Staff Feelings Research Articles

The physical restraint of young people

Children and young people who are in residential care sometimes behave aggressively towards themselves and others, and they may need to be physically restrained by staff. This paper describes a small‐scale study which examines the use of physical restraint in one Scottish region. It explores the circumstances surrounding the restraint and the feelings of staff about the use of the restraint. The study shows that many of the factors that have been shown to be associated with violence and aggression were present in the incidents described.

Hoapital closure: a review of the research into the attitudes and feelings of hospital staff and the implications for managers facing run-down and closure

In this paper the available research on staff attitudes and feelings of hospital staff facing the closure of their long-stay hospital is presented. A simple model focusing upon frequent managerial problems during the process of closure is proposed and discussed. Good two-way communication networks, regular supervision/support, ongoing staff training, and the compilation of a personal portfolio are considered. Some tentative research-based suggestions for managers embarking upon closure are presented.

The Alternatives to Restraints

Nurses frequently verbalize their ambivalence towards the use of restraints, but have lacked efforts to change or decrease the practice. The decision of whether to use restraints may be based on a perception of threat of safety to self or others, the staff's tolerance levels for behavior, a perception of short staffing, or a knowledge gap of alternative approaches. Ongoing assessment and monitoring changes in physical and cognitive functional abilities, with a carefully detailed plan of rehabilitative and restorative nursing, can deter staff's feelings of having to rely on restraint use for safety.

The interpersonal impact approach to patient assessment: Specific links between psychotics' symptoms and staff's feelings

Specific links between the subjective feelings of inpatient staff members and the symptoms of their chronic psychotic patients were explored. The staff's feelings were assessed by a new structured interview. The patients' symptoms were measured by the Brief Psychiatric Rating Scale. Results suggest that differences among staff responses can be adequately described using four dimensions and each of these dimensions has a specific link with patient symptoms on the BPRS.

What Makes a School Evaluation Work?

tion study of a public school program becomes a useful working document to program decision-makers is a conundrum that would baffle even Oedipus. Sometimes, however, evaluators do see the fruits of their labors ripen into a document whose pages become dog-eared, paper clipped, and dirty from reference to it by program decision-makers. Recently, I directed an evaluation study which turned out that way. The evaluation was a comprehensive, rather formal, and objective appraisal of a patently political program. The impact that this evaluation had upon the program-both in terms of policy decisions by program administrators and the staff feelings brought into focus for the first time-was simply astonishing. Let me set the scene. Dr. Wilson Riles, California State Superintendent of Public Instruction, has successfully developed a political base by establishing an Early Childhood Education program (ECE) in the primary grades of a majority of the state's elementary schools. Albeit formal evaluations of ECE are diverse and conflicting in their conclusions of the program's impact upon student achievement, it is generally conceded that from Riles' perspective the effort has been politically worthwhile. It is understandable then, that Riles would wish to extend ECE into the secondary schools. The vehicle for secondary schools' involvement was RISE (Reform in Intermediate and Secondary Education). The work began in 1975 with the formation of a commission whose charge was to make recommendations to Riles and the State Board of Education. Even-

Program Consultation by a Clinical Specialist

Discussion focuses on the utilization of program consultation by a nurse clinical specialist on 1 unit of a large military hospital. The system dysfunction concerned a lack of total nursing care for abortion patients. The program consultation process carried out to assist the nursing staff in dealing with problems in providing care and emotional support for these patients is described. Program consultation is the process whereby an individual with expert clinical skills provides assistance in resolving a system dysfunction. At a meeting on the gynecology unit with the head nurse, several unit staff nurses, the section social worker, and 2 physician residents, several issues were raised. The staff noted that it was not uncommon for the patients to be hysterical both during and after the procedure. The group identified a pressing need to improve nursing care for these patients, particularly in the area of offering emotional support. The staff indicated that patients received little counseling or health education. Additionally, both the medical and nursing staff experienced personal conflicts about the care of these patients. Since comprehensive staff involvement throughout the abortion process was missing, it appeared the dysfunction involved the total system of care. The consultation process is generally comprised of 3 main phases: involvement of the consultant; problem solving; and a closing or culmination. The 1st step in the involvement phase was agreement to assist the consultees in the development of an abortion counseling program. The next step was to obtain approval for the plan. This was followed by negotiating the consultation objectives with the staff. 2 primary objectives were identified: to provide emotional support to abortion patients; and to assist the staff in developing an abortion counseling program. Trust building begins as the consultees start to share limited information about their system's dysfunction. When the consultees started talking in more detail about specific system concerns, problem solving began. During the problem solving process, it became apparent that the staff's thoughts and feelings about abortion were the inhibiting factor which prevented them from providing comprehensive care. The issue of abortion evoked moral, philosophical, and emotional responses within the staff members. As a total group, the staff attempted to decrease their anxiety by using 4 major patterns: acting out; somaticizing, psychosomatic disorders; freezing to the spot, withdrawal depression; and using anxiety in a positive manner in the service of learning. The task during the problem solving phase was to channel the staff's anxiety into a positive direction. The 1st intervention was to demonstrate that the patients could receive comprehensive care. Focus was on the psychosocial aspects while encouraging staff to provide additional supportive care. At the time the program consultation ended, 90% of the patients were receiving counseling and emotional support from the nursing staff.

Bedlam in the therapeutic community: the disruption of a hospital therapeutic community as a pattern of social conflict.

A difficult patient arouses staff feelings to the point where a hospital therapeutic community ceases to function and the patient is forced to leave. The events reveal that there are social forces operative in the community at all times that may become disruptive. They lie in the ambiguities between egalitarian and authoritarian organization of the ward, and role conceptions of attendants, doctors and nurses. Such disruptions may recur more often as conflict over role and status becomes widespread. To manage these forces requires a sensitivity to the dynamics of the community, and a readiness on the part of the members to express their own needs and respond to the needs of others.