Patients' expectations of the functions of psychiatric and medical nurses

The purpose of the study was to determine if stated expectations of psychiatric and medical patients of nurses and nursing functions would be different. A questionnaire containing 70 items which measured patient expectation in two categories, emotional, supportive nursing functions and physical nursing functions was given to 60 psychiatric and 100 medical patients. The results demonstrated that psychiatric patients stated they expected significantly more emotional, supportive nursing functions than medical patients who stated they expected more physical nursing functions. The level of expectations of psychiatric and medical patients on specific emotional, supportive nursing functions and on specific physical nursing functions was also obtained. The mean and S. D. was computed for each item for the two groups of patients on the 70 items. Psychiatric and medical patients indicated a high level of expectancy on 15 items, 2 items were seldom expected 16 items demonstrated a similar level of expectation. Patients did not expect the nurse to shave them or care for their fingernails. All patients expected the nurse to treat them with self respect, to have an accepting attitude, and to establish satisfying communication. A correlation was run on the test scores of psychiatric and medical patients and on the number of admissions. The correlation obtained for psychiatric patients was not significant. The correlation coefficient for medical patients was - .26 (p = .5) which indicated that as the number of admission increased, medical patients expected more emotional, supportive nursing care functions. Psychiatric patients who had had more previous hospitalizations indicated that they had heard of the psychiatric nurse and felt they knew more of what she was supposed to do than first admission patients. Medical patients appeared to have more definite ideas about nurses and their functions than psychiatric patients.

PATIENTS' EXPECTATIONS OF THE FUNCTIONS OF PSYCHIATRIC AND MEDICAL NURSES by Ruth Donaldson Brown A thesis submitted to the faculty of the University of Utah in partial fulfillment of the requirements for the degree of Master of Science College of Nursing University of Utah June 10, 1966 This Thesis for the Master of Science Degree by Ruth Donaldson Brown has been approved May 12, 1966 Ch<firman, Supervisciiy Committee / /-<;/( (I'."'{ . <cri i;~ ~cL~ - Reader, Supervisory Committee J ACKNOWLEDGMENTS Sincere appreciation is expressed to the investigator's supervisory committee for their valuable assistance and encour­agement. Special thanks are given to Mrs. Bonnie Clayton, hospital personnel, and Miss Catharina Koldewyn. Deepest gratitude is expressed to my husband and children for their patience and support. TABLE OF CONTENTS LIST OF TABLES. iii CHAPTER PAGE INTRODUCTION. II METHOD •.•.. 6 III RESULTS AND DISCUSSION 13 IV SUMMARY •.•....• 29 REFERENCES 31 APPENDIX. 34 LIST OF TABLES Table PAGE 1. DIAGNOSIS AND SEX OF PSYCHIATRIC PAT I ENTS. • • 11 2. DIAGNOSIS AND SEX OF MEDICAL PATIENTS . . 12 3. MEANS AND STANDARD DEVIATIONS OF PSYCHIATRIC AND MEDICAL PATIENTS' EXPECTATIONS OF NURSING FUNCTIONS •.....••.....•....•• 14 4. MEAN SCORES AND STANDARD DEVIATIONS OF ITEMS FOR PSYCHIATRIC AND MEDICAL PATIENTS .•. 16 5. CHI-SQUARE ANALYSIS OF THE RELATIONSHIP BETWEEN THE NUMBER OF PSYCHIATRIC ADMISSIONS AND PATIENTS HAVING HEARD OF A PSYCHIATRIC NURSE • . . . . . . . . . . . . • . . . . . 23 6. CHI-SQUARE ANALYSIS OF THE RELATIONSHIP BETWEEN THE NUMBER OF PSYCHIATRIC ADMISSIONS AND WHAT A PATIENT FEELS HE KNOWS ABOUT WHAT A PSYCHIATRIC NURSE IS SUPPOSED TO DO ..... 25 'iv LIST OF TABLES -- Continued Table PAGE 7. CHI-SQUARE ANALYSIS OF THE RELATIONSHIP BETWEEN PSYCHIATRIC AND MEDICAL PATIENT RESPONSES TO PATIENTS HAVING HEARD OF A PSYCHIATRIC (OR MEDICAL) NURSE ...... 26 8. CHI-SQUARE ANALYSIS OF THE RELATIONSHIP BETWEEN PSYCHIATRIC AND MEDICAL PATIENT RESPONSES TO WHAT THE PATI ENT FEELS HE KNOWS ABOUT WHAT A PSYCHIATRIC (OR MEDICAL) NURSE IS SUPPOSED TO DO •.. . . . . 27 CHAPTER I INTRODUCTION In nursing there is an increased effort to develop sc i entific theori es to improve nursing care given to patients. Some of these efforts have taken the direction of identifying the needs, attitudes, and expectations of patients. The importance of attitudes, needs, and expectations of patients in the treatment process is well known clinically and has been demonstrated in a number of studies (Gliedman, 1958, Shapiro, 1959, Volgyesi, 1954). Whiting (1958) concluded from his research that when patient expectations are met, there is greater acceptance of therapy and improvement of the relationsh ip between nurses and patients. Small, Messina, Small (1964) found that in either physical or emotional illnesses the expectations of patients may influence the course and outcome of treatment in a therapeutic or non-therapeutic way whether the approach was medical, surgical or psychological. Generally, patients coming to the hospital have certain expectations for as Paulsen (1962, p. 58) writes, HEven though the patient comes to the hospital without previous experience as a patient, he comes with pre-conceptions about hospital nursing care. These ideas may be expressed in what he says he expects of nurses. 11 Although patients have expectations of nurses, many times these expectations are not communicated adequately. Therefore, one of the 2 problems in nursing is to recognize what patients consciously expect of nursing care. The investigator believed that all patients have similar basic needs of nurses and nursing functions. It was also bel ieved that stated expectations are influenced by cultural, physiological, and psychological factors. However, it was assumed that psychiatric and medical patients may place more or less emphasis on different types of nursing functions because of their presenting needs. A prem ise of the study was that the presenting needs of the patient would determine stated expectations of nurses and nursing care. The purpose of this study was to determine if stated expectations of psychiatric and medical patients would be different. A number of surveys have been made which indicate different types of patient's needs, attitudes and expectations as it relates to a specific type of patient group. Ditcher (1954) found the main feel ing of medical patients is fear. The pati ent feels I ike a hel pi ess ch iI d and has a strong des i re for secur­ity. The patient's experiences and expectations determines his conception of the hospital as being a "house of dreadll or a IIwelcome home. II The greatest need in hospital care, as perceived by these patients, was to receive security through friendly, warm interpersonal relationships with significant people in the environment. Elms and Diers (1963) found that 30 gynecological patients expected the nurse to be interested not only in why they had come to the hospital, but also in how they felt about coming. They wanted the nurse to be friendly, 3 business like and concerned about them as an individual. Tagliacozzo (1963) studied responses of 86 medical patients regarding their expectations of nurses. He found 81% of the respondents stressed the importance of personal ized care, 81°A, stressed the nurse's personal ity attributes, 45% stressed prompt and efficient service, 29% mentioned knowledge and skill. One of the larger studies of patient expectations and evaluation of nurses and nursing care was done by Abdellah and Levine (1957). The major purpose of the study was to discover elements of nursing care which patients, doctors, nurses, and auxil iary personnel considered unsatisfactory. A further purpose was to point out remedial action which could be taken by the hospital and nursing staff. Sixty hospitals were included with 8,660 patients filling in questionnaires concerning their care. Negative responses were given by less than 1% of the respondents. These negative responses were centered around patient's rest and relaxation, receiving cold food, and qual ity and quantity of contact with the nurse. More specifically the first ten most common complaint areas were: (1) Too much noise in the hall; (2) Noise made by other people; (3) Food cold when served; (4) Delayed or no answer to call light; (5) Being awakened too earl y for temperature taking; (6) Poor venti lation; (7) Nurse always in a hurry; (8) Thermometer left in too long; (9) No checks on I V fluids; (10) Bath, meal, rest periods interrupted for treatment. Pearce (1961) surveyed the opinions of 796 psychiatric and neurological patients. Eight questions were asked: (1) How have the nurses been helpful to you; (2) How have the nursing assistants been helpful to you; (3) Who helped you get acquainted when you came to the ward; (4) What th ings do you think nursing assistants can do for the benefit of the patient; (5) What changes in 4 ward practices would you suggest; (6) What things do you think nurses could do for the benefit of the patient; (7) What suggestions can you offer that will hel p us improve the nursing care we are giving at this hospital; (8) Additional remarks. The results showed that patients emphasized wanting emotional support. Patients also valued physical care as well as specific medications and treatm~nts. Robison (1960) administered Whiting's Q-sort to 12 psychiatric patients on a psychiatric unit in a general hospital. She found that patients valued supportive, emotional nursing care first, then physical nursing care second. Butler and Levingston (1963) explored 29 psychiatric patients perception of the functions of the psychiatric nurse. A 60 item psychiatric nurse Q-sort which patients responded to indicated patients I isted physical nursing care first; education by nurses second; I iaison duties third; and meeting their emotional needs fourth. The patients viewing physical care as being most important may well be a refl ection of the pati ent's rejection of h is need for emotiona I support. Nurses and related disciplines saw the nurse as some one who met the patient's emotiona I needs. While these surveys demonstrated areas of similarity in expectations, there was not a study which compared the stated expectations of psychiatric and medical patients. Psychiatric patients predominantly have increased emotional needs. Fromm - Reichman (1950, p. 12) said, liThe main problems of persons with mental illness are due to emotional difficulties in living. The patient's emotional needs have not been fulfilled." Whiting (1955, p. 72) also states, liThe psychiatric patient's basic emotional conflict, which is manifested in h is ill ness, would infl uence h is expectations of nurses and nursi ng functions. Satisfaction of emoHonal needs is an important function of the nurse. 11 Medical patients have increased physical needs as presenting expec­tations. Schafer (1961) emphasizes nursing care of medical patients as being dependent upon the physiological and anatomic changes that have taken place in the patient and the disease from which the patient is suffering. 5 For the purpose of this study a questionnaire was developed that attempted to test patient expectations in two areas of nursing care functions, (1) emotional, supportive nursing care functions, (2) physical nursing care functions. Expectations referred to that which patients considered important and that which they expected the nurse to do. In this investigation a nursing care function was any function which was performed directly for and in behalf of the patient, and which contributed to his well being and feeling of comfort and security. Supportive, emotional nursing care functions were those func­tions performed by the nurse that offered support to the individual by meeting his psychological needs. Physical nursing care functions were those functions directed toward meeting the physical and biological needs of patients. CHAPTER II METHOD Development of Questionnaire A questionnaire was developed from a review of the scales formulated by Whiting (1958), Abdellah (1957) and Ouzounian (1962) and from responses of severa I nurses with preparation at the master's degree level. Whiting's (1958) Q-sort scale consisted of 100 behavioral statements indicating specific functions nurses should perform for patients. The state­ments were arranged in five divisions, phys ical care, emo1"ional care, I ia ison, education, and authority. Abdellah's (1957) scale consisted of two check lists. One check list Was a 52 item questionnaire which patients checked. It con­sisted of seven categori es: (1) Events indicating satisfaction with care; (2) Rest and relaxation; (3) Dietary needs; (4) Personal hygiene; (5) Personal hygiene and supportive physical care; (6) Reaction to therapy; (7) Contact with nurse. The other check list consisted of 50 items which personnel checked. It consisted of nine categories: (1) Administering therapy to patients; (2) Carrying out work assignments; (3) Providing needed physical supportive care to patients; (4) Contacting patient's families and friends; (5) Providing needed help and equipment for elimination; (6) Providing for needed comfort and safety; (7) Meeting the patient's aesthetic needs; (8) Providing an atmosphere for rest and relaxation; (9) Providing nourishment for the patient. Ouzounian1s (1962) scale consisted of 51 statements whi ch sought the psychiatric patient's opinion of the type of nursing care he would prefer if he were given a choice in the matter. The statements included both physical care and emotional care nursing functions. Patients responded to the state­ments by answering "yes" or "no". A survey of the literature did not reveal tools for measuring emotional components of nursing care functions to use in this investigation. 7 Therefore, to obtain meaningful, emotional, supportive nursing care functions wh ich might be discriminative between psych iatric and medi cal patients, several psychiatric nurses were approached and informally asked to answer three questions: 1. What are the areas of emotional and physical nursing care that are important in working with psychiatric patients? 2. What specific nu~ing functions do you perform for psychiatric patients as compared to medical patients? 3. What additional expectations do you feel patients have on medical and psychiatric wards? One of the psychiatri c nurses revi ewed 120 items and indicated those wh ich she felt were useful and appropriate for the questionnai re. A pi lot study was done to test the clarity of ,the developed question­naire. Twelve patients hospitalized on a mixed psychiatric and medical surgical convalescent ward participated. Two items were dropped from the questionnaire because patients inquired about their meaning. From the responses of the psychiatric nurses, from selected ideas from the scales of Whiting, Abdellah, and Ouzounian, from the investigator1s knowledge and results of the pilot study, 70 items were selected for the final form questionnai re. The final form conta ined 35 items of supportive, emo­tional nursing functions and 35 items of physical nursing functions. 8 In this context a nursing care function was any function which was performed directly for or in behalf of the patient, and which contributed to his well being and feel ing of comfort and security. Supportive emotional care included functions performed by the nurse that offered support to the individual by meeting his psychological needs. Statements such as: liThe nurse should take time to listen when the patient desires to talk." or liThe nurse should stay with the patient who becomes afraid. II represented emotional, supportive care. Physical care included nursing functions directed toward meeting the physical needs of the patient. Statements such as: liThe nurse should keep the patient in clean clothes. 11 or liThe nurse should see that the patient does not go too long without a bowel movement. 11 represented physical care. The scale was entitled, 11 Patients"s Expectations of Nursing Functions. 11 A complete copy of the questionnaire is in Appendix A. The items were arranged with a five point scale to the right of each item on which the patient indicated his expectation ranging from definitely expect, expect, not sure, don't expect, definitely don't expect. At the end of the questionnaire three questions were asked. The word psychiatric was used for the psychiatric patient; the word medical was used for the medical patient. The inquiries were: 9 1. "Have you been hospitalized as a psychiatric (medical) patient before? II- --------II Number of admissions II- -----• II This question was asked to determine if there was a relationship between the number of admis-sions and the patient's expectations of the nursing functions. 2. "Have you heard of a psychiatric nurse?" ----• Th is ques-tion was asked to determine if there was a relationship between the number of admissions and the pati ent having heard of a psychiatric nurse. Patients who had been hospitalized would probably have heard of psychiatric nurses. 3. 1100 you feel you know what a psychiatric nurse is supposed to do?1I This question was asked to determine if there was a relationship between the number of admissions and what patients felt they knew about what a psychiatric nurse was supposed to do. Repeated hospital ization may increase patient's awareness of psychiatric nursing functions. This may influence the patient's expectations. The questionnaire was taken individually by patients between their second and fifth hospital day. The patients were told by the investigator that research was be ing conducted to find pati ent expectations of nurses and nursing functions so that patient needs could be more completely met. Patients were told that their names would be kept confidential. The following directions were read to the patient as the questionnaire was handed to him: This study is being conducted to determ i ne patient's expectations of nurses. This is an investigation to determine what patients consider important so that their care may be improved. Please read each statement carefully and check the square which best represents your response. This questionnaire is not a test and there are no right or wrong answers. Your answers will be held in confidence and the information treated as research data. Description of the Sampl e 10 The Patient's Expectations of Nursing Scale was given to 60 psychiatric patients and 100 medical patients. Those selected for the investigation were admitted to the Psychiatric and Medical Service of the Thomas D. Dee Memorial Hospital duri ng October, November, December, 1965. The head nurse on each division el iminated patients that were critically ill, isolated, senile, acutely disturbed, or disoriented. The Dee Hospital is a 275 bed, private, general hospital, owned and operated by the Church of Jesus Christ of Latter Day Saints. There are 30 beds in the psychiatric unit and 37 beds in the medical unit. Table 1 describes the psychiatric patients by diagnostic category and sex. The age range was from 16 years to 59 years. From the 100 medical patients who had completed the questionnaire a random sample of 60 were drawn. Table 2 describes the medical patients by diagnostic category and sex. The age range was from 14 years to 77 years. TABLE 1 DIAGNOSIS AND SEX OF PSYCHIATRIC PATIENTS DIAGNOSIS Mlle Female Total Schizophrenia (all classifications) 5 15 '20 Depression 6 7 13 Attempted Suicide 1 6 7 Alcoholic 4 1 5 Involutional Psychosis 3 3 Sociopath 2 1 3 Anxiety Reaction 1 1 2 Obsessive Compulsive 1 1 Inadequate Personal ity 1 1 Sex Deviate 1 Homosexual 1 Organic Brain Damage 1 Psychosomatic Disorder 1 Post-partum Psychosis TOTAL 23 37 60 TABLE 2 DIAGNOSIS AND SEX OF MEDICAL PATIENTS DIAGNOSIS Male Female Total Cardiac and ateriosclerotic conditions 15 9 24 (All classifications) Diabetes 2 3 5 Pneumonia, U. R. 4 3 7 Peptic Ulcer 4 2 6 Asthma 1 3 4 Lupus Erythematosis 2 2 Arthritis 1 1 2 Cancer 2 2 Gastro-enteritis 1 Headaches 1 1 Skin Infection 2 2 Arterial Embolus 1 1 Kidney Conditions 2 2 Phlebitis 1 1 TOTALS 36 24 60 CHAPTER III RESULTS AND DISCUSSION The data were analyzed to determine if stated expectations of psychia­tric and medical patients woul d be different. In order to get an expectations score, the five possible degrees of expectation were weighted from one to five: "definitely don't expect II • 1, "don't expectll - 2, IInot sure ll - 3, "expect" _ 4, "definitely expect" = 5. The total expectation score for each individual was his score on the physical care items minus his score on the emotional care items. Thus a high positive score represented a higher I evel of expectation of physi cal care nursing func­tions. A low score represented a higher I evel of expectation of emotional supportive items. Tabl e 3 reports the means and standard deviations for the psychiatric and medical patients. A!. test was done to determine if there Was a signifi­cant difference between the mean obtained on psychiatric patients and the mean obtained on medical patients. A!. of 8.66 (p = .001) indicated that psychiatric patients significantly stated they expected more emotional, supportive nursing care than medical patients who stated they expected more physical nursing care. In evaluating these findings it should be remembered that stated TABLE 3 MEANS AND STANDARD DEVIATIONS OF PSYCHIATRIC AND MEDICAL PATIENTS' EXPECTATIONS OF NURSING FUNCTIONS Patients Mean Psychiatric -28.27 Medical -11.63 Standard Deviation 32.24 14.28 15 expectations do not necessari Iy denote all the needs and expectations of patients. Frequently the newly admitted psychiatric or medical patient is suffering from an acute psychological or medical problem. It is reasonable to assume that the needs and resultant expectations of the patients will arise from the presenting problem and need. A medical patient suffering from a bleeding peptic ulcer will first expect to receive physical nursing care to alleviate his condition. Another important factor to consider in determining patient expec­tations is that the only time the medical patient sees a nurse may be when there is a need for physical nursing care. Although somewhat subtly disguised, the patient may seek psychological need fulfillment through physical nursing care. Item Analysis The 70 items were analyzed to show the mean level of expectation and the dispersion about the mean for each item. The mean and standard deviation were computed for psychiatric and medical patients. These are reported in Table 4. Those means having higher values indicate a higher level of expec­tation and those means having a lower value indicate a lower level of expec­tation. Both groups of patients indicated a higher level of expectation on the following items: 9, 16, 19, 37, 39, 42, 44, 47, 56, 62, 63, 64, 65, 66, and 69. All had means above 4. Seven of these 15 items were physical care nurs­ing functions; eight were emotional care items. Four of the physical care items involved the administration and effects of medications, two involved the patient's safety, and one invol ved treatment for the patient. Nursing functions TABLE 4 MEAN SCORES AND STANDARD DEVIATIONS OF ITEMS FOR PSYCHIATRIC AND MEDICAL PATIENTS Psychiatric Medical Patients Patients ITEMS Mean S. D. Mean S.D. 1. The nurse should keep the patient in clean clothes 2.85 1.56 4.42 1. 14 2. The nurse shoul d see the pati ent does not go too long without a bowel movement. 3.28 1.46 4.40 .59 3. The nurse should see that the patient is receiving adequate nourishment. 3.47 1.55 4.26 .82 4. The nurse should help patient ex-press any fears about his i 1\ ness. 3.97 1. 12 3.05 1.27 5. The nurse should leave patient alone if he tells her he doesn't want her help. 2.82 1.37 2.65 1 . 16 6. The nurse should address patient by using his nome. 4.12 1 . 19 3.91 1.44 7. The nurse should decide who takes patient's belongings home. 2.32 1.28 2.58 1.28 8. The nurse should adjust some of the hospital routines to meet the individual needs of the patient. 3.52 1 .31 3.48 1.20 9. The nurse should watch patient for any toxic signs following the admin istration of medication. 4.37 1.02 4.50 .73 10. The nurse should help the angry patient express his feelings. 3.75 1.06 2.68 1.42 '1.1 .. The nurse should stay with patient who becomes afraid 3.92 1. 21 3. 18 1.31 17 TABLE 4 -- (Continued) Psych iatri c Medical Patients Patients ITEMS Mean S. D. Mean S.D 12. The nurse should take time to listen when patient desires to talk 4.25 .88 3.25 1.32 1.3 •. The nurse should shave patient. 1.78 1.34 2.08 1. 17 14. The nurse should decide what cloth-ing the patient will wear. 1.75 .95 3.20 1. 17 15. The nurse should see that patient does not become too ti red. 3.25 1.42 4.06 . 9 16. The nurse should be aware of and consider a patient's emotional condition as much as his physical condition. 4.75 .94 4. 11 .73 17. The nurse should avoid being over-cheerful when a patient is depressed 3.62 1. 15 2.76 1 . 15 18. The nurse should help patient be-come acquainted with other patients 4.03 1. 10 3.33 1. 14 19. The nurse should safeguard patient by using safe, proper equipment. 4.40 1. 01 4.55 .57 20. The nurse should stay with patient until he has taken his medication. 3.62 1.53 4.36 .86 21. The nurse should put patient's val- 3.75 1.35 3.95 1.05 uables in a safe place. 22. The nurse should put her arm around patient when comforting him. 2.37 1. 10 2.15 1.04 23. The nurse should refuse to take care of a patient that tells her she is incompetent. 2.03 .99 2.41 1.08 24. The nurse should involve patient's family in planning for his care. 3.22 1 .29 2.55 1.64 25. The nurse should protect patient from extremes of heat or cold. 3.62 1.25 4.36 .76 26. The nurse should decide what food patient may have. 2. 13 1.22 2.45 1.22 27. The nurse should decide when patient should go to bed. 2.56 1.30 3.31 1.22 28. The nurse shoul d tal k to pati ent when he is lonel y . 3.85 1 . 19 3.05 1. 18 18 TABLE 4 -- (Conti nued) Psychiatric Medical Patients Patients ITEMS Mean s. D. Mean s. D. 29. The nurse should be concerned that patient is worried about home affai rs. 3.62 1. 18 2.85 1.09 30. The nurse should continue being friendly when pati ent feels worth-less. 4.22 .95 3.95 .77 31. The nurse should keep a record of the patient's fluid intake. 3. 15 1.26 3.90 .85 32. The nurse should see that patient has adequate mouth care. 2.73 1.38 3.80 1.04 33. The nurse should keep the patient's ha i r combed. 1.90 1. 17 2.33 1.20 34. The nurse should recognize the im-portance of patient's family in his treatment. 3.88 1.08 3.21 1.40 35. The nurse should allay the fears of patient who is upset over changes in his treatment procedure. 4.20 .45 3.78 .94 36. The nurse should I isten to patient when he complains about environ-mental disturbances. 3.97 1.07 3.57 1. 18 37. The nurse should safeguard patient from injury. 4.45 .56 4.45 . 6 38. The nurse should check the patient frequentl y at night. 3.00 1.76 4.10 .93 39. The nurse should give prescribed medications when patient is Llnabl e to sleep. 4.37 .64 4.21 .92 40. The nurse should talk to patient about his hobbies. 3.30 1. 11 2.25 1.22 41. The nurse should orient a new patient carefully to the ways of the hospital. 4.27 .77 3.77 1. 14 42. The nurse shoul d I isten wi th respect to patient. 4.37 . 8 4.18 .72 43. The nurse should teach pati ent ade-quate health habits to prevent a recurrence of his illness. 3.38 1.30 3.55 1 . 11 19 TABLE 4 -- (Continued) Psych ;atri c Medical Patients Patients ITEMS Mean S.D. Mean S.D. 44. The nurse should explain to patient I the need for unpl easant or pa infu I treatments. 4.02 .88 4.00 1.41 45. The nurse should be responsible to see that patient's skin is kept in good condition. 2.87 1.41 3.78 1.08 46. The nurse should continue to make contact with patient who is depressed 3.98 1.00 3.35 1.27 47. The nurse should introduce herself to the new pati ent. 4.43 .83 4.07 .86 48. The nurse should stay with a patient when he becomes anxious 3.90 1. 14 3.02 1.28 49. The nurse should keep patient's clothes in neat order. 1. 98 1 . 17 2.87 1.24 50. The nurse should keep patient's room clean. 1.87 1.08 2.60 1.41 5l. The nurse should allow patient to function physically as much as he desi res. 3.00 1 .32 2.65 1.34 52. The nurse should help patient to see his behavior that interferes with his relationship with others. 3.92 .85 3. 13 1.26 53. The nurse should move patients away from each other if they irritate one another. 4. 17 .71 3.40 1.28 54. The nurse should join a group of patients who have become argumen-tive and attempt to resolve the d i ffi cui ties. 3.65 1.01 2.57 1.24 55. The nurse should plan patient's physi-cal activities. 2.47 1.30 2.75 1. 19 56. The nurse should check patient's intravenous feedings closely. 4.08 1.25 4.47 .70 57. The nurse should draw the water when a patient is allowed a tub bath. 2.40 1.08 3.25 1.27 58. The nurse should make a point of be-coming acquainted with patient's family. 3.02 1.26 2.37 1. 17 20 TABLE 4 -- (Continued) Psych iatri c Medical Patients Patients ITEMS Mean S. D. Mean S. D. 59. The nurse should be aware if a patient is becoming increasingly anxious. 4.30 .72 3.53 1 • 10 60. The nurse should try to spend extra time with patient who is lonely. 3.70 1.28 2.58 1.22 61. The nurse should care for patient's fingernails. 1. 80 .97 1.95 1.10 62. The nurse should see that patient's treatment is not interrupted. 4. 15 .95 4.23 .54 63. The nurse should explain to patient how to take his medications at home. 4.03 1.14 4.03 .95 64. The nurse should do all she can to help patient feel self respect. 4.45 .42 4.07 .92 65. The nurse should have an accepting attitude with patient. 4.40 .81 4.65 .77 66. The nurse should do all she can to help patient feel she is interested in him as an individual. 4.40 .92 4.25 .76 67. The nurse should give an explanation to patient about diagnostic tests he has been given. 3.08 1.24 2.73 1.29 68. The nurse should see that pa1"ient's bed is made comfortable for him 3.23 1.51 4.42 .58 69. The nurse should do all she can to help establ ish satisfying communi cation between patient and herself. 4.35 .82 4.32 .65 70. The nurse should give patient direc-tions when he loses control. 4. 17 .93 3.83 1. 17 involving medication administration were important to patients. A sampling of the eight emotional nursing functions were statements such as: liThe nurse should do all she can to hel p the patient feel self respect, II or liThe nurse should have an accepting attitude with the patient. II or liThe nurse should listen wi'th respect to the patient. II Nursing functions which concerned patient's self esteem and respect were highly expected. This was consistent with Maslow's (1948) heirarchy of needs. The need for sel f respect and self esteem bei ng I isted as one of five bas ic human needs. On items 13 and 61 both groups of patients indicated a low level of expectation. Pati ents did not expect the nurse to shave them or care for the i r fi ngerna iI s. Responses for psychiatric and medical patients were within a range 21 of .20 in either direction of the mean on items 5, 6, 7, 8, 9, 19, 21, 37, 39, 42, 43, 44, 61, 62, 65, and 69. This indicated similar level of expectation. Whi Ie the item evaluation is rich information for nursing personnel the instrument to measure patient's expectations may not have been diverse enough. There may have been too much emphasis on some areas of nursing functions and not enough emphasis in other areas. For example, four of the 70 items concerned medication administration and three involved clothing. The scale was I imited to 70 nursing functions. Nurses perform more nursing functions than were measured. If the expectations of psychiatric and medical patients are inspected without reference to the type of nursing item, both patients expect approxi- 22 mately the same number of tasks from the nurse. The type or kind of task would dif fer. Previous Hospitalization Experience To determine if there was a relationship between the number of hospital admissions and the expectancy score a Pearson product moment correl-ation coefficient was run. The correlation for psychiatric patients was - .04 which was not significant. The correlation for medical patients was - .26 which was significant beyond the .05 level. This correlation suggests there is a reliable relationship between the number of admissions and the medical patient's expectations of the nursing functions. More emotional, supportive nursing care is expected the more often the patient has been hospitalized. The pass ibil ity suggested by this correlation is that somewhat subtly disguised emotional, supportive, needs became apparent after the more urgent physical needs were fu I fi II ed . Chi-squares were calculated to determine if there was a relationship between: a. The number of times the patient had been admitted to the psychiatric ward and whether the patient was fam iI iar with the term "psychiatric nurse." Table 5 reports ,there was a significant tendency 2 (X = 11.18, p <1%) for the patient who had had more previous hospital admissions to have heard of a psychiatric nurse. b. The number of times the patient had been admitted to the psychia-tric ward and what the patient felt he knew about what a psychiatric nurse TABLE 5 CH I-SQUARE ANALYSIS OF THE RELATIONSHIP BETWEEN THE NUMBER OF PSYCHIATRIC ADMISSIONS AND PATIENTS HAVING HEARD OF A PSYCHIATRIC NURSE HEARD OF A PSYCHIATRIC NURSE ADMISSIONS YES NO 9 24 33 2 - 4 13 6 19 5 - 15 6 2 8 II 28 32 «~ 11.18 P = <.1% 24 was supposed to do. Table 6 reports there was a significant tendency 2 (-;( = 5.08, p <05) for the patient who had had more previous hospital admissions to feel he knew what a psychiatric nurse was supposed to do. c. The responses of psychiatric patients when asked, "Have you heard of a psychiatric nurse?" and the responses of medi cal pati ents when asked, "Have you heard of a medical nurse?" Table 7 reports there was a significantly greater tendency (1...2 - 67.20, p <1%) for medical pati ents to respond affirmatively. d. The responses of psych iatri c patients when asked, II Do you feel you know what a psychiatric nurse is supposed to do?1I and the responses of medical patients when asked, liDo you feel you know what a medical nurse is supposed to do?" Table 8 reports there was a significant tendency tj..2 = 2.71, p < 10 >.05) for medical patients to respond affirmat·ively. Psychiatric pati ents responded "yes" 28 times when asked, II Have you heard of a psychiatric nurse?1I Medical patients responded u yes" 42 times when asked, "Have you heard of a medi cal nurse?" When psychiatric patients were asked, liDo you feel you know what a psychiatric nurse is supposed to do ?II, they responded Ijyes" 26 times. Medical patients responded "yes" 35 times when asked, "Do you feel you know what a medical nurse is supposed to do?1I Patterns of response to these questions suggest that medi cal patients have more knowledge of the nurse serving them. While caution must always be exercised in generalizing from the results of a single study, the findings of this investigat'ion indicate further TABLE 6 CHI-SQUARE ANALYSIS OF RELATIONSHIP BETWEEN NUMBER OF PSYCHIATRIC ADMISSIONS AND WHAT PATIENT FEELS HE KNOWS ABOUT WHAT A PSYCHIATRIC NURSE IS SUPPOSED TO DO KNOWS WHAT NURSE SUPPOSED TO DO ADMISSIONS YES NO 10 23 2 - 4 11 8 5 - 15 5 3 26 34 • 5.08 P <.05 33 19 8 TABLE 7 CHI-SQUARE ANALYSIS OF THE RELATIONSHIP BETWEEN PSYCHIATRIC AND MEDICAL PATIENT RESPONSES TO PATIENTS HAVING HEARD OF A PSYCHIATRIC (OR MEDICAL) NURSE PATIENTS YES NO MEDICAL 42 18 PSYCHIATRIC 28 32 70 SO X 2 = 67.20 p = <1% level 60 60 TABLE 8 CHI-SQUARE ANALYSIS OF THE RELATIONSHIP BETWEEN PSYCHIATRIC AND MEDICAL PATIENT RESPONSES TO WHAT THE PATIENT FEELS HE KNOWS ABOUT WHAT PATIENTS MEDICAL PSYCHIATRIC A PSYCHIATRIC (OR MEDICAL) NURSE IS SUPPOSED TO DO YES NO 35 25 26 34 61 59 x2 = 2.71 60 60 explorations and considerations of the type of nursing care given patients would be of value. The study indicated patients' stated expectations were focused upon needs related to their present illness. It then seems that nurs­ing service and nursing education must' pay heed to the expressions of the patient in formulating nursing care plans, being cognizant of the influence the present ill ness has upon those stated expectations. Further research and investigations should be carried out to determine more rigorously the relatedness between the needs of the patients and the appropriate nursing care which will help them toward health. 28 CHAPTER IV SUMMARY The purpose of the study was to determine if stated expectations of psychiatric and medical patients of nurses and nursing functions would be different. A questionnaire containing 70 items which measured patient expectations in two categories, emotional, supportive nurs ing functions and physical nursing functions was given to 60 psychiatric and 100 medical patients. The results demonstrated that psychiatric patients stated they expected significantly more emotional, supportive nursing functions than medical patients who stated they expected more physical nursing functions. The level of expectations of psychiatric and medical patients on specific emotional, supportive nursing functions and on specific physical nursing functions was also obtained. The mean and S. D. was computed for each item for the two groups of patients on the 70 items. Psychiatric and medical patients indicated a high level of expectancy on 15 items, 2 items were seldom expected, 16 items demonstrated a similar level of expectation. Patients did not expect the nurse to shave them or care for their fingernails. All patients expected the nurse to treat them with self respect, to have an accepting attitude, and to establ ish satisfying communication. A correlation was run on the test scores of psychiatric and medical patients and on the number of adm iss ions • The correlation obta ined for psychiatric patients was not significant. The correlation coefficient for medical patients Was - v '1.6 (p. 5) which indicated that as the number of admissions increased, medi cal patients expected more emotional, supportive nursing care functions. 30 Psychiatric patients who had had more previous hospital izations i ndi­cated they had heard of the psychiatric nurse and felt they knew more of what she was supposed to do than first admission patients. Medical patients appeared to have more definite ideas about nurses and thei r functions than psychiatric patients. REFERENCES REFERENCES Abdellah, Faye and Levine, E. Patients and personnel speak. U. S. Public Health Services, Washington: Government Printing Office, 1957. 33 p. (Public Health Publication 527). Butl er, H. J. and Levingston, Anne G. The i mage of the psych iatric nurse. Journal of Psychiatric Nursing, 1963 (1) 264-268. Ditcher, E. What the patient really wants from the hospital. Modern Hospital 1954, 83, 51-56. Elms, Roselyn R. and Diers, Donna K. The patient comes to the hospital. Nursing Forum, 1963, 2 (3), 89-97. Fromm Reichmann, Frieda. Principles of intensive psychotherapy, Chicago: The University Press 1950. - Gleidman, L. H., Nash, E. H., Imber, S. D. Stone, A. R., and Frank, J. D. Reduction of symptoms by pharmocologically inert substances. Archives of Neurology and Psychiatry, 1958, 79,345-351. Maslow, A. H. Higher and lower needs. Journal of Psychology, 1948, 25; 433-436. Ouzounian, Meada Faye. Indications of insecurity among psychiatric patients. Master's thesis, University of Utah, 1962. Paulsen, Dorothy. Patients give tests too. American Journal of Nursing, 1962, 62, 58-59. Pearce, Helen. The patients tell their story. American Journal of Nursing, 1961, 62, 97. Robison, Ora Loy. Nursing personnel and patient's perceptions of nursing functions contributing to patient care. Master's thesis, University of Utah, 1960. Schafer, Kathleen N.,Sawyer, Janet R.,McCluskey, Audrey M./and Beck, Edna L. Medical-surgical nursing. St. Louis: C. V. Mosby Co., 1961. Shapiro, A. D. The placebo effect in the history of medical treatment. American Journal of Psychiatry, 1959, 116; 298-304. Small, I. F., Messina, J. A., and Small, Joyce G. The meaning of hospital ization: a comparison of attitudes of medi cal and psychia­tric patients. Journal of Neurological and Mental Diseases, 1964, 139; 578-590. - - Tagl iacozzo, Da isy M., Patj ent expectations and the pati ent rol e. Canadian -Nu-rse, 1963, 59; 840-846. Volgyesi, F. A., Schools for patients. British Journal of Medicine and Hyponotism, 1954, 5; 8~ 16. Whiting, F. J. The nurse-patient relationship and the heal ing process. New York: A Progress Report to the American Nurses Association, Inc., 1958,-1. -- Whiting, F. J. Q-Sort: a technique for evaluating perceptions of inter­personal relationships. Nursing Research, 1955,4; 70-73. 33 APPENDIX A INSTRUCTIONS for "PATIENT EXPECTATIONS OF NURSING FUNCTIONSlI This study is being conducted to determine patient's expectations of nurses. This is an investigation to determine what patients consider important so that their care may be improved. Please read each statement carefully and check the square wh ich best repre­sents your response. Th is questionnai re is not a test and there are no right or wrong answers. Your answers wi II be held in confidence and the information treated as research data. APPENDIX A 5 4 3 2 1 Defin- Defin- itely itely Not Don't Don't STATEMENTS Expect Expect Sure Expect Expect 1. The nurse should keep the patient in clean clothes. I 2. The nurse should see patient does not go too long without a bowel movement. 3. The nurse should see that pa-tient is receiving adequate nourishment. 4. The nurse should help the pa-tient express any fears about his i II ness. 5. The nurse shoul d I eave the patient alone if he tells her he doesn't want her help. 6. The nurse should address the patient by using his name. 7. The nurse should decide who' takes the patient's belong-ings home. 8. The nurse should adjust some of the hospital routines to meet the individual needs of patient. 9. The nurse should watch pa-tient for any toxic signs following the administra-tion of medication. 10. The nurse should help the angry pati ent express his feel ings. 11. The nurse should stay with patient who becomes afraid. 12. The nurse should take time to I isten when the pati ent de-sires to tal k. 13. The nurse should shave the pati ent. 36 5 4 3 2 1 Defin- Defin- itely itely Not Don't Don't STATEMENTS Expect Expect Sure Expect Expect 14. The nurse should decide what clothing patient will wear, 15. The nurse should see that the pat i ent does not become too tired. 16. The nurse should be aware of and consider a patient's emo-tional condition as much as his physical condition. 17. The nurse should avoid being over cheerful when a patient is depressed. 18. The nurse should help the pa-tient become acquainted with other patients. 19. The nurse should safeguard pa-tient by using safe, proper equipment. 20. The nurse should stay with pa-tient until he has taken his medication. 2l. The nurse should put the pa-tient's valuables in a safe place. 22. The nurse should put her arm around the patient when com-forti ng him. 23. The nurse should refuse to take care of a patient that tr311s her she is incompetent. 24. The nurse should involve the patient's family in planning for his care. 25. The nurse shoul d protect the pat i ent from extremes of heat and cold. 26. The nurse should decide what food the patient may have. 27. The nurse should decide when patient should go to bed. 37 5 4 3 2 1 Defin- Defin- itely itely Not Don't Don't STATEMENTS Expect Expect Sure Expect Expect 28. The nurse should talk to patient when he is lonely. 29. The nurse shoul d be concerned that patient is worried about ... home aHa irs. 30. The nurse should continue being friendly when the patient feels worthless. 31. The nurse should keep a record of patient's fl uid intake. 32. The nurse should see that pa-tient has adequate mouth care. 33. The nurse should keep the pa-tient's hair combed. 34. The nurse should recognize the importance of the patient's fam-ily in his treatment. 35. The nurse should allay the fears of the patient who is upset over changes in his treatment proce-dure. 36. The nurse shoul d I isten to the patient when he complains about environmental disturbances. 37. The nurse should safeguard the patient from injury. 38. The nurse shoul d check pati ent frequently at night. 39. The nurse shoul d give prescri-bed medi cations when the pa-tient is unabl e to sleep. 40. The nurse should tal k to the patient about his hobbies. 4l. The nurse should orient a new patient carefully to the woys of the hospital. 42. The nurse should listen wfth res-pect to the patient. , 38 5 4 3 2 1 Defin- Defin- itely itely Not Don't Don't STATEMENTS Expect Expect Sure Expect Expect 43. The nurse should teach patient adequate health habits to pre-vent a recurrence of his illness. 44. The nurse should explain to pati ent the need for unpleasant or painful treatments. 45. The nurse should be responsible to see that a patient's skin is kept in good condition. 46. The nurse should continue to make contact with the patient who is depressed. 47. The nurse should introduce her-self to the new patient. 48. The nurse should stay with a pat i ent when he becomes anxious. 49. The nurse should keep the pa-tient's clothes in neat order. 50. The nurse should keep the pa-tient's room clean. 51. The nurse should allow the patient to function physically as much as he desi res. 52. The nurse should help the pa-tient to see his behavior that interferes with his relationship with others. 53. The nurse should move patients away from each other if they irritate one another. 54. The nurse should jo in a group of patients who have become argumentive and attempt to resolve the difficulties. 55. The nurse should plan the pa-tient's physical activities. 39 5 4 3 2 1 Defin- Defin- itely itely Not Don't Don't STATEMENTS Expect Expect Sure Expect Expect 56. The nurse should check the pa-tient's intravenous feedings closely. 57. The nurse should draw the water when a patient is allowed a tub bath. 58. The nurse should make a point of becoming acquainted with the pati ent's fam iI y. 59. The nurse should be aWare if a patient is becoming increas-ingly anxious. 60. The nurse shoul d try to spend extra time with the patient who is lonely. 61. The nurse should care for the pati ent's fingernai Is. 62. The nurse shoul d see that the patient's trea'tment is not interrupted. 63. The nurse should explain to the patient how to take his medica-tions at home. 64. The nurse shoul d do a II she can to hel p the pati ent feel self respect. 65. The nurse should have an accepting attitude with the patient. 66. The nurse shoul d do a II she can to hel p the patient feel she is interested in him as an indivi-dual. 67. The nurse should give an explan· ation to the patient about the diognosti c tests he has been give ~ . 40 5 4 3 2 1 Defin- Defin- tely itely Not Don't Don't STATEMENTS Expect Expect Sure Expect r- ~xpect 68. The nurse should see that the patient's bed is made comfort-able for him. 69. The nurse should so all she can to help establ ish satisfying communication between the pati ent and herself. 70. The nurse should give the pa-tient directions when he loses control. Name Birthplace Birthdate Elementary School Nursing School College University Degree Certificates VITA Ruth Donaldson Brown Ogden, Utah 3 October, 1922 Lewis Elementary Ogden, Utah Thomas D. Dee Memoria I School of Nursing Ogden, Utah 1940 - 1943 Weber State College Ogden, Utah 1940 - 1964 (Periodically) University of Washington Seattlet Washington 1944 - 1945 University of Utah Salt Lake City, Utah 1963 - 1966 B. S. University of Utah Salt Lake City, Utah 1964 M. S., University of Utah Salt Lake CitYt Utah 1966 Teaching Certificate in Medical­Surgical Nurs ing University of Washington Seattle, Washington 1945 Professional Organizations Professional Positions Family VIT A -- Continued Red Cross Home Nursing Teaching Certificate Logan, Utah 1949 Utah State Nurse's Association American Nurse1s Association Phi Kappa Phi Lancaster Community Hospital; Director of Nurses, 1946-1947; Dee Memorial Hospital; Surgical Supervisor, 1948-1950; Utah State Department of Health; Public Health Nurse, 1951-1952; Logan L.D.S. Hospital; Operating Room Supervisor, 1952-1953; Dee Memorial Hospital; Medical Clinical Instructor, 1954-1957; Head Nurse on Medical Division, 1958-1960. House Supervisor, 1960-1963. Married to Loa V. Brown Five children: Loy, Michelle, Michael, Stacey, Carol.