Journal of Advanced Nursing. 1986, I I , 179-195

A comparative analysis of nurse and physician characters in theentertainment media

Philip A. KalischPhD Professor of History. PoUlics and Economics of Nursing and InterimDirector. Centre for Nursing Research. University of Michigan and Beatrice J. Kalisch RN EdDFAAN Titus Distinguished Professor of Nursing ami Chairperson. Parent-Child Nursing, Universityof Michigan. 609 East Liberiy Street. Ann Arbor. Michigan 48108, USA

Accepted for puhlicatiofi U June t9H5

KALISCH P.A. & KALISCH B.J. (1986) Journal of Advanced Nursing 11, 179-195A comparative analysis of nurse and physician characters in the entertainment mediaThe results of a large body of research have yielded findings supportive ofthe view that themass media have a decisive effect on the formation of public attitudes and behaviours. Thisstudy reports the results of a content analysis of 670 nurse and 466 physician charactersportrayed in novels, motion pictures and prime-time television series, published or producedfrom 1920 to 1980. When compared with media physicians, media nurses were consistentlyfound to be less central to the plot, less intelligent, rational, and individualistic, less likely tovalue scholarliness and achievement and exercise clinical judgement. Moreover, in televisionseries nurse characters were depicted as valuing service to others and being helpful to patientsless, and as being lower in nurturance and empathy than physician characters. An analysis ofthese data over time points to a steady and unmistakable decline in the mass mediaentertainment image of nurses while physician characters have remained consistently high orshown improvement. The implications of this image gap are discussed along with the need forimage reshaping efforts which might direct public demand for more collegial and productive'real world' nurse-physician roles and interprofessional relationships.

IMAGES people see all aspects of life including healthcare (King 1979, Nichols 1977, Shorr 1980).

Images surround us. There are those we The mass media have an enormous impactfabricate ourselves, perceptually; and there are on the formation of images, largely on thethose fabricated for us. artistically or com- unconscious level. The dogma of media power-mercially. Images are things that represent lessness, prevalent in the I950's and early(re-present) something else. To represent with 196O's. is no longer tenable. Results of consider-images is to symbolize, and symbolization is able research completed in the last decade leadbasic to communication. By means of symbols, to the undisputable conclusion that the masswe enter into processes of communication and media have a decisive effect on people's concep-exchange with one another. Kenneth Boulding tions of the world. The mass media influence(1956) names the basis for human behaviour the how children and adults think about the society'image" in order to emphasize that it is 'a subjec- around them, or in other words, how they formtive knowledge structure', not necessarily re- their conceptions of 'social reality". This con-fleeting actuality in all of its components. Images elusion is based both on laboratory experimentsare mental representations that influence how and on field studies. Observational learning

179

ISO p. A. Kalisch amiB. J. Kalisch

from the mass media, particularly television,has been demonstrated numerous times.

Studies, for example, have shown that themass media influences attitudes towards pro-ducts lor purchase (Donohue 1975, Caron &Ward 1975. Ward (Vi//. 1977. Goldberg & Gorn1978, Galst & White 1976. Robertson et al.1979. Atkin 1978), the importance of materialpossessions (Churchill & Moschis 1979. Moschis& Churchill 1978). drug use (Milavsky et al.1975, Feingold & Knapp 1977), family values(Greenberg el al. 1980b, Johnson ci al.1978. Fisher & Dean 1976). and health behav-iours (Breed & Defoe 1981. Kaufman 1980.Greenberg vt al. 1980b. White & Sandberg1980), Media portrayals have also been shownto lead to a greater acceptance of aggressivebehaviour (Drabman & Thomas 1974, Thomas& Drabman 1975, Eron & Huesmann 1980a,Huesmann et al. 1981). A higher exposure totelevision violence has been demonstrated toyield increased feelings of fear and mistrust(Gerbner ef al. 1978. Gerbner et al. 1979,Bryant i'/«/. 1981).

Mass Media

The mass media have also been found to pro-mote stereotypic thinking about such groups aswomen (Haskell 1973, Rosen 1973. Silverman c/al. 1979, Seggar 1975, Busby 1974. Henderson& Greenberg 1980, Lemon 1977, Long& Simon1974, Miller & Reeves 1976, Himmelweit &Bell 1980, Williams et al. 1981), the elderly{Greenberg et al. i980a, AronofT 1974. Petersen1973. Stoddard 1980, Harris & Feinberg 1977,Cassata et al. 1980. Kubey 1980, Shinar & Biber1978). and minorities (Mapp 1970. Dominick &Greenberg 1970, Pettit 1980. Bataille & Silet1980. Cripps 1977, Northcott el at. 1975.Greenberg 1972. Surlin & Tate 1976, Meyer1976,Surlin 1978).

The attitudes moulded by the mass mediahave been shown to translate into actual behav-iour. One of the most heavily researched areasin terms of media influence on behaviour hasfocused on the issue of violence and aggression.Viewing television has been found to result inan increase in the violent and aggressive behav-iour of children and adolescents (Belson 1978,Singer & Singer 1980, McCarthy et al. 1975,

Williams 1978, Granszberg & Steinberg 1980,Eron & Huesmann 1980b, Huesmann c/a/. 1981,Hartnagel el al. 1975, Greenberg 1975). Onthe other end of the continuum, studies havedemonstrated that the mass media lead toaltruistic behaviour (Bryan 1975, Elliott &Vasta 1970, Rushton & Owen 1975, Sprafkin etat. 1975, Friedrich & Stein 1973, Friedrich &Stein 1975. Friedrich-Cofer et al. 1979. Towerel al. 1979, Loye et at. 1977) as well as friend-liness (Gorn et at. 1976, Coates et at. 1976).Furthermore, media portrayals have beenlinked to increased ability to delay gratification(Yates 1974. Friedrich & Stein 1973),

Particularly relevant to the study of nursesand physicians in the entertainment mass mediaare studies which have demonstrated that themass media influences attitudes about occu-pational roles (Abel el at. 1981. Seggar &Wheeler 1973. Jeffries-Fox & Signorielli 1978).Specific occupations which have been studiedin depth include ministers (Worden 1962),teachers (Gerbner 1964), newspapermen (Barris1976), and physicians (Cousins 1982, De Bakey1964. Ceccio 1978, Cameron 1973. Trautman1981. Norris 1969. Silvetter 1967). Adults whoview a large amount of health care drama ontelevision, for example, have been found to havemore faith in physicians" abilities to helpthem than those who view none or very few ofthese dramatizations (Volgy & Schwartz 1980,Gerbner et at. 1982). Young children whoare heavy viewers have also been found tohave attitudes about the health care worldsimilar to television depictions (Arenstein 1974,MeLaughlin 1975a, 1975b).

No systematic study

No systematic study of the portrayal of nursesin the entertainment mass media had beenundertaken prior to the present work. Selectedresults from this research have been previouslyreported (Kalisch el al 1980, Kalisch & Kalisch1981, Kalisch et al. 1981, Kalisch & Kalisch1982. Kalisch et al. 1982a, 1982b, Kalisch &Kalisch 1983. Kalisch et al. 1983). The studydescribed here analyses the differences in theportrayal of nurse and physician characters inthe three major forms of entertainment media:

Nur.se chtiraciers in the rtieiUa 181

novels, motion pictures, and prime time tele-vision. Specifically this comparison is made inorder to determine differences in the depictionof nurse and physician characters, demographiccharacterislics. centrality of role, personalityattributes, primary values,, and professionalbehaviours, A secondary purpose is to illuminatechanges in the portrayal of nurse and physiciancharacters from 1920 to the present.

METHOD

Data collection

Novels, motion pictures, and prime timetelevision programmes for the period 1920 to1980, with nurse and physician characters insignificant roles, constituted the study sample.Novels were identified through a comprehen-sive examination of book reviews publishedbetween 1920 and 1980 in the New York TimesBook Review, The Bookman (1920-1933) andPublishers Weekly (1920-1980), Motion pic-tures were identified by a review of the cumu-lative reprints of the New York Times FilmReviews. Variety Weekly Film Reviews, theAmerican Film Institute Catalog of MotionPictures, and through personal research inpublic and private film archives. Prime timetelevision series were identified by a review ofeach weekly issue of TV Guide (New York Cityedition) published from 1950 to 1980. A 20%sample of the episodes was randomly selectedfrom each series identified as appropriate forthe study so that the representativeness of anygiven series in the sample corresponded to itsduration on television. The total sample sizewas made up of 670 nurse characters and 466physician characters. These characters weredivided by media in the following way: 307 innovels, 321 in motion pictures, and 508 intelevision.

Instruments

Using the research methodology of contentanalysis, three instruments were developed andtested for coding the messages about nurses andphysicians in the entertainment mass media.

The Unit Analysis Tool contained variableswhich address dominant impressions of nurs-ing, medicine and health care in a given massmedia portrayal. Contained within this toolwere items on objective actions of the totalgroup of nurse and physician charactersappearing in the entertainment media as well assubjective impressions conveyed by the narratorcomment, behaviour of other characters, film-ing technique, and the situationa! contexts inwhich the characters were presented.

The Nurse Character Analysis Tool and thePhysician Character Analysis Tool were usedto collect data on the portrayals of these char-acters in each episode. Questions dealt with theextent of the character's role in the episode,objective physical attributes and behaviourof the character as well as the subjectiveimpressions created by context, comment andfilming techniques.

Reliability and validity

Coders underwent a standardized training pro-gramme developed for the project, Intra-rater reliability was determined by havingcoders recode a randomly selected sample ofmedia units several months later without accessto their original coding sheets. Intra-rater reli-ability across all coders and all items was 93-1%for motion pictures, 87'I % for novels, and88-4% for television. Inter-rater reliability wasdetermined by having all coders analyze a2OVo sample of the units. Inter-rater agree-ments among all coders was 916% for motionpictures, 88 3% for novels, and 902% fortelevision.

Content validity was established by aninductive and additive process of classifying allaspects of the image of the nurse and physicianwhich were found to exist in the entertainmentmass media until all categories of new phenom-ena were exhausted. Instruments were thenreviewed by a panel of experts and subsequentlymodified prior to actual data collection.

Convergent validity was estimated by testingthe ability of certain measurement items in thedata instruments to predict others in anexpected or hypothesized fashion. For example,92% of units coded as hospital dramas werealso coded as showing nurses and physicians

p. A. Kalisch and B. J. Kalisch

working in a hospital setting. One-hundred percent of the nurse characters who stated thatnursing constitutes a patriotic service were alsocoded as appearing in military drama or comedy.It was also found that nurses who were shownin administrative roles were also portrayedas having power and influence over others(r = 0 54, P<OOI). There was a significantassociation between the extent to which nursecharacters were seen helping patients andthe degree to which they provided emotionalsupport to patients and families (r = 054.

Since our purpose was to capture an inte-grated, composite image of nurse and physiciancharacters, and given the fact that it was easierto deal conceptually and mathematically with afew indices rather than with multiple variables,several different analytic procedures (factoranalysis, principal component analysis, etc.)were used to condense variables into a smallernumber of factors that would represent statisti-cal parsimony. Each construct reported in thisanalysis was subjected first to reliability testingvia estimation of the extent to which it exhibitedinternal consistency {Nunnally 1978, Peter1979), All constructs produced a coefficientalpha of at least 0 69, Split-half reliability wasalso estimated by random assignment of itemswithin a given construct to one of two groupsfollowed by canonical correlation between the

two sets of measures (Muliak 1972), Ail con-structs were found to exhibit split-half reli-ability of at least 058, / '<005. Then eachconstruct was submitted to predictive validitytesting to determine the extent to which Itcorresponded with some external criterionmeasure logically expected to be related.

RESULTS

Demographic characteristics

Media nurses are predominantly female (99%),Caucasian (956%). under 35 years of age(62'5%), single (71%) and childless (89 4%).This demographic profile of nurse charactersprojected in the entertainment mass media didnot change significantly over the 60 years coveredby the study and did not vary significantly bytype of media. Media physicians, by contrast,are older (r(1113) = 8 77, /'<OOOOI), moreoften parents (/(I I29) = 3 68, /'<00001) andenjoy a higher socioeconomic status (^1108) =1508, /'<OOOOI) than nurse characters.Gender difference is the most striking contrastas physicians are overwhelmingly male (92 5%).As was true with the sample of nurse characters,only 5 2% of physician characters representedminority groups. Nurses are more likely to be of

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Centrality of role

Physician characters are presented as more cen-tral to the plot than are nurse characters(/(IO26)=1O13, P<OOOOI). In other words,physicians are shown in a greater number ofleading roles and engaged in more instrumentalbehaviour than are nurses. Nurse characters aretypically relegated to supporting roles whichstrongly conveys a somewhat subtle but unmis-takable message to the viewer that nurses arenot as essential or important in health care.As can be noted in Figure I. over time, physiciansare becoming more central to the dramatiz-ations (r=013. / '<0001) and nurses less so( r=-0-23 . P<OOOI). In other words, thenurse momentarily in the background carryinga tray, pushing a wheelchair or holding a charthas become a media staple, while significant,leading roles for nurses have experienced asteady and alarming decline as female physicianstake on more and more ofthe female roles in thehealth care genre.

Personality attributes and primary values

Personality attributes and primary values ofmedia characters offer both overt and covert

clues to the public about occupational stereo-types in health care. As can be noted in Table I,nurse characters are shown to be significantlyless intelligent and rational, to exhibit lessindividualism, and to value scholarliness andachievement less than physician charactersacross all the types of entertainment media.Media nurses are also portrayed as having lessdrive than media physicians in two ofthe threemedia. In contrast to these characters, nursesscore consistently higher than physicians in allthree media on only one attribute — submissive-ness. Media nurses are also depicted as valuingservice and being empathic significantly lessthan media physicians in the media of tele-vision. Furthermore television nurses are lessnurturant than television physicians.

Table 2 contains the correlations betweendecade and personality attributes and primaryvalues. These data present consistent results.Nurse characters have experienced a significantdecline from 1920 to 1980 in eight of the tenattributes and values studied, while physiciancharacters on the other hand, have shown nosignificant changes except for a decline in valuefor seholarliness, Even the two nurses' attri-butes and values which did not change signifi-cantly— individualism and empathy — show adownward trend.

A comparison of these personality attributesand primary values by each decade for nurseand physician characters revealed that medianurses have always been depicted as more

Nurse characters in the media 185

submissive and as valuing scholarliness andachievement less than media physicians (Table2), Krom 1930 through the 197O's, nurse char-acters have also been portrayed as consistentlyless intelligent and rational. Media nurseshave e,\hibited less individualism since 1940 aswell. Differences between nurse and physicianempathy and nurturance did not emerge untilthe 195O's when nurses were depicted as havingmore of these attributes and then in the 1970"s,they were shown to exhibit significantly less ofthem. Nurse and physician drive and value forservice to others were also not significantlydilTerent until the 197O's when media nursesexhibited significantly less of these charac-teristics than media physicians.

Professional behaviours

As can be noted in Table 4, physician charactersare depicted as viewing their career as moreimportant to their lives and as exercisingclinical judgement significantly more than nursecharacters consistently across all three types ofentertainment media. Praise for professionalbehaviour is higher for physician characters inmotion pictures and television. Favourableattitudes are significantly more likely to beexpressed toward physician characters Ihannurse characters in novels and television. Andfinally, although no differences exist betweennurse and physician positive impact on patientwelfare in novels and motion pictures, nursesarc significantly less likely to be shown helpingpatients on television.

Over time, nurse characters have shown asignificant decline in praise, favourable atti-tudes, positive Impact on patient welfare, anduse ofclinical judgement (See Table 5), Mediaphysicians have experienced a significantdecline in praise and importance of work to life,but they have also been depicted as helpingpatients significantly more over time.

When nurse and physician characters arecompared for each decade, media physicians areconsistently found to score higher than medianurses in terms of favourable attitudesexpressed toward them (See Table 6), Except forthe decade of the twenties, physicians have alsobeen depicted as using clinical judgement more

than nurses. Praise was significantly higher formedia physicians in both the 1930"s and 197O's,while media physicians saw their work as morecentral to their lives than media nurses in the193O's, I960"s. and I970's, But perhaps the mostnoteworthy finding is thai no differences inhelping patients was evident uniil the mostrecent decade, when nurses were significantlyless likely to be shown having a positive impacton patient welfare {Figure 2),

DISCLSSION

The findings of this study point to the fact thatthe contribution of the nurse to health care asportrayed in the entertainment media has beendistinctly underplayed, and conversely the roleof the physician has been presented in anexaggerated, idealistic, and heroic light. Theevidence is substantial. Personality attributes,primary values and professional behaviourassociated with media physicians are heavilylinked wilh a 'man of science" image. In otherwords, physician characters consistently exhibitdrive, individualism, rationality and intelli-gence. They are almost always men who valueachievement and scholarship, see their work ascentral to their life, exhibit strong clinical skills,and are greatly admired by other characters inthe dramatizations.

Media nurses, by contrast, lack distinction inall aspects of scientific work, intellectual pur-suits and career commitment. Even basic intelli-gence, rationality, problem-solving abilitiesand clinical skills are absent in most nurseportrayals. Nurse characters are presented asgenerally unimportant in health care, largelyoccupying the background rather than playingan instrumental role in health care. Medianurses are viewed less positively than physiciansby other characters, and show little commit-ment to their careers. The central and diverserole the nurse actually plays in the de-livery of health care to the American public isvirtually absent in the entertainment media.

Moreover, it is significant to note that nursecharacters are shown to be less empathic and tovalue service to others less than physiciancharacters in the most powerful of ail of theentertainment media — television. Since these

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TABLK 5 Correlations between iletatk and professional behaviours of nurse and physician churacters in thceiitcriainment im-dia

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humanistic characteristics have been tradition-ally associated with the nursing, as opposed loihe medical, profession, it is indeed surprising.,and quile unfortunate, that nurses fall consider-ably short of physicians. These findings arecoupled with the fact ihat although nurse andphysician characters are shown to be similar intheir positive impact on patient welfare inmotion piuiures and novels, television depictsnurses as significantly less likely to be of help topatients. A similar pattern is seen with otherstudy variables.

In analyzing the meaning of these data, itappears thai a set of characteristics that we havelabeled the Marcus Welby syndrome' appearsto be operative in the television health caregenre. As epitomized by ihe lelevision physiciancharacter,, Marcus Welby. this fictitious healthcare provider is consistently portrayed as pro-viding both outstanding medical care and nurs-ing care. Welby. for example, was not onlyshown carrying oul surgery, diagnosing illness,determining medical treatment and other medi-cal tasks, bul was also shown making homevisits., providing virtually all of the emotionalsupport to patients and their families, preparingpaiienis for surgery, carrying out health leach-ing, supervising the hospital nursing staflf. andeven providing 24-hour a day surveillance ifneeded. Although this syndrome has typifiedthe health care genre throughout television's30-year history, the phenomena has been mostevident in the past decade. It is particularlydamaging to the image of the nurse, since thepublic is led to believe that no special body ofnursing knowledge and skill exists and that

physicians can step in at any point in timeand provide excellent nursing care. This alsoreinforces the damaging stereotype that nursingis the lower part ofthe medical profession.

Dominated by the medical voice

Most of the characterizations of nurse.s aredominated by what one might call the medicalvoice. The defmition of nurses" most seriousproblems and the proposed solutions to theseproblems are really, though often covertly.tailored lo meel the needs of fundamentallymedical problems. This kind of characterizationmust be termed stereotyped, because it tendsalways to emphasize one aspect of characterwhile leaving out others of equal or greaterimportance. To be more explicit, the bias is care-fully chosen .so that certain types of physicians"behaviour relative to nurses are justified. Thestereotypes of nurses vary, but they vary inresponse to ihe needs of physicians. The flatter-ing frequency with which nurses appear in theentertainment media is ultimately deluding:they appear nol as they are, certainly not as theywould define themselves, birt as conveniences tothe resolution of physicians' dilemmas.

Perhaps of even greater concern is the con-sistency in the study fmdings which point to asteady and unmistakable decline in the image ofthe nurse over lime. With few exceptions, thedepiction of nurse characters has declined interms of positive personality attributes, primaryvalues, and professional behaviours. The mostrecent decade marks the low point for many of

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these characteristics. Physician characters inthe entertainment media, by contrast, havevirtually remained at high levels for mostattributes, values, and behaviours. When achange has occurred for physicians, it hasalmost always represented a gain in imagery,especially in the humanistic, psychosociai arenaof care.

IMPLICATIONS

The implications of the study findings are far-reaching. Today's nurse stereotypes promotenegative and wasteful social perceptions ofnearly one-half of all health care providers.Current depictions of nurses in the mass mediaare serving to seriously undermine the potentialcontribution nurses can make in health care.The public readily distinguishes between charac-ters who are directly associated with positivehealth care outcomes and those who are not;those who are fairly autonomous problem-solvers and those who are nearly always independent roles: those who are usually maleand those who are overwhelmingly female.

Not only do these stereotypes influence howconsumers view nurses and the e.xtent to whichthey utilize services nurses offer, but they alsoimpact the images nurses hold of themselves. Inother words, when a society gives its sanction,even its praise, to stereotyped images of nurses.

the nurses who work in that culture form theirown self-images accordingly. Stereotypes maybecome, by a sort of perversity, an image ofreality that even nurses seek to perpetuate.When nurses are constantly portrayed in nega-tively stereotyped ways, these images afTect theirlives and their aspirations as well as delimitingthe scope of their work.

Related to this fact is that authors, producers,directors and scriptwriters may actually avoidthe notion that thc current nurse image may bestereotyping and demeaning, and that otherapproaches could work as well or better,because the current approach is ultimately areinforcement of their own prejudices. Tochange the method would need a counter-change, a reformation of their own attitudeswhich would be cognitively discomforting. Themass media industries more than any othershave the opportunity to reaffirm these imagescontinually by portraying the well-taught nurse,like the original Uncle Tom, trustingly respond-ing in the way she now knows; in fact, onlyknows. The mass media acts as a moulder ofoutlook and fosters a legitimization of thoseroies in which nurses are depicted. The role, thelife patterns indicated, the stances adopted, areall consistent in their occurrence and their formand are. it must be remembered, cumulative.

The particular assumptions in mass mediacommunications about the division of healthcare responsibilities between nurses and

.\urse characters iu the media 193

physicians have an important impact on theinterests of the members of both professions.These interests are not always entirely coinci-dent. The fact that certain values favouring theinterests of physicians rather than nurses havebeen embodied positively in a variety of massmedia products indicates that the componentsof the traditional health care genre are a veryimportant means by which these values, andhence major inequalities between medicine andnursing, are maintained. That these assump-tions do not always have to be made explicitsuggests that one is looking at the outcome of apowerful set of ideologies concerning nursesand physicians and that mass media messagesare one of the means by which these ideologiesarc sustained.

Given the time-lagged effect of image re-shaping efforts, the present is not too soon tobegin to educate various publics about Ihe reali-ties of nursing, if we are to have an adequatesupply of qualified nurses to meet the healthneeds of the American public in future decades.In fact, understanding what image power is.how it is acquired, how it can be lost and how itaffects resource allocation decisions could welldetermine whether nursing will move forwardor be left behind in the coming decade.

The mass media, by means of its own qualitiesand colourations, can transform identifiablegroups such as nurses and physicians into"smaller than life' or 'bigger than life*. It may actas both a mirror and a lamp. Not only may itreflect the 'reality' of professional contribu-tions, but it may also light the way to new con-tributions. It is essential for the future of healthcare in this nation that the mass media begin tolight the way f"or nurses and nursing even if thisdoes require a diminishment of the intensity ofthe halo that the media physician has worn inrecent decades.

References

Ahel J., Fontes B., Greenherg B. & Aikin C. {19m) The impauiof television on children's occtjpdtidtiul rok' It'itrnmgt'npubliihed report. Michigan Stale Univcrsily. BastLansing. Michigan.

Arenstem M.L (1974) Tht L-ffcct of television on children^stereotyping of (ici.'upational roles. Unpublished master'sthesis. Annenberg School (if t'limmunications, I'niversity ofPennsylvania

Aroiioll" C. [ 1974) Old age in prime Lime. Jiiurnul iij Ctimimini'

Atkin C. (197H) t ffects of drug commercials on young viewers.Jiitirrialof Coinmunutition 28, 71-79.

Barris A. (1976) Slop tlw Prcsse.s- The Nvwspaperman inAmvrnan Films. A.S. Barnes. New York.

Bataille (i. & Silet C. (19K0) Tlw Prt-iciul Imliam. The Iowa Slatet.'niversily Press. Ames. Iowa

Belson W. (I97H) Television I'iolcrni- aiul thi- AiJulfsit-ni Boy.Saxon House. London.

Biiulding U 119561 The hmigc AVWH/CI/^C in l.ijif artil Socieiy.University of Michigan Press, Ann Arbor.

Breed W. & Deloe J.R. (I9S1) The portrayal ol' ihe drinkingprocess on prime-time television. Jnurnal iif Cimmiunwation31. 5K 67.

BryanJ H (1975) Children'scoopcraiionand hetping behaviour.In Review of Child De\ehipmcrii Research (Helheringtont M ed ). Universiiy of Chicago Press. Chicago.

Bryani J., Car%'elh R. & Brown D, (1981J Television viewing andanxiety: An cxpenmenial examination. Journal ofCummuiu-cutionn, 106 119.

Busby L. (1974) Delining the sex role standard in commertialnetwork television programs directed loward children.Jiiunuilism Quarterly 51. (i O 69(i

Cameron A (1973) The image of the physician in the Amerieannovel. 1859-1925. Pis.wrtaiiun AkUracls InternalioHol 33,II

Caron A. & Ward S. (1975) Gift decision by kids and parents.Journal I'! Ailverti.'img Riwi-arih 15. 12 20.

C assaia M., Anderson P. & Skill J. 119Sn) The older udull in day-lime serial drama. Journal "I C umniuniiution 30,4K 44

Ceetio J (1978) Mediciiw in Literature. Longman. New York.Churchill G. & Moschis G. (1979) Television and interpersonal

inliuences on adolesaint eonsumer learning Journal ofCiimurtter Researchb,2y .15.

Coate> B.. Pusser H.E. & Goodman I. (1976) The influenceol' 'Sesame Street" and 'Mister Rogers' Neighborhood'on children's social behaviotir in the pre-sthool. ChildOfwIopmentAl, L18-I44.

Cousins N. jl982) The Physician m Literature. Satmders,Philadelphia.

Cnpps T (1977) Slo» Fade to BUiek\ Tbe Xegro in AmericanFilmy I*«l()-I942. Oxford University Press. New York

De Bakey L. (1964) The physician-scientist as character in nme-leenlh century American literature. Dissertation AbstractsIntfrricttional24, a.

Domimck J, & Greenberg B. (1970) Three seasons ofblaeks ontelevision. Journal of AdwrtiMiig Research 10, 21 27.

Donohue T. (1975) Effects of commercials on black children.Journalol Advcriistn^ Ri-scarch 15,41-46.

Drabman R.S & Thomas M H (19741 Does media violenceincrease children's toleration of real-life aggression?Ihvelopmenial P.uchology \0..4\\i 421.

tilhoU R. & Vasta R. (1970) The modeling of sharing: effectsassociated with vicarious reinforcement, symbolization.age, and generalization. Jnuriial ct Experimentiii ChiiiiPsychology 10.8 15.

Lron L l ) . & Huesmann I..R. (19K0a) .Adolescent aggression andleleMsion. Annals of ihe .\fn- York Acadeiin of Sciences 347.319 331.

Eron L.D. & Huesmann L.R. (1980b) Inlegrating field and labor-atory investigations iif televised violence and aggression.Paper presented al ibe meeting of the .American Psychologi-cal Asstx;iation. Monlreiil. Canada, I9J(O.

Ixingold PC. & Knapp Ml . , (1977) .Anti-drug abuse commer-cials Journal o/ Ciinimunicalion 27, 2I)--K.

Fisher D. & Dean D. (1976) The realism ol"marital and parentalroles on television, l.'npublished report. St. LawrenceUniversity. Canton, New Yt)rk.

Friedrich L.K & Stem A.H (1973) Aggressive and pro-socialtelevision programs and the natural behavior of preschoolchildren. Mtinographs o/ ilw Society lor Research tn ChildDevelopment 38, 1 64.

194 P. A. Kuli.sch ami B. J. Kuli.^ch

Friedrich L.K. & Stein A H (1975) Pro-social television andyoung children. The effects of verbal labelling and role pla>-ing on learning and behavior. Child Development 46.27-38.

Fried rich-Cofer L.K . Hustoii-Stcin A.. Kipnis D.N,. Su&manE.J. & Cleweti AS. (1979) Lnvironmental enhuncemenl ofprosocial television content; elTects on interpersonal be-havior, imaginative play, and self-regulation m a naturalsetting. Developmental P.wchology 15,637-646.

GaUl J & White M. (19761 The unheaith> per'iuader the re-inforcing value of lelevision and children's ptirchase-influendng uiiempls at the supermarket. Child Developmeni47. ll)t!9-IO96.

Gertiner G. (I9M) Mass communications and popular concep-tions of edueation: a cross-cultural study {CooperativeReseareh Project Technical Report, No. K7fi. I Departmeniof HFW,Ollicei>rEduciiiion, Washington. DC.

Gerbner G., Gross L.. Jackson-Beeck. M.. Jel rie^-Fox S &Signonelli N. (1978) liolence Profile .\o. 9. TremLs inNetwork Television Drama ami l'ie»er Conceptmns of SocialReality I!J67 /y77. Annenberg School orComttiunieations,Universiiy ol' Pennsylvania.

Oerbner G . Gross L.. Signonelli N , Morgun M & Jackson-Beeek M. (1979) lialenre Profile \o. Ill Trends inNetmirk lelevi.sion Drama and liener Conceptions of SocialReality IV67 IWH. Annenberg School of Communications.Universiiy of Pennsylvania.

Gerbner G.. Morgan M. & Signorielh N. (1982) Programminghealth portrayals: what viewers see. say, and do. In Televisionand Behavior Ten Yean of Scientific Progre.w ami Impli-eaiions for the Fighdes (Pearl D., Bouthilct L. & Lazar J.eds). US Government Priming Ofllce. Washington, DC.

Goldberg M. & Gorn G. (I97H) Some unintended consequencesof TV advertising to children. Journal of Consumer Re.search5, 22-29.

Gom G.J , Goldberg M.E. & Kanungo R.N. (1976) The role ofeducational television in changing the iniergroup ulliludesof children. Child Devehprnent 41, m-2f(0.

GranszbergG.&SleinbergK.(l98()) Television atuithe CanadianIndian (Teehnieal report). IX'purtment of Anthropology.University of Winnipeg.

Greenberg N (1972) Children's reactions lo TV blaeks.Journalism Quarterly 49. 5- 14,

Greenberg B.S (I97S) British children and televised violcnee.Public Opinion Quarterly ..W. 531 547,

Greenberg B.. Buerkel-Rothluss N.. Neuendorf K &. Atkin C.(I9S0) Three seasons of television familj role interdictions.In Lite on Ti'levtsion (Greenberg B.S. ed ) Ablex Press.Norwood. Nev*' Jersey.

Greenberg B.S.. Fernandez-CoIIado C . Graef D.. Korzenny F& AdkinC.K. (1980) Trends in the use of alcohol and oihersubstances on lelevision. In Life on 'IVlcvhion (GreenbergB.S. ed.). Ablex Press. Norwoixl. Nevt Jersey.

Harris A. & Feinberg J. (1977) Television and ageing: is what yousee what you gel'.' Geronioiogisi 17.464-468.

Harinagel T.F.. Teevan J.J. Jr. & Mclntyre J.J. (1975) Televisionviolence and violent behavior. Social Forces S4,W 351.

Haskell M. (IV73I From Reverence to Rape: The Treatment otWamen in ihe Movies. Coward. McCann. and Geoghegan.New York.

Henderson L,& Greenberg B.S. (19K0) Li/con Television. /MenPress, Norwood, New Jersey.

Himmelweit H.T. & Bell N. (1980) Television as a sphere ofinfluence on the child's learning about sexuality. In Child-hood Se.xual U'arning: The Ihwritten Curriculum (RobertsE.J. ed.). Ballinger. Cambridge. Massachusetts.

Huesmann L.R.. Eron L.D . Klein R , Bne« P & Fischer P(I98U Sfitigattng the Imitalion of Aggressive Behavior.(Teehnical Rept>rt ) r>epariment of Psychology. Universityof Illinois. Urbuna. Illinois.

Jetl'ries-Fox S. & Signorielli N. (1978) Television and children's

conceptions of oceupalions. Paper presented ai the AirlicHouse Telecommunications Conference, Warren town,Virginia.

Johnson F.. Davis L. & McNamee S (1978) Familial relation-ships. lopiL-s. and conversalion styles in family interjctionson television in the USA. Unpublished report. Universiiy ofMassachusetts. Amherst, Massachuseils.

Kalisch P. & Kalisch B. ll9Hl)The imageofpsychiatric nurses inmotion piclures. Pi-rspi\tive in Psychiatric Care 19,116-139.

Kalisch P & Kalisch B. (19«2) The ntirse-deteciive in Americanfilm. Surging und Health Care i, 146-153.

Kalisch P & Kahsch B. (1981) An analysis of ihc- impact ofauthorship on ihc image of ihe nurse presented in novels.Research in Nursing and Health 6. 17 24.

Kalisch P., Kalisch B & Clinton J (1982) World of nursing onpnme lime television, I95O-1980. Nursing Research 21,35K 363.

Kahsch B., Kalisch P. & McHugh M (t9H0) Conleni ;inalysis ofdim stereotypes of nurses, international Jutirnal of H'omen'sStudie>ii,5}\ 55H.

Kalisch B.. Kulisch P. & MeHugh M. (1982) The nurse as a sexobjeet in motion pictures. 1930 1980. Re.iearch in Nursingandl/ealthi. 147-154.

Kalisch B . Kalisch P & Scobey M. (1981) Reflections on a lele-vision image: the nurses. 1962-1965. Nursinn ami HealthCV(r.-2,248 255.

Kahsch P.. Kalisch B. & Scobey M. (1983) Images ot Nurses onTcli-\i.\ion. Springer. New York.

Kaufman L. (1980) Pnme-time nutrition. Journal of Communi-cation 3. 37 46.

Kmg D.L. (1979) Conditioning.- .•in image Approaeh. Halsted,New York.

Kubey R W (I9K0) Television and ageing: pasi, present, andfuture. Gerontoltigist 20, 16 35.

Lemon J |1'>77| Women and blacks on prime-lime television.Journal til C 'oiiimunication 27, 70 74.

Long M. & Smion R. (1974) The roles and sluluses of womenand children on family TV programs. Journalism Quarterly51, 107 110.

I.oye D.. Gorney R & Steele G (1977) Effects of television: anexperimenial study. Journat ot Communication 11. 206-216.

MappC (1970) Theporlraval ofthe Negro in American motionpictures. 1962 1968. Doctoral dissertation, New YorkUniversity. Dissertation Abstracts International 31,I929A .'O9:A.

Mc( arthy H D . Langner T.S-. CJersten J.C. Eisenberg J.G. &Or7eck L (1975) Violence and behavior disorders. Journalof Communication 25. 71 85.

McLaughhn J. 11975a) Characteristics and symbolic functions oftictional televised medical professional and their effect onchildren. Unpublished master's ihesis. Annenberg School ofCommunicylions. University ol'Pennsylvania.

McLuughlin J. (1975b) The doctor shows. Jnurnal of Communi-cations If,. \V,l-\U.

Meyer T. (1976) Impacl of All in ihe Family' on children.Journal fI Hroadca.\tinglQ,l'S 33.

Milavsky J.. Pekowsky B. & Stipp H. (1975) TV drug advertisingand proprietary and illicit drug use among teenage boys.Public Opinion Qtuirlerlv 39.457 -481.

Miller M & Reeves B (1976) Dramatic TV content and chil-dren's sen-role stereotypes. Journat of Broadcasting 20,35-50.

Moschis G. & thurchill (5. (1978) Consumer socialization: aiheorelical and empirical analysis. Journal ol Marketing 15,599 609.

Muliak S.A (1972) The Foundations of Factor Anaiysis.McGraw-Hill. New York.

Nichols J M (1977) images. Perception and Knowledge. Kluwcr.Boston

Norris C.B. (1970) The image of ihe physician in modem

.\ur.^e ciiaraclcr.s in ihc media 195

American Literature. Di>cloral disserlalion. University ofMiiryland. Dissertation .4h^triict^ hiicrnaiionid M. ^A.

Northcoil If. Seggar J. & Hinton J. (1975) Trends in TVporirayal of hlacks and women. Journalism Quarterly 52.741 744.

Nunn^lly J. (1978) Psychometric Tluorv (2nd edn). McGraw-Hill. New York.

Peter J. (1979) Reliability: a review of psyehomeirie basics andpercenl marketing practices. Journal of Marketing Re\carch16. h 17.

I'L'lersiiii M.( 1973) The visibility and itnagcofold people on tele-vision. Jiuirmilism Quarterly 50. 569 575.

Petin A. |I4HI)) tnia^cs ot itie Me.xican American in Fiction andFilm Te'iiis .A & M I niversiiy Press. College Slation. Texas.

Robertson T . Rossiter J & GleaM)n T (1979) Children's recep-li\il\ lo propnelarv medicine advertising. Journal ot Con-sumer Rc.warchf,. 141 :55.

Rosen M. (1973) Fopiorn i'eniis. Homen, Movie.\ anil the.•imeritan Dream. Coward, McCann and Geoghegan. NewYork.

Rushion J.P. & Ov •en D. (19751 Immediate and delayed elfects ofTV modelling and preaching on children's generosity.Brimti Journal ol Soiial and Clinical i'yvitu'loiiv 14.3(W 310.

Seggar J. (1975) Imagery of women in lelevision drama. Journalol Broadcasting 19. 273 2N2.

Si'ngar J. & Wheeler P. (l'>7.') World of work on TV: ethnic andsex representation m TV drama. Journal of Broadca.sting 17.201 214.

Shinur 1) & Biber A. (1978) Images of aging among specificgroups: ihe theatre as a research framework Paperpresented al ihe meeting ofthe lnternalion.il GerontologiculSociety. Jerusalem. 1978.

Shorr J.. Sobe! B.. Robin P & Coppella J. (1980) Imagery, itsMany Dimen.siims and .AppUiations. Plenum. New N'ork.

Silvcrman L.T . Sprafkin J.N. & Rubinstein L.A (19791 Physicalcontact atid se.vual behavior on prime-time TV. Juurnal ofComniunuation 29. 33 43

Silvetler H. (19(i7) The Doctor <tii Stage. University of TennesseePress, Knos^ille.

Singer J L & Singer D.G. (1980) TelevLsion. imaginationand .Aggression A Study of Pre.tehoolers' Piay. Eribaum.Hillsdalc. New Jersey.

Spralltin J.M.. Lieberg R.M & Poulos R.W. (1975) Efleclsofaprosocial evample on children's helping. Journal of Experi-incnial (. hitd i'.sy, Iwhgy 20. 119 126.

Sloddaril K. 11980) The image of ihe aging woman m Americanpopular film. Doctoral dissertation. Utiiversiiy ofMaryland, 1980. Dis.sertation .Abstracts international 41.:328A 280IA.

Surlin S. (1978) "Roots" research: a summary ortindings. Journalol Broodiiisting 22. 309 320,

Siirlin S. Si. Tate E. (1976) All in the family, is Archie funny?J-nirnal of Communication 26. 61 68.

Thomas M.H. & Drabman R.S. (1975) Toleration of real lifeaggression as a function of exposure lo televised violenceand age ol'subject. Merrill-Palmer Quarterly 21. 227 232.

Tower R.B. Singer DG.,Smger J.L & Biggs A. (1979) Diffcr-enlia! eirect> of television programming on pre-schoolers'cognition, imagination, and social play. American JimrnaiofOrihopnchiatry 4t. 265 2m.

Trautmann J. (1981) tieiding .-Irts in Dialogue. Medicine andi.iicrtiture. Southern Illinois Universiiy Press, Carhondale.Illinois.

Volgy T.J. & Schwartz? J.L! (1980) TV enterlainmeni program-tning and sfK'iopoliiical attitudes. Journalism Qiiartcrh 57.150 155.

Ward S.. Wackman D. & Wariella E. (1977) H,m Children Learnto Btii The development ot Con.sumer inlonnatton Proceis-ing Shitls. Sage, Beverly Hills. California.

White M.A. ASanilberg H. (19K0) The television pnme-liniediet.Paper presented at ihe meeting of the American Psychn-logieal Association. Monlrcal. Canada, 1980.

Williatiis F., LaRose K & I-rosi \^. (19KI) Children. Teleyixionand Sei-Role Sti-reotypin\t. Praegcr. New York.

Williams T.M (1978) Differeniial impact of TV on children: Anatural e.vperimeni in communities wiih and wiihout TV.Paper presented at the meeting cl the Internalional Societyfor Research on Aggression. Washington. DC, I97H.

Worden J. (IV62) The portrayal of ihe protcslaiil minister inAmeriean motion pictures. 1951 I960, anil Us implicationsfor the church loday Doetoral dissertation. BostonLlniversily. 1962. Dissertation Abstracts 23. 1 1 37 1464.

Yales G.( R (1974) Inliuence of leieviscd modeling andvcrhali/alion on children's delay of gratiticalion. Journat ofExpirimentat Child Psychaiogy 18,333-399,