This study concerned the identification of threat associated with alienation in families exhibiting "uncooperative" behavior within the community health nurse's caseload, and, the testing of nursing principles to establish a working relationship with an experimental group of these families to reduce those feelings of threat and thereby change the "colored" perception of the community health nurse as is held by patients with feelings of threat associated with alienation.

Twelve community health nurses were given the following specific behavioral criteria to select a population of "uncooperative" patients from their caseloads: 1. Gives unreliable information 2. Uses the nurse as a "buffer" between helping agencies 3. Demands attention in many ways 4. Has a "problem for your every solution" 5. Demands immediate gratification of requests in a stressful situation 6. Is a visit you would like to postpone 7. Is repeatedly delinquent to clinics and 8. Places emphasis on emergency care, not prevention. From that population, the sample of twenty-two families was randomly selected by the investigator using the general criteria and random number assignment. Of the twenty-two selected, eleven were included in the control group and eleven in the experimental group.

All twenty-two families were visited by the investigator; a pre test questionnaire was administered to measure alienation and its associated "threat perception" of the community health nurse. Every negative response was scored "1"; every positive response was scored "0". Responses scoring two (2) or less indicated little or no "threat" or alienation. Scores above two (2) up to seventeen (17) indicated a greater extent of alienation and associated threat. The scores were rated as follows:

1 to 2 - Minimal

3 to 5 - Low

6 to 10 - Moderate

11 to 17 - High

After three additional visits, one per week, post tests were administered for comparative responses. Nursing activity centered home visits were made with the control group; patient-need centered home visits were made with the experimental group.

The T-test was applied to the data. The patients in the experimental and control groups had a mean difference of 2.6 for the "threat perception." significant at the .01 level, and, a mean difference of .64 significant at .05 level for the alienation factor.

It was concluded that conscious effort to develop a working relationship with patients who have feelings of threat associated with alienation will reduce more of these feelings than will "routine" nursing-activity centered behavior on the part of the community health nurse during her home visits.

LLU Discipline





Graduate School

First Advisor

Ruth M. White

Second Advisor

Sherill Baugher

Third Advisor

Amine Varga

Fourth Advisor

Lois V. Johnson

Degree Name

Master of Science (MS)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Nurse-Patient Relations; Public Health Nursing; Family



Page Count

vii; 56

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives