The norms and values held by three groups of nurses concerning psychosocial nursing practice

Abstract

Research findings indicate that nurses often fail to provide patients with supportive psychosocial nursing care. The reasons for this and the norms and values on which nursing practice is predicated are unknown. The norms and values of three similar groups of nurses concerning psychosocial nursing care were inferred from observation and analysis of the nurses' interactions with each other, with other hospital personnel and with patients. Each group was observed for 5–7 weeks while working on one of three selected medical floors in the same hospital. Each group of nurses had norms and values which were discernable in typical behavior patterns, characteristics, explicit and implicit expectations, orientations, beliefs and attitudes. Two head nurses greatly influenced selection and enforcement of their groups' norms and values. The third group had not developed work-oriented norms and values. Nurses did not usually collaborate with other health-care professionals in the interests of their patients. The head nurses performed this function for each group. All nurses demonstrated knowledge of psychosocial nursing concepts but patient care was usually limited to physical nursing care, giving medications and meeting patients' verbally expressed requests for assistance. Nurses did not respond to or seem to notice patients' non-verbal or incoherent distress. They referred patients who exhibited disruptive behavior to other health professionals without delay. Patients who did not require physical nursing care had little opportunity for interaction with nurses. All three groups had work schedules which facilitated the typical style of nurse-patient interaction on each unit. These interactions were: cool, efficient and rushed on one unit; casual, warm and somewhat superficial on the second unit; brusque and business-like on the third unit. Nurses used social/moral assessment of patients which was facilitated by nurses telling each other anecdotes concerning patients. These anecdotes facilitated one group's typical humane, and two groups' typical dehumanizing nurse-patient interactions. The researcher concluded that group dynamics require consideration when planning nursing care delivery systems and that nurses need to develop pragmatic, supportive, psychosocial nursing interventions.