Communication and behavior on a small psychiatric unit

Abstract

Summary Psychiatric institutions are social units and, as such, are subject to all of the interpersonal disturbances of other social systems. Whatever immunity to conflict and misunderstanding might be conferred by psychological sophistication is eroded by the uncertainty and anxiety resulting from work with psychiatric patients. Administrators of larger institutions have established safeguards which tend to prevent the build-up of tension. Well-trained, experienced supervisors participate in all aspects of the larger hospital's operations. They sense the beginnings of difficulty among staff members or between staff and patients. They act to abort the development of serious problems. The small private psychiatric unit has neither the medical nor the nursing supervisory staff to fulfill this function. When explosions do occur on a small unit, they are less spectacular because fewer patients and nurses are involved. For this very reason, less attention is paid to them and they can easily result in the development of an anti-therapeutic attitude and low staff morale. In this report, one area of nursing communications, namely the report to the succeeding shift, was shown to be one in which unfavorable attitudes are likely to be transmitted and prejudices created. A circular communications pattern enhances the danger of intensification of these attitudes. It is incumbent on the private psychiatrist who has patients in the small private psychiatric unit to consider the relationship of each shift of nurses to himself and to his patient. Further, he must give the members of each shift of nurses the opportunity to inform him of their special problems in dealing with his patients and, in turn, to tell them of his own problems in treating his patients and of his therapeutic program and its rationale.