Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Situational control and well-being in the institutionalized elderly Lavoie, Cora Emily Marie 1988

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1988_A5_7 L38.pdf [ 3.31MB ]
Metadata
JSON: 831-1.0097595.json
JSON-LD: 831-1.0097595-ld.json
RDF/XML (Pretty): 831-1.0097595-rdf.xml
RDF/JSON: 831-1.0097595-rdf.json
Turtle: 831-1.0097595-turtle.txt
N-Triples: 831-1.0097595-rdf-ntriples.txt
Original Record: 831-1.0097595-source.json
Full Text
831-1.0097595-fulltext.txt
Citation
831-1.0097595.ris

Full Text

SITUATIONAL CONTROL AND WELL-BEING IN THE INSTITUTIONALIZED ELDERLY By CORA EMILY MARIE LAVOIE B.Sc.N., The U n i v e r s i t y of V i c t o r i a , 1983 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING i n THE FACULTY OF GRADUATE STUDIES (School of Nursing) We accept t h i s t h e s i s as conforming t o the r e q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA A p r i l 1988 © Cora E m i l y Marie L a v o i e , 1988 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 N u r s i n 9 The University of British Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date A p r i l 19, 1988 DE-6G/81) A b s t r a c t T h i s d e s c r i p t i v e c o r r e l a t i o n a l s t u d y was d e s i g n e d t o e x a m i n e t h e r e l a t i o n s h i p b e t w e e n s i t u a t i o n a l c o n t r o l , a nd b o t h p s y c h o l o g i c a l a nd p h y s i c a l w e l l - b e i n g , i n t h e i n s t i t u t i o n a l i z e d e l d e r l y . A c o n v e n i e n c e s a m p l e o f 52 e l d e r l y i n s t i t u t i o n a l i z e d s u b j e c t s was s e l e c t e d f r o m two i n t e r m e d i a t e c a r e f a c i l i t i e s . The s u b j e c t s c o m p l e t e d t h e P e r c e i v e d W e i l - B e i n g S c a l e , t h e S i t u a t i o n a l C o n t r o l Of D a i l y A c t i v i t i e s S c a l e , a nd t h e S u b j e c t I n f o r m a t i o n S h e e t . A l l r e s i d e n t s were f o u n d t o h a v e a n o v e r a l l p e r c e p t i o n o f s i t u a t i o n a l c o n t r o l . However, r e s i d e n t s p e r c e i v e d a l a c k o f c o n t r o l f o r t h e d a i l y a c t i v i t i e s o f e a t i n g a nd g r o o m i n g . The m a j o r i t y o f r e s i d e n t s o b t a i n e d a m o d e r a t e l y h i g h s c o r e on t h e p s y c h o l o g i c a l w e l l - b e i n g a n d p h y s i c a l w e l l - b e i n g s c a l e s . No s i g n i f i c a n t r e l a t i o n s h i p was f o u n d b e t w e e n s i t u a t i o n a l c o n t r o l a n d p s y c h o l o g i c a l w e l l - b e i n g , o r s i t u a t i o n a l c o n t r o l and p h y s i c a l w e l l - b e i n g . A s i g n i f i c a n t p o s i t i v e r e l a t i o n s h i p was f o u n d b e t w e e n p s y c h o l o g i c a l w e l l - b e i n g a nd p h y s i c a l w e l l - b e i n g . i i i 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 i i i L i s t o f T a b l e s v L i s t o f F i g u r e s v i A c k n o w l e d g e m e n t s v i i C h a p t e r 1: I n t r o d u c t i o n 1 C o n t e x t o f The P r o b l e m 1 S t a t e m e n t o f The P r o b l e m 3 P u r p o s e 4 S i g n i f i c a n c e o f T h i s S t u d y 4 T h e o r e t i c a l Framework 4 H y p o t h e s e s 7 D e f i n i t i o n s 8 A s s u m p t i o n 9 L i m i t a t i o n s 9 D e s c r i p t i o n o f t h e F o l l o w i n g C h a p t e r s 10 C h a p t e r 2: R e v i e w o f R e l a t e d L i t e r a t u r e 11 I n t r o d u c t i o n 11 C o n t r o l 11 W e l l - B e i n g 16 S i t u a t i o n a l C o n t r o l a n d W e l l - B e i n g 22 Summary 27 C h a p t e r 3: M e t h o d o l o g y 29 S ample 29 I n s t r u m e n t a t i o n 30 S i t u a t i o n a l C o n t r o l Of D a i l y A c t i v i t i e s S c a l e 30 The P e r c e i v e d W e l l - B e i n g S c a l e 32 S u b j e c t I n f o r m a t i o n S h e e t 33 E t h i c s a n d Human R i g h t s 34 D a t a C o l l e c t i o n P r o c e d u r e s 34 D a t a A n a l y s i s 35 i v C h a p t e r 4: 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 R e s u l t s 37 D e m o g r a p h i c C h a r a c t e r i s t i c s o f t h e S a m p l e . . 37 P e r s o n a l D a t a 37 i n s t i t u t i o n a l i z a t i o n H i s t o r y o f t h e Sample 39 F i n d i n g s 41 A n c i l l a r y A n a l y s i s 45 D i s c u s s i o n o f R e s u l t s 46 Summary 53 C h a p t e r 5: Summary, 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 56 Summary 56 C o n c l u s i o n s . . 59 I m p l i c a t i o n s F o r N u r s i n g P r a c t i c e 61 R e c o m m e n d a t i o n s F o r F u r t h e r R e s e a r c h 63 R e f e r e n c e s 66 A p p e n d i c e s 70 A S i t u a t i o n a l C o n t r o l Of D a i l y A c t i v i t i e s S c a l e 70 B The P e r c e i v e d W e i l - B e i n g T o o l 75 C S c o r i n g I n s t r u c t i o n s F o r PWB 77 D I n f o r m a t i o n a n d C o n s e n t 79 B S u b j e c t I n f o r m a t i o n S h e e t 82 F P e r m i s s i o n To Use The T o o l s 84 V L i s t o f T a b l e s T a b l e P a g e I R e s i d e n t ' s Age 38 I I H e a l t h P r o b l e m s 38 I I I L e n g t h o f I n s t i t u t i o n a l i z a t i o n 39 I V I n d i v i d u a l s Who P l a n n e d A d m i s s i o n 41 V Number Of A c t i v i t i e s P e r c e i v e d a s R e s i d e n t C o n t r o l l e d 42 V I Number Of E l d e r l y W i t h Or W i t h o u t C o n t r o l By D a i l y A c t i v i t y 43 V I I S c o r e Of P s y c h o l o g i c a l W e i l - B e i n g 44 V I I I S c o r e Of P h y s i c a l W e l l - B e i n g 44 v i L i s t Of F i g u r e s F i g u r e P a g e 1 T h e o r e t i c a l Framework F o r The S e c o n d a r y A p p r a i s a l Of S i t u a t i o n a l C o n t r o l And The A d a p t a t i o n a l Outcome Of P s y c h o l o g i c a l And P h y s i c a l W e l l - B e i n g 5 v i i 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 t o t h a n k my f a m i l y a nd my f r i e n d s S i g g a and C h e r y l f o r t h e i r s u p p o r t t h r o u g h o u t t h e d u r a t i o n o f t h i s s t u d y . I w o u l d a l s o l i k e t o t h a n k my t h e s i s c o m m i t t e e : D r . Ann H i l t o n ( c h a i r p e r s o n ) a n d J o A n n P e r r y f o r t h e i r g u i d a n c e t h r o u g h o u t t h e r e s e a r c h p r o c e s s . F i n a l l y , I w o u l d l i k e t o t h a n k t h e D i r e c t o r s o f R e s i d e n t C a r e , J o y L e e and C a r o l F i n n i e , f o r t h e i r a s s i s t a n c e . I e s p e c i a l l y w o u l d l i k e t o t h a n k a l l t h e r e s i d e n t s who s h a r e d t h e i r t h o u g h t s a n d f e e l i n g s w i t h me. CHAPTER 1 Introduction Context Of The Problem That the e l d e r l y population i s increasing i s re f l e c t e d in an increasing number of i n s t i t u t i o n a l i z e d e l d e r l y . In 1986, 10.7% of Canadians were e l d e r l y and one out of 10 were i n s t i t u t i o n a l i z e d . For those who were 75 years and older, however, two out of ten were i n s t i t u t i o n a l i z e d (The Daily, 1987). Furthermore, i t i s projected that between 1981 and 2001, the number of e l d e r l y 85 years and older w i l l increase by 130% (Canadian Medical Association, 1987). These figures indicate that the national population i s growing older; and that as people age, they are more l i k e l y to require some type of care f a c i l i t y . Unfortunately, the projected figures for the actual number of e l d e r l y expected to be i n s t i t u t i o n a l i z e d in the future are not a v a i l a b l e . Gutman, Gee, Bojanowski, and Mottet (1986), however, found a r e l a t i o n s h i p between being older and being in a f a c i l i t y ( s t a t i s t i c a l s i g n i f i c a n c e not given). Because the number of e l d e r l y i s increasing, more e l d e r l y therefore w i l l l i k e l y be i n s t i t u t i o n a l i z e d , despite the increased emphasis on keeping the e l d e r l y in the community. The l i t e r a t u r e generally indicates that once i n s t i t u t i o n a l i z e d , some e l d e r l y residents experience a 2 decrease In t h e i r w e l l - b e i n g . The l i t e r a t u r e a l s o suggests t h a t t h i s decrease i n w e l l - b e i n g i s r e l a t e d e i t h e r to the e l d e r l y r e s i d e n t ' s normal process of aging, or to t h e i r r e l o c a t i o n process (Borup, 1982; Langer & Rodin, 1976; Melanson & Meagher, 1986; Rosswurm, 1983; Ryden, 1984; S c h u l z , 1976). Other r e s e a r c h e r s , however, suggest t h a t the d e c l i n e i n c e r t a i n e l d e r l y r e s i d e n t ' s w e l l - b e i n g i s much worse i f those r e s i d e n t s p e r c e i v e t h a t the i n s t i t u t i o n a l environment permits them l i t t l e p e r s o n a l c o n t r o l (Rosswurm, 1983; S t r i c k l a n d , 1978). For example, the e l d e r l y person who p e r c e i v e s a lack of c o n t r o l may p e r c e i v e h i m s e l f or h e r s e l f as "powerless p r i s o n e r s " of the i n s t i t u t i o n (Melanson & Meagher, 1986). The aforementioned r e s e a r c h e r s base t h e i r s u g g e s t i o n s on a s e l e c t e d body of f i n d i n g s . Some of these r e s e a r c h e r s suggest t h a t the process of aging r e s u l t s i n a number of l o s s e s f o r the e l d e r l y . For example, aging i s o f t e n accompanied by a l o s s of the e l d e r l y ' s work r o l e , income, c h i l d r e a r i n g r o l e , sensory a c u i t y and t h e i r v i g o u r (Rosswurm, 1983; Tobin & Lieberman, 1976). I t i s a l s o b e l i e v e d t h a t over time these l o s s e s , i f u n r e s o l v e d , may i n c r e a s e an e l d e r l y person's sense of powerlessness and h e l p l e s s n e s s ; and t h a t e v e n t u a l l y these f e e l i n g s may l e a d to d e p r e s s i o n and a lowered sense of w e l l - b e i n g (Rosswurm, 1983; Ryden, 1984; S c h u l z , 1976; Seligman, 1975; S t r i c k l a n d , 1978). 3 Furthermore, those e l d e r l y who have experienced i l l n e s s and are unable t o care f o r themselves adequately i n t h e i r own home, may r e q u i r e a care f a c i l i t y . T h i s r e l o c a t i o n o f t e n i n v o l v e s the s e v e r i n g of s o c i a l t i e s , changes i n l i v i n g c o n d i t i o n s , and a l o s s of autonomy (Reker & Wong, 1984; Rosswurm, 1983; Tobin & Lieberman, 1976). R e l o c a t i o n i s c o n s i d e r e d by some r e s e a r c h e r s to r e s u l t i n i n c r e a s e d a n x i e t y ; and e v e n t u a l l y i n f e e l i n g s of h e l p l e s s n e s s , d e p r e s s i o n and g e n e r a l d e t e r i o r a t i o n of 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 ' s w e l l - b e i n g (Borup, 1982; Kowalski, 1981). P e r c e i v e d c o n t r o l i s c o n s i d e r e d important f o r the e l d e r l y (Melanson & Meagher, 1986). S e v e r a l r e s e a r c h e r s and t h e o r i s t s have suggested t h a t f o r 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 , p e r c e i v i n g c o n t r o l of a s i t u a t i o n has a powerful p o s i t i v e impact on t h e i r w e l l - b e i n g (Chang, 1978a; L e f c o u r t , 1973; Rodin & Langer, 1977; Ryden, 1984; S c h u l z , 1976). On the other hand, f o r the e l d e r l y r e s i d e n t s who p e r c e i v e d a l a c k of c o n t r o l over t h e i r d a i l y a c t i v i t i e s , Rodin and Langer (1977) found t h a t the m o r t a l i t y r a t e was doubled. Statement of the Problem Data e x i s t t h a t suggest a p o s i t i v e r e l a t i o n s h i p between s i t u a t i o n a l c o n t r o l and w e l l - b e i n g i n 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 . T h i s data have been c o l l e c t e d In p a r t s of the United S t a t e s , and C e n t r a l and E a s t e r n 4 Canada. There are no d a t a , however, on 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 p o p u l a t i o n i n B r i t i s h Columbia. Furthermore, the s t u d i e s to date, have not always i n d i c a t e d the s p e c i f i c nature of the i n s t i t u t i o n . T h e r e f o r e , doing a s i m i l a r study i n an i n t e r m e d i a t e care f a c i l i t y i n B r i t i s h Columbia may shed new i n f o r m a t i o n r e l a t e d to t h i s p o p u l a t i o n . Purpose The purpose of t h i s study was to look a t e l d e r l y r e s i d e n t s i n a B r i t i s h Columbia i n t e r m e d i a t e care f a c i l i t y i n terms of t h e i r p e r c e p t i o n of s i t u a t i o n a l c o n t r o l and w e l l - b e i n g , and the r e l a t i o n s h i p between these p e r c e p t i o n s . S i g n i f i c a n c e Of T h i s Study T h i s study's s i g n i f i c a n c e l i e s i n the p o s s i b i l i t y of p r o v i d i n g a deeper understanding of how 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 i n an intermediate care f a c i l i t y p e r c e i v e s i t u a t i o n a l c o n t r o l , and how t h i s p e r c e p t i o n r e l a t e s t o t h e i r p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g . An i n c r e a s e d awareness of these v a r i a b l e s may enhance the a b i l i t y of both nurses and other h e a l t h care p r o f e s s i o n a l s to provide and d e s i g n care f o r 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 i n an i n t e r m e d i a t e care f a c i l i t y . T h e o r e t i c a l Framework The t h e o r e t i c a l framework used i n t h i s study was Lazarus and Folkman's (1984) p s y c h o l o g i c a l s t r e s s theory PERSON Conuni tments (Purpose i n l i f e ) B e l i e f s -about c o n t r o l -> ENVIRONMENT I n s t i t u t i o n a l i z a t i o n REAPPRAISAL COPING RESOURCES - h e a l t h & energy - p o s i t i v e b e l i e f s - p r oblem-solving s k i l l s - s o c i a l network COGNITIVE APPRAISAL Primary A p p r a i s a l (What i s a t stake) I r r e l e v a n t S t r e s s f u l Benlgn-I I P o s i t i v e x— Harm Challenge T h r e a t ( h e l p l e s s n e s s , powerlessness, l a c k of c o n t r o l ) CONSTRAINTS AGAINST UTILIZING COPING -p e r s o n a l -environmental - l e v e l of t h r e a t SECONDARY APPRAISAL (coping o p t i o n s / s i t u a t i o n a l c o n t r o l ) COPING STRATEGIES (problem focused, emotion focused) i n OUTCOMES-work and s o c i a l - f u n c t i o n i n g l i v i n g - m o r a l e / p s y c h o l o g i c a l w e l l - b e i n g -somatic h e a l t h / p h y s i c a l w e l l - b e i n g F i g u r e 1. T h e o r e t i c a l framework f o r the secondary a p p r a i s a l of s i t u a t i o n a l c o n t r o l and the a d a p t a t i o n a l outcome of p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g . Note. Adapted with p e r m i s s i o n from Coping With The U n c e r t a i n t i e s Of B r e a s t Cancer: A p p r a i s a l And Coping S t r a t e g i e s (p.7) by B.A. H i l t o n , 1987. Ann Arbor, MI: U n i v e r s i t y of M i c r o f i l m s I n t e r n a t i o n a l , Mo. 87-00,205. 6 ( F i g u r e 1). T h e i r theory emphasizes t h a t coping i s a continuous process c o n s i s t i n g of c o g n i t i v e a p p r a i s a l f o l l o w e d by u t i l i z a t i o n of coping s t r a t e g i e s t h a t g i v e r i s e t o outcomes. These outcomes, plus any new i n f o r m a t i o n a v a i l a b l e , i n f l u e n c e r e a p p r a i s a l . F i n a l l y , t h i s coping process i s a f f e c t e d by f a c t o r s w i t h i n the person, such as commitments and b e l i e f s ; and f a c t o r s i n the environment, such as n o v e l t y of the s i t u a t i o n . C o g n i t i v e a p p r a i s a l i s comprised of primary a p p r a i s a l and secondary a p p r a i s a l . Primary a p p r a i s a l i s the i n d i v i d u a l ' s e v a l u a t i o n of what i s a t stake and whether i t i s i r r e l e v a n t , benign p o s i t i v e , or s t r e s s f u l . An e v a l u a t i o n of s t r e s s occurs when harm, t h r e a t , or c h a l l e n g e i s a s sessed. Secondary a p p r a i s a l i s the i n d i v i d u a l ' s assessment of whether he or she can c o n t r o l a s t r e s s f u l person-environment r e l a t i o n s h i p . S p e c i f i c a l l y , secondary a p p r a i s a l i s used to assess the demands of a s i t u a t i o n , the a v a i l a b l e coping r e s o u r c e s and o p t i o n s , and the f e a s i b i l i t y of c o n t r o l l i n g the s i t u a t i o n by implementing the necessary coping s t r a t e g i e s . Secondary a p p r a i s a l of s i t u a t i o n a l c o n t r o l may focus on the environment or on one's response t o the s i t u a t i o n . Regardless of the focus, a secondary a p p r a i s a l of s i t u a t i o n a l c o n t r o l i n f l u e n c e s the i n d i v i d u a l ' s coping s t r a t e g i e s . Furthermore, the secondary a p p r a i s a l of s i t u a t i o n a l c o n t r o l i s an ongoing process t h a t may change 7 as the individual receives new information from the environment or from the coping e f f o r t s . Lazarus and Folkman's (1984) framework has provided a cognitive map which l i n k s thought to r e a l i t y . Since secondary appraisal of s i t u a t i o n a l control influences the u t i l i z a t i o n of coping strategies and thereby outcomes such as functioning in work and s o c i a l l i v i n g , morale, or somatic health, a r e l a t i o n s h i p could reasonably e x i s t between s i t u a t i o n a l control and well-being. The intent of t h i s research, therefore, i s to study such a re l a t i o n s h i p . Hypotheses The present study was designed to test the following hypotheses: 1. There i s a posit i v e r e l a t i o n s h i p between s i t u a t i o n a l control and psychological well-being in e l d e r l y i n s t i t u t i o n a l i z e d i n an intermediate care f a c i l i t y . 2. There i s a posit i v e r e l a t i o n s h i p between s i t u a t i o n a l control and physical well-being in e l d e r l y i n s t i t u t i o n a l i z e d in an intermediate care f a c i l i t y . 3 . There i s a positive r e l a t i o n s h i p between psychological well-being and physical well-being in e l d e r l y i n s t i t u t i o n a l i z e d In an intermediate care f a c i l i t y . 8 D e f i n i t i o n s C o g n i t i v e A p p r a i s a l C o g n i t i v e a p p r a i s a l i s both an e v a l u a t i v e and i n t e r a c t i v e process used to assess the person-environment r e l a t i o n s h i p (Lazarus & Folkman, 1984). S i t u a t i o n a l C o n t r o l S i t u a t i o n a l c o n t r o l r e f e r s t o the exte n t t o which a person b e l i e v e s t h a t he or she can shape or Infl u e n c e a p a r t i c u l a r s t r e s s f u l person-environment r e l a t i o n s h i p (Lazarus & Folkman, 1984). S i t u a t i o n a l c o n t r o l was measured by the S i t u a t i o n a l C o n t r o l Of D a i l y A c t i v i t i e s t o o l (Appendix A). P s y c h o l o g i c a l Well-Being P s y c h o l o g i c a l w e l l - b e i n g r e f e r s t o "the presence of p o s i t i v e emotions such as happiness, contentment, joy, and peace of mind and the absence of negative emotions such as f e a r , a n x i e t y , and d e p r e s s i o n " (Reker & Wong, 1984, p. 23). I t was measured by the p s y c h o l o g i c a l w e l l - b e i n g s u b s c a l e of the P e r c e i v e d Well-Being t o o l (Appendix B). P h y s i c a l Well-Being " P h y s i c a l w e l l - b e i n g i s d e f i n e d as s e l f - r a t e d p h y s i c a l h e a l t h and v i t a l i t y coupled with p e r c e i v e d absence of p h y s i c a l d i s c o m f o r t s " (Reker & Wong, 1984, p. 24). I t was measured by the p h y s i c a l w e l l - b e i n g s u b s c a l e of the P e r c e i v e d Well-Being t o o l . 9 I n s t i t u t i o n a l i z e d E l d e r l y Men and women who are 65 years and o l d e r , and who are r e s i d e n t s of an intermediate care f a c i l i t y . Intermediate Care F a c i l i t y A f a c i l i t y t h a t " r e c o g n i z e s the person who i s independently mobile with or without mechanical a i d s , r e q u i r e s moderate a s s i s t a n c e with the a c t i v i t i e s of d a i l y l i v i n g , and who r e q u i r e s d a i l y p r o f e s s i o n a l care and/or s u p e r v i s i o n " (Long-Term Care Program: P o l i c y Manual, 1983, p. 1 ) . Assumption The assumption of t h i s study i s t h a t s u b j e c t s are aware of t h e i r p e r c e p t i o n s and are a b l e to d e s c r i b e them and r e p o r t them h o n e s t l y . L i m i t a t i o n s T h i s study has three l i m i t a t i o n s : two i n v o l v e the sample; the t h i r d i n v o l v e s the s u b j e c t ' s p e r c e p t i o n i n r e l a t i o n to the data c o l l e c t i o n . 1. Using a convenience sample may r e s u l t i n an i n a c c u r a t e r e p r e s e n t a t i o n of the t a r g e t p o p u l a t i o n . 2. The sample i s l i m i t e d to those who can both read and speak E n g l i s h , and to those who are o r i e n t e d to time, p l a c e and person. 3. An i n d i v i d u a l ' s p e r c e p t i o n of s i t u a t i o n a l c o n t r o l and p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g may f l u c t u a t e , depending on the s p e c i f i c time p e r i o d wherein an 10 I n d i v i d u a l i s t e s t e d . T h e r e f o r e , q u e s t i o n s w h i c h a r e a s k e d a t one p o i n t i n t i m e r e s u l t i n d a t a t h a t r e f l e c t s o n l y t h a t moment's p e r c e p t i o n . D e s c r i p t i o n o f t h e F o l l o w i n g C h a p t e r s T h i s t h e s i s i s c o m p r i s e d o f f i v e c h a p t e r s . I n C h a p t e r 2, s e l e c t e d l i t e r a t u r e i s r e v i e w e d u n d e r t h r e e h e a d i n g s : c o n t r o l , w e l l - b e i n g , a n d s i t u a t i o n a l c o n t r o l a n d w e l l - b e i n g . C h a p t e r 3 d e s c r i b e s t h e r e s e a r c h m e t h o d o l o g y ; a n d i n c l u d e s a d e s c r i p t i o n o f t h e d e s i g n , s a m p l e , i n s t r u m e n t s , e t h i c s a n d human r i g h t s , d a t a c o l l e c t i o n m e t h o d s a n d s t a t i s t i c a l p r o c e d u r e s . C h a p t e r 4 i s a 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 t h e f i n d i n g s o f t h e s t u d y . C h a p t e r 5 c o n t a i n s t h e summary a n d c o n c l u s i o n s , d i s c u s s e s i m p l i c a t i o n s f o r n u r s i n g p r a c t i c e , a n d makes r e c o m m e n d a t i o n s f o r f u r t h e r r e s e a r c h . 11 CHAPTER 2 R e v i e w Of R e l a t e d L i t e r a t u r e I n t r o d u c t i o n The l i t e r a t u r e r e v i e w i s d i v i d e d i n t o t h r e e s e c t i o n s . The f i r s t s e c t i o n r e v i e w s t h e t h e o r e t i c a l and r e s e a r c h l i t e r a t u r e on c o n t r o l . The s e c o n d s e c t i o n r e v i e w s t h e t h e o r e t i c a l a n d r e s e a r c h l i t e r a t u r e on w e l l - b e i n g . The f i n a l s e c t i o n r e v i e w s t h e l i t e r a t u r e on t h e r e l a t i o n s h i p b e t w e e n s i t u a t i o n a l c o n t r o l and w e l l - b e i n g . C o n t r o l The l i t e r a t u r e r e v e a l s t h a t c e r t a i n t h e o r i s t s have d i f f e r e n t c o n c e p t u a l i z a t i o n s o f c o n t r o l . F o r i n s t a n c e , L e f c o u r t ( 1 9 7 3 ) s u g g e s t s t h a t c o n t r o l i s a n i l l u s i o n t h a t man i n v e n t e d t o e x p l a i n h i s e x p e r i e n c e s . S e l i g m a n ( 1 9 7 5 ) c o n t e n d s t h a t c o n t r o l h a s a c o g n i t i v e f a c t o r , a n d t h a t e i t h e r c o n t r o l o r p o t e n t i a l c o n t r o l c a n be p e r c e i v e d e v e n i f a c t u a l c o n t r o l d o e s n o t e x i s t . T h e s e t h e o r i s t s a l s o s u g g e s t t h a t p e r c e i v e d c o n t r o l c a n d e c r e a s e s t r e s s and s u s t a i n l i f e . T h e y s u g g e s t , f u r t h e r m o r e , t h a t p r e d i c t a b i l i t y o f t h e s i t u a t i o n c a n e n h a n c e t h e p o s i t i v e a f f e c t s o f p e r c e i v e d c o n t r o l . S e l i g m a n ( 1 9 7 5 ) a l s o c o n t e n d s t h a t i f a n i n d i v i d u a l r e p e a t e d l y a p p r a i s e s a p e r s o n - e n v i r o n m e n t r e l a t i o n s h i p t o be u n c o n t r o l l a b l e , t h a t i n d i v i d u a l may e x p e r i e n c e a s e n s e o f h e l p l e s s n e s s . He s u g g e s t s t h a t t h i s s e n s e o f h e l p l e s s n e s s may lead to a learned s t a t e where the i n d i v i d u a l b e l i e v e s t h a t success or f a i l u r e i s independent of h i s or her a c t i o n s . In other words, i f an i n d i v i d u a l a p p r a i s e s s i t u a t i o n a l c o n t r o l , he or she may use a c t i v e c o p i n g behaviours; whereas i f the i n d i v i d u a l over time a p p r a i s e s t h a t he or she l a c k e d c o n t r o l , he or she may not attempt to use any a c t i v e coping behaviours t o change the s i t u a t i o n . F i n a l l y , Seligman (1975) i n d i c a t e s t h a t f a i l u r e to use a c t i v e coping behaviours may r e s u l t i n the e v e n t u a l d e t e r i o r a t i o n of the i n d i v i d u a l ' s w e l l - b e i n g . R o t t e r (1971) presents a g e n e r a l i z e d expectancy th e o r y t h a t c o n t a i n s the c o n s t r u c t , l o c u s of c o n t r o l . He suggests t h a t l o c u s of c o n t r o l i s a s t a b l e p e r s o n a l i t y t r a i t which r e f e r s to the i n d i v i d u a l ' s o r i e n t a t i o n to c o n t r o l . T h i s o r i e n t a t i o n to c o n t r o l can be p e r c e i v e d as i n t e r n a l which r e f e r s to the i n d i v i d u a l ' s having c o n t r o l or e x t e r n a l which r e f e r s t o powerful o t h e r s , chance or f a t e being i n c o n t r o l . He a l s o suggests t h a t an i n d i v i d u a l ' s response to a s i t u a t i o n may v a r y f o r reasons other than the i n d i v i d u a l ' s locus of c o n t r o l . For example, past e x p e r i e n c e s , the importance of the need, or changing e x p e c t a t i o n s may cause the i n d i v i d u a l to p e r c e i v e the s i t u a t i o n d i f f e r e n t l y . M i l l e r (1983) c o n c e p t u a l i z e s c o n t r o l to be synonymous with power. Furthermore, she contends t h a t an 13 Individual has seven power resources: physical strength and reserve, psychologic stamina and support network, positive self-concept, energy, knowledge, motivation and a belief system (hope). She also indicates that i f one or more power resources are compromised, then the individual may experience situationally determined powerlessness. In addition, she suggests that there is no difference between powerlessness and helplessness. She contends, fi n a l l y , that i f an individual lacks control, perceived powerlessness w i l l increase i f there is an increased need for a specific outcome to be met. Averill (1973) theorizes that there are three main types of personal control: behavioral, cognitive and decisional. He suggests that behavioral control is comprised of regulated administration and modification of noxious stimuli for the purpose of controlling the individual's environment. Cognitive control, he contends, has as i t s purpose the processing of threatening information. He suggests that cognitive control may be either an objective form of information gain (reality oriented) or a subjective form of appraisal (meaning imposed on stimuli). Decisional control exists when the individual has the a b i l i t y to choose between different courses of action. However, the outcome of decisional control is dependent on the degree to which the individual is satisfied with his possible choices. 14 Aver i l l (1973) suggests, furthermore, t h a t the outcome of the three types of p e r s o n a l c o n t r o l may e i t h e r i n c r e a s e or decrease, or have no i n f l u e n c e on, s t r e s s . F i n a l l y , he s t a t e s t h a t an outcome of c o n t r o l i s dependent on the "nature of the response and the context i n which i t i s embedded" ( A v e r i l l , 1973, p. 286). Lazarus and Folkman (1984) s t a t e t h a t c o n t r o l i s a b e l i e f , an a p p r a i s a l and a coping s t r a t e g y . As a b e l i e f , i t i s a person f a c t o r and i s s i m i l a r to R o t t e r ' s locus of c o n t r o l c o n c e p t u a l i z a t i o n . As a p a r t of the a p p r a i s a l p r o c e s s , the assessment of c o n t r o l of the s i t u a t i o n i n f l u e n c e s the coping o p t i o n s a person has to manage the s i t u a t i o n . C o n t r o l l i n g s i t u a t i o n s and emotions are coping s t r a t e g i e s . In t h i s study the i n v e s t i g a t o r w i l l c o n c e n t r a t e on c o n t r o l as a p a r t of the a p p r a i s a l p r o c e s s . Lazarus & Folkman (1984) i n d i c a t e t h a t s i t u a t i o n a l c o n t r o l i s the degree to which a person judges a p a r t i c u l a r event to be w i t h i n or out of h i s or her c o n t r o l . According to Folkman (1984) s i t u a t i o n a l c o n t r o l has two prominent c h a r a c t e r i s t i c s . The f i r s t c h a r a c t e r i s t i c i s t h a t s i t u a t i o n a l c o n t r o l has a r e l a t i o n a l p e r s p e c t i v e and must be viewed w i t h i n a s p e c i f i c s i t u a t i o n . The second c h a r a c t e r i s t i c i s t h a t the degree of s t r e s s f u l n e s s a p p r a i s e d i n a p a r t i c u l a r person-environment r e l a t i o n s h i p i s dependent on the m e a n i n g o f s i t u a t i o n a l c o n t r o l f o r t h a t i n d i v i d u a l . L a z a r u s a n d F o l k m a n ( 1 9 8 4 ) , a l s o i n d i c a t e t h a t a p p r a i s a l o f s i t u a t i o n a l c o n t r o l may e i t h e r r e d u c e s t r e s s o r i n c r e a s e s t r e s s . T h e y c o n t e n d t h a t t h e i n c r e a s e i n s t r e s s may o c c u r i f " h a v i n g c o n t r o l i s c o n t r a r y t o a p r e f e r r e d s t y l e o r c o n f l i c t s w i t h o t h e r c o m m i t m e n t s o r g o a l s " ( L a z a r u s & F o l k m a n , 1984, p. 8 0 ) . T h e y a l s o s u g g e s t t h a t a n i n d i v i d u a l may a p p r a i s e o n l y one a s p e c t o f a s i t u a t i o n a s c o n t r o l l a b l e , and t h a t a p p r a i s a l may c h a n g e o v e r t i m e . One r e s e a r c h e r who e x a m i n e d t h e v a r i a b l e o f s i t u a t i o n a l c o n t r o l i n t h e e l d e r l y i n s t i t u t i o n a l i z e d i n a s k i l l e d n u r s i n g f a c i l i t y (N=30) s u g g e s t s t h a t t h e e l d e r l y r e s i d e n t ' s n e e d f o r s i t u a t i o n a l c o n t r o l v a r i e s d e p e n d i n g on w h i c h a c t i v i t y o f d a i l y l i v i n g i s i n q u e s t i o n f o r t h a t i n d i v i d u a l ( C h a n g , 1 9 7 8 a ) . F o r e x a m p l e , s h e f o u n d t h a t t h e h i g h e s t p e r c e n t a g e o f r e s i d e n t s f e l t t h a t s i t u a t i o n a l c o n t r o l i s most i m p o r t a n t i n r e l a t i o n t o a m b u l a t i n g , and l e a s t i m p o r t a n t i n r e l a t i o n t o g r o u p p a r t i c i p a t i o n . The f i n d i n g s a r e : 3 4 % f o r a m b u l a t i n g ; 2 7 % f o r a l l a c t i v i t i e s ; 1 3 % f o r e a t i n g ; 7% f o r i n t e r a c t i o n ; 7% f o r s o l i t a r y ; 3% f o r d r e s s i n g ; 3% f o r g r o o m i n g ; 3% f o r t o i l e t i n g ; a n d 0 % f o r g r o u p p a r t i c i p a t i o n . A l a r g e number o f r e s i d e n t s , h o w e v e r , f e l t t h a t c o n t r o l o f t h e e i g h t d a i l y a c t i v i t i e s i s i m p o r t a n t . ( I n t h e U n i t e d S t a t e s t h e t e r m s k i l l e d n u r s i n g f a c i l i t y i s c o m p a r a b l e t o what i s c a l l e d a n e x t e n d e d c a r e f a c i l i t y I n B r i t i s h C o l u m b i a ) . M e l a n s o n and 16 M eagher ( 1 9 8 6 ) a l s o s u g g e s t t h a t t h e m a j o r i t y o f e l d e r l y r e s i d e n t s i n one n u r s i n g home f a c i l i t y f e l t t h a t g a i n i n g s i t u a t i o n a l c o n t r o l i s v e r y i m p o r t a n t . U n f o r t u n a t e l y , i n r e v i e w i n g t h e r e s e a r c h on s i t u a t i o n a l c o n t r o l , t h i s i n v e s t i g a t o r f o u n d l i t t l e i n f o r m a t i o n on t h e l e v e l o r d e g r e e o f s i t u a t i o n a l c o n t r o l p e r c e i v e d b y t h e i n s t i t u t i o n a l i z e d e l d e r l y . However, R y d e n ( 1 9 8 4 ) s t u d i e d 113 r a n d o m l y s e l e c t e d s u b j e c t s who had b e e n i n s t i t u t i o n a l i z e d i n one o f f o u r i n t e r m e d i a t e c a r e s e t t i n g s f o r a p p r o x i m a t e l y two y e a r s . She s t a t e s t h a t t h e r e s i d e n t s had a h i g h l e v e l o f s i t u a t i o n a l c o n t r o l (M=7) on t h e S i t u a t i o n a l C o n t r o l o f D a i l y A c t i v i t i e s S c a l e . C o n t r o l , t h e n , h a s s e v e r a l d i f f e r e n t c o n c e p t u a l i z a t i o n s . D e s p i t e d i f f e r e n t t h e o r i e s a b o u t c o n t r o l , h o w e v e r , r e c u r r i n g e l e m e n t s a r e a p p a r e n t i n t h e l i t e r a t u r e . F o r i n s t a n c e , t h e most f r e q u e n t c o n c e p t s a r e t h a t c o n t r o l b o t h h a s some f o r m o f c o g n i t i v e c omponent an d o c c u r s w i t h i n a s p e c i f i c c o n t e x t . V a r i o u s t h e o r i s t s a l s o f r e q u e n t l y s u g g e s t t h a t t h e i n d i v i d u a l ' s p e r c e p t i o n o f c o n t r o l , a s w e l l a s t h e I n d i v i d u a l ' s n e e d f o r c o n t r o l , c o u l d i n f l u e n c e s t r e s s a n d , t h e r e f o r e , t h e I n d i v i d u a l ' s w e l l - b e i n g . W e l l - B e i n g A c c o r d i n g t o t h e l i t e r a t u r e , many c o n c e p t u a l i z a t i o n s e n c o m p a s s w e l l - b e i n g . L a r s o n ( 1 9 7 8 ) , r e v i e w i n g t h i r t y y e a r s o f r e s e a r c h on o l d e r A m e r i c a n s ' w e l l - b e i n g , 17 s t u d i e d t h e numerous c o n c e p t s t h e s e r e s e a r c h e r s s u g g e s t . He s t a t e s t h a t t h e most f r e q u e n t c o n c e p t u a l i z a t i o n o f w e l l - b e i n g i s t h a t w e l l - b e i n g i s l o c a t e d on a p o s i t i v e a n d n e g a t i v e c o n t i n u u m . However, he a l s o s t a t e s t h a t some r e s e a r c h e r s d e f i n e w e l l - b e i n g a s a u n i d i m e n s i o n a l c o n s t r u c t i n d e p e n d e n t o f a n y e x t e r n a l c o n d i t i o n s o f a p e r s o n ' s l i f e , w h i l e o t h e r s d e f i n e w e l l - b e i n g a s a m u l t i d i m e n s i o n a l c o n s t r u c t . L a r s o n ( 1 9 7 8 ) s u g g e s t s t h a t w i t h i n t h e s e d i f f e r e n t c o n c e p t u a l i z a t i o n s o f w e l l - b e i n g i s a common e l e m e n t , w h i c h he c a l l e d s u b j e c t i v e w e l l - b e i n g . I n o t h e r w o r d s , a l l t h e r e s e a r c h e r s t h a t he r e v i e w e d t h e o r i z e t h a t w e l l - b e i n g i s a t t h e v e r y l e a s t p a r t i a l l y d e t e r m i n e d b y t h e i n d i v i d u a l . F r o m t h e r e s e a r c h u s i n g t h o s e c o n c e p t u a l i z a t i o n s o f w e l l - b e i n g , L a r s o n ( 1 9 7 8 ) c o n c l u d e s t h a t t h r e e s e t s o f f i n d i n g s , a l t h o u g h n o t s t a t i s t i c a l l y s i g n i f i c a n t , were g e n e r a l l y a g r e e d u p o n . The f i r s t f i n d i n g i s t h a t i n c r e a s e d age r e s u l t s i n d e c r e a s e d s u b j e c t i v e w e l l - b e i n g among p e r s o n s o v e r 60. The s e c o n d f i n d i n g i s t h a t w e l l - b e i n g i s a s s o c i a t e d w i t h a n i n d i v i d u a l ' s l i v i n g s i t u a t i o n . The t h i r d f i n d i n g i s t h a t h e a l t h i s s t r o n g l y r e l a t e d t o s u b j e c t i v e w e l l - b e i n g . L a r s o n ( 1 9 7 8 ) , h o w e v e r , c o u l d n o t f i n d s i g n i f i c a n t s t a t i s t i c a l e v i d e n c e t o s u p p o r t t h e s e t h r e e f i n d i n g s . F o r i n s t a n c e , t h e c o r r e l a t i o n b e t w e e n age a n d w e l l - b e i n g r a n g e s f r o m z e r o t o 0.1, and t h e c o r r e l a t i o n b e t w e e n h e a l t h a n d w e l l - b e i n g r a n g e s f r o m 0.2 t o 0.4. T h e s e c o r r e l a t i o n s i n d i c a t e t h a t e i t h e r no r e l a t i o n s h i p e x i s t s , o r o n l y a weak r e l a t i o n s h i p e x i s t s b e t w e e n t h e v a r i a b l e s ( D e v o r e & P e c k , 1 9 8 6 ) . One o f t h e more f r e q u e n t l y c i t e d c o n c e p t s o f w e l l - b e i n g i s B r a d b u r n ' s ( 1 9 6 9 ) t h e o r y t h a t w e l l - b e i n g h a s a p o s i t i v e a n d n e g a t i v e a f f e c t d i m e n s i o n , a n d t h a t i t i s t h e d i f f e r e n c e b e t w e e n t h e p o s i t i v e a n d n e g a t i v e a f f e c t t h a t d e t e r m i n e s t h e d e g r e e o f w e l l - b e i n g . T h i s c o n c e p t u a l i z a t i o n r e s u l t s f r o m h i s s t u d y u s i n g a c r o s s - s e c t i o n o f t h e g e n e r a l p o p u l a t i o n i n s e v e r a l l a r g e m e t r o p o l i t a n a r e a s . A c c o r d i n g t o h i s t h e o r y , i f t h e p o s i t i v e a f f e c t i s g r e a t e r t h a n t h e n e g a t i v e a f f e c t , t h e n t h e i n d i v i d u a l w i l l e x p e r i e n c e a h i g h e r d e g r e e o f w e l l - b e i n g . L a w t o n ' s ( 1 9 8 3 ) c o n c e p t u a l i z a t i o n o f w e l l - b e i n g c o n t a i n s f o u r c o n s t r u c t s : b e h a v i o r a l c o m p e t e n c e ( p e r f o r m a n c e ) , p e r c e i v e d q u a l i t y o f l i f e , p s y c h o l o g i c a l w e l l - b e i n g a n d o b j e c t i v e e n v i r o n m e n t . F o r L a w t o n , p s y c h o l o g i c a l w e l l - b e i n g c o n t a i n s b o t h a p o s i t i v e a n d a n e g a t i v e a f f e c t . The p o s i t i v e a f f e c t i s r e l a t e d t o t h e i n n e r p e r s o n ( p e r c e i v e d q u a l i t y o f l i f e ) ; w h e r e a s t h e n e g a t i v e a f f e c t i s r e l a t e d t o t h e e x t e r n a l , I n t e r a c t i v e a s p e c t s o f t h e p e r s o n ' s w o r l d ( o b j e c t i v e e n v i r o n m e n t ) . He a l s o s t a t e s t h a t b e h a v i o r a l c o m p e t e n c e c o n t a i n s i n t e r n a l a n d e x t e r n a l s u b g r o u p s , a nd t h a t t h e s e s u b g r o u p s 19 d e t e r m i n e t h e p o s i t i v e a n d n e g a t i v e a f f e c t s o f p s y c h o l o g i c a l w e l l - b e i n g . A l t h o u g h he d o e s n ' t d i s c u s s p h y s i c a l w e l l - b e i n g , he d o e s s t a t e t h a t p o o r h e a l t h may n e g a t i v e l y i n f l u e n c e a n e l d e r l y p e r s o n ' s p o s i t i v e a f f e c t . S t u d i e s w h i c h a d d r e s s t h e s t a b i l i t y o f l i f e s a t i s f a c t i o n a n d p s y c h o l o g i c a l a n d t o t a l w e l l - b e i n g ( B a u r & Okun, 198 3 ; C o s t a e t a l . , 1 9 8 7 ) , add a n o t h e r d i m e n s i o n t o t h e c o n c e p t o f w e l l - b e i n g . B o t h o f t h e s e l o n g i t u d i n a l s t u d i e s u s e n o n - i n s t i t u t i o n a l i z e d s u b j e c t s . B a u r a n d Okun ( 1 9 8 3 ) s u g g e s t t h a t l i f e s a t i s f a c t i o n i s s t a b l e e v e n t h o u g h i n d i v i d u a l s e x p e r i e n c e d r a m a t i c s i t u a t i o n a l c h a n g e s . F r o m t h e i r f i n d i n g s , B a u r and Okun ( 1 9 8 3 ) c o n c e p t u a l i z e l i f e s a t i s f a c t i o n a s a n " e n d u r i n g c o g n i t i v e a s s e s s m e n t o f a t t a i n m e n t o f o n e ' s d e s i r e d g o a l s o r o v e r a l l c o n d i t i o n o f l i f e " ( p . 2 6 4 ) . C o s t a and c o l l e a g u e s ( 1 9 8 7 ) , on t h e o t h e r h a n d , c o n c e p t u a l i z e w e l l - b e i n g a s h a v i n g a n e g a t i v e a f f e c t , a p o s i t i v e a f f e c t , a n d a h e a l t h c o n c e r n . D e s p i t e t h e d i f f e r e n t c o n c e p t s , t h e y a l s o s u g g e s t t h a t t o t a l w e l l - b e i n g i s s t a b l e b e c a u s e i t shows no s i g n i f i c a n t d i f f e r e n c e s i n t h e d i f f e r e n t age g r o u p s . T h e y d o , h o w e v e r , s u g g e s t t h a t p o o r h e a l t h may d e c r e a s e w e l l - b e i n g . O t h e r r e s e a r c h e r s h ave i n v e s t i g a t e d p o s s i b l e f a c t o r s t h a t m i g h t a f f e c t t h e w e l l - b e i n g o f t h e i n s t i t u t i o n a l i z e d e l d e r l y . T h e s e r e s e a r c h e r s s u g g e s t t h a t t h e r e l o c a t i o n p r o c e s s , c h a r a c t e r i s t i c s o f t h e i n s t i t u t i o n a l 20 e n v i r o n m e n t , q u a l i t y o f c a r e , c h a r a c t e r i s t i c s o f t h e r e s i d e n t s , s e l f - r a t e d h e a l t h , a s w e l l a s t h e c o n g r u e n c e b e t w e e n t h e p e r s o n a n d t h e e n v i r o n m e n t , a r e i m p o r t a n t f o r a n outcome o f w e l l - b e i n g i n t h e i n s t i t u t i o n a l i z e d e l d e r l y ( H a r e l , 1 9 8 1 ; N o e l k e r & H a r e l , 1 9 7 8 ) . S e v e r a l r e s e a r c h e r s a l s o s u g g e s t t h a t a p o s i t i v e r e l a t i o n s h i p e x i s t s b e t w e e n p e r c e i v e d s i t u a t i o n a l c o n t r o l and w e l l - b e i n g i n t h e i n s t i t u t i o n a l i z e d e l d e r l y ( C h a n g , 1978b; R y d e n , 198 4 ; S c h u l z , 1 9 7 6 ) . R e s e a r c h e r s have a l s o s t u d i e d t h e e l d e r l y r e s i d e n t ' s p e r c e p t i o n s o f what c o n s t i t u t e s w e l l - b e i n g . N o e l k e r a n d H a r e l ( 1 9 7 8 ) f o u n d t h a t e l d e r l y r e s i d e n t s o f l o n g t e r m c a r e f a c i l i t i e s (N=125) f e l t t h a t t h e y had a h i g h e r d e g r e e o f w e l l - b e i n g i f c e r t a i n v a r i a b l e s were met. The v a r i a b l e s i n c l u d e d t h e s e c o n s i d e r a t i o n s : i f t h e y d e s i r e d t o l i v e i n t h e f a c i l i t y ; i f t h e y had good f e e l i n g s a b o u t t h e s t a f f ; I f t h e y were p l e a s e d w i t h t h e f o o d ; i f t h e y had t h e v i s i t o r s t h e y w a n t e d ; a n d i f t h e y were h a p p y w i t h t h e i r h e a l t h . No r e v i e w e d s t u d i e s , h o w e v e r , i n d i c a t e t h a t e l d e r l y i n s t i t u t i o n a l i z e d r e s i d e n t s k n o w i n g l y d i s c u s s e d s i t u a t i o n a l c o n t r o l s p e c i f i c a l l y i n r e l a t i o n t o t h e i r w e l l - b e i n g . N o e l k e r and H a r e l ( 1 9 7 8 ) s t u d i e d p o s s i b l e p r e d i c t o r s o f w e l l - b e i n g a n d s u r v i v a l i n s u b j e c t s (N=125) whose a v e r a g e age was 8 1 . The s u b j e c t s were r a n d o m l y s e l e c t e d f r o m 14 n u r s i n g homes an d t h e i r a v e r a g e l e n g t h o f 21 i n s t i t u t i o n a l i z a t i o n was t h r e e y e a r s . The s t u d y i n v o l v e d b o t h a n i n i t i a l i n t e r v i e w w i t h t h e s u b j e c t s t o d e t e r m i n e p o s s i b l e p r e d i c t o r s o f w e l l - b e i n g , a n d a two y e a r f o l l o w - u p . The f o l l o w - u p ' s p u r p o s e was t o d e t e r m i n e t h e s u b j e c t s ' s u r v i v a l r a t e , a n d a n y h e a l t h o r f u n c t i o n a l c h a n g e s . A t t h e end o f two y e a r s , N o e l k e r a nd H a r e l ( 1 9 7 8 ) f o u n d t h a t on t h e L a w t o n m o r a l e s c a l e , s u b j e c t s who w a n t e d t o l i v e e l s e w h e r e had a l o w e r s c o r e (M=10.33) (SD=4.96) t h a n d i d s u b j e c t s who d e s i r e d t o l i v e i n t h e f a c i l i t y (M=12.98) (SD=4.25) (no s i g n i f i c a n c e was g i v e n ) . T h e y a l s o f o u n d t h a t s u b j e c t s who w a n t e d t o l i v e e l s e w h e r e had t w i c e a s many d e a t h s a s s u b j e c t s who d e s i r e d t o l i v e i n t h e f a c i l i t y . As a r e s u l t o f t h e s e f i n d i n g s , t h e y s u g g e s t t h a t t h e e l d e r l y r e s i d e n t s ' d e s i r e t o l i v e i n t h e f a c i l i t y i s t h e p r i m a r y p r e d i c t o r o f t h e e l d e r l y r e s i d e n t ' s w e l l - b e i n g . The i m p o r t a n c e o f t h e e l d e r l y ' s s u b j e c t i v e p e r c e p t i o n s o f w e l l - b e i n g i s s u p p o r t e d b y o t h e r s t u d i e s . T h r e e r e s e a r c h e r s c o n d u c t e d a q u a l i t a t i v e s t u d y t o e x a m i n e t h e m e a n i n g o f h e a l t h a n d w e l l - b e i n g f r o m t h e s u b j e c t ' s p e r c e p t i o n ( T h o r n e , G r i f f i n , & A d l e r s b e r g , 1 9 8 6 ) . T h e s e r e s e a r c h e r s s t u d i e d 15 n o n - i n s t i t u t i o n a l i z e d w e l l e l d e r l y i n d i v i d u a l s . L i k e N o e l k e r a n d H a r e l ( 1 9 7 8 ) , t h e y f o u n d t h a t t h e e l d e r l y ' s s u b j e c t i v e p e r c e p t i o n s a r e i m p o r t a n t ; a n d t h a t i f o n l y o b j e c t i v e c r i t e r i a i s u s e d , 22 t h e n t h e r e s e a r c h e r s ' o b s e r v a t i o n s r e g a r d i n g w e l l - b e i n g w i l l be i n a c c u r a t e . I n a n o t h e r s t u d y , one w h i c h u s e d 205 m a l e a m b u l a t o r y m e d i c a l p a t i e n t s w i t h a mean age o f 7 1 , Snow a nd C r a p o (1982) s u g g e s t t h a t s e l f - r a t e d h e a l t h i s more s t r o n g l y r e l a t e d t o s u b j e c t i v e w e l l - b e i n g t h a n i s p h y s i c i a n - r a t e d h e a l t h . W e l l - b e i n g , i n summary t h e n , h a s many d i f f e r e n t c o n c e p t u a l i z a t i o n s . D e s p i t e t h e s e d i f f e r e n t c o n c e p t s , h o w e v e r , t h e l i t e r a t u r e a l s o r e v e a l e d r e c u r r i n g e l e m e n t s . F o r i n s t a n c e , t h e most f r e q u e n t c o n c e p t u a l i z a t i o n o f w e l l - b e i n g i n v o l v e s a p o s i t i v e a n d n e g a t i v e c o n t i n u u m . A n o t h e r r e c u r r e n c e i s t h e u s e o f t h e e l d e r l y ' s s u b j e c t i v e p e r c e p t i o n t o d e t e r m i n e w e l l - b e i n g . Many a u t h o r s a d d i t i o n a l l y s u g g e s t t h a t r e l i a n c e on o b j e c t i v e o b s e r v a t i o n s w i l l p r o v i d e i n a c c u r a t e d a t a . F i n a l l y , t h e e l d e r l y p e r s o n ' s p o o r h e a l t h i s o f t e n c o n s i d e r e d d e t r i m e n t a l t o t h e i r w e l l - b e i n g . S i t u a t i o n a l C o n t r o l a n d W e l l - B e i n g S e v e r a l r e s e a r c h e r s s u g g e s t t h a t p e r c e i v e d c o n t r o l i s l i n k e d t o a n i n c r e a s e i n w e l l - b e i n g . L a n g e r a n d R o d i n (1976) f o u n d t h a t e l d e r l y r e s i d e n t s who p e r c e i v e c o n t r o l a s a r e s u l t o f p e r c e i v e d c h o i c e a n d d e c i s i o n - m a k i n g , have a n i n c r e a s e d s e n s e o f w e l l - b e i n g . T h e s e r e s e a r c h e r s c o n d u c t e d a f i e l d e x p e r i m e n t w i t h two r a n d o m l y s e l e c t e d g r o u p s o f e l d e r l y r e s i d e n t s f r o m one n u r s i n g home. One g r o u p was r e s p o n s i b i l i t y - i n d u c e d (N=24) . I n o t h e r w o r d s , t h e y were t o l d t h a t i t was t h e i r r e s p o n s i b i l i t y t o make d e c i s i o n s f o r t h e m s e l v e s . The o t h e r g r o u p , t h e c o m p a r i s o n g r o u p , (N=28), was t o l d t h a t t h e s t a f f was r e s p o n s i b l e f o r them. T h i s e x p e r i m e n t s ' r e s u l t s i l l u s t r a t e d t h a t t h e r e s p o n s i b i l i t y - i n d u c e d g r o u p was s i g n i f i c a n t l y h a p p i e r t h a n t h e c o m p a r i s o n g r o u p t = 1 . 9 6 , p_=<.05. R o d i n a n d L a n g e r ( 1 9 7 7 ) a l s o f o u n d t h a t i n a n 18 month p e r i o d , 3 0 % o f t h e e l d e r l y r e s i d e n t s who had n o t p e r c e i v e d c o n t r o l o v e r t h e i r d a i l y a c t i v i t i e s h a d d i e d , w h i l e o n l y 1 5 % o f t h e e l d e r l y r e s i d e n t s who had p e r c e i v e d c o n t r o l had d i e d z=3.14, p_=<.01. I n a n o t h e r s t u d y , R e k e r , P e a c o c k , a n d Wong ( 1 9 8 7 ) a l s o s u g g e s t e d t h a t c o n t r o l o v e r o n e ' s l i f e was p o s i t i v e l y r e l a t e d t o p s y c h o l o g i c a l r = 0 . 5 1 , p_=<.01 and p h y s i c a l r = 0.32, p_=<0.1 w e l l - b e i n g i n t h e n o n - i n s t i t u t i o n a l i z e d e l d e r l y a g e d 65-74 y e a r s . L a z a r u s a n d D e L o n g i s ( 1 9 8 3 ) , h o w e v e r , p r e s e n t a s l i g h t l y d i f f e r e n t v i e w , s u g g e s t i n g t h a t a d e c r e a s e i n p e r c e i v e d c o n t r o l d o e s n o t n e c e s s a r i l y r e s u l t i n a d e c r e a s e i n w e l l - b e i n g . T h i s s u g g e s t i o n i s a l s o i m p l i e d b y S h u p e ' s ( 1 9 8 5 ) r e v i e w o f t h e r e s e a r c h on p e r c e i v e d c o n t r o l , c h o i c e a n d h e l p l e s s n e s s . He c o n t e n d s t h a t t h e 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 c o n t r o l a n d w e l l - b e i n g i s n o t c l e a r . I n o t h e r w o r d s , he s u g g e s t s t h a t t h e r e l a t i o n s h i p may be e i t h e r a p o s i t i v e r e l a t i o n s h i p o r a n e g a t i v e r e l a t i o n s h i p . T h i s c o n t e n t i o n , h o w e v e r , i s c o n t r a r y t o what t h e r e s e a r c h e r s o f t h r e e o t h e r s t u d i e s ( C h a n g , 1 9 7 8 a ; R y d e n , 1984; S c h u l z , 1976) c o n c l u d e , n a m e l y t h a t a p o s i t i v e r e l a t i o n s h i p d o e s e x i s t b e t w e e n s i t u a t i o n a l c o n t r o l a n d w e l l - b e i n g . A c c o r d i n g t o S c h u l z ( 1 9 7 6 ) , c o n t r o l l a b l e p o s i t i v e e v e n t s r e s u l t i n a p o w e r f u l p o s i t i v e i m p a c t on a n i n d i v i d u a l ' s w e l l - b e i n g . H i s s u g g e s t i o n r e s u l t e d f r o m a f i e l d e x p e r i m e n t i n v o l v i n g 42 i n s t i t u t i o n a l i z e d e l d e r l y r e s i d e n t s . The " m a n i p u l a t i o n p h a s e " o f t h e s t u d y c o n s i s t e d o f f i v e u n d e r g r a d u a t e s t u d e n t s v i s i t i n g t h e e l d e r l y r e s i d e n t s a t t h e i r n u r s i n g home. W i t h one g r o u p o f s u b j e c t s , t h e v i s i t o r a l l o w e d t h e r e s i d e n t t o c o n t r o l t h e v i s i t b y p e r m i t t i n g t h e r e s i d e n t t o d e c i d e when t o s t o p t h e v i s i t a n d when t o a r r a n g e t h e n e x t v i s i t . S u b j e c t s i n t h e s e c o n d g r o u p were v i s i t e d j u s t a s f r e q u e n t l y a s t h e f i r s t g r o u p . I n t h i s c a s e , h o w e v e r , t h e r e s i d e n t was n o t a l l o w e d t o c o n t r o l when t h e v i s i t o r came o r how l o n g t h e v i s i t o r s t a y e d . S c h u l z ( 1 9 7 6 ) f o u n d t h a t r e l a t i v e t o t h e g r o u p w i t h o u t c o n t r o l , t h e s u b j e c t s who had c o n t r o l o v e r t h e f r e q u e n c y a n d d u r a t i o n o f v i s i t s had a s i g n i f i c a n t l y h i g h e r d e g r e e o f p s y c h o l o g i c a l w e l l - b e i n g (F=7.13) p_=<.01. Chang ( 1 9 7 8 a ) , l i k e S c h u l z ( 1 9 7 6 ) , f o u n d t h a t a n e l d e r l y r e s i d e n t w i t h s i t u a t i o n a l c o n t r o l h a s a c o r r e s p o n d i n g l y h i g h m o r a l e (F=31.72) p_=<.01. I n s k i l l e d n u r s i n g f a c i l i t i e s , C hang ( 1 9 7 8 a ) s t u d i e d 30 s u b j e c t s f o r s i t u a t i o n a l c o n t r o l , l o c u s o f c o n t r o l , a n d m o r a l e . Her i n s t r u m e n t s were s e l f - r a t e d h e a l t h , l o c u s o f c o n t r o l s c a l e s , t h e SCDA, a n d t h e P h i l a d e l p h i a G e r i a t r i c C e n t r e (PGC) M o r a l e S c a l e . She f o u n d t h a t r e s i d e n t s w i t h a c h a n c e o r i e n t a t i o n ( e x t e r n a l l o c u s o f c o n t r o l ) who p e r c e i v e d s i t u a t i o n a l c o n t r o l had a mean m o r a l e s c o r e o f 13.13 ( s i g n i f i c a n c e n o t g i v e n ) , w h i l e s u b j e c t s w i t h a c h a n c e o r i e n t a t i o n who d i d n o t p e r c e i v e s i t u a t i o n a l c o n t r o l h a d a mean m o r a l e s c o r e o f 4.5 ( s i g n i f i c a n c e n o t g i v e n ) . She c o n c l u d e s t h a t m o r a l e w i l l be h i g h r e g a r d l e s s o f o r i e n t a t i o n , a s l o n g a s t h e e l d e r l y r e s i d e n t p e r c e i v e s i t u a t i o n a l c o n t r o l . U n f o r t u n a t e l y , Chang ( 1 9 7 8 a & 1978b) d o e s n o t i n d i c a t e t h e d e g r e e o f s i t u a t i o n a l c o n t r o l i n h e r f i n d i n g s . R y d e n ( 1 9 8 4 ) s t u d i e d 113 r a n d o m l y s e l e c t e d s u b j e c t s who had b e e n i n s t i t u t i o n a l i z e d i n one o f f o u r i n t e r m e d i a t e c a r e s e t t i n g s f o r a p p r o x i m a t e l y two y e a r s . She s u g g e s t s t h a t b o t h p e r c e p t i o n o f c o n t r o l a n d p e r c e p t i o n o f h e a l t h a r e r e l a t e d t o m o r a l e . She f o u n d t h a t 8 9 . 8 % o f t h e r e s i d e n t s r a t e d t h e i r h e a l t h a s f a i r t o e x c e l l e n t , w h i l e 1 0 . 2 % r a t e d t h e i r h e a l t h a s v e r y p o o r . H e a l t h , h o w e v e r , was n o t s i g n i f i c a n t l y r e l a t e d t o m o r a l e . On t h e o t h e r h a n d , s i t u a t i o n a l c o n t r o l (M=7) was s i g n i f i c a n t l y r e l a t e d t o m o r a l e (M=11.24) p_=.01. T h i s r e v i e w , t h e n , p r o v i d e s t h r e e s u g g e s t i o n s r e g a r d i n g t h e r e l a t i o n s h i p b e t w e e n s i t u a t i o n a l c o n t r o l and w e l l - b e i n g . F i r s t , p e r c e i v e d c o n t r o l i s l i n k e d t o 26 w e l l - b e i n g . S e c o n d , w h e t h e r t h e 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 c o n t r o l a nd w e l l - b e i n g i s a n e g a t i v e o r a p o s i t i v e r e l a t i o n s h i p , i s n o t c l e a r . F i n a l l y , p e r c e i v e d s i t u a t i o n a l c o n t r o l h a s a p o w e r f u l p o s i t i v e i m p a c t on a n i n d i v i d u a l ' s w e l l - b e i n g . S u g g e s t i o n s a b o u t b o t h w e l l - b e i n g a nd t h e r e l a t i o n s h i p b e t w e e n s i t u a t i o n a l c o n t r o l a n d w e l l - b e i n g , t h e n , a r e d i v e r g e n t . T h u s , i t i s i m p o r t a n t t o n o t e s e v e r a l g a p s o r i n c o n s i s t e n c i e s i n t h i s l i t e r a t u r e . F o u r o f t h e s t u d i e s on w e l l - b e i n g , f o r e x a m p l e , were c o n d u c t e d w i t h n o n - i n s t i t u t i o n a l i z e d s u b j e c t s , w h i l e o n l y two s t u d i e s i n v o l v e d i n s t i t u t i o n a l i z e d s u b j e c t s . A l s o , t o c o l l e c t t h e i r s t u d y d a t a , B a u r a n d Okun ( 1 9 8 3 ) p h o n e d some s u b j e c t s , m a i l e d d a t a c o l l e c t i o n m a t e r i a l s t o o t h e r s , a n d d i r e c t l y i n t e r v i e w e d t h e r e m a i n d e r . I n t h e s t u d i e s on s i t u a t i o n a l c o n t r o l a n d w e l l - b e i n g , one r e s e a r c h e r ( S c h u l z , 1976) " m a n i p u l a t e d " h i s s u b j e c t s a nd g a v e them what he d e t e r m i n e d t o be c o n t r o l , b u t he d i d n o t a c t u a l l y t e s t t h e i r p e r c e p t i o n o f c o n t r o l . A l s o , t h i s r e s e a r c h e r d o e s n o t i n d i c a t e what t h e l e v e l o f c a r e i n t h e i n s t i t u t i o n was, n o r d o e s he i n d i c a t e how l o n g t h e s u b j e c t s had b e e n i n s t i t u t i o n a l i z e d . I n a n o t h e r s t u d y , Chang ( 1 9 7 8 a ) i n d i c a t e s t h a t t h e r e w e re many d i s t r a c t i o n s a nd a l a c k o f p r i v a c y w h i l e s h e c o l l e c t e d h e r d a t a . " P e r s o n n e l o f t e n e n t e r e d t h e rooms t o sweep t h e f l o o r , f i l l w a t e r p i t c h e r s , a d m i n i s t e r m e d i c a t i o n s , o r a t t e n d t o t h e n u r s i n g c a r e n e e d s o f o t h e r r e s i d e n t s i n t h e room" ( C h a n g , 1 9 7 8 a , p. 3 2 3 ) . F u r t h e r m o r e , a s h e r s u b j e c t s had b e e n a l l i n s t i t u t i o n a l i z e d f r o m o n l y two weeks t o s i x m o n t h s , t h e y w o u l d n o t have had t i m e t o a d j u s t t o t h e i r new e n v i r o n m e n t (Rosswurm, 1 9 8 3 ) . Summary I n summary, c o n t r o l i s n o t e d t o have s e v e r a l d i f f e r e n t c o n c e p t u a l i z a t i o n s , h o w e v e r , f o u r r e c u r r i n g e l e m e n t s a r e a p p a r e n t . T h e s e e l e m e n t s a r e : t h a t c o n t r o l had some f o r m o f c o g n i t i v e c o n c e p t i o n , t h a t c o n t r o l o c c u r r e d w i t h i n a s p e c i f i c c o n t e x t , a nd t h a t t h e i n d i v i d u a l ' s p e r c e p t i o n o f c o n t r o l a nd t h e i n d i v i d u a l ' s n e e d f o r c o n t r o l i n f l u e n c e s t r e s s a n d , t h e r e f o r e , t h e i n d i v i d u a l ' s w e l l - b e i n g . The c o n c e p t w e l l - b e i n g i s a l s o n o t e d t o have s e v e r a l r e c u r r i n g e l e m e n t s w i t h i n s e l e c t e d t h e o r i z a t i o n s . T h e s e r e c u r r i n g e l e m e n t s a r e : t h a t w e l l - b e i n g i n v o l v e d a p o s i t i v e a n d n e g a t i v e c o n t i n u u m , t h a t s u b j e c t i v e p e r c e p t i o n was u s e d t o d e t e r m i n e w e l l - b e i n g a n d t h a t p o o r h e a l t h was o f t e n c o n s i d e r e d d e t r i m e n t a l t o t h e e l d e r l y ' s w e l l - b e i n g . Some r e s e a r c h e r s s u g g e s t t h a t t h e r e l a t i o n s h i p b e t w e e n s i t u a t i o n a l c o n t r o l a nd w e l l - b e i n g i s p o s i t i v e , w h i l e o t h e r r e s e a r c h e r s s u g g e s t t h a t t h e r e l a t i o n s h i p i s n e g a t i v e , h o w e v e r , t h e s e s t u d i e s a r e done i n s e t t i n g s w h i c h d i f f e r s u b s t a n t i a l l y . F u r t h e r m o r e , g a p s a r e n o t e d I n some o f t h e s t u d i e s . F o r e x a m p l e , I n one s t u d y t h e r e s e a r c h e r d i d n o t a c t u a l l y m e a s u r e t h e s u b j e c t s p e r c e p t i o n o f c o n t r o l , w h i l e i n a n o t h e r s t u d y t h e r e were many d i s t r a c t i o n s w h i l e t h e r e s e a r c h e r c o l l e c t e d h e r d a t a . F i n a l l y , most o f t h e s e s t u d i e s have b e e n done i n C e n t r a l a n d E a s t e r n C a n a d a , a s w e l l a s p a r t s o f t h e U n i t e d S t a t e s . T h e r e f o r e , t h e p u r p o s e o f t h i s r e s e a r c h i s t o s t u d y t h e r e l a t i o n s h i p b e t w e e n s i t u a t i o n a l c o n t r o l a n d p s y c h o l o g i c a l a n d p h y s i c a l w e l l - b e i n g i n t h e c o n t e x t o f e l d e r l y i n s t i t u t i o n a l i z e d i n a n i n t e r m e d i a t e c a r e f a c i l i t y i n B r i t i s h C o l u m b i a . CHAPTER 3 M e t h o d o l o g y I n t h i s c h a p t e r , t h e d e s i g n , s a m p l e and s e t t i n g , i n s t r u m e n t a t i o n , e t h i c s and human r i g h t s , d a t a c o l l e c t i o n p r o c e d u r e s , and t h e method o f d a t a a n a l y s i s w i l l be d e s c r i b e d . The r e s e a r c h d e s i g n u s e d f o r t h i s s t u d y was d e s c r i p t i v e c o r r e l a t i o n a l . Two q u e s t i o n n a i r e s and a s e m i - s t r u c t u r e d i n t e r v i e w were u s e d t o c o l l e c t t h e d a t a . Sample A c o n v e n i e n c e s a m p l e o f 52 e l d e r l y i n s t i t u t i o n a l i z e d s u b j e c t s was s e l e c t e d . To be i n c l u d e d i n t h e s a m p l e , s u b j e c t s met t h e f o l l o w i n g s a m p l e c r i t e r i a : 1. 65 y e a r s o f age o r o l d e r . 2. A b l e t o r e a d a n d s p e a k E n g l i s h . 3. O r i e n t e d t o t i m e , p l a c e , a n d p e r s o n . 4. R e s i d e n t s o f a n i n t e r m e d i a t e c a r e f a c i l i t y f o r more t h a n s i x m o n t h s . The i n i t i a l a d j u s t m e n t p h a s e o f r e l o c a t i o n i s a m a j o r f a c t o r a f f e c t i n g p e r c e p t i o n i n t h e f i r s t s i x months (Rosswurm, 1 9 8 3 ; S t e i n , L i n n , & S t e i n , 1 9 8 6 ) . C r i t e r i a f o u r w o u l d , t h e r e f o r e , e x c l u d e r e s i d e n t s i n t h i s a d j u s t m e n t p h a s e . The s a m p l e s i z e o f 52 was i d e n t i f i e d u s i n g S a m p l e C a l c ( A n d e r s o n , 1 9 8 2 ) . C o n s i d e r i n g a t w o - t a i l e d t e s t w i t h a c o n f i d e n c e i n t e r v a l o f 0.95, s i g n i f i c a n c e 0.05, power 0.7, and a l a r g e e f f e c t s i z e o f 0.5, t h e 30 d e s i r e d s a m p l e s i z e i d e n t i f i e d was 52. The power r e f l e c t s t h e p r o b a b i l i t y o f r e j e c t i o n o f t h e n u l l h y p o t h e s i s when i t i s f a l s e ( V o l i c e r , 1 9 8 4 ) . A l a r g e e f f e c t s i z e p e r m i t s t h e i n v e s t i g a t o r t o i d e n t i f y m a j o r d i f f e r e n c e s b e t w e e n t h e v a r i a b l e s s t u d i e d . I n s t r u m e n t a t i o n T h e r e were t h r e e d a t a c o l l e c t i o n i n s t r u m e n t s u s e d i n t h i s s t u d y . The S i t u a t i o n a l C o n t r o l o f D a i l y A c t i v i t i e s S c a l e (SCDA) ( C h a n g , 1978b) was u s e d t o m e a s u r e s i t u a t i o n a l c o n t r o l , w h i l e t h e P e r c e i v e d W e l l - B e i n g S c a l e (PWB) ( R e k e r & Wong, 1984) was u s e d t o m e a s u r e p s y c h o l o g i c a l a n d p h y s i c a l w e l l - b e i n g . A s u b j e c t i n f o r m a t i o n s h e e t ( A p p e n d i x E) was a l s o i n c l u d e d t o r e c o r d i n f o r m a t i o n on r e l e v a n t d e m o g r a p h i c v a r i a b l e s . S i t u a t i o n a l C o n t r o l Of D a i l y A c t i v i t i e s S c a l e The S i t u a t i o n a l C o n t r o l o f D a i l y A c t i v i t i e s S c a l e (SCDA) was d e v e l o p e d b y Chang ( 1 9 7 8 b ) t h r o u g h a n e x p l o r a t o r y s t u d y o f t h e i n s t i t u t i o n a l i z e d e l d e r l y ' s p e r c e p t i o n o f s i t u a t i o n a l c o n t r o l o f t h e i r d a i l y a c t i v i t i e s . D a t a o b t a i n e d t h r o u g h t h e s t u d y was a n a l y z e d u s i n g c o n s t a n t c o m p a r a t i v e a n a l y s i s . F rom t h e a n a l y s i s , a s e m i - s t r u c t u r e d i n t e r v i e w t o o l c o n t a i n i n g t w e n t y - t w o i t e m s was d e v e l o p e d . T h r e e j u d g e s r a t e d t h e SCDA f o r c o n t e n t v a l i d i t y . W i t h i n t h e c o n t e x t o f t h e SCDA, t h e a c t i v i t i e s o f d a i l y l i v i n g e n c o m p a s s e d n i n e c a t e g o r i e s : a m b u l a t i o n , d r e s s i n g , e a t i n g , g r o o m i n g , t o i l e t i n g , g r o u p p a r t i c i p a t i o n , one t o one i n t e r a c t i o n , s o l i t a r y a c t i v i t i e s a n d a n ' o t h e r 1 c a t e g o r y . The i t e m s i n c l u d e d q u e s t i o n s t o d e t e r m i n e who d e c i d e d w h e t h e r t h e a c t i v i t y s h o u l d t a k e p l a c e , a s w e l l a s t h e t i m e , s e t t i n g , a n d amount o f a s s i s t a n c e n e c e s s a r y f o r t h e a c t i v i t y ( C h a n g , 1 9 7 8 a ) . The SCDA was u s e d t o d e t e r m i n e t h e d e g r e e o f s i t u a t i o n a l c o n t r o l a s w e l l a s a n o v e r a l l c a t e g o r y o f s i t u a t i o n a l c o n t r o l . The SCDA was s c o r e d b y c o d i n g e a c h i t e m a s s e l f - d e t e r m i n e d o r o t h e r - d e t e r m i n e d . I f a c a t e g o r y h a d a n e v e n number o f i t e m s , a n d a t i e b e t w e e n s e l f a n d o t h e r , t h e n a n a d d i t i o n a l q u e s t i o n was a s k e d t o o b t a i n a s e l f o r o t h e r s c o r e f o r t h a t c a t e g o r y . The number o f c a t e g o r i e s c a l c u l a t e d t o be s e l f - d e t e r m i n e d w e r e t h e n r a t e d on a s c a l e o f 1 t o 8 i n o r d e r t o a s s e s s t h e d e g r e e o f s i t u a t i o n a l c o n t r o l t h a t e a c h i n d i v i d u a l p e r c e i v e d . I f 4 o r more o f t h e 8 c a t e g o r i e s were c a l c u l a t e d t o be s e l f - d e t e r m i n e d , t h e n t h e s u b j e c t was c o n s i d e r e d t o h a v e a n o v e r a l l p e r c e p t i o n o f s i t u a t i o n a l c o n t r o l ( C h a n g , 1 9 7 8 b ) . T e s t - r e t e s t r e l i a b i l i t y on 20 s u b j e c t s g a v e a c o r r e l a t i o n c o e f f i c i e n t o f 0.96. I n t e r c o d e r r e l i a b i l i t y was 1.0 f o r t h e c a t e g o r i e s o f s e l f o r o t h e r d e t e r m i n a t i o n o f s i t u a t i o n a l c o n t r o l , a n d 0.98 f o r t h e i n d i v i d u a l a c t i v i t y i t e m s . A l t h o u g h f o u r s t u d i e s t h a t u s e d t h e SCDA 32 ( C h a n g , 1 9 7 8 a ; Downe-Wamboldt & T a m l y n , 1986; M e n t z e r & S c h o r r , 1 9 86; a n d R y d e n , 1984) were f o u n d i n t h e l i t e r a t u r e , t h e r e s e a r c h e r s r e p o r t e d no f u r t h e r t e s t i n g on v a l i d i t y o r r e l i a b i l i t y . F o r t h i s s t u d y , t h e r e l i a b i l i t y c o e f f i c i e n t was a l p h a = 0.23. The P e r c e i v e d W e l l - B e i n g S c a l e The P e r c e i v e d W e l l - B e i n g S c a l e was d e v e l o p e d b y R e k e r a nd Wong ( 1 9 8 4 ) . I n i t i a l l y t h e y p o o l e d 72 i t e m s f r o m t h e i r l i t e r a t u r e r e v i e w o f w e l l - b e i n g . The c o n t e n t v a l i d i t y was t h e n a s s e s s e d b y 20 p s y c h o l o g y f a c u l t y members a n d s t u d e n t s . I t e m s were r e t a i n e d i f 70 p e r c e n t o f t h e j u d g e s r a t e d t h e i t e m s m e a s u r i n g w e l l - b e i n g . F u r t h e r s e l e c t i o n o f t h e f i n a l i t e m s i n v o l v e d a p i l o t t e s t on a s a m p l e o f 80 c o m m u n i t y and i n s t i t u t i o n a l i z e d e l d e r l y . F a c t o r a n a l y s i s w i t h v a r i m a x r o t a t i o n t o s i m p l e s t r u c t u r e was d o n e . T h r e e f a c t o r s were o b t a i n e d f r o m t h e f a c t o r a n a l y s i s : p s y c h o l o g i c a l w e l l - b e i n g , p h y s i c a l w e l l - b e i n g , a n d a m i x t u r e o f p s y c h o l o g i c a l a n d p h y s i c a l w e l l - b e i n g . The t h i r d f a c t o r was e l i m i n a t e d b e c a u s e i t d i d n o t make a n i n d e p e n d e n t c o n t r i b u t i o n t o t h e PWB. The f i n a l t o o l was c o m p r i s e d o f 14 i t e m s . Of t h e 14 i t e m s , 8 i t e m s m e a s u r e d p h y s i c a l w e l l - b e i n g a n d 6 i t e m s m e a s u r e d p s y c h o l o g i c a l w e l l - b e i n g . T o g e t h e r a l l i t e m s m e a s u r e d g e n e r a l w e l l - b e i n g . To s c o r e t h e PWB, a 7 - p o i n t l i k e r t s c a l e was u s e d . R e l i a b i l i t y o f t h e PWB was t e s t e d on a s a m p l e o f 238 c o m m u n i t y a nd i n s t i t u t i o n a l i z e d e l d e r l y . F o r t h e i n s t i t u t i o n a l i z e d e l d e r l y , t h e t a c o e f f i c i e n t s were 0.82 f o r p s y c h o l o g i c a l w e l l - b e i n g a n d 0.78 f o r p h y s i c a l w e l l - b e i n g . T e s t - r e t e s t r e l i a b i l i t y was done on a s a m p l e o f 34 o v e r a 2 y e a r p e r i o d . The r e s u l t i n g s t a b i l i t y c o e f f i c i e n t s were 0.79 p_^<.01 f o r p s y c h o l o g i c a l w e l l - b e i n g , 0.65 p_=<.01 f o r p h y s i c a l w e l l - b e i n g , a n d 0.78 p_=<.01 f o r g e n e r a l w e l l - b e i n g ( R e k e r & Wong, 1 9 8 4 ) . Two s t u d i e s t h a t u s e d t h e PWB ( R e k e r e t a l . , 1 987; a n d Wong & R e k e r , 1984) were f o u n d i n t h e l i t e r a t u r e , b u t t h e r e s e a r c h e r s r e p o r t e d no f u r t h e r t e s t i n g on v a l i d i t y o r r e l i a b i l i t y . F o r t h i s s t u d y , t h e r e l i a b i l i t y c o e f f i c i e n t s w e r e a l p h a = 0.74 f o r p s y c h o l o g i c a l w e l l - b e i n g , a l p h a = 0.55 f o r p h y s i c a l w e l l - b e i n g , a n d a l p h a = 0.73 f o r t o t a l w e l l - b e i n g . S u b j e c t I n f o r m a t i o n S h e e t R e s e a r c h f i n d i n g s i n d i c a t e d s e v e r a l v a r i a b l e s t h a t m i g h t i n f l u e n c e t h e s u b j e c t ' s p e r c e p t i o n o f c o n t r o l a n d w e l l - b e i n g . T h i s i n v e s t i g a t o r , t h e r e f o r e , u s e d t h e i n f o r m a t i o n t o d e v e l o p a s u b j e c t i n f o r m a t i o n s h e e t t h a t i n c l u d e d t h e s e v a r i a b l e s : s e x , a g e , m a r i t a l s t a t u s , number o f f a m i l y v i s i t s p e r month, a n d i n f o r m a t i o n r e l a t i n g t o t h e s u b j e c t ' s p r e v i o u s a n d c u r r e n t p l a c e o f r e s i d e n c e . 34 E t h i c s a n d Human R i g h t s P r i o r t o t h i s s t u d y ' s i n i t i a t i o n , t h r e e s o u r c e s g r a n t e d p e r m i s s i o n : 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 B e h a v i o u r a l S c i e n c e s 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 t u d i e s I n v o l v i n g Human S u b j e c t s , a n d t h e two i n t e r m e d i a t e c a r e f a c i l i t i e s w here t h e s t u d y was u n d e r t a k e n . B e c a u s e human s u b j e c t s have e t h i c a l a n d m o r a l r i g h t s w h i c h must be r e s p e c t e d i n a n y r e s e a r c h s t u d y , a n i n d i v i d u a l c o u l d c h o o s e e i t h e r t o , o r n o t t o , p a r t i c i p a t e i n t h e s t u d y . An i n d i v i d u a l c o u l d a l s o d e c i d e t o l e a v e t h e s t u d y a t a n y t i m e w i t h o u t h i s o r h e r c a r e b e i n g a f f e c t e d . F u r t h e r m o r e , i n o r d e r t o make a n i n f o r m e d d e c i s i o n , a n i n d i v i d u a l was g i v e n b o t h a v e r b a l e x p l a n a t i o n , a n d a n i n f o r m a t i o n a n d c o n s e n t l e t t e r ( A p p e n d i x D ) . L a s t l y , n u m b e r i n g a l l m a t e r i a l s c o l l e c t e d r a t h e r t h a n u s i n g names a s s u r e d c o m p l e t e c o n f i d e n t i a l i t y . D a t a C o l l e c t i o n P r o c e d u r e s The D i r e c t o r o f R e s i d e n t C a r e f o r e a c h o f t h e two i n t e r m e d i a t e c a r e f a c i l i t i e s c r e a t e d a l i s t i d e n t i f y i n g p o t e n t i a l s u b j e c t s a n d g a v e t h e l i s t t o t h e i n v e s t i g a t o r . The i n v e s t i g a t o r t h e n a p p r o a c h e d e a c h r e s i d e n t i n d i v i d u a l l y , i n t r o d u c e d h e r s e l f a n d t a l k e d t o t h e r e s i d e n t a b o u t t h e s t u d y . I f t h e r e s i d e n t a p p e a r e d i n t e r e s t e d , t h e i n v e s t i g a t o r t h e n d i s c u s s e d t h e i n f o r m a t i o n l e t t e r a n d c o n s e n t . I f t h e r e s i d e n t d e c i d e d 35 t o p a r t i c i p a t e i n t h e s t u d y a n d s i g n e d t h e c o n s e n t , t h e n a t i m e w h i c h was c o n v e n i e n t w i t h t h e r e s i d e n t was a r r a n g e d f o r t h e d a t a c o l l e c t i o n . To e n s u r e t h e c o m f o r t , p r i v a c y and c o n f i d e n t i a l i t y o f t h e r e s i d e n t , t h e q u e s t i o n n a i r e s and t h e i n t e r v i e w w e r e c o m p l e t e d i n a p l a c e t h e r e s i d e n t c h o s e . The d a t a were c o l l e c t e d i n t h e f o l l o w i n g s e q u e n c e : t h e PWB, t h e SCDA and t h e s u b j e c t i n f o r m a t i o n s h e e t . C o l l e c t i n g t h e d a t a i n t h i s s e q u e n c e was t o p r e v e n t t h e r e s i d e n t ' s c o m p l e t i o n o f t h e S i t u a t i o n a l C o n t r o l Of D a i l y A c t i v i t i e s S c a l e f r o m i n f l u e n c i n g h i s o r h e r c o m p l e t i o n o f t h e P e r c e i v e d W e l l - B e i n g S c a l e . D a t a A n a l y s i s P a r a m e t r i c s t a t i s t i c s were u s e d t o a n a l y z e t h e d a t a b e c a u s e t h e d a t a were a t a n i n t e r v a l s c a l e o f m e a s u r e m e n t , t h e s a m p l e s i z e o f 52 was c o n s i d e r e d l a r g e e n o u g h , a n d t h e s a m p l e was assumed t o h a v e a n o r m a l d i s t r i b u t i o n ( M u n r o , V i s i n t a i n e r , & P a g e , 1 9 8 6 ) . A l t h o u g h t h e s u b j e c t s were n o t r a n d o m l y s e l e c t e d , o n l y 1 0 % who were a p p r o a c h e d d e c l i n e d t o p a r t i c i p a t e . F o r t y - n i n e p e r c e n t o f t h o s e who met t h e c r i t e r i a were s a m p l e d . The r e s u l t i n g s a m p l e , t h e r e f o r e , was l i k e l y t o be r e a s o n a b l y r e p r e s e n t a t i v e o f t h e t a r g e t p o p u l a t i o n . P e a r s o n ' s r was t h e p a r a m e t r i c t e s t u s e d t o e x a m i n e t h e h y p o t h e s e s . F r e q u e n c y s c a l e s o f t h e v a r i a b l e s , i n c l u d i n g t h e d e m o g r a p h i c v a r i a b l e s , were u s e d f o r 36 d e s c r i p t i v e p u r p o s e s . To a n a l y z e t h e i n t e r n a l c o n s i s t e n c y o f t h e S i t u a t i o n a l C o n t r o l Of D a i l y A c t i v i t i e s S c a l e and t h e P e r c e i v e d W e l l - B e i n g S c a l e , t h e r e l i a b i l i t y c o e f f i c i e n t a l p h a was u s e d . F i n a l l y , t h e l e v e l o f s i g n i f i c a n c e f o r t h i s s t u d y was .05. 37 CHAPTER 4 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 R e s u l t s T h i s c h a p t e r h a s t h r e e s e c t i o n s . The f i r s t s e c t i o n p r e s e n t s t h e s a m p l e ' s d e m o g r a p h i c c h a r a c t e r i s t i c s . The s e c o n d s e c t i o n p r e s e n t s t h e r e s u l t s p e r t a i n i n g t o t h e t h r e e h y p o t h e s e s , a n d t h e t h i r d s e c t i o n d i s c u s s e s t h e r e s u l t s . D e m o g r a p h i c C h a r a c t e r i s t i c s o f t h e Sample T h i s s t u d y ' s s a m p l e was c o m p r i s e d o f 52 e l d e r l y r e s i d e n t s f r o m two i n t e r m e d i a t e c a r e f a c i l i t i e s . T w e n t y - e i g h t r e s i d e n t s ( 5 3 . 8 % ) were f r o m one f a c i l i t y , a n d 24 r e s i d e n t s ( 4 6 . 2 % ) were f r o m t h e s e c o n d . T h e s e f i g u r e s r e p r e s e n t 4 9 % o f e a c h i n s t i t u t i o n ' s r e s i d e n t s who met t h e s a m p l e c r i t e r i a . P e r s o n a l D a t a Of t h e 52 i n t h e s a m p l e , 38 were f e m a l e ( 7 3 . 1 % ) and 14 were m a l e ( 2 6 . 9 % ) . T h e i r a g e s r a n g e d f r o m 66 t o 96 (M=83.2) y e a r s ( s e e T a b l e I ) . The f e m a l e s ' a g e s (M=81.8) were a l m o s t i d e n t i c a l t o t h a t o f t h e m a l e s (M=81.4). I n t e r m s o f m a r i t a l s t a t u s , 36 were widowed ( 6 9 . 2 % ) , 12 were s i n g l e ( 2 3 . 1 % ) , two were m a r r i e d ( 3 . 8 % ) a n d two were d i v o r c e d ( 3 . 8 % ) . The m a j o r i t y o f r e s i d e n t s ( 8 8 . 5 % ) s t a t e d t h a t t h e y had some h e a l t h p r o b l e m s , w h e r e a s 1 1 . 5 % had no h e a l t h p r o b l e m s . The number o f h e a l t h p r o b l e m s r a n g e d f r o m 0 t o 5 (M=2.2) ( s e e T a b l e I I ) . The r e s i d e n t s d e s c r i b e d most Table I Resident's Age Age £ Percent 66-70 3 5.8 71-75 5 9.6 76-80 10 19.2 81-85 14 26.9 86-90 14 27.0 91-95 5 9.6 96-100 1 1.9 T o t a l 52 100.0 Table II Hea l t h Problems Health Problems £ Percent 0 6 11.5 1 15 28.9 2 10 19.2 3 10 19.2 4 7 13.5 5 4 7.7 T o t a l 52 100.0 of t h e i r health problems as cardiovascular and musculoskeletal. Forty-four residents (84.6%) stated that they had v i s i t o r s , whereas 8 residents stated they did not have v i s i t o r s (15.4%). Of the residents who had v i s i t o r s , 13 had d a i l y v i s i t o r s , 17 had weekly v i s i t o r s , 12 had monthly v i s i t o r s , and one stated she had v i s i t o r s once a year. I n s t i t u t i o n a l i z a t i o n History of the Sample The length of i n s t i t u t i o n a l i z a t i o n ranged from 8 months to 12 (M=3.6) (SD=2.58) years (see Table I I I ) . Five residents had l i v e d i n the i n s t i t u t i o n for less than a year but more then s i x months. T a b l e I I I L e n g t h o f I n s t i t u t i o n a l i z a t i o n Year f Percent 0.5-2 23 44.2 3-4 12 23.1 5-6 10 19.3 7-8 4 7.7 9-10 2 3.8 11-12 1 1.9 Total 52 100.0 P r i o r t o t h i s I n s t i t u t i o n a l i z a t i o n , 40 o f t h e r e s i d e n t s had l i v e d i n t h e i r own homes ( 7 6 . 9 % ) , w h i l e 12 r e s i d e n t s l i v e d i n o t h e r l o d g i n g s ( 2 3 . 1 % ) . O t h e r l o d g i n g s w e r e c l a s s i f i e d b y t h e r e s i d e n t s a s a r oom ( 5 . 8 % ) , p e r s o n a l c a r e f a c i l i t i e s ( 1 3 . 5 % ) , o r o t h e r i n t e r m e d i a t e c a r e f a c i l i t i e s ( 3 . 8 % ) . I n r e s p o n s e t o t h e q u e s t i o n , "Who p l a n n e d t h e a d m i s s i o n t o t h i s home?", 2 8 . 8 % o f t h e s u b j e c t s s t a t e d t h a t t h e y a l o n e p l a n n e d t h e i r a d m i s s i o n , w h i l e 1 5 . 3 % s a i d t h a t o t h e r s h e l p e d them p l a n t h e i r a d m i s s i o n . A l a r g e number o f s u b j e c t s , h o w e v e r , s t a t e d t h a t h e a l t h c a r e w o r k e r s a l o n e p l a n n e d t h e i r a d m i s s i o n s ( 3 8 . 5 % ) ( s e e T a b l e I V ) . The s u b j e c t s d e s c r i b e d t h e m a j o r i t y o f t h e s e h e a l t h c a r e w o r k e r s a s p h y s i c i a n s and s o c i a l w o r k e r s . I n summary, t h e s a m p l e c o n s i s t e d o f r e s i d e n t s who w ere p r e d o m i n a n t l y f e m a l e a n d w i d o w e d , and who had v i s i t o r s ; most o f t h e s a m p l e a l s o had h e a l t h p r o b l e m s . The m a j o r i t y o f r e s i d e n t s had b e e n i n s t i t u t i o n a l i z e d f o r more t h a n t h r e e y e a r s , a n d had l i v e d i n t h e i r own home p r i o r t o t h i s r e s i d e n c e . F i n a l l y , a l t h o u g h a l a r g e number o f r e s i d e n t s p l a n n e d t h e i r own a d m i s s i o n , h e a l t h c a r e w o r k e r s p l a n n e d t h e l a r g e s t s i n g l e g r o u p o f a d m i s s i o n s . Table IV I n d i v i d u a l s Who Planned Admission I n d i v i d u a l s f Percent Resident 15 28.9 Hea l t h Care Worker 20 38.5 Fam i l y 7 13.5 Resident, H e a l t h Care Worker Fam i l y 2 3.8 Health Care Worker Fam i l y 2 3.8 Resident, H e a l t h Care Worker 5 9.6 Resident, F a m i l y 1 1.9 T o t a l 52 100.0 F i n d i n g s Data are presented on the v a r i a b l e s of s i t u a t i o n a l c o n t r o l , p s y c h o l o g i c a l w e l l - b e i n g , and p h y s i c a l w e l l - b e i n g p r i o r t o p r e s e n t i n g the f i n d i n g s r e g a r d i n g the hypotheses. A r e s i d e n t was c o n s i d e r e d t o have an o v e r a l l p e r c e p t i o n of s i t u a t i o n a l c o n t r o l i f 4 or more of the 8 c a t e g o r i e s of d a i l y a c t i v i t i e s were c a l c u l a t e d t o be s e l f - d e t e r m i n e d . A l l r e s i d e n t s were found to have an o v e r a l l p e r c e p t i o n of s i t u a t i o n a l c o n t r o l (M=6.65) (SD=0.86) (see Table V). In two d a i l y a c t i v i t i e s , Table V Number of A c t i v i t i e s P e r c e i v e d as Resident C o n t r o l l e d Number of A c t i v i t i e s f Percent 0-3 0 0 4 1 1.9 5 2 3.8 6 17 32.7 7 25 48.1 8 7 13.5 T o t a l 52 100.0 however, the m a j o r i t y of r e s i d e n t s p e r c e i v e d a l a c k of s i t u a t i o n a l c o n t r o l . For the d a l l y a c t i v i t i e s of e a t i n g , 75% (N=39) d i d not p e r c e i v e s i t u a t i o n a l c o n t r o l ; and f o r grooming, 46.2% (N=24) d i d not p e r c e i v e s i t u a t i o n a l c o n t r o l . For each of the remaining d a i l y a c t i v i t i e s , o n l y 0-8% (N=0-4) p e r c e i v e d a lack of s i t u a t i o n a l c o n t r o l (see Table V I ) . For the v a r i a b l e p s y c h o l o g i c a l w e l l - b e i n g , the lowest sco r e the r e s i d e n t c o u l d o b t a i n was 6 and the h i g h e s t s c o r e was 42. Although a number of r e s i d e n t s obtained low sc o r e s f o r p s y c h o l o g i c a l w e l l - b e i n g , the m a j o r i t y of r e s i d e n t s obtained a moderately high score (M=30.98) (SD=8.68) (see Table V I I ) . 43 Table VI Number Of E l d e r l y With Or Without C o n t r o l Bv D a i l y  A c t i v i t y D a i l y c o n t r o l Percent lack of c o n t r o l Percent A c t i v i t y £ f Ambulating 48 92.3 4 7.7 Dre s s i n g 50 96.2 2 3.8 E a t i n g 13 25.0 39 75.0 Grooming 28 53.8 24 46.2 T o i l e t i n g 52 100.0 0 0.0 Group P a r t i c i p a t i o n 51 98.1 1 1.9 One To One I n t e r a c t i o n 52 100.0 0 0.0 S o l i t a r y A c t i v i t i e s 51 98.1 1 1.9 <N=52) For the v a r i a b l e p h y s i c a l w e l l - b e i n g , the lowest sco r e the r e s i d e n t c o u l d o b t a i n was 8 and the hig h e s t s c o r e was 56. Although a number of r e s i d e n t s obtained low s c o r e s , the m a j o r i t y of s c o r e s were moderate (M=29.85) (SD=7.59) (see Table V I I I ) . Pearson's c o r r e l a t i o n c o e f f i c i e n t ( r ) was used t o examine the data r e p o r t e d i n t h i s study and to determine whether or not a p o s i t i v e r e l a t i o n s h i p e x i s t e d between the v a r i a b l e s of s i t u a t i o n a l c o n t r o l and p s y c h o l o g i c a l 44 Table VII Score of P s y c h o l o g i c a l Well-Being Score f Percent 6-11 3 5.8 12-17 1 1.9 18-23 3 5.8 24-29 7 13.5 30-35 21 40.4 36-41 12 23.0 42-49 5 9.6 T o t a l 52 100.0 Note. Maximum score p o s s i b l e =42 (6 items x Table VIII Score of P h y s i c a l Well-Being Score f Percent 8-15 1 1.9 16-23 9 17.3 24-31 22 42.3 32-39 14 26.9 40-47 6 11.6 48-55 0 0.0 T o t a l 52 100.0 Note. Maximum score possible=48 (8 items x 7) 45 well-being, s i t u a t i o n a l control and physical well-being, and psychological and physical well-being. No s i g n i f i c a n t r e l a t i o n s h i p was found between s i t u a t i o n a l control and psychological well-being r=-0.10, p_=.23. No s i g n i f i c a n t r e l a t i o n s h i p was found between s i t u a t i o n a l control and physical well-being r=-0.08, p_=. 29. A s i g n i f i c a n t p o s i t i v e r e l a t i o n s h i p , however, was found between psychological well-being and physical well-being r=0.37, p_=<.01. That i s , the higher the perception of psychological well-being, the higher the perception of physical well-being. A n c i l l a r y Analysis Data were analyzed to determine possible relationships between the personal and i n s t i t u t i o n a l demographic data, and the variables being studied. Between age and the following variables, no s i g n i f i c a n t r e l a t i o n s h i p was found: s i t u a t i o n a l c o ntrol, psychological or physical well-being, and the length of i n s t i t u t i o n a l i z a t i o n . Between the length of i n s t i t u t i o n a l i z a t i o n and physical well-being r*-0.26, p_=.03, a s i g n i f i c a n t r e l a t i o n s h i p was found. That i s , the longer the resident was i n s t i t u t i o n a l i z e d , the lower the resident's perception of physical well-being. F i n a l l y , a s i g n i f i c a n t n e g a t i v e r e l a t i o n s h i p b e t w e e n t h e number o f h e a l t h p r o b l e m s and p h y s i c a l w e l l - b e i n g r = - 0 . 4 6 , pjc.01, was f o u n d . T h a t i s , t h e g r e a t e r t h e number o f p e r c e i v e d h e a l t h p r o b l e m s , t h e l o w e r t h e p e r c e p t i o n o f p h y s i c a l w e l l - b e i n g . D i s c u s s i o n o f R e s u l t s I n t h i s s t u d y , a l l s u b j e c t s p e r c e i v e d s i t u a t i o n a l c o n t r o l . F u r t h e r m o r e , 9 4 % o f t h e s u b j e c t s p e r c e i v e d c o n t r o l i n s i x o f t h e p o s s i b l e e i g h t a c t i v i t i e s o f d a i l y l i v i n g . T h e s e f i n d i n g s r e f l e c t t h a t t h e s a m p l e p e r c e i v e s a h i g h d e g r e e o f s i t u a t i o n a l c o n t r o l (M=6.65). I n t h i s , t h e f i n d i n g s a r e s i m i l a r t o R y d e n ' s ( 1 9 8 4 ) (M=7.00). B o t h i n v e s t i g a t o r s u s e d t h e same s c a l e t o m e a s u r e s i t u a t i o n a l c o n t r o l a n d t h e r e f o r e a r e c o m p a r a b l e . Chang ( 1 9 7 8 a & 1 9 7 8 b ) , h o w e v e r , d i d n o t i n d i c a t e i n h e r r e s u l t s t h e d e g r e e o f s i t u a t i o n a l c o n t r o l , a l t h o u g h s h e d i d s u g g e s t t h a t some s u b j e c t s l a c k e d s i t u a t i o n a l c o n t r o l . T h e r e a r e s e v e r a l f a c t o r s t h a t may h e l p t o e x p l a i n t h e f i n d i n g i n t h i s s t u d y r e g a r d i n g t h e h i g h d e g r e e o f s i t u a t i o n a l c o n t r o l . T h i s i n v e s t i g a t o r ' s f i n d i n g t h a t 1 0 0 % o f t h e s a m p l e p e r c e i v e d s i t u a t i o n a l c o n t r o l , may be p a r t l y e x p l a i n e d b y t h e s u b j e c t ' s l e n g t h o f i n s t i t u t i o n a l i z a t i o n . A l l s u b j e c t s had b e e n i n s t i t u t i o n a l i z e d f r o m 7 months t o 12 y e a r s (M=3.6). R y d e n ' s ( 1 9 8 4 ) s u b j e c t s h a d a l s o b e e n i n s t i t u t i o n a l i z e d f o r a n a v e r a g e o f two y e a r s . C hang's ( 1 9 7 8 a ) s u b j e c t s , h o w e v e r , had o n l y b e e n i n s t i t u t i o n a l i z e d f r o m two weeks t o s i x m o n t h s . A c c o r d i n g t o Rosswurm ( 1 9 8 3 ) , and S t e i n a n d c o l l e a g u e s ( 1 9 8 6 ) , t h e f i r s t s i x months o f i n s t i t u t i o n a l i z a t i o n e ncompass t h e i n i t i a l a d j u s t m e n t p h a s e a n d i s a m a j o r f a c t o r i n a f f e c t i n g t h e r e s i d e n t s ' p e r c e p t i o n . Once o u t o f t h e a d j u s t m e n t p h a s e , Chang's ( 1 9 7 8 a ) s u b j e c t s p o s s i b l y w o u l d h a v e p e r c e i v e d a h i g h e r d e g r e e o f s i t u a t i o n a l c o n t r o l . A n o t h e r e x p l a n a t i o n f o r t h i s s t u d y ' s f i n d i n g s i s t h e amount o f c a r e , c o m p a r e d t o o t h e r s t u d i e s , t h a t e a c h r e s i d e n t r e q u i r e d . F o r i n s t a n c e , r e s i d e n t s i n a s k i l l e d c a r e f a c i l i t y - w o u l d r e q u i r e more a s s i s t a n c e t h a n w o u l d r e s i d e n t s i n a n i n t e r m e d i a t e c a r e f a c i l i t y . P o s s i b l y , r e s i d e n t s r e q u i r i n g a g r e a t e r amount o f a s s i s t a n c e m i g h t p e r c e i v e a l o w e r d e g r e e o f s i t u a t i o n a l c o n t r o l t h a n w o u l d r e s i d e n t s r e q u i r i n g l e s s a s s i s t a n c e . As t h e m a j o r i t y o f t h i s s t u d y ' s r e s i d e n t s were i n d e p e n d e n t a n d c a p a b l e o f d o i n g most o f t h e i r c a r e , t h e y t h e r e f o r e r e q u i r e d m i n i m a l a s s i s t a n c e . Chang's ( 1 9 7 8 a ) s a m p l e was f r o m a s k i l l e d n u r s i n g f a c i l i t y a n d w o u l d r e q u i r e more p h y s i c a l c a r e . T h i s c o u l d i n f l u e n c e t h e i r p e r c e p t i o n o f c o n t r o l , t h e r e b y c o n t r i b u t i n g t o t h e d i f f e r e n c e i n r e s u l t s . T h i s i n v e s t i g a t o r f o u n d t h a t many r e s i d e n t s p e r c e i v e d a l o w d e g r e e o f s i t u a t i o n a l c o n t r o l f o r t h e d a i l y a c t i v i t i e s o f e a t i n g and g r o o m i n g . R y d e n ( 1 9 8 4 ) a l s o f o u n d t h a t t h e r e s i d e n t s p e r c e i v e d t h e l e a s t c o n t r o l i n the d a i l y a c t i v i t i e s of e a t i n g and grooming, some r e s i d e n t s were q u i t e a g i t a t e d when they d i s c u s s e d the f a u l t s of the cooks and d i e t i c i a n s . However, to improve the s i t u a t i o n , a group of r e s i d e n t s i n each i n s t i t u t i o n j o i n e d d i e t a r y p l a n n i n g committees to t r y to improve the q u a l i t y of t h e i r meals. Other r e s i d e n t s had purchased s m a l l f r i d g e s and kept some food i n t h e i r rooms. S t i l l other r e s i d e n t s s a i d they went out to eat as much as p o s s i b l e . D i s c u s s i n g grooming, a number of r e s i d e n t s s a i d they had no c o n t r o l over b a t h i n g . However, as they were ab l e t o r a t i o n a l i z e t h a t the s t a f f had a l a r g e number of people t o bathe, they seemed more a c c e p t i n g of t h i s l a c k of c o n t r o l . The r e s u l t s of those i n t e r v i e w s suggest t h a t the i n t e r n a l c o n s i s t e n c y of the SCDA t o o l alpha=»0• 23 may be low because the focus of the a c t i v i t i e s being asked were not meaningful t o the r e s i d e n t s . M i l l e r (1983), R o t t e r (1971), and Seligman (1975) suggest t h a t the need f o r , or importance o f , c o n t r o l i s p o s i t i v e l y r e l a t e d t o the meaning t h a t c o n t r o l of a s i t u a t i o n has f o r an i n d i v i d u a l . P o s s i b l y , the items of the SCDA t o o l were not tap p i n g i n t o c e r t a i n a r e a s , such as s i t u a t i o n a l c o n t r o l . T h i s p o s s i b i l i t y i s supported by the f i n d i n g t h a t the o n l y two d a i l y a c t i v i t i e s (eating/grooming) where the r e s i d e n t s p e r c e i v e d a l a c k of s i t u a t i o n a l c o n t r o l were a l s o the o n l y two a c t i v i t i e s where the r e s i d e n t s had 49 emotional responses. When i n t e r v i e w e d , the r e s i d e n t s i n d i c a t e d t h a t they f r e q u e n t l y d i d not want to p a r t i c i p a t e i n group a c t i v i t i e s the v a r i o u s i n s t i t u t i o n a l departments o r g a n i z e d . Many r e s i d e n t s (98%), however, p e r c e i v e d a hig h degree of s i t u a t i o n a l c o n t r o l i n t h i s a c t i v i t y . "Yes, I c o u l d go to k n i t t i n g c l a s s e s and the d i f f e r e n t o u t i n g s , but I don't want t o . . . . I t ' s j u s t the same people, always complaining.... I have my own i n t e r e s t s which keep me busy". That many s u b j e c t s i n t h i s study were a l s o i n v o l v e d with Christmas a c t i v i t i e s suggests another reason f o r the r e s i d e n t ' s high degree of s i t u a t i o n a l c o n t r o l . T h i s study's data were c o l l e c t e d between November 15 and December 15. In other words, 75% of the data were c o l l e c t e d i n the Christmas season (December 5 to December 15). Many r e s i d e n t s were i n v o l v e d i n Christmas a c t i v i t i e s : making Christmas d e c o r a t i o n s and d e c o r a t i n g t h e i r rooms, l i s t e n i n g t o Christmas c a r o l s , buying Christmas p r e s e n t s , having more v i s i t o r s , and going on s i g h t s e e i n g e x c u r s i o n s . T h i s a c t i v i t y l e v e l p o s s i b l y may not r e f l e c t t h e i r usual a c t i v i t y l e v e l d u r i n g the r e s t of the year. That t h i s study's f i n d i n g s i n d i c a t e d no r e l a t i o n s h i p between s i t u a t i o n a l c o n t r o l and p s y c h o l o g i c a l or p h y s i c a l w e l l - b e i n g , i s not s u r p r i s i n g . Since a l l s u b j e c t s 50 p e r c e i v e d s i t u a t i o n a l c o n t r o l , very l i t t l e v a r i a n c e t h e r e f o r e e x i s t e d i n the degree of s i t u a t i o n a l c o n t r o l . Ryden (1984), on the other hand, used path a n a l y s i s t o suggest t h a t a s i g n i f i c a n t r e l a t i o n s h i p between s i t u a t i o n a l c o n t r o l and morale e x i s t s (path c o e f f i c i e n t = 0 . 3 4 , p_=.01). Chang (1978a) found t h a t r e s i d e n t s who p e r c e i v e s i t u a t i o n a l c o n t r o l have a higher morale sco r e F=19.54, p_=<.01. P o s s i b l e e x p l a n a t i o n s f o r Chang's s i g n i f i c a n t r e s u l t s , compared to t h i s i n v e s t i g a t o r ' s r e s u l t s , i s l i k e l y due to the lack of s u b j e c t s i n t h i s study who p e r c e i v e d no c o n t r o l . The f i n d i n g t h a t there i s a s i g n i f i c a n t r e l a t i o n s h i p between p s y c h o l o g i c a l w e l l - b e i n g and p h y s i c a l w e l l - b e i n g r=0.37, p_=<.01 agrees w i t h the suggestions i n most of the reviewed l i t e r a t u r e . For i n s t a n c e , Snow and Crapo (1982) found t h a t s e l f - r a t e d h e a l t h i s s i g n i f i c a n t l y r e l a t e d t o l i f e s a t i s f a c t i o n r=0.50, p_<.001. Furthermore, Larson (1978) i n h i s review of the l i t e r a t u r e s t a t e s t h a t h e a l t h i s s t r o n g l y r e l a t e d to s u b j e c t i v e w e l l - b e i n g r_=.2 to r = .4. Ac c o r d i n g t o Munro and c o l l e a g u e s (1986), a c o r r e l a t i o n of 0.26-0.49 i n d i c a t e s a low r e l a t i o n s h i p . They a l s o s t a t e , however, t h a t with human s u b j e c t s a c o r r e l a t i o n of .50 may be q u i t e a c c e p t a b l e . P o l i t and Bungler (1987) s t a t e t h a t p e r f e c t c o r r e l a t i o n s are r a r e i n people. Burns and Grove (1987) a l s o s t a t e t h a t the i n t e r p r e t a t i o n of the c o r r e l a t i o n depends g r e a t l y on which v a r i a b l e s are examined and t h a t there e x i s t s the p o t e n t i a l of d i s r e g a r d i n g a meaningful r e l a t i o n s h i p . C o n s i d e r i n g the m u l t i p l e c o n c e p t u a l i z a t i o n s of w e l l - b e i n g , t h i s r e s e a r c h e r suggests t h a t i n t h i s study the r e l a t i o n s h i p between p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g of r_=.37 i s low but r e f l e c t i v e of the d i r e c t i o n expected. Other r e s e a r c h e r s a l s o suggest a r e l a t i o n s h i p between h e a l t h and w e l l - b e i n g . Both Costa and c o l l e a g u e s (1987), and Lawton (1983b), suggest t h a t poor h e a l t h w i l l decrease an i n d i v i d u a l ' s t o t a l w e l l - b e i n g . Thorne and c o l l e a g u e s (1986) propose t h a t the meaning i n d i v i d u a l s have f o r t h e i r l i v e s " s h i f t s to envelop and c o n t e x t u a l i z e " (p.17) t h e i r p e r c e p t i o n s of h e a l t h and w e l l - b e i n g . T h i s r e s e a r c h e r found a s i m i l a r occurrence as she c o l l e c t e d the d a t a . As they completed the PWB q u e s t i o n n a i r e , many r e s i d e n t s would o f t e n s t o p , t h i n k and then say, "Well, of course I have aches and p a i n s , but a t t h i s age i t i s e x p e c t e d . . . . R e a l l y f o r my age, I am q u i t e w e l l " . T h i s r e s e a r c h e r a l s o found t h a t the longer the r e s i d e n t was i n s t i t u t i o n a l i z e d , the more h e a l t h problems he or she p e r c e i v e d r=0.36, p_=<.01; and the more h e a l t h problems p e r c e i v e d , the lower the p e r c e p t i o n of p h y s i c a l w e l l - b e i n g r = -0.46, p_=<.01. F i n a l l y , the longer the r e s i d e n t was I n s t i t u t i o n a l i z e d , the lower h i s or her p e r c e p t i o n of p h y s i c a l w e l l - b e i n g r = - 0 . 2 6 , p_=.03. T h i s r e s e a r c h e r used Lazarus and Folkman's (1984) p s y c h o l o g i c a l s t r e s s t h e o r y as a framework to understand the r e l a t i o n s h i p between the secondary a p p r a i s a l of s i t u a t i o n a l c o n t r o l and the a d a p t a t i o n a l outcomes of p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g . A c c o r d i n g to the t h e o r e t i c a l framework, there are a number of f a c t o r s w i t h i n the person, such as commitments and b e l i e f s , and f a c t o r s i n the s i t u a t i o n , which may a f f e c t the p e r c e p t i o n of what i s a t s t a k e . Furthermore, one's a p p r a i s a l of s i t u a t i o n a l c o n t r o l i s expected t o i n f l u e n c e the coping s t r a t e g i e s and thereby a f f e c t one's p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g . There are a l s o f a c t o r s w i t h i n the copi n g r e s o u r c e s , as w e l l as c o n s t r a i n t s a g a i n s t u t i l i z i n g c o p i n g s t r a t e g i e s which may a f f e c t w e l l - b e i n g . None of the above f a c t o r s were examined i n t h i s study, however, i t i s p o s s i b l e t o use the t h e o r e t i c a l framework to provide e x p l a n a t i o n s f o r the f i n d i n g s of t h i s study. That no s i g n i f i c a n t r e l a t i o n s h i p e x i s t e d between s i t u a t i o n a l c o n t r o l , and p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g , may be p a r t i a l l y e x p l a i n e d by person, environment and coping resource f a c t o r s . For example, a l l the r e s i d e n t s i n t e r v i e w e d were w e l l versed i n what they c o u l d or c o u l d not do. D i s c u s s i n g e a t i n g , the r e s i d e n t would o f t e n say, "They determine when I e a t , but t h a t i s 53 the r o u t i n e . There are a l o t of people t h a t must e a t " . S e v e r a l r e s i d e n t s who were i n t e r v i e w e d and found t o have a secondary a p p r a i s a l of s i t u a t i o n a l c o n t r o l , but had a low p e r c e p t i o n of p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g , s t a t e d t h a t they " j u s t d i d not have any energy" or they "could not be bothered to p a r t i c i p a t e i n group a c t i v i t i e s " . S e v e r a l r e s i d e n t s i n d i c a t e d t h a t they had v e r y s m a l l s o c i a l networks. Other r e s i d e n t s s t a t e d , " C e r t a i n l y I decide what to do. I have a l l the freedom I want, but nobody c a r e s . I might j u s t as w e l l d i e " . T h i s r e s e a r c h e r suggests t h a t the f i n d i n g s of t h i s s tudy support the t h e o r e t i c a l framework. Lazarus and Folkman (1984) s t a t e t h a t a complex i n t e r a c t i o n occurs between the a d a p t a t i o n a l outcomes. They a l s o s t a t e t h a t m u l t i p l e outcomes, r a t h e r than a s i n g l e a d a p t a t i o n a l outcome, must be c o n s i d e r e d . P o s s i b l y s t r o n g e r c o r r e l a t i o n between p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g was not found, t h e r e f o r e , because of the e f f e c t of the v a r i a b l e s : f u n c t i o n i n g i n work and s o c i a l l i v i n g . For i n s t a n c e , Ryden (1984) conducted a study i n which she found a r e l a t i o n s h i p between f u n c t i o n a l dependency and morale. T h i s r e s e a r c h e r , however, d i d not study the v a r i a b l e s f u n c t i o n i n g i n work and s o c i a l l i v i n g . Summary In summary, the sample c o n s i s t e d of r e s i d e n t s who were predominantly female, widowed and who had been i n s t i t u t i o n a l i z e d f o r more than three y e a r s . A l l r e s i d e n t s were found t o have an o v e r a l l p e r c e p t i o n of s i t u a t i o n a l c o n t r o l , however, r e s i d e n t s p e r c e i v e d a lack of s i t u a t i o n a l c o n t r o l f o r the d a i l y a c t i v i t i e s of e a t i n g and grooming. The m a j o r i t y of r e s i d e n t s obtained a moderately high score of p s y c h o l o g i c a l w e l l - b e i n g and a moderate score of p h y s i c a l w e l l - b e i n g . The r e s u l t s suggested t h a t there was no s i g n i f i c a n t r e l a t i o n s h i p between s i t u a t i o n a l c o n t r o l and p s y c h o l o g i c a l w e l l - b e i n g or s i t u a t i o n a l c o n t r o l and p h y s i c a l w e l l - b e i n g . The r e s u l t s d i d , however, i n d i c a t e a s i g n i f i c a n t r e l a t i o n s h i p between p s y c h o l o g i c a l w e l l - b e i n g and p h y s i c a l w e l l - b e i n g . From the a n c i l l a r y a n a l y s i s , a s i g n i f i c a n t n e g a t i v e r e l a t i o n s h i p was found between the le n g t h of i n s t i t u t i o n a l i z a t i o n and p h y s i c a l w e l l - b e i n g . A s i g n i f i c a n t n e g ative r e l a t i o n s h i p was a l s o found between the number of h e a l t h problems and p h y s i c a l w e l l - b e i n g . T h i s study's f i n d i n g s r e f l e c t a hi g h degree of s i t u a t i o n a l c o n t r o l and i n t h i s way are s i m i l a r t o Ryden's (1984) f i n d i n g s . Both i n v e s t i g a t o r s had s u b j e c t s who r e s i d e d i n int e r m e d i a t e care f a c i l i t i e s and both used the same s c a l e t o measure s i t u a t i o n a l c o n t r o l . C h a n g (1978a), a l s o used the same s c a l e t o measure s i t u a t i o n a l c o n t r o l of r e s i d e n t s i n a s k i l l e d care f a c i l i t y , however, she found t h a t some s u b j e c t s p e r c e i v e d a lack of s i t u a t i o n a l c o n t r o l . P o s s i b l e e x p l a n a t i o n s have been suggested f o r these d i f f e r e n c e s and thereby the lack of r e l a t i o n s h i p found between c o n t r o l and w e l l - b e i n g . The f i n d i n g t h a t p s y c h o l o g i c a l w e l l - b e i n g and p h y s i c a l w e l l - b e i n g were r e l a t e d was as expected and r e f l e c t e d from the l i t e r a t u r e . F i n a l l y , t h i s r e s e a r c h e r found the t h e o r e t i c a l framework h e l p f u l i n understanding the f i n d i n g s of t h i s study. CHAPTER 5 Summary, C o n c l u s i o n s , I m p l i c a t i o n s and Recommendations T h i s study was designed t o examine the r e l a t i o n s h i p between s i t u a t i o n a l c o n t r o l and p s y c h o l o g i c a l w e l l - b e i n g , s i t u a t i o n a l c o n t r o l and p h y s i c a l w e l l - b e i n g , and p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g i n 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 . T h i s chapter c o n t a i n s a summary of the study, c o n c l u s i o n s d e r i v e d from the study, i m p l i c a t i o n s f o r n u r s i n g p r a c t i c e , and recommendations f o r f u r t h e r r e s e a r c h . Summary A review of the l i t e r a t u r e on 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 i n d i c a t e s t h a t some e l d e r l y r e s i d e n t s p e r c e i v e t h a t the i n s t i t u t i o n a l environment c o n s t r a i n s them, and thereby permits them l i t t l e p e r s o n a l c o n t r o l . Other r e s e a r c h f i n d i n g s suggest t h a t i n s t i t u t i o n a l i z a t i o n i s n e g a t i v e l y a s s o c i a t e d with the e l d e r l y r e s i d e n t ' s sense of w e l l - b e i n g . The l i t e r a t u r e a l s o suggests t h a t an in c r e a s e d m o r t a l i t y r a t e among some e l d e r l y r e s i d e n t s i s a s s o c i a t e d with i n s t i t u t i o n a l i z a t i o n . S e v e r a l r e s e a r c h e r s contend t h a t s i t u a t i o n a l c o n t r o l i s l i n k e d t o an i n c r e a s e d f e e l i n g of w e l l - b e i n g , whereas other r e s e a r c h e r s suggest t h a t there i s no r e l a t i o n s h i p between s i t u a t i o n a l c o n t r o l and w e l l - b e i n g . S e v e r a l gaps noted i n the l i t e r a t u r e comprise these d i v e r g e n t r e s e a r c h f i n d i n g s . Furthermore, these s t u d i e s were conducted i n C e n t r a l and E a s t e r n Canada, as w e l l as p a r t s of the Uni t e d S t a t e s . T h i s study's purpose, t h e r e f o r e , was to examine the r e l a t i o n s h i p between s i t u a t i o n a l c o n t r o l , and p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g , i n the context of e l d e r l y i n s t i t u t i o n a l i z e d i n a B r i t i s h Columbia in t e r m e d i a t e care f a c i l i t y . T h i s d e s c r i p t i v e c o r r e l a t i o n a l study was conducted i n two l a r g e intermediate care f a c i l i t i e s l o c a t e d i n a l a r g e western Canadian c i t y . Data were c o l l e c t e d from 52 e l d e r l y r e s i d e n t s . Each r e s i d e n t completed the P e r c e i v e d Well-Being S c a l e , the S i t u a t i o n a l C o n t r o l Of D a i l y A c t i v i t i e s S c a l e , and the Subject Information Sheet. The sample c o n s i s t e d of 38 females and 14 males, aged from 66 to 96 (M=83.2) y e a r s . S i x t y - n i n e percent of the r e s i d e n t s were widowed, 2 3 % were s i n g l e , 4% were married and 4% were d i v o r c e d . The len g t h of i n s t i t u t i o n a l i z a t i o n ranged from 1 t o 12 (M=3.6) y e a r s . P r i o r t o i n s t i t u t i o n a l i z a t i o n , 40 r e s i d e n t s l i v e d i n t h e i r own homes ( 7 6 . 9 % ) , while 12 r e s i d e n t s l i v e d i n other l o d g i n g s ( 2 3 . 1 % ) . In t h i s study, e i t h e r the r e s i d e n t ( 2 8 . 9 % ) , the f a m i l y ( 1 3 . 5 % ) , an o u t s i d e r ( 3 8 . 5 % ) or a combination of these i n d i v i d u a l s ( 1 9 . 1 % ) , planned the r e s i d e n t ' s admission t o the int e r m e d i a t e care f a c i l i t i e s . F o r t y - f o u r r e s i d e n t s ( 8 4 . 6 % ) had v i s i t o r s , and 8 r e s i d e n t s d i d not have v i s i t o r s ( 1 5 . 4 % ) . R e s i d e n t s ' 58 numbers of health problems ranged from 0 to 5 (M=2.2). A l l residents were found to have an o v e r a l l perception of s i t u a t i o n a l control (M«=6.65) (SD=0.86). However, 75% did not perceive s i t u a t i o n a l control for the d a i l y a c t i v i t y of eating, and 46% did not perceive s i t u a t i o n a l control for grooming. For each of the remaining d a i l y a c t i v i t i e s , only 0-8% perceived a lack of s i t u a t i o n a l c o n t r o l . For the variable psychological well-being, the majority of residents obtained a moderately high score; whereas for the variable physical well-being, the majority of residents obtained only moderate scores. Between the variables being tested, no s i g n i f i c a n t r e l a t i o n s h i p was found between s i t u a t i o n a l control and psychological well-being r=-0.10, p=0.29, or between s i t u a t i o n a l control and physical well-being r=-0.08, p=0.29. Between psychological well-being and physical well-being r=0.37, p_=<.01, however, a s i g n i f i c a n t p o s i t i v e r e l a t i o n s h i p was found. There were also three s i g n i f i c a n t relationships between variables that were not stated in the hypotheses. A s i g n i f i c a n t positive r e l a t i o n s h i p was found between the length of i n s t i t u t i o n a l i z a t i o n and the number of health problems r_=0.36, p_=<.01, and a s i g n i f i c a n t negative r e l a t i o n s h i p between the length of i n s t i t u t i o n a l i z a t i o n and physical well-being r = -0.26, p_=.03. F i n a l l y , a s i g n i f i c a n t negative r e l a t i o n s h i p between the number of h e a l t h problems and p h y s i c a l w e l l - b e i n g r=-0.46, p_<.01, was found. Lazarus and Folkman's (1984) p s y c h o l o g i c a l s t r e s s t h e o r y was used i n the c o n c e p t u a l i z a t i o n of the problem and i n the a n a l y s i s of t h i s study's f i n d i n g s . T h i s t h e o r y was an a p p r o p r i a t e model i n t h a t i t r e f l e c t e d p o s s i b l e r e l a t i o n s h i p s among the v a r i a b l e s and, t h e r e f o r e , helped t h i s i n v e s t i g a t o r understand both what to expect and how to i n t e r p r e t the f i n d i n g s . C o n c l u s i o n s For four reasons, the f i n d i n g s of t h i s study cannot be g e n e r a l i z e d . Three of these reasons were a n t i c i p a t e d and s t a t e d as l i m i t a t i o n s of t h i s study, but the f o u r t h reason was not a n t i c i p a t e d . F i r s t , a convenience sample was used, t h e r e f o r e , the t a r g e t p o p u l a t i o n may not be r e p r e s e n t e d . Second, s i n c e an i n d i v i d u a l ' s p e r c e p t i o n of s i t u a t i o n a l c o n t r o l , and p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g may f l u c t u a t e , the r e s u l t s of t h i s study r e f l e c t t h e i r p e r c e p t i o n a t one p o i n t i n time o n l y . In other words, an i n d i v i d u a l ' s p e r c e p t i o n of a s i t u a t i o n may change as the i n d i v i d u a l r e c e i v e s new i n f o r m a t i o n and r e a p p r a i s e s the s i t u a t i o n . T h i r d , the sample was l i m i t e d both to those who c o u l d read and speak E n g l i s h ; and to those who were o r i e n t e d t o time, p l a c e and person. F o u r t h , i n t h i s study the i n t e r n a l c o n s i s t e n c y of the 60 S i t u a t i o n a l C o n t r o l Of D a l l y A c t i v i t i e s S c ale was poor alphas.23 i n d i c a t i n g poor r e l i a b i l i t y . W i t h in the context of the above l i m i t a t i o n s , e l d e r l y r e s i d e n t s i n s t i t u t i o n a l i z e d i n intermediate care f a c i l i t i e s p e r c e i v e s i t u a t i o n a l c o n t r o l , however, the m a j o r i t y of e l d e r l y r e s i d e n t s p e r c e i v e a lack of s i t u a t i o n a l c o n t r o l i n the d a i l y a c t i v i t i e s of e a t i n g and grooming. The m a j o r i t y of e l d e r l y r e s i d e n t s have a moderately high p e r c e p t i o n of p s y c h o l o g i c a l w e l l - b e i n g and a moderate p e r c e p t i o n of p h y s i c a l w e l l - b e i n g . I t i s not c l e a r what r e l a t i o n s h i p e x i s t s between the e l d e r l y r e s i d e n t ' s p e r c e p t i o n of s i t u a t i o n a l c o n t r o l and p s y c h o l o g i c a l w e l l - b e i n g , or s i t u a t i o n a l c o n t r o l and p h y s i c a l w e l l - b e i n g because a l l of the r e s i d e n t s p e r c e i v e d s i t u a t i o n a l c o n t r o l . P o s s i b l y the r e s u l t s c o u l d have have been v e r y d i f f e r e n t had the r e s i d e n t s been from a s k i l l e d n u r s i n g f a c i l i t y . There i s a p o s i t i v e r e l a t i o n s h i p between p s y c h o l o g i c a l w e l l - b e i n g and p h y s i c a l w e l l - b e i n g . E l d e r l y r e s i d e n t s who have been i n s t i t u t i o n a l i z e d f o r a longer p e r i o d of time p e r c e i v e both an i n c r e a s e i n h e a l t h problems and a lower degree of p h y s i c a l w e l l - b e i n g . Furthermore, the e l d e r l y r e s i d e n t who p e r c e i v e s more h e a l t h problems a l s o p e r c e i v e s a lower degree of p h y s i c a l w e l l - b e i n g . F i n a l l y , the age of the r e s i d e n t does not seem to be r e l a t e d t o t h e i r p e r c e p t i o n of s i t u a t i o n a l c o n t r o l , p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g , or the l e n g t h of i n s t i t u t i o n a l i z a t i o n . I m p l i c a t i o n s For Nursing P r a c t i c e Knowing how, why, or when a r e s i d e n t p e r c e i v e s s i t u a t i o n a l c o n t r o l c o u l d be h e l p f u l to the nurse i n an int e r m e d i a t e care f a c i l i t y . For example, i n the two int e r m e d i a t e care f a c i l i t i e s , r e s i d e n t s who were independent, v e r y a c t i v e , and had a s t r o n g s o c i a l network p e r c e i v e d a hig h degree of s i t u a t i o n a l c o n t r o l . I t i s p o s s i b l e , however, t h a t r e s i d e n t s r e s i d i n g i n a s k i l l e d care f a c i l i t y may p e r c e i v e s i t u a t i o n a l c o n t r o l v e r y d i f f e r e n t l y . The nurse must be aware of t h i s p o s s i b l i t y and make i n d i v i d u a l assessments and p l a n s . For example, one r e s i d e n t had a degree of s i t u a t i o n a l c o n t r o l but because he had so much freedom he thought no one cared whether he was a l i v e or dead. In a d d i t i o n , nurses need to look a t t h e i r n u r s i n g i n t e r v e n t i o n s t o ev a l u a t e which are h e l p f u l i n i n c r e a s i n g s i t u a t i o n a l c o n t r o l and which may be d e t r i m e n t a l . In t h i s study a l l r e s i d e n t s p e r c e i v e d s i t u a t i o n a l c o n t r o l f o r the a c t i v i t i e s of ambulating, d r e s s i n g , t o i l e t i n g , group p a r t i c i p a t i o n , one to one i n t e r a c t i o n , and s o l i t a r y a c t i v i t i e s . That the r e s i d e n t s p e r c e i v e d s i t u a t i o n a l c o n t r o l i n these a c t i v i t i e s c o u l d mean t h a t n u r s i n g i n t e r v e n t i o n s aimed a t enhancing the r e s i d e n t ' s p e r c e p t i o n of s i t u a t i o n a l c o n t r o l were e f f e c t i v e . Knowing 62 t h i s knowledge, nurses In a d m i n i s t r a t i o n c o u l d t r y to i n i t i a t e changes t h a t would i n c r e a s e the r e s i d e n t ' s s i t u a t i o n a l c o n t r o l . For example, a d m i n i s t r a t i v e nurses c o u l d meet with r e s i d e n t s to d i s c o v e r what t h e i r wishes and concerns were, and then attempt to implement changes t h a t would address the r e s i d e n t ' s needs. I t i s p o s s i b l e to p e r c e i v e o n l y one aspect of a s i t u a t i o n as being c o n t r o l l e d . For i n s t a n c e , r e s i d e n t s had a high degree of s i t u a t i o n a l c o n t r o l , but they d i d not p e r c e i v e s i t u a t i o n a l c o n t r o l f o r the a c t i v i t i e s of ' e a t i n g and grooming. Because the r e s i d e n t has many d i f f e r e n t areas i n which he or she can p e r c e i v e s i t u a t i o n a l c o n t r o l , nurses must look a t a l l p o s s i b l e a s p e c t s of the p a t i e n t ' s s i t u a t i o n , r a t h e r than doing j u s t a g l o b a l assessment. For example, the nurse must as s e s s each r e s i d e n t i n d i v i d u a l l y t o determine how the r e s i d e n t i s p e r c e i v i n g the s i t u a t i o n , what f a c t o r s are i n f l u e n c i n g the r e s i d e n t ' s p e r c e p t i o n s , and what has meaning f o r the r e s i d e n t . With t h i s knowledge, the nurse can then i n t e r v e n e by i n t r o d u c i n g s t r a t e g i e s such as communication t h a t w i l l enhance the r e s i d e n t ' s p a r t i c i p a t i o n i n the decision-making pr o c e s s . Nurses should be aware t h a t an e l d e r l y r e s i d e n t ' s p e r c e p t i o n of p s y c h o l o g i c a l w e l l - b e i n g i s p o s i t i v e l y r e l a t e d t o t h e i r p e r c e p t i o n of p h y s i c a l w e l l - b e i n g . The nurse s h o u l d a l s o be aware t h a t f a c t o r s such as a s o c i a l network might i n f l u e n c e p s y c h o l o g i c a l w e l l - b e i n g . Knowing these t h i n g s , the nurse i n c o n j u n c t i o n with the r e s i d e n t c o u l d p l a n i n t e r v e n t i o n s aimed a t s t r e n g t h e n i n g f a c t o r s t h a t would improve the r e s i d e n t ' s p s y c h o l o g i c a l w e l l - b e i n g . For example, i f the nurse i s aware t h a t a r e s i d e n t has v e r y few f r i e n d s , then the nurse can support the r e s i d e n t ' s attempts to expand h i s s o c i a l network. Nurses need t o be aware t h a t the r e s i d e n t p e r c e i v e s more h e a l t h problems and a lower l e v e l of p h y s i c a l w e l l - b e i n g the longer he or she i s i n s t i t u t i o n a l i z e d . As w e l l , nurses need to r e c o g n i z e t h a t the r e s i d e n t with an i n c r e a s e d number of p e r c e i v e d h e a l t h problems may have a lower p e r c e p t i o n of p h y s i c a l w e l l - b e i n g . These r e s i d e n t s , t h e r e f o r e , may r e q u i r e m u l t i p l e n u r s i n g i n t e r v e n t i o n s . For example, the nurse must c o l l e c t data, d e s i g n a p l a n and develop i n t e r v e n t i o n s t o d e a l with the r e s i d e n t ' s problems. The nurse can i n t e r v e n e by attempting to i n c r e a s e the r e s i d e n t ' s r e s o u r c e s such as knowledge, hope, and p h y s i c a l s t r e n g t h . Recommendations For F u r t h e r Research A s i m i l a r study i n both an i n t e r m e d i a t e care f a c i l i t y and an extended care f a c i l i t y i n western Canada should be undertaken c o n c u r r e n t l y to t e s t the r e l a t i o n s h i p between the d i f f e r e n t l e v e l s of care and the v a r i a b l e s s i t u a t i o n a l c o n t r o l , and p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g . T h i s Is of p a r t i c u l a r i n t e r e s t 64 because of the independence and high l e v e l of a c t i v i t y among the e l d e r l y r e s i d e n t s of the int e r m e d i a t e care f a c i l i t i e s . Of i n t e r e s t a l s o would be a study conducted a t a d i f f e r e n t time of the year i n order to determine whether or not the Christmas season was a f a c t o r i n t h i s study's r e s u l t s . Furthermore, a l o n g i t u d i n a l study would be v a l u a b l e t o a p p r a i s e change over time. The p o t e n t i a l r e l a t i o n s h i p between s i t u a t i o n a l c o n t r o l and p s y c h o l o g i c a l w e l l - b e i n g , and s i t u a t i o n a l c o n t r o l and morale, should be c l a r i f i e d by d e s i g n i n g a study t h a t w i l l examine these r e l a t i o n s h i p s . Because w e l l - b e i n g has m u l t i p l e c o n c e p t u a l i z a t i o n s , and although s e v e r a l r e s e a r c h e r s found a r e l a t i o n s h i p between s i t u a t i o n a l c o n t r o l and morale, no r e l a t i o n s h i p between s i t u a t i o n a l c o n t r o l and p s y c h o l o g i c a l w e l l - b e i n g was found. I t i s p o s s i b l e t h a t the reason f o r the d i f f e r e n t f i n d i n g s i s because p s y c h o l o g i c a l w e l l - b e i n g and morale make up d i f f e r e n t components of w e l l - b e i n g , and th a t somehow t h i s d i f f e r e n c e a f f e c t s the r e l a t i o n s h i p between s i t u a t i o n a l c o n t r o l and w e l l - b e i n g . Because of the low i n t e r n a l c o n s i s t e n c y of the SCDA t o o l , t h i s r e s e a r c h e r q u e s t i o n s the f i n d i n g t h a t no s i g n i f i c a n t r e l a t i o n s h i p e x i s t s between e i t h e r s i t u a t i o n a l c o n t r o l and p s y c h o l o g i c a l w e l l - b e i n g , or s i t u a t i o n a l c o n t r o l and p h y s i c a l w e l l - b e i n g . Research, t h e r e f o r e , i s r e q u i r e d t o f u r t h e r a s sess and modify the S i t u a t i o n a l C o n t r o l Of D a i l y A c t i v i t i e s S c a l e . F i n a l l y , Lazarus and Folkman (1984) s t a t e t h a t a complex i n t e r a c t i o n occurs between the a d a p t a t i o n a l outcomes, and t h a t m u l t i p l e outcomes must be c o n s i d e r e d r a t h e r than a s i n g l e outcome. For example, the f a c t o r s , f u n c t i o n i n g i n work and s o c i a l l i v i n g , may p o s s i b l y i n f l u e n c e w e l l - b e i n g . Thus, s t u d y i n g these f a c t o r s would be u s e f u l . Path a n a l y s i s i s one method t h a t c o u l d be used t o study the d i r e c t and i n d i r e c t e f f e c t s of these f a c t o r s on p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g . In c o n c l u d i n g , t h i s i n v e s t i g a t o r hopes t h a t as a r e s u l t of t h i s study's f i n d i n g s , h e a l t h care p r o f e s s i o n a l s w i l l become more aware of s i t u a t i o n a l c o n t r o l , and i t s r e l a t i o n s h i p to the p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g of 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 . The i n v e s t i g a t o r a l s o hopes t h a t with t h e i r i n c r e a s e d awareness, these p r o f e s s i o n a l s w i l l be b e t t e r a b l e to provide and d e s i g n care f o r 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 i n an i n t e r m e d i a t e care f a c i l i t y . References Anderson, R. (1982). SarapleCalc. ABT A s s o c i a t e s : Microcomputer Software. A v e r i l l , J.R. (1973). P e r s o n a l c o n t r o l over a v e r s i v e s t i m u l i and i t s r e l a t i o n s h i p to s t r e s s . P s y c h o l o g i c a l  B u l l e t i n . 80 ( 4 ) , 286-303. Baur, P., & Okun, M. (1983). S t a b i l i t y of l i f e s a t i s f a c t i o n i n l a t e l i f e . The G e r o n t o l o g i s t . 23 ( 3 ) , 261-265. Borup, J . (1982). The e f f e c t s of v a r y i n g degrees of i n t e r i n s t i t u t i o n a l environmental change on long-term care p a t i e n t s . The G e r o n t o l o g i s t . 22 ( 4 ) , 409-417. Bradburn, N.M. (1969). The s t r u c t u r e of p s y c h o l o g i c a l  w e l l - b e i n g . Chicago: A d l i n e . Burns, N., & Groves, S.K. (1987). The p r a c t i c e of n u r s i n g  r e s e a r c h : Conduct, c r i t i q u e and u t i l i z a t i o n . P h i l a d e l p h i a : W.B. Saunders. Canadian M e d i c a l A s s o c i a t i o n (1987). Health care f o r the  e l d e r l y : Today's c h a l l e n g e s , tomorrow's o p t i o n s . Ottawa. Chang, B. (1978a). G e n e r a l i z e d expectancy, s i t u a t i o n a l p e r c e p t i o n , and morale among i n s t i t u t i o n a l i z e d aged. Nursing Research. 27 ( 5 ) , 316-324. Chang, B. (1978b). P e r c e i v e d s i t u a t i o n a l c o n t r o l of d a i l y a c t i v i t i e s : A new t o o l . Research In Nursing and  H e a l t h . 1 ( 4 ) , 181-188. Costa, P., Zonderman, A., McCrae, R., Cornoni-Huntley, J . , Locke, B., & Barbano, H. (1987). L o n g i t u d i n a l a n a l y s e s of p s y c h o l o g i c a l w e l l - b e i n g i n a n a t i o n a l sample: S t a b i l i t y of mean l e v e l s . J o u r n a l of  Gerontology. 42 ( 1 ) , 50-55. Devore, J . & Peck, R. (1986). S t a t i s t i c s : The e x p l o r a t i o n  of d a t a . S t . P a u l : West P u b l i s h i n g Company. Downe-Wamboldt, B., & Tamlyn, D. (1986). Determinants of p e r c e i v e d l i f e s a t i s f a c t i o n i n 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 . Nursing Papers, 18 ( 1 ) , 45-55. Folkman, S. (1984). P e r s o n a l c o n t r o l and s t r e s s and c o p i n g p r o c e s s e s : A t h e o r e t i c a l a n a l y s i s . J o u r n a l of  P e r s o n a l i t y and S o c i a l Psychology. 46 ( 4 ) , 839-852. Gutman, G.M., Gee, .M., Bojanowski, B.C., & Mottet, D. (1986). F a c t book on aging i n B r i t i s h Columbia. The Gerontology Research Centre: Simon F r a s e r U n i v e r s i t y . H a r e l , Z. (1981). Q u a l i t y of c a r e , congruence and w e l l - b e i n g among i n s t i t u t i o n a l i z e d aged. The  G e r o n t o l o g i s t . 21 ( 5 ) , 523-531. H i l t o n , B.A. (1987). Coping with the u n c e r t a i n t i e s of  b r e a s t cancer: A p p r a i s a l and coping s t r a t e g i e s . Ann Arbors, MI: U n i v e r s i t y M i c r o f i l m s I n t e r n a t i o n a l , No. 87-00,205. Kowalski, N.C. (1981). I n s t i t u t i o n a l r e l o c a t i o n : Current programs and a p p l i e d approaches. The G e r o n t o l o g i s t , 21 ( 5 ) , 512-519. Langer, E . J . & Rodin, J . (1976). The e f f e c t s of c h o i c e and enhanced per s o n a l r e s p o n s i b i l i t y f o r the aged: A f i e l d experiment i n an i n s t i t u t i o n a l s e t t i n g . J o u r n a l  of P e r s o n a l i t y and S o c i a l Psychology, 34 ( 2 ) , 191-198. Larson, R. (1978). T h i r t y years of r e s e a r c h on the s u b j e c t i v e w e l l - b e i n g of o l d e r Americans. J o u r n a l of  Gerontology. 33 ( 1 ) , 109-125. Lawton, M.P. (1983). The v a r i e t i e s of w e l l - b e i n g . Experimental Aging Research. 9 ( 2 ) , 65-72. Lazarus, R.S. & DeLongis, A. (1983). P s y c h o l o g i c a l s t r e s s and c o p i n g i n a g i n g . American P s y c h o l o g i s t . 38 ( 3 ) , 245-254. Lazarus, R., & Folkman, S. (1984). S t r e s s , a p p r a i s a l , and  c o p i n g . New York: S p r i n g e r . L e f c o u r t , H.M. (1973). The f u n c t i o n of the i l l u s i o n s of c o n t r o l and freedom. American P s y c h o l o g i s t . 28 ( 1 ) , 417-425. Long-term care program (1983). P o l i c y manual. P o l i c y No.  3.2.3. V i c t o r i a : M i n i s t r y of H e a l t h . Melanson, P. & Meagher, D. (1986, M a r c h / A p r i l ) . L i v i n g i n long-term i n s t i t u t i o n : Out of the j u n g l e and i n t o the zoo. G e r o n t l o n . 26-30. Mentzer, C A . & Schorr Anderson, J . (1986). P e r c e i v e d s i t u a t i o n a l c o n t r o l and p e r c e i v e d d u r a t i o n of time: E x p r e s s i o n s of l i f e p a t t e r n s . Advances i n Nursing  S c i e n c e , 9 ( 1 ) , 12-20. 68 M i l l e r , J.F. (1983). Coping with c h r o n i c i l l n e s s : Overcoming  powerlessness. P h i l a d e l p h i a : F.A. Davis. Munro Hazard, B., V i s i n t a i n e r , M. A., & Page Batten, E. (1986). S t a t i s t i c a l methods f o r h e a l t h care r e s e a r c h . P h i l a d e l p h i a : J.B. L i p p i n c o t t . Noelker, L. & H a r e l , Z. (1978). P r e d i c t o r s of w e l l - b e i n g and s u r v i v a l among i n s t i t u t i o n a l i z e d aged. The  G e r o n t o l o g i s t , 18 (6 ) , 562-567. P o l i t , D.F., & Hungler, B.P. (1987). Nursing r e s e a r c h :  P r i n c i p l e s and methods. (3rd e d . ) . P h i l a d e l p h i a : J.B. L i p p i n c o t t . Reker, G.T., & Wong, P.T.P. (1984). P s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g i n the e l d e r l y : The p e r c e i v e d w e l l - b e i n g s c a l e . Canadian J o u r n a l on Aging. 3 ( 1 ) , 23-32. Reker, G.T., Peacock, E . J . & Wong, P.T.P. (1987). Meaning and purpose i n l i f e and w e l l - b e i n g : A l i f e - s p a n p e r s p e c t i v e . J o u r n a l of Gerontology. 42 ( 1 ) , 44-49. Rodin, J . & Langer, E . J . (1977). Long-term e f f e c t s of a c o n t r o l - r e l e v a n t i n t e r v e n t i o n with i n s t i t u t i o n a l i z e d aged. J o u r n a l of P e r s o n a l i t y and S o c i a l Psychology. 35 (12), 897-902. Rosswurm, M. (1983). R e l o c a t i o n and the e l d e r l y . J o u r n a l  of G e r o n t o l o g i c a l Nursing, 9 (12), 632-637. R o t t e r , J.B. (1971). C l i n i c a l psychology (2nd e d . ) . Englewood C l i f f s : P r e n t i c e H a l l . Ryden, M. (1984). Morale and p e r c e i v e d c o n t r o l i n i n s t i t u t i o n a l i z e d e l d e r l y . Nursing Research. 33 ( 3 ) , 130-136. Sch u l z , R. (1976). E f f e c t s of c o n t r o l and p r e d i c t a b i l i t y on the p h y s i c a l and p s y c h o l o g i c a l w e l l - b e i n g of the i n s t i t u t i o n a l i z e d aged. J o u r n a l of P e r s o n a l i t y and  S o c i a l Psychology, 33 (50), 563-567. Schupe, D.R. (1985). P e r c e i v e d c o n t r o l , h e l p l e s s n e s s , and c h o i c e . In J.E. B i r r e n & J . L i v i n g s t o n ( E d s . ) , C o g n i t i o n . S t r e s s , and Aging (pp. 174-198). Englewood C l i f f s : P r e n t i c e - H a l l . Seligman, M.E.P. (1975). H e l p l e s s n e s s : On d e p r e s s i o n ,  development, and death. San F r a n c i s c o : W.H. Freeman. 69 Snow, R. & Crapo, L. (1982). Emotional bondedness, s u b j e c t i v e w e l l - b e i n g , and h e a l t h i n e l d e r l y medical p a t i e n t s . J o u r n a l o£ Gerontology. 37 (5), 609-615. S t e i n , S., L i n n , M.W., & S t e i n , E.M. (1986). P a t i e n t s ' p e r c e p t i o n s of n u r s i n g home s t r e s s r e l a t e d t o q u a l i t y c a r e . The G e r o n t o l o g i s t . 26 ( 4 ) , 424-430. S t r i c k l a n d , B.R. (1978). I n t e r n a l - e x t e r n a l e x p e c t a n c i e s and h e a l t h - r e l a t e d behaviours. J o u r n a l of C o n s u l t i n g &  C l i n i c a l Psychology. 46 ( 6 ) , 1192-1211. The D a i l y . ( J u l y , 1987). S t a t i s t i c s Canada catalogue  11-001E. Ottawa: Government of Canada. Thorne, S., G r i f f i n , C. & A d l e r s b e r g , M. (1986). How's your h e a l t h ? Gerontion, 15-18. Tobin, S., & Lieberman, M. (1976). L a s t home f o r the  aged. San F r a n c i s c o : Josey-Bass. V o l i c e r , B.J. (1984). M u l t i v a r i a t e s t a t i s t i c s f o r n u r s i n g  r e s e a r c h . Orlando, F l o r i d a : Grune & S t r a t t o n . Wong, P.T.P., & Reker, G.T. (1984). S t r e s s , c o p i ng, and w e l l - b e i n g i n Anglo and Chinese e l d e r l y . Canadian  J o u r n a l on Aging. J_ ( 1 ) , 29-37. 70 A p p e n d i x A: S i t u a t i o n a l C o n t r o l o f D a i l y A c t i v i t i e s S c a l e 71 I would now l i k e you to t e l l me In your own words your p t , code p e r c e p t i o n s about your d a i l y a c t i v i t i e s . I n s t i t . Code_ I. Ambulating: T e l l me about your g e t t i n g i n and out of bed s i t t i n g i n a c h a i r and walking about... Do you u s u a l l y get out of bed du r i n g the day? ( f i l l e r ) When? ( f i l l e r ) 1. Who determines that? How l o n g do you s t a y up? ( f i l l e r ) 2. Who determines that? What i f you wanted to get up a t a d i f f e r e n t time? ( c l a r i f i c a t i o n ) Where do you go du r i n g the day? ( f i l l e r ) 3. Who determines that? What i f you wanted to do something d i f f e r e n t ; how would you go about i t ? ( c l a r i f i c a t i o n ) Do you r e q u i r e a s s i s t a n c e ? ( f i l l e r ) 4. Who d e c i d e s how much a s s i s t a n c e you r e q u i r e ? I I . D r e s s i n g : Can you t e l l me about d r e s s i n g . . . o b t a i n i n g c l o t h e s from the c l o s e t (or other storage space) and p u t t i n g them on. Do you u s u a l l y change to c l o t h e s other than your pajamas d u r i n g the day? ( f i l l e r ) 5. Who determines t h a t ? 6. Who determines when you get dressed?. What would happen i f you d i d n ' t want t o f o l l o w t h a t s c h e d u l e ? ( c l a r i f i c a t i o n ) Other Do you r e c e i v e a s s i s t a n c e In dressing? ( f i l l e r ) 7. How was the amount of a s s i s t a n c e decided upon (who determines)? S e l f Other I I I . E a t i n g : Let us t a l k about e a t i n g . . . When do you u s u a l l y e a t ? ( f i l l e r ) 8. How was t h a t d e c i d e d on (who determines)? What If you wanted to eat a t a d i f f e r e n t time? ( c l a r i f i c a t i o n ) How long do you take t o eat? ( f i l l e r ) 9. Who determines t h a t ? Suppose you wanted t o take longer (or s h o r t e r ) time t o eat: how would you go about doing that? ( c l a r i f i c a t i o n ) 10. Who determines where and with whom you eat? Suppose you wanted t o change your usual e a t i n g p l a c e ? ( c l a r i f i c a t i o n ) 11. Who determines what you eat? What i f you wanted something d i f f e r e n t ? ( c l a r i f i c a t i o n ) IV. Grooming: Can you t e l l me about your d a i l y a c t i v i t i e s i n r e l a t i o n to b a t h i n g , b r u s h i n g your t e e t h , combing h a i r , e t c . 12. As f a r as b a t h i n g i s concerned, who determines when you would take a bath? What i f you wanted a d i f f e r e n t schedule? ( c l a r i f i c a t i o n ) 13. Who determines when you brush your t e e t h , h a i r , e t c . ? What i f you wanted t h i s a t a d i f f e r e n t time? ( c l a r i f i c a t i o n ) 73 Do you r e q u i r e a s s i s t a n c e In b a t h i n g and grooming? s 8 i f ( f i l l e r ) 14. How Is t h i s decided upon (who determines the amount of a s s i s t a n c e you r e q u i r e ) ? Other V. T o i l e t i n g : T e l l me about your a c t i v i t i e s s urrounding e l i m i n a t i o n . . . o r going to the t o i l e t , u s i n g a u r i n a l , commode, bedpan, e t c . 15. Who determines whether you take food or drugs s p e c i f i c a l l y r e l a t e d to your bowels? Do you have a schedule f o r t o i l e t i n g ( e i t h e r for u r i n e or bowel movement? ( f i l l e r ) 16. Who determines the schedule you f o l l o w i n us i n g the t o i l e t ( u r i n a l , bedpan, commode)? What i f you wanted a d i f f e r e n t mode of t o i l e t i n g (commode, pan, bathroom) than the one you are p r e s e n t l y using? ( c l a r I f i c a t i o n ) 17. Who determines how much a s s i s t a n c e i s necessary? VI. Group P a r t i c i p a t i o n : Can you t e l l me something about group a c t i v i t i e s here- p a r t i e s , c l a s s e s , games, e t c . . . What k i n d of organized group a c t i v i t i e s do you p a r t i c i p a t e i n . . . ? ( f i l l e r ) 18. Who determines the above? What i f you d i d not wish t o p a r t i c i p a t e ? ( c l a r i f i c a t i o n ) About how much time do you u s u a l l y spend i n group a c t i v i t i e s (per week)? ( f i l l e r ) 19. Who would decide about t h a t ? 74 C a n y o u c h a n g e t h i s i f y o u w i s h ? ( c l a r i f i c a t i o n ) V I I . One t o One I n t e r a c t i o n : Can y o u t e l l me a b o u t y o u r o p p o r t u n i t i e s f o r t a l k i n g t o o t h e r p e r s o n s h e r e o r b y p h o n e o r c o m m u n i c a t i n g b y l e t t e r w r i t i n g ? When d o y o u c h i t - c h a t w i t h o n l y one o r two p e r s o n s ? ( f i l l e r ) 2 0 . Who d e t e r m i n e s t h e t i m e ? What i f y o u w a n t e d more o r l e s s i n t e r a c t i o n ? ( c l a r i f i c a t i o n ) Do y o u u s e t h e t e l e p h o n e o r w r i t e l e t t e r s ? ( f i l l e r ) 2 2 . Who d e c i d e s on t h e a b o v e ? V I I I . S o l i t a r y A c t i v i t i e s : What k i n d s o f t h i n g s d o y o u d o when y o u ' r e a l o n e ? ( I f " w a t c h " ) Who s e l e c t s t h e c h a n n e l s ? Who d e t e r m i n e s t h e h o u r s f o r w a t c h i n g ? ( I f " r e a d i n g " ) Who s e l e c t s t h e r e a d i n g m a t e r i a l s ? Who b r i n q s t h e m t o v o u ? When d o y o u d o y o u r r e a d i n g ? ( f i l l e r ) Who d e t e r m i n e s t h a t ? ( I f " j u s t s i t t i n g , t h i n k i n g , o r c o n t e m p l a t i n g ) When d o you u s u a l l y d o t h a t ? Who d e t e r m i n e s when y o u d o t h a t ? I X . O t h e r : A r e t h e r e o t h e r a c t i v i t i e s i n w h i c h y o u p a r t i c i p a t e d u r i n g y o u r s t a y h e r e w h i c h we h a v e n o t m e n t i o n e d ? 75 Appendix B: The P e r c e i v e d Well-Being Tool 7 6 SELF-PERCEPTION SCALE Gary T. Reker and Paul T.P. Wong We are interested in how you perceive yourself with respect to the following statements. Read each statement carefully, decide how you feel about i t , and answer by circl ing one of the alternatives provided. For example, i f the statement is one with which you STRONGLY AGREE, you would circle SA following the statement. If you STRONGLY DISAGREE with the statement, c i rc le SD. If your opinion is somewhere between STRONGLY AGREE or STRONGLY DISAGREE, choose the appropriate alternative. If you are UNDECIDED, circle U after the statement. However, try to make a decision; use the UNDECIDED category sparingly. There are no right or wrong answer, so answer according to your own personal feelings. SA Strongly Agree SD Strongly Disagree A Agree D Disagree MA Moderately Agree U Undecided MD Moderately Disagree MD U MA Moderately Undecided Moderately Disagree Agree Disagree A Agree SD Strongly Disagree SA Strongly Agree 1. I don't have many physical complaints. SA A MA U MD D SD 2. No one really cares whether I am dead or alive. SD D MD U MA A SA 3. I don't think that I have a heart condition. SD D MD U MA A SA 4. I have a good appetite for food. SA A MA U MD D SD 5. I am often bored. SD D MD U MA A SA 6. I have aches and pains. SA A MA U MD D SD 7. It is exciting to be al ive. SA A MA U MD D SD 8. Sometimes I wish that I never wake up. SD D MD U MA A SA 9. I am in good shape physically. SD D MD U MA A SA 10. I feel that l i fe is worth l iv ing. SA A MA U MD D SD 11. I think my health is deteriorating. SA A MA U MD D SD 12. 1 don't seem to care about what happens to me. SO D MD U MA A SA 13. I don't get tired very easily. SA A MA U MD D SD 14. I can stand a fair amount of physical strain. SD D MD U MA A SA Appendix C: S c o r i n g I n s t r u c t i o n s For PWB 78 SCORING INSTRUCTIONS FOR THE PERCEIVED WELL-BEING SCALE (PWB) Gary T. Reker and Paul T . P . Wong 1. P s y c h o l o g i c a l Wel l -Being (Items 2 ,5 ,7 ,8 ,10 and 12) - For items 2,5 ,8 and 12 SA * 1 . . . SO » 7 - For Items 7 and 10 SA » 7 . . . SO = 1 - Lowest score « 6; h ighest score « 42 2. P h y s i c a l We l l -Be ing (Items 1 ,3 ,4 ,6 ,9 ,11 ,13 and 14) - For items 1,3 ,4 ,9 ,13 and 14 SA - 7 . . . SO - 1 - For items 6 and 11 SA = 1 . . . SO = 7 - Lowest score = 8; h ighest score = 56 3. Genera l Wei 1-Being - add up p s y c h o l o g i c a l and p h y s i c a l w e l l - b e i n g scores^ Lowest s c o r e e 14; h ighest score = 98 V Appendix D: Information And Consent I n f o r m a t i o n And C o n s e n t Dear My name i s C o r a L a v o i e . I am a R e g i s t e r e d N u r s e a nd a M a s t e r o f S c i e n c e i n N u r s i n g s t u d e n t a t 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 . I am c u r r e n t l y d o i n g a s t u d y w i t h p e o p l e who a r e l i v i n g i n i n t e r m e d i a t e c a r e homes. I am i n t e r e s t e d i n how t h e s e p e o p l e p e r c e i v e a s p e c t s o f t h e i r d a i l y l i v e s a n d a s p e c t s o f t h e i r w e l l - b e i n g . P a r t i c i p a t i o n i n t h i s s t u d y i n v o l v e s c o m p l e t i n g two s h o r t q u e s t i o n n a i r e s a s w e l l a s a n s w e r i n g a f e w q u e s t i o n s . T h e s e a c t i v i t i e s w o u l d t a k e a p p r o x i m a t e l y one h o u r t o c o m p l e t e . I w o u l d l i k e t o i n v i t e y o u t o p a r t i c i p a t e i n t h i s s t u d y . P a r t i c i p a t i o n i n t h i s s t u d y i s v o l u n t a r y a nd p a r t i c i p a n t s c a n w i t h d r a w f r o m t h e s t u d y a t a n y t i m e . The n u r s i n g c a r e and t h e m e d i c a l c a r e t h a t y o u ne e d i s i n no way a f f e c t e d b y y o u r d e c i s i o n t o p a r t i c i p a t e o r t o w i t h d r a w . I f y o u d e c i d e t o p a r t i c i p a t e c o m p l e t e c o n f i d e n t i a l i t y i s a s s u r e d b y n u m b e r i n g a l l m a t e r i a l s c o l l e c t e d r a t h e r t h e n u s i n g names. F u r t h e r m o r e , no names s h a l l be m e n t i o n e d e i t h e r v e r b a l l y o r i n p u b l i s h e d a r t i c l e s . T h i s s t u d y may n o t b e n e f i t y o u d i r e c t l y b u t i n f o r m a t i o n f r o m t h i s s t u d y h a s t h e p o t e n t i a l t o p r o v i d e n u r s e s w i t h a d e e p e r u n d e r s t a n d i n g o f t h e e l d e r l y r e s i d e n t ' s f e e l i n g s a b o u t t h e i r d a i l y a c t i v i t i e s a s w e l l a s a s p e c t s o f t h e i r 82 Appendix E: Subject Information Sheet S u b j e c t I n f o r m a t i o n S h e e t Sex Age M a r i t a l S t a t u s How many t i m e s d o e s y o u r f a m i l y v i s i t y o u e a c h month? Where d i d y o u l i v e p r i o r t o c o m i n g t o t h i s p a r t i c u l a r home? Who p l a n n e d t h e a d m i s s i o n t o t h i s home? How l o n g h a v e y o u l i v e d h e r e ? Appendix F: Permission To Use The Too 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0097595/manifest

Comment

Related Items