t i o n exchange . T h e f o l l o w i n g excerp ts p r o v i d e e x a m p l e s o f th is s e c o n d m a j o r t h e m e : I t h i n k p r i vacy m e a n s that y o u a re no t o b l i g a t e d to sha re a l l the de ta i l s o f y o u r l i f e . Y o u ' r e no t a s k e d w h e r e y o u a re g o i n g eve ry t i m e y o u m o v e ou t o f y o u r room. . . I t h i n k y o u r ca re g i r l o n the f l o o r tha t y o u a re o n is pe r fec t l y en t i t l ed to say " A r e y o u g o i n g o u t ? " a n d y o u say "yes" bu t they don ' t ask y o u w h e r e y o u a re g o i n g o r w h y y o u a re g o i n g out . I f y o u w a n t to v o l u n t e e r i n f o r m a t i o n , w e l l that is f i ne a n d s o m e t i m e s p e o p l e w i l l say they ' re g o i n g d o w n t o w n . Y o u don ' t ask t h e m w h a t they a re g o i n g d o w n t o w n for . I t h i n k that 's o n e w a y eve rybody respects e a c h o the r ' s i n d e p e n d e n c e o r f ee l i ng o f p r i vacy . I n that w a y p r i vacy is a w a y o f s h o w i n g respec t f o r a n o t h e r p e r s o n . I t h i n k p r i v a c y m e a n s that y o u c a n c o n t r o l w h a t o thers k n o w a b o u t y o u a n d h o w m u c h y o u k n o w a b o u t o thers a n d that changes d e p e n d i n g o n h o w w e l l y o u w a n t to b e k n o w n o r k n o w o thers . I t h i n k y o u c a n nego t ia te wha t y o u n e e d i n te rms o f p r i vacy . T h e nex t t ransc r ip t i l lus t ra tes the b i - d i r e c t i o n a l na tu re o f p r i vacy r e l a t i o n to i n f o r m a t i o n c o n t r o l : I w o u l d resen t p e o p l e b a r g i n g i n a n d c o m i n g to f i n d out , a s k i n g y o u ques t i ons abou t w h a t y o u a re d o i n g last n igh t . A n d i f I wan t to , I'll t e l l t h e m . A n y o n e i n te r f e r i ng i n m y p r i va te a f fa i rs I w o u l d say I 'm ve ry m u c h against . A n d the s a m e c a n b e e x p e c t e d by o the rs . I r e m e m b e r , w h e n w e l i v e d i n the h o u s e , t he re w a s a c o u p l e nex t d o o r a n d I k n e w h e h a d b e e n i n s o m e bus iness a n d h a d h a d a n in ju ry a n d was ge t t ing qu i te a la rge p e n s i o n fo r it. A n d I h a d o n e m a n c o m e r o u n d o n e day a n d ask m e i f I h a d s e e n h i m w a l k i n g i n the g a r d e n b e c a u s e they w a n t e d to get h i m of f th is d i sab i l i t y p e n s i o n a n d I sa i d rea l l y I don ' t t ake any no t i ce . I wasn ' t g o i n g to te l l t h e m . I k n e w that h e was f o o l i n g t h e m b e c a u s e h e was as n i m b l e as any th ing , bu t w h e n they w e r e a r o u n d h e w a s l i m p i n g a r o u n d . S o that is the sor t o f th ing . I f e e l that w a s h is bus iness a n d n o t h i n g to d o w i t h m e . It 's the s a m e i n he re , I d o n ' t h a v e a right to d i vu lge i n f o r m a t i o n a b o u t o thers w i t h o u t t he i r consen t . T h e next t ransc r ip t p r o v i d e s a n e x a m p l e o f h o w c o n t r o l o f i n f o r m a t i o n m a y b e a f fec ted b y the p e r c e i v e d p r i o r i t y o f a n o t h e r n e e d . I t h i n k the staf f r ea l l y respec t m e as a p e r s o n a n d o n e w a y they s h o w that is by respec t i ng m y p r i vacy . L i k e , i f t hey n e e d to ask m e any ques t i ons , i t 's f o r a r e a s o n , usua l l y m y w e l l - b e i n g , l i k e h o w I s lep t o r i f I ' m l o s i ng we igh t a n d so I f e e l f ree to answer b e c a u s e i t 's to h e l p m e c o p e a n d m a n a g e . S o m e t i m e s the i n f o r m a t i o n m a y b e de l i ca te , l i k e i f a suppos i t o ry w o r k e d a n d y o u ' d t h i n k that y o u ' d b e e m b a r r a s s e d , bu t a f ter a l l i t 's p a r t o f t he i r j o b to ask. C e r t a i n l y , i f the q u e s t i o n w e r e s h o u t e d across the d i n i n g h a l l , that w o u l d b e a n i n v a s i o n o f p r i vacy , bu t qu ie t l y p o s e d i n one ' s r o o m is no t a n i n v a s i o n . E v i d e n t i n th is last t ranscr ip t is h o w the res iden t p e r c e i v e d ab i l i t y to c o p e a n d p e r s o n a l safety as b e i n g m o r e i m p o r t a n t t h a n p r i v a c y i n h is case. C l e a r l y , the m a n n e r i n w h i c h the staff m e m b e r s m a i n t a i n e d h is d ign i t y w h e n d isc ree t l y r e q u e s t i n g ve ry p e r s o n a l i n f o r m a t i o n was v a l u e d by th is res iden t a n d i n th is case , was no t v i e w e d as a v i o l a t i o n o f p r i vacy . E x i s t i n g l i t e ra tu re was l o c a t e d w h i c h i n c l u d e d the c o n t r o l o f k n o w l e d g e c o m m u n i c a t e d a b o u t the se l f to o thers . " P r i v a c y m a y b e s p o k e n o f i n a n i n f o r m a t i o n a l m o d e w h e r e b y the i n d i v i d u a l is f ree to d i sc lose on l y that i n f o r m a t i o n a b o u t h i m s e l f cons is ten t w i t h h is c i r cums tances a n d des i res . A l s o , h e is r e m o v e d f r o m the necess i ty o f t a k i n g i n u n w a n t e d i n f o r m a t i o n f r o m ou ts i de sou rces " (Schus te r , 1972, p. 51) . C r i t i c a l aspects o f p e r s o n a l c o n t r o l a n d v a r y i n g c i r cums tances o u t l i n e d b y the res iden ts ' expe r i ences p a r a l l e l e d c o n c e r n s exp ressed by pa r t i c i pan ts i n Schus te r ' s (1972) s tudy f ocuss ing o n acu te ca re pa t i en t s ' p e r c e p t i o n s o f p r i vacy . O t h e r au tho rs e x a m i n i n g p r i vacy h a v e a l so d e f i n e d p r i v a c y i n te rms o f i n f o r m a t i o n f l o w a n d access. W e s t i n (1968) d e f i n e d p r i v a c y as " the c l a i m o f i n d i v i d u a l s , g roups o r ins t i tu t ions to d e t e r m i n e fo r t hemse l ves , w h e n , h o w a n d to w h a t ex tent i n f o r m a t i o n a b o u t t h e m is c o m m u n i c a t e d to o thers " (p. 7 ) . F r o m the p r e c e d i n g excerp ts , a s ta tement o n p r i vacy w o u l d thus i n c l u d e the i n d i v i d u a l ' s r igh t to res t r ic t o thers f r o m k n o w l e d g e a b o u t h imse l f , the r e c o g n i t i o n that o the rs have the s a m e r igh t a n d that fac to rs s u c h as t i m e , p l a c e , a m o u n t , r a t i o n a l e o r n e e d fo r i n f o r m a t i o n m a y a l l i n f l u e n c e the c o m m u n i c a t i o n o f i n f o r m a t i o n ( B l o c h , 1970). B o u n d a r y C o n t r o l T h e e x p e r i e n c e o f p r i v a c y was d e s c r i b e d as b e i n g d y n a m i c , i n f l u e n c e d by ou t s i de fac to rs a n d c h a n g i n g i n na tu re . R a t h e r t h a n the p e r c e p t i o n that p r i v a c y was a s tat ic p h e n o m e n o n , pa r t i c i pan ts r e v e a l e d that p r i vacy is a cons tan t l y c h a n g i n g p rocess re f l ec t i ng the i n f l uences o f sh i f t i ng fo rces o f e x c l u s i o n a n d i n c l u s i o n o f o t he r res iden ts , staf f a n d f a m i l y m e m b e r s . A s o n e p a r t i c i p a n t s ta ted : It 's l i k e h a v i n g th is i nv i s i b l e f ence a r o u n d me . . . a f ence w i t h a gate tha t I c a n o p e n o r c lose at w i l l . S o m e t i m e s I o p e n the gate to a l l o w s o m e o n e to en te r i n o r d e r that w e c a n share o u r fee l i ngs , thoughts o r jus t qu ie t t i m e . O t h e r t imes , the gate c loses , l i k e w h e n I don ' t f e e l l i k e l i s t en ing to o the r p e o p l e i n h e r e a n d I jus t w a n t to b e b y m y s e l f a n d no t share those th ings. A n d w h e n I c a n success fu l l y o p e r a t e that gate , I f e e l g o o d a b o u t m y s e l f - s o m e h o w p e a c e f u l . T h i s p a r t i c i p a n t was c o n c e r n e d a b o u t h o w h e c o u l d c o n t r o l the a m o u n t o f i n t e r a c t i o n ve rsus the a m o u n t o f so l i t ude h e r e q u i r e d a n d i m p l i e d a t e m p o r a r y i d e a l l e v e l o f i n t e r p e r s o n a l con tac t . L a t e r , h e exp ressed the f o l l o w i n g s ta tements : I w o u l d say that m y n e e d fo r p r i vacy is a f fec ted b y m a n y th ings, l i k e o v e r t i m e , d e p e n d i n g o n the na tu re o f a c e r t a i n r e l a t i o n s h i p a n d m y c i r cums tances . T o g ive y o u a n i d e a o f w h a t I m e a n , w e l l say I 'm t a l k i n g w i t h a c lose f r i e n d w h o I k n o w w e l l . W e m i g h t go b a c k a l o n g w a y a n d I f e e l c o m f o r t a b l e sha r i ng s o m e p e r s o n a l news w i t h h i m b e c a u s e o f the t rust I have that h e w o n ' t b e c a l l i n g the n e w s p a p e r s w i t h w h a t I've sa id - no t that it w o u l d b e o f in te res t o r c o n c e r n to a n y o n e bu t m e . B u t c i r cums tances a re d i f fe ren t w i t h say m y n e i g h b o u r d o w n the h a l l . I w o u l d n ' t w a n t to i n c l u d e h e r i n s u c h a c o n v e r s a t i o n f i rst o f a l l b e c a u s e I don ' t k n o w w h o s h e ' l l say i t to a n d second l y b e c a u s e I m igh t b e i n f r i ng i ng o n h e r sense o f p r i v a c y b y i m p l y i n g a n i n t i m a c y that doesn ' t exist b e t w e e n us . T h i s res iden t p r e s e n t e d a v i e w o f p r i vacy as a n ac t i ve p rocess i n w h i c h i n d i v i d u a l s seek to regu la te b o t h contac ts r e c e i v e d f r o m o thers a n d ou tpu ts to o the rs . T h e f o l l o w i n g excerp t i nd i ca tes that p r i v a c y rep resen ts a d e s i r e d b a l a n c e b e t w e e n t oo m u c h o r t oo l i t t le s e p a r a t i o n f r o m o thers : I t h i n k p r i v a c y is a pa r t o f a b a l a n c i n g act so to speak . W h e n I c o m e u p h e r e to m y r o o m a n d l o c k the d o o r , I don ' t expec t a n y o n e to c o m e b a r g i n g i n u n i n v i t e d a n d i f they d a r e d to d o so a n d I d idn ' t w a n t t h e m i n m y r o o m t h e n m y p r i v a c y w o u l d b e v i o l a t e d a n d t h e n I'd have to ask t h e m to l eave a n d h o p e that they respec t m y w ishes bu t y o u c a n see the b a l a n c e - the l o c k e d d o o r a n d m y reques t f o r p r i vacy versus the ac t ions o f a n i n t rude r . T h i s res iden t c o u l d c lea r l y express h e r w ishes fo r w h a t she p e r c e i v e d as a d e s i r e d l e v e l o f p r i v a c y a n d wha t was the a c h i e v e d p r i vacy w h i c h m a y o r m a y no t re f lec t w h a t w a s d e s i r e d . P a r t i c i p a n t s i n this s tudy d e s c r i b e d the i r p e r c e p t i o n s o f p r i vacy i n te rms o f a d y n a m i c b o u n d a r y c o n t r o l p rocess . T h e s e desc r i p t i ons o f p r i vacy as a b o u n d a r y a re c o n g r u e n t w i t h f i nd ings i n the l i t e ra tu re . B o t h t h e o r e t i c a l ana lys is o f p r i vacy a n d e x a m p l e s o f e m p i r i c a l r esea rch s tud ies suppo r t th is f i n d i n g r e g a r d i n g b o u n d a r y c o n t r o l . A l t a i a n ' s (1974) ana lys is o f p r i vacy p resen ts the c o n c e p t as a n " i n t e r p e r s o n a l b o u n d a r y c o n t r o l p rocess " the extent o f w h i c h is to i n f l u e n c e a n d regu la te i n te rac t i ons w i t h o the r i n d i v i d u a l s (p . 3 ) . T h e ana logy is d r a w n b e t w e e n p r i v a c y a n d a c e l l m e m b r a n e that is at t imes p e r m e a b l e o r access ib le to ou t s i de i n f l uences a n d at o t he r t imes c a p a b l e o f res t r i c t i ng the ex te rna l e n v i r o n m e n t . L i k e the pa r t i c i pan ts i n th is r e s e a r c h ef for t , t he re a re b o t h sub jec t i ve a n d i d e a l l eve ls o f p r i v a c y a n d a c h i e v e d o r a c t u a l i z e d p r i vacy . A c c o r d i n g to A l t m a n , w h e n d e s i r e d a n d a c h i e v e d p r i v a c y leve ls a re e q u a l , o p t i m u m p r i vacy is r e a l i z e d . T h i s au tho r a lso concu rs w i t h the n o t i o n o f b a l a n c e i n r e l a t i o n to p r i vacy . It is a p p a r e n t tha t w h e n a c h i e v e d p r i v a c y is g rea te r t h a n o r less t h a n d e s i r e d p r i vacy , a state o f i m b a l a n c e resu l ts . R e s e a r c h b a s e d o n a p h e n o m e n o l o g i c a l m e t h o d desc r i bes a s i m i l a r b o u n d a r y . Schus te r ' s (1972) m o d e l o f i n t e r p e r s o n a l d i s t a n c i n g ou t l i nes a d y n a m i c c o n t i n u u m o f p r i vacy w h e r e b y subjects b a l a n c e the i r needs fo r " w i t h d r a w a l a n d re t rea t " w i t h the i r needs fo r "d i sc losu re a n d c o m m u n i c a t i o n " (p. 61 ) . Schus te r c o n c l u d e s that desp i te the c o m p l e x i t y o f the concep t , p r i v a c y a lways i n c l u d e s such a b o u n d a r y w h e r e the v i o l a t i o n o f the b o u n d a r y s ign i f ies a n i n v a s i o n o f one ' s p r i vacy . I n the cu r ren t s tudy, res iden ts f r equen t l y r e p o r t e d such invas ions w i t h e x a m p l e s such as h a v i n g s o m e o n e en te r t he i r r o o m w i t h o u t k n o c k i n g o r b e i n g a s k e d p e r s o n a l ques t ions . Schus te r ' s (1972) f i nd ings o f p r i vacy as a b o u n d a r y a lso i n c l u d e the d i m e n s i o n o f f l ex ib i l i t y w h i c h a l l ows m o v e m e n t o f a n i n d i v i d u a l t o w a r d o r away f r o m ano the r . L a s t l y , the m a i n t e n a n c e o f a b o u n d a r y rep resen ts a u t o n o m y o r c o n t r o l . I n th is cu r ren t s tudy, the t ranscr ip ts c l ea r l y r e v e a l the n o t i o n o f c o n t r o l e f for ts d i r e c t e d t o w a r d the m a i n t e n a n c e o r m o d i f i c a t i o n o f a b o u n d a r y . T h e i m p o r t a n c e o f c o n t r o l as a n i n teg ra l p a r t o f p r i v a c y as a b o u n d a r y is i n c l u d e d i n A l t m a n ' s (1974) d e f i n i t i o n o f p r i v a c y as " the se lec t i ve c o n t r o l o v e r access to the se l f o r to one 's g r o u p " (p.6) . T h i s d e f i n i t i o n a lso has p a r t i c u l a r r e l e v a n c e to the s tudy o f l o n g t e r m ca re res iden ts ' p e r c e p t i o n o f p r i v a c y s ince i t i n c l u d e s b o t h i n d i v i d u a l s a n d g roups i n v o l v e d i n the p u r s u i t o f p r i vacy . I n th is study, res iden ts p r e s e n t e d p r i vacy as a d i a l e c t i c b o u n d a r y i n v o l v i n g the o p p o s i n g fo rces o f i n t e r p e r s o n a l con tac t a n d so l i t ude . T h i s v i e w o f p r i v a c y as i n v o l v i n g b o t h access to a n d res t r i c t i on f r o m o thers d i f fe rs f r o m t r a d i t i o n a l wr i t i ngs o n p r i vacy w h i c h p resen t p r i vacy m e r e l y as a p rocess o f w i t h d r a w a l o r s e c l u s i o n . F o r e x a m p l e , the f o u r states o f p r i vacy d e s c r i b e d by W e s t i n (1968) a n d c i t ed i n chap te r two a l l i n v o l v e s o m e f o r m o f a v o i d a n c e f r o m u n d e s i r e d i n t r u s i o n e i t he r b y p h y s i c a l o r p s y c h o l o g i c a l m e a n s . H o w e v e r , suppo r t f o r the d i a l ec t i c na tu re o f p r i vacy is f o u n d i n the l i t e ra tu re . A c c o r d i n g to S i m m e l (1971) : W e b e c o m e w h a t w e are no t on l y by es tab l i sh ing b o u n d a r i e s a r o u n d ou rse l ves bu t a lso by a p e r i o d i c o p e n i n g o f these b o u n d a r i e s to n o u r i s h m e n t , to l e a r n i n g , a n d to i n t i m a c y (p. 81) . T h i s d e f i n i t i o n suppor ts A l t a i a n ' s (1974) v i e w that a d e s i r e d a m o u n t o f p r i vacy va r i es f r o m b e i n g access ib le to o thers to w a n t i n g to b e to ta l l y a l o n e . It a lso suppor t s the desc r i p t i ons o f p r i vacy a m o n g the pa r t i c i pan ts o f th is study. F u n c t i o n s o f P r i v a c y T h e f o l l o w i n g s e c t i o n d iscusses the p r e d o m i n a n t f unc t i ons o f p r i v a c y as p e r c e i v e d by the pa r t i c i pan ts . M i n o r t hemes r e l a t e d to the p r e d o m i n a n t t h e m e o f p r o t e c t e d exp ress ion o f se l f a re i d e n t i f i e d a n d d i scussed . P r o t e c t e d E x p r e s s i o n o f S e l f T h e f o l l o w i n g d i scuss i on p resents the p r i m a r y t h e m e r e l a t e d to the f unc t i ons o f p r i v a c y as p e r c e i v e d b y the pa r t i c i pan ts . P r e d o m i n a n t a m o n g the accoun ts o f p r i vacy ' s f unc t i ons was the o p p o r t u n i t y a f f o r d e d a n i n d i v i d u a l to f e n d o f f p e r c e i v e d v i o l a t i o n o f the d o m a i n o f i n d i v i d u a l i t y o r ident i t y . T y p i c a l l y , pa r t i c i pan t s p e r c e i v e d loss o f p r i v a c y as a v i o l a t i o n o f one ' s sense o f w e l l b e i n g , f e e l i n g e x p o s e d o r n a k e d to the w o r l d o r b e i n g r o b b e d o f a pa r t o f one ' s sense o f self . V i o l a t i o n o f p r i vacy was c o m m o n l y a p p r a i s e d i n te rms o f l a c k o f o p p o r t u n i t y f o r the e x p r e s s i o n o f e m o t i o n s a n d fee l ings . L e t ' s see...I guess I c a n t h i n k o f t imes w h e n I've n e e d e d to b l o w o f f s t e a m o r have a g o o d cry a n d I n e e d e d to d o jus t that - jus t b e b y m y s e l f u n t i l I c o u l d get c o n t r o l o f m y s e l f - no t that there 's a n y t h i n g s h a m e f u l a b o u t sha r i ng y o u r tears o r anger w i t h s o m e o n e e l se , bu t I w o u l d have b e e n e m b a r r a s s e d to act that w a y i n f ron t o f o the rs . I suppose i n that w a y p r i v a c y goes b o t h ways - I p r e s e r v e m y d ign i ty b y re t rea t i ng u p h e r e a n d I don ' t e m b a r r a s s o the rs i n the p rocess . O r i f I 'm angry o r sad a n d I n e e d to get i t ou t , I don ' t have to l o o k l i k e a r a v i n g w o m a n i n f ron t o f v i r t u a l s t rangers . I b e l i e v e that h a v i n g p r i vacy he lps y o u p r e s e r v e s o m e p e r s o n a l d ign i ty . W h e n o thers respec t y o u r p r i vacy they a re s h o w i n g respec t f o r y o u as a p e r s o n . E x p r e s s i o n o f fee l ings o r e m o t i o n s was r e p e a t e d l y d i scussed by pa r t i c i pan t s no t on l y i n so l i t ude bu t a l so i n the p r e s e n c e o f o thers p e r c e i v e d as con f i dan ts , c lose f r i ends o r f a m i l y m e m b e r s . Y o u k n o w , w h e n I recen t l y los t a d e a r f r i e n d a n d was g r i e v i n g so , i t w a s w o n d e r f u l to have a m u t u a l f r i e n d v is i t m e i n m y o w n r o o m a n d sha re o u r m e m o r i e s a n d tears . G o o d n e s s , I c o u l d n ' t h a v e d o n e that d o w n i n the l o b b y w i t h eve ryone abou t . A n d y o u k n o w , i t r e m i n d e d m e o f h o w m u c h o f m y pe rsona l i t y h a d b e e n m o l d e d by h e r a n d h o w g ra te fu l I was to have g r o w n as a p e r s o n b e c a u s e o f he r . T h e f o l l o w i n g t ransc r ip t ou t l i nes p r i vacy ' s f u n c t i o n as e n a b l i n g o n e to express e m o t i o n s a n d a l so is assoc ia ted w i t h a n o p p o r t u n i t y f o r se l f - eva l ua t i on a n d i n t i m a c y w h i c h was m e n t i o n e d by a d d i t i o n a l res iden ts . I c o m e u p h e r e a n d t r ave l i n m y m i n d . I t h i nk b a c k o v e r m y e igh ty -p lus years o f l i v i ng a n d ta l l y u p m y a c c o m p l i s h m e n t s , m y asp i ra t i ons a n d I th ink , w e l l , i t 's b e e n a f u l l a n d e n r i c h i n g l i fe I've l e d . It 's i m p o r t a n t to a c k n o w l e d g e the g o o d th ings a n d m a k e p e a c e w i t h the so r row . P r i v a t e t imes l i k e that r e a f f i r m w h o I a m . N o o n e e lse has l e d m y l i fe o r l i v e d m y m e m o r i e s bu t m e . T h e p e r c e p t i o n that p r i v a c y is necessary f o r i n t i m a c y i n p e r s o n a l r e l a t i ons f i nds suppo r t i n the w o r k o f seve ra l au tho rs . B e n n (1971) con tends that p e r s o n a l r e l a t i ons a re exp lo ra to r y a n d c rea t i ve a n d r e q u i r e c o n t i n u o u s ad jus tmen t as the pe rsona l i t i e s o f the pa r t i es a re " m o d i f i e d b y e x p e r i e n c e , b o t h o f o n e a n o t h e r a n d o f t he i r ex te rna l e n v i r o n m e n t " (p. 17). S u c h r e l a t i onsh ips , a re , i n the i r na tu re p r i va te a n d c o u l d no t exist i f i t w e r e no t p o s s i b l e to c rea te e x c l u d i n g cond i t i ons . T h e a u t h o r c o n c l u d e s that i f p e r s o n a l r e l a t i o n s a re v a l u e d , t h e n o n e mus t r e c o g n i z e t h e m at leas t as spec i f i ca l l y p r i va te a reas . A n o t h e r m e a n s o f e x p r e s s i o n o f one ' s sense o f se l f o r i nd i v i dua l i t y e n h a n c e d by the a t t a i nmen t o f p r i vacy was i d e n t i f i e d b y a l l pa r t i c i pan ts . E a c h p a r t i c i p a n t r e c o u n t e d the r e l a t i o n s h i p b e t w e e n p r i v a c y a n d the o p p o r t u n i t y to p u r s u e r e c r e a t i o n a l ac t iv i t ies o r h o b b i e s . S ta temen ts w e r e f r equen t l y m a d e that exp ressed the i m p o r t a n c e o f m a i n t a i n i n g a n in te res t i n a va r ie t y o f ac t iv i t ies that c o u l d s t i l l p r o v i d e p l e a s u r e desp i te any p e r c e i v e d p h y s i c a l l i m i t a t i o n s o r the res t r i c t ions i m p o s e d by i n s t i t u t i o n a l i z e d Hy ing a c c o m m o d a t i o n s . S i n c e I've b e e n b a c k at the l o d g e th is t i m e , I've h a d the o p p o r t u n i t y to resur rec t m y b r i dge p l a y i n g . O n e t i m e , I h a d two tab les o f b r i d g e d o w n at the e n d o f the h a l l a n d the m a n a g e m e n t w e r e very , ve ry g o o d a b o u t it. T h e y gave us space to b e away f r o m the o the r res iden ts a n d m y o l d f r i ends a l l c a m e a n d b r o u g h t the re f reshmen ts . I've a lways b e e n k n o w n fo r m y e n t h u s i a s m fo r b r i d g e - m y ta len t w e w o n ' t d iscuss a n d i t r ea l l y m a d e m e f e e l g o o d that I w o u l d n ' t h a v e to g ive it u p desp i te the fact that I was n o l o n g e r i n m y o l d apa r tmen t . B r i d g e has a lways b e e n i m p o r t a n t to m e . H a v i n g p r i vacy m e a n s I c a n c o m e u p h e r e a n d r e a d the B i b l e w h i c h he lps m e to get i n t o u c h w i t h m y s e l f a n d r ea f f i rms w h o I a m a n d w h e r e I f i t i n the l a rge r p i c t u r e . T h e r e a re o the r th ings I've en joyed d o i n g i n the past , m o r e p h y s i c a l ac t iv i t ies b u t I 'm s l o w i n g d o w n a n d h a v e g i v e n those u p bu t I've a lways b e e n a r e a d e r a n d i f I cou ldn ' t d o that a n y m o r e , w e l l , I'd b e at a loss. A n d y o u de f in i t e l y n e e d p r i vacy to r e a d a b o o k o r c o n t e m p l a t e the teach ings i n the B i b l e . T h e i d e n t i f i c a t i o n o f p r o t e c t i o n o f p e r s o n a l i den t i t y o r i n d i v i d u a l i t y as a m a j o r t h e m e r e l a t e d to p r i vacy ' s , f unc t i ons is c i t ed i n the w o r k o f seve ra l au tho rs ( A l t a i a n , 1974; G o f f m a n , 1959; & S c h w a r t z , 1968). W e s t i n (1968) , as c i t e d i n chap te r two , i den t i f i es e m o t i o n a l r e l ease as a n i m p o r t a n t f u n c t i o n o f p r i v a c y w h i c h b o t h p h y s i c a l a n d m e n t a l h e a l t h d e m a n d s i m p l y b e c a u s e o f the stresses i m p o s e d b y soc ie ta l l i v i ng . F r e q u e n t r e fe rences by the pa r t i c i pan ts r e g a r d i n g the n e e d fo r e m o t i o n a l r e l ease f r o m the s t i m u l a t i o n p resen t i n the fac i l i t y w e r e n o t e d by th is au tho r . W h i l e the o p p o r t u n i t y f o r expe r i ences i n v o l v i n g s o c i a l i z a t i o n a n d act iv i ty w e r e d e s i r e d a n d sought by the res iden ts , e a c h p a r t i c i p a n t c l ea r l y s ta ted the n e e d fo r p e r i o d i c resp i te f r o m o v e r s t i m u l a t i o n . W e s t i n (1968) re la tes th is n e e d fo r resp i te w i t h a c h a n g e i n the p a c e o f one 's da i l y ac t iv i t ies that a l l o w fo r r e n e w e d " soc i a l engagemen t " (p. 35) . W e s t i n a l so m a k e s r e f e r e n c e to i n t i m a c y bu t as a state o f p r i v a c y r a the r t h a n a f u n c t i o n as was p e r c e i v e d b y the res iden ts i n this study. I n i n t i m a c y , any i n d i v i d u a l is p a r t i c i p a t i n g i n pa r t o f a s m a l l un i t b a s e d o n s e c l u s i o n . E x a m p l e s i n v o l v e any c lose r e l a t i o n s h i p b e t w e e n two o r m o r e i n d i v i d u a l s such as f a m i l i e s , spouses a n d f r i ends . A n o t h e r aspec t o f re lease n o t e d by W e s t i n (1968) is the sa fe ty -va lve f u n c t i o n o f p r i vacy . T h i s aspec t o f re lease o r e x p r e s s i o n has p a r t i c u l a r r e l e v a n c e fo r res iden ts i n i n s t i t u t i o n a l i z e d h e a l t h ca re set t ings s ince i t re la tes to the e x p r e s s i o n o f e m o t i o n s against a p e r c e i v e d au tho r i t y w i t h o u t f ea r o f r e p r i s a l o r r e c r i m i n a t i o n fo r such ac t ions . I n the cu r ren t s tudy, c o m m e n t s i n two t ranscr ip ts w e r e n o t e d that s u p p o r t e d th is sa fe ty -va lve f u n c t i o n a n d s e r v e d as a m e a n s o f p r e s e r v i n g one 's d ign i t y a n d se l f - respec t w h i l e c o n c u r r e n t l y a l l o w i n g fo r e m o t i o n a l re l ie f . B l o c h (1970) desc r ibes a m o d e l o f r e l a t i onsh ips b a s e d o n layers o f p r i v a c y l e a d i n g to the c o r e o f the i n n e r se l f w i t h e a c h d e n o t i n g d e c r e a s i n g p r i v a c y f r o m the i n n e r to the ou te r layers . T h e c e n t r a l c o r e rep resen ts the m o s t p e r s o n a l aspects o f a n i n d i v i d u a l that a re r a r e l y s h a r e d excep t w i t h i n t ima tes o r d u r i n g s t ress fu l p e r i o d s w h e n , a n i n d i v i d u a l seeks e m o t i o n a l re l ie f . C o n v e r s e l y , the o u t e r m o s t l aye r represen ts casua l c o m m u n i c a t i o n o b s e r v a b l e to the ou t s i de w o r l d . S i m i l a r l y , G o f f m a n (1959) u s e d the t e r m "backs tage" to s ign i fy a n a r e a no t p r e s e n t e d to o thers o r a n a u d i e n c e . It is i n this a r e a that b e h a v i o u r d e s c r i b e d as i n t i m a t e is f o u n d . G o f f m a n (1959) , a theor i s t o n i n t e r p e r s o n a l r e l a t i onsh ips , c l a i m s that e a c h p e r s o n is l i k e a n ac to r i n v o l v e d i n p e r f o r m i n g a n e v e r c h a n g i n g n u m b e r a n d var ie ty o f r o l es d e p e n d i n g o n h is a u d i e n c e a n d s o c i a l se t t ing . T h e p l a y i n g o f these ro les genera tes t e n s i o n w h i c h mus t b e r e l i e v e d p e r i o d i c a l l y . E a c h p e r s o n m u s t have the o p p o r t u n i t y to t e m p o r a r i l y f o rego the d e m a n d s r e q u i r e d o f any g i v e n r o l e a n d b e c o m e onese l f . T h e s e p e r i o d s o f t e m p o r a r y resp i te , h e t heo r i zes , m a y b e r e a l i z e d no t on l y i n so l i t ude b u t i n the c o m p a n y o f f r i ends o r f a m i l y o r i n a state o f rese rve i n a g r o u p set t ing . T h i s s ta tement is s u p p o r t e d by this s tudy 's t ranscr ip ts w h i c h r e v e a l a va r i e t y o f c i r cums tances w h e r e res iden ts o b t a i n p r i vacy . F a c t o r s A f f e c t i n g P r i v a c y T h i s nex t s e c t i o n re la tes two p e r s o n a l a n d p h y s i c a l fac to rs i n the i ns t i t u t i ona l e n v i r o n m e n t that i m p a c t o n p r i vacy . T h e s e i n c l u d e : n u r s i n g staf f a t t i tudes a n d b e h a v i o u r s ar id ava i l ab i l i t y o f a n d access to p r i va te r o o m a c c o m m o d a t i o n . N u r s i n g S ta f f A t t i t u d e s a n d B e h a v i o u r s R e g a r d l e s s o f h o w pa r t i c i pan ts r e l a t e d the fac to rs i n f l u e n c i n g p r i vacy i n a l o n g t e r m ca re fac i l i t y set t ing, the p r e v a i l i n g t h e m e o f th is p o r t i o n o f the i r accoun ts was the i m p a c t that nu r s i ng p e r s o n n e l h a d o n t h e m i n a t t a i n i ng a n d m a i n t a i n i n g p r i vacy . T h e p r e v a i l i n g a t t i tude was that the t r ea tmen t p r o v i d e d b y n u r s i n g ca re staf f was c r u c i a l i n a c h i e v i n g d e s i r e d leve ls o f p r i vacy i n the i r day - to -day l i v i n g i n the fac i l i t y . T h e staf f g ive y o u the o p p o r t u n i t y to b e en t i re l y a l o n e . I f y o u w a n t any th ing , y o u ask downs ta i rs , o the rw ise , they l e a v e y o u a l o n e . T h e y usua l l y c o m e i n last t h i ng at n igh t to see y o u a re a l r igh t a n d c o m e i n a r o u n d six i n the m o r n i n g jus t b e f o r e b reak fas t . B u t they n e v e r s p e a k to y o u , b u t I 'm usua l l y a w a k e a n d h e a r t h e m c o m e i n . T h a t is no t a n i n v a s i o n o f p r i vacy . T h e r e is n o o n e f o r c i n g y o u to d o any th i ng - h e r e y o u d o pre t ty m u c h w h a t y o u w a n t to d o , so I h a v e m y p r i vacy . W e c a n have l i q u o r i n o u r r o o m s a n d the staf f a re f i ne a b o u t that , bu t i f y o u w e r e to get d r u n k a n d b o t h e r o the rs , w e l l , t h e n they 'd h a v e to pu t s o m e res t r i c t i ons o n y o u f o r y o u r o w n sake a n d the sake o f o thers a n d I a p p r e c i a t e that . T h i s p a r t i c i p a n t p e r c e i v e d that the staf f r e c o g n i z e d h e r n e e d fo r p r i vacy by a l l o w i n g so l i t ude a n d p e r s o n a l c h o i c e . T h e r e f e r e n c e to the n igh t l y m o n i t o r i n g fo r the p u r p o s e o f safety was no t p e r c e i v e d as a n i n v a s i o n o f p r i vacy . T w o o the r r esponden ts s im i l a r l y d e n i e d s u c h a n i n v a s i o n o f p r i vacy a n d i n f o r m e d the r e s e a r c h e r that i f such m o n i t o r i n g was c o n s i d e r e d o b j e c t i o n a b l e to a res iden t , t h e n th is p r o c e d u r e c o u l d b e m o d i f i e d o r a b a n d o n e d . T h e f o l l o w i n g excerpts re i te ra te the i n f l u e n c e o f staf f b e h a v i o u r o n p e r c e i v e d p r i vacy : H a v i n g l i v e d i n m y o w n h o m e fo r so l o n g , I w o r r i e d a b o u t a l l the ru l es a n d regu la t i ons i n a n u r s i n g h o m e a n d h o w I w o u l d m a n a g e to f i t i n . I 'm so u s e d to b e i n g i n c o n t r o l , t h o u g h I mus t a d m i t that m y m issus was the boss o v e r h o u s e h o l d mat te rs . I d i dn ' t t h i n k I c o u l d accep t o thers t e l l i ng m e w h a t to d o , bu t I d o have c o n t r o l a n d p r i vacy h e r e a n d that 's i m p o r t a n t to m e . I guess that 's a pa r t o f p r i vacy . I p re t ty m u c h d o as l i t t le o r as m u c h as I p l e a s e . T h e y respec t that he re . Y o u can ' t go a r o u n d t e l l i ng s o m e o n e to j o i n th is o r t e l l us tha t o r e a c h s u c h a n d s u c h . T h e y a lways k n o c k o n the d o o r a n d I l i k e the i d e a o f s o m e o n e k e e p i n g a n eye o n y o u . I expec t t h e m to c h e c k o n m e . T h e y have so m a n y th ings h e r e to pu t i n y o u r t i m e a n d the staf f a lways k e e p us i n f o r m e d o f t h e m , bu t y o u n e v e r f e e l f o r c e d to t ake par t . H e r e y o u h a v e s u p e r v i s i o n bu t f r e e d o m , respec t a n d p r i vacy f r o m a l l t he staff. T h e y a re the ones w h o rea l l y set the tone . O r g a n i z a t i o n theo ry l i t e ra tu re asserts that h u m a n b e h a v i o u r is d e t e r m i n e d i n p a r t b y the ru les , ro les a n d respons ib i l i t i es w h i c h c h a r a c t e r i z e the g roups to w h i c h p e o p l e b e l o n g . L a w t o n (1972) c o n f i r m s the n o t i o n that the f u n c t i o n a l l y i m p a i r e d e l d e r l y w h o l i ve i n she l t e red ca re set t ings m a y b e p a r t i c u l a r l y suscep t i b le to such e n v i r o n m e n t a l i n f l uences a n d repo r t s that c e r t a i n p o l i c y a n d p r o g r a m charac te r i s t i cs , s u c h as the p r o v i s i o n o f p r i vacy a n d the extent o f e n v i r o n m e n t a l c h o i c e a n d c o n t r o l d o af fect s u c h res iden ts . T h e t ranscr ip ts ce r ta in l y address such e t h i c a l issues w i t h l o n g t e r m ca re . T h e re fe rences to p r i vacy versus safety p o i n t ou t the d i l e m m a o f w h e t h e r the s e l f - d e t e r m i n a t i o n o f the e lde r l y , i n th is case p r i vacy , o r the dec i s i ons a n d s tandards o f ca reg ive rs have p r io r i t y . E v i d e n t i n the t ranscr ip ts is the v a l u e that c o n t r o l o v e r aspects o f da i l y l i v i ng , such as p r i vacy , has fo r e a c h o f the pa r t i c i pan ts . T h e i m p o r t a n c e o f p r i vacy fo r the i n s t i t u t i o n a l i z e d e l de r l y has suppo r t i n m o r e recen t l i t e ra tu re . A cha r te r o f r ights a n d f r e e d o m s fo r e l de r l y pe rsons i n fac i l i t y ca re ( R e s i d e n c e Y v o n - B r u n e t , 1984) i nc l udes the r igh t to p r i vacy as o n e o f f i ve m a j o r r ights to b e u p h e l d b y nu r s i ng h o m e staff. T h e spec i f i c g u i d e l i n e s d ic ta te m a n y t hemes o f p r i vacy n o t e d by the pa r t i c i pan t s i n the cu r ren t s tudy. T h e y i n c l u d e : c o n t r o l o v e r access to one ' s r o o m , the ab i l i t y to h a v e u n i n t e r r u p t e d conve rsa t i ons , o w n e r s h i p o f p e r s o n a l p rope r t y , the r ight to b e a l o n e , con f i den t i a l i t y a n d the r igh t to m a n a g e one ' s f i nances . I n the n u r s i n g l i t e ra tu re , S t o r c h (1982) conveys the r o l e that n u r s i n g staf f p l a y i n s u p p o r t i n g a res iden t ' s p r i vacy a n d be l i eves that i n c r e a s e d p r i v a c y f o r the e l d e r l y is a g o a l that nurses s h o u l d w o r k t o w a r d . W h i l e a c k n o w l e d g i n g that the i ns t i t u t i ona l se t t ing m a y b e no t a lways b e c o n d u c i v e to p r i vacy , th is a u t h o r be l i eves that nurses c a n " f i nd i n n o v a t i v e ways to c rea te g rea te r p r i vacy " (p. 148) a n d have the capac i t y to r e a l i z e n e e d e d changes i n i ns t i t u t i ona l p o l i c i e s a f fec t ing p r i vacy . A v a i l a b i l i t y o f a n d A c c e s s to P r i v a t e R o o m A c c o m m o d a t i o n T h e s e c o n d p r e v a i l i n g fac to r a f fec t ing p r i vacy is r e p r e s e n t e d by ava i l ab i l i t y a n d access to p r i va te r o o m a c c o m m o d a t i o n . T h e responden ts u n a n i m o u s l y v o i c e d the i r des i re f o r a p r i va te r o o m p r i o r to en te r i ng the fac i l i t y a n d s ta ted that h a v i n g such a c c o m m o d a t i o n i m p a c t e d pos i t i ve l y o n t he i r ab i l i t y to secu re a d e s i r e d l e v e l o f p r i vacy . It is ve ry i m p o r t a n t to have y o u r o w n r o o m . I n a p l a c e l i k e th is w h e n y o u ' r e i ns i de m o s t o f the day s u r r o u n d e d by h u n d r e d s o f p e o p l e , i t w o u l d s e n d m e c razy to h a v e s o m e o n e i n h e r e a l l day . I c a n c lose the d o o r a n d b e myse l f . I have p r i vacy i n m y r o o m b e c a u s e I d o as I p l ease - I don ' t h a v e to b o t h e r w i t h a n y o n e e lse 's ques t i ons o r conve rsa t i ons i f I don ' t wan t to . H a v i n g m y o w n r o o m m e a n s I don ' t h a v e s o m e b o d y e lse w i t h m e w h e n I 'm ge t t ing d ressed o r r e a d i n g o r n e e d i n g to b e qu ie t a n d that 's w o n d e r f u l . W h e n I n e e d the c o m p a n y , I jus t o p e n the d o o r a n d I 'm sure to f i n d a p a r t n e r f o r a cha t o r s o m e ou t i ng . I jus t w a n t m y o w n r o o m w h e r e I c a n c o m e a n d go as I w a n t o r h a v e s o m e b o d y i n as I w a n t a n d no t w o r r y abou t anyone e lse . S e v e r a l r esponden t s s u p p l i e d a d d i t i o n a l c o m m e n t s r e l a t i n g to the i m p o r t a n c e o f h a v e a p r i va te r o o m f u r n i s h e d w i t h p e r s o n a l possess ions . W e l l , h a v i n g a r o o m to you rse l f m e a n s y o u have p r i v a c y b e c a u s e y o u c a n get away f r o m it a l l a n d i t m e a n s that the f u rn i t u re a n d k n i c k k n a c k s have m e a n i n g to m e b e c a u s e they a re a l l m i n e - n o o n e e lse has a r o o m qu i te l i k e m i n e just b e c a u s e o f that . E a c h p i e c e h o l d s a m e m o r y k n o w n on l y to m e a n d that m a k e s m e f ee l g o o d a n d I chose w h e r e eve ry th ing w o u l d b e p l a c e d - l i k e w h e r e m y p i c tu res w o u l d h a n g a n d such . R e s e a r c h r e l a t e d to e n v i r o n m e n t a l psycho logy c o r r o b o r a t e s the i m p o r t a n c e o f a p e r s o n a l space i n p r o v i d i n g p r i vacy a n d m a i n t a i n i n g a p e r s o n ' s w e l l b e i n g . C a r r o l l a n d B r u e (1988) c o n t e n d that a l l res iden ts o f a l o n g t e r m ca re fac i l i t y n e e d the i r o w n p e r s o n a l space that p r o v i d e s a sense o f p r i v a c y a n d o w n e r s h i p o v e r one ' s su r round ings . T h i s i n c l u d e s the c h o i c e ove r the p l a c e m e n t a n d s e l e c t i o n o f p e r s o n a l ef fects a n d f u rn i t u re w h e n e v e r p o s s i b l e . T h e y e m p h a s i z e the res iden ts ' p e r c e p t i o n s that the l o n g t e r m ca re e n v i r o n m e n t s h o u l d b e u s e d to p r o v i d e secur i ty a n d p r i vacy , w h i l e m a x i m i z i n g the p e r s o n ' s ab i l i t i es a n d comfo r t . A s o f t en as p o s s i b l e , i n p u t f r o m the res iden ts s h o u l d b e o b t a i n e d , r espec ted a n d ac ted u p o n . T h e r e f e r e n c e to res iden ts ' cho i ces a n d c o n t r o l is cong ruen t w i t h p e r c e p t i o n s o f p r i v a c y s o l i c i t e d i n the cu r ren t study. T h e des i re f o r p r i va te r o o m a c c o m m o d a t i o n is a l so a d d r e s s e d i n the l i t e ra tu re . R o o s a (1979) a n d L a w t o n a n d B a d e r (1970) a l so u n d e r s c o r e the i m p o r t a n c e o f a p r i va te p l a c e that c a n b e u s e d fo r p r i vacy . T h e i r f i nd ings r e v e a l that res iden ts a lmos t u n a n i m o u s l y s ta ted that the i r o w n r o o m was the p l a c e to h a v e p r i vacy w h e n i t was d e s i r e d a n d that r esponden t s i n s e m i -p r i v a t e r o o m s w a n t e d p r i va te r o o m s . L i k e w i s e , o the r au tho rs ( F i r e s t o n e , L i c h t m a n a n d E v a n s , 1980) i n d i c a t e that w a r d res iden ts i n a l o n g t e r m ca re fac i l i t y i n d i c a t e a p e r c e i v e d l a c k o f p r i vacy a n d p l a c e to b e a l o n e . T h e y a re a l so less success fu l k e e p i n g o thers ou t o f t he i r p e r s o n a l a r e a a n d express m o r e c o n c e r n s a b o u t the ac t ions o f o thers t h a n s ing le r o o m responden ts . A r e l a t e d s tudy ( R y d e n , 1984) c o n c l u d e s that p e r c e i v e d c o n t r o l o v e r the i ns t i t u t i ona l e n v i r o n m e n t by its e l de r l y res iden ts is the o n l y s ign i f i can t v a r i a b l e that has a d i rec t a n d pos i t i ve ef fect o n res iden ts ' m o r a l e . S i m i l a r l y , i n the cu r ren t s tudy, the re is a n obv ious p e r c e p t i o n that h a v i n g c h o i c e ove r one ' s r o o m a c c o m m o d a t i o n a n d its con ten ts is i m p o r t a n t a n d d e s i r e a b l e . T h e C e n t r a l T h e m e o f A u t o n o m y B e f o r e c o n c l u d i n g th is chap te r ' s p r e s e n t a t i o n a n d d i s c u s s i o n o f the f i nd ings , i t is necessary to o u t l i n e the i m p o r t a n c e o f the e t h i c a l p r i n c i p l e a u t o n o m y w h i c h was a c e n t r a l f ocus fo r the res iden ts ' p e r c e p t i o n s o f p r i vacy i n a l o n g t e r m ca re fac i l i t y set t ing. T h e c o n c e p t p e r v a d e d the res iden ts ' de f i n i t i ons o f p r i vacy , the func t i ons o f p r i vacy a n d las t ly the fac to rs a f fec t i ng p r i vacy . I n o r d e r to re la te the s ign i f i cance o f th is e t h i c a l p r i n c i p l e to the cu r ren t r e s e a r c h , c i ta t ions f r o m the l i t e ra tu re w i l l b e p r e s e n t e d . I n g e n e r a l , e t h i c a l p r i n c i p l e s m a y b e v i e w e d as g o v e r n i n g laws o f conduc t , "as codes o f c o n d u c t by w h i c h o n e d i rec ts one ' s l i f e o r ac t ions , o r as g e n e r a l i z a t i o n s that p r o v i d e a bas is f o r r e a s o n i n g " ( D a v i s & A r o s k a r , 1983, p. 40 ) . O n e m a j o r e t h i c a l p r i n c i p l e that is p a r t i c u l a r l y r e l evan t to the pa r t i c i pan t s ' accoun ts is a u t o n o m y . A u t o n o m y , c o n s i d e r e d by s o m e p h i l o s o p h e r s as the m o s t i m p o r t a n t m o r a l v a l u e o r t he v a l u e o n e s h o u l d p rese rve e v e n at the r i sk o f o t he r va lues , is c o m m o n l y r e f e r r e d to as the p r i n c i p l e o f respec t f o r pe rsons , a n d d i rec ts o n e to see i n d i v i d u a l s as u n c o n d i t i o n a l l y w o r t h y agents w i t h a capac i t y f o r r a t i o n a l c h o i c e ( B e a u c h a m p , 1982, p. 26 ) . A c c o r d i n g to th is p r i n c i p l e , i n o r d e r to b e a u t o n o m o u s , i n d i v i d u a l s m u s t b e f ree o f ex te rna l c o n t r o l a n d i n c o n t r o l o f t he i r o w n a f fa i rs . T o respec t the a u t o n o m y o f o thers , o n e mus t r e c o g n i z e a n d accep t t h e m as en t i t l ed to d e t e r m i n e the i r o w n dest iny . A u t o n o m y a l so i m p l i e s that o n e acts f ree ly a n d engages i n vo l un ta r y a n d i n t e n t i o n a l acts i n a m a n n e r cons is ten t w i t h one ' s o w n va lues . W e s t i n (1968) as p r e v i o u s l y n o t e d i n chap te r two , des igna tes p e r s o n a l a u t o n o m y as the f i rst f u n c t i o n that p r i vacy serves fo r i n d i v i d u a l s , A c c o r d i n g to W e s t i n , p e r s o n a l a u t o n o m y is r e f e r r e d to as a pe rson ' s sense o f in tegr i ty a n d i n d e p e n d e n c e a n d h is ab i l i t y to a v o i d b e i n g m a n i p u l a t e d b y o thers . U s i n g th is theory , p r i v a c y is i nex t r i cab l y l i n k e d w i t h a u t o n o m y s ince p r i vacy rep resen ts a ser ies o f zones l e a d i n g to the se l f w h i c h i f p e n e t r a t e d e i t he r by p h y s i c a l o r p s y c h o l o g i c a l m e a n s poses a se r ious th rea t to a n i n d i v i d u a l ' s a u t o n o m y o r i nd i v i dua l i t y . F u r t h e r , a loss o f one ' s "p ro tec t i ve s h e l l " (p. 33) r e n d e r ' s o n e v u l n e r a b l e to the c o n t r o l o f o thers w h o en te r the i n n e r co re a n d l e a r n h is u l t i m a t e secrets . W e s t i n ' s wr i t i ngs l e n d suppo r t to p r i vacy as p e r c e i v e d by pa r t i c i pan ts i n th is s tudy s ince the des i re to a v o i d b e i n g m a n i p u l a t e d , c o n t r o l l e d o r d o m i n a t e d b y o thers was c l ea r l y a n d repea ted l y a r t i c u l a t e d i n the i n i t i a l t ranscr ip ts a n d t h e n v a l i d a t e d d u r i n g s e c o n d r o u n d in te rv iews . Y o u n g (1965) p u r p o r t s that the a u t o n o m y that p r i v a c y p ro tec ts i s essen t i a l f o r f os te r i ng i nd i v i dua l i t y a n d i n d i v i d u a l c h o i c e . I n a d d i t i o n , Y o u n g con tends that w i t h o u t p r i vacy there exists n o i n d i v i d u a l i t y s ince n o o n e c a n k n o w w h o h e is i f n e v e r a l l o w e d the oppo r t un i t y to b e a l o n e w i t h h is fee l ings a n d thoughts . T h e p e r c e p t i o n that p r i vacy is r e l a t e d to o n e aspec t o f i n d i v i d u a l i s m , " the des i re to c o n t r o l w h a t is k n o w n (and b y w h o m ) r e g a r d i n g o n e s e l f a n d one ' s ac t i v i t i es " ( P e n n o c k , 1971, p. x i i i ) appea rs i n the l i t e ra tu re as c r u c i a l to the d e v e l o p m e n t o f se l f - respect a n d d ign i ty . T h i s s ta temen t is p a r t i c u l a r l y s u p p o r t i v e o f th is s tudy 's f i nd ings r e g a r d i n g the th rea t to one 's sense o f self-w o r t h w h e n t h e r e is a p e r c e i v e d v i o l a t i o n o f one ' s sense o f p r i vacy . B e n n ' s (1971) g e n e r a l p r i n c i p l e o f p r i vacy p r o v i d e s the bas is f o r the a r g u m e n t that respec t f o r s o m e o n e as a p e r s o n c a p a b l e o f f r e e - w i l l i m p l i e s respec t f o r h i m as a n i n d i v i d u a l e n g a g e d i n a se l f - c rea t i ve en te rp r i se , w h i c h c a n b e d i s r u p t e d , a l t e r e d o r h a l t e d e v e n by so l i m i t e d a n i n t r u s i o n as w a t c h i n g (p. 26 ) . T h i s p e r c e p t i o n o f p r i v a c y is desc r ip t i ve l y c o n g r u e n t w i t h th is s tudy 's f i nd ings r e g a r d i n g the r e l a t i o n s h i p o f p r i v a c y to p e r s o n a l a u t o n o m y . S u m m a r y T h i s chap te r has d e s c r i b e d the e l d e r l y res iden ts w h o p a r t i c i p a t e d i n this s tudy a n d d e s c r i b e d t he i r accoun ts o f p e r c e p t i o n s o f p r i v a c y i n a l o n g t e r m ca re fac i l i t y se t t ing . I n cons t ruc t i ng accoun ts , the w r i t e r w a s g u i d e d by the t h r e e p u r p o s e s o f the s tudy o u t l i n e d i n chap te r o n e . T h e f i rst p u r p o s e o f the s tudy was to e x p l o r e the res iden ts ' de f i n i t i ons o f the t e r m p r i vacy . A s e c o n d p u r p o s e was to d e t e r m i n e the func t i ons o f p r i vacy fo r the res iden ts . T h e t h i r d was to d e s c r i b e p e r s o n a l a n d p h y s i c a l fac to rs i n the i ns t i t u t i ona l e n v i r o n m e n t a f fec t i ng p r i vacy . D a t a c o l l e c t i o n was a lso g u i d e d b y the s tudy 's p u r p o s e s a n d f i nd ings w e r e p r e s e n t e d as desc r i p t i ons o f e a c h p u r p o s e . D i s c u s s i o n was o r g a n i z e d a r o u n d the top ics r ep resen t i ng the c o n c e p t u a l ca tegor ies d e p i c t e d i n the accoun ts a n d p r e v a i l i n g t hemes w e r e i d e n t i f i e d . T h i s chap te r d e s c r i b e d a n d d i scussed the m a j o r f i nd ings r e g a r d i n g p e r c e p t i o n s o f p r i v a c y i n the p resen t study. C r i t i c a l c o m p o n e n t s o f res iden ts ' p e r c e p t i o n s o f p r i v a c y w e r e i d e n t i f i e d a n d c o n s i d e r e d i n d e t a i l . S u p p o r t f o r p a r t i c i p a n t s ' de f i n i t i ons a n d func t i ons o f p r i vacy was gene ra l l y p r o v i d e d by ex is t ing l i t e ra tu re a n d r e s e a r c h . A n e x a m i n a t i o n o f the fac to rs a f fec t ing p r i v a c y i n the cu r ren t s tudy w e r e a lso o u t l i n e d i n the r e v i e w e d l i t e ra tu re . T h e de f i n i t i ons o f p r i vacy d i scussed by the pa r t i c i pan t s w e r e d o m i n a t e d b y the c o m m o n t h e m e o f so l i t ude w h i c h was p e r c e i v e d i n b o t h p s y c h o l o g i c a l a n d p h y s i c a l t e rms a n d d i f f e ren t i a ted f r o m r e l a t e d te rms s u c h as i s o l a t i o n . T w o o the r t hemes , c o n t r o l o f i n f o r m a t i o n access a n d d i sc l osu re a n d b o u n d a r y c o n t r o l p r o v e d to b e s ign i f i can t f i nd ings . T h e s e f i nd ings w e r e c o r r o b o r a t e d w i t h a subs tan t i a l b o d y o f l i t e ra tu re . S u p p o r t f o r the f i nd ings w a s la rge ly p r o v i d e d b y the w o r k o f K e l v i n (1973) , M a r s h a l l (1970) , Schus te r (1972) a n d W e s t i n (1968) . T h e m a j o r f u n c t i o n o f p r i vacy , p r o t e c t e d e x p r e s s i o n o f self , i n c l u d e d m i n o r t h e m e s o f e x p r e s s i o n o f e m o t i o n , se l f - eva l ua t i on a n d i n t i m a c y a n d , o n c e a g a i n , w a s gene ra l l y s u p p o r t e d b y o the r au thors . H o w e v e r , i t is i n te res t i ng to n o t e that f e w e x a m p l e s o f e m p i r i c a l r e s e a r c h w e r e l o c a t e d to address the f unc t i ons o f p r i vacy . R a t h e r , m o s t o f the l i t e ra tu re a v a i l a b l e was b a s e d o n t h e o r e t i c a l o r p h i l o s o p h i c a l a rgumen ts . F a c t o r s a f fec t ing p r i vacy , the i m p a c t o f nu r s i ng staf f b e h a v i o u r s a n d a t t i tudes a n d the ava i l ab i l i t y o f a n d access to p r i va te r o o m a c c o m m o d a t i o n w e r e r e p o r t e d as s ign i f i can t to the pa r t i c i pan ts o f th is s tudy. T h e f o r m e r f i n d i n g w a s a lso r e p o r t e d b y o the r resea rche rs a n d s tud ies b a s e d o n the la t te r fac to rs w e r e a l so l o c a t e d i n the f i e l d o f n u r s i n g a n d e n v i r o n m e n t a l psycho logy . T h e cen t ra l t h e m e o f a u t o n o m y i n the res iden ts ' p e r c e p t i o n s o f p r i v a c y c o n c l u d e d the d i scuss ion . T h e nex t a n d f i n a l chap te r p resen ts a s u m m a r y o f the study. F i n d i n g s , m a j o r c o n c l u s i o n s , i m p l i c a t i o n s a n d r e c o m m e n d a t i o n s c o n c l u d e the chap te r . CHAPTER FIVE Summary, Conclusions and Nursing Implications T h i s chap te r beg ins w i t h a s u m m a r y o f the s tudy r e p o r t e d i n th is thes is . C o n c l u s i o n s resu l t i ng f r o m the study 's f i nd ings a re d r a w n a n d p r e s e n t e d . L a s t l y , i m p l i c a t i o n s f o r n u r s i n g p rac t i ce , e d u c a t i o n a n d r e s e a r c h a re i d e n t i f i e d . Summary T h i s s tudy was d e s i g n e d to e x p l o r e e l de r l y res iden ts ' p e r c e p t i o n s o f p r i v a c y i n a l o n g t e r m ca re fac i l i t y set t ing. T h e resea rche r , as a c o m m u n i t y h e a l t h nu rse i n l o n g t e r m c a r e , n o t e d the r e c u r r i n g c o n c e r n exp ressed b y e l d e r l y res iden ts r e g a r d i n g the concep t o f p r i vacy . A s a resu l t , the r e s e a r c h p r o b l e m was d e e m e d re levan t a n d se lec ted as a bas is f o r th is study. Spec i f i ca l l y , the r e s e a r c h e r sought to iden t i f y a n d desc r i be e l d e r l y res iden ts ' de f i n i t i ons o f p r i vacy , to iden t i f y the func t i ons o f p r i vacy f o r the res iden ts a n d to d e s c r i b e p e r s o n a l a n d p h y s i c a l fac tors i n the i ns t i t u t i ona l e n v i r o n m e n t a f fec t ing p r i vacy . I n f o r m a t i o n a b o u t p r i vacy was n e e d e d to gene ra te k n o w l e d g e w h i c h c o u l d assist nu rses to p r o v i d e ca re to the e l d e r l y p o p u l a t i o n w h i c h is e f fec t i ve a n d c o m p a t i b l e w i t h c l i en ts ' expec ta t ions . T h i s s tudy f ocussed o n p e r c e p t i o n s o f p r i vacy w i t h i n the c o n c e p t u a l f r a m e w o r k o f p e r s o n a l c o n t r o l ( R o t t e r , 1966) w h i c h p r o v i d e d d i r e c t i o n f o r the m e t h o d o l o g i c a l a p p r o a c h a n d the c o d i n g a n d ana lys is o f da ta . T h i s t h e o r e t i c a l p e r s p e c t i v e is c o n c e p t u a l i z e d as a g e n e r a l expec tancy that p red i c t s the extent to w h i c h i n d i v i d u a l s p e r c e i v e a n ab i l i t y to c o n t r o l events a n d c i r cums tances a f fec t i ng t h e m . P e r s o n a l c o n t r o l , as a c o n c e p t c e n t r a l to that o f p r i vacy , m e r i t e d c o n s i d e r a t i o n s ince a n e x a m i n a t i o n o f the m e a n i n g s o f p r i vacy sugges ted a s h a r e d c o r e d e f i n i t i o n w h i c h r e p r e s e n t e d a p e r s o n ' s ab i l i t y to c o n t r o l i n t e rac t i ons w i t h o thers , the u l t i m a t e a i m b e i n g to e n h a n c e a u t o n o m y o r d i m i n i s h v u l n e r a b i l i t y ( M a r g u l i s , 1974). A l i t e ra tu re r e v i e w w a s c o n d u c t e d w h i c h i n c l u d e d s tud ies a n d t h e o r e t i c a l w o r k s e x a m i n i n g the c o n c e p t o f p r i vacy w i t h i n the f i e lds o f nu r s i ng , p h i l o s o p h y , psycho logy a n d o r g a n i z a t i o n a l b e h a v i o u r . T h e rev i ew , h o w e v e r , r e v e a l e d a pauc i t y o f e m p i r i c a l r esea rch d i rec t l y r e l a t e d to the study 's p r o b l e m s ta tement a n d p r o v i d e d m i n i m a l d i r e c t i o n fo r nurses c a r i n g fo r e l de r l y c l ien ts i n a l o n g t e r m ca re fac i l i t y . T h e qua l i t a t i ve m e t h o d o l o g y c h o s e n to c o n d u c t th is s tudy was p h e n o m e n o l o g y . T h i s m e t h o d o l o g y was se lec ted b e c a u s e it focusses o n the q u e s t i o n o f h o w the w o r l d is e x p e r i e n c e d f r o m the i n d i v i d u a l ' s f r a m e o f r e f e r e n c e a n d , t he re fo re , was a p p r o p r i a t e to e x p l o r e the i n s t i t u t i o n a l i z e d e l de r l y pe rson ' s p e r c e p t i o n s o f p r i vacy . T h e s tudy w a s c o n d u c t e d w i t h a n o m i n a t e d s a m p l e o f f o u r w o m e n a n d two m e n cu r ren t l y r e s i d i n g i n a l o n g t e r m ca re fac i l i t y i n V a n c o u v e r . T h e r e s e a r c h e r u s e d a n u n s t r u c t u r e d i n t e r v i e w t e c h n i q u e to co l l ec t da ta . In i t ia l l y , six i n te rv iews w e r e c o n d u c t e d . E a c h i n t e r v i e w was a u d i o - t a p e d a n d t r a n s c r i b e d v e r b a t i m a n d t h e n a n a l y z e d fo r essen t ia l t hemes . O n c e the c o n c e p t u a l t h e m e s w e r e d e t e r m i n e d , the r e s e a r c h e r r e t u r n e d to r e - i n t e r v i ew e a c h p a r t i c i p a n t i n o r d e r to e l a b o r a t e , v a l i d a t e o r re fu te the t hemes . T h e p r e s e n t a t i o n o f the resu l t i ng accoun ts t h e n f o r m e d the d a t a f o r the study. F i n a l ana lys is o f the d a t a was a c c o m p l i s h e d o n c e the s e c o n d r o u n d o f i n te r v i ews w a s c o m p l e t e d a n d d u r i n g the d ra f t i ng o f the s tudy 's f i nd ings . F i n d i n g s D a t a ana lys is r e v e a l e d that the res iden ts w e r e a b l e to d e s c r i b e the i r p e r c e p t i o n s o f p r i v a c y i n a l o n g t e r m ca re set t ing a n d i den t i f y t he i r fee l ings a n d responses to p e r c e i v e d v i o l a t i o n o f d e s i r e d p r i vacy . T h r o u g h a p rocess o f con ten t ana lys is , the accoun ts o f p r i vacy w e r e c a t e g o r i z e d a c c o r d i n g to m a j o r t h e m e s p r e s e n t e d a n d w i t h i n the f r a m e w o r k o f the s tudy 's t h ree m a j o r p u r p o s e s . D a t a ana lys is o f the accoun ts focuss ing o n the d e f i n i t i o n o f p r i vacy r e v e a l e d that a l t h o u g h e a c h e x p e r i e n c e o f p r i vacy was u n i q u e , the d i m e n s i o n o f s o l i t u d e f o r m e d a n i n teg ra l pa r t o f p r i vacy . S o l i t u d e w a s p e r c e i v e d i n b o t h p h y s i o l o g i c a l a n d p s y c h o l o g i c a l t e rms a n d exp ressed i n w o r d s such as "be ing a l o n e " o r "get t ing away f r o m the c r o w d . " A s ign i f i can t f ea tu re o f th is d i m e n s i o n w a s the v i e w o f p r i vacy as v a l u e d , sought a n d p r o t e c t e d by the subjects . R e s i d e n t s w e r e a l so ab le to d i f f e ren t ia te so l i t ude f r o m r e l a t e d t e rms s u c h as i s o l a t i o n s ince so l i t ude was r e g a r d e d as c h o s e n a n d no t i m p o s e d by ex te rna l fo rces . T w o o the r s ign i f i can t t hemes w e r e a l so i n c l u d e d i n the d e f i n i t i o n o f p r i vacy . T h e s e w e r e : c o n t r o l o f i n f o r m a t i o n access a n d d i sc l osu re a n d b o u n d a r y c o n t r o l . T h e m o s t c o m p e l l i n g fea tu re o f these f i nd ings was the i n c l u s i o n o f s o m e aspect o f p e r s o n a l c o n t r o l w h i c h was a lso r e f l e c t e d i n the r e v i e w e d l i t e ra tu re . W i t h i n the a r e a o f res t r i c ted i n f o r m a t i o n exchange the re was a n assoc ia t i on w i t h the v i e w that i t e n c o m p a s s e d a b i -d i r e c t i o n a l na tu re . Spec i f i ca l l y , res iden ts p e r c e i v e d that o thers h a d the s a m e a n d e q u a l r igh t to res t r ic t the f l o w o f i n f o r m a t i o n a b o u t t hemse l ves as they d i d . T h e last t h e m e o f b o u n d a r y c o n t r o l d e s c r i b e d p r i v a c y as a non-s ta t i c p h e n o m e n o n - a cons tan t l y chang ing p rocess i n f l u e n c e d by ou t s i de fo rces . A l s o n o t e d i n the f i nd ings w e r e the func t i ons that p r i vacy p e r f o r m e d fo r the i n d i v i d u a l s . O n e m a j o r f u n c t i o n , p r o t e c t e d e x p r e s s i o n o f self, e n c o m p a s s e d the v a l u e o f one 's ab i l i t y to w a r d o f f p e r c e i v e d v i o l a t i o n o f i n d i v i d u a l i t y o r i den t i t y a n d a f ee l i ng o f w e l l - b e i n g w h e n they c o u l d r e a l i z e th is g o a l . It a l so i n c l u d e d the o p p o r t u n i t y f o r e x p r e s s i o n o f e m o t i o n s , self-e v a l u a t i o n a n d i n t i m a c y i n p e r s o n a l re la t i ons . Sub jec ts a l so i d e n t i f i e d the i m p o r t a n c e o f p u r s u i n g r e c r e a t i o n a l ac t iv i t ies that d e f i n e d the i r i n d i v i d u a l i t y as b e i n g a f fec ted b y p r i vacy . F a c t o r s a f fec t ing the subjects ' ab i l i t y , t o c o n t r o l p r i v a c y i n c l u d e d n u r s i n g ca re s t a f f s a t t i tudes a n d b e h a v i o u r s a n d the ava i l ab i l i t y a n d access to p r i va te r o o m a c c o m m o d a t i o n . It was p e r c e i v e d a m o n g a l l pa r t i c i pan t s that the fac i l i t y s taf f h a d the p r i m a r y i m p a c t u p o n one 's ab i l i t y to a c h i e v e p r i vacy s ince they w e r e the p e o p l e r espons ib l e fo r b o t h i n t e r p r e t i n g a n d c a r r y i n g ou t fac i l i t y p o l i c i e s that i n f l u e n c e p r i vacy s u c h as k n o c k i n g o n one ' s d o o r b e f o r e e n t e r i n g a n d a l l o w i n g res iden t c o n t r o l o v e r p a r t i c i p a t i o n i n fac i l i t y ac t iv i t ies a n d p r o g r a m s . P r i v a c y was a lso p e r c e i v e d as b e i n g m o s t r e a d i l y a c h i e v e d i n the fac i l i t y w h e n o n e was a b l e to access a n d o c c u p y one ' s p r i v a t e r o o m a n d pa r t i c i pan t s h a d exp ressed the i r des i re f o r such a c c o m m o d a t i o n p r i o r to e n t e r i n g the fac i l i t y . Conclusions T h e study 's f i nd ings suggest a n u m b e r o f c o n c l u s i o n s : 1. T h e i n d i v i d u a l s w h o p a r t i c i p a t e d i n th is s tudy w e r e a b l e to d e s c r i b e t he i r p e r c e p t i o n s o f p r i vacy i n a l o n g t e r m ca re fac i l i t y se t t ing . 2. P r i v a c y is v a l u e d , p r o t e c t e d a n d sought by l o n g t e r m care res iden ts . 3 . P r i v a c y is v i e w e d as so l i t ude a n d has b o t h p s y c h o l o g i c a l a n d p h y s i o l o g i c a l d i m e n s i o n s . 4. C o n t r o l ove r c o m m u n i c a t i o n o f i n f o r m a t i o n is a n essen t ia l c o m p o n e n t o f p r i vacy . 5. P r i v a c y is d e s c r i b e d as b e i n g d y n a m i c , i n f l u e n c e d b y ou ts ide fac to rs a n d cons tan t l y chang ing . 6. P r i v a c y rep resen ts the c o n t r o l o f a p e r s o n a l b o u n d a r y that re f lec ts the e x c l u s i o n o r i n c l u s i o n o f o thers such as res iden ts , s taf f a n d f a m i l y m e m b e r s . A s such , i t is a n ac t i ve p rocess i n v o l v i n g the r e g u l a t i o n a n d c o n t r o l o v e r i n f o r m a t i o n a n d is b i - d i r e c t i o n a l i n na tu re - o thers have the s a m e n e e d to c o n t r o l the c o m m u n i c a t i o n o f i n f o r m a t i o n a b o u t t hemse l ves . 7. P r i v a c y p ro tec ts one 's i n d i v i d u a l i t y o r i den t i t y a n d a f fo rds o n e the o p p o r t u n i t y f o r the e x p r e s s i o n o f e m o t i o n s , f o r s e l f - e v a l u a t i o n a n d the m a i n t e n a n c e a n d g r o w t h o f p e r s o n a l re la t i ons . 8. N u r s i n g ca re staf f is the m a j o r e n v i r o n m e n t a l v a r i a b l e i m p a c t i n g o n one ' s ab i l i t y to secu re a n d m a i n t a i n p r i vacy . 9. R e s i d e n t s a re a b l e to eva lua te the i m p o r t a n c e o f p r i vacy i n r e l a t i o n to o the r needs s u c h as safety. 10. R e s i d e n t s p e r c e i v e d that h a v i n g access to a p r i va te r o o m pos i t i ve l y a f fec ted t he i r ab i l i t y to a t ta in a n d m a i n t a i n p r i vacy . Implications for Nursing Practice D a t a f r o m th is s tudy i n v o l v i n g the e lde r l y pe rson ' s p e r c e p t i o n s o f p r i v a c y i n a l o n g t e r m ca re fac i l i t y se t t ing have i m p l i c a t i o n s f o r nurses i n t e rac t i ng w i t h a n d c a r i n g f o r e l d e r l y pa t ien ts . A m a j o r i m p l i c a t i o n g e n e r a t e d f r o m th is s tudy is the n e e d to u n d e r s t a n d the m e a n i n g that l o n g t e r m ca re res iden ts ass ign to the m e a n i n g o f p r i vacy . A n e x a m i n a t i o n o f the res iden ts ' i n d i v i d u a l needs , p e r s o n a l i t y a n d f o r m e r l i fes ty le a n d h o m e e n v i r o n m e n t c o u l d b e c o n d u c t e d u s i n g the n u r s i n g p rocess a n d u s e d to d e v e l o p a ca re p l a n f o r e a c h i n d i v i d u a l . S i n c e a d m i s s i o n to a l o n g t e r m ca re fac i l i t y is o f t e n a n e x p e r i e n c e f raugh t w i t h anx ie ty a n d fear , nurses c a n fac i l i t a te ad jus tmen t b y so l i c i t i ng the res iden t ' s p e r c e p t i o n s o f i n s t i t u t i o n a l i z e d l i v i n g i n a n a t t emp t to u n d e r s t a n d the i n d i v i d u a l ' s p e r s o n a l d e f i n i t i o n a n d n e e d f o r p r i vacy . C l e a r l y , res iden ts n e e d to have c o n t r o l o v e r the fac to rs i n the p h y s i c a l e n v i r o n m e n t s u c h as space that i m p a c t s o n p r i vacy . I f p r i va te r o o m a c c o m m o d a t i o n is a v a i l a b l e , the nu rse c a n ensure that a l l staf f k n o c k b e f o r e e n t e r i n g a res iden t ' s r o o m . I n a d d i t i o n , she c a n assist t he res iden t to f u rn i sh a n d d e c o r a t e the r o o m w i t h p e r s o n a l a n d c h e r i s h e d possess ions . I n fac i l i t i es w h e r e s e m i - p r i v a t e o r w a r d a c c o m m o d a t i o n p r e v a i l , nu rses c a n fac i l i t a te p r i v a c y by l o c a t i n g a l te rna te si tes i n the fac i l i t y w h e r e the res iden t c a n b e a l o n e s u c h as a n a r e a o f the d i n i n g r o o m , l o u n g e o r ha l lway . N u r s i n g adm in i s t r a to r s w h o es tab l i sh a n d i n te rp re t i ns t i t u t i ona l p o l i c y n e e d to b e a w a r e o f those fac tors i n the e n v i r o n m e n t that e n h a n c e p r i vacy . P o l i c i e s s u c h as n igh t l y m o n i t o r i n g mus t b e as f l ex i b l e as p o s s i b l e s ince th is p r i o r i t y m a y b e less i m p o r t a n t to the res iden t t h a n the n e e d fo r p e r i o d s o f c o m p l e t e so l i t ude . T h e a d m i n i s t r a t o r is i n the u n i q u e p o s i t i o n o f b e i n g r e s p o n s i b l e f o r b a l a n c i n g the res iden t ' s n e e d fo r p r i v a c y w i t h the ins t i tu t ion 's m a n d a t e fo r safe ca re . T h e a d m i n i s t r a t o r c a n a lso i n f l u e n c e staf f b e h a v i o u r s a n d a t t i tudes r e g a r d i n g p r i vacy b y s t ress ing its i m p o r t a n c e to m e n t a l a n d p h y s i c a l w e l l - b e i n g . Sta f f n e e d to b e a w a r e that i n d i v i d u a l s ' needs fo r p r i vacy va ry a n d b e sens i t i ve to s igns that a pe rson ' s p r i vacy is b e i n g i n v a d e d , r a the r t h a n l a b e l l i n g a res iden t ' s b e h a v i o u r as a n t i s o c i a l o r m a l a d a p t i v e . S ta f f w h o k n o c k b e f o r e en te r i ng a r o o m assist the c l i en t to c o n t r o l fac to rs i n the e n v i r o n m e n t that af fect p r i vacy a n d respec t a n i n d i v i d u a l ' s n e e d to l i m i t c o m m u n i c a t i o n o f i n f o r m a t i o n . T h i s a c t i o n a l o n e c a n i m p a c t g rea t l y o n a n i nd i v i dua l ' s ab i l i t y to a c h i e v e a d e s i r e d l e v e l o f p r i vacy . A d d i t i o n a l l y , nu rses w h o a re c o n s u l t e d r e g a r d i n g the des ign o f p l a n n e d fac i l i t i es c a n suggest the i n c l u s i o n o f p h y s i c a l cond i t i ons that p e r m i t p r i vacy s u c h as the p r o v i s i o n o f p r i va te r o o m s , a c c o m m o d a t i o n fo r coup les , s m a l l m e e t i n g a reas a n d p r i va te b a t h r o o m s . F i n a l l y , nu rses n e e d to r e a l i z e that fac i l i t i es f o r the e l d e r l y a re usua l l y d e s i g n e d to o p e r a t e o n p r i m a r i l y a g r o u p o r i e n t a t i o n a n d as s u c h d o no t a c c o m m o d a t e the i n d i v i d u a l ' s n e e d fo r respec t o f p r i vacy . E v e r y e f for t mus t t h e n b e t a k e n by nurses to i nc rease the i r sens i t iv i ty to cues p r o v i d e d by e l d e r l y c l i en ts that i nd i ca te a v i o l a t i o n o f p r i vacy . A n e x a m p l e pe r t i nen t to the l o n g t e r m ca re set t ing i nc l udes the occas ions i n v o l v i n g i n t e r v i e w i n g a c l i en t to so l i c i t n e e d e d h e a l t h ca re i n f o r m a t i o n o r d a t a w i t h o u t r e q u i r i n g the i n d i v i d u a l to d i sc lose m o r e i n f o r m a t i o n t h a n h e o r she des i res . Implications for Nursing Education S i n c e e l d e r l y c l ien ts a re e n c o u n t e r e d b y nurses i n a va r ie t y o f set t ings, i t is sugges ted that nurses i n a l l set t ings c o u l d bene f i t f r o m the k n o w l e d g e , sk i l l s a n d ins igh t r e q u i r e d to u n d e r s t a n d the c o n c e p t o f p r i v a c y f o r the e l d e r l y c l i en t . N u r s e s n e e d to b e ab le to so l i c i t a n d iden t i f y the needs a n d w ishes o f the e l d e r l y i n r e g a r d to the p e r c e p t i o n o f p r i vacy . F o r nurses a l r e a d y i n p rac t i ce , i nse rv i ce e d u c a t i o n p r o g r a m s c o u l d convey th is type o f con ten t a n d o f fe r r e l evan t p r a c t i c e expe r i ences to nu rses . F o r s tudents , the c o n c e p t o f p r i v a c y a n d its r e l a t i o n s h i p to the e l d e r l y c o u l d b e i n c l u d e d i n the b a s i c n u r s i n g c u r r i c u l u m . A n oppo r t un i t y to e x p l o r e a n d ana l yze p e r s o n a l expe r i ences w i t h p r i vacy v i o l a t i o n w o u l d a lso b e b e n e f i c i a l . E d u c a t i n g nurses i n the p h i l o s o p h i c a l d i m e n s i o n s o f p r i v a c y such as the p r i n c i p l e o f a u t o n o m y a n d the e t h i c a l d i l e m m a i n v o l v i n g o p p o s i n g issues such as safety ve rsus p r i v a c y w o u l d b e h e l p f u l . T h i s t heo ry c o u l d assist the s tuden t to d e v e l o p sk i l l s i n e t h i c a l r e a s o n i n g a n d d e c i s i o n - m a k i n g . T h e a c q u i s i t i o n o f th is k n o w l e d g e c o u l d t h e n b e a p p l i e d a n d e v a l u a t e d i n a c l i n i c a l p r a c t i c e se t t ing . F o l l o w i n g c l i n i c a l p r a c t i c e sess ions, s tudents c o u l d t h e n v e r b a l i z e a n d sha re the i r k n o w l e d g e w i t h o the r s tudents i n s e m i n a r s . T h e o p p o r t u n i t y to i den t i f y nu rse b e h a v i o u r s that s ign i f i can t l y i m p a c t e d o n p e r c e i v e d p r i vacy w o u l d a lso b e a f f o r d e d . N u r s e s a lso r e q u i r e c o m p r e h e n s i v e assessment sk i l l s that i n c l u d e b o t h v e r b a l a n d n o n - v e r b a l c o m p o n e n t s . T h e la t te r is s ign i f i can t i n i n t e r p r e t i n g the m e a n i n g o f f a c i a l express ions a n d b o d y ges tu r ing w h i c h m a y i n d i c a t e a n e e d fo r o r v i o l a t i o n o f p r i vacy . A l t h o u g h a l l res iden ts i n th is cu r ren t s tudy c o u l d d e s c r i b e the i r p e r c e p t i o n s o f p r i vacy , e a c h a c c o u n t was u n i q u e a n d necess i t a ted c a r e f u l v a l i d a t i o n to c o n f i r m o r re fu te i n i t i a l t hemes . N u r s i n g s tudents mus t , t he re fo re , so l i c i t the m e a n i n g o f p r i vacy i n any s i t u a t i o n f r o m the pe rspec t i ve o f the e l de r l y c l i en t i n o r d e r to p r o v i d e ca re that is sens i t i ve a n d a p p r o p r i a t e to the i n d i v i d u a l ' s needs . C e r t a i n l y , con ten t f r o m o the r d i sc ip l i nes s u c h as psycho logy , pa r t i cu l a r l y e n v i r o n m e n t a l psycho logy w o u l d b e re l evan t s ince the r e l a t i o n s h i p b e t w e e n one ' s ac t i ons a n d one ' s e n v i r o n m e n t has b e e n s ign i f i can t to the e l de r l y pa r t i c i pan t s i n th is a n d p r e v i o u s r esea rch . T h i s w o u l d assist nu rses to i n c r e a s e the i r k n o w l e d g e base r e g a r d i n g the s o c i a l , p h y s i o l o g i c a l a n d e m o t i o n a l p r o b l e m s w h i c h m a y u l t i m a t e l y i n d i c a t e a c l i en t ' s r e s p o n s e to a p e r c e i v e d v i o l a t i o n o f p r i vacy . K n o w l e d g e i n these a reas c o u l d t h e n fac i l i t a te t h e r a p e u t i c nu rse -c l i en t c o m m u n i c a t i o n essen t ia l to any e f fec t i ve n u r s i n g i n t e r v e n t i o n . I m p l i c a t i o n s f o r N u r s i n g R e s e a r c h T h i s p h e n o m e n o l o g i c a l s tudy f ocussed o n a n e x p l o r a t i o n o f the p e r c e p t i o n s o f p r i vacy a m o n g a s m a l l s a m p l e o f e l d e r l y res iden ts i n a l o n g t e r m c a r e fac i l i t y set t ing. A s such , i t p r o v i d e d s i m p l y a b e g i n n i n g u n d e r s t a n d i n g o f the c o n c e p t o f p r i vacy . M u c h m o r e e m p i r i c a l r e s e a r c h is r e q u i r e d i n o r d e r to e x p l o r e the concep t i n m a n y areas o f i n q u i r y i n f ie lds o the r t h a n nu rs i ng . A l s o , i n o r d e r to g e n e r a l i z e the f i nd ings to o the r p o p u l a t i o n s , i t is necessary to r ep l i ca te the s tudy w i t h e l d e r l y pa r t i c i pan t s i n o t h e r l o n g t e r m ca re fac i l i t i es a n d acu te ca re set t ings. T h e l eng th o f r es idency f o r e a c h pa r t i c i pan t i n the s tudy v a r i e d at the t i m e o f d a t a c o l l e c t i o n . D u e to the t i m e cons t ra in ts o f the resea rche r , i t was no t p o s s i b l e to c o n t i n u e d a t a c o l l e c t i o n ove r a leng thy p e r i o d o f t i m e . It w o u l d l i k e l y b e b e n e f i c i a l to so l i c i t the v iews o f res iden ts r e g a r d i n g the c o n c e p t o f p r i v a c y i n a l o n g i t u d i n a l s tudy s ince such a s tudy c o u l d a u g m e n t a n u n d e r s t a n d i n g o f the changes i n p e r c e p t i o n s o f p r i vacy ove r t i m e . T h i s s tudy 's f i nd ings r e v e a l e d the s ign i f i can t i m p a c t that n u r s i n g ca re staf f b e h a v i o u r s a n d a t t i tudes h a d o n the ab i l i t y to secu re a d e s i r e d l e v e l o f p r i vacy . T h e r e f o r e , i t w o u l d b e i m p o r t a n t to s tudy the p e r c e p t i o n s o f n u r s i n g ca re staf f a n d adm in i s t r a to r s r e g a r d i n g the i r p e r c e p t i o n s o f p r i vacy . A s tudy o f th is na tu re c o u l d p r o v i d e v a l u a b l e i n f o r m a t i o n r e g a r d i n g fac to rs that i n f l u e n c e n u r s i n g b e h a v i o u r s i n r e l a t i o n to p e r c e p t i o n s o f p r i v a c y a m o n g the i r e l d e r l y c l i en ts . A l s o , p r i vacy i nvo l ves c o n t r o l o v e r p e r s o n a l i n t e r a c t i o n b e t w e e n the se l f a n d o thers . T h e r e f o r e , any l a c k o f c o n g r u e n c e b e t w e e n p e r c e p t i o n s o f p r i v a c y c o u l d resu l t i n f r us t ra t i on a n d d i ssa t i s fac t i on fo r b o t h pa r t i es . A n i nves t i ga t i on i n t o d i f fe rences b e t w e e n the p e r c e p t i o n s o f p r i vacy fo r nu rses a n d e l de r l y c l ien ts c o u l d have u t i l i t y i n p r o v i d i n g the n e e d e d l i n k b e t w e e n the pa t ien t ' s des i re to c o n t r o l p r i vacy a n d h is ab i l i t y to d o so. A d d i t i o n a l l y , a r e s e a r c h s tudy r e g a r d i n g the d i l e m m a o f w h e t h e r the sel f-d e t e r m i n a t i o n o f the e lde r l y , i n th is case p r i vacy , o r the dec i s i ons a n d s tandards o f ca reg ive rs have p r i o r i t y w o u l d b e pe r t i nen t . In this study, participants were drawn from a facility providing private room accommodation. It would be beneficial to also explore the phenomenon of privacy with residents occupying semi-private and ward accommodations. Participants in this study unanimously express their desire for a private room and articulated the view that having a private room impacted positively on their ability to secure and maintain a desired level of privacy. A study of individuals residing in alternate living conditions might enhance our understand of the importance of a private room to the attainment of privacy. It could also influence the architectural trends for the design of future long term care facilities. Concluding Remarks Appreciation of and continued research on the concept of privacy are needed by nurses in all settings in the observations of human behaviour and provision of patient care. Additional research in this area will serve to augment the expanding foundation of nursing knowledge that provides the basis for current and future nursing practice. References A l t a i a n , I. (1974) . P r i v a c y : A c o n c e p t u a l ana lys is . I n D . 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( N o v e m b e r , 1982). P r e d i c t o r s o f res iden ts ' a t t i tudes t o w a r d l o n g - t e r m ca re fac i l i t i es . P a p e r p r e s e n t e d at the m e e t i n g o f the G e r o n t o l o g i c a l Soc i e t y o f A m e r i c a , B o s t o n . W a r r e n , S. , & B r a n d e i s , L . (1890) . T h e r igh t to p r i vacy . H a r v a r d L a w  R e v i e w . (4) , 193-220. W e s t i n , A . (1968) . P r i v a c y a n d f r e e d o m . N e w Y o r k : A t h e n e u m . W o l f e , M . , & L a u f e r , R . S. (1974) . T h e c o n c e p t o f p r i vacy i n c h i l d h o o d a n d a d o l e s c e n c e . I n D . H . C a r s o n ( E d . ) . M a n - e n v i r o n m e n t i n te rac t i ons :  E v a l u a t i o n s a n d app l i ca t i ons P a r t II (pp .29-54) . S t r o u d s b u r g : D o w d e n , H u t c h i n s o n & R o s s . Y o u n g , L . (1965) . L i f e a m o n g giants. N e w Y o r k : M c G r a w - H i l l . A p p e n d i x A I n f o r m a t i o n L e t t e r f o r R e s i d e n t s D e a r M y n a m e is J a n i c e S tanbu ry . I a m a R e g i s t e r e d N u r s e a n d a s tudent i n the M a s t e r o f S c i e n c e i n N u r s i n g P r o g r a m at the U n i v e r s i t y o f B r i t i s h C o l u m b i a . I a m in te res ted i n l e a r n i n g a b o u t res iden ts ' p e r c e p t i o n s o f p r i vacy i n l o n g t e r m ca re fac i l i t i es . T h i s le t te r is a n i n v i t a t i o n fo r y o u to pa r t i c i pa te i n m y study. I w o u l d l i k e p e r m i s s i o n to i n t e r v i ew y o u abou t y o u r fee l ings a n d thoughts abou t p r i vacy . M y study w i l l i n v o l v e a t a p e r e c o r d e d i n t e r v i ew las t i ng a p p r o x i m a t e l y th i r ty to sixty m i n u t e s s c h e d u l e d at ou r m u t u a l c o n v e n i e n c e i n y o u r r es i dence . It m a y b e necessary f o r m e to ask y o u fo r o n e to two a d d i t i o n a l i n te rv iews d e p e n d i n g o n m y n e e d to c la r i f y i n f o r m a t i o n p r o v i d e d i n the i n i t i a l i n te rv iew . C o m p l e t e con f i den t i a l i t y w i l l b e e n s u r e d as y o u r n a m e w i l l no t a p p e a r o n any tapes, t ranscr ip ts o r i n the c o m p l e t e d study. A c c e s s to the tapes a n d t yped manusc r i p t s w i l l b e l i m i t e d to m y thesis adv i so rs , m y typist a n d m e . A l l tapes a n d t yped t ranscr ip ts w i l l b e des t royed u p o n c o m p l e t i o n o f the study. Y o u m a y re fuse to answer any ques t ions o r m a y d i scon t i nue the s tudy at any t i m e w i t h o u t p r e j u d i c i n g y o u r fu tu re m e d i c a l o r nu r s i ng ca re i n the fac i l i t y . I f y o u a re w i l l i n g to pa r t i c i pa te i n the study, p l ease i nd i ca te y o u r w i l l i ngness o n the le t te r a n d g ive i t to the D i r e c t o r o f N u r s i n g . I w i l l t hen con tac t y o u by t e l e p h o n e . A l t h o u g h the re is n o d i rec t bene f i t to y o u f r o m 83 A p p e n d i x B S a m p l e Q u e s t i o n s 1. What is your definition of the word privacy? 2. Is privacy important to you? 3. What are the functions of privacy? 4. What aspects of this long term care facility affect your privacy? -staff -physical environment -other residents 5. Are there any changes that could be made here that would give you more privacy? 

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