It has been becoming more and more obvious that the patient´s social context is a contributing emotional factor important in the development, treatment, and rehabilitation of mental illnesses.
With the growing focus on environmental factors influencing psychiatric treatment, the role of the nurse has begun to change from custodial to therapeutic and rehabilitative. It is increasingly apparent we must study the social orientation of psychiatric hospitals with the idea of improving communication and integrating administration and therapy into a total treatment program.
This study examines the nurse-patient interaction and details the factors related to it, such as
1) examination of the overall picture of nurse-patient interactions.
2) the relationship of the time of day to the nurse-patient interaction.
3) the relationship of the day of week to the nurse-patient interaction.
4) the differences in interaction rates of nurse and student nurse with patients.
This study was conducted from October 27, through December 6, 1975, with 46 patients who were admitted to the psychiatric ward of Y University Medical Center and 7 nurses and 14 student nurses who were working with the patients at that time.
A supplemented Korean translated checklist which was developed by Wiliam A. Hargreaves-was used. The study sample was two sets of time-sampled observations, one which was ´oriented toward nursing staff and the other .toward patients.
The result of this study are summarized as follow:
1) The Job Assignment of nursing staff in total observations revealed that 56. 73% of the time was free on ´the ward and 10. 44% was spent in staff meetings. The Patient Contact by nursing staff in total observations revealed that 25. 44% of the time was spent in the nursing station alone with door closed but not dictating reporting, 24. 92% was in conversation or activity with at least one patient, and 11. 69% was spent in conversation with non-patients or dictation of reports.
2) In Job Assignment of nursing staff in total observation, nurse had different assignment in which the nurses were assigned more chores, in paper work and medication as compared with student nurses.
In Patient Contact of nursing staff, nurses interacted less with patients, and spent 77. 21% of total observation time in conversation with non-patient or alone.
In total observation, of student nurses, 64. 63% was spent in the same place and in conversation or activities with patient. Therefore the student nurses spent more time with patients.
3) The Assignment categories of patient in the total observation revealed that free on the ward was 85.58% and passes, occupational therapies, and group therapies were 2. 90%. Interaction of patients in the total observation revealed that 74.32% of the time were not involved in active interaction, 23.13% were involved in active interaction with the staff and 2.58% were off the ward in formal meetings.
4) The Work Assignment of nursing staff for daytime hour and evenings revealed that the largest portion of the day time hours and evenings was free on ward. The next portion of daytime hours was spent in chores and evening in staff meetings. The other categories. for daytimes and evening were not so different.
5) The Assignment Categories of patients for daytimes and evenings revealed occupational therapies and consultation to other department was assigned more in the daytime and, passes and use of seclusion room more on the evening. The interaction of patients for daytime hours and evenings revealed that being in formal meeting and informal interaction was more in the daytime than evening. For evening hours, interaction. with either staff or patients was reduced and being in same place with staff and or patients, but not in conversation or activity was prominent.
6) Work Assignment of nursing staff on Monday revealed that accompanying individual patient off ward, chores, management of ring of keys, and participation in psychiatrists´ round and assistance of physicians were more prominent than on other days of weekday. On Tuesday and Friday, visiting days, were more prominent in chores, on Thursday and Saturday more in medications and paper works, Patient Contact of nursing staff on. Mondays revealed that activities off ward, being in closed room, or formal staff meetings. predominated over interaction with patients. On Tuesday interacting with patients prevailed, on Wednesday being in staff meetings, on Friday in conversation with non-patient and unknown whereabouts, and on Saturday in room adjacent to patients with door open and not in conversation.
7) Assignment of patients on Tuesday and Friday, taking a walk and passes prevailed. Seclusion room was used frequently on Wednesday, Saturday, and Monday. Consultation to other department was more frequently on Tuesday, Saturday, Wednesday and Monday in that order.
Interaction of patients revealed that on Monday, Tuesday, and Wednesday when student nurses were on ward there was more active interactions and Thursday, Friday, and Saturday when there were no student nurses there was more conversation or activity with non staff or solitary activity in room adjacent to staff.
The follow suggestions are presented according to the study.
1) A more therapeutic activity program on .ward is . need, especially on evenings and during& the days on Thursday, Friday, and Saturday.
2) A study is needed to determine the relationship between activity programs and interactions between nursing staff and patient and patient and patient.
3)A study is needed on other wards where the environmental situations are different.
4) A study is needed to determine ´the relationship between nurse´s interaction and her attitude toward mental illness and mental patient.
5) A study clarify the significant differences statistically between observation items and the individual difference in observation is needed to limit observation number equally in all subjects.
6) For the comprehensive picture of ward social participation, the study of interaction rates, among all the personnel on the ward both within and between various role groups is needed.
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