Brief Communications: The Cost of Caring: Nursing on a Psychiatric Intensive Care Unit

The Tradition of Toughness: A Study of Nonprofessional Nursing Care in Psychiatric Settings

“…The adoption of a cooperation model of care would result in decreasing the tradition of toughness and violence. Kavanaugh (1988) conducted a study in a comparable setting, and the conclusions were similar, that is, the differentiation of the curing aspect of the role (medical model) from the caring aspect of the role (nursing model).…”

“…First, this study is not generalizable to all psychiatric settings, particularly to settings that utilize different ideologies. However, the data and literature both suggest that psychiatric institutions are surprisingly similar since most utilize the medical model emphasizing a disease approach (Kavanaugh, 1988;Marler, 1971;Strauss, 1975;Strauss et al, 1981). In addition, the extent of the subjects' stories from previous settings and personal clinical experience suggest that aspects of the tradition of toughness exist in other psychiatric settings.…”

“…Some nursing administrators have made progress toward the increased utilization of professional nurses, and this trend is encouraging. However, many psychiatric hospitals continue to hire nonprofessional nursing staff members to provide the greatest part of nursing care (Kavanaugh, 1988;Marler, 197 1) despite the abundance of literature that documents high authoritarianism within this group. As Kavanaugh suggested, the current health care atmosphere of financial restraint in conjunction with the nursing shortage emphasizes the importance of continuing our efforts to explore options for the use of both professional and nonprofessional nursin staff and the use of nurses with differing levels of educatioa and experience.…”

Theory of protective empowering for balancing patient safety and choices

“…Registered nurses reported an 'ongoing intra-staff debate over levels of control versus patients' rights and self-care' (p.244). 5 Fisher, 7 Forchuk, 8 Garritson, 9 and Lützén and Nordin 10,11 presented similar findings in which psychiatric nurses reported the need to balance beneficence and non-maleficence with autonomy. For example, in Fisher's 7 grounded theory study, nurses described the ethical problem of 'a tension between their desire to give patients latitude to manage their own behaviours and their simultaneous responsibility for maintaining unit safety ' (p.199).…”

“…The problem of nurses' level of control versus providing patients' choices remains a challenge for nursing in general, 2,3 but specifically for psychiatric-mental health nursing. [4][5][6] For example, Kavanagh 5 examined psychiatric nurses' experience of care with patients on three psychiatric units within one urban general hospital that managed actively suicidal, homicidal, and gravely disabled adults. Registered nurses reported an 'ongoing intra-staff debate over levels of control versus patients' rights and self-care' (p.244).…”