PERCEPTIONS OF MEMBERS OF THE
HEALTH TEAM IN SECTARIAN AND
NON-SECTARIAN HOSPITALS

Thesis far the Degree of Ph. D.
MECHEGAN STATE UNWERSITY ;
SISTER MARY ROSARIE SAUNDERS L. 0., M.
1959‘:

THp-cac

0-169

This is to certify that the

thesis entitled

PERCEPTIONS OF MEMBERS OF THE

HEALTH TEAM IN SECTARIAN AND
NON-SECTARIAN HOSPITALS

presented by
Sister M. Rosarii Saunders L.C.M.

has been accepted towards fulfillment
of the requirements for

Ph.D. degree in Education

 
   

Major professor

Date November 18, 1969

 
   
   
   

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ABSTRACT

PERCEPTIONS OF MEMBERS OF THE
HEALTH TEAM IN SECTARIAN AND
NON-SECTARIAN HOSPITALS

by Sister Mary Rosarii Saunders L.C.M.

Purpose of the Study

 

This study was concerned with the perception of
nurses and medical technologists in sectarian and non—
sectarian hospitals. In order to study the perceptions
an instrument called the Professional Perception Index
was developed by the author. The 27 variables of this
index were divided into three groups, activities, senti-
ment and interaction, according to Homans Model.

The purpose of this study is to determine whether
or not there is a difference in the perceptions held by
nurses and medical technologists of the necessary char—
acteristics of other health professionals for effective
team functioning.

It is hypothesized that,

Health professionals differ in perceptions of their own
professional role, individually and collectively, as

well as other health professionals with whom they work,
individually and collectively.

Sister Mary Rosarii Saunders L.C.M.

Design of the Research

 

The Professional Perception Index was developed
to measure the perceptions of nurses and medical techno-
logists in sectarian and non-sectarian hospitals. The
sample consisted of 75 nurses and 75 medical technologists

randomly selected from four mid-Western hospitals.

Results

On the basis of this data, nurses and medical
technologists have different perceptions of the activities,
interaction and sentiment of medical doctors, medical tech-
nologists and nurses as indicated by the Professional
Perception Index. The greatest differences in the percep-
tions of nurses and medical technologists occur in the
ratings of nurses and medical doctors. The difference in
the rating of nurses by nurses and medical technologists is
statistically significant at the .01 level or 99 per cent
level of confidence. The difference in the rating of medical
doctors by nurses and medical technologists is statistically
significant at the .05 level or 95 per cent level of confi-
dence. Although not statistically significant, the ratings
of medical technologists by nurses and medical technologists
cannot be ignored since this 70 per cent level of confidence
does indicate a difference.

On the basis of this data, the more years of formal

schooling a medical technologist had, the higher she ranked

Sister Mary Rosarii Saunders L.C.M.

nurses especially in the categories of activities (.05
level) and interaction (.01 level). Years of formal
schooling appeared to have no effect on the perceptions of
nurses.

The experience of medical technologists appeared
on the basis of this data to have an influence on their
perceptions of nurses especially in the categories of nurses'
activities and interaction (significant to the .05 level).
The experience of nurses did not appear to significantly
effect their perceptions of medical doctors, nurses or
medical technologists.

The differences in age of medical technologists did
not appear to significantly alter their perceptions of
medical doctors, medical technologists and nurses according
to the Professional Perception Index. Although differences
in the age of nurses did not alter their perceptions of
medical doctors or nurses, age differences of nurses did
appear to significantly effect their perceptions of medical
technologists. These differences were statistically signi-

ficant to the .05 level or 95 per cent level of confidence.

Implications

 

Information concerning the differences in percep-
tions of nurses and medical technologists can give direction
to in-service educational programs as well as to the various

programs of health education in the colleges and universities.

Sister Mary Rosarii Saunders L.C.M.

In addition, this study may shed light on the
communications process and conflicts among health pro—
fessionals. Such information could lead to early indoc-
trination of students in the interdisciplinary health team
approach. Through common education and training experience
the groundwork would have begun for eventual mutual under—
standing and hopefully better cooperation among allied
health personnel when they work together.

In View of the limitations of the study, perhaps
future research could be done by utilizing nurses and
medical technologists from other geographic areas. The
instrument developed in this research might be used in
studies of the perceptions of other health professionals,
such as radiologic technologists, dieticians, occupational
therapists and operating room technicians.

Further studies of salaries of health professionals
and their perceptions of such salaries may contribute to

harmonious functioning of the health team.

PERCEPTIONS OF MEMBERS OF THE
HEALTH TEAM IN SECTARIAN AND

NON-SECTARIAN HOSPITALS

BY

Sister Mary Rosarii Saunders L.C.M.

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Administration
and Higher Education

1969

G")
H
I

f

e —/ 7-- :9

Sister Mary Rosarii Saunders L.C.M.
Candidate for the Degree of

Doctor of Philosophy

Oral Examination: November 6, 1969

Dissertation: Perceptions of Members of the
Health Team in Sectarian and
Non-Sectarian Hospitals

Outline of Studies: Major Subject - Higher Education
and Administration

Minor Subject - Curriculum develop-
ment, especially in
medical education

Biographical Born, June 25, 1926, Chicago, Illinois
Information:

Education: Little Company of Mary School of
Nursing — R.N. Degree - 1952

DePaul University - B.S. — 1957

Little Company of Mary School of
Medical Technology - Registered
Medical Technologist - 1957

DePaul University — M.S. Biological
Sciences — 1961

ExPerience: Assistant Professor, Department of
Natural Sciences, St. Xavier
College, Chicago, Illinois - 1959
to 1967

Employed 16 years in Little Company
of Mary Laboratory as Bench Tech—
nologist, Teaching Supervisor,
Laboratory Supervisor and Coordinator

Director, Health Sciences, Moraine

Valley Community College, Palos
Heights, Illinois

State Activities:

National Activities:

Liaison Committee - Illinois Society
of Pathologists - 1963—1967

Delegate to American Society of
Medical Technologists National
Meetings - 1956, 1957, 1958,
1959, 1960, 1961, 1962, 1963,
1964, 1965

State Advisory Committee on Health
Careers - 1965-1966

President of Illinois Society of
Medical Technologists - 1961-1962

Education Committee, Illinois
Regional Medical Programs — 1968
to present

Certified Laboratory Assistants
Committee — 1961-1962

Board of Certified Laboratory
Assistants - 1962-1967

Participated in Health Meetings of
the National Association of Junior
Colleges - 1964

Organized Labor Procedures for the
American Medical Association
Meeting held in Chicago - 1962

Advisory Committee of the National
Committee for Careers in Medical
Technology Education - 1966

Chairman, Catholic Hospital Associa—
tion - 1958-1961

President Johnson's Committee on
Loan Programs in Education - 1967—
1970

Advisory Committee Bureau of Higher
Education - 1967

Participated in Department of Health,
Education and Welfare Conference
on Job Development, Washington,
D.C. - 1966

iii

Publications:

Advisory Committee on Medicare
Regulations for Clinical Laboratory

Working with Federal Government
under the Manpower Development
and Training Act to train Certified
Laboratory Assistants, Operating
Room Technicians and Medical
Transcribers - 1962 to Present

National Board of American Society
of Medical Technologist - 1967-1970

Education Committee American Hospital
Association - 1969 to present

"Certified Laboratory Assistants:
A Partial Answer?" Published in
Hospital Progress, Feb., 1967.

 

"Clinical Laboratory Assistants
Training Upgraded." Published in
Illinois Vocational Progress,
Nov., 1966

 

"Training Program Will Provide New
Lab. Worker: The C.L.A." Published
in Hospital Topics Magazine,
October, 1964

 

"Calcium & Phosphorous Metabolism in
Rana Ripiens." Unpublished Thesis
for Masters Degree

iv

DEDICATION

To my religious community
The Sisters of Little Company of Mary.
An eternally welcomed source of love, support, and in—

spiration. . . .

ACKNOWLEDGMENTS

I would like to acknowledge the encouragement
and professional direction given to me by the members of
my guidance committee: Dr. C. Blackman, Dr. H. Jason, Dr.
V. Johnson, Dr. M. Raines. Particular acknowledgment is
given to Dr. Laurine Fitzgerald, who has served as the
chairman of this dissertation committee and has been of
invaluable assistance as the major advisor for this
research. It has been through her patience, understanding
and insights that this project has reached its conclusion.

To Dr. Max Raines for his guidance, direction and
support as chairman of my committee.

To Mr. Richard Odwazny of the computer center of
Little Company of Mary Hospital for his valuable assistance
in working out the technical details of procedure and
statistical analysis.

To Dr. Wm. Knisely, Director, Institute of Biology
and Medicine, Michigan State University, for his assistance
in obtaining a grant under the Allied Health Professions Act.

To the Public Health Service, Allied Health Trainee-
ship Grant from Department of Public Health Service of Health,
Education and Welfare-—No. AHT-69-049 through Michigan

State University.

vi

To Dr. R. Turner, President, Moraine Valley
Community College, Palos, Illinois, whose insights and
support made this project possible.

To the nurses and medical technologists of the
participating hospitals for their splendid cooperation
and important feedback.

To the administrators of the participating hospi-
tals for their splendid cooperation: Dr. J. Feurig and
Mr. J. Cook, Olin Medical Center, Michigan State University;
Sister Margaret and Mr. P. Wozniak, Little Company of Mary
Hospital, Evergreen Park, Illinois; Mr. J. A. Reinertsen,
Evanston Hospital, Evanston, Illinois; Sister Catherine
Mary, St. Francis Hospital, Blue Island, Illinois; and
Mr. H. Piepenbrink, Tinley Park Hospital, Tinley Park,
Illinois.

To Barbara Brodie, R.N., Doctoral Candidate, Michigan
State University, for her assistance in the development of
the instrument used in this research.

To my family--my beloved Mother enjoying in Heaven
the reward of her generosity, my dear Father, a perpetual
source of wisdom and love, my sister and her husband, Mr.
and Mrs. P. Kelly, my brother and his wife, Mr. and Mrs.
William Saunders for their understanding, patience and love.

And foremost, to the Sisters of the Little Company
of Mary, especially Sisters Mary Catherine, Mary Oliver,

Mary Michael, Mary Paul, Mary Rose and Mary William for

vii

their sacrifice, patience, inspiration and love, without

which this project would still be on the drawing board.

viii

TABLE OF CONTENTS

BIOGRAPHICAL DATA 0 O O O O I O I O O O O O O O O O

DEDICATION O O O O O O O O O O O O O O O O O O O 0

ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . .

LIST OF TABLES O O O O O O O O O O I O O O O O O 0

LIST OF APPENDICES . O O O C O O O O O O O C O O 0

Chapter

I.

II.

III.

STATEMENT OF THE PROBLEM . . . . . . . . . .

The Expanding Horizons of Medical Knowledge
The Greater Productivity Demand . . . . . .
Autonomy and Competence . . . . . . . . . .
Purpose of This Study . . . . . . . . . . .
Hypotheses To Be Evaluated . . . . . . . . .
Definition of Terms . . . . . . . . . . . .

REVIEW OF THE LITERATURE . . . . . . . . . .

Changes in Professional Achievements . . . .
Team Member Nervous Stress and Conflict . .
ROle Theory 0 O O O I O O I I O O O I O O 0

DESIGN OF THE STUDY . . . . . . . . . . . .

Types of Research . . . . . . . . . . .
Nature of the Sample . . . . . . . . . .
Instrumentation . . . . . . . . . . . .
Validity and Reliability . . . . . . . .
weight of Relevancy . . . . . . . . . .
Statistical Analysis . . . . . . . . . .
Limitations of the Study . . . . . . . . . .

ix

Page

ii

vi
xi

xiii

H

(DQQWNH

12

12
13
15

20

20
21
23
27
28

29

Chapter

IV. ANALYSIS OF RESULTS . . . .

Differences in Perceptions of

and Medical Technologists
Sectarian vs. Non-Sectarian
Perceptions vs. Education .
Perceptions vs. Experience
Age vs. Perceptions . . . .
Status and Salary . . . . .
Summary . . . . . . . . . .

Nurses

V. SUMMARY, IMPLICATIONS AND RECOMMENDATIONS

Summary . . . . . . . . . .
Implications . . . . . . .

Recommendations for Future Research

BIBLIOGRAPHY . . . . . . . . . . .

MPENDICES O O O O O 0 0 O O O C O

Page

31

LIST OF TABLES

Table Page

1. Correlation Coefficients of Reliability of
TeSt-ReteSt o o o o o o o o o o o o o o o o 27

2. Relevancy of Items Contained in the Pro-
fessional Perception Index . . . . . . . . 28

3. Difference between Medical Technologists and
Registered Nurses in Rating Medical Doctors,
Medical Technologists and Registered Nurses
Using the Professional Perception Index . . 32

4. Differences in Perceptions Given by Medical
Technologists and Nurses in Sectarian and
Non-Sectarian Hospitals . . . . . . . . . . 34

5. Analysis of Variance of the Education of
Medical Technologists and Their Perceptions
of Medical Doctors . . . . . . . . . . . . 35

6. Analysis of Variance of the Education of
Medical Technologists and Their Perceptions
of Other Medical Technologists . . . . . . 35

7. Analysis of Variance of Years of Formal Schooling
of Medical Technologists and Their Perception
’of the Activities of Nurses . . . . . . . . 36

8. Analysis of Variance of Years of Formal Schooling
of Medical Technologists and Their Perception
of the Interaction of Nurses . . . . . . . 36

9. Analysis of Variance of Years of Formal Schooling
of Medical Technologists and the Perceptions
of Nurses on Total Scores . . . . . . . . . 37

10. Computed F Values of the Years of Formal Schooling
of Nurses and Their Perceptions of Medical Doc-
tors, Medical Technologists and Registered
Nurses . . . . . . . . . . . . . . . . . . 38

xi

Table

11.

12.

l3.

14.

15.

16.

17.

18.

Page

Computed F Values of the Experience of
Medical Technologists and Their Percep-
tions of Medical Doctors, Medical Techno-
logists, and Registered Nurses . . . . . . . 39

Computed F Values of the Differences in
Experience of Nurses and Their Perceptions
of Medical Doctors, Medical Technologists,
and Registered Nurses . . . . . . . . . . . 40

Computed F Values of the Age of Medical Tech-
nologists and Their Perceptions of Medical
Doctors, Medical Technologists, and Regis-
tered Nurses . . . . . . . . . . . . . . . . 41

Computed F Values of the Differences of Age
of Nurses and Their Perceptions of Medical
Doctors, Medical Technologists, and Regis-
tered Nurses . . . . . . . . . . . . . . . . 42

Analysis of Variance Age of Nurses and Their
Perceptions of Medical Technologists . . . . 42

Per Cent of Total Sample Medical Technologists

and Nurses Ranking Other Health Professionals

on Status . . . . . . . . . . . . . . . . . 44
Per Cent of Sample Medical Technologists and

Nurses Ranking Health Professionals on

Salary . . . . . . . . . . . . . . . . . . . 44

Status and Salary Scale . . . . . . . . . . . 45

xii

 

\Elraflnm

“‘9'. _
l

Appendix
A. Definitions of Terms
B.
Exhibit 1.
C.
With Program Development .
D. Personnel Needs in Hospitals:
Needed in 1975 . .
E. Statistical Methods
F. Health Team Models .

LIST OF APPENDICES

The Instrument of this Study - Perceptions
of the Members of the Health Team . . .

Weighing of the Relevance . .

Fields With Existing Associate Degree Job-
Entry Programs and Associations Concerned

Actual Staff

1966 (Estimated) and Estimated Total

xiii

Page

64

68

76

79

82

84

89

CHAPTER I
STATEMENT OF THE PROBLEM
The Expanding Horizons of Medical Knowledge

The marked proliferation of scientific knowledge,
coupled with the rapid expansion in health care services,
has increased the demand for health manpower, particularly
in the technical areas related to health care delivery.

In 1900 there were 60 health profession workers for
each physician--today the ratio is one to 400.1

In the fifteen years from 1950 to 1965, while the
number of physicians increased by 20 per cent, the number
of clinical laboratory personnel rose by 70 per cent. While
the number of dentists increased by 15 per cent, the number
of dental hygienists expanded by 54 per cent.

Frederick C. Mosher2 has shown that there has been a
consistent increase in the number of professionals. Between
1900 and 1960 he states that the American labor force grew

about 123 per cent while the numbers in professional

~ ass?

 

 

1L. T. Coggeshall, Planning for Medical Progress
Through Education (Evanston, IlIinois: Association of
American Medical Colleges, 1967).

2Frederick C. Mosher, The Professions, Professional
Education, and the Public Service (San Francisco: Chandler
Publishing Company, 1968).

 

 

occupations multiplied by 485 per cent. The United States
Public Health Service3 reports that in 1967 there were 3.4
million people in health occupations and this figure comprised
a gain of one-half million in the allied health occupations

since 1965.
The Greater Productivity Demand

The rapid growth of health care services demands
greater physician productivity. This requires delegating
routine tasks, now performed by physicians, to other health
professionals and technologists. Not only will physicians
have to delegate tasks to others, but dentists, nurses,
pharmacists and many other health professionals will find it
necessary to delegate to others several of their present
responsibilities.

It is imperative that individuals with various kinds
of knowledge and differing levels of skill are educated and
trained for the expanding delivery of health care. It is
observed that:

The "allied" health occupations include a broad range-*
perhaps every group beyond medicine and dentistry.

 

3U. S. Department of Health, Education and Welfare,

Health Manpower - United States 1965—67, Public Health Service
Publication, 1000 Series 14, Number 1 (Washington D.C.: U. S.
Government Printing Office, 1968).

 

4Report of the Allied Health Professions Education
Subcommittee of the National Advisory Health Council, Education
for the Allied Health Professions and Services, Public Health
Service Publication Number 1600 (Washington D. C.: U. S.
Government Printing Office, 1967) p. l.

 

Delegation of responsibility, the develOpment of
new allied health occupations by physicians and technolo-
gical advances have contributed to the precipitation of
the "team" concept in health care. Because the team demands
cooperation, collaboration, and a free flow of communication,
its members must understand and appreciate the contributions
of one another. In an age of intensive specialization, each
of the health professions has develOped its own technologi—
cal society and professional organization. Because communi-
cation is primarily within the individual profession, rather
than between professions, there are increasing chasms that
tend to isolate one profession from another. In fact, at
times, members of one health profession find themselves in
direct conflict with members of another health profession.

As health professionals are aware, growth and matur-
ity of all organisms depend upon the heritage with which
they are endowed and upon the environment from which they
obtain their sustenance. To each of these ambients adapta-
tion must be made continually. Neither inheritance nor
adaptability to environment alone will assure mature growth.
Each ambient must be present.5

Geoffrey Millerson6 has noted that of all the socio-

logical concepts one of the most difficult to analyze is

 

5William K. Selden, “Just One Big Happy Family,"
American Journal of Medical Technology, 35-36 (June, 1969), 357.

6Geoffrey Millerson, The Qualifying Associations - A
§Eydy of Professionalization, (London: Rutledge and Kegan,
Paul,’I964).

that of a profession. He points out that the wide and
indiscriminate use of the word has led to much confusion.
Furthermore, attempts to delineate fundamental character-
istics of a profession and to apply them to all professional
associations encounter structural limitations and do not

allow sufficiently for the dynamic changes which are occurring
in all organizations.

Despite these admonitions Millerson and others have
identified certain characteristics which are commonly accepted
hallmarks of a profession. These essential features include:
(1) skill based upon theoretical knowledge, (2) skill requir-
ing education and training, (3) demonstration of competence
by the passing of a test, or tests, (4) integrity maintained
by adherence to a code of conduct, (5) service provided for
the public good, and, (6) organization of practitioners into
a body, the professional association.

Williams7 describes the inter—relation of members of
different professions working together for the solution of
a problem that in some way demands the attention of a
number of persons that are skilled in the various areas of
the science-art of healing, especially when the combined
skills of the various members of the "team," are focused on
the problem of healing the affliction of a hospitalized

patient:

 

Williams, Donald H., M.D., Director of Division of

Continuing Education, Health Science Center, University of
British Columbia Vancouver, Canada, lecturing, "Professional
Competence and Obsolescence," Royal Victoria Hospital, Ire-

land, May 7, 1969.

. . . a health team is a group of health professionals
with their associated technologists, technicians and
other essential staff personnel. The functions of this
team are the promotion of health, the prevention of
disease, diagnosis and treatment of illness, and the
alleviation of suffering. Cooperation, coordination and
integration of efforts provide health care that embraces
all relevant knowledge, skill and technology by all of
the relevant sciences that may be applicable to the art
of healing. The health team recognizes every healthy, or
apparently well person, each patient, the family, and
the community as integral participants in the process

of providing this overall care.

Autonomy and Competence

In contrast with our social attitude towards other
occupations, society has accorded professions either expli-
citly or implicitly relatively complete autonomy in their
‘work. It has been assumed that if their performance is
unsatisfactory only another member of the profession can
state whether this is the result of incompetence.

Medicine most completely fulfills Becker's8 symbols
Of a profession. It is this inheritance which we find present
in varying degrees in all of the organized health professions,
and which inheritance reinforced by environmental factors leads
to potential and actual conflicts among the health professional
organizations, and also to conflicts with our rapidly changing
public policy.

It is important for administrators and supervisors to
remember the high price they pay for inefficient conflict

 

Howard S. Becker, "The Nature of a Profession,"
Education for the Professions, (Chicago: National Society
for the Study of Education, 1921).

resolution, both from a personal as well as an
organizational point of view. Although this is true
in any organization it is particularly true in hos-
pital administration, where service demands are
intense and staff size is at times overwhelming.

Conflicts among health professionals which have
appeared sporadically in the past, will undoubtedly increase
in frequency and intensity in the future. To prevent such
potential conflicts from exploding and disrupting the pro-
per delivery of health care, increased and more widespread
cooperation among the health team professionals and educa-
tors of health professionals will be needed. COOperation is
more likely to result if there is, first of all, a mutual
understanding of the functions and roles of other health
professionals and secondly an adequate means of communica—
tion among them. Dolson observes,

When asked to select six crucial problem areas in their
hospital, doctors and administrators emphasized depart-
ment head and departmental functioning, planning patient
care services, working with medical staff, and business
and financial management. The doctors also selected per—

sonnel management and employee relations, and community
relations crucial.

9Larry L. Larrabee, Ph.D. and Robert E. Lefton, Ph.D.,
"Managing Intergroup Conflict within Your Organization,"
figspital Progress, Vol. 49, No. 4, (April 1968), 62.

0Miriam T. Dolson, Ph.D., "M.D.--Administrators are
Older, Earn More Money, Run Bigger Hospitals: Survey,"
Mgdern Hospital, Vol. 112, No. 2. (McGraw—Hill Publication,
February, 1969), 96-98.

 

Purpose of This Study

The purpose of this study is to determine whether
or not there is a difference in the perceptions held by
nurses and medical technologists of the necessary char—
acteristics of other health professionals for effective
team functioning.

It is hypothesized that,

Health professionals differ in perceptions of their
own professional role, individually and collectively,
as well as other health professionals with whom they
work, individually and collectively.
In both sectarian and non-sectarian hospitals the team
approach to medical care has developed rapidly within the
.last five to ten years. However, there has not been a

concurrent change in the education of health personnel to

accommodate the team concept.

Hypotheses to be Evaluated

The following hypotheses are established:
H ° There are significant differences in the responses
of nurses when compared with medical technologists

on the Professional Perception Index.

H2: There is a relationship between the age of the
nurses and their perceptions of other health team
workers.

H3: There is a relationship between the age of the

medical technologists and their perceptions of

other health team workers.

H4: There is a relationship between the number of
years of experience of the nurses and their

perceptions of other health team workers.

H5. There is a relationship between the number of
years of experience of medical technologists and
their perceptions of other health team workers.

H6: There is a relationship between the amount of

education received by the nurses and their per—
ceptions of other health team workers.

H7: There is a relationship between the amount of edu-

cation received by the medical technologists and

their perceptions of other health team workers.
Definition of Terms

Health Team - A group of health personnel working in

 

concert toward the goal of excellence in patient care.

Affective — Relating to arising from, or influencing

 

feelings or emotions.

Cognitive - The act or process of knowing including

 

awareness, judgment and action.
Nurse - Registered Nurse licensed to practice in
the United States.

Physician - Medical Doctor licensed to practice in

 

the United States.

Health Profession — Can be defined as one for which

 

preparation is at the baccalaureate level.

 

 

Allied Health Occupation — The "allied" health

 

occupations include a broad range--perhaps every group beyond
medicine and dentistry.

Technologist - The word "technologist" is used to

 

mean a person with baccalaureate level preparation and
registered by the American Society of Medical Technologists.

Tavistock Model - Socio-technical system which is a

 

combination of technology and a social system.

Technology - Task requirement, physical layout,

 

equipment and supplies.

Social System - A system of relationship among those

 

whom must perform the job.

Role Theory - Is defined as including theories of

 

interpersonal perception, theories of organizational concept,
theories of individual behavior, theories of legislatures,
etc., may all involve the concept of role in their explana-
tory processes, and thus be considered "role theories."

Statistical significance .05 - The .05 level means

 

that an obtained result that is significant at the .05
level could occur by chance only 5 times in 100 trials.

Statistical significance .01 — The .01 level means

 

that an obtained result that is significant at the .01 level

could occur by chance only once in 100 trials.

Theoretical Definitions of Variables

 

The following terms are used throughout this dis—

cussion of the study. In order to provide for clarity of

meaning they are stated here in glossary fashion.

 

rw—v—v—f—r—w—

 

10

Independent Variables:

1. Experience - Number of years working as a

professional nurse or medical

technologist.

2. Education - The number of years spent in college,

post high school. Education refers
to the highest academic degree earned,

diploma or certification.

3. Age - Refers to chronological years.

Dependent Variables:

1. Activity - Refers to movements, action, work, typing,

2. Interaction -

writing, driving, etc. These are basically
things people do to, or with nonhuman
objects, or with other peOple when their
reaction or reciprocal behavior is

ignored (such as cutting a person's hair).
Refers to feelings (happy, sad, angry,
stern, loving); to attitudes (this is

his job; it is time to go; he is con-
servative); or to beliefs. These con-
stitute the inner state of the person,

the things an individual subjectively

perceives.

3. Sentiment - Refers to statements about interaction

including going with someone, eating

11

together, working together, and the
like. The basic characteristic of
interaction is that it is behavior
directed toward another person when
his reaction or reciprocal behavior

is taken into account.

CHAPTER II

REVIEW OF THE LITERATURE

Changes in Professional Achievements

Ours is indeed an age of startling and breathtaking
changes. Surely, this change is reflected in the burgeoning
demands for allied health workers precipitating the prolifer—
ation of more than 200 health occupations. The result of
such proliferation is increased stratification within each
health profession, as well as increased conflict among the
various health professions.

The increased professionalization of health personnel
such as nurses and medical technologists has resulted in an
increase in professional independence leading to what Levy
calls "Intra-Individual Conflict."1 In the present age, no
health professional is operating by himself in more or less
of an endless vacuum. The physician is being asked to
Change from the private entrepreneur to the coordinator,

collaborator and responsible agent for the total product of

the team effort.

...—-.._—

 

1Samuel Levy, "The Hospital Reconsidered," Hospital
Administration, Fall 1961, pp. 6—21.

 

12

13

Lambertsen submits that:

Traditional roles of all practitioners in the health
field are being challenged. If the hospital system
is to meet the challenges, the physician in concert
with administrators, nurses and other health service
personnel must assume responsibility as one of the
principal architects.

Remedial measures that not only provide for but also
demand physician participation in major policy decisions
affecting the expansion or limitation of resources or
services at any given time are imperative. But just

as imperative is the recognition by physicians that

many other health specialists, as well as community
groups, are competent to-—and expect to-—participate

in these decisions.

The physician cannot continue to insulate himself from
organizational stress and interpersonal conflict, but

rather he must become increasingly aware that his con-
cept of his role may well be a causative factor.2

Team Member Nervous Stress and Conflict

Laporte3 studied the strains between scientists and
aidministrators in industrial research organizations from a
tzheoretical base similar to Etzioni's. From the literature
fie derived seven sources of possible conflict. However, using
(fliata from several previous studies, his analysis found only

11‘fi0>sources to be conflictual, goal orientation and restric-
tiveness of measures of control and coordination. In inter-

preting his findings, Laporte argues that there existed

\

I) 2Eleanor C. Lambertsen, Ed.D., "Knowing Roles Aids
(Drztor-Nurse Accord," Modern Hospital, Vol. 112, No. 1
(McCraw Hill Publications, JanuaryT969) , 75—77.

61 3T°dd R- LaForte/"Conditions of Strain and Accommo—
S a‘Ssion in Industrial Research Organizations," Administrative
.IJEEEEEDCG Quarterly, Vol. 10 (June, 1965), p. 24.

 

 

14

three "elements of accommodation." They were separation
of major functional roles within the organization between
scientists, managers, and administrators, mechanisms
neutralizing major external strains from corporations and
government, and the similarity in background of the
scientists, managers, and administrators.
This similarity of backgrounds was not far from
what Goss found to be operative among physicians in the out—
patient clinic.5 She examined the generalization, similar
to that questioned by Hall, that professionals require a
freedom to make decisions according to their own trained
judgment. Her results indicated that no conflict arose
;primarily because all persons in the hierarchy were physi-
<:ians, and conflict was avoided because the professional
Ilorms governing doctor-doctor relationships deemed such
(:onflict unacceptable. What evolved in this situation in—
EStead of a formal authority hierarchy was a "formal advisory
Irelationship."6
Other investigators have examined the nature of the
.EDJfiofessional's conflict with his employing organizations,

although each orientation to the problem varies somewhat.
\

41bid., p. 31.

~ 5Mary E. Goss, "Influence and Authority Among Physi-
<=31uans in an Outpatient Clinic," American Sociological Review,
‘CDJH 26, (February, 1961), 39—50.

6Ibid., p. 50.

15

Kornhauser, for example, defined the problem as being the
basic organizational dilemma of autonomy vs. integration.
That is, scientists must be given enough autonomy to enable
them to fulfill their professional needs, yet their activity
must contribute to the overall goals of the organization.
Perucci studied social distance, bargaining power,
and compliance with rules on a psychiatric hospital ward.
An organization, according to Perucci, is,
. . . a network of social distance patterns built about
a set of fixed positions, whose occupants behave in
such a way as to enhance or maintain their status in
the hierarchy.9
He hypothesized that
the degree to which attendants on a hospital ward were
rule-oriented was indirectly related to their access to

public and private knowledge about doctors who were
their super-ordinates.

Role Theory

Levinson sums up the literature on the role theory

in these words,

g

 

 

7William Kornhauser, Scientists in Industry: Conflict
fypd Accommodation, Berkeley: University of California Press
(1962) .

8

Robert Peurcci, "Social Distance, Bargaining Power
61nd Compliance with Rules on a Hospital Ward," Psychiatry,
Vol. 29 (1) (1966), 42—55

91bid., p. 42.

loIbid., p. 43.

16

The concept of role remains one of the most over-
worked and underdeveIOped in the social sciences.

The purpose here is to first sort out the various meanings
that have been ascribed to the term, "role," examine the
concept of "role concensus," and present a sample of those
studies related to the tOpic under investigation.

Levinson suggests that different writers, and at
times the same writer, have used three definitions of the
global term, role. It has been used to connote the struc-
turally given demands of a given social position such as
norms and responsibilities. In other instances it has
been defined as the actions of individual members as seen in
relation to prevailing norms. Or it has been defined as
the member's orientation or conception of the part he is
to play in the organization. And Linton put them all togeth-
er and defined "role" to

include the attitudes, values and behavior ascribed by
the society to any and all persons occupying a status.

In this latter sense society shapes the attitudes and beliefs
of all the occupants of a given role.

An adjunct to the concept of "role," is "role and con—
<2ensus." That is, there is a consensus among persons as to

‘Nhat is expected of an incumbent of a particular role.

‘

1Daniel J. Levison, Role, Personality and Social
Eiggucture in the Organizational Setting, Mimeographed paper,
0 10

U

. 12Ralph Linton, The Cultural Background of Persep-
EELiEY (New York: Appleton-Century 1945).

17

Cross13 in his exhaustive analysis of the role of the

school superintendent, however, found

little or no consensus to exist among such persons as
teachers, school board members and community business—
men regarding what constitutes the role of the super—

intendent.

This lack of role consensus is a characteristic of
many in the health field. To assume that a role consensus
exists for the hospital nurse or medical technologist,

would imply that

her role-requirements will be understood and agreed
upon by the hospital administration, the nursing
authorities, the physicians, etc.

TheikflJaciousness of this assumption is borne out by Hurling,
Lentz, and Wilson's study of hospitals.15 Using the tech-
niques of participant observation and structured interviews
over a period of two years, these researchers found, in

part, confusion regarding nursing administration, differences
in nurses’ needs and expectations about supervision, and a

breakdown of the status system, hierarchy and role expecta—

tions. The results of other studies of hospitals were

 

 

similar.16

13Neal Gross, W. S. Mason, and A. W. McEachern, Explpr-
fitions in Role Analysis (New York: John Wiley, 1958).

14

Levy, op. cit., p. 15.

15Temple Burling, Edith Lentz and Wilson, Theggiyg
EEQQgTake in Hospitals (New York: Putnam, 1956).

16Chris Argyris, Diagnosing Human Relations in
Engagnizations: A Case Study of a Hospital (New Haven: Labor
Management Center, Yale University, 1956) .

18

The literature on hospitals, specifically, was
found to be either anecdotal or of the participant obser—
vation type. As Seeman notes with regard to hospital studies,

The bulk of work of the status system in medical
organizations has been anecdotal in character or has
avoided altogether the measurement of medically rele-

vant consequences.

Also of note is the absence of any methodology utilizing

comparison groups across hospitals. Thus, it is evident that

concepts such as role conflict and organizational conflict

 

have been used in a variety of ways. Smith's definition of
the term "organizational conflict" as being

. . . a situation in which the conditions, practices
or goals for the different participants are inherently
incompatible18

is an example of broad statements that add to the confusion.
Not any studies were found which used affective and cogni-
tive variables to serve as the basis for Operationalizing

the problem of conflict and role confusion in the functioning

of the health team.

It is believed that the findings of this study will
be of help to all health team personnel who have problems

Similar to those investigated, and that in some way such

——..__._ .-.__. _.

‘

17Melvin Seeman and J. W. Evans, "Stratification and
I‘Iospital Care: Part 1," American Sociological Review, Vol.
26. 1961, 193-203.

18Clagett G. Smith,"A Comparative Analysis of Some
COnditions and Consequences of Intra-Organizational Conflict.
gimnistrative Science Quarterly, Vol. 10 (4) March, .1966
04-529.

19

problems will be resolved into cooperative Operationality

through innovations in the education of health professionals.

CHAPTER III

DESIGN OF THE STUDY
Types of Research

This study will combine the use of historical,

descriptive, and analytical research methods. It has been

stated that:
1. The purpose of this study is to determine whether
or not there is a difference in the perceptions

held by nurses and medical technologists of
necessary characteristics for effective function-

ing;
and,

2. It is hypothesized that health professionals differ
in perceptions of their own professional role as
well as in that of other health professionals

with whom they work.2

Although there are multiple health professionals,
the author elected to study carefully the nurse and the
medical technologist as representatives of the whole. There-
fore, in this study, nurses and medical technologists from
two sectarian and two non-sectarian hospitals were asked to
irate physicians, nurses and medical technologists on several
<:ognitive and effective variables.

According to Cook3 the nature and purpose of his—

‘torical research in education is described as follows:

 

lSupra., p. 6.

21bid.

3David R. Cook, A Guide to Educational Researgh
(BOSton: Allyn and Bacon, Inc., 1965), pp. 15-16.

 

2L

21

A knowledge of history has often been glibly defended
as enabling us to avoid making the same mistakes in
the future, or in some cases even to predict the
future. There is a grain of truth in this, but it
makes more sense to think of an understanding of his-
tory as providing us with a perspective on the future.
Generally problems involving educational policy or
processes can be studied by historical methods.

John W. Best gives the following definition of

descriptive research:

Descriptive research describes and interprets what is.
It is concerned with conditions or relationships that
exist; practices that prevail; beliefs, or points of
view, or attitudes that are being felt; or trends that
are developing. The process of descriptive research
goes beyond mere gathering . . . of data. It involves
an element of interpretation of the meaning or signifi—
cance of what is described.

Smith, Stanley and Shores5 submit that analytical

research is

. . . content selection . . . of the things peOple do
in order to discover the subject matter functioning
in . . . various activities . . . There are three
forms of analyses, as activity analysis, . . . job
analysis, . . . and use of the processes of analysis
to determine the elements of knowledge or the skills
having general utility.

 

 

Nature of the Sample

The sample consisted of 75 nurses and 75 medical
technologists from four hospitals, two sectarian and two

non-sectarian in Illinois. Of the 150 c0pies distributed,

4John W. Best, Research in Education, (Englewood
Cliffs, New Jersey: Prentice Hall, Inc., 1959), pp. 102-3.

SSmith, Stanley and Shores, "The Nature of
‘Analytical Procedure," Fundamentals of Curriculum Buildigg
(New York: World Book Co., 1950) pp. 306-312.

22

147 or 98 per cent were returned. However, 23 of those
returned were considered invalid because they had left two
or more blanks or two or more items of the Professional
Perception Index were not answered. Therefore the sample
consisted of 66 nurses and 58 medical technologists, or a
total of 124 health professionals (82.6 per cent). Of
these 29 nurses and 38 medical technologists are employed
by sectarian hospitals. Those used in the study employed
by non-sectarian hospitals numbered 38 nurses and 20 med-
ical technologists.

NUMBER OF NURSES AND MEDICAL TECHNOLOGISTS
IN THE SAMPLE

Sectarian Non-Sectarian
Registered Nurses 29 38
Medical Technologists 38 20

Both the nurses and the medical technologists were chosen
at random by using a table of random numbers.6
SAMPLE POPULATION PROFILE

Medical Technologist

 

 

 

g§ge (years) Experience (years) Education (degree) Sectarigp;
41 were 20-29 6 had -1 1 had A A 30 were
12 were 30-39 23 had 1-3 14 had ASCP 28 were

11 was 40-49 10 had 4-6 40 had BA or BS not

‘4 were over 50 8 had 7-9 3 did not specify

11 had over 10

6John E. Freund, Modern Elementary Statistics
(Englewood Cliffs, N. J.: Prentice-Hall, Inc., 1967).

23

Registered Nurse

 

 

 

Age Experience Education Sectarian
40 were 20-29 12 had -1 9 had A A 29 were

11 were 30-39 21 had 1-3 44 had ND 37 were not
10 were 40-49 4 had 4-6 12 had BA or BS

5 were over 50 4 had 7-9 1 had MA or MS

23 had over 10
2 did not specify

Instrumentation

The data instrument of this study was sent to 75
nurses and 75 medical technologists who served four Illinois
hospitals. The study was conducted in two sectarian and
two non-sectarian institutions. The instrument used is
titled "Professional Perception Index," and was designed
to measure the "Perceptions of the Members of the Health
Team" as may be directly identified by nurses and medical
technologists. The study consists of two parts. One is
‘the develOpment of an instrument for the measurement of

irole perceptions of nurses and medical technologists. The
=3econd part of the study is an analysis of the data obtained
Sin.using the instrument developed by the researcher.
After a study of Osgood's Semantic Differential,

t:he personality attributes underlying Riesman's (1950)
Itilner-Directed-Other-Directed distinction, Whyte's (1956)
Ci£iscription of the Protestant ethic versus the social ethic,
Eilld the self descriptions of top managers versus middle

Inanagers reported by Porter and Ghiselli (1957), the researcher

24

put together 150 items considered important for the

proper functioning of a health team. Three pilot studies
were performed utilizing 11 nurses and 7 medical techno-
logists. After an item analysis of their responses, the
researcher selected 27 items and combined these items into

a composite with thirteen in the affective domain and four-

 

teen in the cognitive domain.

 

In an attempt to conceptualize a model for team
functioning, the work of the Tavistock Institute in London
was studied. This institute made studies of changing
technology in the coal mining industry and the redesign of
work in Indian textile mills. From their studies they
developed the concept of the socio-technical system which
implied that any productive organization or part thereof
is a combination of technology (task requirements, physical
layout, equipment) and a social system (a system of rela-
tionship among those whom must perform the job). The
technology and the social system are in mutual interaction
with each other and each determines the other. With this
concept in mind the twenty-seven variables compiled for this
study have been divided into two parts--one relating to
technology and the other to the social system as described
by Trist of the Tavistock Institute. The model developed
by the sociologist George Homans is not fundamentally at
odds with the Tavistock model, but is somewhat more differ-

entiated and complex. Homans postulates that activities,

25

interactions, and sentiments are mutually dependent on one
another. (See Appendix G.)

Homans presents three aspects of a model: activities,
interaction and sentiment. In Homans' theory there are three
elementary concepts: the first, activities refers to move-
ments, action, work, typing, writing, driving, etc. These
are basically things people do to, Or with nonhuman objects,
or with other people when their reaction or reciprocal
behavior is ignored (such as cutting a person's hair).
Second, statements of sentiment refer to feelings (happy,
sad, angry, stern, loving); to attitudes (this is his job;
it is time to go; he is conservative); or to beliefs. These
constitute the inner state of the person, the things an
individual subjectively perceives. Thirdly, statements
about interaction including going with someone, eating
together, working together, and the like. The basic char-
acteristic of interaction is that it is behavior directed
toward another person when his reaction or reciprocal
behavior is taken into account.7

Thus, any change in any of these three will produce
some change in the other two. Therefore, the higher the
rate of interaction of two or more people, the more

positive will be their sentiments toward each other. In

 

7George C. Homans, The Human Group (New York: Har-
court, 1950).

 

26

this study, interaction, in the mind of the author, is
analogous to social system in the Tavistock studies;
activity is analogous to technology and sentiment a
function of both interaction and technology.

After consultation with various medical doctors,
nurses, medical technologists the following items of the
instrument were grouped under the heading of Activity,

Sentiment and Interaction as proposed by Homans.

Item Numbers of Professional Perception Index

 

 

Sentiment Activity Interaction
1 2 5
7 3 8
12 4 10
16 6 11
21 9 14
22 13 15
24 20 17
25 18
19
23
26
——— ——— 27
Total 8 7 —I2

In addition, the participants were asked to rank various
health professionals as to status and salary. The medical
doctor was excluded on the salary question because those
in the hospitals used for this study are independent entre-
preneurs.

The sample consisted of seventy-five nurses and

seventy-five medical technologists from four Illinois

27

hospitals--two sectarian institutions and two non-sectarian
institutions. The instrument developed by the author is
called the Professional Perception Index. Sectarian and
non-sectarian hospitals were used because of the possibility
that perceptions of professionals in sectarian institutions

might be different due to the influence of religious beliefs.

Validity and Reliability

A group of experienced specialists made up of nine
postgraduate nurses with at least five years of experience,
seven medical technologists with at least three years of
experience, two hospital administrators, two pathologists
and one internal medicine doctor were consulted in the
development of the instrument.

Reliability was computed on a Test-Retest measure
from the data obtained from the administration of the
instrument to nurses and medical technologists on two

different occasions 20 days apart.

Table 1. Correlation Coefficients of Reliability of Test-

 

Retest
M.D. M.T. R.N.
Activity 0.6 0.6 0.8
Interaction 0.6 0.7 0.6
Sentiment 0.6 0.9 0.8
Total 0.6 0.7 0.8

The reliability coefficient is an estimate of the coefficient

of correlation between the original set of scores versus the

28

independent scores gathered 20 days later. The correla-
tions range between .6 and .9 with the average correla-
tion for the entire test being .75. Thus, it is assumed
that the reliability of the instrument is within acceptable

limits.
Weight of Relevancy

In order to evaluate the relevance of each item
of the instrument a self-administered questionnaire was
given to 14 nurses and 12 medical technologists. (See

Appendix B.)

Table 2. Relevancy of Items Contained in the Professional
Perception Index

Per Cent of The
Measure of Relevancy, Number of Responses Total Responses

 

 

 

very important 447 63.67
Moderately important 201 28.63
Slightly important 38 5.41
Irrelevant 3 0.43

If the very important and the moderately important are
grouped together, 92.3 per cent of the items of the
Professional Perception Index were considered relevant

by members of the two health professions studied. This is
an indirect measure of the validity of the Professional

Perception Index.

29

Statistical Analysis

Statistical methods used were "t" Test of Signifi-
cance Between Two Sample Means using Fisher's distribution.
In addition the Pearson product moment correlation coefficient
was used to measure linear regression and correlation.
(Appendix E.)

The Pearson Product Moment Correlation Coefficient
was used in the analysis. The choice of this statistical
procedure may be justified on the basis of the random
sampling procedure used and the size of the sample. With
a sample size of 150 randomly chosen we can assume a
fairly normal distribution of index scores. In addition,
the scores are independently determined.

For a continuous, quantitive range of index scores,
the correlation coefficient is a more sensitive and powerful
test of relationship than a Chi-Square test or other non-
parametric statistical test.

Also, the researcher examined hypotheses two
through seven by means of application of the t Test of
Significance. The t Test of Fisher has been chosen in
preference to the Z because of the sample size and the

independence of the items used.

Limitations of the Study

Since this research was done primarily in the

Chicago Metr0politan area, one cannot extrapolate to other

30

geographic areas. Furthermore, the 27 variables subsumed
under the three categories of Homans' model, activities,
sentiment and interaction may not have been accurately
grouped. Although there was relatively good agreement on
the category to which each variable should be placed, there
was some disagreement on the part of nurses and medical
technologists especially in the categories of sentiment and

interaction.

CHAPTER IV

ANALYSIS OF RESULTS

Differences in Perceptions of Nurses and
Medical Technologists

The sample consisted of 124 subjects of which 66
were registered nurses and 58 were medical technologists.
The instrument used was the Professional Perception Index
developed by the author. The instrument, the Professional
Perception Index, is a self-administered questionnaire
consisting of two parts. Part A deals with demographical
information and Part B is composed of 27 items considered
part of effective health team functioning. (Appendix B.)
The subjects were asked to rank on a 1 to 5 scale medical
doctors, nurses and medical technologists on each variable.

Each of the items in the Professional Perception
Index is independent. Therefore, each subject responded
freely to each item and had a range of five possible
responses from which he could choose one.

The difference in the scores given by nurses and
medical technologists are given in Table 3 using t scores
and per cent probability that the difference in scores was

due to chance.

31

32

Table 3. Difference between Medical Technologists and
Registered Nurses in rating Medical Doctors,
Medical Technologists and Registered Nurses
Using the Professional Perception Index

 

Total or

Sub_Total M.D. M.T. R.N.
t %p t %p t %p

Activity -l.234 30 0.996 40 -5.654

Interaction -2.467 2 0.925 40 -6.504

Sentiment -l.9l4 10 1.077 30 -5.890 1

Total -2.204 5 1.099 30 -6.617 1

The above data indicates that the differences in the per-
ceptions of nurses and medical technologists are statis-
tically significant in all aspects of the professional per-
ception index dealing with nurses. A 1 per cent proba-
bility that the difference is due to chance means that the
difference is statistically significant at the .01 level

or 99 per cent level of confidence. Therefore, we can
infer that nurses perceive themselves very differently from
the way medical technologists perceive them.

When rating medical doctors, nurses and medical
technologists differed significantly in the total scores as
well as in those items grouped in the category, interaction.
Since nurses because of their function are more frequently
involved with medical doctors than are medical technologists,
the differences in their perceptions are not surprising.

A 2 per cent probability that the difference is due to

chance means that the difference is statistically significant

33

at the .02 level or 98 per cent confidence level. There

are differences in the perceptions of medical doctors by
nurses and medical technologists in those items grouped
under sentiment. However, the difference is not statis-
tically significant because this difference could occur

by chance 10 times out of 100 or 90 per cent level of confi-
dence. However, this difference of .10 level cannot be
disregarded, even though it is less than the commonly
accepted .05 level. In Homans' category, Activity, there
was far less difference in the scores which medical techno-
logists and nurses gave to medical doctors. Thus, we can
infer that nurses and medical technologists are more congruent
in their perceptions of the activities of medical doctors
than in their perceptions of those items of the Professional
Perception Index grouped under interaction or sentiment as
applied to medical doctors.

Although nurses and medical technologists rate
medical technologists differently, this difference is not
statistically significant. Therefore, we can infer that
nurses and medical technologists perceive the activities,
interaction and sentiment of medical technologists more
similarly than they perceive the same attributes of nurses

or medical doctors.

 

34

Sectarian vs. Non-Sectarian

The differences in the scores given by nurses and
medical technologists in sectarian and non-sectarian
hospitals are given in Table 4 using t scores and per cent
probability that the difference in scores was due to

chance.

Table 4. Differences in Perceptions Given by Medical
Technologists and Nurses in Sectarian and Non-
Sectarian Hospitals

 

Total or

Sub-Total M.D. M.T. R.N.-
t %p t %p t gp

Activity -0.882 40 -l.1876 30 -0.0924 100

Interaction -0.5851 60 -0.7619 50 -0.9345 40

Sentiment -0.2105 90 -0.0080 100 0.0706 100

Total -0.6523 60 -0.7467 50 -0.4809 70

In this table %p refers to the probability that the
differences in the scores were due to chance. Thus we can
infer that the perceptions of nurses and medical technologists
working in sectarian and non-sectarian hospitals are not
significantly different. Thus, on the basis of this data,

we can say:

Sectarian Sectarian Non-Sect Non-Sect
Nurse + Med Tech = Nurse + Med Tech
Views Views Views Views

this doesn't necessarily mean that

Sectarian Non-Sect Sectarian Non-Sect
Nurse = Nurse and Med Tech = Med Tech
Views Views Views Views

35

Perceptions vs. Education

The education of medical technologists does not
appear to influence significantly their perceptions of

medical doctors and medical technologists.

Table 5. Analysis of Variance of the Education of Medical
Technologists and their Perceptions of Medical

 

 

Doctors

Source of Degrees Sum of Mean
Variation of Freedom Squares Squares P Value
Attributable

to Regression 1 748.08252 748.08252 2.88030
Deviation from

Regression 53 13765.35547 259.72363
Total 54 14513.43750

An F value of 2.880 or 90 per cent level of confidence means
that there is a difference but this difference is not signi-

ficant at the .05 level.

Table 6. Analysis of Variance of the Education of Medical
Technologists and their Perceptions of other
Medical Technologists

 

 

Source Degrees Sum of Mean
Variation of Freedom Sgpares Sguares F Value
Attributable

to Regression 1 511.29883 511.29883 2.56755
Deviation from

Regression 53 10554.36719 199.13899
Total 54 11065.66406

An F value of 2.567 or less than 90 per cent level of confi-
dence means that the differences in years of formal schooling
of medical technologists do not significantly effect their

perceptions of medical technologists.

36

However, the education of medical technologists
does appear to influence their perceptions of nurses in all

three of the components, activities, interaction and sentiment.

Table 7. Analysis of Variance of Years of Formal Schooling
of Medical Technologists and Their Perception of
the Activities of Nurses

 

 

Source of Degrees Sum of Mean
Variation of Freedom Squares Sguares F Value
Attributable

to Regression l 123.23311 123.23311 5.19818
Deviation from

Regression 53 1256.46997 23.70697

Total 54 1379.70288

An F value of 5.198 indicates that the difference in the years
of formal schooling of medical technologists relative to their
perceptions of the activities of nurses is statistically
significant to the .05 level. This means that only 5 per

cent of the difference can be attributed to chance, therefore,
the level of confidence is 95 per cent. When analyzing the
dependent variable, interaction, the effects of education

of medical technologists on their perceptions of the inter-
action of nurses the differences were even greater than those

of the dependent variable, activity.

Table 8. Analysis of Variance of Years of Formal Schooling
of Medical Technologists and Their Perception of
the Interaction of Nurses.

 

 

Source of Degrees Sum of Mean
Variation of Freedom Sguares Squares F Value
Attributable

to Regression 1 463.85693 463.85693 7.66405
Deviation from

Regression 53 3207.75757 60.52373

Total 54 3671.61450

37

An F value of 7.664 indicates that the difference in

the education of medical technologists relative to their
perceptions of the interaction of nurses is statistically
significant to the .01 level. This means that only 1 per
cent of the difference can be attributed to chance. There-
fore, the level of confidence is 99 per cent.

The education of medical technologists did not
appear to influence to the .05 level of significance their
perceptions of nurses on those items grouped under sentiment.
The F value for this analysis of variance was 3.47636, which
would indicate a confidence level of 90 per cent. When the
total number of items of the Professional Perception Index
was analyzed, to determine the effects of formal schooling
on the perceptions of medical technologists toward nurses,
it appears that formal schooling may have an effect on the
perceptions of medical technologists when ranking nurses.
Therefore, we cannot reject the hypothesis that years of
formal schooling influence the perceptions of medical

technologists as reflected by the Professional Perception Index.

Table 9. Analysis of Variance of Years of Formal Schooling
of Medical Technologists and the Perceptions of
Nurses on Total Scores

 

 

Source of Degrees Sum of Mean
Variation of Freedom Sguares Squares F Value
Attributable

to Regression l 1740.51050 1740.51050 7.38732
Deviation from

Regression 53 12487.21094 235.60774

Total 54 14227.71875

38

An F value of 7.387 or confidence level of 99 per cent
means that the differences in the years of formal schooling
of medical technologists suggest that years of formal
schooling may effect their perception of nurses. The more
years of formal schooling the medical technologist has,

the more favorably she perceives the nurse. The years of
formal schooling of nurses does not appear to influence
their perceptions of medical technologists, medical doctors

or nurses .

Table 10. Computed F Values of the Years of Formal Schooling
of Nurses and Their Perceptions of Medical Doc-
tors, Medical Technologists and Registered Nurses

 

Total or

Sub-Total M.D. M.T. R.N.
Activity 0.26806 0.01107 1.19774
Interaction 0.07965 0.12802 0.03341
Sentiment 0.24723 0.44607 0.10807
Total 0.02351 0.18128 0.00926

None of these computed values are significant, therefore,
it cannot be said that the perceptions of nurses are effected

by years of formal education post high-school.

Perceptions vs. Experience

When comparing the years of work experience as a
medical technologist with their perceptions of medical
doctors, nurses and medical technologists, it appears on
the basis of the following data that differences in exper-

ience do effect the perceptions of medical technologists.

39

Table 11. Computed F Values of the Experience of Medical
Technologists and Their Perceptions of Medical
Doctors, Medical Technologists, and Registered

 

Nurses
Total or
Sub-Total M.D. M.T. R.N.
Activity 1.5568 3.6703 0.0068
Interaction 2.2395 5.3772 0.7664
Sentiment 1.3627 1.1487 0.0003
Total 2.3158 4.4561 0.1784

With 1 and 56 degrees of freedom an F value statistically
significant at the .05 level must be over 4.000. An F value
of 5.377 is statistically significant at the .05 level or 95
per cent level of confidence.

Experience of Medical Technologists as compared with
their perceptions of Interaction of Medical Technologists.

An analysis of the F values and the sign of the
regression coefficient indicates that the more experienced
medical technologists rated the medical technologist more
poorly than did the inexperienced medical technologist
especially in the category of interaction. A possible
explanation may be that the more experienced medical tech-
nologists become more demanding as they get older.

Although not statistically significant, the differences
in experience of medical technologists appear to effect
their perceptions of medical doctors. However, on the
basis of this data experience of medical technologists

has very little affect on their perceptions of nurses.

4O

Differences in the experience of nurses did not appear
on the basis of the following data to significantly effect
their perceptions of medical doctors, medical technologists

and nurses.

Table 12. Computed F Values of the Differences in Experience
of Nurses and Their Perceptions of Medical Doctors,
Medical Technologists, and Registered Nurses

 

Total or

Sub-Total M.D. M.T. R.N.
Activity 0.8028 0.9612 0.2899
Interaction 0.2161 2.6622 0.0082
Sentiment 0.0116 1.7853 0.0812
Total 0.2655 2.3262 0.0093

With one and 62 degrees of freedom the F value to be
statistically significant at the .05 level would have to

be 4.00 or more. In the above data it appears that experi-
ence of nurses may effect their perceptions of medical
technologists especially in the category of Interaction. An
F value of 2.6522 means that the level of confidence is less
than 90 per cent. Although this value is not statistically
significant at the .05 level, the regression coefficient
does suggest that the more experienced nurses ranked medical

technologists lower than did the inexperienced nurses.

Age vs. Perceptions

When comparing the age of medical technologists with

their perceptions of medical doctors, nurses and medical

41

technologists, it appears on the basis of the following
data that age does not significantly alter the perceptions

of medical technologists.

Table 13. Computed F Values of the Age of Medical Techno-
logists and their Perceptions of Medical Doctors,
Medical Technologists, and Registered Nurses

 

Total or

Sub-Total M.D. M.T. R.N.
Activity 0.0372 2.3996 0.1384
Interaction 0.0656 1.9776 0.7910
Sentiment 0.0979 0.6197 0.7210
Total 0.0250 2.0786 0.6875

An F value of 2.399 means that the differences in percep-
tions could occur by chance at least one time out of 10 or
less than 90 per cent level of confidence. Therefore we
cannot reject the hypothesis that the regression line does
not do a significantly (to the .01 or .05 levels) better
job of representing the data than a horizontal line whose
height is the mean. In other words, we cannot be 90 per
cent confident if we say that "There is a variation of
medical technologists perceptions with age" on the basis
of our data.

When comparing the age of nurses with their percep-
tions of medical doctors, medical technologists, and registered
nurses, it appears on the basis of the following data that
differences in age may significantly alter the perceptions

of nurses.

42

Table 14. Computed F Values of the Differences of Age of
Nurses and Their Perceptions of Medical Doctors,
Medical Technologists, and Registered Nurses

 

Total or

Sub-Total M.D. M.T. R.N.
Activity 0.6838 2.7560 0.3326
Interaction 0.3365 5.2518 0.1498
Sentiment 0.7653 4.0241 0.1555
Total 0.1115 5.1502 0.2064

With 1 and 64 degrees of freedom, an F value of 4.00 is
statistically significant at the .05 level. Therefore, the
data indicate that the age of nurses may influence their
perceptions of medical technologists especially in Homans'
categories of Interaction and Sentiment as measured by the

Professional Perception Index.

Table 15. Analysis of Variance Age of Nurses and Their
Perceptions of Medical Technologists

 

 

Source of Degrees Sum of Mean
Variation of Freedom Squares Sguares F Value
Attributable

to Regression 1 1497.74072 1497.74072 5.15020
Deviation from

Regression 64 18611.99609 290.81226
Total 65 20109.73437

An F value of 5.1502 is statistically significant at the

.05 level. Therefore, these differences are statistically
significant at the .05 level or 95 per cent level of confi-
dence. Thus, older nurses rated medical technologists better

than did younger ones. This may be due to the rapid

43

technological advancements made in laboratory medicine in
the past 10 years. If one were to assume that the older
nurses were in supervisory positions, they would be more
familiar with the technical advancements because they would
be requesting laboratory procedures as directed by the
physician. However, the age of nurses does not appear to
significantly alter their perceptions of medical doctors or

nurses on the basis of this data.
Status and Salary

In addition, the participants were asked to rank
various health professionals as to status and salary. The
medical doctor was excluded on the salary question because
those in the hospitals used for this study are independent
entrepreneurs.

It is interesting to note that 64 per cent of the
total sample population rated the administrator first in
status and 46 per cent rated the physician first in status.
This may be explained by the fact that a dual hierarchy exists
in most hospitals whereby, the administrator is responsible
for supplying personnel while the physician diagnoses and
prescribes for patients. Therefore, both nurses and medical
technologists take directions from both the administrator
and physician. However, administrators pay the salaries of
both nurses and medical technologists employed by the

hOSpital. The following table reflects the data on status:

44

Table 16. Per Cent of Total Sample Medical Technologists
and Nurses Ranking Other Health Professionals

on Status

 

One Two Three Four Five Six Seven
X-Ray
Technologist 0 1 17 36 21
Physician 32 57 0
Medical
Technologist 0 1 ll 17 25 l7 17
Administrator 64 25 1 0 0 0 1
Practical Nurse 0 2 2 10 10 10 13
Nurse 4 l 37 24 17 8 1
Dietician 0 0 7 10 18 16 26
Pharmacist 0 6 42 26 10 6 2
As to salary, 90 per cent rated the administrator
first and 74 per cent ranked the pharmacist second. The
dietician was ranked below both the medical technologist

and the nurse by 61 per cent. See Table 17

for salary

rankings of both nurses and medical technologists:

Table 17. Per Cent of Sample Medical Technologists and
Nurses Ranking Health Professionals on Salary

 

One Two Three Four Five Six Seven

Nurse 0 4 26 37 16 0
Administrator 90 0 0 0 3
Pharmacist 0 74 8 1 1
Practical Nurse 0 0 1 4 9 18 58
X-Ray

Technologist 0 0 5 10 28 37 10
Medical

Technologist 0 6 21 19 23 ll 8
Dietician 0 2 29 17 18 19

45

Employing a simple ranking procedure it was dis-
covered that although both medical technologists and nurses
agreed on many positions within the Salary and Status
Scales for other health professions, they each saw the other
ranked below themselves. Thus, nurses ranked themselves
fourth on the Status Scale and technologists sixth. They
also ranked themselves third on the Salary Scale while
placing the technologists fifth. Conversely, the medical
technologists placed themselves third on the Status Scale
and ranked nurses immediately below them in the fourth
position. Continuing in this pattern they ranked themselves
third on the Salary Scale and the nurses immediately below

them in the fourth position.

Table 18. Status and Salary Scale

Registered Nurse Rankings

 

 

 

Status Scale Salary Scale
Administrator Administrator
Physician Pharmacist
Pharmacist Nurse

Nurse Dietician

Dietician Medical Technologist
Medical Technologist X-ray Technician
X-ray Technician Practical Nurse

Practical Nurse

Medical Technologist Rankings

 

 

 

Status Scale Salary Scale
Administrator Administrator
Physician Pharmacist

Medical Technologist Medical Technologist
Nurse Nurse

Dietician v Dietician

X-ray Technician X-ray Technician

Practical Nurse Practical Nurse

46

Summary

In summary, nurses and medical technologists have
different perceptions of the activities, interaction and
sentiment of medical doctors, medical technologists and
nurses as indicated by the Professional Perception Index.

The greatest differences in the perceptions of nurses

and medical technologists occur in the rankings of nurses

and medical doctors. The difference in the ranking of nurses
by nurses and medical technologists is statistically
significant at the .01 level or 99 per cent level of
confidence. The difference in the ranking of medical doctors
by nurses and medical technologists is statistically signi-
ficant at the .05 level or 95 per cent level of confidence.
Although not statistically significant, the rankings of
medical technologists by nurses and medical technologists
cannot be ignored since this 70 per cent level of confidence
may indicate a difference.

On the basis of this data, the more years of formal
schooling a medical technologist has, the higher she ranked
nurses especially in the categories of activities (.05 level)
and interaction (.01 level). Years of formal schooling
appeared to have no significant effect on the perceptions of
nurses.

The experience of medical technologists has an

influence on their perceptions of nurses especially in

47

the categories of nurses' activities and interaction on
the basis of this data (significant to the .05 level).
The experience of nurses did not appear to significantly
alter their perceptions of medical doctors, nurses or
medical technologists.

The differences in age of medical technologists did
not appear to significantly alter their perceptions of
medical doctors, medical technologists and nurses according
to the Professional Perception Index. Although differences
in the age of nurses did not appear to alter their percep-
tions of medical doctors or nurses, age differences of
nurses did appear to significantly alter their perceptions
of medical technologists. These differences were statisti-
cally significant to the .05 level or 95 per cent level of

confidence.

CHAPTER V

SUMMARY, IMPLICATIONS AND RECOMMENDATIONS

Summary

In summary, nurses and medical technologists have
different perceptions of the activities, interaction and
sentiment of medical doctors, medical technologists and
nurses as indicated by the Professional Perception Index.

The greatest differences in the perceptions of nurses and
medical technologists occur in the ratings of nurses and
medical doctors. The difference in the rating of nurses

by nurses and medical technologists is statistically
significant at the .01 level or 99 per cent level of confi-
dence. The difference in the rating of medical doctors by
nurses and medical technologists is statistically significant
at the .05 level or 95 per cent level of confidence. Al-
though not statistically significant, the ratings of medical
technologists by nurses and medical technologists cannot be
ignored since this 70 per cent level of confidence does indi-
cate a difference.

On the basis of this data, the more education a
medical technologist had, the higher she rated nurses

especially in the categories of activities (.05 level)

48

49

and interaction (.01 level). Years of formal schooling
did not appear to alter the perceptions of nurses.

The experience of medical technologists does
appear to influence their perceptions of nurses especially
in the categories of nurses' activities and interaction on
the basis of this data (significant to the .05 level).

The experience of nurses did not appear to significantly
alter their perceptions of medical doctors, nurses or
medical technologists.

The differences in age of medical technologists did
not appear to significantly alter their perceptions of
medical doctors, medical technologists and nurses according
to the Professional Perception Index. Although differences
in the ages of nurses did not alter their perceptions of
medical doctors or nurses, age differences of nurses did
appear to significantly alter their perceptions of medical
technologists. These differences were statistically signi-

ficant to the .05 level or 95 per cent level of confidence.

Implications

The advent of comprehensive care and extended care
has contributed to the changing role of health professionals.
The team approach implies cooperation, collaboration, open
communications, elimination of power struggles and commitment

to the concept of optimum health care for all. Respect and

50

positive interpersonal relations will be enhanced by an
understanding of the contributions of each of the health
professionals.

Since there are significant differences in the way
nurses perceive themselves and the way medical technologists
perceive nurses, one can infer, on the basis of this data,
that these differing perceptions may contribute to the daily
observable conflict on the health team. Because the patient
is housed in a unit administered by nurses, the therapeutic,
diagnostic and institutional services are usually initiated,
coordinated and facilitated by a nurse. In view of the sta-
tistically significant differences in the perceptions of
nurses by medical technologists, the data in this research
would suggest both pre-professional and professional
education of medical technologists relative to the role of
the nurse. However, this education should begin with
emphasis on the commonalities found in the functioning of
all health professionals, namely, the best possible patient
care.

Due to the technological advancements and the resulting
radical changes in health care, all health professionals must
be educated for change and adaptation. Furthermore, the
health professional organizations in consort with hospital
administrators need to define the role of each health pro-

fessional. The patterns of organization and processes of

51

interaction among the various professionals must be re-
assessed. The degree of planned interaction among health
professionals is directly related to the quality of patient
care. "The many misunderstandings that can occur during
each day have a high probability of reducing the opportuni-
ties for expert care. Time that probably would be devoted
to the care of patients must be used to untangle misunder-
standings and salve hurt feelings."1

Because the role of the various health professionals
is in a state of transition, differences in the perceptions
of these roles must be clarified. In addition to role
definition, there must be a definition of the functions and
sc0pe of each department in the hospital. In addition to
"intra-personal" conflict on the health team, inadequate
role definition and role consensus contributes to institu-
tional role conflict. When nurses or medical technologists
are expected to assume responsibility for a managerial role,
the inevitable result is conflict between the organizational
goals and professional orientation.

Clarification of roles and territorial imperatives
might be delineated by the use of inter-professional
committees in universities and hospitals. Such committees

would give to each health professional the opportunity to

 

1Luther P. Christman, R.N., Ph.D., "Nurse-Physician
Communications in the Hospital," JAMA, 194 (November 1, 1965)
539.

52

voice his Opinions, problems and concerns in an atmosphere

of open forum. In universities, inter-professional leader-
ship groups could provide direction for curriculum programming
with emphasis on the team concept in health care. In-ser-
vice education in the hospital could take the form of an

open forum where each health professional would be oriented

to the role of other health professionals.

At the present time, the role of the nurse is
fragmentized into many parts. Because she is coordinator of
patient services, she must fill in when the specialty person,
such as the dietician or medical technologist, does not
appear on duty, i.e. in the absence of the dietician, the
nurse must pass trays; in the absence of the medical tech-
nologist, the nurse must contact a physician or resident
physician to draw blood for therapeutic or diagnostic pro-
cedures.

In this study, nurses perceived the role of medical
technologists much more congruently than did medical tech-
nologists perceive the role of nurses. This data suggests
that medical technologists are not aware of the multiple
interactions of nurses with other health professionals nor
of the limited interactions of medical technologists with
other health professionals.

Thus, interdisciplinary education in the pre-

professional and professional development of health

53

personnel would help to clarify the roles of health pro-
fessionals in the present transition as well as in future
planning.

As to pre-professional education, the sharing of
courses and aspirations, as well as formal and informal
conferences on the roles of various health professionals
may help to preserve the altruistic nature of health pro-
fessional students at the time of their entrance to the
program. Since attitudes are shaped in the pre-professional
days, it is essential that the high degree of commitment in
applicants be preserved and enhanced. For a better under-
standing of the role of the nurse, education programs for
other health professionals might well include clinical time
in nursing to observe the total patient care day and to become
cognizant of the fact that an ordinary patient may see
30-40 persons in the course of a single day in the hospital.
Conversely, nursing education would benefit from some
clinical time at least in the major ancillary departments,
i.e., clinical laboratory and radiology.

The suggested program content mentioned above could
be used for in-service education in hospitals and other
health care facilities. In addition, both pre-professional
and in-service education should provide background in depth
in the field of human relations by providing behavioral
science courses and/or workshops dealing directly with

patient care.

54

In an effort to convey an understanding of the
total patient care environment found within a hospital
setting, the author has attempted to devise a model. The
model depicts in a schematic drawing the various complicated
interplays between members of the health team.

In this model, the patient is central and of prime
importance. The physician is the closest to the patient
since it is because of the physician that the patient is
in the hospital. The physician writes the medical orders.
These orders then pass through the filter of the nurse who
translates these orders and activates the allied health
personnel in the appropriate department for implementation.
In addition, the specific health professional must colla-
borate with the nurse for the efficient performance of the
physician's orders. Thus, the nurse is responsible for
filtering the doctor's orders. She also initiates orders
i.e., oxygen therapy, housekeeping and emergency laboratory
procedures.

Two-way communication must exist in all facets
represented. This graphic representation of total hospital
ambience is presented as a partial solution to the misconcep-

tions of roles of the various health professionals.

1...;

55

Key:

-- interaction
between health
members only.

c—b direct inter-

 

  
 
 
 
  

health team
member.

 

 

1. Pharmacy 11. Cardiology

2. Occupational Therapy 12. Electro-encephalography
3. Physical Therapy 13. Pulmonary Function

4. Radiology 14. Clinic Services

5. Clinical Laboratory 15. Public Relations

6. Chaplain Service 16. Dentistry

7. Housekeeping 17. Dietetics-nutrition

8. Accounting Department 18. Neuro-mental

9. Social Service 19. Volunteer Service

0- Maintenance Department 20. Nursing Education

56
Recommendations for Future Research

Since this research was done primarily in the
Chicago Metropolitan area the data are limited to that
geographic area and may not apply to all parts of America.

Research such as this answers some questions but
leaves others unanswered and creates still further tOpics
for future research. Some problems yet to be explored
suggest the following possibilities:

1. Replicate this study in another geographic area.

2. Replicate this study in health facilities other
than hospitals (i.e., Nursing Homes, Clinics).

3. Develop a similar study using as subjects other
health professionals such as radiologic technolo—
gists and dieticians.

4. A similar study involving only students in the
health professions in their last year of education.

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Alfred P. Sloan School of Management, Massachusetts
Institute of Technology, 1965b (mimeo).

Sherlock, B.J.; and Morris, R.T. "The Evolution of the
Professional: A Paradigm." Sociological Inquiry,
37, 27-46.

Smith, Clagett G. "A Comparative Analysis of Some Conditions
and Consequences of Intra-Organizational Conflict."
Administrative Science Quarterly, 10 (4)(March
19667, 504-529.

Stein, Leonard I. "The Doctor-Nurse Game." American
Journal of Nursing, 68 (l)(January 1968), 1 1-04.

 

Warren, J.R. "Self Concept, Occupational Role Expecta-
tion, and Change in College Major." Journal of
Counseling Psychology, 8 (1961), 164-69.

 

Weil, Thomas P. and Parrish, Henry M. "Development of a
Coordinated Approach for the Training of Allied
Health Personnel." Journal of Medical Education,
42 (July 1967), 658.

Zilm, Glennis, B.Sc.N., B.J. "Nursing Associations--Are
They Coming or Going?" The Canadian Nurse,
(September 1969).

Unpublished Material

 

Levinson, Daniel J. "Role, Personality & Social Structure
in the Organizational Setting." Mimeographed paper.

APPENDICES

APPENDIX A

DEFINITIONS OF TERMS

Theoretical Definitions of Variables

 

The following terms are used throughout this

discussion of the study. In order to provide for clarity

of meaning they are stated here in glossary fashion.

Independent Variables:

1.

2.

3.

Experience - Number of years working as a

Education -

Age -

Dependent Variables:

1.

2.

Activity -

Interaction-

professional nurse or medical
technologist.

The number of years spent in college,
post high school. Education refers
to the highest academic degree earned,
diploma or certification.

Refers to chronological years.

Refers to movements, action, work, typing,
writing, driving, etc. These are basically
things peOple do to, or with nonhuman
objects, or with other peOple when their
reaction or reciprocal behavior is

ignored (such as cutting a person's hair).
Refers to feelings (happy, sad, angry,
stern, loving); to attitudes (this is

his job; it is time to go; he is con-

servative); or to beliefs. These

65

66

constitute the inner state of the
person, the things an individual
subjectively perceives.

3. Sentiment — Refers to statements about interaction
including going with someone, eating
together, working together, and the
like. The basic characteristic of
interaction is that it is behavior
directed toward another person when
his reaction or reciprocal behavior

is taken into account.

Definitions

 

Health Team - A group of health personnel working

 

in concert toward the goal of excellence in patient care.

Affective - Relating to arising from, or influencing

 

feelings or emotions.

Cognitive - The act or process of knowing including

 

awareness, judgment and action.
Nurse - Registered Nurse licensed to practice in
the United States.

Physician - Medical Doctor licensed to practice in

 

the United States.

Health Profession - Can be defined as one for which

 

preparation is at the baccalaureate level.

67

Allied Health Occupation - The "allied" health

 

occupations include a broad range--perhaps every group beyond
medicine and dentistry.

Technologist - The word "technologist" is used to

 

mean a person with baccalaureate level preparation and
registered by the American Society of Medical Technologists.

Tavistock Model - Socio-technical system which is

 

a combination of technology and a social system.

Technology - Task requirement, physical layout,

 

equipment and supplies.

Social System - A system of relationship among

 

those whom must perform the job.

Role Theory - Is defined as including theories of

 

interpersonal perception, theories of organizational concept,
theories of individual behavior, theories of legislatures,
etc., may all involve the concept of role in their explana-

tory processes, and thus be considered "role theories."

APPENDIX B

THE INSTRUMENT OF THIS STUDY

PERCEPTIONS OF THE MEMBERS OF THE HEALTH TEAM

August 19, 1969

Dear Participant,

This questionnaire is part of a study of public
and non-public hospitals. The objectives of the study
are to gain a better understanding of some of the
factors that influence both registered nurses and medical
technologists.

Please respond to the following questions as they
relate to your perceptions of the average health pro-
fessional.

Your responses will remain entirely anonymous.
We are concerned only with answers from groups of people,
not with any single individual's response. The numbers
on the questionnaire serve only to keep the sections
together, not to identify persons. Thank you for your
cooperation.
Sincerely,

Sister M. Rosarii Saunders
Michigan State University

69

PERCEPTIONS OF THE MEMBERS OF THE HEALTH TEAM

 

 

Part A
Size of Hospital
1. 100 to 200 beds
2. 200 to 400 beds
3. Over 400 beds
Nature of Hospital
1. Public
2. Non-public
Profession
1. Nurse
2. Medical Laboratory Technologist

 

Offices held in your professional organization (local,
county)

1. None (local, county)
2. One to three (local, county)
3 More than three (local, county)

 

Offices held in your professional organization (state,
regional)

1. None (state, regional)
2. One to three (state, regional)
3. More than three (state, regional)

 

Offices held in your professional organization (Nat'l.,
or Int'l.)

1. None (Nat'l., Int'l.)
2. One to three (Nat'l., Int'l.)
3. More than three (Nat'l., Int'l.)

What is your marital status

1. Single

2. Married
3. Widowed
4. Divorced

70

10.

ll.

12.

13.

71

Please check your age range scale

 

1. 20-29
2. 30-39
3. 40-49
4. Over 50
Your sex

1. Male

2. Female

Predominant shift worked for the past 2 years

1. Days
2. Evenings
3. Nights

How many years of experience as either a nurse or
medical technologist do you have

1. Less than one
2. 1-3

3. 4-6

4. 7-9

5. Over 10

 

Please indicate your highest academic achievement. Check
only one.

. BA or BS

MA or MS or MEd

Associate of Arts (Community College)

Nursing Diploma

Registration by American Society of Clinical
Pathologists

Ph.D. - Ed.D.

. Other (Please Specify)

UlubLaJNH
.0

um

 

 

Your present position (check only one)

. Staff Nurse

Head Nurse

Nurse Supervisor

Staff Medical Technologist

Laboratory Supervisor (Two or more units i.e.,
Chemistry and Hematology).

Unit or Department Chief Technologist (i.e.,
Chemistry or Hematology, etc.)

WAUNH
0 o o o

ax

72

 

7. Clinical Instructor in Nursing

8. Clinical Instructor in Medical Technology

9. Other (Please specify)
Part B

Following is a list of items which are considered
part of effective health team functioning. Using the
Medical Laboratory Technologist, Registered Nurse and
Medical Doctor as professionals on this team, rank (1 =
highest; 5 = lowest) the members as you perceive their
average performance for each variable. These three team
members are listed in alphabetical order for your con-
venience. (You may use the same rank number twice as per
example #2 below.)

 

Example: (These are not considered part of
the health team.)

(M.D.) (M.T.) (R.N.)

 

3 (Ex.) Drives conservative car
2 (Ex.) Is afraid of cars

NH
O

U1
MN

(M.D.) (M.T.) (R.N.)

. persuasive

adheres to hospital policies

is organized in work

is accurate in observations

accepts suggestions well

O‘UTAUJNH

. is aware of patients' physical
needs

7. is discreet in use of confiden—
tial information

8. actively contributes to formula—
tion of team policy

9. accurate in carrying out pro-
cedures

10. possesses respect for contri-
bution of other team members

(M.D.)

(M.T.)

(R.N.)

ll.
12.

13.
14.

15.

16.

17.

l8.

19.
20.
21.

22.

23.

24.

25.

26.

27.

73

has good patient relationship

is tolerant of errors of
other team members

adheres to aseptic techniques

has a good relationship with
subordinates

is willing to communicate down-
ward

is aware of patients' emo-
tional needs

seeks contributions of other
team members

is willing to communicate
upward

delegates responsibility
influences hospital policy

adapts easily to change in
procedures

is willing to compromise when
alternative measures are to
be presented

has a good relationship with
other health team profes-
sionals (i.e., physician
to medical technologist;
medical technologist to
nurse; etc.)

has empathetic concern for
the patient

readily admits errors and
omissions

has good relationship with
peer members (i.e., physi-
cian to physician; nurse
to nurse; etc.)

uses terminology understand-
able to Specific team
members

******

74

On a typical day, how much time do you spend communicating
with the following?

0 min. 5 min. 15 min. 30 min. or more
28. a nurse
29. a physician

30. a medical
technologist

*****

On an 8-point scale (1 being the highest, and 8 being the low-
est) please rate to the left of the following according to
STATUS in the hospital.

31. _____ x-ray technologist
32. __fl__ physician

33. _____ medical technologist
34. _____ administrator

35. _____ practical nurse

36. _____ nurse

37. _____ dietician

38. pharmacist

*****

0n a 7-point scale please rate the following according to
PAY SCALE

39. nurse

40. administrator
41. pharmacist
42. practical nurse

43. medical technologist

75

44. x-ray technologist

45. dietician

In your hospital what is your estimate of the average amount
of formal education (years post highschool) of the following

46. registered nurse years

47. registered medical laboratory technologist _ yrs.

Thank you very much!

APPENDIX B

Exhibit 1

WEIGHING OF THE RELEVANCE

77

Exhibit 1

Please check the variables #1 through #27, Part B (supra)

as to importance for health team functioning.

the following scale:

V.I. - Very Relevant

You may use

- Slightly Important

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M.I. - Moderately Important Irrelevant
81.1. Ir.

1. Persuasive _
2. Adheres to hospital policies _
3. Is organized in work _
4. Is accurate in observations
5. Accepts suggestions well __~~_
6. Is aware of patients' phy-

sical needs 1111
7. Is discreet in use of con-

fidential information _ “““w
8. Actively contributes to

formulation of team

policy
9. Accurate in carrying out

procedures _g_
10. Possesses respect for con-

tribution of other

team members ___g
11. Has good patient relation-

ship ___H -
12. Is tolerant of errors

of other team members ,111-
13. Adheres to aseptic tech-

niques _.»1
14. Has a good relationship

with subordinates

 

 

15.

16.

l7.

l8.

19.

20.

21.

22.

23.

24.

25.

26.

27.

V.I. M.I. Sl.I.

Ir.

 

Is willing to commu-
nicate downward

 

 

Is aware of patients'
emotional needs

 

 

Seeks contributions of
other team members

 

 

Is willing to communi-
cate upward

 

Delegates responsibility

 

Influences hospital
policy

 

Adapts easily to change
in procedures

 

 

Is willing to compromise
when alternative mea-
sures are presented

 

 

Has a good relationship
with other health team
professionals (i.e.,
physician to medical
technologist to nurse,
etc.)

 

 

Has empathetic concern
for patient

 

 

Readily admits errors
and omissions

 

 

Has good relationship
with peer members (i.e.,
physician to physician;
nurse to nurse, etc.)

 

 

Uses terminology under-
standable to specific
team members

 

APPENDIX C

FIELDS WITH EXISTING ASSOCIATE DEGREE

JOB-ENTRY PROGRAMS AND ASSOCIATIONS

CONCERNED WITH PROGRAM DEVELOPMENT

APPENDIX C

Fields with Existing Associate
Degree Job-Entry Programs

 

Dental Assisting

Dental Hygiene

Dental Laboratory Technology

Environmental Health Technology

Food Service Supervision

Inhalation Therapy Technology

Medical Laboratory Technology

Medical Record Technology

Medical Secretarial and/or
Assisting

Mental Health Technology

Nursing

80

Associations Concerned with
Program DevelOpment

 

American Dental Assistants
Association and American
Dental Association

American Dental Hygienists
Association and American
Dental Association

American Dental Association
National Sanitation Foundation
American Dietetics Association

American Association of Inhala-
tion Therapists, American
Medical Association, American
Society of Anesthesiologists,
and the American College of
Chest Physicians

American Society of Medical
Technologists, American
Society of Clinical Patholo—
gists, and American Medical
Association

American Association of Medi—
cal Record Librarians and
American Medical Association

American Association of Medi-
cal Assistants

National Commission on Mental
Health Careers

National League for Nursing
and American Nurses Associa~
tion

81

Fields with Existing Associate
Degree Job-Entry Programs

Associations Concerned with
Program Development

 

Occupational Therapy Assisting

Ophthalmic Dispensing
(Opticianry)

Optometric Assisting

Prosthetics-Orthotics
Technology

Source:

 

American Occupational Therapy
Association

American Board of Opticianry,
Guild of Prescription Opti-
cians, and Better Vision
Institute

American Optometric Assoc.

American Orthotics and
Prosthetics Association

National Health Council, A Guide for Health Technology

 

Program Plannipg (1740 Broadway, New York, New

 

York 10019).

APPENDIX D

PERSONNEL NEEDS IN HOSPITALS: ACTUAL
STAFF 1966 (ESTIMATED) AND ESTIMATED

TOTAL NEEDED IN 1975

APPENDIX D

PERSONNEL NEEDS IN HOSPITALS: 1966 and 1975 for U.S.A.

 

Additional Estimated

 

Actual needed for total
Staff 1966 optimum needed in

CATEGORY OF PERSONNEL (Estimated) care 1966 1975*
Total professional and technical . . . 1,332,100 257,200 2,034,300
NURSING SERVICE:
Nurse - RN . . . . . . . . . . . . . 361,000 79,500 563,800
Idcensed Practical nurse . . . . . . 150,600 41,400 245,800
Surgical technician . . . . . . . . 17,600 3,900 27,500
Aide, orderly (except in psychiatric

hospitals) . . . . . . . . . . . . . 374,400 51,300 544,900
Aide, orderly in psychiatric hospitals 117,600 18,500 174,200
DIAGNOSTIC SERVICES:
lbdical technologist . . . . . . . . . 54,500 9,200 81,500
Laboratory assistant . . . . . . . . . 14,600 2,500 21,900
Cytotechnologist . . . . . . . . . . . 1,600 500 2,700
Histologic technician . . . . . . . . 3,900 700 5,900
Electrocardiograph technician . . . . 5.900 800 8.600
THERAPEUTIC SERVICES:
Occupational therapist . . . . . . . . 4,100 2.300 8.200
Occupational therapy assistant . . . . .3,800 1.200 6,400
Physical therapist . . . . . . . . 8,500 2,900 14,600
Physical therapy assistant . . . . 5,200 1,100 8.100
Social worker . . . . . . . . . . . . 10,700 5,100 20.200
Social work assistant . . . . . . . . 1,500 500 2.600
F@creation therapist . . . . . . . . . 3,800 1.600 6.900
Inhalation therapist . . . . . 5,600 2,200 10, 000
Speech pathologist and audiologist 1,200 500 9.200
RADIOLOGY:
Radiologic technologist . . . . . . 24,000 3,900 35,700
X-ray assistant . . . . . . . 6,000 900 8,800
PHARMACY:
fMarmaCist . . . . . . . . . . . . . 9,400 1,900 14.90“
Pharmacy assistant . . . . . . . . . 5,600 900 8.300
DEDICAL RECORDS:
lbdical record librarian . . . . . . . 6,300 1,800 10.400
lhdical record technician . . . . . . 10,100 1,800 l5.200
DIETARY:
[Hetitian . . . . . . . . . . . . . . 12,700 3,500 20.7””
Fbod service manager . . . . . . . . . 5,400 800 7.90”
KU.other professional and technical . 106,500 16,000 156.800

 

*EStimated on the basis of present staff and additional needed to give
(Wmimum care; taking into account the expected increase (28? ) in hospital
beds between 1966 and 1975.

&muce: AAJC Occupation Education Bulletin, November 15, 1963.

83

APPENDIX E

STATISTICAL METHODS

SIMPLE LINEAR REGRESSION
AND CORRELATION
Where height is a variable denoted by X and weight
is denoted by Y we look for a line that goes through the
points (Xi'?i)' where Xi is the ith value of the indepen—
dent variable and Y1 is our best prediction of the depen-
dent variable Y. The form of equation we shall consider

first is

which is the equation of a straight line with intercept

a0 and slope a If we define

1'
y1 = Yi - Y
x. = X. - X

1 1

thus eliminating one unknown.

A simple expression for the SIOpes of the bust-
fitting lines through a scatter where "best fit" is defined
as that line for which the sum of the squared deviations
is a minimum. This relation still holds true for the

stochastic case. For that line,

_ £(x-i)(Y-i)
a1 ' 2(x4x)TI

 

or

_ Xxy
a1 ‘ z

X

85

86

and

We can then write the expression for the best prediction
of Y as
Y. = [Y - alil + a

1X1

Y + a1(Xi-X)
MEASURING THE "GOODNESS" OF REGRESSION--CORRELI\TION

The average squared error, better known as the

variance of points around the best—fitting line, Oylx is
defined as before by

~ 2
2 _ >3(Yi’Yi)
Oylx — N

 

If the relationship between Y and X is "good" so that all

the points in Y lie very close to their predicted values,

then
£(y-§)2+o
and
o§lx+0
On the other hand, when the relationship between Y and x is

"poor" so that Y is not predicted from the knowledge of x,
then for each Xi there will occur a number of values for Yj
which represent, in essence, a random sample of values or
Y from the total population. When this happens, the host

estimate of Y is equal to Y, so that as

‘
"‘ Ila-n: f

 

87

_~

3?.»y
.‘ 2 ~ _‘2
22(Yi Yi) +L(Yi Y)

and

2

02 +0
YIX y

We may summarize this by saying that when the relationship

described by our linear regression line is "good," Oylx

becomes very small. On the other hand, where the regression

line does not fit, then knowing Xi will not help us, and

02 will be no better than oz.
YIX y

We use this knowledge of the relationship between
o;|x and o; to define the goodness of a relationship. The
measure we employ here is the proportion by which Oylx is

smaller than 0; or

02 2
r2 = .x, xix
02

Y

where r is known as the Pearson product moment correlation

 

coefficient. Note that if the relationship is good, then

 

limit °2|x = 0
r2+l y

and if the relationship is poor, then

limit OZIX = O2
r2+0 y y

In this way r2 takes on values between 0 and l proportional
to the "goodness" with which we can predict Y from a know-

ledge of X.

88

The computational formula of r derived from its
definition is

_ X[(x-X)(Y—Y)1
/§f§:§Tl/EY§ZY77

 

TESTS OF SIGNIFICANCE
"t" Test of Significance Between Two Sample Means
(x1 and x2).

(Use Fischer's t distribution)

Paired variates:

~

d

 

 

 

 

 

t = _ with N - 1 degrees of freedom
Fuai-a)2
JNZN-l;
where d = xl—x2
d1: X11’x21
d2: xlz-Xzzetc.
N = sample size
Unpaired variates:
t = i. 22 i 2 ..-
J[£1(X11'X1) +£1‘X21‘X2) (Ni-+fil)
N1+N2—2 l 2
with N1_N2-2 degrees of freedom
where N1 = size of sample 1
N = size of sample 2

2

APPENDIX F

HEALTH TEAM MODELS

90

 

INTERACTION

MODEL OF HEALTH TEAM FUNCTIONING*

*Based on Homans' Conceptualization of Group Behavior
The Human Group, Harcourt & World, New York, 1950.

 

p..-

91

Key:

-- interaction
between health
members only.

9 direct inter-
action between

 

 
  
 
  
  

health team
member.

 

 

1. Pharmacy 11. Cardiology

2. Occupational Therapy 12. Electro—encephalography
3. Physical Therapy 13. Pulmonary Function

4. Radiology 14. Clinic Services

5. Clinical Laboratory 15. Public Relations

6. Chaplain Service 16. Dentistry

7. Housekeeping 17. Dietetics-nutrition

8. Accounting Department 18. Neuro-mental

9. Social Service 19. Volunteer Service

0. Maintenance Department 20. Nursing Education

     

   

   

   

   

TV LIBR

I" \lHllilTs
8

353

 

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3 1 2 9 3 0 3 16 9