Judging the other: psychiatric nurses’ attitudes towards identified inpatients as measured by the semantic differential technique

Abstract

Nurses' attitudes towards psychiatric patients can be expressed in terms of either a symptom-oriented approach or a personhood-focused approach where the latter is characterized by the ambition to establish a genuine and lasting relationship, while the former places the emphasis on correcting 'defective' patient behaviour. To study whether previous typologies found in a qualitative in-depth interview study exist in a larger quantitative investigation and, if so, to identify and describe a structure for the nurses' attitudes connected to each of the identified typologies. Six psychiatric group dwellings and six acute psychiatric hospital wards participated in the study. In all, 2700 assessments of 163 patients were sent out to 160 respondents and 2436 answers were returned, that is, the external dropout rate was 9.8%. The semantic differential technique was used. This is a method for quantifying the meaning that is attached to an identified phenomenon through series of bipolar pairs of adjectives. The scale has 57 bipolar pairs of adjectives, which estimates an unknown number of dimensions of nurses' attitudes towards an identified patient. The respondents' answers were analysed through entropy-based measures of association combined with structural plots. The analysis revealed that the four typologies existed as a delimited group, especially the groups of 'good' and 'evil' patients, while the 'crazy' and 'invisible' patients existed in a more blurred form. The analysis also revealed that the two groups, 'good' and 'evil', were connected to the nurses' ethical and aesthetic attitude structure, while the 'crazy' patients were linked to the cognitive structure and the 'invisible' patients to the empathetic structure. The study indicates that the two typologies, 'good' and 'evil', could be seen as each other's antithesis and, together with the other two typologies, 'crazy' and 'invisible', they touched upon a structure of the nurses' attitudes that was closely connected to a negative view of the patient except in one case -'the good' patients, which was probably based on his/her exterior symptoms.

“Being good or evil”: Applying a common staff approach when caring for patients with psychiatric disease

“…According to Scheff (1999), stereotyped imagery of mental disorders is learned early in life, including the commonly held view that a person suffering from a mental disorder is potentially dangerous (Crisp, Gelder, Rix, Meltzer & Rowlands, 2000), unpredictable, and less intelligent than others (Angermeyer & Schulze, 2001). For example, patients diagnosed with borderline personality disorder diagnosis are stereotyped as ''difficult'' and ''demanding'' by staff (Gallop, 1988) and long-term schizophrenics can still be seen as ''empty shells'' without any ability to think, feel, or act (Davidson & Stayner, 1997), and are therefore judged by staff as being stupid, incompetent, or ignorant (Lilja, Ö rdell, Dahl & Hellzén, 2004). Nurses also tend to overrate their own importance when it comes to psychiatric patient's well-being (Lilja & Hellzén, 2007).…”

“…Different studies have shown that nurses in psychiatric care have a strong tendency to use typologies in relation to the patients, leading to distanced relationships and to their not seeing the patient as an unique person (e.g. Lilja, Ö rdell, Dahl & Hellzén 2004). Foucault (2006) talks about a pessimistic perspective based on the carers' paternalistic view of the patients.…”

Disconfirmed in one's otherness: A comparison between the nurse's view of the patient's past, present and future and the patient's own view of the past, present and future

“…The results of two earlier studies (Lilja et al, 2004(Lilja et al, , 2006 indicated that in order to reach a deep enough understanding of the nurses' attitude, a new research strategy was needed. Consequently, a phenomenological-hermeneutic approach was used (Lindseth & Norberg, 2004) with the narrative picturing technique (Stuhlmiller, 1994) as a way of bringing to conscious awareness memories the body has stored.…”

“…Earlier in this project, nurses' attitudes have been described from a quantitative point of view. Findings showed that nurses had a strong tendency to use typologies in relation to the patients, leading to a distanced relationship and to their not seeing the patient as an unique person (Lilja, Ö rdell, Dahl, & Hellzén, 2004), and their having a strongly medical approach to their patients (Lilja, Hellzén, Lind, & Hellzén, 2006). To increase our understanding it is important to go further in our studies about attitudes and try to determine whether there is harmony or a discrepancy between nurses' and patients' view of the patient's former life, hospital stay and caring goals.…”

“…This problem is found within the field of psychiatric care (e.g. Lilja et al, 2004;Hellzén, Lind, Dahl & Hellzén, 2005;Marland & Cash, 2005), where it may be an important obstacle on which to focus, since relationships are the basis of mental health care.…”