Peggy Moloney, RN, PhD

ew people in American society are perceived as being less powerful and less worthy of attention than women over age 65, who are often defined - and dismissed - according to what they can no longer do: bear children, earn as much money as younger women or men of any age, compete as successfully in the sexual arena. But the cultural assumption that all older women are weak is not universally held by the subjects themselves, Assistant Professor of Nursing Margaret (Peggy) Moloney has found. The ability of some older women to define themselves as strong, in the face of a cultural bias to the contrary, can have a profound, positive impact on their health and, ultimately, on their health care providers. "To understand strength from a woman's perspective can change the way nurses view themselves and their female clients," Moloney wrote in a 1995 IMAGE article about the self-perception of strength among older women. "Understanding the possibility that an older woman perceives herself as strong, instead of assuming that she sees herself as weak, changes the ways in which nurses assist others. Helping women verbalize their strength may help them visualize themselves as strong in a way that potentiates health."

his realization came early to Moloney, during her days as a public health nurse (and nurse practitioner, eventually) in inner-city St. Louis in the mid 1970s. Sent to one of the poorest and most drug-ridden parts of the city, she found octogenarian women who parked shotguns inside their front doors - and used them - to keep the addicts and dealers away. "Yet these women were happy and enthusiastic, active in their churches," Moloney says. "I was only 25, and I would ask, 'What's your secret?' and they'd tell me. They would fix me in the eye and answer, 'You need to hear this . . . .' " Soliciting stories from these women wasn't part of any formal research method, she says, but came about naturally as a part of caring for patients in whom she was genuinely interested. Nevertheless, what she heard from them has, to a large degree, guided the path of her subsequent research. Her 1993 doctoral dissertation, for example, was based on responses given by women over age 65 to the statement, "Tell me a story, of a time you'll never forget, about being strong." A common element in many of the responses was the concept of home - making a home, leaving home, losing a home, coming home - leading Moloney to a new field of inquiry. "The Meaning of Home in the Stories of Older Women" was published in 1997 in the Western Journal of Nursing Research. The entire corpus of Moloney's research into self-perceptions of strength among older women earned her a Faculty Scientist Award from the School of Nursing in 1998.

hen Peggy Moloney moved to Atlanta in 1987, she got a job in PruCare's HMO while pursuing a PhD in nursing at Georgia State University. Noticing that women clients sought out Moloney for their internal medicine and gynecology needs - as well as for the kind of vague complaints that are often dismissed in the perimenopausal years - the HMO encouraged her focus on "mid-years women's health" and menopause. (Moloney continues to see clients one day a week with the PruCare/Meridian Medical Group.) Moloney's current research, supported by her Faculty Scientist Award, is an extension of that focus and examines a particular perimenopausal health complaint that is sometimes overlooked, the migraine headache. She is presently preparing a pilot study of migraines that looks qualitatively at women's descriptions of their symptoms and quantitatively at diaries of their experiences as well as at laboratory values. She used part of her Faculty Scientist Award in July to attend an institute for nurse researchers that taught the use of certain laboratory techniques she will need to evaluate her data. In the midst of all this activity, she also recently finished a study of mid-years women's perceptions of strength. In the first year of the award, Moloney concentrated on networking with nationally prominent nurse researchers of menopause and reinforcing ties with Emory's own experts, including premenstrual syndrome researcher Dr. Ora Strickland (who is currently collaborating on a nationwide $15-million National Institutes of Health study of women's health), clinician Dr. Marianne Scharbo-DeHaan, and basic scientist Dr. Joyce King. Such connections are valuable in and of themselves, she feels, in that they reinforce a community of health researchers that can, in the big picture, sometimes be marginalized. Just like the older women she has interviewed - a population often considered unworthy of attention, unimportant, unpowerful - Moloney points out that "nurses might also be considered to be in the margins, since most are women and their work is often directed by others. For instance, the work of advanced practice nurses is especially marginal, close to the boundaries of mainstream nursing practice and infringing on the boundaries of medical practice. According to M.C. Bateson, it is in these margins 'where new visions may be born.' It is in these margins that nursing research must continue to explore new visions of practice and new visions of health care." Nurse, teacher, feminist, philosopher . . . Peggy Moloney is dedicated to seeing those margins re-mapped.