Staff and patient perception of patient mood.

Abstract

The present study explored (1) staff-patient and intrastaff congruence with regard to appraisals of patients' affective state and (2) the factors that affect staff's perception of patient mood. Patients on a physical rehabilitation unit rated themselves on the Depression Adjective Check List (DACL), a set of 32 mood-related descriptors. Staff members from six disciplines rated patients on the same instrument, and also completed a checklist of symptoms of depression, thereby describing the data base that determined their ratings on the adjective list. Although the average DACL ratings of patients and staff did not differ significantly, a substantial and clinically important degree of variability was observed. Ratings on the symptom checklist differed significantly among staff groups, and some variation was observed in the salience of particular symptoms for different disciplines. The findings suggest that discrepancies among staff perceptions of patient mood may be attributable, in part, to differences in the behavioral criteria employed by different professional disciplines. It is important to note that behaviors considered to be symptomatic of depression in other populations may possess a different significance for patients reacting to the impact of severe physical trauma.

Patient–staff agreement in the perception of spinal cord lesioned patients' problems, emotional well-being, and coping pattern

“…Our results give additional support for the requirement for spinal injury care and rehabilitation to be undertaken in specialized units, being able to provide an integrated process of management including rehabilitation from injury and onwards. 34 The finding that staff tended to overestimate patients' psychosocial and emotional problems is in accordance with previous reports from SCL 6,7,10,11 and cancer care. [2][3][4][5] One explanation given by Cushman and Dijkers 11 is that staff creates an expectation of a 'negative mood state' for SCL patients, either through a 'requirement of mourning' 23,35 or based on their projection of how they themselves might respond to an SCL.…”

“…Rehabilitation staff have been reported to overrate SCL patients' emotional distress compared to patients' own description, both when asked to estimate the distress of the average SCL patient 6,7 and when trying to estimate individual patients' mood. 10,11 It has been suggested that the rehabilitation staff have preconceived notions of how persons do or should react when afflicted by an SCL, and that the staff tend to consider the patients to be more demoralized than they are. 6 According to Trieschmann,12 such conceptions of the staff may 'create a psychological climate in which the person with SCI realizes that everyone considers him to be very unfortunate'.…”

Differences between rehabilitation disciplines in views of depression in spinal cord injury patients

“…While there now is sufficient evidence to support the claim that, at least at some level, rehabilitation staff expect SCI patients to be depressed (Bodenhamer el al., 1983;Caplan, 1983;Cushman and Dijkers, 1986), further research is needed to determine what concrete effect these expectations have on staff-patient contacts. We may speculate that a loose model of phases of adjustment has some utility in helping professionals to organise their impressions of what occurs in a majority of patients.…”

“…More importantly, it is likely that if the patients are 'forced' to go through the stages in their proper sequence according to a fixed time schedule, this will only increase their burden. Caplan (1983) pointed out the importance of similarity of perception regarding specific patients among staff members in the clinical situation; if various staff members give conflicting reports concerning a patient's mood, proper assessment of psychological state and of its role in the rehabilitation process is hampered. The present study dealt with the hypothetical 'average' patient, and thus a lack of consensus does not have dire consequences.…”

“…Lawson (1977); Ernst (1987). Recent research by Caplan (1983), Bodenhamer et ai. (1983), Ernst (1987) and Cushman and Dijkers (1986) has provided evidence that rehabilitation staff tend to over estimate the frequency and/or intensity of negative mood states, and to disregard the optimism, hope and even happiness in their SCI patients.…”