Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Privacy needs of women hospitalized for gynecological surgery Anderson, Lynda May 1990

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

Item Metadata

Download

Media
831-UBC_1990_A5_7 A52.pdf [ 4.35MB ]
Metadata
JSON: 831-1.0098006.json
JSON-LD: 831-1.0098006-ld.json
RDF/XML (Pretty): 831-1.0098006-rdf.xml
RDF/JSON: 831-1.0098006-rdf.json
Turtle: 831-1.0098006-turtle.txt
N-Triples: 831-1.0098006-rdf-ntriples.txt
Original Record: 831-1.0098006-source.json
Full Text
831-1.0098006-fulltext.txt
Citation
831-1.0098006.ris

Full Text

PRIVACY NEEDS OF WOMEN HOSPITALIZED FOR GYNECOLOGICAL SURGERY By LYNDA MAY ANDERSON B.S.N., The University of V i c t o r i a , 198 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in THE FACULTY OF GRADUATE STUDIES (School of Nursing) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA AUGUST 19 90 @ LYNDA MAY ANDERSON, 1990 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 1 \ u v _, x *\ The University of British Columbia Vancouver, Canada DE-6 (2/88) A b s t r a c t This phenomenological study was designed to explore the privacy needs of gynecological patients, as perceived by the c l i e n t s during h o s p i t a l i z a t i o n , for the purpose of adding to knowledge and understanding of patients' privacy. Data were c o l l e c t e d through sixteen in-depth interviews with eight recently h o s p i t a l i z e d patients. The interviews were tape-recorded and transcribed verbatim for each p a r t i c i p a n t . Data were analyzed using Giorgi's (1975) procedure. Analysis of p a r t i c i p a n t s ' accounts revealed that privacy was important to p a r t i c i p a n t s ' maintenance of t h e i r s e l f -i d e n t i t y . C h a r a c t e r i s t i c s of privacy that p a r t i c i p a n t s i d e n t i f i e d as helping to maintain t h e i r s e l f - i d e n t i t y included providing time alone for contemplation and helping to control interactions with others. Participants reported that privacy was important for t h e i r comfort during situations involving nursing care, basic needs and s o c i a l interactions with others. Participants suggested that even though they reduced t h e i r expectations of privacy during the hospital stay, t h e i r privacy needs i n h o s p i t a l were at times s t i l l not met. Factors within the hospital s e t t i n g that contributed or detracted from pa r t i c i p a n t s ' h o s p i t a l privacy included behavior of the nurses, doctors, roommates and the physical environment of the h o s p i t a l . Participants i n d i c a t e d t h a t nurses were the main f a c t o r i n meeting p r i v a c y needs e s p e c i a l l y while c a r i n g f o r p a r t i c i p a n t s and p a r t i c i p a n t s ' roommates. The f i n d i n g s of t h i s study i n d i c a t e d t h a t p a r t i c i p a n t s were w i l l i n g t o t r a d e some p r i v a c y f o r h e a l t h c a r e . However, p a r t i c i p a n t s s t i l l v a l u e d p r i v a c y and c o n s i d e r e d i t important d u r i n g t h e i r h o s p i t a l s t a y . There i s a l a c k of r e s e a r c h on p r i v a c y and acute care h o s p i t a l i z a t i o n . Recommendations f o r f u r t h e r n u r s i n g r e s e a r c h , n u r s i n g p r a c t i c e , n u r s i n g e d u c a t i o n and n u r s i n g a d m i n i s t r a t i o n , based on the f i n d i n g s of t h i s study, are p r e s e n t e d i n the f i n a l chapter of the study. i v TABLE OF CONTENTS Abstract i i Table of contents i v Acknowledgements v i CHAPTER ONE Introduction 1 Background to the Problem 1 Significance 2 Conceptualization of the Problem 3 Problem Statement 5 Purpose of the Study 6 Research Question 7 Theoretical and Methodological Perspectives 7 Introduction of the Methodology 7 D e f i n i t i o n of Terms 9 Assumptions 10 Limitations 10 Summary 11 CHAPTER TWO Review of Selected Literature 12 Introduction 12 Qu a l i t i e s and Charact e r i s t i c s of Privacy 12 Purpose of Privacy 15 Management of Social Interaction 15 Plans & Strategies for Interacting with Others 16 Development & Maintenance of Se l f - I d e n t i t y 18 Research Related to Privacy 18 Summary 20 CHAPTER THREE Methodology 22 Interpretation of Phenomenological Approach 22 C r i t e r i a for Selection 25 Selection Procedure 26 Data C o l l e c t i o n 26 Procedure for Data C o l l e c t i o n 27 E t h i c a l Considerations * 27 Construction of Accounts 29 Data Analysis 29 R e l i a b i l i t y & V a l i d i t y 30 Summary 31 V CHAPTER FOUR Presentation of Accounts 32 Introduction 32 Cha r a c t e r i s t i c s of the Participants 32 Purpose of Privacy 33 Maintaining S e l f - i d e n t i t y 33 Sit u a t i o n a l Privacy Needs 40 Basic Human Needs 40 Nursing Care Situations 44 Personal Information Situations 46 Personal Conversations 47 Factors A f f e c t i n g Participant's Privacy 49 Personal Factors 50 Interpersonal Factors 51 Physical Environment 61 Summary 66 CHAPTER FIVE Discussion of Findings 67 Introduction 67 Privacy and S e l f - i d e n t i t y 68 Char a c t e r i s t i c s of Privacy 73 Privacy and Situations 77 Factors That Affect Privacy 80 Interpersonal Factors 81 Environmental Factors 88 Summary 91 CHAPTER SIX Summary, Conclusions and Implications of the Study 92 Summary of the Study 92 Conclusions of the Study 95 Implications of the Study 96 Implications for Nursing Practice 96 Implications for Nursing Administration 97 Implications for Nursing Education 99 Implications for Nursing Research 100 Conclusion 103 Bibliography 104 Appendices A. Letter of I n i t i a l Contact 110 B. Consent 112 C. Sample Interview Questions 113 Acknowledgements v i I wish to express my thanks to the "women" who generously and candidly shared t h e i r privacy experiences with me. Without t h e i r help t h i s study could not have be accomplished. I also wish to extend my sincere thanks to my thesis committee, Alison Rice and Marilyn Dewis for t h e i r help i n understanding the research process. They encouraged me to s t r i v e for a deeper understanding of the data and to express that understanding with c l a r i t y and conciseness i n my writing. F i n a l l y , I extend my thanks to my family and friends, e s p e c i a l l y to my husband, John, whose love and understanding has been a source of strength throughout t h i s endeavour. 1 CHAPTER ONE Introduction Background to the Problem A l l s o c i e t i e s provide for the maintenance of privacy for t h e i r members. However, the type and degree of privacy varies depending on d i f f e r e n t c u l t u r a l and s i t u a t i o n a l contexts (Altman, 1977). Individuals l i v i n g i n North America have s p e c i f i c c u l t u r a l norms r e l a t i n g to privacy. For example, Bates (1964) states "We seem to f e e l that women have a right to more privacy than men, the sick more than the well" (p.431). Certainly, North American society acknowledges the individual's right to privacy of the body. Body privacy relates not only to body exposure, but also to functions of waste elimination, to sexual a c t i v i t i e s , to s e n s i t i v i t i e s aroused by sickness or physical defects, and to sleeping arrangements (Bates, 1964) . Gynecological nursing i s the care of women r e l a t i n g to reproductive and to elimination functions. To provide t h i s care nurses must observe and touch the normally private parts of a woman's body. Patients receiving t h i s care must share information about elimination and reproduction normally not shared with others. Thus, the nature of gynecological nursing may infringe on an indiv i d u a l ' s privacy. 2 With the value that society places on privacy, one would expect that women's privacy needs are met. However, Janet L. Storch, a nurse and a well known health consumer advocate, thinks not. Instead, Storch (1985) states "hospitals and other health care agencies are not designed primarily for privacy" (p.42). Although nurses frequently i d e n t i f y the patient's need for privacy, research about privacy and gynecological nursing i s nonexistent i n both general and nursing l i t e r a t u r e . Instead the l i t e r a t u r e focuses on the importance of information c o n f i d e n t i a l i t y , t e r r i t o r i a l i t y , and s p a t i a l issues, rather than on the privacy needs of the health care consumer (Curtin, 1986, Klien, 1985, Storch, 1985). Thus, there i s a need for empirical research exploring "how the patient's need for privacy i s supported, encouraged, met or i n h i b i t e d i n the provision of health services and es p e c i a l l y nursing" (Bloch, 1970, p. 251) . Therefore, t h i s study focuses on what are the privacy needs of women experiencing inpatient gynecological surgery. Significance The intention of t h i s research i s to focus on the importance of privacy needs for the inpatient gynecological surgery patient. The information provided by t h i s study w i l l help i d e n t i f y the gynecological health consumer privacy 3 needs. This new knowledge w i l l benefit women i n a variety of ways. F i r s t , nurses w i l l have an improved understanding of what the privacy needs of women ho s p i t a l i z e d for gynecological surgery actually are. As a re s u l t , nurses w i l l be able to anticipate consumers' privacy needs more accurately and w i l l be able to plan appropriate nursing actions. Also, nurses w i l l be better able to provide input into the planning of health care f a c i l i t i e s that w i l l help to provide environments that support the privacy needs of women. In addition, nurses w i l l be able to use t h e i r new knowledge to act on behalf of women with other health care problems. Conceptualization of the Problem Altman's conceptualization of privacy regulation i s the framework selected for t h i s research study. Altman (1974) i d e n t i f i e s that individuals meet t h e i r privacy needs through the " s e l e c t i v e control of access to s e l f " (p.24). Altman describes several properties of privacy useful for understanding privacy needs. F i r s t , i n d i v i d u a l s meet privacy needs through an in t e r a c t i v e process involving a balance of opening and closing to others over time and with changing circumstances. Second, individuals further meet privacy needs through an interpersonal boundary control process that regulates, paces and controls s o c i a l 4 i n t e r a c t i o n s . Third, individuals, can have l e v e l s or regions of too much or too l i t t l e i n t e r a c t i o n r e s u l t i n g i n unmet privacy needs. Fourth, desirable i n d i v i d u a l l y determined privacy l e v e l s are subjectively defined. Optimum privacy exists with the achievement of desired privacy l e v e l s . If the desired l e v e l of privacy i s greater than the achieved l e v e l , lack of privacy or environmental crowding occurs. Conversely, the in d i v i d u a l experiences i s o l a t i o n or inadequate i n t e r a c t i o n i f the privacy l e v e l achieved exceeds the desired l e v e l . F i n a l l y , Altman suggests that people i n a l l cultures have privacy needs unique to that culture. Individuals i n a l l cultures engage i n si m i l a r and d i s s i m i l a r actions to regulate s o c i a l i n t e r a c t i o n s p e c i f i c to that culture (Altman, 1974, 1975, 1977; Marguilis, 1974, 1977). According to Altman, individuals use four behaviourial mechanisms to meet privacy needs. These are: verbal content and structure, nonverbal behaviour, environmental mechanisms and c u l t u r a l l y based norms. (Altman, 1974, 1975, 1977; Marguilis, 1977). The author anticipates that women h o s p i t a l i z e d for gynecological surgery have fewer opportunities than non-hospitalized women to u t i l i z e the four behaviour mechanisms to meet t h e i r privacy needs because of the nature of t h e i r i l l n e s s e s and the health care system. Altman's theory of privacy i s the conceptual framework used to explore women's privacy needs. 5 Problem Statement Thomas (1986) i d e n t i f i e s women as b e i n g the l a r g e s t consumers of h e a l t h s e r v i c e s . A l s o , Thomas (1986) b e l i e v e s women h e a l t h consumers are most at r i s k of becoming i n v o l v e d i n c o n f l i c t s c o n cerning p r i v a c y . As a nurse i n acute care h o s p i t a l s , the author has observed many s i t u a t i o n s where women h o s p i t a l i z e d f o r g y n e c o l o g i c a l surgery may have had t h e i r p r i v a c y compromised. During the admission process some women request a p r i v a t e room. The l a c k of p r i v a t e rooms i s the most frequent cause f o r denying the request. During admission and subsequent n u r s i n g care, nurses ask women qu e s t i o n s such as: "When was your l a s t menstrual p e r i o d ? " , or "Did you have a bowel movement to-day?". For many women, who normally do not share t h i s i n f o r m a t i o n with c l o s e f r i e n d s or f a m i l y , these requests f o r p e r s o n a l i n f o r m a t i o n by s t r a n g e r s i n the h e a l t h care system are d i s t u r b i n g ( C u r t i n , 1986). Exposure of the woman's g e n i t a l area i s a requirement f o r nurses attempting t o p r o v i d e much of the g y n e c o l o g i c a l n u r s i n g care. These n u r s i n g a c t i o n s have the p o t e n t i a l of i n t e r f e r i n g with the woman's p r i v a c y needs. Nur s i n g textbooks and n u r s i n g j o u r n a l a r t i c l e s f r e q u e n t l y c i t e the importance of p r o v i d i n g p r i v a c y f o r p a t i e n t s . For example, Campbell (1984) i d e n t i f i e s the need t o "provide p r i v a c y d u r i n g b a t h i n g , meals, p e r i o d s of p a i n 6 or i l l n e s s and during emotional episodes" or to "place patients i n a private room to provide quiet and to reduce the stress of environmental s t i m u l i " (p.1516). Narrow and Buschle (1987) i d e n t i f y that an es s e n t i a l nursing action generic to a l l nursing procedures i s the protection of the patient's privacy. Yet, the l i t e r a t u r e i s lacking i n descriptions of what the privacy needs are for women i n general and s p e c i f i c a l l y for women ho s p i t a l i z e d for gynecological surgery. Motivation for t h i s study of gynecological patients' need for privacy comes from the lack of empirical research and the author's own c l i n i c a l experiences. Therefore, t h i s study asks the research question: "What are the privacy needs of women experiencing inpatient gynecological surgery"? Purpose of the Study The purpose of the research question "What are the privacy needs of women experiencing inpatient gynecological surgery?" i s three-fold. The f i r s t i s to i d e n t i f y and to describe the privacy needs of women h o s p i t a l i z e d for gynecological surgery. The second i s to i d e n t i f y the purpose of privacy for women ho s p i t a l i z e d for gynecological surgery. The f i n a l purpose i s to i d e n t i f y personal and physical factors of h o s p i t a l i z a t i o n and care provision that a f f e c t the privacy of women. 7 Research Question The research question for t h i s study i s : "What are the privacy needs of women experiencing inpatient gynecological surgery?" Theoretical and Methodological Perspectives of the Study Introduction of the Methodology. The phenomenological research perspective of q u a l i t a t i v e research theory i s the methodological approach to t h i s study. Qualitative research methods are defined as the "descriptive a n a l y t i c a l investigations of the world of human experience" (Field & Morse, 1985, p.125 ). Qualitative research methods d i f f e r from quantitative methods i n that the aim i s not to determine causal or measurable relationships among variables but rather to describe, understand, interpret and generate theory about the nature and meanings of l i f e experiences (F i e l d & Morse,1985; Parse, Coyne & Smith, 1985). The phenomenological perspective produces inductive, descriptive research methodology (Ornery,1983). The task of phenomenological research methodology i s to investigate and to describe a l l phenomena, including the human experience, in the way these phenomena appear " i n t h e i r f u l l e s t breadth and depth" (Spiegelberg, 1965, p.2). The i n t e r p r e t i v e 8 sc h o o l of human s c i e n c e holds t h a t a l l knowledge i s d e r i v e d from an " i n t e r s u b j e c t i v e world of c u l t u r e " ( S c h u l t z , 1962, p. 10) and t h a t i n d i v i d u a l s d e r i v e meaning through human i n t e r a c t i o n s . While the need f o r p r i v a c y i s widely accepted, a review of a v a i l a b l e l i t e r a t u r e r e v e a l s t h a t t h e r e i s l i t t l e r e s e a r c h a n a l y z i n g i t from a t h e o r e t i c a l p o i n t of view. A " t h e o r e t i c a l stance i s t o stand back from, t o r e f l e c t upon and t o review the experience taken f o r granted i n the n a t u r a l stance" (Schuster, 1972, p . l ) . The focus of t h i s study i s t o determine from the p a r t i c i p a n t s themselves the meaning of p r i v a c y as they understand i t . To o b t a i n t h i s knowledge the r e s e a r c h e r ' s p r e c o n c e p t i o n s or assumptions are suspended or "bracketed" so t h a t a pure apprehension of the experience i s ob t a i n e d ( O i l e r , 1982). The g o a l of the phenomenological approach i s to " s y s t e m a t i c a l l y examine human experience and from t h i s examination d e r i v e c o n s e n s u a l l y v a l i d a t e d knowledge" (Lynch-Sauer, 1985, p.97). In order t o achieve t h i s g o a l , the author w i l l use an open i n t e r v i e w i n g process i n which the p a r t i c i p a n t s w i l l have an o p p o r t u n i t y t o d e s c r i b e t h e i r p e r c e p t i o n s of p r i v a c y d u r i n g t h e i r h o s p i t a l i z a t i o n f o r g y n e c o l o g i c a l surgery. Nurse r e s e a r c h e r s , who have used t h i s p e r s p e c t i v e i n examining problems i n the n u r s i n g p r o f e s s i o n , i n c l u d e ; Anderson (1981), Davis (1978) and Lynam (1985). 9 D e f i n i t i o n of Terms C l i e n t : a woman, over the age of 19, h o s p i t a l i z e d f o r g y n e c o l o g i c a l surgery, speaks f l u e n t E n g l i s h and p e r s o n a l l y not known t o the re s e a r c h e r . Need: a requirement, a n e c e s s i t y . P r i v a c y : an i n t e r p e r s o n a l boundary pr o c e s s by which a person or group r e g u l a t e s i n t e r a c t i o n with o t h e r s . By a l t e r i n g the openness of s e l f t o others, a h y p o t h e t i c a l p e r s o n a l boundary i s more or l e s s r e c e p t i v e t o s o c i a l i n t e r a c t i o n with o t h e r s . " P r i v a c y i s t h e r e f o r e , a dynamic pr o c e s s i n v o l v i n g s e l e c t i v e c o n t r o l over a self-boundary, e i t h e r by an i n d i v i d u a l or by a group" (Altman, 1977, p.6) H o s p i t a l i z a t i o n : a p e r i o d of be i n g i n an acute care h o s p i t a l as a p a t i e n t . Gynecology: the study of women's d i s e a s e s , e s p e c i a l l y d i s e a s e s of the female g e n i t a l organs and u r i n a r y d i s t u r b a n c e s , e x c l u d i n g problems o c c u r r i n g i n l a t e pregnancy. Surgery: the work of a surgeon i n o p e r a t i n g manually or i n s t r u m e n t a l l y upon i n j u r i e s , d e f e c t s e t c . 10 S e l f - i d e n t i t y : a p e r s o n ' s p e r c e p t i o n o f t h e i r i n d i v i d u a l i t y , p e r s o n a l i t y or c h a r a c t e r . Assumpt ions 1. Women, who have been h o s p i t a l i z e d f o r g y n e c o l o g i c a l s u r g e r y , are a b l e to d e s c r i b e and t o d e f i n e p r i v a c y needs a c c o r d i n g to the contex t i n which they view the s i t u a t i o n and t h e i r p e r s o n a l b e l i e f s . 2. P r i v a c y i s a s i g n i f i c a n t concept f o r women e x p e r i e n c i n g h o s p i t a l i z a t i o n f o r g y n e c o l o g i c a l s u r g e r y . 3. P r i v a c y i s a u n i v e r s a l phenomenon but the needs and e x p r e s s i o n s , p r o c e s s e s and p a t t e r n s o f t h i s need may v a r y among c u l t u r e s . L i m i t a t i o n s The r e a l i t y , i n which the r e s e a r c h i s conduc ted , i s c u l t u r a l l y and s o c i a l l y d e f i n e d by the r e s e a r c h e r and the p a r t i c i p a n t s . Thus, the a b i l i t y to g e n e r a l i z e the f i n d i n g s i s l i m i t e d to the c u l t u r a l and s o c i a l groups r e p r e s e n t e d i n the s tudy sample . The i n f o r m a n t s i n the s tudy are c o n s i d e r e d c u l t u r a l r e p r e s e n t a t i v e s , o r , the e x p e r t s o f the p o p u l a t i o n o f women who have been h o s p i t a l i z e d f o r g y n e c o l o g i c a l s u r g e r y . Summary 11 I n t h i s c h a p t e r , t h e background t o t h e problem, t h e c o n c e p t u a l framework g u i d i n g t h e s t u d y , as w e l l as t h e t h e o r e t i c a l and m e t h o d o l o g i c a l p e r s p e c t i v e s o f t h e s t u d y , have been d i s c u s s e d . S t u d y i n g t h e p r i v a c y needs o f g y n e c o l o g i c a l p a t i e n t s i s o f g r e a t i m p o r t a n c e t o n u r s i n g , s i n c e , n u r s i n g c a r e has t h e p o t e n t i a l t o h i n d e r o r a s s i s t p a t i e n t s ' p r i v a c y . Altman's c o n c e p t u a l i z a t i o n o f p r i v a c y p r o v i d e s an e x c e l l e n t framework f o r s t u d y i n g t h e c l i e n t s ' p e r c e p t i o n s and d i r e c t i n g t h e r e s e a r c h e r t o choose t h e p h e n o m e n o l o g i c a l r e s e a r c h approach. The methodology w i l l be d i s c u s s e d i n g r e a t e r d e t a i l i n C h a p t e r Three. The f o l l o w i n g c h a p t e r w i l l d i s c u s s t h e l i t e r a t u r e p e r t i n e n t t o t h e t o p i c o f g y n e c o l o g i c a l i n p a t i e n t s ' p r i v a c y needs. 12 CHAPTER TWO Review of Selected Literature Introduction There i s a lack of relevant l i t e r a t u r e about the problem statement, however, there i s abundant l i t e r a t u r e focusing on the problems of information c o n f i d e n t i a l i t y , t e r r i t o r i a l i t y , and s p a t i a l considerations. This l i t e r a t u r e review i s organized into three areas. The three areas include: an overview of the q u a l i t i e s and c h a r a c t e r i s t i c s of privacy, the purpose of privacy, and research focused on privacy. Q u a l i t i e s and Characteristics of Privacy The q u a l i t i e s and c h a r a c t e r i s t i c s of the concept privacy d i f f e r depending on the d i s c i p l i n e of the researcher. Sociologists, Laufer, Proshansky and Wolfe (1976) express the complexity of the concept by describing privacy as a "psychological phenomenon, a p o l i t i c a l phenomenon and i n d i r e c t l y , even as an economic phenomenon" (P. 206). In addition, d e f i n i t i o n s of privacy r e f e r to the need for solitude i n s e l f - i d e n t i t y development (Altman, 1977, Westin, 1967). 13 Westin (1968), a lawyer, attempts t o d e s c r i b e the q u a l i t i e s and c h a r a c t e r i s t i c s of p r i v a c y r e l a t i n g t o p r i v a c y of i n f o r m a t i o n . He a s s e r t s t h a t p r i v a c y i s the " c l a i m of i n d i v i d u a l s , groups or i n s t i t u t i o n s t o determine f o r themselves when, how and to what extent i n f o r m a t i o n about them i s communicated" (Westin, 1967,p.7). Westin examines the r e l a t i o n s h i p between p r i v a c y , the i n d i v i d u a l and s o c i a l i n t e r a c t i o n . He i d e n t i f i e s i n d i v i d u a l s ' v o l u n t a r y and temporary withdrawal from s o c i e t y as a c t s of p r i v a c y . Foddy & F i n i g h a n (1980), A u s t r a l i a n s o c i o l o g i s t s , a l s o d e s c r i b e p r i v a c y from a c o n f i d e n t i a l i t y p e r s p e c t i v e . P r i v a c y i s "the p o s s e s s i o n by an i n d i v i d u a l of c o n t r o l over i n f o r m a t i o n t h a t would i n t e r f e r e with the acceptance of cla i m s f o r an i d e n t i t y w i t h i n a s p e c i f i e d r o l e r e l a t i o n s h i p " (Foddy & Finighan,1980, p.6). The essence of Foddy and F i n i g h a n s ' c l a i m i s t h a t i n d i v i d u a l s need c o n t r o l over i n f o r m a t i o n which i s r e l e v a n t t o t h e i r r o l e i n s o c i e t y . A c c o r d i n g t o Bates (1964), p r i v a c y p e r t a i n s t o the i n d i v i d u a l ' s i n t e r a c t i o n with o t h e r s . T h i s i n t e r a c t i o n always i n v o l v e s some degree of i n t r u s i o n upon another's p r i v a t e space. Bates claims p r i v a c y t o be "a s e l f - r e l a t e d s u b j e c t i v e experience which may i n c l u d e one or many persons" (1964, P. 429). A c c o r d i n g t o Bates, p r i v a c y has t h r e e a s p e c t s . The f i r s t aspect of p r i v a c y i s the f e e l i n g an i n d i v i d u a l experiences when an unwanted a c t u a l or p o t e n t i a l i n t r u s i o n happens. The second aspect of p r i v a c y i s the mental image conjured up by the emotion and picture of one's performance i n groups. The t h i r d aspect of privacy i s the s i t u a t i o n a l context which relates to the ind i v i d u a l ' s perception of the s i t u a t i o n . However, psychologists Klopfer & Rubenstien (1977) view privacy from a b i o l o g i c a l basis r e f e r r i n g to research done on animal t e r r i t o r i a l i t y . Klopfer & Rubenstien view privacy as "a regulatory process that serves s e l e c t i v e l y to control external stimulation to ones's s e l f or [to control] the flow of information to others" (p.52). Also, Kloper & Rubenstien (1977) consider privacy to be a t r a i t that extends across both animals and human beings. Privacy, or the control of access to one's own t e r r i t o r y , i s c r i t i c a l for est a b l i s h i n g privacy i n both animals and human beings. Sociologist, Irwin Altman presents the most complete d e f i n i t i o n of privacy. Altman (1975) views privacy as a process of boundary regulation, the purpose of which i s to control how much or how l i t t l e contact an i n d i v i d u a l has with others. Altman's (1975) d e f i n i t i o n i s : Privacy i s an interpersonal boundary process by which a person or group regulates i n t e r a c t i o n with others. By a l t e r i n g the degree of openness of s e l f to others, a hypothetical personal boundary i s more or less receptive to s o c i a l i n t e r a c t i o n with others. Privacy i s therefore, 15 a dynamic process involving s e l e c t i v e control over a self-boundary, either by an i n d i v i d u a l or by a group (p.6). Altman's d e f i n i t i o n has s u f f i c i e n t scope to examine the complexity of the concept of privacy from the perspective of women who have been h o s p i t a l i z e d for gynecological surgery. It i s the author's choice for a d e f i n i t i o n of privacy. Purposes of Privacy Altman (1977) suggests that privacy serves three purposes: management of s o c i a l i nteraction, establishment of plans and strategies for i n t e r a c t i n g with others, and development and maintenance of s e l f - i d e n t i t y (Altman, 1974, 1977; Marguilis, 1977). Altman's three purposes w i l l be used as the framework for discussion of the findings of other privacy t h e o r i s t s . Management of Social Interaction. Altman (1977) states that we have c u l t u r a l privacy norms that govern when, where and how people observe and communicate with each other. Westin (1967) focuses on the communication aspect of privacy. He suggests that privacy serves the purpose of l i m i t i n g and protecting communication. Foddy and Finighan (1980) go a step further and stress the 16 importance of in d i v i d u a l s ' need for control over information about t h e i r role i n society. Schwartz (1968) takes an even broader view and presents the opinion that privacy i s i n s t i t u t i o n a l i z e d to preserve a group or a s o c i a l r e l a t i o n s h i p . Laufer & Wolfe (1977) take a s o c i e t a l view, as well. They see privacy as the indivi d u a l ' s understanding of privacy rights and obligations within the context of a given society. Laufer & Wolfe state "privacy and the invasion of privacy always involves a balancing of normative and in d i v i d u a l i n t e r e s t s " (1977, p.36). The issue of choice or of control i s always present in the determination of an individual's sense of privacy (Laufer & Wolfe, 1977). In summary, the purposes of privacy are the management of s o c i a l action through the control of information and the control of groups and s o c i a l r e l a t i o n s h i p s . Plans and Strategies for Interacting With Others. The second purpose of privacy, proposed by Altman (1977), i s that people have unique and i n d i v i d u a l plans and strategies for in t e r a c t i n g with each other. Westin (1967) i s more s p e c i f i c and suggests that privacy serves the need for providing emotional releases. This i s something he considers necessary for int e r a c t i n g with others. Westin describes various types of emotional release mechanisms. Two examples are decreased stimulation, and freedom from 17 observation while performing certain body functions. Also, privacy helps meet the needs of indivi d u a l s for respite from the emotional stimulation of d a i l y l i f e . Another aspect of emotional release i s the need for privacy i n the management of bodily and sexual functions. F i n a l l y , emotional release through privacy plays an important part i n an in d i v i d u a l ' s l i f e at time of loss, shock or sorrow. Westin considers self-evaluation another purpose of privacy. Individuals need to integrate t h e i r experiences into meaningful patterns and to exert t h e i r i n d i v i d u a l i t y on the events (Westin,1967). Therefore, privacy serves both as processing and as planning need. Schwartz (1968) considers privacy necessary to reduce ine q u i t i e s i n society. Inequities are minimized by assuring that persons of high rank who may have many more means of atta i n i n g i n s u l a t i o n from others do not use that to the disadvantage of someone of lesser rank. Also, Schwartz sees privacy as allowing for forms of deviation i n behaviour that might otherwise undermine the s t a b i l i t y of the society. Laufer & Wolfe (1977) suggest that privacy has environmental elements that relate to physical settings and stages i n the l i f e cycle. These environmental elements have a major impact on the purpose privacy serves at any given point i n an in d i v i d u a l ' s l i f e . In conclusion, privacy serves as a plan or a strategy i n dealing with d a i l y l i f e through emotional release, control of s o c i a l rank p r i v i l e g e and 18 environmental elements though out an i n d i v i d u a l ' s l i f e . Development and Maintenance of S e l f - I d e n t i t y . Altman (1977) believes privacy i s necessary for the i n d i v i d u a l to define the l i m i t s and boundaries of s e l f , one's personal autonomy. Westin (1967) supports t h i s claim by considering personal autonomy to be a purpose of privacy. Personal autonomy relates to s o c i e t a l b e l i e f s about the uniqueness of the i n d i v i d u a l . Personal autonomy helps to maintain t h i s i n d i v i d u a l uniqueness. Westin (1967) notes "without privacy there i s no i n d i v i d u a l i t y . There are only types" (p.34). Schwartz (1968) considers privacy i n r e l a t i o n to s e l f as well. He indicates that privacy prevents the ego from i d e n t i f y i n g i t s e l f too c l o s e l y with or lo s i n g i t s e l f i n public roles. Laufer & Wolfe (1977) agree with other researchers about the connection between privacy and development of s e l f . They consider the purpose of privacy i s to a s s i s t the self-ego i n the development of s e l f or the autonomy of the i n d i v i d u a l . In conclusion, most privacy t h e o r i s t s recognize the important role privacy plays i n the i d e n t i f i c a t i o n and the determination of s e l f . Research Related to Privacy A search of the l i t e r a t u r e i d e n t i f i e d three studies relevant to t h i s author's research. Marshall (1971) a 19 s o c i o l o g i s t , analyzed the individual's orientation to privacy. He attempted to i d e n t i f y the re l a t i o n s h i p between privacy and personality as well as elements of the physical and s o c i a l environment. Marshall developed a "privacy p r o f i l e " questionnaire for young adult subjects and t h e i r parents. The "privacy p r o f i l e " consisted of six factors: neighbouring, seclusion, solitude, anonymity, s e l f -disclosure and intimacy. Results of t h i s study indicated that i n d i v i d u a l s do have an orientation to privacy that influences t h e i r e f f o r t s to es t a b l i s h or protect i t . Roosa (1979), a nurse researcher, studied s i x t y nursing home residents' perceptions of privacy and found that they unanimously selected solitude or aloneness i n t h e i r d e f i n i t i o n of privacy. In t h i s study almost every resident i d e n t i f i e d that his or her room was the best place to have privacy. Some respondents provided additional d e f i n i t i o n s such a personal control, maintaining secrecy or l i m i t i n g s e l f - d i s c l o s u r e . Rossa also speculated that a person's physical and mental c a p a b i l i t i e s may affe c t access to privacy. Schuster (1972) i s the only nurse researcher to study privacy i n the acute care hospital setting. She used a phenomenological approach to study the privacy perceptions of twenty-one h o s p i t a l i z e d patients. The study resulted i n a d e f i n i t i o n of privacy based on ideas offered by the these patients. Schuster's empirically derived d e f i n i t i o n 20 i n c l u d e s r e f e r e n c e t o the "person's autonomy or c o n t r o l t o achieve a comfortable s t a t e of s o c i a l r e t r e a t " as w e l l as the aspect of " a c h i e v i n g a f l e x i b l e boundary t o ma i n t a i n the s t a t e of p r i v a c y " (Schuster, 1972, p.41). Schuster's study i d e n t i f i e d f o u r major v a r i a b l e s which i n f l u e n c e p a t i e n t s ' a b i l i t y t o c o n t r o l or t o p r o t e c t t h e i r p r i v a c y . These v a r i a b l e s are: m o b i l i t y , l e v e l of consciousness and awareness, the s p e c i f i c c h a r a c t e r i s t i c s of p a t i e n t - t o -p a t i e n t r e l a t i o n s h i p s and p e r c e p t i o n of r o l e . One s i g n i f i c a n t r e s u l t from Schuster's study i s t h a t members of the h e a l t h care team have numerous o p p o r t u n i t i e s t o i n f l u e n c e the q u a l i t y and q u a n t i t y of the p a t i e n t ' s p r i v a c y . H e a l t h p r o f e s s i o n a l s i n f l u e n c e a p a t i e n t ' s p r i v a c y through e i t h e r a c t s of commission or a c t s of omission. The l i t e r a t u r e review has demonstrated the complex and unique nature of p r i v a c y . P r i v a c y has d i f f e r e n t meanings t o d i f f e r e n t people. P r i v a c y can be a " c l a i m t o determine i n f o r m a t i o n " (Westin, 1967), "A s e l f - r e l a t e d s u b j e c t i v e e x p e r i e n c e " (Bates, 1954) or a "process of boundary r e g u l a t i o n " (Altman, 1977/ M a r g u i l i s , 1977). Summary Schuster's (1972) study c l e a r l y i n d i c a t e s t h a t nurses are the h e a l t h care p r o f e s s i o n a l s who have the most c o n s i s t e n t and prolonged co n t a c t with p a t i e n t s i n acute care h o s p i t a l s . As h e a l t h care p r o f e s s i o n a l s , nurses have an o b l i g a t i o n t o be aware of p a t i e n t s ' need f o r p r i v a c y . Schuster's study a l s o suggests t h a t acute care nurses may have o p p o r t u n i t i e s t o a s s i s t or t o h i n d e r consumers' a b i l i t y t o r e g u l a t e t h e i r p e r s o n a l boundaries or p r i v a c y . Thus, acute care nurses have the dual r e s p o n s i b i l i t y of p r o v i d i n g care f o r the g y n e c o l o g i c a l consumer while a l s o h e l p i n g t o d e f i n e and defend the consumer's r i g h t t o p r i v a c y . 22 CHAPTER THREE Methodology The phenomenological perspective of q u a l i t a t i v e research theory guided the methodological approach of t h i s study. This chapter describes how t h i s perspective was interpreted and implemented i n the sel e c t i o n of part i c i p a n t s , data c o l l e c t i o n and data analysis. Interpretation of Phenomenological Approach The phenomenological research perspective directed t h i s researcher to use nonprobability, t h e o r e t i c a l sampling. Morse (1986) pointed out that the purpose of se l e c t i n g nonprobability samples i s to " f a c i l i t a t e understanding, for description and to e l i c i t meaning"(p.184). When using nonprobability sampling techniques, the researcher cannot generalize the findings to the general population. As the researcher knows nothing about the d i s t r i b u t i o n of the phenomena. Morse suggested that the c r i t e r i a for evaluating nonprobability samples be appropriateness and adequacy rather than p r o b a b i l i t y and sample size as used i n quantitative research. Appropriateness refers to the "degree i n which the method of sampling " f i t s " the purpose of the study as determined by the research study" (Morse, 1986, p.185). According to Morse, i f a q u a l i t a t i v e research question i s asked, then, a p r o b a b i l i t y method i s inappropriate and a nonprobability method should be used. In phenomenological research, the study sample draws from a population l i v i n g the experience under investigation (Oiler, 1982, Morse, 1986). Qualitative research informants are selected according to t h e i r knowledge base and r e c e p t i v i t y (Morse, 1986). The philosophical b e l i e f of phenomenological research i s that the personal experiences of these indiv i d u a l s makes them the most legitimate and accurate source of information, therefore, making a nonprobability sample suitable for t h i s research. One of the assumptions of nonprobability sampling i s that not a l l actors i n a setting are equally informed about the knowledge sought by the researcher. Informants who are knowledgeable about privacy may vary depending upon roles, status, age, past experiences and a b i l i t y to r e c a l l (Douglas, 1976). Morse considered t h i s assumption an element of the adequacy of the sample. Morse (1986) stated "adequacy refers to the s u f f i c i e n c y and quality of the data" (p.185). The way the adequacy of sample size i s evaluated d i f f e r s from q u a l i t a t i v e research and quantitative research. In q u a l i t a t i v e research evaluation i s done by the "quality, completeness, and amount of the information contributed by 24 the informants rather than by the number of cases. Thus, informational adequacy includes the meaning, accuracy, p r e c i s i o n and completeness of the data" (Morse, 1986, p.185). Adequacy refers to the " s u f f i c i e n c y and quality of the data" (Morse, 1986, p.185). In q u a l i t a t i v e research, adequacy i s evaluated by the "quality, completeness, and amount of information contributed by informants rather than by the number of cases as i n quantitative research" (Morse, 1986, p.185). According to Morse, adequacy i s attained and sampling ceases when the researcher gains understanding of the s i t u a t i o n or setting, obtains coherence, does not c o l l e c t new information and cannot locate negative cases. When t h i s occurs, the categories are considered " f i l l e d " (Morse, 1986). Morse (1986) also emphasized that q u a l i t a t i v e research p a r t i c i p a n t s are chosen for t h e i r knowledge of the phenomena in question and for t h e i r willingness to share information. The method of sampling begins with nonprobabilty sampling and moves to t h e o r e t i c a l sampling. In t h i s study, part i c i p a n t s were obtained through an "Informational Letter" given to gynecological patients at Peace Arch D i s t r i c t Hospital. Burns and Grove (1987) i d e n t i f i e d t h i s as a "convenience or i n c i d e n t a l method of sampling" (p. 216). Theoretical sampling occurs "after the researcher has become f a m i l i a r with the setting and the actor, a l l informants are d e l i b e r a t e l y selected by the researcher 25 a c c o r d i n g t o the t h e o r e t i c a l need and d i r e c t i o n of the r e s e a r c h " (Morse, 1986, p.184). T h e o r e t i c a l sampling i s used i n phenomenology, but i t i s d i f f i c u l t f o r the r e s e a r c h e r t o know how many p a r t i c i p a n t s w i l l be r e q u i r e d . Past r e s e a r c h has shown t h a t s i x t o e i g h t p a r t i c i p a n t s u s u a l l y are s u f f i c i e n t (Anderson, 1985; Lynam, 1985; Parse, Coyne & Smith, 1985; Thorne, G r i f f i n & A d l e r s b e r g , 1986). Adequate sample s i z e i s o b t a i n e d when no new themes or concepts appear i n the i n t e r v i e w s (Anderson, 1985). For t h i s study, p a r t i c i p a n t s , who had e x p e r i e n c e d h o s p i t a l i z a t i o n f o r g y n e c o l o g i c a l surgery and who c o u l d speak t o the phenomena of p r i v a c y needs w i t h i n t h a t context were s e l e c t e d . C r i t e r i a f o r S e l e c t i o n The c r i t e r i a f o r s e l e c t i n g p a r t i c i p a n t s i n c l u d e d : women who had been h o s p i t a l i z e d f o r e l e c t i v e g y n e c o l o g i c a l surgery w i t h i n the l a s t two weeks, and who were p h y s i c a l l y and m e n t a l l y capable of understanding and answering q u e s t i o n s i n E n g l i s h . Women l i v i n g i n the White Rock/Surrey area and who had no c h r o n i c i l l n e s s r e q u i r i n g home n u r s i n g care. 26 Selection Procedure In order to r e c r u i t the sample, p o t e n t i a l p a r t i c i p a n t s meeting the c r i t e r i a for selection were given an Informational Letter (Appendix A) by the Head Nurse of Second Floor at Peace Arch D i s t r i c t Hospital. From the po s i t i v e responses to the informational l e t t e r the author developed a l i s t of knowledgeable and receptive p o t e n t i a l p a r t i c i p a n t s . The author selected p a r t i c i p a n t s by s t a r t i n g at the beginning of the l i s t and stopping when no further concepts and ideas were obtained i n the data generated from the interviews. Departures from t h i s procedure occurred i n two instances i n which two women, when approached by the researcher, declined to p a r t i c i p a t e i n the study. In one case, the woman explained the "nursing care was just fine thank you". In the l a t t e r case, a woman f e l t i t was an invasion of her privacy for the researcher to come and do an interview i n her home. Spradley, (1979) also discovered that some people are more receptive to being interviewed and are more l i k e l y to disclose information to the researcher than others. Data C o l l e c t i o n Unlike the t r a d i t i o n a l empirical researcher, the researcher using the phenomenological approach does not 27 b e l i e v e t h a t the data w i l l be contaminated or b i a s e d by the f u l l p a r t i c i p a t i o n of the s u b j e c t s ( C l a s p e l l , 1984). Instead, the f u l l p a r t i c i p a t i o n of the s u b j e c t s e n r i c h e s the r e s e a r c h data, thus, i n c r e a s i n g data a v a i l a b l e f o r a n a l y s i s . Procedure f o r Data C o l l e c t i o n To o b t a i n the data needed t o answer t h i s study's q u e s t i o n , audio-taped i n t e r v i e w s were used. Two i n t e r v i e w s were conducted i n the p a r t i c i p a n t ' s home at a mutu a l l y convenient time. The f i r s t i n t e r v i e w s were u n s t r u c t u r e d u s i n g t r i g g e r q u e s t i o n s t o s t i m u l a t e the p a r t i c i p a n t ' s involvement i n the i n t e r v i e w (Appendix C). T r i g g e r q u e s t i o n s were generated by t h i s study's r e s e a r c h q u e s t i o n , the l i t e r a t u r e review and Altman's (1977) c o n c e p t u a l i z a t i o n of p r i v a c y . The quest i o n s were open-ended i n order t o e l i c i t as broad a response as p o s s i b l e from the p a r t i c i p a n t s . A second i n t e r v i e w was conducted with each p a r t i c i p a n t t o v a l i d a t e the f i n d i n g s of the f i r s t i n t e r v i e w . E t h i c a l C o n s i d e r a t i o n s Before i n i t i a t i n g t h i s study, the r e s e a r c h e r o b t a i n e d a p p r o v a l from a number of a u t h o r i t i e s . F i r s t , a u t h o r i z a t i o n t o conduct the study was obt a i n e d from the U n i v e r s i t y of B r i t i s h Columbia B e h a v i o u r i a l Sciences Screening Committee For Research and Other Stud i e s I n v o l v i n g Human Su b j e c t s . 28 Second, approval from both the Peace Arch D i s t r i c t Hospital Administration and the two gynaecologists who practice at the h o s p i t a l were obtained. The rights of the par t i c i p a n t s were safeguarded i n the following ways. Potential participants were v i s i t e d and both verbal and written explanation of the study were given. Potential p a r t i c i p a n t s were given an opportunity to ask questions and c l a r i f y any concerns about the study. Then, each p o t e n t i a l p a r t i c i p a n t signed an informed consent form i n the presence of the researcher. The written consent c l e a r l y indicated that the participant could withdraw from the study at any time and that the participant could refuse to answer any questions. Each participant received a copy of the consent form. P r i o r to each interview t h i s researcher reaffirmed, with each participant, that each was s t i l l w i l l i n g to p a r t i c i p a t e i n the study (Munhall, 1988) . C o n f i d e n t i a l i t y of results was maintained by coding the pa r t i c i p a n t s ' names for the purposes of the t r a n s c r i p t s . Participants were asked not to mention names during the interviews. Any names mentioned were deleted from the t r a n s c r i p t . Participants had the right to request erasure of any tape, or any portion of the tape, at any time during the study. 29 Construction of Accounts Data analysis Giorgi (1975) offers the following procedure for q u a l i t a t i v e analysis which the author used for t h i s study: 1. The researcher reads the entire description to get a sense of the whole. 2. The researcher reads the same description more slowly and delineates each time that a t r a n s i t i o n i n meaning i s perceived.... and obtains a series of units or constituents. 3. The researcher then eliminates redundancies, but otherwise keeps a l l units. The researcher then relates the meaning units to each other and to the sense of the whole. 4. The researcher r e f l e c t s on the given constituents, s t i l l expressed e s s e n t i a l l y i n the concrete language of the subject and transforms the meaning of each unit from the everyday naive language of the subject into the psychological science. 5. The researcher then synthesizes and integrates the insights achieved into a consistent description (p.74-75). In t h i s study the "meaning uni t s " were developed from the researcher's f i r s t interviews. Further interviews were scheduled, as necessary, to c l a r i f y and expand the meaning units. The meaning units were presented, empirically, from 30 the perspective of the participants i n the study. The l i t e r a t u r e was then reviewed to a s s i s t t h i s author further c l a r i f y meaning units. F i n a l l y , a synthesis of the l i t e r a t u r e and each participant's interview was presented i n the discussion of the findings. R e l i a b i l i t y & V a l i d i t y The c r i t e r i a to appraise the v a l i d i t y and r e l i a b i l i t y of q u a l i t a t i v e research i s d i f f e r e n t from quantitative research. Findings are v a l i d and r e l i a b l e i n q u a l i t a t i v e research when findings a i d i n knowing and understanding phenomena as f u l l y as possible and "consistently reveal meaningful and accurate truths about p a r t i c u l a r phenomena" (Leininger, 1985, p.69). Sandelowski (1986) stated " a u d i t a b i l i t y i s achieved when the researcher leaves a clear decision t r a i l concerning the study from beginning to i t s end" (p.34). Researchers conducting q u a l i t a t i v e research demonstrate the rigor of t h e i r studies by having available research materials concerning a l l phases of the study (Sandelowski, 1986). Data from t h i s study were used to support and explain the decisions made by the researcher and are demonstrated throughout the report of t h i s study. Summary 3 1 T h i s chapter d i s c u s s e d the s e l e c t i o n of p a r t i c i p a n t s , the e t h i c a l c o n s i d e r a t i o n s of p a r t i c i p a n t s and the p rocesses i n v o l v e d i n data a n a l y s i s and r e l i a b i l i t y . Chapter Four i d e n t i f i e s and d e s c r i b e s meaning u n i t s from p a r t i c i p a n t s ' accounts. 32 CHAPTER FOUR Presentation of Accounts Introduction This chapter i d e n t i f i e s and describes the accounts of womens' privacy needs during h o s p i t a l i z a t i o n for gynecological surgery. The f i r s t section of the chapter contains demographic and descriptive information about the par t i c i p a n t s . The second section contains the meaning units constructed from p a r t i c i p a n t s ' accounts. Analysis of pa r t i c i p a n t s ' responses generated categories under which the meaning units could be organized. The categories generated were remarkably consistent with findings presented i n the l i t e r a t u r e . The three categories generated were as follows: the purpose of privacy for participants, situations i n which par t i c i p a n t s required privacy and factors that affected p a r t i c i p a n t s privacy. These categories w i l l be used as the framework for i d e n t i f y i n g and describing accounts. Cha r a c t e r i s t i c s of the Participants Eight women pa r t i c i p a t e d i n the study. A l l eight part i c i p a n t s were English-speaking Canadians, l i v i n g i n White Rock-South Surrey, B r i t i s h Columbia. Five 33 p a r t i c i p a n t s were m a r r i e d , two were d i v o r c e d and one was widowed. T h e i r ages ranged from 45 y e a r s t o 73 y e a r s at the t ime o f the s t u d y . A l l p a r t i c i p a n t s were h o s p i t a l i z e d f o r e l e c t i v e g y n e c o l o g i c a l s u r g e r y . S i x o f the p a r t i c i p a n t s had a hys terec tomy per formed and two p a r t i c i p a n t s had a n t e r i o r and p o s t e r i o r r e p a i r . Purpose o f P r i v a c y M a i n t a i n i n g S e l f - i d e n t i t y A c c o r d i n g t o p a r t i c i p a n t s , p r i v a c y i s n e c e s s a r y f o r the maintenance o f s e l f - i d e n t i t y . P a r t i c i p a n t s d e f i n e d s e l f - i d e n t i t y as the r e c o g n i t i o n by o t h e r s o f t h e i r un iqueness or i n d i v i d u a l i t y . F o r example, one p a r t i c i p a n t d e s c r i b e d the r e l a t i o n s h i p between p r i v a c y and s e l f - i d e n t i t y i n t h i s way: I t l e t s me be me and t o s o r t out what ' s happening t o me. Without p r i v a c y I c o u l d n ' t do t h a t . P r i v a c y h e l p e d p a r t i c i p a n t s m a i n t a i n t h e i r s e l f - i d e n t i t y i n h o s p i t a l i n a v a r i e t y o f ways. B e i n g a lone h e l p e d p a r t i c i p a n t s m a i n t a i n t h e i r s e l f - i d e n t i t y . P a r t i c i p a n t s used p r i v a c y or b e i n g a lone f o r c o n t e m p l a t i o n and a n a l y s i s o f e v e n t s . F o r example, p a r t i c i p a n t s d e s c r i b e d the need f o r t ime a lone to u n d e r s t a n d the s i t u a t i o n they were e x p e r i e n c i n g . 34 Participants provided these explanations: If you don't have privacy, you f e e l l i k e you are just an object, not a person. You f e e l l i k e a product instead of a person, i f you don't have privacy, i t takes away your s e l f - i d e n t i t y , privacy i s something that helps you sort out who you are. The above accounts alluded to the need for private time to contemplate and to adjust to the hos p i t a l s i t u a t i o n . Participants needed time alone to think about what was happening to them. The following accounts r e i t e r a t e the need for privacy and quiet contemplation. These accounts also demonstrate the p o s i t i v e e f f e c t that quiet contemplation had on pa r t i c i p a n t s : I just pulled the curtain and was alone with my thoughts and was able to work out by myself what was happening to me. I f e l t much better afterwards. At night when the l i g h t s went out and my roommates were going to sleep that was my own time, I was able to think about what was happening to me and 35 make sense of i t . During these p r i v a t e times, some p a r t i c i p a n t s contemplated the e f f e c t t h e i r surgery would have on t h e i r l i v e s . For some p a r t i c i p a n t s , surgery meant the end of t h e i r r e p r o d u c t i v e years; an event which c o u l d p o t e n t i a l l y have a major e f f e c t on t h e i r s e l f - i m a g e . The f o l l o w i n g account r e f l e c t s t h i s : I know not being able t o have any more k i d s shouldn't bother me but i t d i d you know. Sometimes I needed to be alone t o t h i n k about t h a t Sometimes I would say t o myself look at the b r i g h t s i d e of i t ....no more p e r i o d s ! I s t i l l t h i n k about i t , when I go f o r walks by myself or i f I'm at home alone. During those p r i v a t e times p a r t i c i p a n t s were able t o t h i n k about and to develop an understanding of the a c t u a l and p o t e n t i a l changes to t h e i r s e l f - i m a g e caused by t h e i r s urgery. P a r t i c i p a n t s a l s o needed t h i s time, alone, to a d j u s t t h e i r s e l f - i d e n t i t y t o the demands of the h o s p i t a l s i t u a t i o n . The f o l l o w i n g account demonstrates t h i s : I'm a s t r o n g woman you know. I was one of the f i r s t female loan o f f i c e r s i n the bank. I've had t o be s t r o n g . I t ' s hard to come i n t o h o s p i t a l where you have to do e v e r y t h i n g when 36 "they" want you to. You eat and sleep according to the hospital routine. I r e a l l y needed my privacy to sort out my feelings of not being boss. It was a r e a l adjustment for me. These accounts have i l l u s t r a t e d how important privacy, or being alone, was to participants i n maintaining t h e i r i n d i v i d u a l i t y and t h e i r self-worth while i n h o s p i t a l . These accounts have also shown that privacy or solitude was important for participants to f e e l valued as a person. Participants f e l t privacy was necessary for them to maintain t h e i r humanness. Part of retaining t h i s humanness and s e l f -i d e n t i t y was being able to control verbal interactions with others. The control of verbal interactions was another way privacy helped participants maintain t h e i r s e l f - i d e n t i t y . In order to maintain t h e i r s e l f - i d e n t i t y while i n hospit a l , p a r t i c i p a n t s used varying degrees of privacy to l i m i t to whom they talked, and when. The following account i l l u s t r a t e s t h i s : I guess i t l e t s me decide who I w i l l t a l k to and who I won't ta l k to. The usefulness of privacy as a control of verbal i n t e r a c t i o n i s depicted i n the following account: I'm a very private person and when I don't want 37 t o t a l k t o someone, I j u s t went to my own space and people d i d n ' t t a l k t o me. The p r e c e d i n g account d e s c r i b e s how p a r t i c i p a n t s used p r i v a c y t o c o n t r o l communications with others, thus p r o t e c t i n g t h e i r s e l f - i d e n t i t y . They a l s o used another aspect of p r i v a c y ; freedom from o b s e r v a t i o n t o r e i n f o r c e t h e i r s e l f - i d e n t i t y . P a r t i c i p a n t s maintained t h e i r s e l f -i d e n t i t y i n h o s p i t a l by t r y i n g t o c o n t r o l the exposure of the p r i v a t e p a r t s of t h e i r b o d i e s . P a r t i c i p a n t s s t a t e d t h a t freedom from o b s e r v a t i o n d u r i n g p a t i e n t care was important t h e i r s e l f - i d e n t i t y . One account d e s c r i b e d i t t h i s way: P r i v a c y l e t s you keep p a r t s of y o u r s e l f from b e i n g seen by others, e s p e c i a l l y when the nurse i s l o o k i n g a f t e r you. You don't want other people t o see p a r t s of your body. I t s O.K. f o r the nurse and d o c t o r but not f o r other people. Thus, by having a p r i v a t e s t a t e d u r i n g care, p a r t i c i p a n t s were able t o maintain t h e i r s e l f - i d e n t i t y . The i d e a of s e l e c t i v e o b s e r v a t i o n was another aspect of p a r t i c i p a n t s ' d e s c r i p t i o n s of p r i v a c y . P a r t i c i p a n t s f r e q u e n t l y noted t h a t o b s e r v a t i o n by care g i v e r s was a c c e p t a b l e while o b s e r v a t i o n by others was not. 38 Participants s e l e c t i v e l y used privacy as a mechanism to control who did or did not observe them. This was es p e c i a l l y so during the expression of certa i n emotions. Part of our s e l f - i d e n t i t y i s our a b i l i t y to control emotions i n front of others. The stress of h o s p i t a l i z a t i o n , of i l l n e s s and of being away from family caused some par t i c i p a n t s to f e e l anxious, lonely and t e a r f u l . However, to r e l i e v e these feelings some participants described the need for privacy. The next account describes how two par t i c i p a n t s were able f i n d private places to express t h e i r f e e l i n g s : On my fourth day i n hospit a l , I just f e l t so weepy, I missed my kids and I guess I was f e e l i n g sorry for myself. I didn't want to cry in front of everybody so I went into the bathroom, had a good cry and f e l t a l o t better. The bathroom i s private place to have a l i t t l e tear, you know, you don't want others to see you then. This privacy or freedom from observation was necessary for p a r t i c i p a n t s to vent feelings created by i l l n e s s and h o s p i t a l i z a t i o n . Participants found that to maintain t h e i r s e l f - i d e n t i t y they needed to claim a private space i n the hos p i t a l to c a l l 39 t h e i r own. Participants defined personal t e r r i t o r y or private space as the area around t h e i r bed delineated by the bed curtain. Important q u a l i t i e s of t h i s private space were that i t was constant, i t was marked by a physical b a r r i e r ; the bedside curtain and by the patient's personal belongings. The following accounts i l l u s t r a t e p a r t i c i p a n t s ' use of privacy afforded by personal t e r r i t o r y : The space around the bed i s yours, you get to know i t , you know when you come back from a walk that that's yours. The space i n the centre of the room i s everyones, but that space around your bed i s yours. You need to have some spot i n the hospital to c a l l your own. That the space you leave your personal things, l i k e your books, crossword puzzles, your k n i t t i n g . You need that space to help you f e e l l i k e a person. Personal t e r r i t o r y provided part i c i p a n t s with an area within the hospital where participants could safely store and leave t h e i r personal belongings. This helped to reinforce p a r t i c i p a n t s ' sense of i n d i v i d u a l i t y or s e l f - i d e n t i t y . Participants i d e n t i f i e d that the main purpose of privacy was the maintenance of s e l f - i d e n t i t y . Consequently, 40 p a r t i c i p a n t s used p r i v a c y t o m a i n t a i n t h e i r s e l f - i d e n t i t y o r i n d i v i d u a l i t y i n a v a r i e t y o f ways. These i n c l u d e d h a v i n g a p r i v a t e space f o r c o n t e m p l a t i o n and adjustment and f o r h a v i n g p r i v a t e t i m e t o c o n s i d e r t h e e f f e c t o f t h e i r s u r g e r y on t h e i r s e l f - i d e n t i t y . P a r t i c i p a n t s a l s o needed a p l a c e t o be a l o n e and t o e x p r e s s t h e emotions c r e a t e d by i l l n e s s and h o s p i t a l i z a t i o n . P r i v a c y h e l p e d p a r t i c i p a n t s keep t h e i r s e l f - i d e n t i t y i n t a c t d u r i n g n u r s i n g c a r e . F i n a l l y , p a r t i c i p a n t s ' s e l f - i d e n t i t y was s u p p o r t e d when each p a r t i c i p a n t had p e r s o n a l t e r r i t o r y o r p r i v a t e space f o r b e l o n g i n g s i n w h i l e h o s p i t a l . S i t u a t i o n a l P r i v a c y Needs In a d d i t i o n t o d e s c r i b i n g p r i v a c y as a r e q u i s i t e f o r m a i n t a i n i n g s e l f - i d e n t i t y , p a r t i c i p a n t s d e s c r i b e d v a r i o u s e v e n t s i n which some degree o f p r i v a c y was a n e c e s s i t y t o f e e l c o m f o r t a b l e about t h e ev e n t . S i t u a t i o n s where p a r t i c i p a n t s i d e n t i f i e d p r i v a c y was i m p o r t a n t t o f e e l c o m f o r t a b l e about t h e s i t u a t i o n , i n c l u d e d b a s i c human need a c t i v i t i e s , r e c e i v i n g n u r s i n g c a r e , s h a r i n g p e r s o n a l i n f o r m a t i o n and d u r i n g p e r s o n a l c o n v e r s a t i o n s . B a s i c Human Needs P a r t i c i p a n t s i d e n t i f i e d t h e need f o r p r i v a c y d u r i n g e l i m i n a t i o n , p e r s o n a l h y g i e n e and d r e s s i n g . P r i v a c y was 41 e s p e c i a l l y important to participants during elimination a c t i v i t i e s . Since a l l participants had t h e i r catheters removed on the t h i r d day, the need for privacy focused around a v a i l a b i l i t y of, and use of the bathroom. The need for the privacy that the bathroom afforded during elimination was such that absence of privacy could i n t e r f e r e with a basic body function. The following account i l l u s t r a t e s t h i s . At f i r s t , the nurse put me on the commode beside the bed to pass my water, I couldn't go, even with the curtain pulled. I couldn't relax enough to go. The curtain just wasn't private enough for me. Once I went into the bathroom, locked the door, I was able to pass my water without any trouble. Participants required complete privacy to meet elimination needs. Participants described complete privacy as freedom from being overheard and freedom from observation. Some participants even included freedom from odors as part of the privacy necessary during elimination a c t i v i t i e s . The following accounts i l l u s t r a t e p a r t i c i p a n t s ' descriptions of elimination privacy. I t r i e d to use the bathroom when people were tal k i n g , that way they wouldn't hear me. 42 It's hard to go when someone might accidentally walk i n . It's embarrassing you know, you go into the bathroom and you hope no one else wants to use i t r i ght a f t e r you, the smell, you know, even a f t e r you use the room freshener, the smell i t s s t i l l there. It's hard aft e r surgery, you need to pass gas, you go i n the bathroom and t r y to be as quiet about i t as you can. You don't want other people to hear you. The preceding accounts have i l l u s t r a t e d how important complete privacy was to participants t r y i n g to meet personal elimination needs. Privacy was also important to par t i c i p a n t s while they washed and performed other personal hygiene needs. Participants, on t h e i r f i r s t day afte r surgery, assisted with t h e i r own bed bath. While performing hygiene tasks i n bed, pa r t i c i p a n t s were anxious that at any moment someone would open the curtain and observe the private parts of t h e i r body. The following account demonstrates t h i s : When the nurse l e f t me the water and t o l d me to wash as much of myself as I could, I washed my chest r e a l l y quickly, then put my gown on fa s t . 43 You just don't know when someone i s going to pop t h e i r head i n and I didn't want anyone to see me. The next account i l l u s t r a t e s the invasion of a par t i c i p a n t ' s privacy during hygiene a c t i v i t i e s and her reaction to that invasion of privacy: I had f i n i s h e d my shower and was just drying o f f when the door opened. It was the nurse looking for another patient's watch. I was able to use the towel to quickly cover my body. I never f e l t that I had privacy i n the shower after that. I didn't know the nurses could unlock the door i f they wanted to. The foregoing accounts have i l l u s t r a t e d that privacy was necessary to par t i c i p a n t s ' comfort during hygiene procedures. Participants also needed privacy during dressing to f e e l comfortable about uncovering t h e i r bodies. Participants needed freedom from observation when changing gowns or undressing and when dressing at admission and discharge. The following account i l l u s t r a t e s t h i s : I always made sure no one could see me when I changed and when I got dressed to go home. I'm not a prude, I just didn't want anyone to see me without clothes. 44 Participants described f e e l i n g vulnerable during undressing and dressing or changing t h e i r h o s p i t a l gown. I f e l t r e a l l y vulnerable when I f i r s t a r r i v e d at the h o s p i t a l . The nurse pulled the curtain and t o l d me to change into a hospital gown. I thought that curtain doesn't look very secure. This i s n ' t very private. I faced the wall as I took o f f my clothes and changed r e a l l y fast to protect myself more. These accounts have shown that p a r t i c i p a n t s required privacy to f e e l secure during dressing or undressing. Whether i t be dressing, washing or going to the bathroom, privacy was an important element i n the successful completion of the task. In some accounts, lack of privacy prevented the completion of a basic human needs task, that of elimination. When participants were re c i p i e n t s of nursing care, privacy again was important to them. Nursing Care Situations Participants needed privacy while nursing care was being given. Participants understood that nurses needed to do procedures that brought nurses into contact with private areas of the t h e i r bodies. This i s i l l u s t r a t e d by the following account. 45 I mean, you can't have privacy i n a hos p i t a l i n that respect, you know, enemas and shaving, because, I mean, the nurses are there to do t h e i r job. I mean, they're supposed to give you an enema, we don't know how to do that for ourselves, right? However, what appeared to be c r u c i a l to par t i c i p a n t s was the provision of privacy during nursing care. Participants explained that privacy reduced the embarrassment f e l t i n the si t u a t i o n . The following account relates to a nurse checking a partic i p a n t ' s i n c i s i o n : I wasn't embarrassed because she pul l e d the curtain, i t was just her who could see me. Also, she was matter of a fact about i t . She acted l i k e she had seen m i l l i o n s of bodies before .... and I thought, I guess I'm no d i f f e r e n t than anyone else. By recognizing each participant's need for privacy during care, the nurse prevented the pa r t i c i p a n t from f e e l i n g embarrassed during the procedure. Participants i d e n t i f i e d another s i t u a t i o n i n which privacy was important to them. The s i t u a t i o n of sharing personal information with health professionals was important to p a r t i c i p a n t s ' privacy. 46 Personal Information Situations Privacy helped participants control who had access to t h e i r personal information. Participants recognized i t was necessary to share personal information that would contribute to t h e i r care. However, during the process of sharing that information, participants needed to r e s t r i c t others from overhearing that information. This was accomplished through privacy, which con t r o l l e d the extent to which the information was shared. The following account i l l u s t r a t e s p a r ticipant need to control information sharing: I know nurses and doctors have to know about me to look af t e r me. But I r e a l l y don't think i t i s anybody else's business, your personal information shouldn't be overheard by others. The need for privacy during information sharing becomes most urgent i n nurse-patient or doctor-patient s i t u a t i o n s . The following accounts demonstrate t h i s : I t e l l the nurses and doctor about me because i t w i l l help them look after me better. But what I object to i s that nurses-doctors tend to think as soon as the curtain i s pulled no one else can hear what's going on and r e a l l y people can. Participants were w i l l i n g to share personal information about themselves with nurses and doctors. However, 47 provision had to be made that t h i s information would be shared with no one else for parti c i p a n t s to f e e l comfortable. This comfort was p a r t l y achieved by privacy. Another interpersonal i n t e r a c t i o n that p o t e n t i a l l y involved the sharing of s e l f and information about s e l f was s o c i a l conversation. Participants used privacy to control conversations with roommates, family and friends. Personal Conversations Privacy was important to parti c i p a n t s during s o c i a l conversations as well as during situations that focused on the sharing of personal information with health care professionals. Participants f e l t strongly regarding the control of access to s e l f i n the s o c i a l arena. Participants used privacy to control the number of conversations they had with roommates and v i s i t o r s . A l l p a r t i c i p a n t s mentioned the importance of r e s t r i c t i n g the number, length and frequency of conversation they had with others during h o s p i t a l i z a t i o n . However, pa r t i c i p a n t s ' responses d i f f e r e d as to what was an appropriate for them. The differences i n responses are i l l u s t r a t e d by the following accounts: The best thing about a private room i s that you don't have to ta l k to other people i f you don't want to. 48 It's nice to be able to t e l l someone else about the t e r r i b l e soup, i t makes the s i t u a t i o n more bearable. I l i k e having people to t a l k to. As described i n the preceding accounts, p a r t i c i p a n t s wanted varying degrees of privacy for managing t h e i r conversations with others. Participants did not agree on what was an appropriate length or frequency of conversation. The following account demonstrates the amount of privacy one par t i c i p a n t f e l t was necessary for her: I was so glad when my fr i e n d came to v i s i t me. She had surgery l i k e mine l a s t year. We went for a walk down the h a l l so I could t a l k to her p r i v a t e l y . However, participants did agree that i f the appropriate amount of privacy was not provided for them, conversations were hampered. The following accounts demonstrate t h i s : I wanted just to t a l k about my surgery to my husband but there were other v i s i t o r s and patients i n the room who might overhear what I said and I didn't want them to hear. We went to the lounge to t a l k . We needed privacy to be able to t a l k openly with each other about what was happening at home. 49 Clearly, appropriate privacy was a necessary component for p a r t i c i p a n t s to have meaningful conversations with others. In summary, participants i d e n t i f i e d numerous privacy needs. Privacy was of prime importance for the maintenance of s e l f - i d e n t i t y or i n d i v i d u a l i t y during the h o s p i t a l stay. Privacy contributed to p a r t i c i p a n t s ' privacy i n a number of ways. The state of privacy provided for an appropriate milieu for personal contemplation, for comfort during nursing care and for adjustment to new s i t u a t i o n s . Also, p a r t i c i p a n t s consistently i d e n t i f i e d events i n which privacy was a necessary element. These were: basic human needs a c t i v i t i e s , nursing care a c t i v i t i e s , sharing of personal information and personal conversations. Throughout i n d i v i d u a l accounts participants referred to factors that influenced t h e i r a b i l i t y to meet t h e i r privacy needs. Time and time again, part i c i p a n t s stressed how important these factors were to them. These factors are i d e n t i f i e d and described i n the next section. Factors A f f e c t i n g Participants' Privacy. This section w i l l discuss the personal, interpersonal and physical factors that affected p a r t i c i p a n t s ' privacy. The factors w i l l be discussed i n the order stated. 50 Personal Factors A variety of personal factors influenced p a r t i c i p a n t s ' view of privacy. Participants' expectations of what they needed for privacy were in d i v i d u a l and diverse. The following accounts are examples of pa r t i c i p a n t s ' personal expectations of privacy needs: a private room was es s e n t i a l to my privacy as long as I can go to a bathroom myself I've got privacy as long as information about me i s kept private. That's most important to me. my husband and I are very private people, we don't even know our neighbours. I couldn't have been i n a four bed ward. I couldn't have coped with the loss of privacy. The preceding examples have demonstrated the unique and diverse nature of each participant's expectations of privacy. Expectations of what constituted privacy varied not only with p a r t i c i p a n t s ' expectations, but also with t h e i r l i f e experiences as well. Participants, with many l i f e experiences seemed to be more tolerant i n t h e i r expectations of privacy, as i l l u s t r a t e d by the following: 51 I've seen so much over the years, privacy i s n ' t as important to me as i t used to be. One middle aged participant, with teenage daughters, gave t h i s account about the e f f e c t of l i f e experiences on her privacy needs: It would be a l o t harder for my daughters to deal with the loss of privacy i n the hospital than i t i s for me. I've given b i r t h , a f t e r that, being i n h o spital i s nothing. Participants described diverse and i n d i v i d u a l expectations of privacy while i n h o s p i t a l . One major factor i n p a r t i c i p a n t s ' expectations of privacy was l i f e experience. According to some participants, the more l i f e experiences, the more tolerant one becomes of less privacy. Participants also i d e n t i f i e d that other people affected t h e i r privacy i n h o s p i t a l . Interpersonal Factors Participants i d e n t i f i e d that i n t e r a c t i o n with nursing s t a f f , doctors, roommates and v i s i t o r s had a major e f f e c t on t h e i r privacy. As soon as participants came into contact with other people, they f e l t the need to regulate t h e i r interactions. For example, participants sharing a four bed ward were constantly regulating t h e i r interactions with roommates, while the participant i n a private room 52 maintained her privacy with much less e f f o r t . Roommates were a s i g n i f i c a n t factor to p a r t i c i p a n t s attempting to meet t h e i r privacy needs. Participants described that the more opportunities there were for i n t e r a c t i o n with others, the greater the need to regulate inter a c t i o n s . Thus, the number of other women with whom a par t i c i p a n t shared a room affected each roommate's privacy. The next accounts i l l u s t r a t e s how the number of roommates effected p a r t i c i p a n t s ' privacy. It's hard to share your space with three other people when you are used to being alone. I asked for a semiprivate or a private room but I didn't get i t . I l i k e my time alone. You sure don't get i t i n a four bed ward. There i s always someone t r y i n g to t a l k to you. Sometimes I'd just turn and face the wall, just so I wouldn't have to t a l k to anyone. I think having to share the bathroom with three other people was the hardest part of a l l . The foregoing accounts described how d i f f i c u l t i t was for some partic i p a n t s to share a room with other women. Some par t i c i p a n t s f e l t they did not have the privacy they needed. Also participants recognized that lack of privacy 53 increases as the number people sharing the room increases. A par t i c i p a n t , admitted to a semi-private room and then transferred to a four bed ward for the hospital's convenience, provided t h i s account: I had a l o t more privacy when I was i n the semiprivate room, I only had to share i t (bathroom) with one other person, now I share i t with four, and i t s awful. The amount of conversation between pa r t i c i p a n t s and roommates affected t h e i r privacy, as well. The match between the expected amount of verbal exchange and the actual amount of verbal exchange was important. Participants t r i e d to obtain t h i s match by c o n t r o l l i n g opportunities for conversation. This i s portrayed by the following accounts: Some of the patients are chatty, you can't wait u n t i l you are well enough to go for a walk down the h a l l to get away from them. You sort of set out rules, when you are i n a four bed ward, l i k e everyone knew not to t a l k to me u n t i l a f t e r breakfast. Participants explained that as the number of roommates increased the a b i l i t y to maintain t h e i r privacy decreased. The main cause of t h i s decreased privacy was unwanted 54 conversations between participants and roommates. The amount of care roommates required also influenced the amount of privacy participants perceived they had. This was e s p e c i a l l y noticeable at night. Some par t i c i p a n t s had roommates who required care at night causing noises that disturbed the privacy and sleep of others i n the room. The following demonstrates t h i s : At night, when the nurses came i n to turn Mrs. X, the noise always woke me up, I know they needed to turn her but I need my sleep and to sleep, I needed my privacy too. I was so glad to get home. I r e a l l y needed a good nights sleep. You don't get that i n the hospital you know. There i s always noises to wake you up. Thus, the night time noise of the nursing care of roommates was an intrusion into other womens' privacy. On the other hand, roommates contributed to each other's acceptance of the lack of privacy. In our society c e r t a i n behaviours r e l a t i n g to elimination are inappropriate i n the presence of others. For example, i t i s not appropriate to pass f l a t u s around other people. One part i c i p a n t was embarrassed because aft e r her surgery, she needed to "pass gas". She was reassured by roommates that passing gas was a l r i g h t . The following demonstrates t h i s : 55 It's O.K. dear We are a l l i n the same boat, go ahead and do i t . The preceding account i s an example of how roommates reassured each other and helped each other accept the reduced privacy a hospital s i t u a t i o n presents. The foregoing accounts have demonstrated the e f f e c t roommates had on each others' privacy. Participants described how increases i n the number of roommates decreased t h e i r p o t e n t i a l to maintain privacy. Also, p a r t i c i p a n t s described how the amount and type of nursing care roommates required decreased p o t e n t i a l to maintain privacy. Conversely, the reassurance and support given by roommates assisted participants to adjust to loss of privacy found i n ho s p i t a l . Nurses were important players i n a f f e c t i n g p a r t i c i p a n t s ' privacy. Privacy helped p a r t i c i p a n t s f e e l comfortable during nursing care. Part of being i n a private state was the establishment of a boundary that l i m i t e d observation by others. In the hospital setting, nurses established a boundary for participants by p u l l i n g the bedside curtain around the bed. Nurses who were ca r e f u l that the bedside curtain was completely closed were perceived by participants as caring about t h e i r privacy and of them as i n d i v i d u a l s . This i s demonstrated i n the following accounts. 56 Some are more careful than others to make sure the curtain i s pulled. The nurse pulled the curtain which was good. You can't have much privacy i n the hospital but the curtain sure helps. I was embarrassed when the nurse didn't p u l l the curtain around Mrs. XX when she was on the commode. I reached over and pulled i t for her. Participants also explained that the nurse's behaviour when providing care of an intimate nature, such as shaving the perineal area, affected t h e i r sense of privacy. The following accounts describe t h i s : The nurse could t e l l I was embarrassed because she was shaving me down there, because she started to t e l l me about her family. We found out that our g i r l s are the same age and go to the same school. I didn't f e e l so embarrassed af t e r that. I f e l t l i k e she was my friend, that we had something i n common. When the nurse started to shave me down there, she was so matter of fact and so quick, I didn't even think about i t . Just accepted i t as part of 57 getting the operation over with. In the f i r s t account, the nurse's s e n s i t i v i t y to the pa r t i c i p a n t ' s feelings helped the pa r t i c i p a n t adjust to the s i t u a t i o n . In the second account, the nurse's s k i l l i n performing the preoperative procedure helped the participant adjust to the s i t u a t i o n . These accounts i l l u s t r a t e d two d i f f e r e n t nurse behaviours that contributed to pa r t i c i p a n t s f e e l i n g comfortable about including nurses i n t h e i r private body space. Participants also i d e n t i f i e d nurse behaviours that did not contribute to t h e i r privacy. For example, nurses who did not acknowledge privacy boundaries had a negative influence on pa r t i c i p a n t s ' privacy and sense of comfort. Participants described nurse behavior t h i s way. The nurse just popped her head i n to ask my nurse about another patient, I f e l t so exposed because I was a l l uncovered and she could see and I didn't know her. One of the nurses was r e a l l y careless about p u l l i n g the curtain. She always l e f t a gap between the two curtains. That caused me to f e e l bare and vulnerable. The nurse unlocked and opened the door while I 58 was having my shower. I was shocked that someone could see me so e a s i l y . Participants f e l t strongly that the door or the curtain established a boundary for privacy and that privacy boundaries should be respected by others. When nurses did not respect those boundaries, part i c i p a n t s f e l t that t h e i r privacy was invaded. Nurses have many opportunities to support p a r t i c i p a n t s ' privacy. These opportunities include respecting and providing a private space for a participant and being s e n s i t i v e to a partici p a n t ' s need for privacy during care to intimate parts of her body. The other health professional who affected p a r t i c i p a n t s ' privacy was the doctor. Doctors' behaviour was both a p o s i t i v e and a negative factor that contributed to a partici p a n t ' s sense of privacy. One p o s i t i v e factor, was the s e n s i t i v i t y , doctors demonstrated for p a r t i c i p a n t s ' privacy during t h e i r physical examination. The following accounts demonstrate t h i s : The doctor pulled the curtain when he examined my stomach and i n c i s i o n . The anaesthetist just p u l l e d my gown away and put the stethoscope down to hear my heart. 59 The previous accounts are examples of doctors' actions that helped participants meet t h e i r need for privacy. In the f i r s t account, the doctor provided a private space. In the second account, the doctor minimized the amount of the p a r t i c i p a n t ' s body that would be observed. These actions helped part i c i p a n t s maintain t h e i r privacy. The tone and volume of the doctor's voice affected p a r t i c i p a n t s ' privacy too. The following account i l l u s t r a t e s t h i s point: This one doctor, he had a booming voice, everyone i n the room could hear what he said to his patient. You t r y to not l i s t e n but his voice was so loud, you couldn't help but hear. Now my doctor, he always came close to the bed and talked i n a soft tone that only I could hear. That r e a l l y helped me f e e l private. This account demonstrated the e f f e c t the doctor's tone and volume of voice had on p a r t i c i p a n t s ' perception of privacy. There i s one more group of people who had a major influence on p a r t i c i p a n t s ' privacy. V i s i t o r s , both the p a r t i c i p a n t s and t h e i r roommates affected p a r t i c i p a n t s ' privacy. V i s i t o r s affected p a r t i c i p a n t s ' privacy i n a variety of ways. The greater the number of v i s i t o r s , the less privacy 60 p a r t i c i p a n t s f e l t . When v i s i t o r s came to see one roommate, other roommates f e l t t h e i r privacy was compromised. The following account i l l u s t r a t e s t h i s : Because we belong to so many community organizations, I had l o t s of v i s i t o r s . Eleven the f i r s t day, nine the second. I wouldn't wish that on anybody. It affected my stomach, I don't l i k e to repeat everything to everybody. Thus, the number of v i s i t o r s and the sharing of information that took place reduced p a r t i c i p a n t s ' a b i l i t y to control space and privacy. V i s i t o r s influenced the privacy of other patients i n the room as well. Participants f e l t uncomfortable getting out of bed or going to the bathroom when roommates' v i s i t o r s were in the room. This account i l l u s t r a t e s t h i s point: V i s i t o r s get bored and watch what other patients are doing. I didn't l i k e getting out of bed or going to the bathroom. People would watch you and know what you are doing. The presence of v i s i t o r s r e s t r i c t e d p a r t i c i p a n t s ' a c t i v i t i e s , either by t h e i r physical presence or by t h e i r a b i l i t y to be able to observe the actions of others. Thus, v i s i t o r s decreased options participants had to meet t h e i r privacy needs. 61 This section has i d e n t i f i e d and described how other patients, nurses, doctors and v i s i t o r s influenced p a r t i c i p a n t s ' privacy during h o s p i t a l i z a t i o n . Participants' descriptions of how the physical environment of the hospital influenced t h e i r privacy w i l l be discussed next. Physical Environment The t h i r d variable that affected p a r t i c i p a n t ' s perception of privacy was the hospital's physical environment. The bathroom and the bedside curtain had the greatest e f f e c t on p a r t i c i p a n t s ' privacy. A l l p a r t i c i p a n t s i d e n t i f i e d the bathroom as a major factor i n meeting privacy needs. The bathroom i s one physical space where society considers i t appropriate to be alone. As a result, individuals needing privacy, attempted to use the bathroom. The following account i l l u s t r a t e s t h i s : The bathroom i s a place to go, you can close the door, no one can see or hear what you are doing. The bathroom i s a r e a l important part of privacy, e s p e c i a l l y a f t e r surgery when you have gas n' everything. The bathroom provided privacy for other a c t i v i t i e s besides elimination. These a c t i v i t i e s were washing and 62 dressing. Participants needed the security that the physical separation of a bathroom provides to f e e l at ease during hygiene and dressing a c t i v i t i e s . The following account i l l u s t r a t e s t h i s : I needed the privacy of the bathroom to f e e l safe while I washed and changed hospital gowns, the curtain was too easy for nurses to pop t h e i r heads i n without asking you f i r s t . However, there was not consensus among the pa r t i c i p a n t s as to whether or not sharing a bathroom was a factor that i n t e r f e r e s with privacy. This account was from a p a r t i c i p a n t i n a private room: I think having your own bathroom i s a r e a l l y important part of privacy. Yet t h i s account from a participant i n a four bed ward expresses the view that sharing the bathroom was an acceptable variable i n meeting privacy needs. It's OK to share i t with the other people i n your room, I wouldn't l i k e to have to share i t with patients from other rooms as well. Another aspect of the bathroom privacy was the lock on the bathroom door. A lock affected the control the p a r t i c i p a n t had over the bathroom. The fact that the nurse could use a key to open the door reduced the degree of privacy p a r t i c i p a n t s f e l t they had i n the bathroom. This reduced the effectiveness of the bathroom for meeting pa r t i c i p a n t s ' privacy needs. The following account i l l u s t r a t e s t h i s : It's just that f e e l i n g that when you lock the doors, i t f e l t l i k e you, s t i l l weren't private. They gave you security, but you knew i t r e a l l y wasn't. The parti c i p a n t s f e l t that because the nurse had the key to the locked door, t h i s reduced control over the bathroom door and ultimately t h e i r privacy. Consequently, the bathroom was an important factor for p a r t i c i p a n t s ' privacy. Participants described the bathroom as the most appropriate physical space i n which to meet t h e i r privacy needs r e l a t i n g to basic needs. The degree to which the bathroom helped to meet basic needs was moderated by the number of patients sharing the bathroom and whether or not parti c i p a n t s had t o t a l control over the bathroom. The second most important physical factor for pa r t i c i p a n t s ' privacy was the bedside curtain. Participants perceived the bedside curtain to be a physical marker of t h e i r own personal space and t e r r i t o r y while i n h o s p i t a l . Whether a bedside curtain was pulled, or not pulled, i n a s i t u a t i o n influenced a partic i p a n t ' s sense of privacy. The following accounts i l l u s t r a t e t h i s : The curtain, i t ' s just a piece of f a b r i c , but i t says Keep Out. Like a sign. I didn't l i k e i t when the curtain was pul l e d halfway. When the curtain was closed I f e l t I was i n privacy, I had my own space. When the nurses are looking a f t e r you. You need your own space. You need to have the curtains around. That way you don't f e e l exposed. But you have to have the curtain completely shut to f e e l that way. The preceding demonstrates the importance of the bedside curtain for pa r t i c i p a n t s ' privacy. Although the bedside curtain was not a firm physical b a r r i e r , i t was perceived by participants to be a strong personal privacy marker. However, the degree to which i t was e f f e c t i v e depended at times on who had control over the curtain. Th was i l l u s t r a t e d by the following: Once I could get up and p u l l the curtain myself, I f e l t I had more privacy. When you had t o depend on the nurse t o p u l l the c u r t a i n , some were b e t t e r than o t h e r s . Some l e f t a space i n the c u r t a i n and other people c o u l d see what was happening. Lots of times other p a t i e n t s d i d n ' t r e a l i z e the c u r t a i n wasn't c l o s e d completely because t h e i r back was t o the open c u r t a i n . I always checked t o see t h a t the nurse had p u l l e d the c u r t a i n b e f o r e she s t a r t e d . Nurses pop t h e i r heads i n through the c u r t a i n without a s k i n g . The above demonstrated t h a t p a r t i c i p a n t s who had c o n t r o l over the bedside c u r t a i n p e r c e i v e d t h a t they had g r e a t e r o p p o r t u n i t y f o r p r i v a c y than p a r t i c i p a n t s who r e l i e d on the nurse t o c l o s e the c u r t a i n . Thus, the e f f e c t i v e n e s s of the c u r t a i n as a p h y s i c a l b a r r i e r f o r promoting p r i v a c y depended on who had c o n t r o l of the c u r t a i n . O v e r a l l , p a r t i c i p a n t accounts i l l u s t r a t e d t h a t the bedside c u r t a i n was an important f a c t o r i n meeting needs f o r p r i v a c y d u r i n g h o s p i t a l i z a t i o n . F a c t o r s t h a t have i n f l u e n c e d p a r t i c i p a n t ' need f o r p r i v a c y have been i d e n t i f i e d i n t h i s s e c t i o n . The f i n d i n g s were d i s c u s s e d under the g e n e r a l headings of p e r s o n a l , i n t e r p e r s o n a l and p h y s i c a l environment. Summary In t h i s chapter the a n a l y s i s of the p a r t i c i p a n t s ' accounts have been i d e n t i f i e d and d e s c r i b e d . The f i n d i n g were p r e s e n t e d under the t o p i c s developed from the analys of t h e i r accounts. A d i s c u s s i o n of the a n a l y s i s of p a r t i c i p a n t s ' accounts and r e l e v a n t l i t e r a t u r e w i l l be p r e s e n t e d i n Chapter F i v e . 67 CHAPTER FIVE Discussion of Findings Introduction In t h i s chapter, the findings of the study, presented i n the previous chapter, w i l l be discussed. The discussion w i l l consider these findings i n r e l a t i o n to the l i t e r a t u r e , and Altman's theory of privacy. The previous chapter presented the meaning units derived from the data. The accounts c l e a r l y i l l u s t r a t e d that the main purpose of privacy, for these p a r t i c i p a n t s , was to a s s i s t i n the support and maintenance of s e l f -i d e n t i t y . Participants also i d e n t i f i e d events and situations i n which privacy was a necessary element. F i n a l l y , factors reported by participants which affected t h e i r privacy i n hospital were i d e n t i f i e d . The f i r s t part of t h i s chapter w i l l discuss the role of privacy i n supporting and maintaining p a r t i c i p a n t s ' s e l f - i d e n t i t y . Then, c h a r a c t e r i s t i c s of privacy that p a r t i c i p a n t s considered important to t h e i r s e l f - i d e n t i t y w i l l be discussed. Next, situations i n which privacy was an important element for participants w i l l be discussed. F i n a l l y , factors that affected p a r t i c i p a n t s ' privacy i n hos p i t a l w i l l be discussed. Privacy and S e l f - i d e n t i t y 68 Participants indicated that privacy played an important part i n the management of s e l f - i d e n t i t y during h o s p i t a l i z a t i o n . In fact, private time was a necessary part of h o s p i t a l i z a t i o n for participants to maintain t h e i r s e l f - i d e n t i t y . According to participants, privacy supported the maintenance of s e l f - i d e n t i t y i n three ways. F i r s t , a private state provided participants with an opportunity to be by themselves and to contemplate the s i t u a t i o n i n which they found themselves. Second, privacy helped p a r t i c i p a n t s keep control over who had access to t h e i r personal information. F i n a l l y , p a r t i c i p a n t s ' s e l f - i d e n t i t y was enhanced by a private area; a personal t e r r i t o r y , that p a r t i c i p a n t s used to support t h e i r sense of i n d i v i d u a l i t y . These w i l l be discussed i n the order stated. The r e l a t i o n s h i p between privacy and s e l f - i d e n t i t y has been described by several authors (Altman, 1974; Goffman, 1959; & Schwartz, 1968). Westin (1968) described personal autonomy, an individual's sense of i n t e g r i t y and independence, as a major goal of privacy. Some developmental t h e o r i s t s have suggested that development of s e l f - i d e n t i t y i s the process of separation of the person from the s o c i a l and physical environment (Erikson, 1964). 69 P a r t i c i p a n t s used p r i v a c y as an i n d i c a t o r of t h e i r s t a t u s i n a s i t u a t i o n and to h e l p d e f i n e who they are. I f the d e s i r e d l e v e l of p r i v a c y was met or was not met gave p a r t i c i p a n t s messages as to t h e i r s e l f - w o r t h and s e l f -i d e n t i t y . One p a r t i c i p a n t s a i d t h a t when she d i d not have p r i v a c y she f e l t l i k e an " o b j e c t " , a non-person. Another p a r t i c i p a n t s a i d simply " i t [privacy] l e t s me be me". Simmel (1971) d e s c r i b e d the theme of p r i v a c y and s e l f -i d e n t i t y : We need to be a p a r t of others, of i n t i m a t e c i r c l e s , f a m i l i e s , communities, n a t i o n s , p a r t of humanity and we need t o be so r e c o g n i z e d by others t o be supported by t h e i r approval f o r our a f f i l i a t i o n and our l i k e n e s s t o them. But we a l s o need t o c o n f i r m our d i s t i n c t n e s s from others, to a s s e r t our i n d i v i d u a l i t y , t o p r o c l a i m our c a p a c i t y t o enjoy, or even s u f f e r , the c o n f l i c t s t h a t r e s u l t from such a s s e r t i o n s of i n d i v i d u a l i t y (p.73). Simmel a l s o d e s c r i b e d the element of c o n t r o l c o n t a i n e d i n p r i v a c y as c e n t r a l to our s e l f - i d e n t i t y . A c c o r d i n g t o Simmel (1971) : We become what we are not only by e s t a b l i s h i n g boundaries around o u r s e l v e s but a l s o by a p e r i o d i c opening of these boundaries t o nourishment, to l e a r n i n g , and t o i n t i m a c y (p.81). P a r t i c i p a n t s , i n t h e i r accounts, d e s c r i b e d u s i n g the 70 element of c o n t r o l i n p r i v a c y t o determine t o whom they would or would not t a l k . P a r t of s e l f - i d e n t i t y i s management of emotion. P a r t i c i p a n t s needed p r i v a c y t o be alone when they found the s t r e s s of i l l n e s s or h o s p i t a l i z a t i o n became overwhelming. During time alone p a r t i c i p a n t s were able t o express f e e l i n g s p r i v a t e l y , sometimes through t e a r s . Westin (1968) suggested t h a t one f u n c t i o n of p r i v a c y i s t o p r o v i d e a time f o r "people who need p e r i o d s of s o l i t u d e f o r v a r i o u s types of emotional r e l e a s e " (p.9). T h i s was c o n s i s t e n t w i t h p a r t i c i p a n t ' s view of p r i v a c y f o r emotional v e n t i n g . Maintenance of s e l f - i d e n t i t y seems to r e l a t e t o the i n f o r m a t i o n t h a t i s known about someone by o t h e r s . The s h a r i n g of i n f o r m a t i o n i s another aspect of p r i v a c y and s e l f - i d e n t i t y . There i s a need t o c o n t r o l p e r s o n a l i n f o r m a t i o n about o u r s e l v e s . In p a r t i c u l a r , i n f o r m a t i o n t h a t has the p o t e n t i a l t o a l t e r others p e r c e p t i o n , of us i s important t o our s e l f - i d e n t i t y . P a r t i c i p a n t s d e s c r i b e d t h i s d u r i n g t h e i r i n t e r v i e w s . P a r t i c i p a n t s understood the n e c e s s i t y of s h a r i n g p e r s o n a l i n f o r m a t i o n with h e a l t h care p r o f e s s i o n a l s as p a r t of the " g e t t i n g w e l l " p r o c e s s . However, p a r t i c i p a n t s f e l t s t r o n g l y t h a t t h i s i n f o r m a t i o n should only be shared with those who needed t o know. Westin's r e s e a r c h on p r i v a c y confirmed t h i s i d e a of i n f o r m a t i o n a l p r i v a c y . 71 P r i v a c y i s "the c l a i m of i n d i v i d u a l s , groups or i n s t i t u t i o n s t o determine f o r themselves, when, how and to what extent i n f o r m a t i o n about themselves i s communicated to o t h e r s " (Westin, 1968, p.7). P a r t i c i p a n t s r e l a t e d t h a t freedom from b e i n g overheard was a necessary and sometimes m i s s i n g p a r t of c o n v e r s a t i o n s between t h e i r f a m i l i e s and themselves or between t h e i r nurse and themselves. Westin (1970) c a l l e d t h i s " l i m i t e d and p r o t e c t e d communication". " P r i v a c y p r o v i d e s the o p p o r t u n i t y t o be alone w i t h another or a small group of persons and t o share c o n f i d e n c e s with them" (Westin 1970, p.32). Thus, Westin's r e s e a r c h supports p a r t i c i p a n t s ' claims f o r the need of c o n t r o l over the amount and to whom i n f o r m a t i o n i s d i s t r i b u t e d . C o n t r o l over access t o i n f o r m a t i o n was a l s o important to p a r t i c i p a n t s ' s e l f - i d e n t i t y . S chuster's (1972) study of p r i v a c y i n acute care h o s p i t a l s a l s o i d e n t i f i e d the importance of i n f o r m a t i o n a l p r i v a c y . Schuster (1972) c o n s i d e r e d p r i v a c y " i n an i n f o r m a t i o n a l mode whereby the i n d i v i d u a l i s f r e e t o d i s c l o s e only t h a t i n f o r m a t i o n about h i m s e l f c o n s i s t e n t with h i s circumstances and d e s i r e s " ( p . 5 1 ) . P a r t i c i p a n t s i n t h i s study d e s c r i b e d behaviours of h e a l t h p r o f e s s i o n a l s which i n t e r f e r e d with t h e i r need to c o n t r o l s h a r i n g of i n f o r m a t i o n . P a r t i c i p a n t s r e p o r t e d b e h a v i o r s such as d o c t o r s t a l k i n g i n a l o u d v o i c e or t a l k i n g about matters of a p e r s o n a l nature a c r o s s the room. Schuster's (1972) and Westin's (1968) research on informational privacy supported p a r t i c i p a n t s ' accounts of the need to control who has access to t h e i r personal information. The control over access to information was important to the maintenance of pa r t i c i p a n t s ' s e l f - i d e n t i t y during h o s p i t a l i z a t i o n . In an e f f o r t to maintain a s e l f - i d e n t i t y , p a r t i c i p a n t s established an area i n the hospital that was t h e i r s . P a rticipants defined as personal t e r r i t o r y , the area around t h e i r bed, delineated by the bedside curtain. Important q u a l i t i e s of t h i s space were that i t was constant, and that i t was marked by the bedside curtain and by the pa r t i c i p a n t s ' belongings. Edney (1976) i d e n t i f i e d the purpose of personal t e r r i t o r i e s . Personal t e r r i t o r i e s "provide a place where one can spend continuous spans of time" (Edney, 1976, p.84). Without personal t e r r i t o r i e s i t would be very d i f f i c u l t to maintain s e l f - i d e n t i t y patterns of behaviour and habits necessary for basic needs such as sleeping and eating (Edney, 1976). Lyman and Scott described these personal t e r r i t o r i e s somewhat d i f f e r e n t l y . Lyman and Scott (1967) c a l l e d them "home t e r r i t o r i e s " . Home t e r r i t o r i e s were defined "as areas where the regular part i c i p a n t s had a r e l a t i v e sense of freedom of behaviour and a sense of intimacy and control over the areas" (Lyman & Scott, 1967, p.238). Participants echoed Lyman and Scott's perception of home t e r r i t o r i e s i n 73 accounts about the space around t h e i r h o s p i t a l beds. Participants spoke of that area i n terms of "It's mine, I know i t w i l l be there when I come back from a walk". Participants also described the space around the bed as t h e i r s ; one that held t h e i r personal belongings. It was personal belongings that helped part i c i p a n t s to i d e n t i f y themselves as individuals during the hos p i t a l stay. Participants said that privacy was necessary to help them maintain t h e i r sense of i n d i v i d u a l i t y or s e l f - i d e n t i t y during h o s p i t a l i z a t i o n . As pa r t i c i p a n t s i d e n t i f i e d the importance of privacy to t h e i r s e l f - i d e n t i t y , they also described c h a r a c t e r i s t i c s of privacy that were important to them. These c h a r a c t e r i s t i c s w i l l be discussed next. Charact e r i s t i c s of Privacy In t h e i r accounts, participants described numerous c h a r a c t e r i s t i c s of privacy that assisted i n the maintenance of t h e i r s e l f - i d e n t i t y . One central c h a r a c t e r i s t i c described was the concept of control. Participants discussed the importance of control for interpersonal relationships, and for control of information. Participants said that t h i s control was gained through various types and degrees of privacy depending on the s i t u a t i o n . These c h a r a c t e r i s t i c s w i l l be discussed i n the order stated. 74 Inherent i n the need for interpersonal r e l a t i o n s h i p control was p a r t i c i p a n t s ' need to control an imaginary boundary between themselves and others. P a r t i c i p a n t s ' notion of control was consistent with findings i n the l i t e r a t u r e . For example, Altman's (1974) analysis presented privacy as an "interpersonal boundary control process". The intent i s to influence and regulate interactions with other i n d i v i d u a l s . This was also consistent with Schuster (1972) findings. She concluded that despite the complexity of the concept, privacy always included a boundary where the u n s o l i c i t e d break i n that boundary s i g n i f i e d an invasion of privacy. However, Schuster viewed privacy and the element of control from a dynamic continuum perspective. In t h i s dynamic privacy continuum, subjects balanced t h e i r needs for "withdrawal and retreat" with t h e i r needs for "disclosure and communication" (p.61). Participants described a s i m i l a r c h a r a c t e r i s t i c of privacy. They reported giving up some of t h e i r need for privacy i n order to obtain nursing or medical care. This i s congruent with Altman's view that privacy i s "the s e l e c t i v e control over access to the s e l f or to one's group" (p.6). This idea of s e l e c t i v e control implies a choice or p o t e n t i a l to negotiate access to s e l f i n a s i t u a t i o n . Altman (1975) described t h i s as an "interpersonal 75 boundary-control process that paces and regulates interactions with others (p.10). Altman explained that sometimes the "person or group i s receptive to outside inputs, and sometimes the person or group closes o f f contact with the outside environment" (1975, p.10). Participants described that i t was acceptable for nurses to perform procedures involving normally private areas of t h e i r body. Laufer, Proshansky & Wolfe (1975) i d e n t i f i e d t h i s phenomena as "control over choice" and "control over access". "Control over choice" involved the ind i v i d u a l ' s control over being private either p h y s i c a l l y or psychologically. The in d i v i d u a l could decide whether or not to j o i n an in t e r a c t i o n or not. "Control over access" to s e l f involved the ind i v i d u a l ' s decision to share or not to share some aspect of t h e i r l i f e . Individuals used "control over access" when i t was important that others not know about or intrude upon behaviors, thoughts or actions (Laufer, Proshansky, & Wolfe, (1975). Participants said that as patients they had very l i t t l e choice over being p h y s i c a l l y or psychologically private i n ho s p i t a l . Participants expressed the view that "control over choice" and "control over access" were diminished during h o s p i t a l i z a t i o n . Participants relinquished "control over choice" and "control over access" as part of the bargain to receive health care. 76 According to both the l i t e r a t u r e and the p a r t i c i p a n t s , control i s i n t e g r a l to the concept of privacy. A key element i n control of privacy i s the idea of choice. Participants also reported a change i n the amount of privacy they needed depended upon the people and the s i t u a t i o n . Participants described a n t i c i p a t i n g the amount of privacy they would get i n hospital and that they lowered t h e i r expectations accordingly. However, when these lowered expectations were not met, participants f e l t they lacked privacy. The l i t e r a t u r e refers to the fact that desired privacy depends on the s i t u a t i o n . This c h a r a c t e r i s t i c of privacy involved obtaining the appropriate amount of privacy for the s i t u a t i o n or event. Altman c a l l e d t h i s "desired privacy -and "achieved privacy". Desired privacy i s a subjective statement of an i d e a l l e v e l of i n t e r a c t i o n with others. Achieved privacy i s the actual degree of contact that r e s u l t s from i n t e r a c t i o n with others" (Altman, 1975, p.10). I n t r i n s i c to desired privacy i s the recognition of the desired l e v e l of privacy by those involved i n the s i t u a t i o n . For example, most participants would have l i k e d more privacy during the nursing history taking process than was provided. Also i n s u f f i c i e n t privacy was available during washing and dressing. Participants also described, not only degrees of privacy, but also d i f f e r e n t types of privacy depending on the s i t u a t i o n s . According to part i c i p a n t s , privacy provided freedom from observation, freedom from being overheard or a combination of both. These d i f f e r e n t types of privacy again, depended on the s i t u a t i o n . For example, freedom from observation was es s e n t i a l for privacy during nursing care, while freedom from being overheard was necessary during personal history taking and elimination a c t i v i t i e s . P articipants have i d e n t i f i e d numerous e s s e n t i a l c h a r a c t e r i s t i c s of privacy. The c h a r a c t e r i s t i c s of privacy that p a r t i c i p a n t s i d e n t i f i e d were the need to control a personal boundaries, the elements of choice as part of control, and that privacy varied by type and degree depending on the s i t u a t i o n . Participants also i d e n t i f i e d s p e c i f i c events or situations i n which privacy was important to t h e i r comfort and s e l f - i d e n t i t y . These situations w i l l now be discussed. Privacy and Situations Participants consistently reported that having privacy helped them to adjust to hospital s i t u a t i o n s . Privacy was important to par t i c i p a n t s ' s e l f - i d e n t i t y during situations involving nursing care and basic human needs. This study has i d e n t i f i e d that some privacy was necessary to help participants cope with the touching and 78 observing of t h e i r bodies, that naturally occurs during h o s p i t a l i z a t i o n and nursing care. Participants accepted that nurses needed to perform procedures that brought them into contact with, or observation of, normally private areas of t h e i r body. Privacy provided a space that included the p a r t i c i p a n t and the care giver, yet, excluded a l l others. This i s consistent with Westin's intimacy dimension of privacy. According to Westin (1968), the intimacy dimension of privacy, "concerns a group of people who wish to deal with one another out of the range of contact with others" (p.7). Simmel (1971) summarized t h i s i n his statement, "not only by es t a b l i s h i n g boundaries around ourselves but also by periodic opening of these boundaries to nourishment, to learning, and to intimacy" can we maintain our well being (p.81) . Privacy was not only important to p a r t i c i p a n t s as they maintained t h e i r own i n d i v i d u a l i t y during nursing care a c t i v i t i e s , but privacy was also important during basic needs a c t i v i t i e s . Society, i n an e f f o r t to organize and control i n d i v i d u a l behavior and action, has developed c e r t a i n norms and rules for behavior during the performance of basic needs such as elimination and other a c t i v i t i e s . As a r e s u l t , even in h o s p i t a l , a cer t a i n degree of privacy was necessary for pa r t i c i p a n t s during these a c t i v i t i e s . 79 Privacy during elimination meant freedom from observation and freedom from being overheard. This was sim i l a r to Westin's (1970) description of privacy as "solitude". In "solitude" a person i s alone and free from observation by others. Privacy provided the necessary aloneness for participants to s a t i s f a c t o r i l y perform t h e i r elimination functions. Freedom from observation was also necessary to perform hygiene and dressing functions. However, what mattered most to p a r t i c i p a n t s was the s t a b i l i t y of the boundary. If the b a r r i e r or boundary was flimsy, such as a bedside curtain, p a r t i c i p a n t s f e l t anxious and f e a r f u l that t h e i r actions would be observed. Who observed them was important to p a r t i c i p a n t s . Unexpected observation by a nurse was acceptable, however, inadvertent observation by other patients or v i s i t o r s was not. Participants reported that observation by the nurse, although s t a r t l i n g , i f unexpected, was acceptable because i t i s part of the nurse's role. Kira (1970) c a l l e d these " p r i v i l e g e d r o l e s " . The nurse's " p r i v i l e g e d r o l e " resulted from the unique and spe c i a l service nurses perform for society. Since nurses provide t h i s special service, participants accepted the nurse's observation of a c t i v i t i e s normally completed i n privacy. 80 Ki r a (1970) suggested the anxiety caused by inadvertent exposure of private body parts to others than those i n a "pr i v i l e g e d role", could be rooted i n the need to protect self-image. If the need for privacy i s not met, the par t i c i p a n t might be observed by others and not meet the other's expectations. If the participant did not meet the expectations of others, t h i s could change the behavior of others towards the pa r t i c i p a n t . Norris (1978), i n her discussion of body image describes the pa i n f u l sanctions that are imposed by society for deviations from the usual structure or usual behavior. Possibly the fear of sanctions, disapproval or lack of acceptance by others might be the basis for the anxiety p a r t i c i p a n t s f e l t when the poten t i a l for observation by others was present during washing and dressing. The r e l a t i o n s h i p between privacy and comfort during the provision of care and during basic human needs has been discussed. Factors that influenced p a r t i c i p a n t s ' privacy w i l l be discussed next. Factors That Affect Privacy Interpersonal and environmental factors that af f e c t privacy w i l l now be discussed. These factors w i l l be discussed i n the order stated. 81 Interpersonal Factors Participants reported that interactions with nurses, doctors, roommates and v i s i t o r s had an e f f e c t on privacy. Analysis of the accounts revealed that two main groups of people affected p a r t i c i p a n t s ' privacy. The f i r s t group was the health care professionals, nurses and doctors. The second group was s o c i a l clusters of roommates and v i s i t o r s . The e f f e c t of nurses' and doctors' behaviors and attitudes on the pa r t i c i p a n t ' s privacy w i l l be discussed f i r s t . The nurse's behaviour during the delivery of nursing care was a major factor that influenced whether or not the par t i c i p a n t had privacy. Nurses, by virtu e of t h e i r role i n health care, entered into the partic i p a n t ' s personal space to provide care. Much of t h i s nursing care was provided i n the intimate zone which i s 0 to 18 inches from the person (Smith & C a n t r e l l , 1988). Normally, when t h i s intimate zone i s invaded by others, anxiety or discomfort i s experienced (Smith & C a n t r e l l , 1988) . Nurse behaviors either increased or decreased the part i c i p a n t ' s anxiety or discomfort during the nursing care provided i n the participant's intimate zone. Nurses decreased anxiety by establishing a boundary around the themselves and the pa r t i c i p a n t . Nurses usually used the bedside curtain to e s t a b l i s h t h i s boundary. 82 Schuster (1972) c a l l s t h i s "privacy of event" (p.40). This was the most transient form of privacy. The state of privacy was only maintained as long as required for the event to occur. Participants gave examples of care such as a perineal skin shave or an enema. According to the participants of t h i s study, the nurse action that best established "privacy of event" was the complete closure of the bedside curtain. Leaving the curtain open, even a small amount, resulted i n p a r t i c i p a n t s having less than desired privacy and f e e l i n g tense and anxious about the event. Nurses, who were ca r e f u l to p u l l the curtain closed, were perceived, by p a r t i c i p a n t s , as caring about the person as an i n d i v i d u a l and contributing to her s e l f - i d e n t i t y . Nurses' attitudes and behaviours that helped to meet pa r t i c i p a n t s ' privacy are s i m i l a r to behaviours that Watson has c l a s s i f i e d as caring behaviours. According to Watson (1979, 1985) there are two types of caring behaviors, "Expressive A c t i v i t i e s " and Instrumental A c t i v i t i e s " . Watson (1979, 1985) includes respecting and accommodating privacy and t e r r i t o r i a l needs i n her view of caring. She considers accommodating for privacy and t e r r i t o r i a l needs as part of caring behaviors. According to Watson (1985) "Expressive A c t i v i t i e s " are physical action-oriented helping behaviours or assistance with g r a t i f i c a t i o n of human needs. "Instrumental A c t i v i t i e s " , are the second 83 type of caring interventions, which related to the maintenance of a physical environment. Nurse actions that could be considered as "Expressive A c t i v i t i e s " were described by the p a r t i c i p a n t s . For example, a nurse who was s k i l f u l and quick during procedure was perceived by participants as caring about t h e i r privacy. P a r t i c i p a n t s ' descriptions of nurse a c t i v i t i e s that could be considered as "Instrumental A c t i v i t i e s " were a c t i v i t i e s such as c l o s i n g the bedside curtain and a s s i s t i n g p a r t i c i p a n t s to the bathroom. Nurses who demonstrated caring behaviours such as those described by Watson, helped participants adjust to the less than desired private situations found i n hospitals. Benn (1971) shared t h i s view i n his statement " a general p r i n c i p l e of privacy might be grounded on the more general p r i n c i p l e of respect for persons"(p.8). However, not a l l nurse behaviours helped p a r t i c i p a n t s meet t h e i r privacy needs. For example, nurses who did not respect the closed curtain and invaded the p a r t i c i p a n t s ' space without asking for permission were a negative influence on p a r t i c i p a n t s ' privacy. Other examples were the nurse who did not close the curtain completely and the nurse who opened the shower door without knocking. Participants described increased anxiety r e s u l t i n g from lack of control over personal space and lack of privacy. This need for control over personal space was well documented i n the 84 l i t e r a t u r e . Altman (1975) stated: personal space involves an i n v i s i b l e boundary around the s e l f , i n t r usion into which creates tension and discomfort. Furthermore, a l l manners of s o c i a l units -families, communities, c i t i e s and nations define t h e i r existence i n part, by boundaries i n the form of walls, fences and man-made barriers"(p.27). Nurses' actions that invaded p a r t i c i p a n t s ' space and privacy inappropriately caused unnecessary anxiety and tension for the participant during h o s p i t a l i z a t i o n . Nurses i n the performance of t h e i r p r i v i l e g e d role are a p o s i t i v e or a negative influence on p a r t i c i p a n t s ' privacy. Nurse actions that demonstrate caring behaviors can a s s i s t p a r t i c i p a n t s with t h e i r privacy needs. Unauthorized intrusion by the nurse into the par t i c i p a n t s ' private space can detract from pa r t i c i p a n t s ' privacy i n h o s p i t a l . The other health professional that can a f f e c t p a r t i c i p a n t s ' privacy are doctors. Doctors were another major factor that affected the pa r t i c i p a n t s ' privacy. Like nurses, doctors can be a p o s i t i v e or a negative factor i n pa r t i c i p a n t s ' attempts to meet t h e i r privacy needs. Po s i t i v e factors related to the doctor's s e n s i t i v i t y to the patient's need for freedom from observation. Actions such as p u l l i n g the bed curtain closed and l i f t i n g the par t i c i p a n t ' s gown, only as necessary for examination 85 purposes, c o n t r i b u t e d to the p a t i e n t f e e l i n g p r i v a c y had been maintained. C a n t r e l l (1978) d e s c r i b e s t h i s as " s o l o - t y p e " p r i v a c y , which i s t o be l e f t alone or t o chose one's own companions. C a n t r e l l e x p l a i n s "there are no a b s o l u t e standards, because a s i t u a t i o n t h a t may be t r i v i a l t o most people can be i n t e n s e l y embarrassing to o t h e r s " (p.197). He goes on t o say t h a t " p r i v a c y i s not a problem f o r the m a j o r i t y of p a t i e n t s but i t i s v i t a l t h a t d o c t o r s and nurses are s e n s i t i v e t o the few who do guard t h e i r p r i v a c y j e a l o u s l y " (p.198). Doctors' v e r b a l communication with p a r t i c i p a n t s a l s o i n f l u e n c e d whether or not the p a r t i c i p a n t s f e l t t h e i r need f o r p r i v a c y was met. Doctors who spoke l o u d l y and enabled the communication content to be overheard were seen by p a r t i c i p a n t s as not c o n t r i b u t i n g to t h e i r p r i v a c y . P a r t i c i p a n t s f e l t d o c t o r s with l o u d v o i c e s i n t e r f e r e d with the p r i v a c y of others i n the room as w e l l . C a n t r e l l (1975) c a l l e d t h i s "data-type p r i v a c y " Data-type p r i v a c y i n v o l v e d the " c o n t r o l over c e r t a i n types of i n f o r m a t i o n about themselves" ( C a n t r e l l , 1975, p.196). T h i s i n f o r m a t i o n was shared with the d o c t o r w i t h i n the context t h a t i t only be shared with those who would a s s i s t w i t h the p a r t i c i p a n t s ' care. Thus p a r t i c i p a n t s ' "data-type p r i v a c y " needs were not met when do c t o r s spoke i n l o u d v o i c e s or d i d not p u l l the bed c u r t a i n c l o s e d , a l l o w i n g 86 information to be shared with others who were not providing care. Doctors, then, by virtue of t h e i r r e l a t i o n s h i p with the part i c i p a n t s , had many opportunities to be either contributors or detractors to pa r t i c i p a n t s ' privacy. The second group of people who aided or hindered p a r t i c i p a n t s ' privacy was roommates and v i s i t o r s . P a r t i c i p a n t s ' roommates s i g n i f i c a n t l y affected p a r t i c i p a n t s ' attempts for privacy. The p o s s i b i l i t y that t h e i r privacy would be in t e r f e r e d with increased as the number of roommates, that participants had, increased. This resulted mainly from having to share a common resource with others, be i t the room space, or the bathroom. Participants described rules developed by each group of patients sharing a room. Rules governing access and control of a valued physical environment, such as the bathroom, evolved naturally within the group. These rules governed a c t i v i t i e s such as, who went to the bathroom f i r s t i n the morning, and how long one spent i n the bathroom. Ittelson's (1970) study of s o c i a l i n t e r a c t i o n of a ps y c h i a t r i c ward i d e n t i f i e d that "rules and norms are communicated formally and informally to patients by others i n the room"(p.269). Participants reported asking roommates about the rules that governed the use of the bathroom. An example of an understood rule related to the space around the participant's bed. A l l p a r t i c i p a n t s respected 87 and i n turn expected, the space around t h e i r bed to be respected and considered private by roommates. Nursing care of roommates interfered, at times, with p a r t i c i p a n t s ' a b i l i t y to have privacy. At night, roommates' nursing care created noises that disturbed p a r t i c i p a n t s . Woods and Falk ( 1974) i n t h e i r study of noise i n acute care nursing units, reported that the noise l e v e l "was often at a l e v e l that could i n t e r f e r e with patients' rest and sleep" (p.149) . As the number of roommates increased, the p o t e n t i a l for p a r t i c i p a n t s ' privacy decreased. Participants, with roommates, described privacy invasions caused by roommates' radios and u n s o l i c i t e d conversations. Roommates, either by t h e i r own behavior or by needing care, can inadvertently i n t e r f e r e with each others' maintenance of privacy. Pa r t i c i p a n t s ' v i s i t o r s and roommates' v i s i t o r s affected p a r t i c i p a n t s ' privacy. Participants f e l t that they had no control over who or how many v i s i t o r s came to v i s i t or how long they stayed. This forced some par t i c i p a n t s to have to share t h e i r personal t e r r i t o r y with others. V i s i t o r s also asked for information that participants would have preferred not to share with others. Altman (1975) c a l l e d t h i s "Input and Output Processes" of privacy. "Boundary regulation includes input from 88 persons and s t i m u l i outside the s e l f ranging from zero input on some occasions to maximum input on others" (Altman, 1975, p.27) . Roommates' v i s i t o r s inadvertently intruded into the privacy of p a r t i c i p a n t s by t h e i r physical presence i n the room, t h e i r unannounced a r r i v a l and t h e i r behaviour while v i s i t i n g . Participants described f e e l i n g uncomfortable about getting out of bed i f v i s i t o r s were in the room and were able to observe them. In summary, participants and previous research supports the claim that nurses, doctors, roommates and v i s i t o r s can be either a p o s i t i v e or a negative factor i n the p a r t i c i p a n t ' s quest for privacy i n h o s p i t a l . Environment Factors To maintain privacy i n the hospital setting, p a r t i c i p a n t s adjusted t h e i r environment. This i s consistent with Proshansky, Ittelson and R i v l i n view of peoples' attempts to meet privacy needs. Ittelson, Proshansky, and R i v l i n (1970) stated, "man's attempt at need s a t i s f a c t i o n always involves him i n interactions and exchanges with his environment"(p.174). This i s s i m i l a r to accounts by participants i n t h i s study who adjusted the environment during conversations with family, friends and roommates. 89 Participants used the bedside curtain to manipulate the environment i n an e f f o r t to provide some privacy during family v i s i t s . Participants seeking solitude during the day, p u l l e d the bedside curtain part way to discourage conversations between themselves and the next patient. When part i c i p a n t s wanted to be sure of privacy, they went to the bathroom or went for a walk down the h a l l . This was consistent with Schuster's (1972) study which i d e n t i f i e d that mobility was a major influence i n maintaining or obtaining privacy i n the ho s p i t a l . Some partic i p a n t s were able to control the environment by requesting and receiving a private room. Participants considered the private room the most permanent and secure of the options available to control for privacy i n h o s p i t a l . The bathroom was the place of choice to perform the a c t i v i t i e s of elimination, personal hygiene and dressing. In fact, some participants were unable to perform elimination functions without access to the bathroom. This i s consistent with Kira's (1970) research on privacy and the bathroom. Kira (1970) found that some people r e l i e d so heavily on privacy during elimination that privacy becomes the esse n t i a l t r i g g e r i n g mechanism for the elimination functions. However, according to Kir a (1970) and Altman (1977), privacy during elimination i s a s o c i a l l y learned norm. As children we are s o c i a l l y conditioned that the privacy of the bathroom i s necessary to perform 90 elimination functions. Kira's research supported p a r t i c i p a n t s ' claims that some degree of privacy was necessary for the comfortable performance of a c t i v i t i e s r e l a t i n g to elimination functions. The p a r t i c i p a n t ' s bed and bedside curtain were used to provide privacy during nursing care a c t i v i t i e s . P articipants r e l i e d on the bedside curtain as a privacy marker for others during nursing care or when they needed some time to themselves. The bedside curtain also marked the personal t e r r i t o r y that the participant could c a l l her own. However, participants also recognized the need to share t h e i r personal t e r r i t o r y with health professionals i n order to receive the care they required. The environment, e s p e c i a l l y the area around the par t i c i p a n t ' s bed, the bedside curtain and the bathroom were manipulated by participants i n an e f f o r t to obtain t h e i r desired privacy. Participants manipulated the environment i n an e f f o r t to meet t h e i r privacy needs. This finding i s supported by previous research on privacy. Summary 91 T h i s chapter has d i s c u s s e d the f i n d i n g of t h i s study i n l i g h t of r e l e v a n t l i t e r a t u r e and Altman's c o n c e p t u a l i z a t i o n of p r i v a c y . The c h a r a c t e r i s t i c s of p r i v a c y have been d i s c u s s e d . The importance of p r i v a c y t o p a r t i c i p a n t s ' a b i l i t y t o maintain s e l f - i d e n t i t y d u r i n g h o s p i t a l i z a t i o n was addressed. S i t u a t i o n s i n which p r i v a c y was important t o p a r t i c i p a n t s have a l s o been d i s c u s s e d . F i n a l l y , both p e r s o n a l and environmental f a c t o r s t h a t i n f l u e n c e d p a r t i c i p a n t s ' p r i v a c y were examined. The f i n a l chapter w i l l summarize and conclude the d i s c u s s i o n of t h i s study's f i n d i n g s and p r e s e n t 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 d m i n i s t r a t i o n and r e s e a r c h . CHAPTER SIX Summary, Conclusions, and Implications of the Study The summary, conclusions and implications of the study w i l l be presented. The summary of the study w i l l be discussed f i r s t . Summary of the Study This study examined the privacy needs of women hos p i t a l i z e d for gynecological surgery. The conceptual framework that guided the study was Altman's theory of privacy. This theory directed the researcher to design phenomenological study which explored p a r t i c i p a n t s ' perceptions of privacy needs during h o s p i t a l i z a t i o n for gynecological surgery. Studying the privacy needs of women ho s p i t a l i z e d for gynecological surgery, from pa r t i c i p a n t s ' perspectives, provided valuable insight into the needs of these s p e c i f i c h o s p i t a l i z e d women. A l i t e r a t u r e review was conducted to provide a background for the study. It revealed privacy to be a complex concept and that very l i t t l e research had been done on the privacy needs of ho s p i t a l i z e d women. A number of privacy models were explored and Altman's was selected as the conceptual underpinnings for t h i s study. The phenomenological perspective of q u a l i t a t i v e research theory was the methological approach used i n t h i s study. The phenomenological research approach directed the researcher to use nonprobability, t h e o r e t i c a l sampling. Eight women pa r t i c i p a t e d i n the study, ranging i n age from 45 to 73. Data were c o l l e c t e d through 16 indepth, non-directive interviews that were tape recorded and transcribed, verbatim, for each p a r t i c i p a n t . Data were analyzed using Giorgi's (1975) procedure. The i d e n t i f i c a t i o n and discussion of meaning units has been presented. A summary of the findings w i l l now be presented. The findings of the study w i l l be presented under the general headings of privacy and s e l f - i d e n t i t y , privacy and situations and factors that affected p a r t i c i p a n t s ' privacy. During the interviews, participants described what privacy meant to them. They described that privacy was important to t h e i r s e l f - i d e n t i t y . Participants used privacy or solitude for contemplation and adjustment to changes brought about by t h e i r i l l n e s s and the hospital s i t u a t i o n . They also used privacy for the venting of emotions caused by i l l n e s s and h o s p i t a l i z a t i o n . Privacy also helped them manage t h e i r relationships with roommates and health professionals. Integral to t h i s 94 management of t h e i r relationships with others was the control of access to personal information. Also, p a r t i c i p a n t s strengthened t h e i r s e l f - i d e n t i t y by claiming a personal space or t e r r i t o r y around t h e i r bed. Participants said that c h a r a c t e r i s t i c s of privacy such as control, choice and types and degrees of privacy were important t h e i r s e l f - i d e n t i t y . Control, choice, degree and type of privacy were personally defined and related to both the s i t u a t i o n and the people involved. Participants reported that privacy was necessary for t h e i r comfort i n certain s i t u a t i o n s . These sit u a t i o n s related to being the recipient of nursing care and the performance of basic human needs such as elimination and washing. Participants reported that nurse's actions and attitude have a major aff e c t on p a r t i c i p a n t s ' privacy. Unfortunately, the very nature of h o s p i t a l i z a t i o n , decreased p a r t i c i p a n t s ' opportunities for privacy. The h o s p i t a l s i t u a t i o n contained factors that influenced both p o s i t i v e l y and negatively, a p a r t i c i p a n t ' s a b i l i t y to meet her privacy needs. Participants i d e n t i f i e d the most important of these factors to be: nurses, doctors, roommates, and the physical environment of the h o s p i t a l . The conclusions of the study w i l l be discussed next. C o n c l u s i o n s o f the Study 95 The f o l l o w i n g c o n c l u s i o n s were d e v e l o p e d from t h i s s t u d y . 1. P r i v a c y was i m p o r t a n t f o r p a r t i c i p a n t s ' t o m a i n t a i n t h e i r s e l f - i d e n t i t y and autonomy d u r i n g h o s p i t a l i z a t i o n . 2. P r i v a c y was n e c e s s a r y f o r p a r t i c i p a n t s ' adjustment t o the changes caused by i l l n e s s , h o s p i t a l i z a t i o n and s e p a r a t i o n from f a m i l y and f r i e n d s . 3. P r i v a c y was b o t h i n d i v i d u a l l y and s i t u a t i o n a l l y d e f i n e d . 4. P r i v a c y was n e c e s s a r y f o r p a r t i c i p a n t s t o manage t h e i r r e l a t i o n s h i p s w i t h roommates and h e a l t h p r o f e s s i o n a l s . 5. N u r s e s ' a t t i t u d e s and a c t i o n s had the g r e a t e s t i n f l u e n c e on p a r t i c i p a n t s ' p r i v a c y . 6. Other f a c t o r s such as roommates, p h y s i c i a n s and v i s i t o r s a l s o i n f l u e n c e d p a r t i c i p a n t s ' p r i v a c y . 7 . The v e r y n a t u r e o f the p h y s i c a l environment o f the h o s p i t a l c r e a t e d f a c t o r s t h a t reduced the amount o f p r i v a c y a v a i l a b l e t o p a r t i c i p a n t s . 7 . P a r t i c i p a n t s expec ted p r i v a c y to be l e s s i n h o s p i t a l , however, t h e r e were l e v e l s o f p r i v a c y t h a t p a r t i c i p a n t s i n d i v i d u a l l y de termined as u n a c c e p t a b l e . Implications of the Study 96 The purpose of t h i s phenomenological study was to explore the privacy needs of women h o s p i t a l i z e d for gynecological surgery, from the womens' perspectives, for the purpose of adding to the knowledge and understanding of the concept. The findings of the study suggested several implications for nursing practice, administration, education, and research. These w i l l be explored i n the following subsections. Implications for Nursing Practice In the nursing l i t e r a t u r e , privacy i s stressed as an important aspect to consider during the delivery of c l i e n t care. However, l i t t l e d i r e c t i o n i s given to nurses as to how to provide privacy during the delivery of care or what the c l i e n t considers to be a state of privacy. This study i d e n t i f i e s that nurses' actions and attitudes have a major aff e c t on p a r t i c i p a n t s ' privacy. According to participants i n t h i s study, privacy i s defined by both the i n d i v i d u a l and the s i t u a t i o n . Nurses can a s s i s t patients to meet t h e i r privacy needs by being s e n s i t i v e and receptive to patients' cues about t h e i r privacy needs. 97 T h i s study i d e n t i f i e d t h a t c o n t r o l i s an i n t e g r a l c h a r a c t e r i s t i c of p r i v a c y . Nurses who encourage and r e s p e c t p a t i e n t s ' r i g h t t o manage s i t u a t i o n s w i l l a l s o be h e l p i n g p a t i e n t s meet t h e i r p r i v a c y needs. T h i s study i d e n t i f i e s t h a t the p h y s i c a l environment had a p o s i t i v e or ne g a t i v e e f f e c t on p a r t i c i p a n t s ' p r i v a c y . Nurses can a s s i s t the p a t i e n t ' s e f f o r t s t o manipulate the environment by a s s u r i n g t h a t the bedside c u r t a i n i s c l o s e d and t h a t the p a t i e n t ' s p r i v a c y i n the bathroom i s r e s p e c t e d . The f i n d i n g s of t h i s study show t h a t d o c t o r s ' and roommates' a t t i t u d e and behaviors a l s o i n f l u e n c e d p a r t i c i p a n t s ' p r i v a c y . Nurses can be r o l e models f o r other h e a l t h p r o f e s s i o n a l s i n a s s u r i n g p a t i e n t s ' p r i v a c y i s maintained. Nurses can be advocates f o r p a t i e n t p r i v a c y be m o n i t o r i n g v i s i t o r s and roommates a c t i v i t i e s f o r p a t i e n t s unable t o monitor those a c t i v i t i e s f o r themselves. I m p l i c a t i o n s f o r Nu r s i n g A d m i n i s t r a t i o n The f i n d i n g s of t h i s study have i m p l i c a t i o n s f o r nurse a d m i n i s t r a t o r s . Nurse a d m i n i s t r a t o r s are now p a r t i c i p a t i n g i n the d e s i g n i n g of new h o s p i t a l s or r e n o v a t i o n of o l d b u i l d i n g s . C e r t a i n f a c t s from t h i s study are worthy of t h e i r c o n s i d e r a t i o n . A c c o r d i n g t o 98 the data gathered i n t h i s study, a v a i l a b i l i t y of and access to bathrooms are important to privacy i n ho s p i t a l . Nurse administrators can promote patient privacy by lobbying for fewer four bed wards and more semi-private and private rooms. Patient privacy can also be promoted by the arrangement of the bathroom to promote privacy and by increasing the number of bathrooms available to ambulatory patients. Participants of t h i s study i d e n t i f i e d that the .bedside curtain i s an important privacy marker. When p a r t i c i p a t i n g i n decisions about the purchase of bed curtains and other privacy markers, nurse administrators have an opportunity to advocate for women's privacy. Women's privacy can be supported through the purchase of bed curtains that f i t well together and have some method of securing the two ends together. Results of t h i s study have shown that night time noise was considered, by participants, to be an invasion of t h e i r privacy. Nurse administrators can support patients' privacy by purchasing equipment that makes minimal noise during use or transport. Participants i n t h i s study indicated that the attitudes and behaviors of the nurses a f f e c t t h e i r privacy. The attitudes and behaviors of the care giving nurses are influenced by the philosophy of nursing i n 99 that h o s p i t a l . Nurse administrators, as leaders i n the hospi t a l setting, are i n a pos i t i o n to influence the philosophy of nursing on which the care of patients i s based. Women's privacy can be supported by a philosophy of nursing that encourages the caring behaviors described by Watson (1985). In order to promote a philosophy of nursing, based on respect and caring, the nurse administrator needs to have a better understanding of the hospital environment from the c l i e n t ' s perspective. The research on privacy for h o s p i t a l patients i s minimal. Nurse administrators can gain t h i s knowledge by supporting further research on the privacy needs of hos p i t a l i z e d patients. Implications for Nursing Education Data from t h i s study indicated that privacy was important to women ho s p i t a l i z e d for gynecological surgery. Participants of t h i s study i d e n t i f i e d that nurses are a major factor i n meeting t h e i r need for privacy. For nursing students, the concept of privacy should be included in the content of nursing education programs. Experiential learning experiences, which enable students to explore the f e e l i n g created from private and non-private states, should be considered by nurse educators. The development of verbal and nonverbal 100 communication s k i l l s t h a t i n c r e a s e s e n s i t i v i t y t o cues from p a t i e n t s about t h e i r p r i v a c y needs should a l s o be p a r t of the e d u c a t i o n a l experience f o r n u r s i n g s t u d e n t s . During c l i n i c a l e x periences, student b e h a v i o r s t h a t promote p a t i e n t p r i v a c y should be supported and encouraged by nurse educators. Conversely, student b e h a v i o r s t h a t do not support p r i v a c y should be i d e n t i f i e d t o the student and d i s c o u r a g e d . Nurse educators are r o l e models f o r n u r s i n g s t u d e n t s . As r o l e models, nurse educators should examine t h e i r own behaviours and i d e n t i f y behaviours which demonstrate s u p p o r t i n g and not s u p p o r t i n g p a t i e n t s ' p r i v a c y . L e a r n i n g about the p r i v a c y needs of p a t i e n t s does not have t o end with completion of a n u r s i n g e d u c a t i o n program. The importance of b e i n g s e n s i t i v e and r e s p o n s i v e t o the unique p r i v a c y needs of p a t i e n t s c o u l d be p a r t of a c o n t i n u i n g e d u c a t i o n program developed by h o s p i t a l s . I m p l i c a t i o n s f o r N u r s i n g Research T h i s study p r o v i d e s f u r t h e r knowledge about women's p e r c e p t i o n s of p r i v a c y needs d u r i n g h o s p i t a l i z a t i o n f o r g y n e c o l o g i c a l surgery. 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 beyond t h i s s p e c i f i c sample. However, i n 101 view of the findings, several areas for further study are suggested. This phenomenological study focused on the privacy needs of women ho s p i t a l i z e d for gynecological surgery. It provides a glimpse into the complex concept of privacy. More descriptive and exploratory research i s necessary to f u l l y understand the concept of privacy. Further research i s necessary using other patient populations. This study focused on the middle age to the el d e r l y woman's need for privacy during h o s p i t a l i z a t i o n for gynecological surgery. The privacy needs of other age groups requires empirical research as well. Also further research i s needed on women's privacy needs during h o s p i t a l i z a t i o n for other types of surgery and medical treatments. A study of t h i s nature would help to i d e n t i f y i f the needs of women ho s p i t a l i z e d for other reasons are si m i l a r or d i s s i m i l a r to those women hos p i t a l i z e d for gynecological surgery. This study explored privacy from a woman's perspective. It i s possible that a man's perspective of privacy i s d i f f e r e n t . Research on privacy from a gender perspective i s nonexistent. This lack of research makes i t impossible to determine i f the purpose of privacy and need for privacy i s the same for men and women. 102 T h i s study suggests t h a t nurses are a major f a c t o r t o p a t i e n t s ' p r i v a c y . However, t h e r e i s a l a c k of r e s e a r c h on n u r s i n g s t a f f ' s p e r c e p t i o n of what p r i v a c y means t o p a t i e n t s . A study of t h i s nature would i d e n t i f y c o n s i s t e n c i e s and v a r i a n c e s between the nurses' e x p e c t a t i o n s of p a t i e n t p r i v a c y needs and the p a t i e n t s ' e x p e c t a t i o n s of p r i v a c y needs. T h i s study c o n s i d e r e d p r i v a c y from a female, E n g l i s h speaking person's p o i n t of view. Other p r i v a c y r e s e a r c h e r s (Altman, 1977, Marquis, 1974) take the p o s i t i o n t h a t p r i v a c y i s c u l t u r a l l y d e f i n e d . I f p r i v a c y i s a s o c i a l l y determined c o n s t r u c t , then the needs and methods f o r o b t a i n i n g p r i v a c y may vary from c u l t u r e t o c u l t u r e . Understanding d i f f e r e n t c u l t u r a l p e r s p e c t i v e s of p r i v a c y needs and methods of meeting those needs i s e s s e n t i a l knowledge f o r nurses attempting t o care f o r a c u l t u r a l l y d i v e r s e c l i e n t p o p u l a t i o n . Since the l i t e r a t u r e i s l a c k i n g i n t h i s area, f u r t h e r r e s e a r c h on the c u l t u r a l aspects of p r i v a c y i s recommended. The p o p u l a t i o n of t h i s study was women e x p e r i e n c i n g an acute i l l n e s s . Chronic i l l n e s s i s one of the major f o r c e s a f f e c t i n g our h e a l t h care system. More and more n u r s i n g care i s b e i n g p r o v i d e d t o p a t i e n t s with c h r o n i c i l l n e s s e s . The l i t e r a t u r e i s completely l a c k i n g i n e m p i r i c a l r e s e a r c h r e l a t i n g t o the p r i v a c y needs of 1 0 3 c h r o n i c a l l y i l l p a t i e n t s . Research on the p r i v a c y needs of c h r o n i c a l l y i l l p a t i e n t s would p r o v i d e the necessary knowledge to understand the p r i v a c y needs of i n d i v i d u a l s e x p e r i e n c i n g a c h r o n i c i l l n e s s . C o n c l u s i o n To conclude, t h i s study has e x p l o r e d one s m a l l aspect of a vast and complex concept, p r i v a c y . Nurses need t o have a deeper understanding of t h i s concept. Only through f u r t h e r r e s e a r c h and the a p p l i c a t i o n of the r e s e a r c h by care g i v e r s , can p a t i e n t s hope to have t h e i r p r i v a c y needs met d u r i n g h o s p i t a l i z a t i o n . 104 Bibliography Adam, E. (1980). To be a nurse. Toronto: W.B.Saunders. Archea, J. (1977). The place of a r c h i t e c t u r a l factors i n behaviourial theories of privacy. Journal of Social  Issues, 33 (3), 116-137. Altman, I. (1973). Reciprocity of interpersonal exchange. Journal of Social Behaviour, 3. (2), 249-261. Altman, I. (1974). A conceptual analysis. In D.H. Carson (ed.) Man-environment interactions: Evaluation and  applications Part 11 (pp.3-28). Stroudsburg, PA: Dowden, Hutchinson & Ross. Altman, I. (1975). The environment: Privacy, personal space  and crowding. Monterey, CA: Brooks/Cole. Altman, I. (1977). Privacy regulation: C u l t u r a l l y universal or c u l t u r a l l y s p e c i f i c ? In S. T. Margulis (Ed.), The  Journal of Social Issues, 33 (3), 66-83. Anderson, J. (1981). Making sense of normality: An in t e r p r e t i v e perspective on normal' and disturbed'  family. Doctoral Dissertation, University of B r i t i s h Columbia. Anderson, J., & Chung, J. (1982). Perspectives on the health of immigrant women: A feminist analysis. Advances i n  Nursing Science, 8. (1), 61-76. American Psychological Association. (1983). Publication manual of the /American Psychological Association (3rd Ed.). Washington, DC: Author. Bates, A.P. (1964). "Privacy - A useful concept". Social  Forces, 5, 429-434. Bloch, D. (1970). Privacy. In C. Carlson & B. Blackwell (Eds.), Behaviourial and concepts and nursing  intervention 2nd ed. (pp. 226-239). Philadelphia: J.B. Lippincott. Burns N. & Grove, S. (1987). The practice of nursing  research conduct, c r i t i q u e and u t i l i z a t i o n . Philadelphia: W.B. Saunders. Campbell, C. (1984). Nursing diagnosis & intervention i n nursing practice 2nd ed. New York: John Wiley & Sons. 105 C a n t r e l l , T. (1978) . Privacy - The medical problems. In J.B. Young (Ed.), Privacy (pp.195-214). Toronto: John Wiley & Sons. C l a s p e l l , E.L. (1984). An existential-phenomenological  approach to understanding the meaning of g r i e f . University of B r i t i s h Columbia: an unpublished doctoral d i s s e r t a t i o n . Curtin, L. (1986). Guest r e l a t i o n and private obligations. Nursing management, 17 (5), 40-42. Davis, A. (1978). The phenomenological approach to nursing research. In N. L. Chaska (Ed.). The nursing  profession - Views through the mist, (pp.186-196). New York: McGraw-Hill. Derlega, V. J. & Chaikin, A.L. (1977). Privacy and s e l f -disclosure i n s o c i a l relationships. Journal of Social  Issues, 33 (3), 102-115. Douglas, J.D. ( 1976). Investigative s o c i a l research: Individual and team f i e l d research. Beverly H i l l s , CA: Sage. Edney, J. J. (1976). Human t e r r i t o r i e s comment on functional properties. Environment and Behavior, 8. (1), 31-45. Erikson, E.H. (1964). Inner and outer space: Reflections on womanhood. In R.J. L i f t o n (Ed.). The woman i n America. Boston: Beacon. Ernst, M. & Schartz, A. (1962). The right to be l e t alone. New York: McGraw-Hill. Fried, C. (1968). Privacy. The Yale Law Journal, 77, 475-493. F i e l d , P.A. & Morse, J.M. (1985). Nursing research: The application of Qualitative Approaches. Rockville, MD: Aspen. Foddy, W.H. & Finighan, W.R. (1980) . The concept of privacy from a symbolic int e r a c t i o n perspective. Journal for  the Theory of Social Behaviour, 10 (1), 1-17. Giorgi, A. (1975). Convergence and divergence of methods i n psychology. Dusguesne studies i n phenomenological  psychology (pp. 72-103). Pittsburgh: Duquesne University Press. 106 Glaser, B.G. & Strauss, A. (1967). The discovery of grounded  theory. Chicago: A l i d i n e . Gross, H. (1971). Privacy and autonomy. In J. Pennock & J. Chapman (Eds.) Privacy (pp. 169-181). New York: Atherton. Ittelson, W.H., Proshansky, H.M. & R i v l i n , L.G. (1970). Bedroom size and s o c i a l i n t e r a c t i o n of the p s y c h i a t r i c ward. Environment and Behavior, 2. (3), 255-270. Kelvin, P. (1973). A social-psychological examination of privacy. The B r i t i s h Journal of Social and C l i n i c a l  Psychology, 12, 248-261. Klien, CA. (1985) Invasion of privacy. Nurse P r a c t i t i o n e r , 10 (1),50-52. Kira, A. (1970). Privacy and the bathroom. In H.M. Proshansky, W.H. Ittleson, and L.G. R i v l i n (Eds.). Environmental psychology: People and t h e i r physical  settings (2nd ed.) (pp.269-275) New York: Holt, Rinehart and Winston. Klopfer, P.H. & Rubenstein, D.I. (1977). The concept of privacy and i t s b i o l o g i c a l basis. Journal of Social  Issues, 33 (3), 52-65. Laufer, R.S., Proshansky, H. M. & Wolfe, M. (1976). Some a n a l y t i c a l dimensions of privacy. In H.M. Proshansky, W.H. Ittleson, and L.G. R i v l i n (Eds.). Environmental  psychology: People and t h e i r physical settings (2nd ed.)(pp.206-217) New York: Holt, Rinehart and Winston. Laufer, R.S., & Wolfe, M. (1977). Privacy as a concept and a s o c i a l issue: A multidimensional developmental theory. Journal of Individual Psychology, 22, 185-195. Leininger, M. (1984). Care: The essence of nursing and  health. Thorofare NY: Charles B. Slack. Lyman, S.M. & Scott, M.B. (1967). T e r r i t o r i a l i t y : A neglected s o c i o l o g i c a l dimension. Social Problems, 15 (2), 236-249. Lynam, J. M. (1985). Support networks developed by immigrant women. Social Science Medicine, 21 (3), 327-333. Lynch-Sauer, J. (1985). Using phenomenological research method to study nursing phenomena. In M. Leininger (Ed.), Qualitative research methods i n nursing. Orlando, F l : Grune & Stratton. 107 Marguilis, S. (1974). Preface to privacy. In D. H. Carson (Ed.). Man-environment interactions: Evaluations and  applications. (pp.1-3) Washington: Environmental Design Research Association. Marguilis, S. (1977). Conceptions of privacy: current status and next steps. Journal of Social Issues, 33 (3), 5-21. Marshall. M.J. (1970). Orientation toward privacy: Environmental and personality components. Doctoral Dissertation, University of C a l i f o r n i a . Morse, J.M. (1986). Quantitative and q u a l i t a t i v e research: Issues i n sampling. In P.L. Chinn (Ed.), Nursing  research methodology. Rockville, MD: Aspen, pp. 181-193. Munhall, P. L. (1988). E t h i c a l considerations i n q u a l i t a t i v e research. Western Journal of Nursing research, 10 (2), 150-162. Narrow, B.W. & Buschle, K.B. (1987) Fundamentals of nursing  practice (2nd.ed). New York: John Wiley & Sons. Norris, CM. (1979) . Body image i t s relevance to professional nursing. In C. Carlson & B. Blackwell (Eds.), Behaviourial and concepts and nursing  intervention 2nd ed. (pp. 5-36). Philadelphia: J.B. Lippincott. Nursing89. (1989). Should you protect a patient from himself? Nursing89, 1, 67-69. Oi l e r , C. (1982). The phenomenological approach i n nursing research. Nursing research, 31 (3), 178-181. Oi l e r , C. J. (1986) Phenomenology: the method. In P.L. Munhall & C.J. O i l e r , Nursing Research A Qualitative  Perspective, pp.69-84. Norwalk, CT: Appleton-Century-Crofts . Ornery, A. (1983). Phenomenology: A method for nursing research. Advances i n Nursing Science, 5 (2), 49-63. Parse, R.R., Coyne, A.B. & Smith, M.J. (1985). Nursing  research: g u a l i t a t i v e methods. Bowie, MD: Brady Communications Company. Schuster, E. (1972). Privacy and the h o s p i t a l i z a t i o n experience. Doctoral Dissertation, University of C a l i f o r n i a . 108 Schwartz, B. (1968). The s o c i a l p s y c h o l o g y o f p r i v a c y . /American J o u r n a l o f S o c i o l o g y . 73, 741-742. S c h u l t z , A. (1970). On phenomenology and s o c i a l r e l a t i o n s . C h i c a g o : U n i v e r s i t y o f C h i c a g o P r e s s . Simmel, A. (1968). P r i v a c y . I n D. S i l l s ( E d . ) , I n t e r n a t i o n a l e n c y l o p e d i a o f t h e s o c i a l s c i e n c e s , (pp.480-487). New York: A t h e r t o n . Smith, B. J . & C a n t r e l l , P. J . (1988). D i s t a n c e i n n u r s e -p a t i e n t e n c o u n t e r s . J o u r n a l o f P s y c h o s o c i a l N u r s i n g . 26 ( 2 ) , 22-26. S p i e g e l b e r g , H. (1965). The p h e n o m e n o l o g i c a l movement (V o l 2 ) . The Hague: M a r t i n u s N i j h o f f . S p r a d l e y , J . P. (1979), The e t h n o g r a p h i c i n t e r v i e w . NewYork: H o l t , R i n e h a r t & Winston. S t o r c h , J . L. (1985). The Canadian H e a l t h Care Consumer. In Canadian H o s p i t a l A s s o c i a t i o n I n t r o d u c t i o n t o N u r s i n g  Management: A Canadian P e r s p e c t i v e (pp. 39-50) Ottawa: A u t h o r . Thomas, D.N. (1986). The c u r r e n t h e a l t h s t a t u s o f women. In J . G r i f f i t h - K e n n e y (Ed.), Contemporary Women's  H e a l t h . Menlo P a r k : Addison-Wesley P u b l i s h i n g Company, pp. 50-72. Thorne, S., G r i f f e n , C , & A d l e r s b e r g , M. (1986). W e l l s e n i o r s ' p e r c e p t i o n s o f t h e i r h e a l t h and w e l l - b e i n g . G e r o n t i o n : A Canadian Review o f G e r i a t r i c Care. Nov/Dec. Rawsley, M. (1980). The concept o f p r i v a c y . Advances i n  N u r s i n g S c i e n c e , 22 ( 2 ) , 25-31. Warren, S. & B r a n d e i s , L. (1890). The r i g h t t o p r i v a c y . H a r v a r d Law Review, 4, 193-220. Watson, J . (1979). N u r s i n g : The p h i l o s o p h y and s c i e n c e o f  c a r i n g . B o s t o n : L i t t l e , Brown. Watson, J . (1985). N u r s i n g : Human s c i e n c e and human c a r e . Norwalk, CT: A p p l e t o n - C e n t u r y - C r o f t s . Weiss, A.G. (1987). P r i v a c y and i n t i m a c y : a p a r t and a p a r t . J o u r n a l o f H u m a n i s t i c P s y c h o l o g y , 27 ( 1 ) , 118-125. W e s t i n , A. (1968). P r i v a c y and freedom. New York: Atheneum. 109 Woods, N. F. & Falk, S.A. (1974). Noise s t i m u l i i n the acute care area. Nursing Research, 23 (2), 147. 110 Appendix A L e t t e r of I n i t i a l Contact My name i s Lynda Anderson and I am a candidate i n the Masters of Science i n Nursing program at the U n i v e r s i t y of B r i t i s h Columbia. I am conducting a r e s e a r c h p r o j e c t e n t i t l e d "Women's Need f o r P r i v a c y During H o s p i t a l i z a t i o n f o r G y n e c o l o g i c a l Surgery". In t h i s r e s e a r c h p r o j e c t I w i l l i n t e r v i e w women about t h e i r experiences of p r i v a c y as h o s p i t a l p a t i e n t s admitted f o r g y n e c o l o g i c a l surgery. I f you are i n t e r e s t e d i n p a r t i c i p a t i n g i n t h i s p r o j e c t , I would l i k e t o hear from you. The procedure of the study w i l l i n v o l v e one t o t h r e e one-hour, tape r e c o r d e d i n t e r v i e w s , scheduled at our mutual convenience, i n your home, about two weeks f o l l o w i n g d i s c h a r g e from h o s p i t a l . Even i f you decide t o p a r t i c i p a t e i n the study, you can chose not t o answer any q u e s t i o n d u r i n g the i n t e r v i e w s . A l s o , you can withdraw from the study at any time. Furthermore, you have the r i g h t t o request any tape or p o r t i o n of a tape be era s e d at any time d u r i n g the study. Your d e c i s i o n t o p a r t i c i p a t e or withdraw from the study w i l l not a f f e c t your h e a l t h care i n any way, now, or at any f u t u r e date. Complete c o n f i d e n t i a l i t y w i l l be ensured. Your name w i l l not appear on any t r a n s c r i p t s or i n the completed study. I f d u r i n g the i n t e r v i e w you a c c i d e n t a l l y g i v e an Appendix B Consent I hereby give my consent to p a r t i c i p a t e i n the study "Women's Need for Privacy During H o s p i t a l i z a t i o n for Gynecological Surgery" as described by Lynda Anderson, a candidate i n the Masters of Science i n Nursing Program at the University of B r i t i s h Columbia. I understand that the study w i l l involve one to three one hour tape recorded interviews. I can refuse to answer any questions during the interviews and I can withdraw from the study at any time. I can request erasure of any tape or portion of a tape at any time during the study. I understand that my decision to p a r t i c i p a t e or withdraw from the study w i l l not affe c t my health care i n any way. Also, my name w i l l not appear on any of the t r a n s c r i p t s or i n the study . Any name I accidentally give w i l l be deleted by Lynda Anderson when the tapes are transcribed. I acknowledge that the study has been adequately explained to me and that I have a copy of the Letter of I n i t i a l Contact and of the Consent form. Signed Witness Date 113 Appendix C Sample Interview Questions 1. Could you d e s c r i b e as f u l l y as you can what you need f o r p r i v a c y ? 2. Could you d e s c r i b e your experience w i t h p r i v a c y when you were h o s p i t a l i z e d f o r g y n e c o l o g i c a l surgery? 3. What c o n t r i b u t e d t o your sense of p r i v a c y i n the h o s p i t a l ? . 4. What d i d not c o n t r i b u t e t o your sense of p r i v a c y i n the h o s p i t a l ? 

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.831.1-0098006/manifest

Comment

Related Items