Thesis Nurs. 1995 P438f
c.2
Perfetto, Patricia A.

Family education in the
rural psychiatric
1995.
FAMILY EDUCATION IN THE RURAL PSYCHIATRIC INPATIENT SETTING:

STAFF NURSES’ PERCEPTIONS OF ROLE AND PREPARATION

by

Patricia A. Perfetto, B.S.N., R.N.

Submitted in Partial Fulfillment of the Requirements for the
Master of Science in Nursing Degree

approved by:

Chairperson, Thesis Committee

Date

Edinboro University of Pennsylvania

^Committee Member

Date

Committee Member

Date

J-/'

ACKNOWLEDGEMENTS

The writer wishes to express sincere thanks and appreciation
to her committee members:

Charlotte P. Paul, Ph.D., R.N., Dean L.

Stoffer, Ph.D., and Beverly Danielka, M.S.N., R.N., for their
guidance and support during the writing of this thesis.

In addition, a special thanks to Bob Perfetto, for all of
his encouragement, belief and support throughout this process.

P.A.P.

January, 1995

ii

Abstract

A sample survey of nurses practicing in rural psychiatric settings

was conducted to examine their perceptions of preparation for
the family educator role.

A self-rating tool was sent to nurses

practicing on inpatient units of rural hospitals in southeastern
Kentucky and southern West Virginia.

Nurses were asked to rate

themselves in response to questions pertaining to teaching set
and preparation for teaching.

The conceptual framework of

Megenity and Megenity was used as the basis for the study and the

rating tool which was developed by the investigator.

statistics were used to analyze the data collected.

Descriptive
The results

of the survey showed that while nurses felt adequate in the family

teaching role, their formal educational preparation stopped at the
entry level of associate degree; that they value basic education

and experience equally as the most helpful preparation; and that
they did not plan for the teaching event.

These findings were

inconsistent with the literature, which supports an advanced
credential for practitioners teaching families, and the model

which supports grounding in educational and teaching-learning

theories, as well as planning for the teaching event.

iii

TABLE OF CONTENTS

page
ACKNOWLEDGMENTS

ii

ABSTRACT

iii

CHAPTER
I.

II.

INTRODUCTION

1

Background of the Problem

2

Statement of the Purpose

3

Research Question

5

Assumptions

6

Definition of Terms

6

Scope and Limitations of Study

6

REVIEW OF THE LITERATURE

8

Families’ Identification of Need for Education . .

8

Educational Programs and Characteristics of
Leader-Teacher

HI,

9

Teaching as a Function of Nursing

12

Summary.

14

METHODOLOGY.

16

Conceptual Framework

16

Setting and Sample

17

Instrumentation

17

iv

IV.
V.

Pilot Study

18

Data Collection

24

Procedures for Data Analysis

25

PRESENTATION AND ANALYSIS OF DATA

26

CONCLUSIONS

32

Summary

32

Discussion of Findings

34

Conclusions

36

Recommendations .

37

38

APPENDICES

A.

Self-Rating Tool: Original

38

B.

Self-Rating Tool: Revised

41

C.

Director of Nursing Request

44

D.

Permission to Conduct Study

45

E.

Collegial Request

46

47

REFERENCES.

v

CHAPTER I

Introduction

Background of the Problem
The importance and positive effects of family education
during psychiatric hospitalization is a resurging issue for the

mental health professional (Hatfield, 1979; Greenberg, Fine,

et al., 1988; Bernheim, 1990; Kane, DiMartino, Jimeniz, 1990;
Koontz, Cox and Hastings, 1991).

Twenty five years ago, the

literature contained anecdotal accounts of family members’ pain
and need, as they described feeling left out of the care of their
loved one, while simultaneously being cited as the cause of the
disorder under treatment (Lillis, 1974).

Currently, the move for

deinstitutionalization, the return to the community and family

caregiving, short-term acute inpatient stays, as well as the rise
of consumerism by families present mental health professionals

with new challenges and demands to work with families.

Studies

repeatedly show that families want education, not therapy, from

professionals (Hatfield, 1979; Rose, 1985; McElroy, 1985).
In the sixties, the deinstitutionalization movement was begun

through initiatives of the federal government (Huddleston, 1992).
With the advent of medications which were more effective in

1

2

stabilizing symptoms, the chronically mentally ill patient was
able to return to family, with the therapeutic supportive backup

supplied by Community Mental Health Centers.

In theory, this

movement was to allow for patients to remain close to families

during periods of remission and as necessary, utilize short term

hospitalization for exacerbations of the illness when there were
overt symptoms of harm to self or others exhibited by the patient.

In reality, many families became the primary care givers and

assumed a great emotional and interactional burden (Huddleston).

The need for education and support was felt by families

who turned first to mental health professionals for help in
dealing with the myriad of problems they faced in daily living
with a chronically mentally ill family member.

Families

identified their needs as knowledge about the illness and
treatment, resources in the community and practical coping and

management skills which they could put in place at home (Hatfield,
Professionals responded with traditional individual

1979, 1992).

and family therapies.

Their expectations unmet, families developed

self help groups, where emotional support was given and advice
exchanged.

These evolved into advocacy groups for families of the

mentally ill, the most prominent of which is the Alliance for the
Mentally Ill (Woolis, 1992).

Families and consumers rely on such

groups for community education and political advocacy for the
mentally ill.

3
In one rural area, deinstitutionalization has just begun.

In 1992, the Kentucky legislature authorized the building and
staffing of a 100 bed mental health facility in southeastern

Kentucky, in a joint effort with a private not-for-profit health
care organization.

Prior to this, hospitals for the mentally ill

were located in the western and central parts of the state.

With

the opening of the new facility in midyear 1993, chronically ill

patients were transferred to a hospital closer to home.

In

addition to providing inpatient care to the chronically ill person

short term care is offered to residents of a twenty one county
area.

This is one part of a multi-phased mental health care

initiative in the area.

The Community Mental Health Centers

offer outpatient care, however, crisis intervention is still a

missing component in the delivery system, and residential
programming is minimal.

It is apparent that history is repeating itself in this small

area.

Thirty years ago, families were ill prepared to care for

their chronically mentally ill relatives who returned from long

term hospitals.

There were few community resources available for

patients and little established for families.

This is true of

southeastern Kentucky.
Recruiting skilled professionals to this impoverished area

is difficult;

rural settings are generally not attractive to

physicians or other professionals, due to perceived lacks in

technological, cultural and educational resources (Raffel and
Raffel, 1989).

4
There is a confluence of events and reasons which put the
nurse in the position of becoming a family educator.

families generally view the nurse as a resource.
instances, the nurse is known to the family.

Rural

In most

There is a lack of

anonymity in rural nursing which doesn’t exist in the urban

counterpart (Weinart and Long, 1991).

This familiarity breeds a

trust which can’t be attained easily by outsiders.
part of the nurses’ role and responsibility.

Education is

Licensure not only

allows it, but requires it (KY Nurse Practice Act, 1993).
External reviewers expect to find evidence of teaching and
learning activities on inpatient settings (JCAHO, 1993).

Professionally, the ANA Psychiatric/Mental Health Standards of
Practice (1982) call for education of clients and families.

The lack of other professionals, such as social workers,
prepared at the advanced level within the rural setting puts the
nurse in the sometimes inevitable position of crossing role

expectations to deliver in the practice setting aspects of care

usually performed by other professionals in the urban setting
(Weinart and Long).

The literature supports the theme of highly

skilled, advanced credentialled professionals delivering family

education and support.

The rural nurse does not necessarily have

the educational credential suggested by the literature.

Indeed,

73% of nurses in Kentucky are educated at the associate degree
level (NLN Data Source, 1992).

educational degree.

For most, this is a terminal

How then, the nurse prepares for the role

5
of family educator is relevant to nursing practice.

Purpose of the Study

The purpose of this study was to examine nurses’ perceptions

of preparation for the role of family educator in the rural

psychiatric acute care setting.

The findings of this study will

assist educators and practitioners in designing strategies to
assist the generalist nurse in implementing the teaching role.

Research Question

To examine nurses’ perceptions about preparation for the

family educator role in practice, the following questions were
asked:

1.

How did nurses perceive their preparation for the role

of family educator?
2.

Which method of preparation was perceived as most valuable

to the nurse?

Assumptions

The assumptions which were made for this study were:

1.

The nurses’ perceptions could be evaluated.

2.

The nurses prepared for the role of educator.

6
3.

The nurses delivered education to families in a variety

of methods.
4.

The nurses would answer the research questions honestly.

Definition of Terms

Family education-any active intervention performed by the nurse
designed to increase the understanding and/or
knowledge of psychiatric illness, treatment
and/or coping skills
Family-■a relationship to an identified patient, whether
legal or biological; includes non-marital,
significant others
Preparation■any action taken by the nurse to increase own
knowledge base and/or skill in the delivery of
education; can be formal, i.e. classes, or
informal, i.e. reading; includes teaching and
learning theory, adult education, educational
assessment techniques
•attitudes, beliefs, and/or feelings of the nurse
Perceptions'

Scope and Limitations

This study was limited by the use of a descriptive survey
design using a self-report questionnaire developed by the

investigator.

Since this instrument has not been used in other

studies, comparative findings were not available.

The findings

of the study reflected the perceptions of those who responded to
the questionnaire and may not represent the perceptions of the
population of nurses practicing in rural settings.

The study

7
was confined to small, rural communities in southeastern
Kentucky and southern West Virginia, served by general hospitals

of varying sizes, each with designated psychiatric units.

CHAPTER II

Review of the Lite ra tur e

The purpose of this study was to examine nurses’ perceptions

of preparation for the role of family educator in the rural
psychiatric acute care setting.

Families’ Identification of Need for Education
Families of the mentally ill have asked for communication

with and education from mental health professionals for over

twenty years.

Lillis (1974), in an article regarding her sister’s

illness not only poignantly described the pain her family suffered
during her sister’s hospitalization, but also listed desired,
needed information that would lessen the frustration of not

knowing what was happening during treatment.
Hatfield (1979) called for mental health professionals to

align with families as part of the total treatment team.

She

stated that learning how the family responds to mental illness

would be a step in building positive relationships.

In this

study, families identified knowledge as a priority.

They further

required that this knowledge by delivered in a language which they

could easily understand.

Similar to Lillis’ appeal for

information, they wanted to know about diagnosis, prognosis,

8

9
techniques for dealing with behaviors and available community
resources.

The literature suggests that while families are able to
identify what they need, educational programming strategies are

developed from the providers point of view, despite evidence that
there can be a discrepancy between the professionals’ and

families’ perception of what is and is not important.

McElroy

(1985) conducted a descriptive study identifying educational

needs of families of severely mentally ill patients and measured

congruence with the professionals’ perceptions on the same
dimensions.

The resultant incongruency between the two groups

suggested that some professionals needed to modify their approach

with families to include those issues which the families deemed
had merit.

Both groups in the study agreed that families do not

want therapy for themselves and supported Hatfield’s earlier
contention (1979) that families do want education from

professionals.

Educational Programs and Characteristics of Leader-Teacher

Studies of psychoeducational programs included descriptors

of the professionals conducting the programs.

Consistently,

whether the program was led by the researcher and/or a colleague,

the leaders were described or implied as advanced educational level

clinicians.

10
Scharfstein and Libbey (1982), masters prepared social
workers, conducted orientation groups for families.

They met

once with multiple families for one and one-half hours, in a

setting structured into three phases;
discussion.

social, educational and

The theoretical framework was group, patient

education and family systems theories.

The outcome was the

belief that families benefitted, although no ratings or testing

were conducted to validate this.
Rose, et al. (1985) described a support group led by the

investigators, intended to help families develop coping skills
utilizing a self-help group model.

While not an educational

model, lack of knowledge of the mental health system, mental
illness and treatment were the number one concerns of families.

The investigators noted that the professional group leader must
have an understanding of group dynamics to facilitate such a
group.

Greenberg, et al. (1988) conducted an evaluation of a

multi-disciplinary psychoeducational model for patients with
Schizophrenia and their families in an acute care setting.

The

program was developed by the investigator and was conducted by
psychiatrists and masters prepared social workers.

The staff

nurse, educational credential unidentified, was involved in

patient education, utilizing a teaching tool scripted by the
investigators.

The nurse was not involved in family education.

11

In a comparison study of psychoeducational and support
groups for relatives, psychoeducation was suggested to be the

method of choice of families.

Kane and BiMateo (1990) measured

the impact of both approaches in increasing family coping ability.

The researchers and graduate students in nursing conducted the

groups.

Huddleston (1992), in a descriptive study of psychoeducation
focused groups for patients with Schizophrenia and their families
states that group effectiveness requires a facilitator with not

only a significant amount and variety of direct treatment
experience, but also a need for knowledge in academia and family
role in treatment.

Harter (1988) in her descriptive study of the multifamily
education groups conducted in many inpatient acute care settings,

stated that the group needed to be run by a seasoned clinician,

with an adjunct role played by the staff nurse, who gave families
day-to-day information regarding the patient’s treatment plan and
progress.

Applying Harter’s framework in another setting, Koontz,

Cox and Hastings (1991) received positive anecdotal responses from

families.

Their study suggests that the leader needs to be

knowledgable, fluid, and skillful in introducing and reinforcing

topics pertaining to the diverse needs of multiple families in
a group setting.
Thompson and Weisburg (1990) found in their study on family

12
as educational consumers, that families with the least amount of

formal education wanted the most assistance from nurses, and that
nurses primarily provided the most information to families in the
most highly educated groups.

The study focused on the effect of

psychoeducational groups which were conducted by social work
staff, so the fact that families saw the nurse as the professional
with the desired information was a significant finding.

The

education and proficiency of the nurse was not described.

Teaching as a Function of Nursing
While not always so, nursing curricula today includes the
integration of teaching-learning principles in a variety of

coursework, such as psychology, sociology, and clinical practicums

(Megenity and Megenity, 1982).

Texts and coursework on patient

and family education exist and are utilized in some practice

settings.

No matter what the basic educational level of the nurse

there are resources to develop this skill.

Continuing education

programs are available to assist the practitioner in synthysizing

and applying learning theories which would suggest that nurses

are seeking more assistance and knowledge about the teaching
process.
In their work on teaching and nursing, Megenity and Megenity

(1982) define nursing as a helping process for promoting,

maintaining and restoring the health of nursing clients.

Clients

13
are defined as families, individuals, groups or communities.

The

function of nursing is to carry out the three major processes

above through care giving, teaching and supporting activities.
The nurse in this framework is more than a technician.

The nurse

is viewed as an educated person in the health field, with a well

developed knowledge base, skill in communication with others and
able to articulate his/her philosophical beliefs regarding nursing
role, health, society and humanity.

The nurse should be able to

use knowledge and skills in the application of problem solving

in the three major activities of nursing;

and supporting.

care giving, teaching,

Within this view of nursing, expertise in

patient-client teaching is required and assumed.

The Megenitys

state that the nurse must consider his or her philosophical
beliefs about nursing and the role of the nurse.

Without knowing

or defining these for self, the nurse will have no conceptual

basis for practice, but will accept the dependent role, carrying
out client health tasks defined by others.

Further, they state

that practitioners of nursing generally are people who want to

assist and direct others toward more healthy lives, and that
nurses believe that they should teach.

The priority that the

nurse places on this teaching will vary with each nurse,

influenced to a degree on the nurse's base in the educational
processes of teaching-learning.

This is consistent with role

theorists, who state that performance in a role requires

14
competence m role specific behaviors (Hardy and Conway, 1988).
Preparation for a role includes cognitive skill development.
This, according to sociologists can be obtained through education

and role socialization.

Summary

In this era of decreased hospitalization and increased
community care, families want and need education regarding the

condition, treatment and on-going coping skills necessary to deal
with behaviors associated with the mental illness of their loved

ones.

Professionals have not always been responsive to families,

although recent literature describes attempts to meet the
educational needs expressed by families.

A common theme in the

documented attempts is a leader/teacher who is multi-skilled in
psychosocial practice, group theory and teaching-learning theory
and techniques.

Cognitive and affective education in these areas

is usually obtained in advanced practice education programs, such
as master’s level education.

Rural areas have traditionally

experienced difficulty in attracting professionals prepared at
this level.

Rural nurses, generally regarded by families as the

professional expert to be trusted for health care and educational

need fulfillment, are primarily educated at the associate degree

level.

One model proposes that teaching is a major function of
nursing; it also assumes a base of education which includes an

15
understanding and use of educational, and teaching-learning
theories.

The nurse in this model plans the education of clients.

There is minimal use of intuitive, occasional teaching.

Inherent

in this model is the assumption that the nurse prepares for the
role of teacher through education.

Utilizing this model as a framework, the intent of this
study was to look at how a sample population of rural nurses,
working on inpatient psychiatric units perceived their preparation
for and adequacy in the role of family educator.

CHAPTER III

Methodology

The purpose of this study was to examine nurses’ perceptions

of preparation for the role of family educator in the rural
psychiatric acute care setting.

Conceptual Framework
This study was organized around the concepts presented by
Megenity and Megenity (1982) on nursing and teaching.

Defining

nursing as a helping process for promoting, maintaining and
restoring the health of clients, they further describe the major

functions of nursing as care giving, teaching and supporting
activities.

As with any phenomenon studied, the descriptors of

Megenity and Megenity

the action/behaviors must be identified.

do this in relation to teaching in the teaching set.
components of the set are:

and evaluation.

The

intended learner outcomes, instruction

These parallel the Nursing Process and provide a

framework to study teaching in the model.

It is believed in this

model that while some teaching actions of the nurse are intuitive
and will occur incidentally, for the teaching process to be

effective, it must be a planned event.

16

The philosophy, education

17
base, attitudes and beliefs about teaching, learning, and
nursing will influence this event.

Inherent in the model is the

assumption that the nurse prepares for the role of teacher through
education and the study of the teaching-learning process.

Setting and Sample
The convenience sample was obtained from nurses who were
working on psychiatric units located in one of three rural
hospitals in southeastern Kentucky and southern West Virginia.

Instrumentation
The self-rating tool used in this study was developed by a
three member committee comprised of a community educator, a
consumer, and a nurse, who was a candidate for a master’s degree.

The tool was then submitted to a four member panel of experts
for critique.

This panel was comprised of two master's prepared

nurses, one master’s prepared social worker and one associate

degree nurse

who is enrolled in an RN to Master’s Degree program.

This panel was asked to review the tool for readibility, ease of

use and content validity (Appendix A).

A suggestion made by this

panel was to change one question from an open-ended to a forced

choice answer.

This was. incorporated into the tool (Part II,

Appendix B).

The self-rating tool was comprised of a series of questions
designed to examine the nurse s

perceptions regarding the use of

18
the teaching set, preparation for the role of family educator, and
evaluation of that preparation.

It was divided into two specific

parts, with demographic questions completing the tool.
Part I of the tool was comprised of five questions which

asked the nurse to rate teaching practices on a time demension.
The use of assessment, planning methods and evaluation were the
data sought by the investigator in this section.

In Part II of the tool, the nurse was asked to identify
preparation for family teaching on two dimensions, actual and

valued.

These were the research questions that were the thrust

of the study.

In one question in this part of the tool, the nurse

was asked to respond to feelings of adequacy in the role of family

educator.

The final section of the tool was designed to elicit a
description of the nurse in terms of educational level, experience

(total time and time in specialty area), and affiliations, both
professional and with consumer groups.

Pilot Study
A pilot study was conducted to determine if desired data

could be gathered using the self-rating tool.
participated in the pilot study;

Seven nurses

five were employed in the

same

two were employed in other facilities.
facility as the investigator;
These individuals were excluded from the study since they were
participants in the pilot study.

19
Results of the Pilot Study
The first research question to be answered was:

How do

nurses perceive their preparation for the role of family educator?
Respondents in the pilot study self reported that they utilized

basic education, followed by the experience of teaching most in

preparing for the teaching role.

The use of a mentor was the

least utilized method of preparation (see Table 1).

Table 1
Mean Response of Methods Utilized by Nurses in Preparing for the

Family Educator Role

Mean

Method
Basic Education

4.0

Continuing Education

3.2

College Coursework

3.0

Mentoring

1.5

Experience

3.5

Note. Scale:

4 = to a great degree; 3 = to a moderate degree;

2 = to a minimal degree; 1 - never

20
The second research question to be answered was: Which method

of preparation was perceived as the most valuable to the nurse?
Respondents in the pilot group reported that the experience, "just

doing it", was the most valuable.

Mentoring was the least valued

method of preparation (see Table 2).
Table 2
Most Valued Preparation for the Family Educator Role by Percentage

of Respondents

Method

Respondents

Experience

42%

Basic Education

28%

Continuing Education

14%

College Coursework

14%

Mentoring

Note,

0

n = 7

The survey questioned whether respondents obtained specific

courses in teaching and educational theories, based on the belief
of the Megenitys' model (1982) that grounding in educational and

teaching theories are required for effective teaching.

The pilot

group reported that they had coursework in these educational

principles (see Table 3).

21
Table 3
Percentage of Respondents^Qbtaining Coursework in Educational

Theories

Type of Course

Respondents

Teaching/Learning Theory

85%

Educational Assessment

71%

Learning Tools

85%

Adult Education

71%

Note, n = 7

In response to the question regarding feelings of adequacy in
the role of family educator, the pilot group unanimously reported

that they felt adequate.

The teaching set as described by Megenity and Megenity (1982)
includes the processes of assessment, planning, intervention and

evaluation of the teaching act.

The pilot group reported that

they assessed families generally through interview or by observing
interactions.

They tended not to use a formal tool for assessment.

The method of teaching most used by respondents in the pilot
in a one-to-one setting.
group was written and oral presentation

The pilot group reported that a preplanned lecture or lesson plan
was seldom used.

The group tended to evaluate family teaching at

least some of the time (see Table 4).

Written responses on the

survey tool indicated that the method used to evaluate was the

22

repetition of instructions by the family.
Table 4

Mean Responses of the Use of Aspects of the Teaching Set by Nurses

Aspect

Mean Response

Assessment

Interviewing

2.7

Observation

2.5

Formal Tool

1.8

Setting
One-to-one

2.5

Small groups

2.0

Lecture

1.6

Method

Answer questions only

1.8

Answer questions; give written
explanation

2.1

Use written information only

1.8

Give written information, followed
by oral presentation

2.2

Use a preplanned lesson plan

1.8

Evaluation of teaching

Note.

Scale:

2.2

3 = most of the time; 2 = some of the time; 1 =

seldom or never.

The higher the mean, the more often the nurses

use the aspect being measured.

23
Families have asked for an alignment of professionals with

the families as part of the total treatment team.

One measure

of this alignment is responding to families’ identified needs for

education and information.

In response to the survey question

regarding the content of family education, the pilot group
reported that they taught families about the diagnosis, course of
illness, treatment, including side effects and coping skills
needed for care at home (see Table 5).

Table 5
Mean Responses of Content of Family Teaching Done by Nurses

Topic

Mean Response

Diagnosis

3.0

Course of illness

2.6

Alternative treatments

2.1

Effects/side effects of treatment

2.8

Care at home

2.7

Note.

Scale:

3 = most of the time; 2 = some of the time; 1 =

seldom or never.

The higher the mean response, the more the nurse

teaches the item.

Another measure of positive alignment with families is
membership in a family/consumer group.

little involvement in this area.

The pilot group reported

Only two of the seven respondents

24
were affiliated with family groups.

There were no changes made in the tool as a result of the
pilot study.

With the conclusion of the pilot study, data

collection for the research study was conducted during the first
two weeks of November, 1994.

Data Collection

Directors of Nursing of the three hospitals were asked by
telephone and via a letter to participate in this study
(Appendices C and D).

They were asked to distribute the survey

tools to nurses on the psychiatric units of their hospitals through
the nurse-managers (Head Nurses).

The distribution of the tools

in this way enabled the investigator to reach a wider convenience

sample for this study.

Each tool was accompanied by both a

cover letter, which explained that voluntary participation was
assumed if participants chose to complete and return the survey
(Appendix E), and a stamped self-addressed envelope for ease in

return.

The participants were asked to not sign the survey nor

mark it in any way to indicate identification.

They were informed

that only group summary data would be used in the study.

Finally,

they were asked to return the survey within one week of receipt.
The surveys were color coded to enable the investigator to
monitor the return rates for each hospital.

While a target for

the aggregate data of 35% was reached, the individual hospital

return rates were twenty nine, fifty and seventy per cent.

25

A follow up telephone call to the Directors of Nursing
revealed that the surveys were distributed during scheduled

staff meetings.

The nurse managers ensured that staff who did

not attend the meetings received surveys.

Procedures for Analysis of Data
In this descriptive study, the results of the surveys were

analyzed using the simple statistics of frequencies, mean of

responses and percentage.
The first research question:

How does the nurse prepare for

the role of family educator, was analyzed using the mean of

responses to the preparation items.

The second research question:

What preparation was most valued, was analyzed by converting the
raw numbers to percentages of the study respondents and then
ranking these percentages.

The teaching set analysis was conducted by comparing the
mean of responses of the degree of time (most, some, never) that

the participants utilized a planned approach to family teaching.
Demographic information was analyzed by obtaining the average

of the responses to experience in nursing, educational level and
age of respondent.

The remainder of the data obtained from the

survey was analyzed by converting raw numbers to percentages and

making comparisons.

CHAPTER IV

Presentation and Analysis of Data

This study was designed to examine staff nurses’ perceptions
of preparation for the role of family educator in the rural

psychiatric inpatient setting.

Demographics

Fifty nine surveys were distributed to nurses in three
hospitals, each having a psychiatric inpatient unit or units.

Twenty eight surveys were returned completed, for a response
rate of forty seven per cent (47%).

In this group, the average

respondent was 36 years old; held an Associate Degree in Nursing;
and had an average of 10.6 years experience, with an average of
4.5 years experience in psychiatric nursing.

Data Analysis

The first research question to be answered was:

How did

nurses perceive their preparation for the role of family educator?

Respondents reported that their primary preparation for the role
of family educator was through their basic education, followed
closely by the experience itself (see Table 6).

26

27

Table 6
Mean Responses of Methods Utilized by Nurses in Preparing for the
Family Educator Role

Method

Mean Response

Basic Education

3.7

Continuing Education

2.3

College Coursework

3.1

Mentoring

2.0

Experience

3.6

Scale:

Note.

2

4 = to a great degree; 3 = to a moderate degree;

to a minimal degree; 1 = never
The second research question to be answered was:

Which

method of preparation was perceived as the most valuable to the
nurse?

Respondents self reported that basic education was the

most valuable method.

Again, experience was rated a close second.

The least valued by the respondents was college coursework (see
Table 7 ).

28
Table 7

Most Valued Preparation for the Family Educator Role by Percentage
of Respondents

Method

Respondents

Basic Education

78.5%

Experience

71.4%

Mentoring

10.7%

Continuing Education

7.1%

College Coursework

3.5%

Note.

n = 28
The survey questioned whether respondents obtained specific

courses in teaching and educational theories, based on the belief

of the Megenitys’ model (1982) that grounding in educational and

teaching theories are required for effective teaching.

The study

group respondents reported that they had some coursework in this
area (see Table 8).

29

Table 8
Percentage of Respondents Obtaining Coursework in Educational
Theories

Type of Course

Respondents

Teaching/Learning Theory

40%

Educational Assessment

32%

Learning Tools

24%

Adult Education

32%

Note.

n = 28
In response to the question regarding feelings of adequacy in

the role of family educator, the survey group response was positive
for 78% of the respondents.

The survey tool asked respondents to rate their use of
assessment, planning and evaluation in the teaching act.

Respondents were also asked to rate the use of specific methods

of teaching.

The survey respondents reported that they assessed

families most of the time through interview and observation.

They

tended to use the one to one setting most in their teaching,

rather than groups or lecture settings.

The methods of teaching

most often used by respondents was a combination of written and

oral presentations.

The respondents tended not to preplan the

teaching act or to evaluate their teaching efforts (see Table 8).

30
Table 8
Mean Responses of the Use of Aspects of
the Teaching Set by Nurses
Aspect
Mean Response
Assessment

Interviewing
Observation

2.7

2.5

Formal Tool

1.4

Setting

One-to-one

2.5

Small groups

1.6

Lecture

1.2

Method
Answer questions only

1.6

Answer questions; give written
explanation

2.5

Use written information only

1.6

Give written information, followed
by oral presentation

2.5

Use a preplanned lesson plan

1.5

Evaluation of teaching

Note.

Scale:

1.9

3 = most of the time; 2 = some of the time; 1 =

seldom or never.

The higher the mean, the more often the nurses

use the aspect being measured.

31

Alignment with families was measured in this survey by
asking the respondents to rate how othen they teach items which

have been requested by families.

The self reports indicate that

nurses in this study do teach what families have identified as

needs (see Table 9).

Table 9
Mean Responses of Content of Family Teaching Done by Nurses

Topic

Mean Response

Diagnosis

3.0

Course of illness

2.6

Alternative treatments

2.1

Effects/side effects of treatment

2.8

Care at home

2.7

Note.

Scale:

3 = most of the time; 2 = some of the time; 1 =

seldom or never.

The higher the mean response, the more the nurse

teaches the item.
Another measure of positive alignment with families is

membership in a family/consumer group.
little involvement in such groups.
belong to family groups.

The survey group reported

Only 10% of the respondents

CHAPTER V

Conclusions

Summary
The purpose of this study was to examine the staff nurses’

perceptions of preparations for the role of family educator in
the rural psychiatric inpatient setting.

The conceptual framework for this study was that of Megenity
and Megenity (1982).

In this model preparation for the teaching

role requires that the nurse is knowledgable in teaching and

learning theories and educational principles.

In addition, the

model proposes that the nurse plans the teaching act based on
assessment.
The literature review for this study focused on the

identification of family education needs, the characteristics of
the teacher in the psychiatric setting, and teaching as a function

of nursing.
Families have identified their needs as information regarding

the diagnosis, prognosis, and treatment of their loved one, as well
as needed coping skills for dealing with their loved one at home

(Hatfield, 1979).

They have asked to be included in the planning

for the care of their loved one and for a positive alignment of
professionals with families in an attempt to understand families’

32

33
needs and concerns.

In one study (Thompson and Weisburg, 1990),

families identified nurses as the professionals giving them the

most desired information during hospitalization, despite the

availability of a family education group offered by masters

prepared social workers.

In general, families in the rural

settings have identified nurses as the health professionals whom
they trust for their health education needs.

Multiple studies on family education (Scharfstein and Libbey,
1982; Rose, et al., 1985; Greenberg, 1988; Huddleston, 1992; and

Harter, 1988) identified the teacher as needing multiple skills
and a knowledge base consistent with an advanced educational

credential.

When nurses were identified as teachers, they were

educated at the masters level.
primarily in urban areas.

These studies have been conducted

Rural areas have been identified as

lacking in nurses and other professionals educated at this level

(Raffel and Raffel, 1989).
Megenity and Megenity (1982) state that preparation in

educational theories and teaching principles are required for the
nurse to be an effective teacher.

The teaching set proposed by

the Megenitys involves assessment, planning and evaluation of

the teaching act.

Planning is of particular importance in this

model; without it, teaching will be intuitive and the nurse
risks functioning at the technician level, with teaching acts

directed by others.

34
Discussion of Findings
In this study, the primary educational level of the nurse

was the associate degree, which suggests that the population

studied reflects the rural experience.

In this study, respondents answers to the research questions
indicate that they prepared for the role of family educator through
their basic education.

They valued basic education over other

choices of preparation for this role.

Nurses who participated in

this study are relatively young practitioners (average experience

in psychiatric/mental health nursing was 4.5 years) and have a
limited formal education (associate degree).

Participation in

coursework designed to build on educational theories and skill

development were rated low in value for role preparation.

This

does not correlate with the Megenitys’ concepts, which state that

the nurse needs to be well grounded in educational and teaching

theory.

In their model for nursing, the lack of educational

preparation limits the nurses’ role to that of technician, i.e.
one who is dependent on others for direction in practice.

The

lack of advanced formal education is also inconsistent with other

literature which suggests that family educators be educated at an
advanced level (masters degree).
This study finding could reflect the opportunities for

education available within this locale, as much as a value.

The

only entry level education available to the population studied has

35
been associate degree programs.

technical nurse (Kelly, 1985).

By definition, this prepares a
Leaving the locale to obtain

higher education is not generally a characteristic of the
population (Caudill, 1962).

It is only within the past two years

that a bridge program (RN to Master of Science in Nursing) has
been available within a one hundred mile radius.

The demand for

numbers of nurses has been the primary focus of educational
efforts of the community colleges.

Continuing education offered

by hospitals has focused on medical nursing skill development,
and except for critical care nursing courses, involve long travel.
Hatfield (1979) asked for a positive alignment with mental

health professionals to assist families in coping with the living

with a chronically ill family member.

One measure of this

positive alignment was measured by the survey responses to the
questions regarding the content of teaching.

Nurses reported that

they taught faim' 1ies about the diagnosis, prognosis, treatment and

coping skills needed to care for the family member at home.
was consistent with family members’ requests.

This

Another measure of

alignment with families, membership in consumer/family groups was
not correlated positively by the survey group responses;

only 10%

of those surveyed belong to such groups.

Megenity and Megenity propose that the teaching act should be
a planned event and should be evaluated by the teacher.

Neither

36
aspect of the teaching act; preplanning or evaluation could be

positively correlated via the self reports of the survey group.
According to the Megenitys, this yields ineffective teaching.
The quality and depth of the teaching of nurses in the psychiatric
setting was beyond the scope of this study.

Of interest, the majority of the respondents felt adequate

in the role of family educator.

Conclusions

1.

The nurses perceived the most valuable preparation for the
role of family teacher as being their basic education.

2.

The nurses in this study prepared themselves for the role of
teacher through basic education (associate degree level).

3.

The nurses in this study felt adequate in the role of family
educator.

4.

The nurses in this study reported teaching what families have

identified as needed topics.

37

Recommendations

1.

Further study of the family educator role should be conducted

to examine the depth and quality of the education delivered by

nurses in the rural setting.

2.

Nurse administrators should evaluate the preparation of nurses

before assigning this role, and consider the development of an

education program which would combine experience with theory
to assist nurses in the development of this role.

3.

Nursing faculty should evaluate the role of teacher in

coursework to assist in the preparation for the practice
setting.

5.

Nurses should consider joining family/consumer groups as a
means of aligning positively with families.

38

APPENDIX A
ORIGINAL
SELF-RATING TOOL:

PART I

NURSE PERCEPTIONS OF PREPARATION FOR FAMILY
EDUCATOR ROLE

DIRECTIONS:

Please circle the response that best reflects
your practice using the following guide:

1
2
3
Each question
1.

I teach families about:

a.
b.
c.
d.
e.
f.
2.

= Most of the time
= Some of the time
= Seldom or never
could have more than one response.

the diagnosis of the patient
the course of the illness
alternative treatments
effects/side effects of treatment i.e. meds
how to care for their family member at home
other

1
1
1
1
1
1

2
2
2
2
2
2

3
3
3
3
3
3

1
1

2
2

3
3

1
1

2
2

3
3

I assess families’ need for education based on:
a. interviews with the families
b. observation of family/patient interactions
c. use of a formal test instrument to determine
knowledge level of families
d. other method

3.

I teach families:
1
1
1
1

2
2
2
2

3
3
3
3

4.

a. only in one to one settings
b. in small group settings
c. in formal lecture settings
d. other
_ ________________________
I use the following methods when I teach:

I answer questions asked of me
I answer questions and use written information
I present written information only
I present written information and
give an oral explanation
e. I conduct a pre-planned program or use a
lesson plan
I evaluate my family teaching with the family
If the answer to #5 is yes, please describe

1
1
1

2
2
2

3
3
3

1

2

3

1

2

3

1

2

3

a.
b.
c*.
d.

5.

39
Self-Rating Tool—Page II

Directions:

For the following question, use the following guide:

1
2
3
4
1.

=
=
=
=

to a great degree
to a moderate degree
to a minimal degree
never

Before I began teaching families, I prepared myself using
the following:
a.

basic nursing education

1

2

3

4

b.

continuing education

1

2

3

4

c.

college course work

1

2

3

4

d.

worked

1

2

3

4

e.

learned by experience, "just doing it”

1

2

3

4

with a mentor

SECTION II
Please respond to the following:

1.

I have had formal courses in:

a.

Teaching/Learning theory

yes

no

b.

Educational assessment

yes_

no

c.

Learning tools

yes

no

d.

Adult education

yes

no

2.

The most helpful preparation for family teaching for me has
been

3.

I feel adequate in the role of family educator.yes

no

40
FOR STATISTICAL PURPOSES, PLEASE COMPLETE THE FOLLOWING SECTION

OF THE SURVEY.

ALL ANSWERS WILL KEPT COMPLETELY CONFIDENTIAL.

1.
2.
3.
4.
5.

Age

6.

Do you belong to any professional organizations?

Years in Practice
Years in Psychiatric/mental health Practice,

State your degree level:

ADN

BSN

MSN

OTHER

Do you hold ANA or other certification?

If yes, please list

7.

Do you belong to any family/consumer organizations?

If yes, please list

8.

Are there any comments you would like to offer about your
feelings about family education in your practice setting?

THANK YOU FOR YOUR PARTICIPATION IN THIS SURVEY!’!

41
APPENDIX B

REVISED

SELF-RATING TOOL:

PART I

NURSE PERCEPTIONS OF PREPARATION FOR FAMILY
EDUCATOR ROLE

DIRECTIONS:

Please circle the response that best reflects
your practice using the following guide:

1
2
3
Each question could
1.

I teach families about:
a.
b.
c.
d.
e.
f.

2.

- Most of the time
= Some of the time
= Seldom or never
have more than one response.

the diagnosis of the patient
the course of the illness
alternative treatments
effects/side effects of treatment i.e. meds
how to care for their family member at home
other

1
1
1
1
1
1

2
2
2
2
2
2

3
3
3
3
3
3

1
1

2
2

3
3

1
1

2
2

3
3

I assess families’ need for education based on:

a. interviews with the families
b. observation of family/patient interactions
c. use of a formal test instrument to determine
knowledge level of families
d. other method
3.

I teach families:

1
1
1
1

2
2
2
2

3
3
3
3

4.

a. only in one to one settings
b. in small group settings
c. in formal lecture settings
d. other
I use the following methods when I teach:
I answer questions asked of me
I answer questions and use written information
I present written information only
I present written information and
give an oral explanation
I
conduct a pre-planned program or use a
e
lesson plan
I evaluate my family teaching with the family
If the answer to #5 is yes, please describe

1
1
1

2
2
2

3
3
3

1

2

3

1

2

3

1

2

3

a.
b.
c.
d.

5.

42
SELF-RATING TOOL
DIRECTIONS:

PAGE II

For the following question, use the following guide:

1
2
3
4

=
=
=
=

to a great degree
to a moderate degree
to a minimal degree
never

Before I began teaching families, I prepared myself using the
following:

a. basic nursing education

1

2

3

4

b. continuing education i.e. How to
Teach, adult Education, etc.

1

2

3

4

c. college courses on education

1

2

3

4

d. worked with a mentor

1

2

3

4

e. learned by experience-Just did it

1

2

3

4

When I evaluate my preparation for family teaching, I feel that
the most valuable has been:

(Please check one)

a. basic nursing education
b. continuing education

c. working with a mentor
d. experience-just doing it

I feel adequate in the role of family educator.

yes

no

I have had formal courses in:
a. Teaching/Learning Theory

yes

no

b. Educational assessment

yes
yes_

no
no

yes

no

c. Learning tools
d. Adult education

43
FOR STATISTICAL PURPOSES, PLEASE COMPLETE THE FOLLOWING SECTION
OF THE SURVEY. ALL ANSWERS WILL KEPT COMPLETELY CONFIDENTIAL.
1. Age_____ __________
2. Years in Practice

3. Years in Psychiatric/mental health practice
4. State your degree level: ADN
BSN
MSN

OTHER

5. Do you hold ANA or other certification?
6. Do you belong to any professional organizations?
If yes, please list
7. Do you belong to any family/consumer organizations?
If yes, please list
8. Are there any comments you would like to offer about your
feelings about family education in your practice setting?

THANK YOU FOR YOUR PARTICIPATION IN THIS SURVEY!!!!

44

APPENDIX C
Director of Nursing Request

Dear Director,

As per our telephone discussion, I am completing a study on

nurses’ perceptions of preparation for family teaching as part of
the requirements for the Master of Science in Nursing Degree, and

I greatly appreciate your help with this.

Enclosed are the self-rating tools which you have agreed to

distribute to nurses working on the psychiatric unit of your
hospital.

I have also attached a stamped, self-addressed envelope

to each survey to allow for the confidential return of the surveys.
All data received will be treated confidentially.

data will be used in the study;
facility will be identified.

Aggregate

no individual nor individual

The information obtained will only

be used for this study and will be destroyed at the end of the
study.
Again, thank you for your assistance with this project.

Sincerely,

Pat Perfetto, RN

45

APPENDIX D
Facility Agreement
This acknowledges that Patricia Perfetto, a student of

Edinboro University of PA, has permission to tuilize this facility

for the purpose of a graduate student research study.

Specifically

the student may distribute a survey tool to a preselected group of
nurses within this facility to obtain data for the study.

It is

understood that the individual survey results are confidential and
that they will only be utilized for this study.

Further, it is

understood that aggregate data will be utilized for this study and
no individual nor individual facility participating in this study
will be identified.

Facility Representative

Student

46

APPENDIX E
Collegial Request

Dear Colleague,

As part of the requirements for a Master of Science in

Nursing Degree, I am conducting a research study, and I need
your help.
This study will examine nurses’ perceptions of preparation
for the family educator role,

Attached to this letter is a

self-rating tool which I am using to collect the data for the

study.

If you would take approximately ten minutes to complete

this and return it in the envelope provided within the week, I

would greatly appreciate it.
Participation in this study is voluntary.

Consent to

participate is assumed if you return a completed survey.

For

statistical purposes, please return the survey, whether you
complete it or not.

The results from all returned surveys will

be used as totals;

no individual or individual facility will be

identified.
marks on it.

Please do not sign this survey or make any identifying
All surveys will only be used for this study and

will be destroyed at the end of the study.

Thank you for your time and assistance with this study.

I

really appreciate it.

Sincerely,

Pat Perfetto, RN

47

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