248 Sample Final Paper
Section Exemplars
Section Exemplars
Betsy Vos
Intro Section
Throughout history, the plight of poor has been a constant and increasingly complex problem. there have always been poor people, there are poor people now, there will always be those who live in poverty. In cities all over the United States, homelessness is a visible component of poverty. Often when people think of homelessness, they instantly assume that the homeless are those who cannot or refuse to work. Unfortunately, this is not the case. In Chicago alone, there are 173, 295 families that fall into the category of working poor. They generally work thirty-five hours a week for fifty weeks out of the year (Knowles, 1997). Many of these families, however, continue to struggle to make ends meet. In addition, often those who are working poor are not eleigble for health care and benefits, which either becomes a cause or an effect of homelessness. In general, private health care is much too expensive for the working poor and as a result, "on;y one in five poor, non-elderly americans and one in two of the near-poor are covered by private insurance" (Rosenthal, 1994). The glaring lack of national health care in America becomes yet another problem for those who are struggling to maintain housing or for those already homeless. The fact that those who are working cannot escape poverty and homelessness forces us to look at homelessness as a societal rather than an individual problem.
When discussing homelessness, it is vital to attempt to identify those who fit into this category. Because of the nature of being homeless, that is not having a residence, it is difficult to know the exact numbers and demographics of those who are homeless. As of 1992, the possible numbers of homeless people in the United States ranges from a low of 250,000 to high of 3 million (Hombs, 1994). Drawing further from Hombs (1994) work, th homeless population is composed of seventy-three percent single adult men, eleven percent single women, two percent youth, and thirty-two percent familes with children. Fifty-two percent of all homeless people are African-American while thirty-three percent are white, eleven percent are Hispanic, three percent are Native American, and one percent are Asian. Contrary to what most people believe, the plight of homelessness is not one that merely plagues people of color. A significant amount of white people are homeless, as well. The average amount of time that people are homeless ranges from two months to one year (Hombs, 1994). The typical homeless family in the 90s consists of a minority woman who is a single mother with one to two children. In addition, this single mother with children is most likely on welfare or works at a minimum wage job (Seltser & Miller, 1993).
As mentioned previously, homelessness is caused by a number of complex issues that are prevalent in our society. Since the 1980s, homelessness has steadily been on the rise to such an extent that those in both urban and rural communities can no longer ignore it (Hombs, 1994). Additionally, the economic recession that lasted from 1981 to 1982 had a severe impact on the nature of homelessness in the United States. Shelters and soup kitchens, for example, reported drastic increases in the use of their services during those years (Burt, 1992). The recession only played a part in a larger scheme, however, that set the stage for a progressive trend of increasing homelessness.
Although economic conditions improved in 1983, the numbers of homeless in the United States continued to grow. In 1984, there were approximately 250,000 to 300,000 homeless people, but by 1987, there were 500,000 to 600,000 (Burt, 1992). This increase cannot be decisively linked to merely one cause, but a number of causes.
The availability of affordable housing, for instance, severely decreased in the 1980s. Not only were more people forced to rent rather than buy housing, but a significant amount of SRO's (Single Room Occupancies) were eliminated. In Chicago, some 18,000 SRO units were lost or converted between 1973 and 1984. This problem was compounded by spiraling rents while the income of the renters was decreasing. In addition, programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI) failed to adjust for inflation. People who were already receiving benfits, such as those suffering from mental illness or chemical dependency, noticed a marked decrease in their existing benefits. In essence, the growth of homelessness in the eighties was caused by the recession, unemployment, population growth, changes in social insurance programs, certain Reagan Administration policies, lack of affordable housing, and personal problems such as mental illness and alcoholism (Burt, 1992). The many factors of the eighties played a significant part in shaping homelessness in the nineties.
In a city as large as Chicago, homelessness is an ever-present problem. Every day we walk down the street, we are reminded of those without food, money, or homes. Yet, often we do not know how to respond to those who ask for money. Some may think that giving money is the best solution while others simply do not care, or do not have the time to deal with people begging in the streets. The dire situation that many find themselves in, however, is not one in which any person is completely exempt from.
The research that will be conducted is not going to focus on homelessness in general, but specifically on panhandling. The term panhandler was coined as far back as 1874 during a time of severe homelessness that was occurring in New York City (Russell, 1991). Therefore, it is not as if panhandling is a contemporary phenomenon; it is obviously something that has been a prevalent probelm in this country for a significant amount of time.
Panhandlers request money or food for nothing in return. The interaction between the panhandler and the potential donor is not a communication-based event that has been studied very extensively. This investigation will focus on the reaction of the reciever, or the potential donor, rather than the source of the message, or the panhandler.
In this study, the interpersonal communication of panhandling will be assessed in terms of compliance-gaining. The interaction between a panhandler and a potential donor is influenced by a number of different factors. Compliance-gaining has to do with a person's willingness to respond to the request being made (Grant, King, & Behnke, 1994). In essence, in this study's context, compliance would mean that the potential donor would directly respond to the request being made by the panhandler. A positive response would include a donation or even acknowledgment of the panhandler's existence and humanity. Coversely, a negative response would either be verbal abuse by a potential donor or complete ignorance of the panhandler's presence. Often, however, situations do not work that smoothly and people respond to panhandlers on a variety of levels. This occurs for a number of different reasons, but this study will focus directly on the variables of request legitimacy, verbal behavior, and non-verbal behavior.
As Searle (1979) notes, request legitimacy, "gives the influencer the right to make the request, and obligates the influencee to comply with the request" (cited in Hirokawa, Mickey, & Miura, 1991, p.425). Whether a panhandler possesses legitimacy depends upon the way in which a potential donor perceives him/her. The question then becomes: does the panhandler have the right to make the request? This right is influenced by verbal and non-verbal behaviors. Some verbal behaviors that have an impact on the outcome of the interaction are verbal aggression, persuasion, defense mechanisms, direct or indirect requests, and the potential donor's negativeness or argumentativeness. In addition, non-verbal behaviors such as race, biological sex, gaze, touch, proximity, and dress all relate to a potential donor's willingness to comply.
The communication between potential donors and panhandlers has important implication for finding more effective solutions to the homeless problem in this city. Currently, the outcome of the lack of communication leaves many potential donors perplexed as to how they should respond to panhandlers. As Seltser and Miller (1993) argue, "Just as we are tempted to cross to the other side of the street when confronting a destitute person who might make some demand on us, so we may avert out attention from the social and economic factors that create homelessness" (p.x). If homelessness was merely an individual problem, ther would not be 250,000 to 3 million homeless people in our country. Seltser and Miller (1993) recognize that we need to, "break down the barriers to understanding and compassion" (p.xi). Through this research, ideally, we will have a better understanding of the reasons why potential donors are willing or unwilling to help panhandlers.
Rationale Section
People make requests for many reasons and do so in a variety of different ways. Persuasive request situations are familiar events in everyday life, particularly for panhandlers. The ability to effectively get what one wants from other people, in this case money, is a hightly important communicative skill. The nonverbal and verbal messages that panhandlers use to elict a donation could ultimately decide whether a donation will be given.
When researching the interactions between panhandlers and potential donors, little evidence was available that examined relevant messages or meanings. The evidence that was known, and supported, were the empirical findings that indicated homelessness would continue to be a problem. In this paper, the present author will demonstrate the prevalence of the homeless, an analysis of the homeless population, the need for further research, and the benefits of such research. Panhandling and homelessness are important issues for individuals, families, and society. Without an understanding of the homeless, and what they have to do to survive, individuals only worsen the communication problems that already exist between panhandlers and society.
How many people in America are homeless? This seemingly simple question is extremely difficult to answer. In an attempt to record the number of homeless individuals, researchers are faced with formidable problems when trying to gather data. For instance, there is the problem of missing people when estimating, counting individuals twice, and miscalculating the number of homeless on the streets. These estimates also do not take into account the "near homeless," that is, individuals who are a paycheck away from living on the streets.
With regard to the number of homeless that are said to exist, the U.S. Department of Housing and Urban Development estimates that there are between 250,000 and 350,000 homeless individuals in the United States (Simon, Whitbeck, & Bales 1989, p.482). Other research conducted by Vacha and Marin estimate that the homeless population is as high as 3 million (1994). Although the debate over the number of homeless continues, there is little evidence to suggest that there has been a substantial decline in the homeless population during the 1990s.
The 90s have been a time when economic recessions, welfare reforms, job lay-offs, and downsizing are all too familiar. Homelessness is on the rise in both urban and rural communities. According th Vacha and Marin (1994), "one out of six low-income households seeking energy assistance were currently sheltering people who would otherwise be forced to live outdoors or in homeless shelters." Thus, many of those who are very poor have been able to avoid literal homelessness through the generosity of family, friends, and strangers. Conditions in the economy fluctuate; however, a recent analysis has described the Midwestern economy as, "losing some momentum" (Gruber, 1997). More than ever, individuals and families are having financial difficulties. These financial difficulties can lead to homelessness, which presents a very real and urgent problem to us all; much more severe than the American public may care to admit.
If the American public wants additional proof that there is a homelessness problem, all they should do is observe the characteristics of the homeless. Stereotypical representations of the homeless once consisted of older males with alcohol problems, who weren't willing to work. Today, the homeless population enccompass a much more diverse group of individuals. The homeless population now embodies young people, women, families, and individuals who do not have substance abuse problems (Simons, Whitbeck & Bales 1992, p.483). As one can ascertain, homelessness is no longer an individual or family problem. Indeed, it is a problem for all of society.
Surely society will have to acknowledge the fact that when the poor are no longer able to meet monthly bill payments, help is required. When the money for food and housing costs is not available, and when government assistance is not enough, the poor will be forced to request monetary assistance from another source, namely society. These people who are forced to ask for money from strangers, from society, are referred to as panhandlers. When panhandlers ask for money, potential donors respond to the interaction in a variety of ways.
Although the problem causing homelessness are significant issues, the focal point of this research is to better understand the variety of interactions that occur between potential donors and the homeless. This study will address the reactions of potential donors, and how the interactions with panhandlers affect compliance-gaining tactics. As noted previously, little is known about the interaction that occurs between panhandlers and potential donors. Continued research on the interaction between the panhandlers and potential donors could be beneficial since every individual, at one poit in his/her life, will be asked for money.
The study will also add to prior research on interpersonal communication and our understanding of the communication obstacles faced in compliance-gaining tactics. Such obstacles are the nonverbal and verbal messages that panhandlers employ. This research seeks to show that the various nonverbal and verbal tactics used by panhandlers, does in some manner, influence whether a donation will be given. Ideally, our research will not only lessen the anxiety that potential donors may feel, buts also help them make informed decisions about yielding to the requests of panhandlers. Perhaps the most important pragmatic benefit of this research will be the elimination of the destructive manner in which most potential donors deal with panhandlers.
In particular, if potential donors could become aware of the impact of their verbal and nonverbal messages, and communicate with sensitivity, it would help to "humanize" interaction with the panhandler. Humanizing communication between panhandlers and potential donors could be likely to bolster their respective self-images. Perhaps having a more positive self-image, panhandlers would feel less alienated by society. Incorporation into society thus requires the ability to communicate. For successful communication to occur with the panhandler, the potential donor has to be conscientious about the way they react to the monetary request.
In most instances, potential donors are not conscientious, and ignore the request completely. To avoid confrontation, many potential donors do not even establish eye contact, or give an explanation why they cannot help. What potential donors do not take into consideration, is the interpretation of the nonverbal messages they send to panhandlers.
Disconfirming nonverbal communication such as, angry facial expressions, alienating gestures, and dismissive eye behavior, attacks one's self-image. By ignorning panhandlers, the potential donors are viewing them as "nonhuman." Viewing someone as 'nonhuman' is engaging in object communication. According to Kreps (1986), object communication, "is insensitive and demonstrates the communicator's lack of respect for the other person" (p.36).
Object communication helps the receiver of a message, in this case the panhandler, feel unimportant and unintelligent. Ignoring the panhandler's monetary request leaves the panhandler affected with a range of negative emotions including: feelings of inadequacy, humiliation, hoplessness, despair, and depression (Infante, Riddle, Horvath, & Tumlin, 1992). Clearly, having to rely on monetary donations for survival is not a pleasant experience. Having potential donors treat panhandlers in a dehumanizing manner only damages the self-image of panhandlers to a greater degree.
One reason potential donors treat panhandlers as an object is because they view panhandlers in a negative way. All too often, many potential donors tend to believe that all panhandlers are lazy and untrustworthy. Another reason potential donors have a difficult time donating is because they do not believe the legitimacy of the request. Many potential donors believe that the money will only be used for alcohol or drugs.
Others believe that panhandlers are dangerous and dirty persons who have problems living in normal society. To remove themselves from any moral obligations to comply, potential donors are of the opinion that panhandlers are not members of society, but a problem to society. The panhandlers' failure to support
oneself is a personal problem; therefore, it should not involve the assistance of society. By not granting the monetary request, or acknowledging the existence of panhandlers, potential donors are lessening their degree of responsibility towards those less fortunate.
For example, in an ethnographic study of homelessness conducted by an anthropologist, one woman on a subway, after denying a monetary request made by a panhandler, commented, "It's a shame, in a rich country like ours, that we cannot take better care of the poor" (p.26). Another potential donor commented, "giving money to such people encourages them to 'pollute' the train with their noise (monetary request)" (p.26). A large part of society apparently believes that homeless are a burden; a feeling that only worsens the communication between the two.
How people view panhandlers is a significant indicator for how the panhandler feels about him/herself. Verbal attacks against panhandlers such as ridicule, physical appearance attacks, and demeaning references are hazardous to the psychological state of panhandlers (Ifert & Roloff, 1994). Constant denials of a request leaves a panhandler questioning his/her self-worth. Questioning their self-worth, panhandlers can become angry at being treated as an abject instead of a human being. As frustration mounts, aggressive and destructive forms of communication are likely to occur. This form of offensive communication can affect the panhandlers' nonverbal and verbal message requests toward potential donors.
To avoid offensive communication, and to 'humanize' communication, potential donors need to communicate personally. To communicate personally, the potential donor needs to take into some account the feelings and position of the panhandler. The practical application of personal communication will enable potential donors to become informed citizens capable of acting in a morally conscientious manner toward panhandlers who share the identity of "fellow citizen" (Williams, 1995).
Viewing panhandlers somewhat like onself, potential donors will better understand how to react to panhandlers in a manner that does not inflict, or further the pain and rejection they already feel. As Grant, King, & Behnke (1994) state, "pro-social rewarding strategies will prove more effective than anti-social punishing strategies" (p.100). Rewarding strategies, such as acknowledging the panhandlers' existence, could aid the interction with the poor.
Adopting a 'pro-social' attitude whe making decisions could allow potential donors to better understand whether or to whom to give money. When potential donor comprehend what the proper social interactions with panhandlers are, they do not have to feel guilt about his/ her decisions. Perceiving panhandlers as human, and not as abject, allows potential donors to understand what must be done, why it must be done, and that the exchange can be positive; whether money is given or not.
Accommodating to the requests of a panhandler, or at least acknowledging the request of a panhandler, is a self-conscious moral and political act. By giving money, donors often feel that they have regained control of their "space" -- physical and ideological -- by paying panhandlers to "move on" (Williams, 1995). Many potential donors also feel that they should pity the panhandlers; therefore, a donation should be given. To receive these donations, panhandlers develop ways of helping others identify with their plight. For example, a homeless woman explains to potential donors that the money will be used to feed her hungry children. Potential donors then sympathize and empathize with the panhandler by giving her their spare change. Even if money isn't given, the interaction can still be positive; especially if the donor engages in personal communication.
One manner panhandlers have identified with potential donors is by "bridging the gap" between themselves and society. By referring to their humanness, (I am a human being) and theri humanity ( I am not trying to hurt anyone), panhandlers become individuals, not objects. The potential donor views the panhandler as another human, who at the moment, is hard-pressed and in need of assistance. To encourage assistance, panhandlers try to evoke and play on individuals' sympathies. To evoke compassion, potential donors present themselves in a fashion that associates the donor with the panhandlers's dilemma. Donors sustain the belief that "except for the grace of God, that could be me."
By giving money as a cheap means of providing assistance to the panhandler, potential donors are helping themselves handle guilt. Guilt of knowing that they are responsible, as individuals, for the quality of life in our society. Individuals also are likely to recognize that they have very little control over the quality of life. Potential donors have concerns, like those of our fellow citizenns, that require compassion and morally acceptable actions that will aid the quality of life in which someone lives. Through personal communication, and conscientious decisions, both the panhandler and potential donor can successfully communicate with one another. Successful communication between both parties, as Kreps (1986) states, "opens you up to be influenced by what the other person has to say" (p.37).
Rationale : Theory-Based Benefits
Dean Kurth
By studying the communication between panhandlers and potential donors, the opportunity is presented to extend our knowledge of verbal and nonverbal compliance-gaining strategies. The study proposed should provide information that will benefit communication theory by increasing the generalizability of other compliance-gaining theories. The theoretical benefits of the study are threefold.
First, the study will be characterized by a limited scope, validity, and simplicity. The scope of the study will be limited in that it will focus on potential donors' perceptions and willingness to comply based on verbal and nonverbal solicitations. For example, subjects will be asked to indicate to what degree they will or will not comply with a request based on a panhandler's choice of words. The race or sex of panhandlers are nonverbal factors will also be considered to determine potential donors' willingness to comply. In studying compliance-gaining. Wilson, Cruz, and Kang (1992) noted, " individual differences should have important implications for people's interpretation and message choices during interaction" (pp.350-351). Every potential donor is influenced to comply, or to deny a request, by their personal biases. One potential donor may be particularly ignorant to the predicament of a panhandler, while another potential donor may be extremely sympathetic and compassionate. By measuring potential donor's willingness to comply based on individual factors that influence compliance-gaining, a better understanding of the communication between panhandlers and potential donors should be obtained.
Second, previous studies have focused on the many facets of compliance-gaining strategies. The current study will expand upon the findings of several of these studies. For example, compliance-gaining studies have been conducted to focus on the interaction between various specified groups other than panhandlers and potential donors. Boster, Rodriguez, and Marshall (1995) examined the compliance-gaining strategies between friends and strangers. 64 college students were used as subjects in the study. 32 of the subjects were close friends of some of the experiementers. Subjects received either a direct request to purchase a raffle ticket or received the request after having a favor done for them by the person asking. the subjects were given the requests by both their friends and people whom they had never met. The results of the study showed that subjects were more likely to comply with requests from friends. Among strangers, requests preceded by favors produced more compliance than direct requests (Boster et al., 1995). The results provide a foundation point for the present study. For example, if people are more likely to donate to friends, are they also more likely to give to those that are similiar to them in appearance? What types of messages conveyed during requests influence a potential donor? The present study can benefit from the Boster et al. research and other research like it. Previous findings can be built upon by seeking data which addresses similar types of questions, but in regards to compliance-gaining.
The third benefit of the study includes the communicative and inspirational characteristics of the study. By either confirming or rejecting whether or not verbal and nonverbal behaviors are factors in compliance-gaining situations involving panhandlers, the study can motivate future compliance-gaining research. Previous studies have been concerned with compliance-gaining aspects such as strategies, situational variation, resistance, and individual differences. Their findings have been employed to formulate other theories and research studies. The present study has the potential to do the same by focusing on a communication phenomenon that most people experience. The topic is a meaningful one because it concerns many people. The study will be an opportunity to educate those unfamiliar and those interested in learning more about the verbal and nonverbal behaviors as they influence communications between potential donors and panhandlers.
Clearly, the communication between panhandlers and potential donors in worthy of study by scholars and public alike. By examining verbal and nonverbal behaviors of panhandlers the occasion to increase generalizability is created. The justification of the study is increased by the theoretical benefits stated above.
Nicola S. Caso
Lit Review
Nursing is a very important profession; today more than ever. Due to recent developments in medicine, large numbers of individuals are living longer, fuller lives. Thus, there is a demand for nurses who can successfully treat the spirit as well as the body. Nurses have always been at the vanguard in terms of communication skills and empathic manner to achieve a more positive interaction with their patients.
Today, associate and bachelor degrees are favored rather than nursing school diplomas. New drugs and scientific innovations allow those in the medical profession to save the lives of many individuals who would have had no hope twenty years ago. Nurses must be ever ready and able to accept the challenges and responsibilities that advancements in technology bring. As Curtin, (1996) reports, "We've seen tremendous advances in technology and pharmacology, which have given nurses more responsibility, and require even deeper levels of knowledge. We're involved in more decision making and are faced with ethical issues we've never confronted before, such as those swirling around gene therapy" (p. 33). These new duties nurses face in the nineties have given them a renewed sense of confidence and pride in their work, and has also led to the development of nursing specialties.
Unfortunately, however, as more hospitials are cutting costs, many nurses are being laid off and replaced by nurses aides and nurse technicians. Gilliland reports, "Nurse executives, expected to decrease expenses, resort to cutting RN positions . . .With six weeks or less of training, unlicensed assistive personnel are supposed to take the RN's place at the bedside!" (1997, p.320). Further, nurses who do remain on staff are overloaded with patients. The result is often inadequate patient care and frenzied employees, which can have deadly results. A 1998 survey of nurses by RN magazine states "72% of respondents report that the quality of care at their hospital has deteriorated over the past year because of cost-containment decisions, a 12% jump since 1988" (Cited in Wolfe, 1999, p. 28; actual sample size is not reported).
Thankfully, legislation is now being passed in some states to protect nurses; those who speak out against dangerous conditions cannot be threatened with termination. Also, nurses' unions have won the right to decide nurse-patient ratios in contract negotiations. According to Kunen, unions and consumer groups have put forth propositions which "would require the state to enforce minimum staffing levels for licensed personnel at all medical facilities and would protect whistle-blowing health-care workers from being fired" (p.56). Administrations and staff are slowly finding a way to work together to find solutions to budget woes without compromising care. "Busy work" is being done away with and wasteful expenses are cut instead of nurses (Gilliland, 1997, p.322).
Nurses must accomplish several goals when interacting with patients, such as understanding, agreement, and action (Sherman, 1994, p. 8). All of these goals are directly related to a nurse's communication skills. Further, the way nurses communicate with patients has evolved. Usually, nurses work very close to patients and therefore are more likely to develop emotionally-involved relationships. This bond is key because it is a nurse's job to carry out what the doctor has requested and patient compliance is crucial. By becoming familiar with each patient on a somewhat personal level, nurses can encourage them to feel more at ease which in turn leads to improved attitudes and greater compliance. According to Sherman (1994), the best way to establish and maintain a positive nurse-patient relationship is through two-way or transactional communication: "Two-way communication allows and expects the reciever to give feedback and become actively involved ... It is an active process in which the sender is able to check the reciever's understanding of the message" (p.12). This flow of conversation is called interaction. By using reassuring language as well as nonverbal cues (appropriate, meaningful eye contact and non-defensive body language), nurses can achieve the best interaction possible. It is also paramount for nurses to be aware of "metamessages," which convey the thoughts and feelings behind what someone is saying. For example, paraphrasing from Sherman (1994, p.20), an irritable and listless patient is bellowing that he/she needs a "proper" nurse. A nurse who is not tuned to the metamessage may come away from the situation feeling hurt and angry. However, a nurse who is aware of the intent behind the message would understand that the patient is feeling frustrated and helpless. Lashing out and displacing his/her feelings gives some comfort and release. Being attuned to metamessages provides a greater insight into how the patient is feeling, and allows the nurse to react accordingly.
Sometimes, there is a disruption in communication, which can be quite serious if not detected early. It is critical for nurses to keep the doctor up-to-date on any and all details of a patient's condition. Failing to relay information of a patient's condition. Failing to relay information in its entirety can result in deadly complications. As Sullivan (1996) states, "Prudence should always guide your [the nurse's] communications [ is not referring to mass media]. That, and a willingness to err on the side of caution when speaking directly with patients or members of the health care team: Better too much communication than not enough" (p.64).
The nursing profession is quite a difficult one; not only must they keep [maintain] order and control while carrying out doctors' instructions, their first priority is the patients. Nurses, as stated by Adams (1998), are the "only licensed health-care professionals at a patient's bedside 24 hours a day" (p.17). It is a nurse's duty to treat and attend to patients, to maintain if possible high comfort and compliance levels, as well as fear and pain levels low. Hence a nurse's main job is to care. Most individuals are caring; however, nurses have raised this idea to its highest form. As Brykcznska (1997) cogently argues: "Caring in nursing practice is a core concept, because it concerns a fundamental aspect of nursing. Without the presence of a wise, caring, compassionate approach to the delivery of nursing, the nursing tasks would be seen as faulted. Without caring, nursing would represent an incomplete or even disingenuous and non-effacious picture of what it is about. It would be nursing without its soul" (p.1).
At the heart of a nurse's care for his/her patients is empathy. As Sherman (1994) suggests, "Empathy is actually the use of several behaviors. It involves the ability to be sensitive to the feelings of others, the ability to explore feelings while expressing sympathetic understanding, and the act of caring in a nurturing way" (p. 52). When one is empathic it goes far beyond feeling sorry for someone's situation, he/she provides comfort and a place of healing. An empathic nurse, through opening hi/herself up to the feelings of a patient, shares control and allows the patient to be candid.
The comfort a patient feels due to an empathic nurse is very beneficial, not merely for gathering information, but it truly helps the healing process. Establishing a bond between patient and nurse can instill hope. In several medical settings, hope has been indispensible in helping patients to become healthy and stay that way, as well as cope with a devastating illness. Having empathy for a patient also is a sign of respect in identifying with patient concern and attending to them. Again from Sherman (1994), "The empathic nurse is able to establish a more accurate understanding of a patient by tuning in to the patient's frame of reference. Empathy also allows for greater rapport by keeping channels open for patients to express their concerns and feelings" (p.53). Thus, empathy can lead to greater patient satisfaction, can facilitate rapport building between patients and nurses and can be therapeutic.
A number of studies have attempted to document patients' response to nurses who employ empathy. although they cannot say with absolute certainty that empathic nurses acquire a substantially positive response from patients, many agree that empathic care is important in order to treat the "whole" person. In a 1987 study done by LaMonica, Wolf, Madea, and Oberst, nurse empathy levels and their impact upon patients suffering from cancer were assessed (Allen, 1994, p.97). Specific emotions, such as depression, anxiety, hostility, and care satisfaction were targeted in the hopes that they would either decrease or increase, respectively, with empathic care. Nurses were instructed in how to properly treat patients empathically, and their levels of empathy were measured before and after training. "The patient subjects showed significant decreases in anxiety and hostility and nonsignificant differences in the predicted direction for depression and satisfaction with care . . . The changes in patients were judged to have considerable clinical significance" (Allen, 1994, p. 98).
In a similar study done by Schirm and Fennell (1991), which is documented by Allen (1994,), the empathy of nurses who cared for elderly patients in their homes was investigated as well as its effect upon the "strain" of family caregivers. The family of a very ill individual often suffers tremendous stress in caring for him/her. "Home health nurses rated with the ECRS [Empathy Construct Rating Scale] were highly empathic, although the correlation between empathy and family caregiver strain was not significant" ( p.99). The nureses' performance, gauged according to the ECRS, determines received empathy in the realm of patient care.
Further, nurses who display an interest in what their patients have to say and foster patient involvement brings about a dramatic impact upon the content and quality of a patient's response. Such a finding, according to Kreps and O'Hair (1995), "suggests that patients are more active, expressive, and assertive when providers are supportive, interested in the patient's concerns , and actvely encourage the patient's participation in the consultation" (p.101). Nurses who exhibit a "patient-centered" approach to their bedside care and consultation have gained a greater insight into the patients' thoughts and feelings; patients also seem to play a larger role in decision-making when interacting with a concerned, thoughtful nurse.
Finally, reassurance is a key element in promoting high levels of patient involvement and interaction. Reassuring an individual, however, must be performed in the correct manner. A nurse should ease concerns by educating the patient as to what is going on around him/her. It is not enough to simply tell them not to worry. As stated by Ray and Donohew (1990), " In a related study, Buchsbaum (1986) argued that the goals of reassurance should include not only restoring his or her sense of autonomy. [S]uccessful reassurance rests more on communicative ability than on understanding of human pathology" (p.41).
Without nurses, we certainly would not have the quality of health care that exists in our society today. Nurses are truly the "heart and soul"of the medical profession, and it is their gift of caring that makes a major and dramatic difference. As Gaut and Boykin (1994) suggest, "The core of nursing is caring -- a deep human and professional communion. The idea of caring is to alleviate suffering in a spirit of 'caritas,' i.e., in faith, hope, and love (p.14).
Intro Section
Throughout history, the plight of poor has been a constant and increasingly complex problem. there have always been poor people, there are poor people now, there will always be those who live in poverty. In cities all over the United States, homelessness is a visible component of poverty. Often when people think of homelessness, they instantly assume that the homeless are those who cannot or refuse to work. Unfortunately, this is not the case. In Chicago alone, there are 173, 295 families that fall into the category of working poor. They generally work thirty-five hours a week for fifty weeks out of the year (Knowles, 1997). Many of these families, however, continue to struggle to make ends meet. In addition, often those who are working poor are not eleigble for health care and benefits, which either becomes a cause or an effect of homelessness. In general, private health care is much too expensive for the working poor and as a result, "on;y one in five poor, non-elderly americans and one in two of the near-poor are covered by private insurance" (Rosenthal, 1994). The glaring lack of national health care in America becomes yet another problem for those who are struggling to maintain housing or for those already homeless. The fact that those who are working cannot escape poverty and homelessness forces us to look at homelessness as a societal rather than an individual problem.
When discussing homelessness, it is vital to attempt to identify those who fit into this category. Because of the nature of being homeless, that is not having a residence, it is difficult to know the exact numbers and demographics of those who are homeless. As of 1992, the possible numbers of homeless people in the United States ranges from a low of 250,000 to high of 3 million (Hombs, 1994). Drawing further from Hombs (1994) work, th homeless population is composed of seventy-three percent single adult men, eleven percent single women, two percent youth, and thirty-two percent familes with children. Fifty-two percent of all homeless people are African-American while thirty-three percent are white, eleven percent are Hispanic, three percent are Native American, and one percent are Asian. Contrary to what most people believe, the plight of homelessness is not one that merely plagues people of color. A significant amount of white people are homeless, as well. The average amount of time that people are homeless ranges from two months to one year (Hombs, 1994). The typical homeless family in the 90s consists of a minority woman who is a single mother with one to two children. In addition, this single mother with children is most likely on welfare or works at a minimum wage job (Seltser & Miller, 1993).
As mentioned previously, homelessness is caused by a number of complex issues that are prevalent in our society. Since the 1980s, homelessness has steadily been on the rise to such an extent that those in both urban and rural communities can no longer ignore it (Hombs, 1994). Additionally, the economic recession that lasted from 1981 to 1982 had a severe impact on the nature of homelessness in the United States. Shelters and soup kitchens, for example, reported drastic increases in the use of their services during those years (Burt, 1992). The recession only played a part in a larger scheme, however, that set the stage for a progressive trend of increasing homelessness.
Although economic conditions improved in 1983, the numbers of homeless in the United States continued to grow. In 1984, there were approximately 250,000 to 300,000 homeless people, but by 1987, there were 500,000 to 600,000 (Burt, 1992). This increase cannot be decisively linked to merely one cause, but a number of causes.
The availability of affordable housing, for instance, severely decreased in the 1980s. Not only were more people forced to rent rather than buy housing, but a significant amount of SRO's (Single Room Occupancies) were eliminated. In Chicago, some 18,000 SRO units were lost or converted between 1973 and 1984. This problem was compounded by spiraling rents while the income of the renters was decreasing. In addition, programs such as Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI) failed to adjust for inflation. People who were already receiving benfits, such as those suffering from mental illness or chemical dependency, noticed a marked decrease in their existing benefits. In essence, the growth of homelessness in the eighties was caused by the recession, unemployment, population growth, changes in social insurance programs, certain Reagan Administration policies, lack of affordable housing, and personal problems such as mental illness and alcoholism (Burt, 1992). The many factors of the eighties played a significant part in shaping homelessness in the nineties.
In a city as large as Chicago, homelessness is an ever-present problem. Every day we walk down the street, we are reminded of those without food, money, or homes. Yet, often we do not know how to respond to those who ask for money. Some may think that giving money is the best solution while others simply do not care, or do not have the time to deal with people begging in the streets. The dire situation that many find themselves in, however, is not one in which any person is completely exempt from.
The research that will be conducted is not going to focus on homelessness in general, but specifically on panhandling. The term panhandler was coined as far back as 1874 during a time of severe homelessness that was occurring in New York City (Russell, 1991). Therefore, it is not as if panhandling is a contemporary phenomenon; it is obviously something that has been a prevalent probelm in this country for a significant amount of time.
Panhandlers request money or food for nothing in return. The interaction between the panhandler and the potential donor is not a communication-based event that has been studied very extensively. This investigation will focus on the reaction of the reciever, or the potential donor, rather than the source of the message, or the panhandler.
In this study, the interpersonal communication of panhandling will be assessed in terms of compliance-gaining. The interaction between a panhandler and a potential donor is influenced by a number of different factors. Compliance-gaining has to do with a person's willingness to respond to the request being made (Grant, King, & Behnke, 1994). In essence, in this study's context, compliance would mean that the potential donor would directly respond to the request being made by the panhandler. A positive response would include a donation or even acknowledgment of the panhandler's existence and humanity. Coversely, a negative response would either be verbal abuse by a potential donor or complete ignorance of the panhandler's presence. Often, however, situations do not work that smoothly and people respond to panhandlers on a variety of levels. This occurs for a number of different reasons, but this study will focus directly on the variables of request legitimacy, verbal behavior, and non-verbal behavior.
As Searle (1979) notes, request legitimacy, "gives the influencer the right to make the request, and obligates the influencee to comply with the request" (cited in Hirokawa, Mickey, & Miura, 1991, p.425). Whether a panhandler possesses legitimacy depends upon the way in which a potential donor perceives him/her. The question then becomes: does the panhandler have the right to make the request? This right is influenced by verbal and non-verbal behaviors. Some verbal behaviors that have an impact on the outcome of the interaction are verbal aggression, persuasion, defense mechanisms, direct or indirect requests, and the potential donor's negativeness or argumentativeness. In addition, non-verbal behaviors such as race, biological sex, gaze, touch, proximity, and dress all relate to a potential donor's willingness to comply.
The communication between potential donors and panhandlers has important implication for finding more effective solutions to the homeless problem in this city. Currently, the outcome of the lack of communication leaves many potential donors perplexed as to how they should respond to panhandlers. As Seltser and Miller (1993) argue, "Just as we are tempted to cross to the other side of the street when confronting a destitute person who might make some demand on us, so we may avert out attention from the social and economic factors that create homelessness" (p.x). If homelessness was merely an individual problem, ther would not be 250,000 to 3 million homeless people in our country. Seltser and Miller (1993) recognize that we need to, "break down the barriers to understanding and compassion" (p.xi). Through this research, ideally, we will have a better understanding of the reasons why potential donors are willing or unwilling to help panhandlers.
Rationale Section
People make requests for many reasons and do so in a variety of different ways. Persuasive request situations are familiar events in everyday life, particularly for panhandlers. The ability to effectively get what one wants from other people, in this case money, is a hightly important communicative skill. The nonverbal and verbal messages that panhandlers use to elict a donation could ultimately decide whether a donation will be given.
When researching the interactions between panhandlers and potential donors, little evidence was available that examined relevant messages or meanings. The evidence that was known, and supported, were the empirical findings that indicated homelessness would continue to be a problem. In this paper, the present author will demonstrate the prevalence of the homeless, an analysis of the homeless population, the need for further research, and the benefits of such research. Panhandling and homelessness are important issues for individuals, families, and society. Without an understanding of the homeless, and what they have to do to survive, individuals only worsen the communication problems that already exist between panhandlers and society.
How many people in America are homeless? This seemingly simple question is extremely difficult to answer. In an attempt to record the number of homeless individuals, researchers are faced with formidable problems when trying to gather data. For instance, there is the problem of missing people when estimating, counting individuals twice, and miscalculating the number of homeless on the streets. These estimates also do not take into account the "near homeless," that is, individuals who are a paycheck away from living on the streets.
With regard to the number of homeless that are said to exist, the U.S. Department of Housing and Urban Development estimates that there are between 250,000 and 350,000 homeless individuals in the United States (Simon, Whitbeck, & Bales 1989, p.482). Other research conducted by Vacha and Marin estimate that the homeless population is as high as 3 million (1994). Although the debate over the number of homeless continues, there is little evidence to suggest that there has been a substantial decline in the homeless population during the 1990s.
The 90s have been a time when economic recessions, welfare reforms, job lay-offs, and downsizing are all too familiar. Homelessness is on the rise in both urban and rural communities. According th Vacha and Marin (1994), "one out of six low-income households seeking energy assistance were currently sheltering people who would otherwise be forced to live outdoors or in homeless shelters." Thus, many of those who are very poor have been able to avoid literal homelessness through the generosity of family, friends, and strangers. Conditions in the economy fluctuate; however, a recent analysis has described the Midwestern economy as, "losing some momentum" (Gruber, 1997). More than ever, individuals and families are having financial difficulties. These financial difficulties can lead to homelessness, which presents a very real and urgent problem to us all; much more severe than the American public may care to admit.
If the American public wants additional proof that there is a homelessness problem, all they should do is observe the characteristics of the homeless. Stereotypical representations of the homeless once consisted of older males with alcohol problems, who weren't willing to work. Today, the homeless population enccompass a much more diverse group of individuals. The homeless population now embodies young people, women, families, and individuals who do not have substance abuse problems (Simons, Whitbeck & Bales 1992, p.483). As one can ascertain, homelessness is no longer an individual or family problem. Indeed, it is a problem for all of society.
Surely society will have to acknowledge the fact that when the poor are no longer able to meet monthly bill payments, help is required. When the money for food and housing costs is not available, and when government assistance is not enough, the poor will be forced to request monetary assistance from another source, namely society. These people who are forced to ask for money from strangers, from society, are referred to as panhandlers. When panhandlers ask for money, potential donors respond to the interaction in a variety of ways.
Although the problem causing homelessness are significant issues, the focal point of this research is to better understand the variety of interactions that occur between potential donors and the homeless. This study will address the reactions of potential donors, and how the interactions with panhandlers affect compliance-gaining tactics. As noted previously, little is known about the interaction that occurs between panhandlers and potential donors. Continued research on the interaction between the panhandlers and potential donors could be beneficial since every individual, at one poit in his/her life, will be asked for money.
The study will also add to prior research on interpersonal communication and our understanding of the communication obstacles faced in compliance-gaining tactics. Such obstacles are the nonverbal and verbal messages that panhandlers employ. This research seeks to show that the various nonverbal and verbal tactics used by panhandlers, does in some manner, influence whether a donation will be given. Ideally, our research will not only lessen the anxiety that potential donors may feel, buts also help them make informed decisions about yielding to the requests of panhandlers. Perhaps the most important pragmatic benefit of this research will be the elimination of the destructive manner in which most potential donors deal with panhandlers.
In particular, if potential donors could become aware of the impact of their verbal and nonverbal messages, and communicate with sensitivity, it would help to "humanize" interaction with the panhandler. Humanizing communication between panhandlers and potential donors could be likely to bolster their respective self-images. Perhaps having a more positive self-image, panhandlers would feel less alienated by society. Incorporation into society thus requires the ability to communicate. For successful communication to occur with the panhandler, the potential donor has to be conscientious about the way they react to the monetary request.
In most instances, potential donors are not conscientious, and ignore the request completely. To avoid confrontation, many potential donors do not even establish eye contact, or give an explanation why they cannot help. What potential donors do not take into consideration, is the interpretation of the nonverbal messages they send to panhandlers.
Disconfirming nonverbal communication such as, angry facial expressions, alienating gestures, and dismissive eye behavior, attacks one's self-image. By ignorning panhandlers, the potential donors are viewing them as "nonhuman." Viewing someone as 'nonhuman' is engaging in object communication. According to Kreps (1986), object communication, "is insensitive and demonstrates the communicator's lack of respect for the other person" (p.36).
Object communication helps the receiver of a message, in this case the panhandler, feel unimportant and unintelligent. Ignoring the panhandler's monetary request leaves the panhandler affected with a range of negative emotions including: feelings of inadequacy, humiliation, hoplessness, despair, and depression (Infante, Riddle, Horvath, & Tumlin, 1992). Clearly, having to rely on monetary donations for survival is not a pleasant experience. Having potential donors treat panhandlers in a dehumanizing manner only damages the self-image of panhandlers to a greater degree.
One reason potential donors treat panhandlers as an object is because they view panhandlers in a negative way. All too often, many potential donors tend to believe that all panhandlers are lazy and untrustworthy. Another reason potential donors have a difficult time donating is because they do not believe the legitimacy of the request. Many potential donors believe that the money will only be used for alcohol or drugs.
Others believe that panhandlers are dangerous and dirty persons who have problems living in normal society. To remove themselves from any moral obligations to comply, potential donors are of the opinion that panhandlers are not members of society, but a problem to society. The panhandlers' failure to support
oneself is a personal problem; therefore, it should not involve the assistance of society. By not granting the monetary request, or acknowledging the existence of panhandlers, potential donors are lessening their degree of responsibility towards those less fortunate.
For example, in an ethnographic study of homelessness conducted by an anthropologist, one woman on a subway, after denying a monetary request made by a panhandler, commented, "It's a shame, in a rich country like ours, that we cannot take better care of the poor" (p.26). Another potential donor commented, "giving money to such people encourages them to 'pollute' the train with their noise (monetary request)" (p.26). A large part of society apparently believes that homeless are a burden; a feeling that only worsens the communication between the two.
How people view panhandlers is a significant indicator for how the panhandler feels about him/herself. Verbal attacks against panhandlers such as ridicule, physical appearance attacks, and demeaning references are hazardous to the psychological state of panhandlers (Ifert & Roloff, 1994). Constant denials of a request leaves a panhandler questioning his/her self-worth. Questioning their self-worth, panhandlers can become angry at being treated as an abject instead of a human being. As frustration mounts, aggressive and destructive forms of communication are likely to occur. This form of offensive communication can affect the panhandlers' nonverbal and verbal message requests toward potential donors.
To avoid offensive communication, and to 'humanize' communication, potential donors need to communicate personally. To communicate personally, the potential donor needs to take into some account the feelings and position of the panhandler. The practical application of personal communication will enable potential donors to become informed citizens capable of acting in a morally conscientious manner toward panhandlers who share the identity of "fellow citizen" (Williams, 1995).
Viewing panhandlers somewhat like onself, potential donors will better understand how to react to panhandlers in a manner that does not inflict, or further the pain and rejection they already feel. As Grant, King, & Behnke (1994) state, "pro-social rewarding strategies will prove more effective than anti-social punishing strategies" (p.100). Rewarding strategies, such as acknowledging the panhandlers' existence, could aid the interction with the poor.
Adopting a 'pro-social' attitude whe making decisions could allow potential donors to better understand whether or to whom to give money. When potential donor comprehend what the proper social interactions with panhandlers are, they do not have to feel guilt about his/ her decisions. Perceiving panhandlers as human, and not as abject, allows potential donors to understand what must be done, why it must be done, and that the exchange can be positive; whether money is given or not.
Accommodating to the requests of a panhandler, or at least acknowledging the request of a panhandler, is a self-conscious moral and political act. By giving money, donors often feel that they have regained control of their "space" -- physical and ideological -- by paying panhandlers to "move on" (Williams, 1995). Many potential donors also feel that they should pity the panhandlers; therefore, a donation should be given. To receive these donations, panhandlers develop ways of helping others identify with their plight. For example, a homeless woman explains to potential donors that the money will be used to feed her hungry children. Potential donors then sympathize and empathize with the panhandler by giving her their spare change. Even if money isn't given, the interaction can still be positive; especially if the donor engages in personal communication.
One manner panhandlers have identified with potential donors is by "bridging the gap" between themselves and society. By referring to their humanness, (I am a human being) and theri humanity ( I am not trying to hurt anyone), panhandlers become individuals, not objects. The potential donor views the panhandler as another human, who at the moment, is hard-pressed and in need of assistance. To encourage assistance, panhandlers try to evoke and play on individuals' sympathies. To evoke compassion, potential donors present themselves in a fashion that associates the donor with the panhandlers's dilemma. Donors sustain the belief that "except for the grace of God, that could be me."
By giving money as a cheap means of providing assistance to the panhandler, potential donors are helping themselves handle guilt. Guilt of knowing that they are responsible, as individuals, for the quality of life in our society. Individuals also are likely to recognize that they have very little control over the quality of life. Potential donors have concerns, like those of our fellow citizenns, that require compassion and morally acceptable actions that will aid the quality of life in which someone lives. Through personal communication, and conscientious decisions, both the panhandler and potential donor can successfully communicate with one another. Successful communication between both parties, as Kreps (1986) states, "opens you up to be influenced by what the other person has to say" (p.37).
Rationale : Theory-Based Benefits
Dean Kurth
By studying the communication between panhandlers and potential donors, the opportunity is presented to extend our knowledge of verbal and nonverbal compliance-gaining strategies. The study proposed should provide information that will benefit communication theory by increasing the generalizability of other compliance-gaining theories. The theoretical benefits of the study are threefold.
First, the study will be characterized by a limited scope, validity, and simplicity. The scope of the study will be limited in that it will focus on potential donors' perceptions and willingness to comply based on verbal and nonverbal solicitations. For example, subjects will be asked to indicate to what degree they will or will not comply with a request based on a panhandler's choice of words. The race or sex of panhandlers are nonverbal factors will also be considered to determine potential donors' willingness to comply. In studying compliance-gaining. Wilson, Cruz, and Kang (1992) noted, " individual differences should have important implications for people's interpretation and message choices during interaction" (pp.350-351). Every potential donor is influenced to comply, or to deny a request, by their personal biases. One potential donor may be particularly ignorant to the predicament of a panhandler, while another potential donor may be extremely sympathetic and compassionate. By measuring potential donor's willingness to comply based on individual factors that influence compliance-gaining, a better understanding of the communication between panhandlers and potential donors should be obtained.
Second, previous studies have focused on the many facets of compliance-gaining strategies. The current study will expand upon the findings of several of these studies. For example, compliance-gaining studies have been conducted to focus on the interaction between various specified groups other than panhandlers and potential donors. Boster, Rodriguez, and Marshall (1995) examined the compliance-gaining strategies between friends and strangers. 64 college students were used as subjects in the study. 32 of the subjects were close friends of some of the experiementers. Subjects received either a direct request to purchase a raffle ticket or received the request after having a favor done for them by the person asking. the subjects were given the requests by both their friends and people whom they had never met. The results of the study showed that subjects were more likely to comply with requests from friends. Among strangers, requests preceded by favors produced more compliance than direct requests (Boster et al., 1995). The results provide a foundation point for the present study. For example, if people are more likely to donate to friends, are they also more likely to give to those that are similiar to them in appearance? What types of messages conveyed during requests influence a potential donor? The present study can benefit from the Boster et al. research and other research like it. Previous findings can be built upon by seeking data which addresses similar types of questions, but in regards to compliance-gaining.
The third benefit of the study includes the communicative and inspirational characteristics of the study. By either confirming or rejecting whether or not verbal and nonverbal behaviors are factors in compliance-gaining situations involving panhandlers, the study can motivate future compliance-gaining research. Previous studies have been concerned with compliance-gaining aspects such as strategies, situational variation, resistance, and individual differences. Their findings have been employed to formulate other theories and research studies. The present study has the potential to do the same by focusing on a communication phenomenon that most people experience. The topic is a meaningful one because it concerns many people. The study will be an opportunity to educate those unfamiliar and those interested in learning more about the verbal and nonverbal behaviors as they influence communications between potential donors and panhandlers.
Clearly, the communication between panhandlers and potential donors in worthy of study by scholars and public alike. By examining verbal and nonverbal behaviors of panhandlers the occasion to increase generalizability is created. The justification of the study is increased by the theoretical benefits stated above.
Nicola S. Caso
Lit Review
Nursing is a very important profession; today more than ever. Due to recent developments in medicine, large numbers of individuals are living longer, fuller lives. Thus, there is a demand for nurses who can successfully treat the spirit as well as the body. Nurses have always been at the vanguard in terms of communication skills and empathic manner to achieve a more positive interaction with their patients.
Today, associate and bachelor degrees are favored rather than nursing school diplomas. New drugs and scientific innovations allow those in the medical profession to save the lives of many individuals who would have had no hope twenty years ago. Nurses must be ever ready and able to accept the challenges and responsibilities that advancements in technology bring. As Curtin, (1996) reports, "We've seen tremendous advances in technology and pharmacology, which have given nurses more responsibility, and require even deeper levels of knowledge. We're involved in more decision making and are faced with ethical issues we've never confronted before, such as those swirling around gene therapy" (p. 33). These new duties nurses face in the nineties have given them a renewed sense of confidence and pride in their work, and has also led to the development of nursing specialties.
Unfortunately, however, as more hospitials are cutting costs, many nurses are being laid off and replaced by nurses aides and nurse technicians. Gilliland reports, "Nurse executives, expected to decrease expenses, resort to cutting RN positions . . .With six weeks or less of training, unlicensed assistive personnel are supposed to take the RN's place at the bedside!" (1997, p.320). Further, nurses who do remain on staff are overloaded with patients. The result is often inadequate patient care and frenzied employees, which can have deadly results. A 1998 survey of nurses by RN magazine states "72% of respondents report that the quality of care at their hospital has deteriorated over the past year because of cost-containment decisions, a 12% jump since 1988" (Cited in Wolfe, 1999, p. 28; actual sample size is not reported).
Thankfully, legislation is now being passed in some states to protect nurses; those who speak out against dangerous conditions cannot be threatened with termination. Also, nurses' unions have won the right to decide nurse-patient ratios in contract negotiations. According to Kunen, unions and consumer groups have put forth propositions which "would require the state to enforce minimum staffing levels for licensed personnel at all medical facilities and would protect whistle-blowing health-care workers from being fired" (p.56). Administrations and staff are slowly finding a way to work together to find solutions to budget woes without compromising care. "Busy work" is being done away with and wasteful expenses are cut instead of nurses (Gilliland, 1997, p.322).
Nurses must accomplish several goals when interacting with patients, such as understanding, agreement, and action (Sherman, 1994, p. 8). All of these goals are directly related to a nurse's communication skills. Further, the way nurses communicate with patients has evolved. Usually, nurses work very close to patients and therefore are more likely to develop emotionally-involved relationships. This bond is key because it is a nurse's job to carry out what the doctor has requested and patient compliance is crucial. By becoming familiar with each patient on a somewhat personal level, nurses can encourage them to feel more at ease which in turn leads to improved attitudes and greater compliance. According to Sherman (1994), the best way to establish and maintain a positive nurse-patient relationship is through two-way or transactional communication: "Two-way communication allows and expects the reciever to give feedback and become actively involved ... It is an active process in which the sender is able to check the reciever's understanding of the message" (p.12). This flow of conversation is called interaction. By using reassuring language as well as nonverbal cues (appropriate, meaningful eye contact and non-defensive body language), nurses can achieve the best interaction possible. It is also paramount for nurses to be aware of "metamessages," which convey the thoughts and feelings behind what someone is saying. For example, paraphrasing from Sherman (1994, p.20), an irritable and listless patient is bellowing that he/she needs a "proper" nurse. A nurse who is not tuned to the metamessage may come away from the situation feeling hurt and angry. However, a nurse who is aware of the intent behind the message would understand that the patient is feeling frustrated and helpless. Lashing out and displacing his/her feelings gives some comfort and release. Being attuned to metamessages provides a greater insight into how the patient is feeling, and allows the nurse to react accordingly.
Sometimes, there is a disruption in communication, which can be quite serious if not detected early. It is critical for nurses to keep the doctor up-to-date on any and all details of a patient's condition. Failing to relay information of a patient's condition. Failing to relay information in its entirety can result in deadly complications. As Sullivan (1996) states, "Prudence should always guide your [the nurse's] communications [ is not referring to mass media]. That, and a willingness to err on the side of caution when speaking directly with patients or members of the health care team: Better too much communication than not enough" (p.64).
The nursing profession is quite a difficult one; not only must they keep [maintain] order and control while carrying out doctors' instructions, their first priority is the patients. Nurses, as stated by Adams (1998), are the "only licensed health-care professionals at a patient's bedside 24 hours a day" (p.17). It is a nurse's duty to treat and attend to patients, to maintain if possible high comfort and compliance levels, as well as fear and pain levels low. Hence a nurse's main job is to care. Most individuals are caring; however, nurses have raised this idea to its highest form. As Brykcznska (1997) cogently argues: "Caring in nursing practice is a core concept, because it concerns a fundamental aspect of nursing. Without the presence of a wise, caring, compassionate approach to the delivery of nursing, the nursing tasks would be seen as faulted. Without caring, nursing would represent an incomplete or even disingenuous and non-effacious picture of what it is about. It would be nursing without its soul" (p.1).
At the heart of a nurse's care for his/her patients is empathy. As Sherman (1994) suggests, "Empathy is actually the use of several behaviors. It involves the ability to be sensitive to the feelings of others, the ability to explore feelings while expressing sympathetic understanding, and the act of caring in a nurturing way" (p. 52). When one is empathic it goes far beyond feeling sorry for someone's situation, he/she provides comfort and a place of healing. An empathic nurse, through opening hi/herself up to the feelings of a patient, shares control and allows the patient to be candid.
The comfort a patient feels due to an empathic nurse is very beneficial, not merely for gathering information, but it truly helps the healing process. Establishing a bond between patient and nurse can instill hope. In several medical settings, hope has been indispensible in helping patients to become healthy and stay that way, as well as cope with a devastating illness. Having empathy for a patient also is a sign of respect in identifying with patient concern and attending to them. Again from Sherman (1994), "The empathic nurse is able to establish a more accurate understanding of a patient by tuning in to the patient's frame of reference. Empathy also allows for greater rapport by keeping channels open for patients to express their concerns and feelings" (p.53). Thus, empathy can lead to greater patient satisfaction, can facilitate rapport building between patients and nurses and can be therapeutic.
A number of studies have attempted to document patients' response to nurses who employ empathy. although they cannot say with absolute certainty that empathic nurses acquire a substantially positive response from patients, many agree that empathic care is important in order to treat the "whole" person. In a 1987 study done by LaMonica, Wolf, Madea, and Oberst, nurse empathy levels and their impact upon patients suffering from cancer were assessed (Allen, 1994, p.97). Specific emotions, such as depression, anxiety, hostility, and care satisfaction were targeted in the hopes that they would either decrease or increase, respectively, with empathic care. Nurses were instructed in how to properly treat patients empathically, and their levels of empathy were measured before and after training. "The patient subjects showed significant decreases in anxiety and hostility and nonsignificant differences in the predicted direction for depression and satisfaction with care . . . The changes in patients were judged to have considerable clinical significance" (Allen, 1994, p. 98).
In a similar study done by Schirm and Fennell (1991), which is documented by Allen (1994,), the empathy of nurses who cared for elderly patients in their homes was investigated as well as its effect upon the "strain" of family caregivers. The family of a very ill individual often suffers tremendous stress in caring for him/her. "Home health nurses rated with the ECRS [Empathy Construct Rating Scale] were highly empathic, although the correlation between empathy and family caregiver strain was not significant" ( p.99). The nureses' performance, gauged according to the ECRS, determines received empathy in the realm of patient care.
Further, nurses who display an interest in what their patients have to say and foster patient involvement brings about a dramatic impact upon the content and quality of a patient's response. Such a finding, according to Kreps and O'Hair (1995), "suggests that patients are more active, expressive, and assertive when providers are supportive, interested in the patient's concerns , and actvely encourage the patient's participation in the consultation" (p.101). Nurses who exhibit a "patient-centered" approach to their bedside care and consultation have gained a greater insight into the patients' thoughts and feelings; patients also seem to play a larger role in decision-making when interacting with a concerned, thoughtful nurse.
Finally, reassurance is a key element in promoting high levels of patient involvement and interaction. Reassuring an individual, however, must be performed in the correct manner. A nurse should ease concerns by educating the patient as to what is going on around him/her. It is not enough to simply tell them not to worry. As stated by Ray and Donohew (1990), " In a related study, Buchsbaum (1986) argued that the goals of reassurance should include not only restoring his or her sense of autonomy. [S]uccessful reassurance rests more on communicative ability than on understanding of human pathology" (p.41).
Without nurses, we certainly would not have the quality of health care that exists in our society today. Nurses are truly the "heart and soul"of the medical profession, and it is their gift of caring that makes a major and dramatic difference. As Gaut and Boykin (1994) suggest, "The core of nursing is caring -- a deep human and professional communion. The idea of caring is to alleviate suffering in a spirit of 'caritas,' i.e., in faith, hope, and love (p.14).
