Abstract
This is an exploratory thesis but nevertheless methodological in nature which aims to examine the physical and emotional needs of the mentally ill and to compare those needs with the nursing care given. It also examines nursing workload in four wards within a large psychiatric hospital. The study was organisationally motivated with nurse managers expressing an interest in the outcome. A small working party comprising of charge nurses and nurse managers was convened to advise the Researcher on aspects of psychiatric nursing and hospital administration. Consultants, the Psychologist and staff representatives were kept informed of the study's progress. A review of pertinent literature v/as undertaken and this helped to form criteria from which the physical and emotional needs categories were derived and the research design constructed. The research methodology necessitated three different research designs and there- fore three separate studies v/ere undertaken. The first study v/as concerned with the development of a patient state assessment form which included nursing care requirements of a physical, technical and emotional nature. This form was. used by nurses to assess the patients' needs. The second study examined patient activity and the amount of observed nurse/patient interaction. The third examined nursing workload. The method used for studies 2 and 3 was systematic observation at 5 minute intervals in four wards selected for study. The sample v/as the total patient and nurse population in each of the wards studied. The systematic observation was carried out by the Researcher plus four other observers. The observations were continued from 7 am - 7 pm daily for 14 days on each ward giving a total of 194,229 observations for Study II and 26,745 for Study III. Data analysis v/as carried out using a computer. It was necessary to have programmes written especially for the data analysis; use was also made of the Statistical Package- for the Social Services (SPSS). The nurses using the patient state assessment form reported greater awareness of patients' needs and placed greater emphasis on emotional need. The patient state forms when analysed indicated different care requirements for different categories of patients. The psychogeriatric patients required totally different care from patients admitted to the acute admission ward. It was evident (and to be expected) that both physical and emotional dependency increases with advancing age. The observed nurse/patient interaction suggested that interaction is centred more around basic nursing tasks than around nurse/patient discourse. It was also observed there v/as little doctor/patient contact. The results indicate it is the least 'skilled' who have most contact with patients. The care given is predominantly task orientated, offering long-term supportive care with minimum medical intervention. Similarly, nursing officer involvement with staff and patients at ward level was minimal, neither was there any formal teaching observed on the wards. There were no directed group discussions nor multi-disciplinary group meetings during the period of study. Data from all wards suggests 'task' rather than individual patient centred care, with a great dependence on the use of psychotropic drugs. Likewise, the nursing workload was basic care. Staff meal breaks were observed to amount for 1/10th of the total working time and nurses left to man-the-wards during mealtimes appeared under pressure. It was also observed that as the patient/ nurse ratio increases the nurse exerts control by whatever means she can often reverting to a 'herding' type of care.