Behavioural analysis of ward rounds within a general hospital psychiatric unit.

A naturalistic observational procedure was used to examine the content of staff verbal interaction during the ward rounds of two inpatient teams in a general hospital psychiatric unit. Observers reliably rated staff discussion of 10 neurotic and 10 psychotic inpatients, using a nine category behavioural scale. The major focus of this scale was the extent to which three broad orientations, viz the medical, psychotherapeutic and sociotherapeutic models, were utilized by the staff. It was found that an eclectic approach was used by staff in their discussion of patients' aetiology, treatment and prognosis. However, the medical model was primarily utilized to formulate patient care, with the sociotherapeutic approach being employed for approximately one-third of the time. The psychotherapeutic orientation was only used 2.9% of the total time that patients were discussed. This pattern of use of the three orientations was consistent across the psychotic and neurotic patient groups. The behavioural data were found to be at variance with the degree to which staff believed the models should be applied. Analysis of the amount of time during which each professional group spoke in the ward rounds, and the rate at which they were found to make denned ‘authority statements’, indicated that a hierarchical model of management operated in the unit. These findings are related to the concept of shared power and responsibility within the therapeutic team.     

T-Group Theory and Laboratory Method: Innovation in Re-Education Edited by Leland P. Bradford,Jack R. Gibb,and Kenneth D. Benne

The authors conducted a quantitative examination of parallels between milieu and therapy group dynamics on a short-term inpatient unit. The Ward Atmosphere Scale was used to assess the milieu, and the Group Climate Questionnaire-S to measure processes in key groups. Assessments were made by patients and staff once each week for 10 months. The authors found clear parallels between ward and therapy group processes. The parallels reflected the impact of patterns utilization of the unit, its treatment philosophy, and the emotional dynamics of its constituents. Examination of these associations also revealed limitations of the treatment setting, clarified the potential impact of particular staff interventions, and demonstrated biases in the rating methods. Study of parallel process on the psychiatric unit is a rich source of information on the nature of inpatient treatment.     

Inpatient group processes parallel unit dynamics.

The authors conducted a quantitative examination of parallels between milieu and therapy group dynamics on a short-term inpatient unit. The Ward Atmosphere Scale was used to assess the milieu, and the Group Climate Questionnaire-S to measure processes in key groups. Assessments were made by patients and staff once each week for 10 months. The authors found clear parallels between ward and therapy group processes. The parallels reflected the impact of patterns utilization of the unit, its treatment philosophy, and the emotional dynamics of its constituents. Examination of these associations also revealed limitations of the treatment setting, clarified the potential impact of particular staff interventions, and demonstrated biases in the rating methods. Study of parallel process on the psychiatric unit is a rich source of information on the nature of inpatient treatment.     

ACQUISITION AND CROSS-SETTING GENERALIZATION OF MANUAL SIGNS WITH SEVERELY RETARDED INDIVIDUALS

In this study, we assessed the effect of a transfer of stimulus control procedure on the acquisition and cross-setting generalization of manual signs with four profoundly retarded individuals. Two individuals were trained to produce appropriate signs to verbal instructions, whereas the other two were trained until manual signs were controlled by visual stimuli (objects). Data obtained from three probe situations (two for one individual) constituted the dependent variables of the investigation. The results, gathered within a multiple-baseline design across signs showed that (a) individuals acquired the trained signs and (b) maintenance and generalization across settings (classroom, ward) and persons (teachers, ward staff) occurred, but was highly variable between and within individuals.     

Evaluation of a participatory,competency‐based model of staff training in a community habilitative setting

This study evaluated a participatory model of staff training within a community habilitative setting for adults with developmental disabilities. The objectives were to formulate an approach to training that was not time intensive, included multiple instructional methods, and incorporated all levels of staff involvement. Senior administrative, middle‐level supervisory, and direct‐care personnel comprised a committee that designed and implemented a training program that targeted performance and verbal report competencies required by ‘on‐line’ staff. Training consisted of corrective feedback, modeling, rehearsal, and practice procedures that were carried out with three individuals in a multiple baseline design across sets of target competencies. The training program was effective in establishing staff competencies although individual learning effects were revealed. The implications of these findings for the design of staff training programs within human service agencies are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

The team meeting on a rapid turnover psychiatric ward: clinical illustration of a model for stages of group development.

This article illustrates stages of group development in a semi-structured team meeting of staff and patients in an inpatient psychiatric unit. Clinical material drawn from such a group at the Massachusetts Mental Health Center is presented in support of the view that, even in a rapid-turnover ward, group process in a mixed-level, mixed-diagnosis "ward meeting" follows some predictable lines and responds to the articulation of certain predictable concerns. Garland's (1981) model of group development is adapted to show the cyclical nature of group process in a teaching hospital, where doctors as well as patients may make only brief stays. Effective leadership strategies are suggested.     

Food and violence: Childhood violence and emotional abuse as complicating factors in the inpatient treatment of eating disorders

SUMMARY

This paper considers the treatment, on an inpatient eating disorders ward, of patients who have suffered violence and emotional abuse during childhood. The complex web of relationships surrounding these patients is discussed, and it is suggested that there are multiple transferences — to the institution, to various members of staff, and to other patients — and that splitting of these transferences is inevitable. Staff experience powerful countertransference feelings, related to the patient's violent history. A central task for the staff team as a whole is to understand and contain the patient's disturbance — taking on, tolerating, and processing the projections. This demands the close working-together of the members of the multidisciplinary team, so that staff can together openly examine the patient's interaction with them and their own emotional responses to the patient and to other members of staff. If these responses are not understood by the ward staff, they can lead to conflict and inappropriate decisions. On the other hand, if the staff team together can build up a picture of the patient's relationships on the ward, and their meaning for the patient, this picture, like a particular projection of the world in an atlas, provides a ‘map’ of the patient's inner world. This ‘map’ can be used by the staff team in navigating their interactions with the patient. It can also assist the psychotherapist in her work to help the patient recognise and, eventually, own the split-off parts of herself.     

BEING DRIVEN MAD: TOWARDS UNDERSTANDING BORDERLINE AND OTHER DISTURBED STATES OF MIND THROUGH THE USE OF THE COUNTER‐TRANSFERENCE

In this paper material is presented from supervision groups run for nurses and other mental health professionals. The patients presented to the group came from different mental health settings with a diagnosis that included borderline features and/or other disturbed states of mind. All of the patients described caused strong counter‐transference feelings of sympathy, confusion, anger, hopelessness and guilt. Although these views were not expressed in formal ward rounds or recorded in clinical notes, evidence of their influence could be seen in the staff's attitude toward these patients. In supervision groups staff would either say that the patients were victims of mistreatment or they adopted a rather moralistic tone saying, ‘the patient is attention‐seeking’, ‘manipulative’ or ‘not mentally ill’. Psychoanalytic supervision which puts the transference and counter‐transference relationship at the centre of practice can help staff to think about their feelings and digest them in a way that makes use of them as evidence rather than discarding them as purely subjective. It also helps to reduce the toxic effects of the patient's projections upon the clinician's mind and this in turn helps to reduce retaliatory or manic clinical decisions. In this paper I argue that staff teams need time to reflect on their practice in handovers and clinical meetings and that psychoanalytic supervision can offer a particularly valuable clinical perspective on patients with Borderline features. This sort of support should be seen as an essential part of the work of nurses and other mental health professionals rather than an unaffordable luxury.     

A Short-Term,Family-Oriented,Child and Adolescent Psychiatric Inpatient Treatment Program

We describe a short-term inpatient treatment program whose purpose is to integrate the different interventions in the child, his or her family, and the outpatient professional network. The interaction between the family and the ward is the basic structural element of child psychiatric inpatient treatment. The child, the family, the professional outpatient network, and the ward community together form an extended therapeutic system. Inpatient treatment can be understood as a coevolving process between these systems. The essential feature in our working model is the continuous, daily nursing staff supervision and a focus on interactions in the extended therapeutic system.     

Spirituality and Substance Abuse Recovery

Researchers explored patient and staff perceptions of spiritual well-being and the spiritual needs of patients enrolled in a residential substance abuse treatment program. The Spiritual Well-Being Scale was used to gather quantitative data. Additionally, a brief questionnaire containing one qualitative and two quantitative questions was completed by both clients and staff. A statistically significant difference was found, indicating a more positive sense of spiritual well-being among patients upon discharge. Although the staff and clients of the residential program have similar perceptions regarding the concept of spiritual well-being, their definitions do not appear identical.     

Living with obsessive-compulsive disorder: A case study of a woman's construction of self

This qualitative case study employed social constructionist theory and a discursive or language-based approach to examine aspects of identity and subjectivity in one woman's account of living with obsessive-compulsive disorder (OCD). Two, 2-hour semi-structured interviews were conducted, 6 weeks apart. In the first interview, the participant was asked to tell her ‘story’ of what her life with OCD was like. A discursive analysis focusing on the woman's construction of self was conducted on her narrative. During the second interveiw, the participant was asked to give her reactions to the analysis and to provide further interpretations and/or explanations which were then discussed. The results indicate how different ‘voices’ in the woman's narrative represent the power relations involved in her self-presentation of life with OCD within a particular social and discursive context. A key discourse involving religion as a metaphor was also identified as a way of representing the woman's experience of OCD and understanding her perception of control. The study illustrates how a discursive approach involving reflexivity can be used to explore identity and subjectivity with an OCD respondent/client.     

Professionalism and Helping: Harmonious or Discordant Concepts? An Attribution Theory Perspective

In examining whether a leader's professionalism implies more or fewer helping behaviors for followers, this study designed a model integrating attributional theory explanations with professionalism to predict helping behaviors. Four distinct helping behaviors were conceptualized: supporting, motivating, referral, and rejection. Qualitative methods used in the study consisted of content analysis of interviews with 12 superiors at healthcare organizations concerning their means of helping staff, and the circumstances. Quantitative data were gathered by an experimental design in which four case studies were presented to each of 171 healthcare superiors, who were asked to deal with a distressed staff nurse whose stability and controllability of the distress were rated either high or low. Superiors' professionalism was assessed. Results indicated that the relationship between professionalism and helping was complex, and critically dependent upon the type of helping behaviors provided, the help provider's professionalism, and attributions of the help seeker's controllability and stability. The qualitative and quantitative results favor attribution explanations, and imply that highly professional superiors provide higher levels of supporting, motivating, and rejecting helping behaviors as means to maintain professionalism of staff.     

Exploring the Base for Family Therapy Edited by Nathan W. Ackerman,Frances L. Beatman,and Stanford N. Sherman

General systems theory and group psychoanalytic psychology are utilized to present a typology of consultation requests that face the liaison psychiatrist in a general medical ward. These theories are also used to suggest interventions that enable the liaison psychiatrist to accomplish the dual purpose of providing useful consultations to the medical staff and training them in the psychological care of their patients without becoming trapped in the contradictory demands of the pressured medical-ward setting. Examples of psychosocial-medical rounds are presented illustrating three different kinds of consultation requests and specific intervention strategies.     

Self‐managed learning groups in higher education: Students' perceptions of process and outcomes

Background. Self‐managed learning groups are increasingly used in higher education. There is a need for more systematic investigation of university students' perceptions of the processes and outcomes of this learning method. Aims. This study aimed to identify the domains of process issues that students perceive as relevant to their participation in self‐managed learning groups, and how these processes are perceived to influence group outcomes. Sample. Participants were undergraduate psychology students who were members of self‐managed learning groups. Method. The first study employed qualitative methods (namely, students' written accounts, interviews, and observation) to study learning groups (N =180 students) and identify the process domains. In the second study, first and second year students (N =207) used a questionnaire (based on the domains identified in Study 1) to evaluate the processes and outcomes of their learning groups. Results. Analysis of qualitative data (Study 1) identified seven process domains: task focus, staff support, process learning, environmental fit, managing differences, equity and responsibility, and collaboration and cooperation. Factor analysis of students' responses (Study 2) identified an underlying structure of two process factors: personal responsibility and collaborative climate, and staff support and environmental fit. Both process factors were associated with the self‐reported satisfaction and productivity of this group of students. Conclusions. University students' perceptions of the processes of self‐managed learning groups have a clear structure. These process factors are associated with perceived group outcomes in systematic and theoretically consistent ways.     

Indonesian leadership styles: A mixed‐methods approach

Indonesian leadership characteristics were examined in three studies, using mixed methods. In the first, qualitative study 127 indigenous characteristics of Indonesian leadership were identified from interviews and focus group discussions with Indonesian managers and staff. In the second study, a questionnaire based on the characteristics found in the first study was administered to Indonesian managers to identify Indonesian leadership styles. Using factor analysis, two highly correlated dimensions were extracted, labelled benevolent paternalism and transformational leadership. In the third study, a questionnaire consisting of leadership characteristics from the GLOBE study, supplemented with a selection of 49 items from the Indonesian questionnaire, was administered to another sample of Indonesian managers. We found that Indonesian leadership has two components; the first involves a more local modernization dimension that ranges from (traditional) benevolent paternalism to (modern) transformational leadership, the second is a more universal person‐ versus team‐oriented leadership dimension. We conclude that Indonesian leadership has both emic and etic aspects.