The impact of nurses’ opinion of client behaviour and level of social functioning on the amount of time they spend with clients

Abstract

The impact of nurses' opinion of client behaviour and level of social functioning on the amount of time they spend with clients For people afflicted with different kinds of psychiatric disorder, suffering is a common denominator. The time the nurses spend with psychiatric clients may mirror their attitudes towards and feelings for these clients. The aim of this study was to investigate the connections between the time spent together and the nurses' opinion of client behaviour and social functioning in community-based psychiatry. In this quantitative study, 29 clients were assessed by 30 nurses, who answered the Global Assessment of Functioning Scale (GAF) and the Positive and Negative Syndrome Scale (PANSS). At the same time, 11,200 non-participant observations of clients were registered using the Patient Activity Classification (PAC) to investigate how they spent their time at two psychiatric group dwellings. The PAC instrument revealed that clients spent an average of 60.8% of time alone, while only 20% of their daily time was spent with the nurses. Based on a factor analysis, indices were made by setting cut-off points for the PANSS and the GAF scores, and four small groups of clients were generated: a relatively high level of social functioning and a low degree of psychiatric symptoms (A); a relatively high level of social functioning and a high degree of psychiatric symptoms (B); a low level of social functioning and a low degree of psychiatric symptoms (C); and, finally, a low level of social functioning and a high degree of psychiatric symptoms (D). The clients judged as having a low level of social functioning in combination with high degrees of psychiatric symptoms, that is, the most vulnerable and dependent individuals, receive less staff attention (18%) and are the clients who spend the most time alone (71.4%). It might be possible to interpret the results of this study in the light of a process of dehumanization.

Management of person with dementia with aggressive and violent behaviour: a systematic literature review

“…Low social interaction between staff and nursing home residents seem to be strongly connected to cognitive impairment (Chen et al. , 2000) and an additional barrier to staff interaction is aggressive behaviour (Kristiansen et al. , 2005; Hellzén & Asplund, 2006).…”

“…Although there is documented knowledge that impaired residents are particularly vulnerable to low social interaction (Kelly, 1997), staff interactions outside the expected routines of resident care is still low (Norbergh et al, 2002). Low social interaction between staff and nursing home residents seem to be strongly connected to cognitive impairment (Chen et al, 2000) and an additional barrier to staff interaction is aggressive behaviour (Kristiansen et al, 2005;Hellzén & Asplund, 2006).…”

Left alone - Swedish nurses’ and mental health workers’ experiences of being care providers in a social psychiatric dwelling context in the post-health-care-restructuring era. A focus-group interview study

“…Attempts to reconstruct mental health nursing from institutional, nurse‐controlled care to a home‐based, client‐centred perspective are still incomplete and lack knowledge from other disciplines, such as social science and ethics (15). Furthermore, people with long‐term mental illnesses who were involved in rehabilitation programmes experienced the support as being inadequate or misdirected, indicating that the professionals were obstacles to their rehabilitation (4); the most socially and psychiatrically disabled clients tended to spend more time in solitude than their co‐clients (13,16). Taken together, the above‐mentioned studies indicate a need to clarify the professional role of nurses as they undergo a period of role re‐definition (17).…”

The integration of solution‐focused brief therapy principles in nursing: a literature review

“…Despite this reduction in bed numbers, many clinicians believe that inpatient care remains an essential option for times of severe distress when a patient may need constant monitoring and care (Burns & Firn 2003). Paradoxically, there is some evidence that most vulnerable and dependent individuals may receive the least staff attention following admission (Kristiansen et al . 2005).…”

“…One of the most consistent complaints made by patients is that too little effort is made to engage with them (Laurence 2002). In Sweden, a study revealed that psychiatric inpatients spent an average of 60.8% of time alone, while only 20% of their daily time was spent with the nurses (Kristiansen et al . 2005) and there is little agreement in the nursing literature on how inpatient care should most effectively be structured and on the nature of the interactions/interventions that inpatient nurses should provide.…”