| Description |
The recent trend in the care of psychiatric patients has been away from long-term institutional care to community based, outpatient treatment. When necessary, patients are being admitted to psychiatric units in general hospitals, where the treatment program most likely to be employed is based on theories of brief, crisis-oriented, psychotherapy. There has been a deficit of research designed to measure the effectiveness of psychiatric nursing care planned to assist patients who remain in the hospital for 12 days or less. The purpose of this study was to determine if a psychiatric nursing approach planned around brief but frequent contacts would significantly influence patients' social adjustment as compared with a control group of patients. Ten patients, matched according to sex, diagnosis and age were divided into a control and experimental group. The experimental group was visited by a psychiatric nurse 15 minutes twice a day for ten consecutive visits. The content of the visits was directed toward current personal concerns of the patients and their adjustment to the ward. No attempt was made to foster insight. Patients in the control group were likewise contacted twice a day for ten visits; however, the content and length of contact was different. Contacts were limited to two to five minutes; they were brief and friendly but not designed to be therapeutic. Several studies have indicated that social adjustment can be used as a measure of patient progress in psychotherapy. Therefore, a 16-item semantic differential rating scale (PSRS), and a 5-item patient self rating scale (SRS) were devised to measure changes in patients' social adjustment. Seven Registered Nurses and the investigator evaluated patients on the second and later on the seventh hospital day following final contact by the investigator. Patients rated themselves at these same time intervals. Three hypotheses were made and none was supported. There was no evidence to support the hypothesis that the experimental group would show significant improvement in socialization from the first to the second rating. The analysis of variance of mean difference scores incorporating groups and adjectives indicated a significantly higher score for the control than for the experimental group. This failed to support the second hypothesis that the experimental group would exhibit greater improvement in socialization than the control group. Although not significant, there was also a tendency for the control group to improve more than the experimental in patient self rating scores. As stated by the third hypothesis, patients in the experimental group did not rate themselves as significantly more improved than the control group. There were numerous variables that confounded these results, such as sampling method, matching of patients, reliability of the rating scales and difficulty in holding variables of the nursing approach consistent between the two groups. Other problems in the design of the study were identified. There may have been desirable results of the brief nursing intervention which the scales designed for the study did not measure. Reactions to termination empirically suggested that the investigator did establish meaningful relationships with the experimental patients. Additional research is needed to establish valid and reliable methods of measuring the outcome of nursing intervention. |
