Reported incidents of physical aggression between spouses fifty years or older

Physical aggression between spouses has not been widely researched by nursing and has been limited to case studies or discussions focusing on younger spouses. Nursing interventions have also been targeted towards this younger population. The purpose of this study was to investigate reported incidents of physical aggression between spouses 50 years or older who are now divorced. A beginning framework for nursing intervention was formulated for this population of individuals. Personal interviews were conducted with 111 participants in their homes or place of their choosing. The interviews were audiotape to aid in information gathering and analysis. Content analysis and statistical analysis of the interview responses were conducted. Of the 111 participants, 44 participants had been involved in at least one physical aggressive incident. The mean length of marriage of the participants was 29.7 years. Most participants were Caucasian and members of the Church of Jesus Christ of Latter-day Saints (LDS or Mormon). Male spouses were the initiators of physically aggressive incidents 50% of the time. Female participants initiated physical aggression incidents in 25% of the instance. Both spouses were responsible for initiating physical aggression 25% of the time. Physical injuries resulting from physical aggression incidents were reported by approximately 50% of the participants. The most common types of physical aggression reported by participants were hitting and pushing. The frequency of physical aggressive incidents ranged form one time only to daily occurrences. The majority of participants utilized some type of resource to copy with physical aggression incidents. Physical or emotional withdrawal was reported by most participants as the primary coping mechanism. Individual therapy was reported by participants as the most common outside resource used. Implications for nursing practice are for nurses to ask the question of whether or not physical aggression has occurred and to become more aware of the signs of physical aggression between spouses. Through careful screening and assessments by nurses, more individuals can benefit by intervention. Nursing education should include teaching student nurses to perform skilled assessments to intervene appropriately with those older individuals who are or have been involved in physical aggressive relationships. Nursing research should be focused on large studies of older individuals who have involved in physical aggressive relationship to increase empirical knowledge of physical aggression between older spouses.

REPORTED INCIDENTS OF PHYSICAL AGGRESSION BETWEEN SPOUSES FIFTY YEARS OR OLDER by Marilyn L. Little A thesis submitted to the faculty of The University of Utah in partial fulfillment of the requirements for the degree of Master of Science College of Nursing The University of Utah August 1987 THE UNIVERSITY OF UTAH GRADUATE SCHOOL SUPERVISORY COMlVIITTEE APPROVAL of a thesis submitted by Marilyn L. Little This thesis has been read by each member of the following supervisory committee and by majority vote has been found to be satisfactory. f)~ Ii 1'1'?1 v Bonnie Clay on Paula Gollan THE l~]\;I\,ERSITY OF rTAH GRADUATE SCHOOL FINAL READING APPROVAL To the Graduate Council of The University of Utah: I have read the thesis of Mar; lyn L. L i ttl e In Its final form and have found that (1) its format. citations, and bibliographic style are consistent and acceptable; (2) its illustrative materials including figures. tables. and charts are in place; and (3) the final manuscript is satisfactory to the Supervisory Committee and is ready for submission to the Graduate School. 9~ I~ Ifi1 Date. i Approved for the Major Depanment Linda K. Amos Chairman Dean Approved for the Graduate Counci1 B. Gale Dick Dean of The Gradu31e School Copyright © Marilyn L. Little 1987 All Rights Reserved ABSTRACT Physical aggression between spouses has not been widely researched by nursing and has been limited to case studies or discussions focusing on younger spouses. Nurs'ing interventions have also been targeted towards this younger population. The purpose of this study was to investigate reported incidents of physical aggression between spouses 50 years or older who are now divorced. A beginning framework for nursing intervention was formulated for this population of individuals. Personal interviews were conducted with 111 participants in their homes or place of their choosing. The interviews were audiotaped to aid in information gathering and analysis. Content analysis and statistical analysis of the interview responses were conducted. Of the 111 participants, 44 participants had been involved in at least one physically aggressive incident. The mean length of marriage of the participants was 29.7 years. Most participants were Caucasian and members of the Church of Jesus Christ of Latter-day Saints (LOS or Mormon). Male spouses were the initiators of physically aggressive incidents 50% of the time. Female participants initiated physical aggression incidents in 25% of the instances. Both spouses were responsible for initiating physical aggression 25% of the time. Physical injuries resulting from physical aggression incidents were reported by approximately 50% of the participants. The most corrmon types of physical aggression reported by participants were hitting and pushing. The frequency of physical aggressive incidents ranged from one time only to daily occur­rences. The majority of participants utilized some type of resource to cope with physical aggression incidents. Physical or emotional withdrawal was reported by most participants as the primary coping mechani sm. I nd i v idua 1 therapy was reported by part i c i pants as the most common outside resource used. Implications for nursing practice are for nurses to ask the question of whether or not physical aggression has occurred and to become more aware of the signs of phys i ca 1 aggress i on between spouses. Through careful screening and assessments by nurses, more individuals can benefit by intervention. Nursing education should include teaching student nurses to perform skilled assessments to intervene appropriately with those older individuals who are or have been involved in physical aggressive relationships. Nursing research should be focused on large studies of older individuals who have been involved in physical aggressive relationships to increase empirical knowledge of physical aggression between older spouses. v TABLE OF CONTENTS ABSTRACT • • • LIST OF TABLES Chapter I. INTRODUCTION AND REVIEW OF LITERATURE Introduction •••••••• Purpose of Study • • • • • • • • Review of Literature •••• Significance of the Study Research Questions. II. METHODOLOGY Design ••••••• Setting ••••• Samp 1 e • • • Specific Aims •••• Data Collection •••• • ••••• Method of Data Ana lys is. • • • • Procedures during Content Analysis •• Strengths and Limitations of the Study ••• III. ANALYSIS OF DATA •••••••••••• Demographic Characteristics of Participants Descriptions of Physical Aggressive Incidents Content Analysis ••••••••••••• Types of Physical Aggression •••••••• Physical Injuries •••••••••••••• Triggering Factors of Physical Aggression Coped with Physical Aggression •••• Physical Aggression One Time Only Surrmary IV. DISCUSSION ••• Implications for Nursing. Page iv viii 1 1 2 2 21 22 24 24 24 24 26 26 27 29 30 33 33 35 37 39 41 43 45 48 48 50 50 Appendices A. PERMISSION LETTER FOR SAMPLE POPULATION B. PROSPECTIVE RESPONDENT LETTER C. CONSENT FORM • • • • • • • . • D. PHYSICAL AGGRESSION QUESTIONNAIRE REFERENCES • • . • • • . • • • • • • • . vii Page 58 61 63 65 68 Table 1. 2. 3. 4. 5. LIST OF TABLES Demographic Characteristics of Participants (~= 111) •. Frequency of Physical Aggression ••• Participation in Physical Aggression Results of Physical Aggression Use of Resource • • Page 34 36 36 38 38 CHAPTER I INTRODUCTION AND REVIEW OF LITERATURE Introduction There is a dearth of empirical knowledge about family violence, although physical aggression between spouses is a common occurrence. In this country approximately 50-60% of all married couples have at least one incident of physical violence during their marriage (Langley & Levy, 1977). It is estimated that 50% of all American families have experienced some kind of physical violence (Blair, 1986). It has also been predicted that spouse abuse will occur at least once in two-thirds of all marriages (Gelles, Steinmetz, & Straus, 1980). Most of the research about family violence focuses on younger battered women, primarily 19-40 year-old persons (Appleton, 1980; Carlson, 1977; Gelles et al., 1980; Roy, 1982; Straus, 1980). Because incidents of physical aggression between spouses are so prevalent, further research is needed to obtain knowledge that will be helpful for famil ies in disrupting the cycle of violence. Likewise, research on divorce has concentrated on relationships of less than 10 years duration and on i nd i v id ua 1 s under the age of 35 (Brown-Wi 1 son & DeShane, 1981; Hagestad & Smyer, 1982). Yet it is posited that over 20% of all divorces are occurring in middle and later life (DeFrain, Hayes, & Stinnett, 1980). Th i s research was des igned to study phys i ca 1 aggress i on between older-divorced spouses in order to gain empirical knowledge about this 2 particular population. Purpose of Study The purpose of the study was to investigate reported incidents of physical aggression between spouses who are at least 50 years old, were married 13 years or more, and who are now divorced. It is hoped that with this information, a framework for nursing intervention will be developed based on the research participants· descriptions of physical aggression and their patterns of coping. Review of Literature The review of literature will give an overview of current research and theories related to physical aggression between spouses and later­life divorce. Theories of Family Violence There are multiple definitions of violence. Shupe and Stacey (1983) define violence as "physical harm or the irrrnediate threat of such harm" (p. 5). Walker (1979) describes battering as "physical violence resulting in bodily injury" (p. xiv). F am i 1 y v i ole n c e i s defined as "behavior toward another family member that would evoke legal action if directed toward a stranger" (Goodwin, 1985, p. 1074). Thus, family violence has a wide variety of definitions ranging from threats of harm to actual bodily injury. Theories of family violence can be useful in analyzing physica,l aggress i on between spouses. Campbe 11 and Humphreys (1984) descr ibe three ger.eral theories of family violence: abuser-focused theories, situational-stress theories, and theories focusing on the nature of 3 family relationships. In the abuser-focused theories, the cause of the abuse is sought in the psychological state of the abuser. This theory suggests that the abuser is psycho 1 ogi ca lly un stab 1 e, and therefore unable to control his behavior. Thus, the solution would be to treat the abuser's psychological problem and the abuse will then cease. Situational-stress theories focus on stress as the cause of family violence. Situational causes of stress may be poverty, isol ation, or unemployment. One or more of these stressors in a family situation may lead a person to abuse family members. If the stress can be decreased or alleviated and the family unit treated, the abuse may either decrease or be eliminated. Theories focusing on the nature of family relationships suggest that the existence of a well-established pattern of abusive behavior may be learned early in 1 ife, possibly as a way to cope with life's problems. Treatment would be aimed at intensive individual and family therapy that focuses on new ways of relating to one another. Stress as the cause of family violence is described by Farrington (1980). His theory suggests that physical aggression can be triggered by high amounts of stress in the fam"ily or by inadequate patterns of handling family stress. This theory could be valuable in treating families by alleviating stress, assisting family members in learning ways to handle stress, and improving interactional patterns. A multifactorial theory for violence is suggested by Rounsaville (1978). This theory assumes that there are multiple determinants that pave the way for the beginning of and the perpetuation of spouse abuse. These determinants or contributing factors stem from psychological, sociological, and societal influences in a person's life. Psychological 4 infl uences may be pathological confl icts of dependency and autonomy; deficient impul se control, alcohol, or chemical abuse; and "learned helplessness" (Walker, 1979). Sociological influences include such things as early entry into marriage, distorted views of marital roles learned in childhood, continued presence of severe social stress, and status inconsistency of male/female roles (Rounsaville, 1978, p. 28). Society contributes to spouse abuse because it does not recognize the problem as serious and fails to provide adequate support and aid to the victims. Another theory of family violence based on multicausal factors is that of Giles-Sims (1983). This approach concentrates not on cause and effect, but instead on the importance and complexity of mutually causal events. It focuses on lithe processes that occur and the interrelationships between events, people, or other elements of the system" (p. 18). The fo 11 owi ng six poi nts descri be the processes that perpetuate fami 1 y vi 01 ence: 1. The establishment of the family system: The basic groundwork is laid for ongoing patterns of interaction, patterns of interact i on become 1 earned behav i or, boundar i es are established, and the rules evolve which will govern the fami ly system. 2. The first incident of violence: There are two alter­natives, either the violence will not be repeated or it will recur with the possibility of escalation. After the first incident, a return to normal patterns of relating without any changes sets up a positive feedback loop for the violence to subsequently be repeated. On the other hand, if changes are instituted, the pattern of violence may be disrupted before it is ever firmly established. 3. Stabilization of the violence: The family system is not able to basically be changed, or detrimental patterns of relating are not corrected. Thus, the pattern of violence may continue and become strengthened. 4. The choice point: This is when ongoing patterns of violence are not being tolerated, and there is a possibility for fundamental change to occur at this poi~t in the cycle. 5. Leaving the system: This is the process of one or more family members withdrawing from and gradually leaving the family system. A new system emerges, with poss ibl e structural changes. If positive feedback is occurring, reorientation and conversion to the new system is possible. 6. Resolution: Resolution can occur if there is a stabilization of the new system's patterns. This is a direct feedback loop to the former establ ishment of the family system, only this time excluding the ex-spouse. (Giles-Sims, 1983, pp. 121-139) 5 Violence in the family, therefore, is the result of ongoing patterns of relating within the family system. This theoretical approach can facilitate understanding the family organization so that interventions may be instituted to eliminate the violence. The etiology of family violence is theoretically explained by Barnhill (1980) in an effort to provide an accurate clinical assessment for treatment. This theory is similar in design to several theories already described (Campbell & Humphreys, 1984; Giles-Sims, 1983; Rouns­aville, 1978). Barnhill's theory is divided into five components that are related to family violence: (a) physiological-medical factors, (b) individual psychological factors, (c) current interpersonal-familial factors, (d) cultural/family background factors, and (e) life stress and resources. Physiological-medical factors are physical dysfunctions that may be major causes of violence. For example, if a spouse has a chronic debilitating disease, the other spouse may become physically abusive towards them due to emotional or physical burnout in caring for them. Individual psychological factors concentrate on defects in mental health functioning as a reason for violence. An example might be an alcoholic who becomes physically abusive when he or she is inebriated. Current interpersonal-familial factors suggest that dysfunctional patterns of interaction, along with increased stressors, lead to positive feedback loops for the occurrence of violence. For instance, families 6 who verbally abuse each other during conflicts may have a greater risk for physical abuse to begin. Cultural/family background factors point the blame for violence at early learned violent behaviors, violence being more accepted in different cultures, and violence commonly being portrayed on television or in the media. This theory posits multiple causa 1 factors of vi 0 1 ence and proposes ho 1 is tic i ntervent ions, since the theory encompasses so many facets of an individual's or family's life. Walker (1986) identifies three other current theories of violence between spouses. First, the feminist-political theory explains the causation of marital violence by the need some men have to beat women in order to gain power. Next, the sociocultural theory focuses on society's tolerance of violence, especially when directed at women and children. The third is the psychological theory that is based on the assumption that women are basically masochistic and, therefore, provoke the abuse. In summary, there are many theories that attempt to explain the reasons for family violence. The commonality among the theories includes multiple factors leading to family physical violence. The importance of researching family violence lies not in generalizing factors that apply to all families, but in assessing each individual family's contributing factors and intervening appropriately. Battered Wives Until and before the 1800s, wife beating was permitted for correctional purposes, since wives were considered the property of their husbands. As rights for women increased, there was a corresponding decrease in wife-beating laws, e.g., the IIrule-of-thumb law. 1I This law allowed husbands to strike their wives as long as the switch they used was no 7 thicker than a man's thumb (Goodwin, 1985, p. 1075). laws were further changed during the 1800s; for instance, in 1824 a Mississippi decision a 11 owed husband s "moderate chas t i sement incases of emergency" and in 1890 when husbands were finally prohibited from committing even a slight assault upon their wives (Martin, 1983, pp. 32-33). These and similar laws at last paved the way for restricting or eliminating male physical dominance over females in this country. Nevertheless, current research studies, focusing on physical aggression between married couples, have indicated that men are primarily the abusers and women are the abused (Berk, Fenstermaker-Berk, loseke, & Rauma, 1983; Chiriboga, Melichar, & Thurner, 1983; Cornell & Gelles, 1985; Jacobson, 1983; Straus, 1980). Th ismay be one of the reasons why there is currently considerable interest in the literature regarding young-battered wives and the "battering cycle." The wife-battering cycle is a process that describes the way in which both men and women contribute to the perpetuation of physical aggression in marriage. Researchers describe similar phases of a wife­battering cycle that contribute to maintaining the battering relationship (Appleton, 1980, Macleod, 1980; Walker, 1979). The cycle includes three phases: (a) the slow, tension-building phase where minor incidents occur that create increasing levels of tension; (b) acute-battering inc ident when the phys i cal aggress ion actua lly happens; and (c ) cal m, loving respite, and/or reconciliation which leads the woman to believe her husband loves her and wi 11 really change. The cyc 1 e beg ins all over again with the battered woman attempting to survive psychologically and the husband attempting to maintain the relationship by continuing 8 to abuse. The psychological stages that battered women experience have been categorized as follows: (a) denial or blocking the experience out; (b) guilt and feeling that she deserves abuse; (c) enlightenment, when the woman no longer assumes responsibility for the abuse and recognizes that she does not deserve the abuse, although she is still committed to the relationship; and (d) responsibil ity, when the battered woman accepts the fact that her husband cannot or will not change. She can no longer submit to the abuse; therefore, a new life away from the situation is beg un (Lora i ne, 1981, p. 24) • Battered women may move throug hall or part of the psychological stages, as well as fluctuate back and forth between them. It is not uncommon for women to become stuck in the denial or guilt stages without becoming enl ightened or without being able to take on the responsibility for severing the relationship. The battered woman can also move through all the psychological stages and out of the relationship into a new beginning and way of life, or if the aggression is stopped, the marital relationship may be changed enough to survive. The reactions and effects of wife battering on the woman have been described in the 1 iterature. Three corrmon reactions of women to wife battering are depression, fear, and impaired trust (Star, 1982). The effects of wife battering on women include physical damage, social isolation, loss of self-esteem, depression, fear, and a sense of help­lessness/ hopelessness (Thorman, 1980). These effects coincide with the notion of "learned helplessness" as a contributing factor to perpetuation of the violence cycle. Learned helplessness is a sense of powerlessness 9 and loss of control to change circumstances. Thus, helplessness abounds and the cycle continues (Walker, 1979). Since the battered-wife cycle is continuous in some relationships, there must be reasons why some women remain in abusive relationships. Low self-esteem, a strong sense of loyalty to the relationship, a passive interpersonal style, social isolation, limited social skills, and fear of the stigma of divorce are a few of the reasons (Gesino, Keckich, & Smith, 1982). Butler and Lewis (1977) suggest that women over 40 years of age remain in an abusive relationship for similar reasons with an additional sense of loyalty to the marital contract, since their generation of women "were raised in a male dominant-female subordinate culture" (po 128). Pagelow (1980) posits that women stay in an abusive relationship because they do not want to stir up marital disruption, are us i ng the man for a "meal ticket," or for other benefi ts they may get out of the relationship. There have been many studies focusing on the contributing or triggering factors of physical aggression between spouses. Roy (1977) surveyed 150 reports of wife battering and concluded that primary triggering factors were arguments over money, jealousy, sexual difficul­ties, alcohol, arguments over children, unemployment, and objections to the wife going back to work. Cornell and Gelles (1985) cite reasons for marital violence as alcohol, low income, social stress, and isolation. Alcohol, as a significant triggering factor, ;s posited by several researchers (Appleton, 1980; Carlson, 1977; Eisenberg & Micklow, 1977; Gayford,1975). Battered women who presented at an emergency room setting were the 10 participants in a study researching resources used and triggering factors of physical aggression between spouses (Appleton, 1980). Resources utilized by participants within 24 hours of an acute battering episode were: relatives (33%), friends (29%), pol ice (24%), hospitals (12%), church (8%), and other (6%). Reported triggering factors of abuse were -an argument prior to the battering incident, drinking, unemployment, psychological imbalance, or past learned behavior patterns that contributed to the cycle. An emergency room was the sett ing for another study (Amatruda, Benson, Christiano, Perron, & Pollard, 1986). The aim of this study was to investigate recognition of spouse abuse and intervention with battered women. Over 2 years there was an increase from 36 to 98 inc i dents of phys i ca 1 aggress i on reported to the emergency room by battered women who came there. This constitutes a 180% increase. The age range of women was 15-76 years, a 1 though 67% of the women were under the age of 31. The authors suggest that higher proportions of physically aggressive incidents among younger women may be due to underdeveloped coping mechanisms or that the younger population tend to be more violent. The study indicates that properly trained health care workers are often ·in prime positions for recognizing incidents of physical aggression and beginning interventions for those in abusive relationships who are seeking assistance. A study of abused women at a women's shelter included 4,000 interviews over a 4-year period (Roy, 1982). The participants ranged in age from under 25 to over 60 years. The highest percentage of abusers were husbands in the 26- to 35-year-old-age range. Abusers aged 51 years or 11 older comprised only 9%. Those participants who had been abused and were 51 years or older comprised 11%. The duration of the relationships ranged from 0 to 26 years or more with the most common length of marriage being 0 to 5 years. The frequency of physical abuse ranged from occa­sionally to very often, with "very often" the highest percentage (34%). The types of injuries reported were: bruises (50%), unspecified bodily injuries (23%), black eyes (18%), and broken limbs (9%). The types of physical violence between spouses have also been researched by others. One study involved 542 women's shelter residents during the years 1980 to 1982. These residents had sought physical safety, shelter, and food soon after an acute battering incident. The most commonly reported types of violence were: slapping, punching, and k i c kin g . 0 the r forms 0 f v i ole n c e 1 e s s f r e que n t 1 y rep 0 r ted we r e : burns, sexual abuse, threats to use a weapon, battering while pregnant, and choking (Shupe & Stacey, 1983). On ly one study was found in the 1 iterature pertaining to the older-battered woman (Gesino et al., 1982). This study reviewed two cases of older-battered women who were admitted to a psychiatric inpatient unit for treatment of depression shortly after the physical aggression within the marriage stopped. One woman's husband had died 2 years prev i ou s ly, after phys i ca lly abus i ng her throughout the i rent i re 37 years of marriage. The other woman was married for 47 years and had been physically assaulted with numerous injuries during her marriage. Her husband's hea 1 th had severe ly dec 1 i ned, as did the frequency of phys i ca 1 assau 1 ts. Both women had domi neer i ng hu sbands, and when the physical abuse was halted, they became depressed, guilty, and unable to 12 participate in self-care activities. The authors concluded that the women's roles shifted from passive to dominant, taking away the common and famil iar patterns of relating, leading to their inabil ity to cope adequately and ultimately to depression. According to several researchers, marital physical aggression frequently is not reported (Appleton, 1980; Blair, 1986; Goodstein & Page, 1981; Hi 1 berman, 1980). The reasons cited for neg 1 ect i ng to report physically aggressive incidents were: fear of social stigmatization, fear of retal iation from partners, feel ings of guilt and shame, perception of violence as a normal part of living, and lack of resources or alternative situations. In contrast, other studies involving psychiatric inpatients and outpatients seeking assistance indicate significant reporting of physically aggressive incidents, as high as 50%, in both past and present relationships (Back et al., 1980; Carmen-Hilberman, Mills, &Rieker, 1984; Hilberman & Munson, 1978). Societal suggestions that women provoke, deserve, or enjoy being beaten are considered to be false by many feminists. Pizzey (1974) founded a shelter for battered women in Chiswick, England which provides for over 250 women and children. Pizzey states that the facts are that a man's home is still regarded as his castle and he can do whatever he wants in it, meaning that no matter what the laws are regarding wife beating, it still occurs regularly. Campbell and Humphreys (1984) describe feminist views of domestic violence in regards to criminal justice practitioners' attitude of a IIhands-off" policy in matters of domestic violence. Feminists argue that the court I s II hand s-off" att i tude is due to the be 1 i ef that women 13 fail to follow through with prosecution. Feminists posit that women who are abused do want to pursue all sensible avenues of recourse. Feminists further argue that women do not cause physical aggression because they like being abused; however, battered women are socialized to expect and accept male dominance and physical punishment as a normal part of life. These views place the blame for continued wife battering on society and minimal support from the law. Feminists advocate stronger laws being implemented for prosecution of physical aggression in marriage, as well as societal support for battered women's efforts to seek assistance and relief from abusive relationships. Pagelow (1980) identifies reasons for society's justification of battering of women, either that the man is a victim of nagging or that the battered women must somehow be at fault or the abuse would not occur. Martin (1983) quotes examples of why women remain in physically aggressive relationships: 1. lIyou just have to take it.1I 2. IIWell-educated, well-to-do people don't discuss such things. 1I 3. "I became a super cover-up artist." 4. "Sometimes I would talk about leaving him, but I never really meant it. I knew I had to keep the fami ly together. II 5. "I didn't think I had the right to talk about it:' (pp. 80-82) Feminists suggest that women attend consciousness-raising groups and assertiveness training (Jansen & Myers-Abell. 1981). NOW (National Organization for Women) advocates for all battered women the motto "I can," meaning "I can make it," so that self-reliance and self-survival can then begin and be achieved (Sommers, 1973), p. 15). The Feminist Counseling Collective in Washington, D.C. suggests that women seek 14 assistance from battering relationships through psychotherapy, especially with female therapists to encourage self-worth, acknowledgment of their own strengths, as well as recognition of their own capabilities (Martin, 1983). This particular therapy approach provides women with a way to increase self-esteem and autonomy. An advantage of having a female therapist would be relating to someone who understands what it is like to be a woman in this society. This may assist the abused woman in overcoming societal expectations of the passive womanfs role. Society asks the question, "What did she do to provoke him?1I when seeking to justify spouse physical abuse. Maybe the real question to be dealt with is, "What is it about our society that keeps a woman hostage in a violent home?" (Walker, 1979, p. 267). Perhaps decreasing or eliminating violence against women will not happen by becoming rabble-rousing feminists, but by men and women working together to learn new ways in which to live equally in social and sexual relationships as a way to end exploitation, oppression, and abuse of women. Mutual Spouse Abuse Physical expressions of hostility are often found to be mutual in marital relationships (Steinmetz, 1978). Steinmetz has been the most outspoken researcher on the controversial subject of mutual spouse and husband beating. She hypothesizes that husband-beating has been ignored and hidden, possibly because of embarrassment to the victim, lack of empirical data, selective inattention by the media and researchers, tendency of men to more often infl i ct phys i ca 1 damage on women than vice versa, and the reluctance of men to admi t to phys i ca 1 abuse by women. Steinmetz indicates that husbands stay in abusive relationships 15 for the same reasons that abused wives do. In all three of Steinmetz's studies on marital violence, more wives were found to physically abuse their husbands than the other way around (Steinmetz, 1977a; Steinmetz, 1977b; Steinmetz, 1978). Steinmetz advocates increased societal awareness and interest in mutual spouse abuse in order to acknowledge this growing problem, as well as accepting that men deserve and should seek assistance just as women do. In rebuttal to Steinmetz (1977a, 1977b, 1978), Fields, and Kirch­ner (1978) counter that the claim of widespread husband-beating is fal se and that recognition of battered women's needs should be of paramount public concern. These authors suggest that battered husbands are few and any physical attacks made by women are so insignificant as to not even deserve notice. They further indicate that violence against husbands has not received the amount of attention that violence against wives has, since more women are seriously hurt and tend to seek legal and medical assistance. Therefore, women are the ones who deserve both attention and intervention. Another argument against Steinmetz's (1977a, 1977b, 1978) position that husband and wife physical aggression is mutual was found in the 1 iterature (Berk et al., 1983). These researchers studied reports filed by investigating officers in 262 domestic disturbance incidents. It was reported in only 4% of the cases that a male had been injured, as opposed to a very high percentage of fema 1 es wi th i nj uri es. Ma 1 e injuries were also significantly less serious than those of females. The authors posit that women are still the victims of spouse abuse, and there is virtually no such thing as husband-battering. An argument in 16 support of Steinmetz could be that many incidents of husband abuse are unreported, are less serious, and consequently attract less attention, and that some men can defend themsel ves better than women, so the violence stops before it escalates into a full-scale attack. A study involving both males and females indicates that physical aggression between spouses is mutual (Jacobson, 1983). This study included 102 participants who were either separating or divorcing. Self-report interviews from participants showed that 44% had physically attacked their spouses and 55% had been attacked during their marriage. During the separation of divorce, physical hostility was still occurring. The authors conclude that interspouse physical aggression is mutual, even among separating and divorcing couples. A pilot study using in-depth interviews with 80 families revealed that 54% of the couples had mutually engaged in physical force at some time during their marriage (Gelles, 1974). A later and larger nationally representative study by Gelles et ale (1980) included 2,134 adults between the ages of 17 to 70 years. Sixteen percent of the participants had at least one incident of physical violence in their marriage and mutual spouse abuse was apparent in 49% of the cases. Violent behaviors exhibited most frequently were: throwing something at a spouse, pushing, shoving, grabbing, slapping, kicking, biting, threatening with a gun or knife, or actually using a gun or knife. The mean frequency of physically aggressive occurrences was reported to be eight to nine times a year. This study, as well as others described, lend credence to the idea that spouse abuse is often mutual and not always initiated by the man. 17 Elder Abuse One study was found in the 1 iterature 1 inking elder abuse to spouse abuse (Campbe 11 & Humphreys, 1984). Th i s study ana 1yzed ques­tionnaires and interviews with 77 abused elderly persons aged 60 and over. The part i c i pants' responses revea 1 ed that 12% of the abusers were the spouse of the vi ct im. Ch i 1 dren of the abused accounted for 49% of the abusers and other relatives who were abusive comprised 18%. The most prevalent ages of the abused participants were 60 to 69 (31%) and 70 to 79 (33%). The types of abuse infl icted by a spouse were: physical abuse (7%), physical neglect (8%), emotional neglect (11%), emotional abuse (9%), and financial abuse (taking advantage of a mentally deficient spouse's money) (7%). The study also indicated long-standing patterns of family violence that continued for the entire duration of marriage. Marital abuse was more common in cases where one spouse was either considerably older or more infirm than the other. Several cases showed instances where the usual marital violence roles were reversed, with the man the victim and the woman the abuser. This particular study serves the purpose of enlightenment that spouse abuse does occur among the older population. Further studies in the area of spouse abuse among the older population are imperative in order to increase knowledge and data, so that appropriate interventions can be instituted. Divorce in the Older Adult Divorce among older adults is increasing, leading many people to believe there is a divorce boom for this age group_ According to Hunt and Hunt (1977), the reason there is an increase in this age group is that there are more divorces in every age group today _ The authors 18 that there are more divorces in every age group today. The authors cite statistics indicating that one-third of all divorces occur after 10 or more years of marriage and one-tenth occur after 20 or more years of marriage. The divorce rate for individuals aged 65 and older is at least 10 times greater for individuals who have been married more than once, than for persons who have been married only once (Hennon, 1983). Hennon's point is that with each subsequent divorce for an individual, the risk increases for more divorces. Divorce in later life is a neglected area of research. Atchley, Miller, and Troll (1979) state that divorce in the second half of adulthood is "one of the most neglected areas of research in social gerontology" (p. 80). However, causes and consequences of divorcing persons married 20 years or more have been researched (Deckert & Langl ier, 1978). Their study included 295 female and 132 male participants with a mean age of 50.09 years. The causes of divorce most frequently reported by participants were: adultery, sexual problems, alcoholism, and mental cruelty. The consequences of divorce that most participants reported were: impairment in social circles--including possible social censure--decreased self­esteem and feeling incompetent as a spouse, economic changes with usually decreased income, and legal difficulties. The authors advocate a call for research in several areas to gain greater empirical knowledge of those individuals divorcing in later life. The areas that need current research are: demographic aspects of late-life divorce, social and psychological consequences of divorce, adaptation to divorce, and legal and economic consequences of divorce in later life. 19 Approximately one-third of individuals reaching age 65 between the years 2010 and 2014 will have been through at least one divorce (Myers & Uti 1 en berg , 1981). These researchers descr i be reasons for expect i ng divorce rates for the older adult to continue to increase. The primary reason is that since divorce rates for every age group are increasing, this then indicates a future trend in that direction. Another reason is that many older adults are remarrying and remarriages are at a greater risk for divorce, although other researchers claim that second marriages seem more stable. Other reasons are that the older adult is becoming more accepting of divorce as a solution for an unhappy marriage. As is the rest of our society, women are becoming more economically independent of men, and people are living longer, which means fewer marriages are terminated by death. All of these reasons may contribute to the older population becoming more at risk for divorce. The transition to start over may be more difficult and lonel iness may be a greater factor than for younger persons. Also, individuals who experience divorce later in adulthood are more likely to regard the break-up as a personal failure (Hagestad & Smyer, 1982). Therapeutic Interventions The definition of nursing given by the American Nurses Association (1980) in its Social Policy Statement is lithe diagnosis and treatment of human responses to actua 1 or potent i a 1 hea 1 th prob 1 ems II (p. xi). Since marital physical violence is an actual or potential health problem, nursing care and intervention is appropriate and should be targeted toward prevention, detection, and treatment. A plan for nursing intervention with the battered woman was found 20 in the literature (Finley, 1981). The plan includes providing a safe environment, increasing opportunities for autonomy, assisting in setting and achieving realistic goals, and leading therapy groups for the battered woman. Counse 1 ing or psychotherapy can teach women to take control of their own lives, thus increasing the chance that women will not be actual or potential victims of physical abuse (Walker, 1979). Individuals can be taught to change the failure expectancy, so that a positive cognitive set is attained. This can be achieved by increasing self-esteem, competency, and motivation for a life without violence. Roy (1977) makes the suggestion that: In order for the vicious cycle of violence to be broken, society needs to recognize its obligations to find solutions, to offer help and immediate protection for all the women and children who actively seek it, and to explore nonviolent modes for the expression of conflict. (p. 43) Roy's method of intervention is aimed at improving verbal communication skills for all family members with the expected goal being a reduction in need and desire to resort to physical aggression to solve conflicts. Bowen's family systems approach to family therapy, especially with the emphasis on differentiation of self, has been supported as a means to intervene in family marital abuse s ituat ions (Gemmi 11, 1982). Understanding family dynamics is crucial to intervention, keeping in mi nd that "v; 0 1 ence ; s a symptom of a dysfunct i ona 1 fami lyll (p. 23). Bowen's approach can be described as putting the two most powerful people in the family system in contact with a third person, the therapist, in order to create a triangle. The triangle serves the purpose of creating change through increasing anxiety and assisting the couple in facing their problems with a change in the expected way of dealing with 21 them. The therapist should be careful not to take sides, thus forcing the couple to deal directly with their problems. Another tactic the therapist may use is to spur one member of the triangle to change behaviors and ways of relating. This tactic is based on the theory that if one member of the triangle changes, the whole triangle changes, thereby setting the stage for changing the entire family system (Bowen, 1978). It is important in this type of family therapy for the therapist to then "detriangulate," so anxiety can be diffused. Change is possible by creating anxiety, a motivator for change; then when it is no longer needed, it is appropriately removed. The therapist would finalize therapy by assisting the family in discovering new ways of relating and in setting new goals. Since all individuals should have the right to control what happens to their bodies, an imperative goal of society is to reduce all inter­personal violence and especially the public's acceptance of violence. A step further could be improvement of services provided for those who seek it, expansion of research in the area of marital physical aggression, and continuing education for the public and health care workers. Significance of the Study The paucity of research on family violence by nurse researchers has been pointed out in the 1 iterature (Campbell & Humphreys, 1984). The problem has been researched primarily by law enforcement and social work. Nursing interventions have thus been based on knowledge and theory from other disciplines. "Nursing research based on nursing theory is required and empirical study testing the effectiveness of interventions is necessary" (p. 407), and lithe need for nursing research 22 in the area of family violence is tremendous" (p. 409). Family violence is an appropriate area for nursing research, as it includes the individual, the environment, health, nursing, and all their interrelatedness. Nursing research pertaining to family violence, thus far, has primarily consisted of case studies or discussions. Larger studies in all areas of family violence are indicated in order to formulate a basis for nursing. It is hoped that the shared-life experiences of older persons involved in physically aggressive relationships will provide nurses with a framework for intervention. Research Questions The following research questions were asked: 1. Was physical aggressiqn present during the marriages of individuals 50 years or older who are now divorced? 2. Was physical aggression a precipitating factor in divorce between spouses 50 years or older? 3. What types of physical aggression occurred between older spouses during their marriages? 4. Did any of the incidents of physical aggression between older spouses result in injuries and/or require medical treatment? 5. What triggered the incidents of physical aggression between older spouses? 6. How often did the incidents of physical aggression occur between older spouses? 7. How did older spouses cope with the incidents of physical aggression? 23 8. What resources were utilized by older spouses after incidents of physical aggression occurred? CHAPTER II METHODOLOGY Family violence is a common occurrence in many individuals' lives. The individual's subjective perceptions of the physically aggressive incidents are helpful in understanding the experience. A beginning framework for nursing intervention can be developed by analyzing the qualitative information given by participants who have been involved in physically aggressive relationships. Design This research is part of an ongoing cross-sectional descriptive study of older-divorced persons being conducted at the University of Utah College of Nursing. Setting Salt Lake County in the State of Utah, with a population of close to 1,000,000, the sett i ng for the study. Th e popu 1 at i on refl ects the demographics of the state, being predominantly Caucasian and members of the Church of Jesus Christ of Latter-day Saints (Mormon or LOS). Scunple The participants of the study were 111 older-divorced individuals. Criteria for the inclusion of older-divorced individuals in the sample were as follows: 1. Age: 50 years or older at the time of divorce 25 2. Length of marriage: at least 13 years at the time of divorce 3. Number of divorces: no more than two divorces 4. Time after separation: within 3 years of divorce 5. Time after divorce: within 2 years of divorce 6. Permission: willingness of the divorced individual to give informed consent to participate in the study. The participants of the study were chosen by reviewing official cert i fi cates of divorce reg is tered wi th the Utah State Department of Health. Information on the certificates includes the divorcing individual· s age, race, address, date of marriage, and date of divorce. Permission was granted to use this sample population (see Appendix A). Both divorcing partners of a marriage were included in the study when both met the criteria for inclusion. Letters were mailed to participants explaining the reasons for the research study and were followed by a telephone call (see Appendix B). At that time, it was determined whether part icipation met the qua 1 ifications for the study and questions concerning the study were answered for the participant. Appointments were then made if the participant was agreeable and verbal consent was given. Those individuals that could not be located were sent a second letter and other efforts were made to contact them through telephone directory assistance and voter registry. People who had remarried were excluded from the study. Those individuals who chose not to participate in the study were not included. Thirty-five percent of the potent i a 1 subjects were not reached despi te attempts made to contact them. Another 38% refused to participate. 26 Specific Aims The specific aims of the research study were to: 1. Describe the patterns of physical aggression that occur between spouses married 13 years or more and who are 50 years or older. 2. Describe how older-divorced individuals coped with the physical aggressive incidents during their marriage. 3. Develop a beginning framework for nursing intervention with spouses involved in physically aggressive relationships. Data Collection The data were collected as part of the ongoing older-divorced person project during tape-recorded persona 1 interv iews from Ju ly to October 1986. Written consent was obtained at the beginning of each interview, and the participants were free to drop out at any time (see Appendix C). The interviews of the divorced participants lasted ap­proximately 2 hours and took place in the participant's home or other place of convenience. Interviewers were trained so that each interview followed the same format. The questions were asked in the same sequence for all interviews. Questions were worded so as not to be invasive. The participants were not expected to answer all the questions if they chose not to do so. The data of this project are the demographics of the participants and incidents of physical aggression described, as well as the answers to the questions asked regarding patterns of physical aggression between spouses, cop i ng behav i ors, and ut i 1 i zat i on of resources (see Append i x D, questions 32-42). It was hoped that participants would be willing to identify physically aggressive incidents during marriage without 27 fear of retaliation, since they were now divorced. Responses to the following questions were analyzed: 1. Sometimes arguing and fighting are expressed in a physical way, e.g., pushing or hitting. Did physical aggression ever occur during your marriage? 2. Who generally initiated these conflicts? 3. Were both of you involved actively in the physical fighting? 4. Was physical aggression a factor in precipitating your divorce? 5. What types of physical fighting occurred? 6. Were you physically hurt? If so, how? 7. Did any of your injuries require medical treatment? 8. Think of a typical situation which ended in fighting. Would you describe what usually triggered the episode? 9. How did you handle these situations? 10. Did you use any of the following resources for help (family, friends, police, court, individual therapy, group therapy, church, other, or none)? Method of Data Analysis To begin to develop an understanding of the patterns of physical aggress ion between older spouses, the responses to the closed-ended questions were statistically analyzed. The responses to the remaining questions were content analyzed. Qualitative data consist 1I0f detailed descriptions of people, events, situations, or observed behavior" (Polit & Hungler, 1983, p. 466). In this study, the descriptions were of physically aggressive incidents and of coping strategi~s used by the research participant. 28 During the process of content analysis, the actual theory emerges from the data. In a sense, it is a method of observation, an observation not specifically of the participants, but instead of the communications of the part ic ipants (Po 1 it & Hungl er, 1983). The process of content analysis is inductive so as not to allow the researcher to impose his or her bias on the data. Content analysis began by reading the responses several times to gain familiarity with the data, as well as to begin to identify common patterns and behaviors in order to determine what fit together into possible categories. As data recurred in the responses to the quest ions, th i s was he 1 pfu 1 in determin i ng that the data were representing patterns of physical aggression and coping behaviors of the participants. Categories were developed utilizing single semantic relationships in order to facil itate structuring of the data. The semantic relationships chosen for this study were IIstrict inclusion" and "cause and effectll (Spradley, 1979, p. 111). For example, the 5th interview question identified the types or kinds of physical aggression (X) that occurred within a physically abusive relationship (Y). Therefore, if hitting was given for a response, this would be a specific type or kind of physical aggression. Using the cause (X)/effect (Y) semantic relationship, the 8th interview question asked for a description of what usually triggered (X) the physically aggressive episodes (Y). For instance, drinking (X) might have triggered the physically aggressive incident (Y). Cause/ effect was a 1 so used for the 10th and 11 th i nterv i ew q ues t i on s. Fo~ example, the participant might have driven away in a car (Y) because of bei ng phys; ca lly abused (X) or may have call ed the pol; ce (Y) as a 29 means of obtaining relief from a physically aggressive incident (X). In content analysis, each category should represent a single pattern and all items should, therefore, be logically related to meet the spec ifi cat ions for i nterna 1 homogeneity. On the other hand, the criterion for external homogeneity of categories is met by bold and easily discernible differences between categories and a lack of similarity between the categories (Patton, 1980). During the process of content analysis, the emerging categories were continually analyzed for similarities and differences, that is, for internal and external homogeneity. For instance, crying, ignoring, or leaving the situation are all similar ways of coping with physical aggression by withdrawing. These ways are different from seeking resources, such as call i ng the pol ice or seek i ng he 1 p from fam i ly or friends after a physically aggressive incident. The utilization of single semantic relationships during content analysis was facilitative in developing categories through the process of clustering similarities and differences. This adherence to explicit and systematic rules during the content analysis enhances objectivity, as it enables another researcher to analyze the material following the same guidelines. Procedures during Content Analysis The responses to the interview questions were read several times in order to gain familiarity with the data, as well as to search for data that repeatedly recurred. Data that were found to repeatedly recur were written on index cards. Separate index cards were used for each type of data that were found to be different from each other. This was helpful in the beginning to cluster data into categories. All 30 of the data were eventua lly coded on the index cards accord i ng to questions responded to, type of data, and the participant's code number. As the data and the index cards were reviewed, themes began to emerge and categories were developed in adherence to the rules of internal and external homogeneity. Data sheets were also used and were important in helping to narrow down the categories under specific themes. The data sheets were used by drawing horizontal lines down the sheet and putting the initial categories from the ana lyzed responses across the top of the sheet. The code numbers of the participants were written under the appropriate categories. This method enabled the researcher to identify how often the data ina part i cu 1 ar category had occurred and if the data were occurring in more than one category. It also assisted the researcher in the process of narrowing down the categories in order to be clear and concise during content analysis. Strengths and limitations of the Study Physical aggression patterns of older adults who were married 13 years or more were identified. Since there is a dearth of nursing research on the subject of physical aggression between spouses, it was anticipated that the analyzed data would serve as a beginning description of patterns of physical aggression between older spouses, as well as offer clues to assisting those older adults currently involved in a physically aggressive relationship within marriage. The use of self-reports during the interviews has both advantages and disadvantages. Common advantages are that the interviewer can 31 clarify misinterpretations of questions, respondents are allowed flexi­bility in taking time to answer questions, the interviewer has a standard format for asking the questions, and the interviewer is responsible for recording the responses. Disadvantages are primarily problems with validity and accuracy (Polit & Hungler, 1983). These were mainly overcome by providing a comfortable setting and manner of interviewing, as well as adhering to the standard format for interviewing and tape recording the responses. A major limitation of the study is the lack of generalizability. The findings are limited to the sample population. Further studies are indicated in order to determine if similar patterns of reported incidents of physical aggression in marriage are occurring in different cultural contexts. The strengths or weaknesses of this study in relation to the scientific criteria of internal validity, external validity, reliability, and objectivity will be discussed in the remainder of the chapter. Internal Validity Internal validity is the extent to which the findings reflect the truth of the research, rather than other factors wh i ch were not contro 11 ed. The threats to internal val idity are: testing, history, maturation, experimental morality, selection, and instrumentation. History was a threat to the study since the physically aggressive incidents were being reported by the participants, retrospectively. The lapse in time from the physically aggressive incidents to the time of interview may pose a threat because people· s memor i es and percept ions of the events may change over time. Instrumentat ion a 1 so was a val id threat to internal validity since data were obtained by several interviewers. 32 This leaves some room for bias, although the interviewers were carefully and uniformly trained. Self-selection was a problem, since there are many reasons why participants chose to be included in the study, and some of those reasons may have influenced the responses given. Others who met the sample criteria chose not to participate. External Validity The sample was typical to the population of Salt Lake County, bei ng pr imar i ly Caucas i an and Mormon. The samp 1 e is, however, repre­sentative of older-divorced individuals who have been involved in a physically aggressive relationship during marriage, but it is bound by context. Reliability It is difficult to determine how consistently and truthfully the interview responses reflected actual incidents of physical aggression between older spouses, since the responses were subjective and retro­spectively reported. Reliability was strengthened by having a clinical expert content analyze five randomly selected interviews following the cod -j ng scheme of the researcher. Us i ng th i s process, the i ntercoder reliability of the study was established at 89%. Objectivity The data of the study can be verified by other researchers, since they are not only written interview responses, but the interviews were audiotaped as well. As mentioned before, another researcher randomly analyzed a portion of the data in order to decrease the likelihood of researcher bias. CHAPTER III ANALYSIS OF DATA Demographic Characteristics of Participants There were 66 female and 45 male participants in the study. The majority of the participants were in their 50s. The participants ranged in age from 50 to 73 years old. The 111 older-divorced persons had been married from 13 to 44 years with the mean length of marriage 29.7 years. The majority (87%) of the participants had been married one time only. Those participants who had been married more than once had lost their former spouses through divorce or death. The majority of the participants (95%) were Caucasian. The remainder of the participants represented other races. The religion of the majority of participants (58.6%) was Mormon. All but 8 (8%) of the participants claimed a religious preference. Most of the participants were presently employed either full-time or part-time. A few (8%) were retired. Table 1 describes the sex, religion, race, number of times married, and present employment status of the older-divorced participants. The demograph i c data of the tota 1 number of part i c i pants in the study were compared with those participants who were involved in a physically aggressive relationship. The demographics compared were sex, age, education, number of marriages, and length of marriage using Table 1 Demographic Characteristics of Participants (~ = 111) Characteristic Sex Male Female Race Caucasian Other Religion LOS Catholic Protestant Jewish Other No preference Present employment status Full-time Part-time Retired Homemaker Unemployed Number of times married Two Three N 45 66 106 5 65 10 18 1 9 8 73 22 8 6 1 87 22 2 34 Percent 40.5 59.5 95.5 4.5 58.6 9.0 16.2 .9 8.1 7.2 65.8 19.8 7.2 5.4 .9 78.4 19.8 1.8 35 chi-square and ~ tests. There were no significant differences between the two groups. Descriptions of Physical Aggressive Incidents In the sample of 111 older-divorced persons, 44 (39.6%) participants experienced physically aggressive incidents during their marriage. The frequency of physically aggressive incidents ranged from one time only to daily occurrences. The most common frequency reported was four to six times during the entire marriage. Several participants had been i n vol ved ina p hy sic a 11 y a g g res s i ve inc ide n t on e t i me on 1 y • Tab 1 e 2 describes the frequencies of physically aggressive incidents of par­ticipants. Male spouses were the initiators of physically aggressive incidents 50% of the time. Female spouses initiated physically aggressive incidents in 25% of the instances. Both spouses were responsible for initiating physical aggression 25% of the time. In the study, twice as many men initiated physical aggression as did women. This is significant, since current research suggests that men are the initiators of most physical aggression between spouses (Berk et al, 1983; Chiriboga et al., 1983; Cornell & Gelles, 1985; Jacobson, 1983; Straus, 1980). Of all the incidents of physical aggression reported, the majority of incidents involved 1 spouse only. This indicates that most spouses did not respond with physical force after being physically attacked by their spouses. Both spouses became mutually involved in one-fourth of the instances. This may partially support Steinmetz's (1978) position that spouse abuse is mutual. Table 3 describes the characteristics of Table 2 Frequency of Physical Aggression Participants N Percent One time only 7 16.3 Four to six times during marriage 14 32.6 Up to four times a year 9 20.9 Monthly 5 11.6 Weekly 2 4.7 Three to four times a week 2 4.7 Daily 4 9.3 Note. Percentages may total over 100%, since participants may have used more than one resource. Table 3 Participation in Physical Aggression Former Self spouse Both Na Percent N Percent N Percent Initiator of aggression 6 13.6 27 61.4 11 25.0 Involvement in aggression 4 9.6 24 57.1 14 33.3 aThe number of participants who were involved in physically aggressive incidents is N = 44. However, N may vary, since not all participants responded to every question. - 36 37 those participants who initiated and became involved in physically aggressive incidents. The role of physical aggression between spouses was a factor in the dec is i on to divorce in approx imate ly one-th i rd of the marr i ages. This suggests that the older-divorced participants may have chosen to remain loyal to the marital relationship in spite of the physically aggressive incidents. Physical injuries resulting from physically aggressive incidents occ urred for approx imate ly one-ha 1 f of the part i c i pants. Of tho s e injuries that were reported by participants, only a few of them required medical treatment. Table 4 describes the results of physical aggression between spouses perta in i ng to the ro 1 e of phys i ca 1 aggress i on in the decision to divorce, physical injuries, and injuries requiring medical treatment. The majority of participants util ized some type of resource in order to cope wi th the phys i cally aggress ive inc idents. The resource most often used was individual therapy. Other types of resources used were family, friends, police, court, group therapy, and church. Table 5 describes the types of resources utilized by the older-divorced participants. Content Analysis The responses from the open-ended questions listed below were content analyzed: 1. What types of physical fighting occurred? 2. Were you physically hurt? If so, how? 3. Think of a typical situation which ended in fighting? Would Table 4 Results of Physical Aggression Role of aggression in divorce decision Physical injuries Injury required medical treatment No N Percent 28 22 37 65.1 51.2 90.2 Yes N Percent 15 21 4 34.9 48.8 9.8 aThe number of participants who were involved in physically aggressive incidents is N = 44. However, N may vary, since not all participants responded to every question. - Table 5 Use of Resource Responses N Percent No 16 38.1 Yes 26 61.9 Types of resources used Fami ly 10 23.8 Friends 3 7.1 Police 5 11.9 Court 2 4.8 Individual therapy 13 31.0 Group therapy 4 9.5 Church 6 14.3 Other 7 16.7 Note. Percentages may total over 100%, since participants may have used more than one resource. 38 you describe what usually triggered the episode? 4. How did you handle these situations? 39 The remaining sections of this chapter will present the content analysis of the older-divorced participants I responses to the interviewers I questions about incidents of physical aggression between spouses and their patterns of coping. Specific topics to be discussed are types of physical aggression, types of physical injuries, triggering factors of physical aggression, ways of coping, as well as the single incident of physical aggression. Types of Physical Aggression The description of types of physical aggression that occurred between older spouses was achieved by the analysis of the participants' responses to the interviewer's question: "What types of physical fighting occurred?1I There were two types of physical fighting that occurred during incidents of physical aggression: 1. Body contact: (a) hitting, (b) shoving, (c) kicking, (d) choking, (e) grabbing, (f) scratching, and (g) hair-pulling 2. Threatening with a weapon: (a) gun or (b) knife. Body Contact The most commonly reported kind of body contact was hitting. This was reported by 24 participants (55%). The kinds of hitting included slapping, punching, and beating. Some of the participants described feel ings of surprise and shock at being struck by their spouses and others reported that they expected the physical aggression to happen, often knew when it would occur, and felt that they deserved it. 40 Thirteen (30%) participants stated that they had been shoved, pushed, thrown, or knocked down. Other kinds of body contact reported by participants were kicking and grabbing, each involving 5 (11%) participants, choking and hair-pull ing both described by 3 (7%) par­ticipants, and scratching reported by 2 participants (5%). The following responses from participants clearly describe the kinds of body contact: I did hit her maybe half a dozen times with my fist and in my opinion, always for a reason. He hit me black-and-blue once from top to bottom. When he starts hitting, he can't quit. Oh, she would strike me, then I would push her away. He'd shove me and knock me down, you know, and then lid get angry. He kicked me out of bed really bad one time, just right against the wall. His mother was present the time he choked me, and she knew about it. She could pull my hair, she could scratch my face, she could hit me, but I never laid a hand on that pretty lady. He had the biggest bruises on his face from my clawing. Threatening with a Weapon There were only 3 (7%) participants who stated the kind of physical fighting that had occurred in their marriage involved being threatened with a weapon. The descriptions of this kind of physical aggression were: She came into the bedroom and put the gun right up to my head and I could see her finger tightening up on the trigger. She even threatened me wit~1 a gun at the same time. After weld have a few arguments, held go downstairs and get his rifle all the time. Held point it at me. He shot shells, they were blanks, though. I never knew it and I didn't care. Physical Injuries 41 The types of physical injuries were described in the participants' responses to the interview question: "Were you physically hurt? If so, how?" Four types of physical injuries occurred between spouses during physically aggressive episodes. The four types which will be discussed separately are: 1. Bruises 2. Broken bones 3. Broken skin: (a) scratches, (b) abrasions, and (c) lacerations 4. Loss of consciousness. Bruises The type of phys i ca 1 i nj ury reported most often by part i c i pants was bruises. This was evident in 17 (39%) cases. The kinds of bruises varied from light bruising to severe bruising with partial immobility. Examples of the kinds of bruises and the context in which they were inflicted can be seen in the following descriptions: It got to the point where he would never do anything to bruise me. I think he began to think about the fact that I could bring charges against him. Just bruised .... Once he hit me and gave me a black eye. He'd shove me and knock me down, I mean I really didn't walk for a couple of days. 42 Broken Bones There were only 2 (5%) participants who described physically aggressive incidents in which bones were broken. These two incidents are described by the participants: She hit me very fast, slapped me on my left ear, and she broke my drum, and that hurt, and that produced a very serious problem for me. He hit me right here, broke my cheekbone. Broken Skin Four (8.5%) participants described three kinds of broken skin injuries: 1. Scratches 2. Abrasions 3. Lacerations. He twisted my hand here and of course my skin is tender, but he drew blood and I called the police. She did scratch my face, she clawed me. I still have a big scar. The scar across the bridge of my nose, the scar on my cheek. I have scars in my hair, underneath. loss of Consciousness There was 1 participant who described a physically aggressive incident in which she lost consciousness. The following example is taken from her response: I had a bad bruise and worst of all I had to go to school. I was knocked out a number of times. Triggering Factors of Physical Aggression 43 The older-divorced participants' responses to the interview question: "Think of a typical situation which ended in fighting. Woul d you describe what usually triggered the episode?" identifies the triggering factors of physical aggression. The triggering factors are inherent in three categories: 1. Arguing 2. Dr i nk i ng 3. Anything. Arguing Arguing was the most common triggering factor indicated by par­ticipants. Nineteen (43%) older-divorced participants described arguing as a precipitating factor for physically aggressive incidents to occur between spouses. Sources of arguments were described, such as difficulties with communication: I just gave up and quit talking. That would make him mad, you know. Arguments over money matters were described as triggering physical aggression as follows: Well, weld try to talk finances over and we ended up usually kind of really yelling at each other. Another kind of argument that was a trigger for physical aggression was attributed to high levels of family stress and frustration. This can be seen in the following example: High frustration, but the reasons were, I don't know ••. 44 Infidelity was also described as a factor that precipitated an argument prior to a physically aggressive incident. One participant said: This physical fighting occurred when I first found out about it [infidelity]. In other words, I was in the process of accusing and not getting the right answers. A spouse threatening to leave or being absent from the household was reported to precede an argument leading to a physically aggressive incident and can be illustrated in the following responses: She got in the automobile and was going to take off and I tried to stop her. Well, he was never home and when I said something about that then he'd get mad at me for being mad at him. Arguing about the children was given as a triggering factor for physically aggressive episodes as follows: Usually probably about the kids. Drinking Eleven (25%) participants stated that drinking was the triggering factor for physically aggressive incidents. Most of the participants indicated that their spouse had been drinking prior to a physically aggressive episode; however, a few of the participants disclosed that their own drinking behavior was responsible for precipitating the physical aggression. In order to understand more fully how drinking was an enabler of physical aggression, the following examples are given from participants' responses: He would be abusive because he'd been drinking and I think once he did knock me down and I think he kicked me at the same time. Drink. She was drunk half the time. 45 The last time was drinking and one other time drinking was involved. Even when he's drinking, if you don't push him, he doesn't get violent. Well, he would get drunk, drinking and I'd say the wrong thing and then he'd fly at me and I was very frightened of him. It would be when he was intoxicated. He drank so much t hat I t h ink the r e was a 1 co h 01 i n his s Y stem a 11 the time, even in the morning. Anything There were only 3 (7%) participants who responded that II any thing!! was a triggering factor for an incident of physical aggression. These examples of participants' responses can more clearly describe the phenomenon of "anything:1I You know, it could be anything. We just didn't get along on anything. The tragic part is if somebody wants to trigger an argument, they can do it and it doesn't have to be anything. Anything, more or less. He demanded a great deal of what he wanted. Coped with Physical Aggression Patterns of coping with physically aggressive incidents were described by the participants in response to the interviewer's question: "How did you handle these situations?" There were four patterns of coping used. The participants: 1. Physically or emotionally withdrew 2. Attempted to defend self 3. Reacted emot i ona lly: (a) cried, (b) upset, and (c) became submissive 4. Called police. Physically or Emotionally Withdrew 46 The mos t common pattern of cop i ng wi th phys i ca 11 y aggres s i ve inc i dents was withdrawal. This was evident in 45% of the cases reported by the participants. The participants described various kinds of physical or emotional withdrawal, for instance, leaving the room or house, backing off, letting things cool down, or trying to ignore the situation. The following examples from the participants' responses to the interview question describes physically or emotionally withdrawing: You know, lid just get mad and leave. I would just go into another room. He jus t wa 1 ked out of the house and when he came bac k everything was cooled down. I would just let him run out, let it run its course. I guess there would just be a period of coolness and then that would be the end of it. Attempted to Defend Self There were 7 (15%) participants who coped with physically aggressive incidents by trying to defend themselves as a way to stop the physical aggression. The ways in which those participants coped by attempting to defend themselves were ascertained by the following responses: I would try to hold her down so that she couldn't do this, so she couldn't hurt me. I didn't realize I had the gumption in me, but I came back and smashed him so hard that I sent myself flying. I don't care what she ever did to me, I'd never strike her back, but I will constrain her. 47 Reacted Emotionally Emotional reaction to physical aggression between spouses as a way to cope was described by 10 (23%) participants. These participants utilized various emotional reactions to cope with the physical aggression, for example, crying, becoming upset or frightened, or becoming submiss ive. Some examples of the participants' responses that will illustrate using emotional reactions to cope with the physically aggressive incidents are: As far as being in charge of my immediate emotions and my mouth, I was out of control. The first time I was so shocked I just cried and stayed out of his way. I'd get upset and cry. I knew there were ways to get him to stop and that was generally to pull the completely submissive bit ••• whatever. That would work. I kept very quiet, tried not to say anything that would aggravate him. Called Police Seven (15%) participants coped with the physically aggressive incidents by call ing the pol ice. The following examples describe the use of police intervention as a way to cope with the physical aggression: He drew blood on my hand and I was frightened. That's the reason I called the police. I called the police, but I didn't file a formal complaint because I thought he would lose his job. One time I had him arrested. When he threatened me with the gun, I just called the police to have them come over and get the gun. 48 Physical Aggression One Time Only In response to the interview question, "Sometimes arguing and fighting are expressed in a physical way, e.g., pushing or hitting. Did physical aggression ever occur during your marriage?" 7 (16%) participants described only a single physically aggressive incident that occurred during their marriage. The following describes physically aggressive incidents that occurred one time only: Only once, that's when I hit him. I slapped his face, but he never laid a finger on me. He wouldn't have dared. She hit me over the head with a book and started calling me names and that, so I just got up and pushed her. I was hit once, just once. He never laid a hand on me again. Only once. She grabbed the phone, she had my arm and it just hit against her chest. SlIIIIIary The descriptions given in the participants' responses indicate that 50% of the time incidents of physical aggression were initiated by males, although in one-fourth of the incidents both spouses became involved in the physical aggression. The physical aggression exhibited ranged from mild to moderate. Even though no participants were injured by a weapon, this type of physical aggression is potentially more serious, since the threat of taking a life is implied. Most startling is the percentage (39.6) of older spouses who experienced physical aggressive incidents; however, it should be noted that in most cases the role of physical aggression in the marriage was not a significant factor in the decision to divorce. This indicates that spouses may have remained loyal to the marriage and to the perpetuation of the cycle of violence as prescribed by their age and culture (Appleton, 49 1980; Macleod, 1980; Wa 1 ker, 1979). The tr i gger i ng factors of phys i ca 1 aggres s ion descr i bed by the participants are wide in variety. Many of the triggering factors described are factors that are also present in famil ies functioning without incidents of physical aggression between spouses. Perhaps interpersonal communication and problem solving were more effective in families without physical aggression between spouses. The coping behaviors utilized by the participants were varied. Most of the participants reported attempting to stop the physical aggressive incident by either physical or emotional withdrawal. This suggests that the participants coped primarily by fleeing the situation. In instances where physical aggression occurred one time only during the marriage, the cycle of aggression was not perpetuated. In those relationships, significant change in verbal fighting patterns may have occurred, so that further incidents of physical aggression did not occur. It is significant that the majority of participants sought some type of resource after incidents of physical aggression. This may be due to soc i eta 1 encouragement to seek ass i stance from any type of abuse, instead of allowing and keeping quiet about physical aggression as was expected in previous generations. The resources (i.e., individual therapy, family, friends, and police) used by older-divorced participants are similar as those revealed in another study (Appleton, 1980). CHAPTER IV DISCUSSION Implications for Nursing The study of older-divorced persons who have been involved in physically aggressive relationships has implications for nursing practice, nursing education, and nursing research. These will each be discussed in an effort to begin to develop a beginning nursing framework for working with spouses experiencing physical aggression between them. Nursing Practice Nurses often work with individuals who are or have been involved in physically aggressive relationships. Theoretically, these nurses have an opportunity to intervene in a recent physically aggressive episode, as well as to initiate follow-up treatment with those individuals who have removed themselves from a physically aggressive relationship. In this study, many of the older-divorced participants sought assistance from individual (31%) or group therapy (9.5%), while remaining in the physically aggressive relationship. It is not known, however, whether the therapists being seen were nurses or other health care professionals. Nevertheless, nurses need to be aware that a physically aggressive relationship may be a hidden agenda for some clients in therapy. An important part of the nursing process is a careful assessment of an individual or a situation. Physical aggression is often not easily discernible; however, a thorough assessment may uncover the 51 problem and lead to treatment. With proper training through inservices, workshops, or academic programs, nurses are often in prime positions for recognition and beginning interventions for those individuals involved in physically aggressive relationships (Amatruda et al., 1986). Training should consist of teaching nurses awareness that the possibility of physical aggression between spouses needs to be discerned by simply asking the question: "ls physical aggression occurring in your marriage?1I The nurse is often available and should be prepared to assist the individual in a crisis situation or soon after. Often when individuals are in a crisis, they will be more amenable and receptive to assistance and suggestions. This is to the nurse's advantage as immediate help with food and shelter can be provided, as well as therapeutic interventions in interrupt i ng the dys funct i ona 1 phys i ca lly aggress ive cyc 1 e. IIProbab ly the most critical element in helping abused women is the nurse's response to the woman's disclosure" (Limandri, 1987, p. 9). There is a need for nurses to respond to the abused by being able to listen and give support without being judgmental, condemning, or giving advice. Since the older-divorced participants in the study did not overtly seek nursing assistance, nurses should become more aware of the signs of potential or actual physical abuse in various settings, such as emergency rooms, cl inics, senior centers, corrmunity menta 1 heal th setti ngs, or home health care where older adults are more apt to be. Nursing intervention should be aimed at prevention, detection, and elimination of physical aggression between spouses. Primary intervention should be targeted towards recognition and identificat ion of those 52 individuals who may be at risk for spouse physical aggression. Nurses can utilize psychosocial skills in assess-ing the individual who may be at risk for spouse abuse, their environment, stresses, financial status, and any evidence of marital problems. The participants in the study who were formerly involved in physically aggressive relationships should be considered at risk for future physically ag·gressive relationships. Those individuals found to be at risk should be encouraged to seek assistance when stress escalates within the marital relationship or at the first signs of physical aggression. Assertiveness training is also recommended and helpful in enhancing communication skills, as well as increasing self-esteem (Jansen & Myers-Abell, 1981). Secondary intervention is detection of physical aggression between older spouses, either in the beginning stages or after a pattern of physical aggression has been established. If the intervention begins early in the physically aggressive cycle, often marital counseling can assist in changing former patterns of relat-ing, especially conflict­solving so that the marriage may survive. Since arguing and lack of effective conflict solution were cited as triggering factors by many par tic i pan t s -j nth iss t u d y, i m pr ov i n g c orrm un i cat ion and con f 1 i c t - sol v i n g between spouses could have an impact on decreasing physical aggression between spouses. When the phys i ca 1 aggress i on has repeated ly occ urred over a long period of time, the marriage is often not repairable. This was revealed in a study in one-third of the participants who chose divorce as a way out of the physically aggressive relationship. Nurses can prov ide -irrmense emot i ona 1 support to the phys i ca lly abu sed i nd iv i dua 1 • Some important pitfalls to avoid in working with those individuals who 53 have been involved in a physically aggressive relationship are advice­giving, lecturing, being judgmental, or taking sides (Limandri, 1987). Working with those individuals who are attempting to disrupt a phys i cally aggress i ve re 1 at i onsh i p can be very frus trat i ng and emot i ona lly drain"ing for the nurse, since many individuals wanting to break the physically aggressive cycle often do not succeed, even after repeated attempts. Countertransference is often a factor to cons ider and care shoul d be taken to separate the nurse therapi s t 's fee 1 ings from the client's, so that they are not unconsciously acted out during therapy. Collegial support is both supportive and insightful for the nurse, to reduce burnout, and to help maintain an objective point of view. Tertiary intervention should be aimed at el imination of physical aggression between spouses, as well as rehabilitation of the individual(s). This can be accomplished by supporting the individual's choice to terminate the relationship. When the physical aggression has not been immediate, but recent, the nurse can have an impact by providing individual, group, or family therapy. The nurse can also assist the individual in becoming aware of available options. In this study, the participants had a 1 ready termi nated the phys i ca 1ly aggress ive re 1 at ions hip through divorce, so treatment coul d be targeted towards prevent i on of future physically aggressive relationships by processing the former relationship while providing emotional support. Nurses working with older individuals who have not only been involved in a physically aggressive relationship, but have also recently been divorced, face a challenge in assisting those individuals in starting over. Evaluation of present social supports and enhancing present and 54 planning for future supports can be of immense help to the older-divorced individual (Deckert & Langlier, 1978). The older individual should be assisted in gaining insight into why patterns of physical aggression were begun and perpetuated, so that the chances for a future physically aggressive relationship may significantly decrease (Roy, 1977). Nurses can help the older-divorced individual rebuild self-esteem and confidence through individual therapy (Finley, 1981). Group therapy can be supportive, as the individual gains acceptance and emotional support from those individuals who have had similar experiences. Group feedback on individual behavior can enhance insight to enable change in family and other social relationships. Nursing Education The present trend in nursing education is in the direction of baccalaureate prepared nurses as the entry level of nursing practice. This step in advocating more highly educated nurses suggests that nurses will be better prepared to practice. As nurses become more knowledgeable and better prepared, they can utilize that knowledge in teaching others. Clinical assignments of nursing students in community settings is a step in the direction of preparing nurses how to teach others to intervene effectively with persons involved in physically aggressive relationships. This population is difficult for nurses to discover; however, older individuals involved in a physically aggressive relationship can be found in many settings, such as hospitals, psychiatric settings, clinics, physicians· offices, churches, senior centers, community groups, schoo 1 s, or home health care. Nurses can educate the genera 1 public through speaking at various places around the community. As 55 nurses teach about physical aggression between older spouses, individuals many gain the courage to seek assistance or help others to seek assistance from physically aggressive relationships. To better prepare future nurses, educational content on physical aggression between spouses should be included in every nursing program (Campbell & Humphreys, 1984). An interdisciplinary approach should a 1 so be taught to nurses so that a team approach can be ut i 1 i zed for continuity of care. An interdisciplinary approach is helpful for nurses, so that expert i se can be ga i ned from many hea 1 th care disc i P 1 i nes. Nursing Research This research was a beginning study of physically aggressive incidents between older spouses. The responses of participants to the interview questions indicate that physical aggression between older spouses does occur, sometimes frequently and with resultant injuries. Both men and women were the initiators of the physical aggression. Following the initiation, both spouses often became involved in the fighting. In instances when only one spouse was involved in the physical aggress ion, the other spouses tended to attempt to stop the phys i ca 1 aggression by physical or emotional withdrawal. Resources, such as individual therapy, family, friends, and church, were utilized by participants most of the time and occasionally police intervention became necessary. Most of the participants remained "in the physically aggressive relationship, even though the physical aggression kept occurring. This may indicate a loyalty to the marital relationship, as could be expected for that generation of individuals. Nurses are in an ideal position to make many contributions to the 56 knowledge base of physical aggression between older spouses, yet only a few research studies have been reported (Campbell & Humphreys, 1984). Before a nursing theory can be fully developed in the area of physical aggression between spouses, further studies are indicated. A beginning theoretical framework for nurses working with older individuals, who are or have been involved in physically aggressive relationships, includes prevention, detection, and elimination of physical aggression. A major problem working with persons who are involved in physically aggressive relationships is how to encourage them to seek assistance when needed and to become aware of available options, so that the physical aggression does not have to continue. Family therapy can be instrumental in changing dysfunctional patterns of conflict-solving and communication. Follow-up counseling should be provided in order to assess and monitor if the family is maintaining the new learned patterns and to make sure that the physical aggression cycle is not recurring (Giles-Sims, 1983). Those older persons who have previously been involved in a physically aggressive relationship would benefit most from a preventative intervention approach. Since many of the participants in the study sought individual therapy as a resource, the nurse therapist could intervene during therapy by reinforcing prevention, i.e., teaching risk factors, role playing difficulties in communication, or conflict-solving. With increased societal awareness and acceptance of those individuals who seek assistance from physically aggressive relationships, perhaps research in this area will be accelerated. Future studies recommended are: 1. Clinical nursing intervention studies with those older spouses 57 involved or formerly involved in physically aggressive relationships which is targeted toward prevention, detection, and elimination of the physical aggression 2. Studies involving those participant~ who have had a physically aggressive episode one time only in order to gain knowledge of triggering factors, as well as what was beneficial in stopping the pattern of aggression before it became an integrated cycle 3. Studies involving the frequency of physical aggression between older spouses and phases of the marriage when physical aggression occurred 4. Transcultural studies in order to gain empirical knowledge of patterns of physical aggression between older spouses in other cultures 5. Studies involving children of older spouses who were involved in physically aggressive relationships. It is only with continuing studies in the area of physical aggression between older spouses that nurses will be able to formulate a basic nursing theory for intervention with those individuals who have been involved in such relationships. APPENDIX A PERMISSION LETTER FOR SAMPLE POPULATION ITATI OF UTAH OEPARTMENT OF HEALTH Nova-ber 12. 1185 Bonnie C. Cllyton. I.N., Ph.D. Director. Division of Psychosoc1ll Nursing College of Nursing University of Utlh 25 South Med1cll Drivi Silt Like City, Utah 84112 Delr Professor Clayton: This is in response to your litter of October 30, 1185. We have reviewed your proposed study, -Divorce Ind the Older Person,- and believe thlt your _thod of selecting a simple will not conflict with the conf1dent1111ty requirements of this office. I am, therefore, authorizing you to ut111ze the divorce records in thh office to select a sub-sanaple of individuals who you .. y contact to become participants in your research study. I regret to 1nfol"ll you that the 1983 Ind 1984 divorce records are not yet computerized. Therefore, we are unable to use the computer to select a sample for you. It wil; be necessary for you, or other .. mbers of the research study team, to .. nually review the divorce records to select those individuals who Ire 50 years of age or older and ~o hive been .. rr1ed for 20 yelrs or .are. The divorce records are on .1crofl1.. The .1crofl1. is done in IIOnthly ~!tches and the divorce records .y be on rolls of f11. with other vital records such as _mages. births, deaths, etc. The divorce records are grouped by county where the d1vorcl was fl1ed and that .ans that at least one party to the divorce ~s a resident of that county. Thus, elch ~nthly bitch of divorces would include all of the Salt Lake County residents together. We will be happy to arran,e for you to cone into our offiCI and use the .1crof1 ,. readlr that .... hav. aVlnabl. to abstract the .1crof1l.. It would be necessary for you to .nually record the nllllS and addresses of those 1nd1v1dulls you want to 1nclud. in your s.-ple. There would be no chlrge for the us. of the .1crof11. or the ~crof11. read.r. You and the oth.r PI"ons 1nvolvtd 1n the study IlUst sign I conf1dent1al1ty a,re_nt, assurint that thl 1nfo,.t1on abstracted would .. 1nta1ned in a confidential .. nn.r and thlt no individuals would be 1dent1f1'd in any published results. 59 letter to Clayton Nov..oer 12, 1985 Page 2 I will be out of the office starting Wednesday, November 13 through November 21, 1985. If you want to commence your study prior to that date, you .. y contact Mrs. Gwen Inselsberger, 533-6186, to arrange the appropriate date and time for coming into our office to perfoMm the abstracting. cc: Gwen Inselsberger Marvin levy _~sN1""nCl\"et~~ John E. Brockert. Director Bureau of Health Statistics 533-6186 60 APPENDIX B PROSPECTIVE RESPONDENT LETTER 62 Dear ----- We are writing you for assistance with a project which we are undertaking at the University of Utah College of Nursing. The impact of divorce and separation on older people and their famil ies has been a subject of increasing concern among professional and community people alike. For this reason, we are gathering information concerning the reactions, needs, and concerns of recent ly divorced persons 50 years old or older and who have been separated 3 years or less. If you meet these requirements, we are especially interested in the uniqueness of this experience for you. Your name was obtained from the State of Utah, Department of Hea 1 th I s pu b 1 i c divorce cert i fi cates. Th i s proj ect has been approved by the Department of Health and the University of Utah Human Subjects Review Board. If you agree to participate in this study, you will be interviewed in your home (or other place of convenience) at an agreeable time. The interview will take approximately 1 to 2 hours and is designed to help us obtain some information about your situation and your needs as a divorced individual. Some of the questions you will be asked may be uncomfortable for you. You may not wish to answer all questions. If you choose to participate in this study, and then wish to drop out at anytime, you are free to do so. Confidential ity will be maintained in all aspects of this study. Code numbers will be used. Names will never be associated with the information collected. Names are only used to arrange the interviews. We hope you will decide to help us in this study. Your contribution would add considerable to our knowledge about the effects of divorce at an older age on individuals and their families. We will call you within the next several days to make an appointment for an interview. If your phone number is unlisted or changed or should you want to get in touch wi th us before then, please fee 1 free to contact us at 581- 8244. Thank you very much for your assistance. Sincerely, APPENDIX C CONSENT FORM 64 We are inviting you to participate in a research project concerning the impact of divorce on individuals 50 years or older who had been married 15 years or more. The research will deal with your attitudes, beliefs, and feelings about your divorce process. We hope that from your participation we will be better able to assist others who are in a similar situation. Yo ur name wa s obta i ned from the State of Utah, Department of Health's public divorce certificates. You will be interviewed at your convenience in your home or other place of your choosing. The interview will take approximately 2 hours and will include one tape-recorded portion that will last approximately 40 minutes. Some of the questions you wi 11 be as ked may be uncomfortable for you. You may not wi sh to answer all questions. All the information that you give will be strictly confidential. Any report of this study will be presented in such a way as to make lt impossible to identify either you or any member of your family. Your participation in this study is entirely voluntary, and if you decide not to participate, you are free to drop out at anytime. If you have any additional questions about the project, please contact either Dr. Bonnie Clayton or Dr. Marge Pett. They can be reached at 581-8244 (College of Nursing, University of Utah). If you have ques t ions concern i ng the proj ect that you wou 1 d prefer not to discuss with the project investigators, please contact the Institutional Review Board office at 581-3655. I have received a copy of this consent document and hereby agree to participate in the research project as described. (Participant's signature) (Date) Witnessed by: (Date) APPENDIX D PHYSICAL AGGRESSION QUESTIONNAIRE 66 30. What do you think your former spouse would say are the three most important reasons for your divorce? 31. Using the 7-point scale below, how would you evaluate the amount of conflict, i.e., arguing, fighting, that was involved in the divorce process itself? 1 2 3 No conflict 4 5 6 7 Tremendous conflict 32. Sometimes arguing and fighting is expressed in a physical way, e.g., pushing or hitting. Did physical aggression ever occur during your marriage? Yes (IF YES, CONTINUE WITH QUESTION 33) No (IF NO, PLEASE GO TO QUESTION 44, PAGE 22) 33. -" Who genera lly in i t i ated these confl i cts? Self Former spouse Both 34. Were both of you involved actively in the physical fighting? Both Spouse only Self only 35. Was physical aggression a factor in precipitating your divorce? Yes No 36. What types of physical fighting occurred? 37. Were you physically hurt? (a) Yes ... if so, how? (b) No (IF NO, PLEASE GO TO QUESTION 39) 38. Did any of your injuries require medical treatment? Yes No 67 39. Think of a typical situation which ended in fighting. 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