Apego En Adulto Mayor

N U R S I N G T H E O R Y A N D C O N C E P T D E V E L O P M E N T O R A N A LY S I S

Attachment in older adulthood: concept clarification Craig Cookman

PhD RN

Assistant Professor, Health Sciences Center, School of Nursing,Texas Tech University, Lubbock, Texas, USA

Accepted for publication 2 September 2004

Correspondence: Craig Cookman, Health Sciences Center, School of Nursing, Texas Tech University, 3601 4th Street, Lubbock, Texas, USA. E-mail: [email protected]

Journal of Advanced Nursing 50(5), 528–535 Attachment in older adulthood: concept clarification Aims. This paper is an analysis to clarify the concept of attachment by: (1) specifying the antecedents of attachment in older adulthood, (2) describing the defining or critical attributes of attachment as relevant for development beyond adulthood, including older adulthood and old age, and (3) specifying the consequences of attachment in older adulthood. Background. Attachment is a concept that has been studied both within and outside the discipline of nursing. Most of the scholarly work on the concept has involved investigations of the concept as it applies at very early developmental phases of the lifespan. Despite this concentration of effort on the concept in childhood, theorists have consistently called for attention to the concept in adulthood and older adulthood to advance our understanding of how such close and supportive relationships relate to health. Results. Antecedents of attachment behaviour include any number of fear-provoking or challenging situations, as well as interactions that involve conflict. Illnesses commonly have these characteristics and so are broadly included as antecedents. Defining attributes of attachment behaviour include three distinct behaviours: (1) proximity, or keeping to one or more ‘preferred others’, (2) protest following involuntary and perceived permanent separation from a preferred other and, (3) the presence of a secure base, viewed as necessary for developmental exploration and growth. Consequences include environmental interaction secure in the belief that a safe haven exists should reliable clues to danger present themselves, and the mobilization of personal and interpersonal assets called developmental resources. Conclusions. Nursing implications include the ability of nurses to intervene positively with older clients who may be experiencing age-related transitions that affect health. Knowledge about attachment will help nurses mediate the potentially negative impact of health transitions on developmental tasks and promote high-level wellness and successful ageing.

COOKMAN C. (2005)

Keywords: attachment, concept analysis, gerontological nursing, nursing theory, older adults

Introduction Scientific analysis of concepts for use in theory, practice and research is not new to nursing. Nurses have developed so-called Wilson-derived (Wilson 1969) methods of concept analysis to describe more precisely important concepts for use in the discipline (Chinn & Jacobs 1983, Walker & Avant 528

1995, Schwartz–Barcott & Kim 2000). More recently, the adequacy and relevance for nursing of these methods have been questioned (Hupcey et al. 1996). Researchers and theorists have been encouraged to consider carefully additional strategies for concept development, including qualitative methods, critical analysis, and quantitative methods (Morse et al. 1997).
2005 Blackwell Publishing Ltd

Nursing theory and concept development or analysis

What follows is a clarification of the concept of attachment in older adulthood. Selected elements of Wilson-derived methods of concept analysis are used to assist in this process. A critical appraisal of the concept considers principles of lifespan development alongside the clarified concept. Strategies for continued development of the concept complete the analysis. Beginning with a mother’s bond to her unborn child and progressing through life, attachment has been identified as a critical factor in healthy human development. Researchers in human development and nursing have studied attachment extensively, but almost exclusively in infancy and childhood. Development of nursing theory using the concept of attachment has most frequently involved the study of maternal–fetal (Cranley 1981, Kemp & Page 1987, Mercer et al. 1988) and parental–infant attachment (Gaffney 1986, Koniak-Griffin 1988). Understanding attachment in the later developmental phases is clearly needed, considering the hypothesized implications of early attachment patterns for subsequent health (Ainsworth 1985, Bowlby 1988, Paterson & Moran 1988). Consistent with this emphasis, a systematic analysis of the concept of parent–infant attachment has been described (Goulet et al. 1998). The relevance and significance of attachment in later developmental phases is theorized to be important, but has been studied relatively little (Lipson-Parra 1990). Advocates of inquiry into attachment in adulthood and ageing call for rigorous work on clearly defining the concept (Knudtson 1976), as its exact meaning and structure thus far remained unaddressed.

Attachment in older adulthood

wrote: ‘Psychological development is characterized …by the individual’s becoming increasingly aware of the set-goals he (sic) has developed, by his developing increasingly sophisticated plans for achieving them, and by his increasing ability to relate one plan to another’ (p. 154). Bowlby’s (1969, 1973, 1980 descriptions of attachment involved ‘increasing awarenesses’, ‘increasingly sophisticated plans’, and ‘increasing abilities’ resulting from the ‘activation within a particular environment of behavioural systems that are integrated’ (Bowlby 1973, p. 134). Knowledge about attachment, and in particular about the formation of new attachment relationships with ageing, would lend important support to the development of models of health development for older adults. The promise of knowledge about attachment in older adulthood lies in the positive consequences resulting from the vulnerabilities of ageing.

Assumptions Attachment is viewed as a continuous concept throughout the lifespan. Central to any investigation of attachment is the assumption that ‘the capacity to make bonds with other individuals …is regarded as a principal feature of effective personality functioning and mental health’ (Bowlby 1988, p. 3); this has far-reaching implications throughout the life of the individual. Accordingly, phenomena such as attachment are of particular interest to nurses who strive to optimize growth and development as critical components of health promotion and illness prevention.

Understanding healthy development in later life

Aims

Exploring concepts as they present in older adulthood requires a gerontological perspective in which characterizations of ageing as progressive decline and loss are critically scrutinized. Ageing as the time of life when one’s family and friends are lost can lead to an overall view of older adulthood as a time of loss and decline (Phillips 1990). Loneliness, depression and isolation are all too often the expectation among caregivers of older adults and perhaps worse, older adults themselves. A central principle of the lifespan development perspective is that development occurs according to the orthogenetic principle (Werner 1957), where development is an irreversible process of increasing differentiation and hierarchical integration. Reed (1983) characterized this principle as an essential feature of development, meaning that, with development, behaviours will become more complex but more internalized or integrated within the person to define a higher level of human development for that person. Bowlby (1973) echoed this developmental principle when he

The major aim of this analysis is to clarify the concept of attachment as it applies to development in older adulthood and old age. Attachment has been described as social bonds (Rajecki et al. 1978), social relationships (Rutter 1978), symbolic interdependence (Stephen 1984) and object relations (van den Daele 1986), but there remains no generally accepted meaning or definition of attachment. A second aim of this analysis is to specify antecedents, defining attributes and consequences of attachment in older adulthood. In particular, the defining attributes are needed to guide research-exploring attachment among older adults.

History of the conceptual work on attachment Conceptual development has generally proceeded from earlier to later developmental phases of the life course. The earliest writings were almost exclusively about the very early bonds formed between infants and their mothers. Once this


2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535

529

C. Cookman

base of knowledge was established, the concept was explored among increasingly older groups, including adolescents, adults and most recently older adults.

Beginning descriptions Freud (1926) described a theory of secondary drive to explain the bonds that developed between human infants and their mothers. According to this view, there are a small number of primary drives designed to meet survival needs such as food, warmth, sex and liquids. Secondary drives, including attachment, were proposed as learned behaviours that supported these primary drives. As stated by Freud (1926), ‘The reason why the infant in arms wants to perceive the presence of its mother is only because it already knows by experience that she satisfies all its needs without delay’ (Vol. 20, p. 137). This theory was first brought into question by the work of Lorenz (1935) in his experiments with young birds. These demonstrated that, in the hours following hatching, ducklings would follow any moving object they saw, including rubber balloons and cardboard boxes. Over time, the ducklings would follow these objects and no others – findings that brought serious questions about the validity of any theory of secondary drive. Experiments by Harlow and Zimmerman (1959) added to the scepticism. These researchers raised eight infant monkeys with two surrogate mothers – one of cloth and another made from wire. Half of the infants were then ‘fed’ by these surrogate mothers. Monkeys of both groups spent no more than 1 or 2 hours a day on the wire monkey and an average of 15 hours a day on the cloth monkey. Some of the monkeys who were fed by the wire model managed to suck the teat of the wire model while maintaining a grasp on the cloth one. The researchers concluded that ‘an infant fed from a lactating wire mother does not become more responsive to her, as would be predicted from a drive-derived theory, but instead becomes increasingly more responsive to its non-lactating cloth mother’ (Harlow & Zimmerman 1959, p. 423). At this point in the evolution of thinking about attachment, substantive doubts arose about the role of attachment strictly viewed as a strategy for meeting basic needs. These doubts led Bowlby (1969, 1973, 1980) to propose a new definition of attachment based on his studies of the concept among young war orphans. Bowlby (1980) described attachment as a natural protective system that evolved within the species because it enhanced an individual’s chances for survival. This view holds that infants who are predisposed to maintain proximity to an attachment ‘figure’ are afforded protections from predation. This system promotes healthy development wherein an individual can confidently explore 530

the environment with the knowledge that, should the threat of danger arise, a quick return to an attachment ‘object’ will afford safety (the so-called ‘secure base effect’). Attachment behaviours, then, are the observable components of this system, seen when this system is invoked to protect the individual displaying the behaviours. According to Bowlby, an attachment is a bond developed with ‘some other differentiated and preferred individual, who is usually conceived as stronger and/or wiser’ (1977, p. 203). Attachments are directed toward a differentiated other, are characterized by their relatively long duration and serve the biological function of survival. Importantly, Bowlby described attachment as a lifespan development concept ‘held to characterize human beings from cradle to grave’ (Bowlby 1979, p. 129). Ainsworth (1985) viewed attachment as a type of ‘affectional bond’ that individuals may form throughout their lives, some of which ‘may be identifiable as attachments, some as having attachment components, whereas others may not resemble attachments in some critical way’ (p. 799). According to this description, an attachment is an affectional bond. Ainsworth extended Bowlby’s conceptualizations about attachment. In particular, she demonstrated that individuals at a very young age develop cognitive schemas, or internal representations about the relative degree of safety afforded by attachment figures. Called ‘patterns of attachment’, Ainsworth et al. (1978) demonstrated that most infants display confidence in the protective abilities of their attachment figure (mothers), and this is indicative of a ‘secure’ pattern of attachment behaviours. Others, however, display behaviours indicative of ‘insecure’ attachment and characterized by angry and resistant behaviour mingled with contact-seeking (Ainsworth 1982). Hinde (1982) differentiated between attachment behaviour, an attachment behavioural system and attachment. Attachment behaviour refers to proximity keeping. An attachment behaviour system ‘refers to a system postulated as controlling several types of attachment behaviour’ where ‘…the system is either switched on, with the resultant display of attachment behaviour or, when a ‘‘set goal’’ is reached, switched off’ (Hinde 1982, p. 64). Attachment is defined as a ‘label for a relationship or for aspects of a relationship, assessed over a span of time’ that ‘…refers to an aspect of interpersonal relationships’ (Hinde 1982, p. 65).

Attachment in adolescence In adolescence, the parental attachment system is believed to persist, although peer relationships become increasingly important. At the same time, however, the secure base


2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535

Nursing theory and concept development or analysis

provided by parents ‘remains indispensable nonetheless for optimal functioning and mental health’ (Bowlby 1988, p.3). Further evidence for the hypothesized persistence of parents as primary attachment figures for adolescents are provided by Weiss (1982) in his description of a Separation Distress Syndrome, likened to homesickness and seen most acutely during hospitalization of children. Weiss (1982) described four elements of this syndrome: • Focusing of attention on the parent’s absence • Difficulty focusing on other matters • A state of tension that discourages sleep and appetite • An impulse to search for parents Weiss (1982) concluded that adolescents ‘…continue to demonstrate…that their sense of security is dependent on their parents’ continued accessibility’ (p. 175). Developmental growth results in ever more frequent and long-lasting excursions away from the secure base provided by the parents. Eventually, attachments involving peers as significant attachment figures come to supplement those established in childhood.

Adult attachment From his earliest writings, Bowlby (1969) asserted that ‘attachment behaviour in adult life is a straightforward continuation of attachment behaviour in childhood’ (p. 207). Later attachment theorists echoed this appreciation for the continuous quality of attachment with development. According to Parkes and Stevenson-Hinde (1982): ‘…the properties of attachment in children are just those required for effective pair bonding in adults, and (that) this may account for the very evident capacity of human adults to display attachment’ (p. 183). Heard and Lake (1986) wrote that: ‘Individuals have a natural propensity to have ‘‘companionable interactions’’ in specifiable circumstances with peers, that is, people of broadly equivalent intelligence, stamina, capacity to handle fear and panic, and competence in pursuit of interests’ (Heard & Lake 1986, p. 431). Companionable interaction with select others (commonly referred to in attachment literature as ‘attachment figures’) leads to a state of assuagement where ‘…an affective experience of mental and physical well-being’ (Heard & Lake 1986, p. 431) is experienced. Attachment figures were viewed within a system theory of social networks. Individuals develop networks of ‘preferred relationships’ that refer to ‘relationships in which individuals regularly expect to find opportunities for companionable and/or supportive interactions which are experienced as more rather than less effective’ (p. 433). Weiss (1991) identified three features of adult attachment as evidence that attachment is a developmentally continuous

Attachment in older adulthood

concept: (1) the similarity of emotional characteristics, (2) the generalization of experience, and (3) the temporal linkage. As theorized by Weiss (1991), ‘in adults as well as in children, attachments appear to be relationships critical to continuing security and so to maintenance of emotional stability’ (p. 75).

Attachment in older adulthood Attachment has been examined in older adulthood (Knudtson 1976, Troll & Smith 1976, Weiss 1986, West et al. 1987, Shaver et al. 1988, Cicirelli 1989). Bradley and Cafferty (2001) described attachment as relevant for ageing in three major areas: (1) care giving and chronic illness, (2) bereavement and coping with loss, and (3) adjustment to ageing and well-being in old age. Writers have acknowledged that the conditions imposed by severe chronic illness such as Alzheimer’s disease and stroke are significant attachment-related phenomena (Wright et al. 1995) that involve both the ill person and their caregiver. Issues surrounding loss and bereavement have long been acknowledged as developmental challenges that confront older adults (Havighurst 1952). Similarly, the influence of attachment processes on well-being in older adulthood has long been acknowledged (Antonucci 1976, Troll & Smith 1976, Kahn & Antonucci 1980). Beyond hypothesizing about the continued relevance of attachment for ageing, systematic efforts specifically designed to explore the specialized nature of concept for older adulthood are sparse (Cookman 1996).

Wilsonian concept analysis elements The following section uses the three main components of a concept analysis as described by Walker and Avant (1995) to further this clarification of attachment: antecedents, critical attributes and consequences.

Antecedents Common to many perspectives on attachment is the notion of humans as potentially vulnerable to dangers that are lessened when in the company of another or others: ‘Separation from an attachment figure is found to be one of a class of situations each of which is likely to elicit fear’ and ‘comprise(s), among others, darkness, sudden large changes of stimulus level including loud noises, sudden movement, strange people and strange things’ (Bowlby 1977, p. 205). Kobak and Duemmler (1994) described three categories of antecedents to attachment, defined as ‘attachment system activators’. Fear-provoking situations that lead to searches for ‘safe havens’ are the first. This is consistent with Bowlby’s (1969) and Ainsworth’s


2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535

531

C. Cookman

et al. (1978) initial descriptions of attachment as serving evolutionary and protective functions. Additionally, the fearful experiences associated with vulnerability and dependence are thought to precede attachment behaviours (Bradley & Cafferty 2001), as are exhaustion, distress, and illness (Rholes et al. 1998). Challenging situations that lead adults to seek out attachment figures to provide a secure base are a second antecedent of adult attachment. Thirdly, conflictual interactions are hypothesized to be attachment system activators by Kobak and Duemmler (1994). Importantly, antecedents of attachment need not represent actual or ‘real’ danger; simply being alone is sufficient to result in attachment behaviour (Bowlby 1977).

Defining attributes Defining attributes are a ‘list of characteristics’ that ‘help you and others name the occurrence of a specific phenomenon as differentiated from another similar or related one’ (Walker & Avant 1995, p. 39). Ainsworth (1985) listed three criteria of attachment that can serve as defining or critical attributes. Firstly, Ainsworth (1985) stated that ‘…attachment figures are never wholly interchangeable with or replaceable by another, even though there be another with whom one is also attached’ (p. 799). This notion of an attachment figure as ‘preferred and differentiated’ is a widely accepted central feature of attachment. A ‘…desire to maintain closeness to the partner as well as a need to keep proximity to him’ (Ainsworth 1985, p. 800) is reflective of a notion of proximity-keeping that is a second defining attribute. Her third criterion is the secure base effect, described as ‘the experience of comfort and security in relationship to the other and yet the ability to move off from this secure base with confidence to engage in other activities’ (Ainsworth 1985, p. 800). Weiss (1991) identified three critical features of adult attachment: (1) proximity-keeping (to a parent or other attachment figure), (2) secure base effect, and (3) separation protest. The first two closely mirror those identified by Ainsworth (1985). Separation protest arises when proximity between the person and attachment figure is interrupted (Weiss 1991). Weiss asserted that the secure base effect described by Ainsworth (1982) also applied to adult forms of the concept, and also that whereas, the infant displayed more immature behaviours to represent the ‘secure base effect’, adults displayed mature forms of what was essentially the same behaviour. In adulthood, separation protest leads to active attempts at reunion with the attachment object, as opposed to the crying or withdrawal that may evidence it in infancy. Taken together, these three criteria seem to represent 532

the central, core ideas used to represent the phenomenon of attachment both in earlier development and in adulthood and beyond.

Consequences The consequences of attachment seemingly follow from the early directions provided by Bowlby. Consequences represent linear extensions of early attachment experiences and subsequent personality development initially formed by the infant towards the mother. Hence, the consequence of attachment would be the relative persistence of a specified pattern of behaviour throughout one’s life. According to Bowlby (1988), the scientific task remaining for researchers interested in attachment is to test the hypothesis that ‘each person’s resilience or vulnerability to stressful life events is determined to a very significant degree by the pattern of attachment he or she develops during the early years and …to clarify to what degrees and in what ways the earlydeveloped patterns influence subsequent development’ (p. 8) Ainsworth (1985) described these consequences of attachment in terms of secure, anxious and avoidant patterns of attachment. Heard and Lake (1986) described assuagement as an outcome of attachment, defined through a description of its three features: ‘(1) an affective experience of mental and physical well-being, a feeling of satisfaction and enjoyment in what one is doing, (2) a sense of confidence and selfesteem in the ability to achieve short or longer-term aims, which are consistent with stages of life, abilities and interests, and (3) awareness that one’s personal supportive environment is secure and that opportunities for companionable and supportive interactions are available’ (p. 431). Assuagement enables individuals to consider the consequences of their actions, to see issues from another’s point of view, to reappraise past experiences and to integrate new approaches with known routines to carry out short- and longer-term plans. It appears that this view offers a confounding view of the defining attributes and consequences – namely in its reference to the ‘secure base’ as a result of the concept. For the purposes of this clarification, the notion of a secure base is a central defining attribute of the concept, not what follows from it. According to Heard and Lake’s conceptualization, attachment results in the possibility of two dichotomous outcomes: assuagement as described above, and a negative outcome called dissasuagement. Here ‘…an individual suffers loss of a sense of confidence and competence in his (sic) ability to manage not only to external circumstances, but also to his own feelings and thoughts, and tends to lose faith in what previously


2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535

Nursing theory and concept development or analysis

gave him a sense of security and significance’ (Heard & Lake 1986, p. 435). It is, however, also possible to adopt a broader conceptualization of the concept by keeping the secure base effect within the domain of defining, or critical attributes. This allows the possibilities for ‘what follows’ to be defined as consequences of the concept. Viewed as a developmental process, what follows is interaction with the environment and the mobilization of resources associated with task achievement. From the experiences of infants, to children and on through adulthood, what attachment affords is a safe haven from which to explore the environment. It follows, then, that these confident excursions into the environment to grow, learn and explore represent the most robust conceptualization of the outcomes of attachment. Two consequences then become possible: (1) environmental interaction, and (2) resource mobilization. Environmental interaction refers to the physiological, psychological, spiritual, social and cultural interplay between dimensions that interact with the client and have individual, as well as global implications for health and health care. Nurses routinely engage in therapeutic nursing interventions to manage, modify and, manipulate internal and external environmental dimensions to promote optimal health and prevent disease. Resource mobilization involves the employment of intrapersonal as well as extrapersonal assets to meet basic needs and to promote developmental growth. Figure 1 depicts these elements of attachment, including antecedents, defining attributes and consequences of the concept.

A definition Attachment as defined from this concept clarification is as follows: attachment refers to feelings of safety and security afforded by proximity to attachment figures in response to reliable clues to danger, challenge or conflict. To the extent that the person is confident in attaining these feelings when needed, they can more fully interact with the environment, mobilize developmental resources, and address developmental tasks.

Elements of later life attachment Antecedents

Defining attributes

Fear provoking situations

Proximity keeping

Challenging situations

Separation protest

Conflictual interactions

Secure base effect

Consequences

Attachment in older adulthood

Related concepts Several concepts are sometimes used interchangeably with attachment. These related concepts can cause confusion unless clearly differentiated from attachment. Hagerty and Williams (1999) described attachment as ‘an individual’s level of involvement with persons, objects, groups or natural environments and the concurrent level of comfort or discomfort associated with that involvement’ (p. 292). Another related concept is emotional bondedness (Snow & Crapo 1982, Bitzan 1998), ‘conceptualized as comprising three components: (a) the sense that one receives emotional support from a given other; (b) the sense of mutual sharing with another; and (c) feelings of positive affect with another’ (Snow & Crapo 1982, p. 609). While the critical attributes of a secure base and separation protest are not specifically included as defining the concept, the notion of positive affect is shared by both. Another related concept is dependence. Bowlby addressed this potential confusion with attachment when he wrote: ‘Whereas dependence is maximum at birth and diminishes more or less steadily until maturity is reached, attachment is altogether absent at birth and is not strongly in evidence until after an infant is past 6 months’ (Bowlby 1969, p. 228).

Conclusion Promoting nursing research Concepts have been described as the essential building blocks or basic elements of theory for a discipline (Rodgers & Knafl 2000). The challenge of clarifying the basic structure of the concept of attachment in older adulthood remains, despite this paper. This analysis has offered a basic definition and outlined the antecedents, critical attributes, and consequences of attachment from a very general perspective. It is hoped that this clarification will serve as a stimulus for further clarification efforts using systematic and rigorous approaches (Morse et al. 1996). In particular, it was suggested that with development, attachment can exist not only between people, but also be meaningful between people and places, pets, cherished possessions, and even symbolic representations of these such as memories (Cookman 1996). Interesting questions about the nature of the concept within all these different types of expression could be posed by researchers wishing to clarify this concept further.

Environmental interaction Resource mobilization

Figure 1 Antecedents, defining attributes, and consequences of attachment in older adulthood

Practice implications Nurses and others working with older adults can use knowledge about attachment to enhance care for their older


2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535

533

C. Cookman

What is already known about this topic • Attachment is a critical concept for understanding healthy human development across the lifespan. • Concepts are the building blocks of nursing theory. • Nursing theories composed of clearly defined concepts contribute to the construction of useful nursing knowledge.

What this paper adds • Attachment is a concept with consistent defining elements across all life phases, but the behaviours representative of these elements can differ across life phases. • Older adulthood and ageing represent particularly salient life phases for the study of attachment owing to the importance of establishing new attachment bonds to replace lost ones. • Clarification of the concept is an important first step in furthering knowledge in this important health-related area of human development, and continued, systematic work is needed to further this clarification and incorporate it into gerontological nursing theory and practice.

clients. Awareness that attachment is as relevant a concept for senior citizens as at other life phases will help combat stereotypes of older adulthood as only a time of loss and deterioration. Nurses can use knowledge about attachment to search for ways to connect older people with others, and also to explore connections with other attachment figures such as pets, places, and cherished possessions. Reminiscence therapies may provide a rich source of insight into older people’s previous attachments, the effect of those losses, and ways to move on. Just as with clients from earlier life phases, nurses should continue to enhance ever higher levels of developmental growth and mastery of developmental tasks.

References Ainsworth M.D. (1982) Attachment: retrospect and prospect. In The Place of Attachment in Human Behavior (Parkes C.M. & Stevenson-Hinde J., eds), Basic Books, New York, NY, pp. 3–30. Ainsworth M.D. (1985) Attachments across the lifespan. Bulletin of the New York Academy of Medicine 61(9), 792–812. Ainsworth M.D., Blehar M.C., Waters E. & Wall S. (1978) Patterns of Attachment. Lawrence Erlbaum Associates, Hillsdale, NJ. Antonucci T. (1976) Attachment: a life-span concept. Human Development 19, 135–142.

534

Bitzan J.E. (1998) Emotional bondedness and subjective well-being between nursing home roommates. Journal of Gerontological Nursing 24(9), 8–15. Bowlby J. (1969) Attachment and Loss. Vol. I. Attachment. Hogarth Press, London, UK. Bowlby J. (1973) Attachment and Loss. Vol. II. Separation, Anxiety and Anger. Hogarth Press, London, UK. Bowlby J. (1977) The making and breaking of affectional bonds. British Journal of Psychiatry 130, 201–210, 421–431. Bowlby J. (1979) The making and breaking of affectional bonds. British Journal of Psychiatry 130, 201–210. Bowlby J. (1980) Attachment and Loss. Vol. III. Loss. Basic Books, New York, NY. Bowlby J. (1988) Developmental psychiatry comes of age. The American Journal of Psychiatry 145(1), 1–10. Bradley J.M. & Cafferty T.P. (2001) Attachment among older adults: current issues and directions for future research. Attachment and Human Development 3(2), 200–221. Chinn P.L. & Jacobs M.K. (1983) Theory and Nursing: A Systematic Approach. Mosby, St Louis, MO. Cicirelli V.G. (1989) Feelings of attachment to siblings and wellbeing in later life. Psychology and Aging 4(2), 211–216. Cookman C.A. (1996) Older people and attachment to things, places, pets, and ideas. Image: Journal of Nursing Scholarship 28(3), 227– 231. Cranley M.S. (1981) Roots of attachment: the relationship of parents with their unborn. Birth Defects: Original Article Series 17(6), 59–83. van den Daele L. (1986) Homeostasis and attachment: an integration of classical and object relational approaches to the good-enough mother. The American Journal of Psychoanalysis 46(3), 203–218. Freud S. (1926) The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 20. The Hogarth Press, London, UK. Gaffney K.F. (1986) Maternal–fetal attachment in relation to selfconcepts and anxiety. Maternal–Child Nursing Journal 15, 91– 101. Goulet C., Bell L., Tribble D.S., Paul D & Lang A. (1998) A concept analysis of parent–infant attachment. Journal of Advanced Nursing 28(5), 1071–1081. Hagerty B.M. & Williams A.R. (1999) The effects of sense of belonging, social support, conflict, and loneliness on depression. Nursing Research 48(4), 215–219. Harlow H.F. & Zimmerman R.R. (1959) Affectional responses in the infant monkey. Science 130, 421. Havighurst R.J. (1952) Developmental Tasks and Education. David McKay, Inc., New York, NY, pp. 92. Heard D.H. & Lake B. (1986) The attachment dynamic in adult life. British Journal of Psychiatry 149, 430–438. Hinde R.A. (1982) Attachment: some conceptual and biological issues. In The Place of Attachment in Human Behavior (Parkes C.M. & Stevenson-Hinde J., eds), Basic Books, New York, NY, pp. 60–70. Hupcey J.E., Morse J.M., Lenz E.R. & Tason M.C. (1996) Wilsonian methods of concept analysis in nursing: a critique. Scholarly Inquiry for Nursing Practice: An International Journal 10(3), 185– 210.


2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535

Nursing theory and concept development or analysis Kahn R.L. & Antonucci T.C. (1980) Convoys over the life course: attachment, roles, and social support. In Life-span Development and Behavior, Vol. 3. (Baltes P.B. & Brim O.G., eds), Academic Press, New York, NY, pp. 253–286. Kemp V.H. & Page C.K. (1987) Maternal prenatal attachment in normal and high-risk pregnancies. Journal of Obstetric, Gynecologic, and Neonatal Nursing 16, 179–184. Knudtson F.W. (1976) Life-span attachment: complexities, questions, considerations. Human Development 19, 182–196. Kobak R.R. & Duemmler S. (1994) Attachment and conversation: toward a discourse analysis of adolescent and adult security. In Attachment Processes in Adulthood (Bartholomew K. & Perlman D., eds), Jessica Kingsley, London, pp. 121–149. Koniak-Griffin D. (1988) The relationship between social support, self-esteem and maternal attachment behavior in adolescents. Research in Nursing and Health 2, 269–278. Lipson-Parra H. (1990) Development and validation of the adult attachment scale: assessing attachment in elderly adults. Issues in Mental Health Nursing 11(1), 79–92. Lorenz K.Z. (1935) Der Kumpan in der umvelt des vogels. F. Orn. Berl., 83. English translation. In Instinctive Behavior (Schiller C.H., ed.), International Universities Press, New York, NY. 1957. Mercer R.T., May K.A., Ferketich S., DeJoseph J. & Sollid D. (1988) Further exploration of maternal fetal attachment. Research in Nursing & Health 11, 83–95. Morse J.M., Hupcey J.E. & Lenz E.R. (1996) Concept analysis in nursing research: a critical appraisal. Scholarly Inquiry for Nursing Practice: An International Journal 10(3), 253–277. Morse J.M., Hupcey J.E. & Lenz E.R. (1997) Choosing a strategy for concept analysis in nursing research: Moving beyond Wilson. In Clarifying Concepts in Nursing Research (Gift A. ed.). Springer, New York, NY. Parkes C.M. & Stevenson-Hinde J. (eds), (1982) The Place of Attachment in Human Behavior. Basic Books, New York, NY. Paterson R.J. & Moran G. (1988) Attachment theory, personality development, and psychotherapy. Clinical Psychology Review 8, 611–636. Phillips L.R. F. (1990) The elderly, the nurse, and the challenge. In Nursing Care in an Aging Society (Corr D.M. & Corr C.A., eds), Springer Publishing Company, New York, NY, pp. 3–21. Rajecki D.W., Lamb M.E. & Obmascher P. (1978) Toward a general theory of infantile attachment: a comparative review of aspects of the social bond. The Behavioral and Brain Sciences 3, 417–436. Reed P.G. (1983) Implications of the life-span developmental framework for well-being in adulthood and aging. Advances in Nursing Science 6(1), 18–25. Rholes W.S., Simpson J.A. & Stevens J.G. (1998) Attachment orientations, social support, and conflict resolution in close relationships. In Attachment Theory and Close Relationships

Attachment in older adulthood (Simpson J.A. & Rholes W.S., eds), Guilford Press, New York, NY, pp. 166–188. Rodgers B.L. & Knafl K.A. (eds), (2000) Concept Development in Nursing: Foundations, Techniques, and Applications. W.B. Saunders, Philadelphia, PA. Rutter M. (1978) Attachment: its meaning and consequences. The Behavioral and Brain Sciences 3, 455–456. Schwartz-Barcott D. & Kim H.S. (2000) An expansion and elaboration of the hybrid model of concept development. In Concept Development in Nursing, 2nd edn. (Rodgers B.L. & Knafl K.A. eds), W.B. Saunders, Philadelphia, PA, pp. 129–159. Shaver P.R., Hazen C. & Bradshaw D. (1988) Love as attachment: the integration of three behavioral systems. In The Psychology of Love (Sternberg R. & Barnes M. eds), Yale University Press, New Haven, CT, pp. 68–99. Snow R. & Crapo L. (1982) Emotional bondedness, subjective well-being, and health in elderly medical patients. Journal of Gerontology 37(5), 609–615. Stephen T.D. (1984) Symbolic interdependence and post-break-up distress: a reformulation of the concept of the attachment construct. Journal of Divorce 8(1), 1–16. Troll L.E. & Smith J. (1976) Attachment through the life-span: some questions about dyadic bonds among adults. Human Development 19, 156–170. Walker L.O. & Avant K.C. (1995) Strategies for Theory Construction in Nursing 3rd edn. Appleton & Lange, Norwalk, Conn. Weiss R.S. (1982) Attachment in adult life. In The Place of Attachment in Human Behavior (Parkes C.M. & Stevenson-Hinde J., eds), Basic Books, New York, NY, pp. 171–184. Weiss R.S. (1986) Continuities and transformations in social relationships from childhood to adulthood. In Relationships and Development (Hartup W. & Rubin Z. eds), Erlbaum, Hillsdale, NJ, pp. 95–110. Weiss R.S. (1991) The attachment bond in childhood and adulthood. In Attachment Across the Life Cycle (Parkes C.M., Stevenson– Hinde J. & Marris P. eds), Routledge, London, UK, pp. 66–76. Werner H. (1957) The concept of development from a comparative and organismic point of view. In The Concept of Development (Harris D.B., ed.), University of Minnesota Press, Minneapolis, MN, pp. 125–148. West M., Sheldon A. & Reiffer L. (1987) An approach to the delineation of adult attachment: scale development and reliability. The Journal of Nervous and Mental Disease 175(12), 738–741. Wilson J. (1969) Thinking with Concepts. Cambridge University Press, New York, NY. Wright L.K., Hickey J.V., Buckwalter K.C. & Clipp E.C. (1995) Human development in the context of aging and chronic illness: the role of attachment in Alzheimer’s disease and stroke. International Journal of Aging and Human Development 41(2), 133–150.


2005 Blackwell Publishing Ltd, Journal of Advanced Nursing, 50(5), 528–535

535