UBC Theses and Dissertations

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UBC Theses and Dissertations

Staff-patient communication in a mental hospital. |b A pilot study of social worker's information-giving… Bogren, Lyle 1967

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STAFF-PATIENT COMMUNICATION IN. A,MENTAL HOSPITAL A p i l o t s t u d y o f s o c i a l w o r k e r ' s i n f o r m a t i o n - g i v i n g and p a t i e n t ' s i n f o r m a t i o n - r e c e i v i n g i n a c u t e t r e a t m e n t u n i t s a t R i v e r v i e w H o s p i t a l ; i n c l u d i n g a p r o p o s e d d e s i g n f o r a more comprehensive s t u d y o f s t a f f - p a t i e n t c ommunication. by L y l e Bogren W e n d e l l Coady R o b e r t G i l l i l a n d R e g i n a l d . P e t e r s D a v i d T u r n e r A T h e s i s S u b m i t t e d i n P a r t i a l F u l f i l l m e n t o f the Requirements f o r t h e Degree of. MASTER OF SOCIAL WORK i n the S c h o o l o f S o c i a l Work We a c c e p t t h i s t h e s i s as c o n f o r m i n g t o the r e q u i r e d s t a n d a r d . S c h o o l o f S o c i a l Work 1967 The U n i v e r s i t y o f B r i t i s h C o l u m b i a In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r an a d v a n c e d d e g r e e a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t t h e L i b r a r y s h a l l m a k e i t f r e e l y a v a i l a b l e f o r r e f e r e n c e a n d s t u d y . I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s may be g r a n t e d by t h e H e a d o f my D e p a r t m e n t o r by h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . D e p a r t m e n t T h e U n i v e r s i t y o f B r i t i s h C o l u m b i a V a n c o u v e r 8, C a n a d a i i ABSTRACT T h i s s t u d y i s a f o r m u l a t i v e e x p l o r a t o r y s t u d y i n t h e a r e a of c o m munication. I t i n v e s t i g a t e s the o p e r a t i o n o f t h e s o c i a l w o r k e r - p a t i e n t c ommunication p r o c e s s w i t h r e s p e c t t o s e l e c t e d v a r i a b l e s t h o u g h t t o i n f l u e n c e t h i s p r o c e s s . The s t u d y c o n s i s t s of t h r e e p a r t s ; the o r i g i n a l r e s e a r c h d e s i g n , the c r i t i q u e o f t h e o r i g i n a l d e s i g n , and t h e new d e s i g n . The p r o j e c t t a k e s p l a c e a t t h e R i v e r v i e w . H o s p i t a l and i n v o l v e s b o t h C r e a s e C l i n i c and C e n t r e Lawn u n i t s . The o r i g i n a l d e s i g n i s formed around a frame of r e f e r e n c e w h i c h u n d e r l i n e s the need f o r communication by p a t i e n t s a t a m e n t a l h o s p i t a l . U n f o r t u n a t e l y , the o r i g i n a l d e s i g n , w h i c h i n v o l v e d a s t u d y o f f a c t o r s a f f e c t i n g t h e i n f o r m a t i o n f l o w between s o c i a l w o r k e r and p a t i e n t , f a i l e d t o a c h i e v e a c l e a r f o c u s i n i t s p u r p o s e and p r o b l e m f o r m u l a t i o n . The c r i t i q u e p o i n t e d out t h e v a r i o u s f a c t o r s i n f l u e n c i n g the o r i g i n a l s t u d y and w h i c h l e d t o t h e n e c e s s a r y r e v i s i o n of t h e s t u d y d e s i g n . I t i n c l u d e s a comprehensive o u t l i n e o f t h e e x t r a n e o u s v a r i a b l e s w h i c h were e n c o u n t e r e d i n t h i s s t u d y and s u g g e s t s the e x t e n t t o w h i c h t h e y may a f f e c t t h e v a l i d i t y o f t h e s t u d y f i n d i n g s . The new d e s i g n i n c o r p o r a t e s the f i n d i n g s and i m p l i c a t i o n s of the o r i g i n a l d e s i g n , and was e n l a r g e d t o i n c l u d e communication between the s t a f f t r e a t m e n t team ( d o c t o r , s o c i a l w o r k e r , c h a r g e n u r s e ) and the p a t i e n t . A more s p e c i f i c t h e o r e t i c a l frame o f r e f e r e n c e was d e v e l o p e d and i n a d d i t i o n s u g g e s t i o n s f o r i m p l e m e n t a t i o n of t h e new d e s i g n a r e made and can s e r v e as a r e f e r e n c e p o i n t f o r any c o n t i n u i n g s t u d i e s i n t h i s a r e a . i i i . PREAMBLE As has been s t a t e d i n t h e a b s t r a c t , t h i s t h e s i s c o n s i s t s o f t h r e e p a r t s ; t h e o r i g i n a l d e s i g n , a c r i t i q u e o f the o r i g i n a l d e s i g n , and a s u g g e s t e d new d e s i g n . O r i g i n a l l y , our aim was t o p e r f o r m a f u l l s c a l e r e s e a r c h p r o c e s s on an e x p l o r a t o r y f o r m u l a t i v e l e v e l o f r e s e a r c h d e s i g n . However, from t h e b e g i n n i n g we e n c o u n t e r e d d i f f i c u l t i e s i n p o s i n g a s t a t e m e n t o f p u r p o s e i n terms o f a s p e c i f i c f o r m u l a t i o n o f the p r o b l e m w h i c h we i n t e n d e d t o s t u d y . As t h e r e were f i v e r e s e a r c h e r s engaged i n t h i s p r o j e c t d i f f e r e n t l e v e l s o f u n d e r s t a n d i n g d e v e l o p e d w i t h each r e s e a r c h e r t e n d i n g t o d e v e l o p h i s own p o i n t o f v i e w . D i f f i c u l t i e s o f communication among us s u b s e q u e n t l y became a p p a r e n t . T h i s t h e s i s was conducted w i t h i n a m e n t a l h o s p i t a l and as a r e s u l t p e c u l i a r p roblems o f i m p l e m e n t i n g the r e s e a r c h d e s i g n were e n c o u n t e r e d w h i c h were uni q u e t o t h i s " s e t t i n g . . I t was n e c e s s a r y f o r us t o e s t a b l i s h c o n t a c t w i t h many s t a f f members from s e v e r a l p r o f e s s i o n s . I m p l e m e n t a t i o n o f our r e s e a r c h d e s i g n d i d n o t p e r m i t an e x p l a n a t i o n o f our p u r p o s e too the p a t i e n t s a d d i n g more c o n f u s i o n t o our p r o b l e m f o r m u l a t i o n and p u r p o s e . As t h e s t u d y p r o g r e s s e d and i n c r e a s e d awareness was g a i n e d r e l a t i n g t o our p u r p o s e we r e a l i z e d t h a t many o f our o r i g i n a l a s s u m p t i o n s had been somewhat i n a c c u r a t e and d i d n o t a p p l y r e a l i s t i c a l l y t o the r e s e a r c h d e s i g n w h i c h we were c u r r e n t l y i n the p r o c e s s o f i m p l e m e n t i n g . A t t h i s s t a g e , due t o the t i m e a v a i l a b l e f o r t h e r e s e a r c h p r o j e c t we were n o t i n a p o s i t i o n t o c o r r e c t many of the e r r o r s and a s s u m p t i o n s w h i c h we knew t o e x i s t . S u b s e q u e n t l y we d e c i d e d t o c o n s i d e r our o r i g i n a l d e s i g n as e s s e n t i a l l y a p i l o t p r o j e c t , c o n t a i n i n g a t e s t o f the r e s e a r c h i n s t r u m e n t s , and a s m a l l p i l o t s t u d y o f 8 p a t i e n t s . A second p a r t o f our t h e s i s was de v o t e d t o a c r i t i q u e o f our o r i g i n a l ( i v . d e s i g n w h i c h e n a b l e d us t o f o r m a l l y r e c o g n i z e t h e e r r o r s w h i c h had been made e a r l i e r and a t the same time s e r v e as an a i d t o o t h e r r e s e a r c h e r s who i n t h e f u t u r e may e n c o u n t e r s i m i l a r problems t o o u r s . A l s o t h e c r i t i q u e s u g g e s t e d a new r e s e a r c h d e s i g n and a more s p e c i f i c t h e o r e t i c a l frame of r e f e r e n c e . The s e c t i o n d e v o t e d t o the new r e s e a r c h d e s i g n embodies the changes recommended i n t h e c r i t i q u e . T h i s s e c t i o n i s p r i m a r i l y a framework of what we c o u l d have done i f we had the n e c e s s a r y t i m e . I t i s o r g a n i z e d i n such a f a s h i o n t h a t a n o t h e r r e s e a r c h s t u d y can c o n t i n u e where we l e a v e o f f . I n summary i t was n o t our o r i g i n a l aim t o d i v i d e our t h e s i s i n t o t h r e e b r o a d p a r t s , r a t h e r i t was used as an o r g a n i z a t i o n a l method t o o r g a n i z e our e x p e r i e n c e i n r e s e a r c h w h i c h we have g a i n e d from t h i s s t u d y . AUTHORSHIP OF THE THESIS T h i s s t u d y was a group p r o j e c t i n v o l v i n g f i v e M.S.W. c a n d i d a t e s . Each of t h e f i v e members p a r t i c i p a t e d i n t h e p r e p a r a t i o n and c r i t i c i s m o f each c h a p t e r and the o r g a n i z a t i o n of t h e t h e s i s as a w h o l e . However, each member was a s s i g n e d r e s p o n s i b i l i t y f o r the c o m p l e t i o n o f the f i n a l d r a f t o f one c h a p t e r . C h a p t e r I R. T u r n e r C h a p t e r I I R. P e t e r s C h a p t e r I I I W. Coady Chapt e r IV L. Bogren C h a p t e r V R. G i l l i l a n d V . TABLE OF CONTENTS Cha p t e r I . THE INTRODUCTION I n t r o d u c t i o n . F a c t o r s A f f e c t i n g the Flow of I n f o r m a t i o n . R e l e v a n c e o f t h e Study. A l t e r n a t i v e s t o R e s e a r c h . R e s e a r c h I d e n t i f i c a t i o n o f t h e S o c i a l Work P r o b l e m . The N a t u r e o f S o c i a l Work I n f o r m a t i o n . P u r p o s e o f t h e S t u d y . Review o f the L i t e r a t u r e . O r g a n i z a t i o n o f the R e s e a r c h R e p o r t p. 1 C h a p t e r I I . PILOT STUDY DESIGN AND FINDINGS A s s u m p t i o n s o f t h e S t u d y . I n f o r m a t i o n A r e a s . Independent V a r i a b l e s . L e v e l of R e s e a r c h D e s i g n . S a m p l i n g P r o c e d u r e s . Methods o f G a t h e r i n g Data. Data C o l l e c t i o n I n s t r u m e n t s . P r e - t e s t o f P a t i e n t I n t e r v i e w G u i d e . P i l o t S t u d y p. 12 C h a p t e r I I I . CRITIQUE.OF PILOT STUDY I n t r o d u c t i o n . Study D e s i g n . Methods of Data C o l l e c t i o n . Study P r o c e d u r e . E x t r a n e o u s V a r i a b l e s . Method o f . A n a l y s i s p. 27 C h a p t e r IV. THEORETICAL BASIS FOR A NEW DESIGN I n t r o d u c t i o n . T h e o r e t i c a l Framework. R o l e o f I n f o r m a t i o n i n a H o s p i t a l S e t t i n g . . I n f o r m a t i o n - g i v i n g on a H o s p i t a l Ward. The R e c e p t i o n n of I n f o r m a t i o n on a H o s p i t a l Ward. V a r i a b l e s p. 38 C h a p t e r V. THE PROPOSED DESIGN I n t r o d u c t i o n . The P r o p o s e d H y p o t h e s e s . D e v e l o p i n g a D e s i g n Format. I m p l e m e n t a t i o n o f D e s i g n . L i s t o f I n f o r m a t i o n Items. The Committee. The P a t i e n t Sample. Treatment Team Check L i s t . P a t i e n t I n t e r v i e w G u i d e . L i s t o f V a r i a b l e s . A n a l y s i s of the D a t a p- 53 B i b l i o g r a p h y p. 66 A p p e n d i x A; - P a t i e n t I n t e r v i e w Guide p. 69 A p p e n d i x B - S o c i a l Worker Q u e s t i o n n a i r e p. 71 A p p e n d i x C - F i l e I n f o r m a t i o n Guide p. 72 A p p e n d i x D - S o c i a l Worker I n t e r v i e w Guide p. 73 A p p e n d i x E - O r g a n i z a t i o n a l C h a r t of R i v e r v i e w H o s p i t a l p. 75 LIST OF TABLES T a b l e I - C o m p i l a t i o n o f D a ta C o l l e c t e d v i i . ACKNOWLEDGEMENTS T h i s r e s e a r c h p r o j e c t was made p o s s i b l e by t h e k i n d p e r m i s s i o n o f t h e a d m i n i s t r a t i o n o f the R i v e r v i e w H o s p i t a l , who u n d e r s t a n d i n g l y o f f e r e d t h e i r s t a f f , p a t i e n t s and f a c i l i t i e s t o a s s i s t i n t h e s t u d y . Many i n d i v i d u a l s t a f f members, too numerous t o m e n t i o n h e r e , o f f e r e d i n v a l u a b l e a s s i s t a n c e and d i s p l a y e d i n t e r e s t i n our endeavours. Our g r a t e f u l a p p r e c i a t i o n i s extended t o the ward s o c i a l w o r k e r s , who w i l l i n g l y c o o p e r a t e d i n the s t u d y and o f f e r e d h e l p f u l s u g g e s t i o n s . We w i s h t o thank the charge n u r s e s who gave t h e i r c o o p e r a t i o n and a s s i s t a n c e i n s p i t e o f v e r y f u l l s c h e d u l e s o f t h e i r own. We would l i k e t o acknowledge the always c h e e r f u l and h e l p f u l e f f o r t s o f t h e s t e n o g r a p h i c s t a f f , who a s s i s t e d i n t h e p r e p a r a t i o n o f m a t e r i a l , o f t e n a t s h o r t n o t i c e . Our s p e c i a l a p p r e c i a t i o n t o the p a t i e n t s who p a r t i c i p a t e d i n the s t u d y by s h a r i n g t h e i r t h o u g h t s and f e e l i n g s d u r i n g t h i s d i f f i a u l t t ime i n t h e i r l i v e s . The s t u d y would have been more d i f f i c u l t , i f n o t i m p o s s i b l e , w i t h o u t the i n v a l u a b l e a s s i s t a n c e of our A d v i s o r y Committee. Our s p e c i a l g r a t i t u d e i s e x p r e s s e d t o M i s s D.R. Begg, M i s s B e r n i e R e i d and Mr. R.M. Ro s s , who, t o g e t h e r and i n d i v i d u a l l y , s h a r e d our d i f f i c u l t i e s and gave f r e e l y o f t h e i r c o u n s e l . Wives and f a m i l i e s o f the r e s e a r c h e r s gave i n i n n u m e r a b l e ways. T h e i r c h e e r f u l u n d e r s t a n d i n g , encouragement and a s s i s t a n c e o f f e r e d t o the r e s e a r c h e r s added t o our r e s o l v e and gave us impetus when i t was needed. F i n a l l y , s p e c i a l t hanks t o our s u p e r v i s o r o f s t u d i e s , Dr. G l e n H a m i l t o n , who gave o f h i s knowledge o f r e s e a r c h , a d v i c e and s u p p o r t and t h i s we g r a t e f u l l y a p p r e c i a t e . STAFF-PATIENT COMMUNICATION:IN.A MENTAL HOSPITAL CHAPTER I INTRODUCTION THE IMPORTANCE OF INFORMATION Communication between s t a f f and p a t i e n t s i n any l a r g e i n s t i t u t i o n i s s u r p r i s i n g l y complex and i n o r d e r t o a d d r e s s o u r s e l v e s t o the s t u d y o f i n f o r m a t i o n i n the ti m e a v a i l a b l e i t was n e c e s s a r y t o c o n c e r n o u r s e l v e s w i t h o n l y a s m a l l sub-system o f the t o t a l c ommunication network - t h e p r o c e s s o f communication o c c u r r i n g between t h e s o c i a l w o r k e r and the p a t i e n t . More s p e c i f i c a l l y we d e c i d e d t o f o c u s on t h e i n f o r m a t i o n a l component of communication w i t h i n t h i s s p e c i f c c o n t e x t . S chwartz i n a s t u d y i n v o l v i n g S o c i a l R e s e a r c h i n a m e n t a l h o s p i t a l drew a t t e n t i o n t o the i m p o r t a n c e o f r e c o g n i z i n g b l o c k s and o m i s s i o n s i n the communication p r o c e s s w h i c h tended t o i n t e r f e r e w i t h t h e t r a n s m i s s i o n and r e c e p t i o n o f i n f o r m a t i o n w i t h i n a m e n t a l h o s p i t a l s e t t i n g . " D e f e c t s i n communicative o r g a n i z a t i o n , breakdowns, b l o c k s , d i s t o r t i o n , o m i s s i o n s i n t h e t r a n s m i s s i o n o f i n f o r m a t i o n , the p a s s i n g on of a c c u r a t e or i n a c c u r a t e d a t a , a l l may c o n t r i b u t e t o m i s u n d e r s t a n d i n g s between and among h o s p i t a l p a r t i c -i p a n t s . These m i s u n d e r s t a n d i n g s tend t o p e r p e t u a t e the p a t i e n t s i l l n e s s " . ( 3 1 , p. 19.3) Sc h w a r t z goes on t o s u g g e s t t h a t f o l l o w i n g the removal o f b l o c k a g e s t o communication the p a t i e n t s a n x i e t y and e x c i t e m e n t tend t o d e c r e a s e . I m p l i c i t i n t h i s i s an a s s u m p t i o n t h a t the removal or m o d i f i -c a t i o n o f f a c t o r s h i n d e r i n g t h e f l o w o f i n f o r m a t i o n w i l l enhance the t h e r a p e u t i c c o u r s e o f the p a t i e n t . These f a c t o r s o r v a r i a b l e s may o p e r a t e i n d e p e n d e n t l y o r combine and a c t as a t o t a l i t y t o i n f l u e n c e the i n f o r m a t i o n f l o w between the s o c i a l w o r k e r and the p a t i e n t . I n f o r m a t i o n f l o w i s m a n i f e s t e d i n p a t i e n t i n t e r a c t i o n w i t h each o t h e r i n t h e i r a t t e m p t s t o g r a t i f y t h e i r need f o r i n f o r m a t i o n . The dangers o f t h i s t y p e o f i n f o r m a t i o n a l f l o w i s i l l u s t r a t e d i n t h e p a s s i n g on of i n a c c u r a t e i n f o r m a t i o n . The amount o f i n f o r m a t i o n r e c e i v e d by the p a t i e n t from t h e s o c i a l w o r k e r was c o n s i d e r e d an i n d e x o f the degree to w h i c h the commun-i c a t i o n p r o c e s s had been a f f e c t e d by s p e c i f i c f a c t o r s i n f r i n g i n g on the p r o c e s s . T h i s s t u d y was p a r t i a l l y a r e s u l t of the r e c o g n i t i o n t h a t a p p r o p r i a t e i n f o r m a t i o n a l f l o w between s o c i a l worker and p a t i e n t i s a n e c e s s a r y c o r r e l a t e o f e f f e c t i v e t r e a t m e n t . The a c c u r a t e r e c e p t i o n of i n f o r m a t i o n by the p a t i e n t has i m p o r t n o t o n l y t o the p r o g r e s s o f h i s t r e a t m e n t but a l s o t o t h e e f f i c i e n c y o f i t s a p p l i c a t i o n by the s o c i a l w o r k e r . FACTORS AFFECTING THE FLOW OF INFORMATION The i n t e r r e l a t i o n s h i p of v a r i a b l e s a f f e c t i n g p a t i e n t r e c e p t i v i t y o f i n f o r m a t i o n i s e x c e e d i n g l y complex. The communication p r o c e s s between s o c i a l worker and p a t i e n t may depend on such v a r i a b l e s as s p a t i a l d i s t a n c e , s t a t u s and v a l u e d i f f e r e n c e s . An a c t i v e o r g a n i z a t i o n o f p a s t r e a c t i o n s and e x p e r i e n c e s on t h e p a r t o f t h e p a t i e n t was a l s o presumed t o be o p e r a t i v e i n terms o f p a t i e n t r e c e p t i o n of i n f o r m a t i o n . I t was c o n s i d e r e d i m p o r t a n t t o work toward s u g g e s t i n g r e l a t i o n s h i p s and h y p o t h e s e s among s p e c i f i c f a c t o r s i n f r i n g i n g on t h e i n f o r m a t i o n a l f l o w between s o c i a l w o r k e r and p a t i e n t . Why has i n f o r m a t i o n w h i c h would tend t o a m e l i o r a t e p a t i e n t a n x i e t y n o t been a p p r o p r i a t e l y r e c e i v e d by the p a t i e n t . The s p e c i f i c f a c t o r s a f f e c t i n g i n f o r m a t i o n a l f l o w s t u d i e s i n t h i s i t h e s i s were chosen i n c o n s u l t a t i o n w i t h t h e s u p e r v i s o r y s t a f f o f t h e S o c i a l . S e r v i c e Dept. o f R i v e r v i e w H o s p i t a l and was n o t c o n s i d e r e d t o be an e x h a u s t i v e l i s t , b u t r a t h e r , the s e l e c t i o n was based upon th o s e f a c t o r s w h i c h were thought t o have t h e most i n f l u e n c e on t h e r e c e p t i o n of i n f o r m a t i o n by t h e p a t i e n t . OBJECTIVES OF STUDY There has been v e r y l i t t l e r e s e a r c h done i n t h i s a r e a . Subse-q u e n t l y , i t was d e c i d e d t h a t t he g e n e r a l p u r p o s e o f t h i s s t u d y c o r r e l a t e d w i t h P o l a n s k y ' s o b j e c t i v e o f an e x p l o r a t o r y f o r m u l a t i v e r e s e a r c h d e s i g n , i n t h a t , "The o b j e c t i v e i s the i d e n t i f i c a t i o n o f sound q u e s t i o n s p r o m i s i n g c o n c e p t s and p r e l i m i n a r y h y p o t h e s e s i n a f i e l d w h i c h , as y e t , has had l i m i t e d development and t h e r e f o r e i s n o t p r e p a r e d f o r e l a b o r a t e e x p e r i m e n t a l d e s i g n t o t e s t complex h y p o t h e s e s " . (25, p.51) I n i t i a l l y t he o b j e c t i v e o f t h i s s t u d y was t o d e t e r m i n e t h e e f f e c t o f s p e c i f i c f a c t o r s on p a t i e n t r e c e p t i v i t y o f i n f o r m a t i o n . I t i s t o be remembered t h a t our purpose was n o t t o condemn e x i s t i n g p r o c e s s e s r a t h e r t h e r e was an att e m p t a t e x p l o r a t i o n and s u g g e s t i o n . We were n o t concerned w i t h t h o s e f a c t o r s w h i c h may d i s t o r t t he w o r k e r s p e r c e p t i o n o f the i n f o r m a t i o n t o be s e n t t o t h e p a t i e n t . RELEVANCE OF THE STUDY TO DIFFERENT GROUPS The o r i g i n a l r e s e a r c h d e s i g n and pu r p o s e was b e l i e v e d t o be o f importance t o a number o f s e c t o r s o f t h e p o p u l a t i o n . W i t h the i n s t i t u t i o n o f a new d e s i g n and subsequent r e o r g a n i z a t i o n o f purpose and method we s t i l l f e e l t h a t t h i s t h e s i s as a t o t a l i t y has r e l e v a n c e t o a number o f groups o f p e o p l e . P o l i c y makers on the governmental l e v e l s a r e l i n k e d i n many ways t o t h e a d m i n i s t r a t i o n o f the h o s p i t a l . I n d i v i d u a l s i n v o l v e d i n p l a n n e d e x t e n s i o n of M e n t a l H e a l t h f a c i l i t i e s b o t h a t R i v e r v i e w and o t h e r a r e a s a r e n a t u r a l l y c o n c e r n e d w i t h a t h e r a p e u t i c m i l i e u f o r the p a t i e n t . T h i s s t u d y , p u r e l y on an a r c h i t e c t u r a l l e v e l may e n a b l e such changes as o f f i c e l o c a t i o n , t o be p l a n n e d i n such a way t h a t i n f o r m a t i o n a l needs o f the p a t i e n t would be b e s t f a c i l i t a t e d . Some S o c i a l Work o f f i c e s a r e l o c a t e d a t a g r e a t d i s t a n c e from the ward s e r v e d and a r e n o t as a c c e s s i b l e as t h o s e o f f i c e s w h i c h a r e p l a c e d on or near t h e ward. The optimum number o f S o c i a l Workers employed i n t h e two a c u t e a r e a s o f the R i v e r v i e w H o s p i t a l , namely Crease and C e n t e r Lawn U n i t s i s p r e s e n t l y under c o n s i d e r a t i o n by a d m i n i s t r a t i o n and s u p e r v i s o r y s t a f f . H o p e f u l l y , t h i s s t u d y w i l l have a b e a r i n g on t h e i m p l e m e n t a t i o n o f such p l a n s as t h e s e . P r a c t i t i o n e r s o f c l i e n t s e r v i c e method a r e by v i r t u e o f t h e i r p r o f e s s i o n a l s t a t u s and r o l e w i t h i n t h e h o s p i t a l c o n c e r n e d w i t h the optimum enhancement o f t h e i n d i v i d u a l p a t i e n t ' s s o c i a l f u n c t i o n i n g . Other p r o -f e s s i o n a l groups o p e r a t i n g i n the h o s p i t a l a r e n a t u r a l l y concerned w i t h the S o c i a l Worker's e f f e c t i v e n e s s as p a r t o f the t r e a t m e n t team. T h i s s t u d y i s o n l y concerned w i t h the communication between S o c i a l Worker and p a t i e n t . But by the n e c e s s a r y d e l i n e a t i o n of t r e a t m e n t f u n c t i o n i n h e r e n t i n the S o c i a l Worker's r o l e o t h e r groups a r e n e c e s s a r i l y concerned w i t h the t o t a l t r e a t m e n t o f the p a t i e n t . B e t t e r use o f t i m e a v a i l a b l e t o S o c i a l Workers a r e o f c o n c e r n t o t h e S o c i a l Worker h i m s e l f i n termsa o f e f f e c t i v e and e f f i c i e n t c a s e l o a d s and a l s o t o p o l i c y makers and d e c i s i o n makers. The e f f e c t i v e r e c e p t i o n o f i n f o r m a t i o n by the p a t i e n t i s one o f the main c o r r e l a t e s of e f f e c t i v e t r e a t m e n t . Enhanced communication and i n f o r m a t i o n f l o w d e c r e a s e s a n x i e t y w h i c h i n c r e a s e s t h e p a t i e n t ' s a c c e s s i b i l i t y t o t r e a t m e n t . C l i e n t groups have a v e s t e d i n t e r e s t i n the s t u d y as i t a t t e m p t s t o d e t e r m i n e f a c t o r s w h i c h may have a d e t r i m e n t a l e f f e c t on t h e i r p r o g r e s s i n t r e a t m e n t . I t has been our e x p e r i e n c e t h a t p a t i e n t s i n g e n e r a l a r e p o o r l y i n f o r m e d as t o w h i c h s t a f f member i s more a p p r o p r i a t e t o s a t i s f y t h e p a t i e n t s i n f o r m a t i o n a l needs. T h i s s t u d y may i n g e n e r a l , s u p p o r t r e o r g a n i z a t i o n o f t h e S o c i a l Worker's communicative o r g a n i z a t i o n , w i t h t e n t a t i v e a p p l i c a t i o n t o o t h e r s t a f f members b e n e f i t t i n g the t r e a t m e n t o f t h e p a t i e n t as a t o t a l p e r s o n . W i t h t h i s f a c i l i t a t i o n t h e p a t i e n t i s b e t t e r a b l e t o engage h i m s e l f i n the t h e r a p e u t i c endeavours made, n o t o n l y by S o c i a l W o r k e r s , b u t a l s o by o t h e r members o f the t r e a t m e n t team. We b e l i e v e t h a t t h i s s t u d y has v a l u e to t h e r e s e a r c h e r who i s c o n d u c t i n g r e s e a r c h w i t h i n a m e n t a l h o s p i t a l . More and more m e n t a l h o s p i t a l s a r e b e i n g used as r e s e a r c h s i t e s by v i r t u e o f s p e c i a l advantages i n h e r e n t i n i t s s t r u c t u r e . S c h w a r t z o u t l i n e s a number o f b a s i c r e a s o n s f o r t h i s growth i n i n t e r e s t and r e s e a r c h a c t i v i t y : 1. Ready a c c e s s i b i l i t y o f c a p t i v e r e s e a r c h s u b j e c t s ; 2. O b s e r v a t i o n i s f a c i l i t a t e d by v i r t u e of l i m i t e d p h y s i c a l space 3. A h o s p i t a l ward may be v i e w e d as a s m a l l s c a l e s o c i a l system 4. V a r i a b l e s may be more e a s i l y r e s t r i c t e d ; 5. P a t i e n t f e e l i n g s a r e more e a s i l y p e r c e i v e d as many p a t i e n t s l a c k the a b i l i t y t o c o n t a i n them; 6. An e v a l u a t i o n o f d e v i a n t b e h a v i o u r may h e l p e x p l a i n convent7 i o n a l s t r u c t u r e d o r g a n i z a t i o n s . A l s o t h i s s t u d y may i l l u s t r a t e the impact o f S o c i a l R e s e a r c h upon ward s t a f f and o t h e r p r o f e s s i o n a l s u b - s y s t e m s . We b e l i e v e r e s e a r c h e r s a r e a l s o concerned w i t h the p o s s i b l e r e s u l t s o f t h i s s t u d y by v i r t u e o f i t s h e u r i s t i c e x p l o r a t o r y f o r m u l a t i v e d e s i g n . The f o r m u l a t i o n o f more f r u i t f u l h y p o t h e s e s b e i n g an i n h e r e n t g o a l o f t h i s s t u d y w i l l be u s e f u l i n o t h e r r e s e a r c h s t u d i e s . D e f i n i t e r e s e a r c h problems w h i c h a r e e n c o u n t e r e d d u r i n g the p e r i o d o f t h e s t u d y , such as d i f f i c u l t i e s i n d e f i n i n g s t a f f r o l e s and p o s s i b l e s k e w i n g o f o b j e c t i v e d a t a r e c e i v e d from m e n t a l l y d i s t u r b e d i n d i v i d u a l s w i l l be i l l u s t r a t i v e o f p o s s i b l e p i t f a l l s t o be a v o i d e d i n f u t u r e r e s e a r c h s t u d i e s . The l i t e r a t u r e on i n f o r m a t i o n f l o w i n a m e n t a l h o s p i t a l of t h i s s i z e i s not l a r g e , h o p e f u l l y t h i s s t u d y w i l l c o n t r i b u t e t o t h e g e n e r a l fund o f knowledge i n t h i s a r e a . The p u b l i c a t l a r g e a r e m a n i f e s t i n g an i n c r e a s i n g i n t e r e s t i n the t r e a t m e n t o f m e n t a l p a t i e n t s . C o n s t r u c t i v e r e s e a r c h s t u d i e s a r e g r o w i n g i n p o p u l a r i t y as t h e r e i s a i n c r e a s e d p u b l i c p r e s s u r e t o r e o r g a n i z e the l a r g e m e n t a l h o s p i t a l s . S i m p l y t h e p u b l i c a t l a r g e has a v e s t e d i n t e r e s t i n m e n t a l i l l n e s s and i t s t r e a t m e n t . The l a r g e number o f p e o p l e who a t one t ime or a n o t h e r w i l l be c o n f i n e d i n a m e n t a l h o s p i t a l , (one out of e v e r y t e n C a n a d i a n s ) , a r e the c o n c e r n o f the p u b l i c . P o s s i b l e s t r u c t u r a l and o r g a n -i z a t i o n a l changes s u g g e s t e d by t h i s s t u d y may a l s o i n c i d e n t l y r e d u c e t h e c o s t o f m a i n t a i n i n g a l a r g e i n s t i t u t i o n such as R i v e r v i e w H o s p i t a l . ALTERNATIVES TO RESEARCH There were a number of a l t e r n a t i v e s o l u t i o n s t o the s o c i a l work p r o b l e m w h i c h was i d e n t i f i e d i n p r e v i o u s d i s c u s s i o n and w h i c h r e l a t e d t o the o r i g i n a l r e s e a r c h d e s i g n . We assumed t h a t t h e b a s i c p r o b l e m was t h a t of t h e d i f f i c u l t i e s i n p r o v i d i n g i n f o r m a t i o n t o the p a t i e n t s . L o g i c a l l y , we may have s t a t e d t h a t t h e p a t i e n t s need f o r i n f o r m a t i o n i s n o t p a r t i c u l a r l y i m p o r t a n t . C h e m i c a l and p h y s i c a l t r e a t m e n t would c u r e t h e p a t i e n t and s u b s e q u e n t l y he would be a b l e t o s e c u r e the needed i n f o r m a t i o n upon d i s c h a r g e from t h e h o s p i t a l . T h i s v i e w p o i n t would s t a t e t h a t a l t h o u g h i n f o r m a t i o n may be h e l p f u l t o p a t i e n t s i t i s n o t e s s e n t i a l t o t h e i r t r e a t -ment re g i m e n i n h o s p i t a l . T h i s s o l u t i o n was c o n t r a - i n d i c a t e d by a s u r v e y o f the l i t e r a t u r e w h i c h s t r e s s e d the i m p o r t a n c e of s a t i s f y i n g t h e i n f o r m a t i o n -a l needs o f t h e p a t i e n t as an i n t e g r a l p a r t of the t o t a l t r e a t m e n t p l a n . A n o t h e r p o s s i b l e s o l u t i o n was i d e n t i f i e d as p r o v i d i n g the needed i n f o r m a t i o n t o p a t i e n t s t h r o u g h d i f f e r e n t communi.Sation p r o c e s s e s . I n o t h e r words th e communicative s i t u a t i o n would be improved upon by f r e e i n g t h e S o c i a l Worker o f o t h e r r e s p o n s i b i l i t i e s or t o o t h e r w i s e make him more a v a i l a b l e t o g i v e t h e needed i n f o r m a t i o n . The number o f S o c i a l Workers c o u l d be i n c r e a s e d . T h i s s o l u t i o n a l t h o u g h v a l i d i s p a r t i a l l y negated by t h e c h r o n i c n a t u r e o f s t a f f s h o r t a g e s . A n o t h e r s o l u t i o n became ap p a r e n t when i t was deduced t h a t perhaps i t was u n n e c e s s a r y f o r the S o c i a l Worker t o g i v e i n f o r m a t i o n and t h a t t h i s r o l e may be a s s i g n e d t o a n o t h e r s t a f f member. However, much of the i n f o r m a t i o n g i v e n by the S o c i a l Worker i s dependent upon h i s r o l e w h i c h i s based upon p r o f e s s i o n a l knowledge and e x p e r i e n c e . Hence t h i s was deemed i m p r a c t i c a l . A n o t h e r p o s s i b l e s o l u t i o n was l o g i c a l l y i d e n t i f i e d i n t h a t needed i n f o r m a t i o n t h a t a S o c i a l Worker g i v e s m i g h t be p u b l i s h e d and i s s u e d t o p a t i e n t s w h i c h would t h e n d e c r e a s e t h e amount o f c o n t a c t needed f o r i n f o r m a t i o n g i v i n g . T h i s was r e j e c t e d as a r e s u l t o f t h e p r e s e n t d e l e t e r -i o u s e f f e c t s of s t a f f s h o r t a g e s w i t h subsequent r e d u c t i o n o f s t a f f - p a t i e n t c o n t a c t a t t h e p r e s e n t t i m e . A n o t h e r s o l u t i o n t h r o u g h the use o f d i f f e r e n t c ommunicative p r o c e s s e s was seen as r e l y i n g on o t h e r p a t i e n t s t o communicate needed i n f o r m a t i o n . T h i s no doubt o c c u r s now. Perhaps t h i s c o u l d be i n s t i t u t e d i n a more f o r m a l and p u r p o s e f u l manner. However, t h i s may i n c r e a s e the amount o f e r r o r i n t h e i n f o r m a t i o n g i v e n ; much of the o r i g i n a l c o n t e n t and meaning may be l o s t when i n f o r m a t i o n i s communicated by i l l and u n t r a i n e d p e o p l e . RESEARCH IDENTIFICATION OF THE SOCIAL WORK PROBLEM A c e r t a i n amount o f i n f o r m a t i o n may be g a t h e r e d from the l i t e r a t u r e . U n f o r t u n a t e l y t h e r e has been l i t t l e r e s e a r c h i n the a r e a o f our t h e s i s p r o j e c t . We n o t e d however, t h a t t h i s a r e a has been s u g g e s t e d as one r e q u i r i n g r e s e a r c h . We were u n c e r t a i n as t o what f a c t o r s were r e s p o n s i b l e f o r t h e 8. assumed l a c k o f i n f o r m a t i o n r e c e i v e d by the p a t i e n t s . Our a s s u m p t i o n t h a t t h e r e was a l a c k o f i n f o r m a t i o n was based o n l y on p e r s o n a l e x p e r i e n c e and r e a d i n g s o f communication problems i n o t h e r h o s p i t a l s and b$s. n o t y e t been v a l i d a t e d by r e s e a r c h a t R i v e r v i e w H o s p i t a l . We s u r m i s e d t h a t the o r i g i n a l r e s e a r c h d e s i g n would be a b l e t o show: t h e e x t e n t o f t h e l a c k o f i n f o r m a t i o n r e c e p t i o n by p a t i e n t s and s e c o n d l y t h e s i g n i f i c a n c e o f some o f the v a r i a b l e s w h i c h were assumed t o be i n v o l v e d . These v a r i a b l e s had been s e l e c t e d on t h e b a s i s o f a common sense or r a t i o n a l l o o k a t t h e pr o b l e m . On the b a s i s o f our c o l l e c t e d d a t a we c o n s i d e r e d i t p o s s i b l e t o d e m o n s t r a t e t r e n d s w h i c h would s u g g e s t t h e i m p o r t a n c e o f s p e c i f i c f a c t o r s i n t h e communication o f i n f o r m a t i o n . One o f the v a r i a b l e s t o be employed i n t he o r i g i n a l r e s e a r c h d e s i g n was the a c c e s s a b i l i t y o f the worke r t o the p a t i e n t s . T h i s i n p a r t , would be measured by t h e a v a i l a b i l i t y o f an i n t e r v i e w o f f i c e on the ward. I t had been n o t e d from o b s e r v a t i o n and d i s c u s s i o n w i t h w o r k e r s t h a t t h e r e appeared t o be more work.done w i t h p a t i e n t s when t h e r e i s an o f f i c e on the ward. I t was thought t h a t r e s e a r c h s h o u l d be a b l e t o o f f e r some v a l i d d a t a f o r t h e c o n f i r m a t i o n o r r e f u t a t i o n o f t h i s . T h i s i n t u r n may w e l l have an i n f l u e n c e on whether or n o t the S o c i a l S e r v i c e Dept. pushed f o r S o c i a l Work o f f i c e s on the ward. THE NATURE OF SOCIAL WORK INFORMATION I n i t i a l l y i t was b e l i e v e d - . n e c e s s a r y t o d e t e r m i n e what i s i n f o r m a t i o n of a S o c i a l Work n a t u r e w i t h i n t h e r o l e o f a S o c i a l Worker i n a m e n t a l h o s p i t a l . I t was thought t h a t i n f o r m a t i o n o f a S o c i a l Work n a t u r e c o u l d be o b t a i n e d from the p r o f e s s i o n a l l i t e r a t u r e o f S o c i a l Work and from the s u p e r v i s o r y s t a f f o f the R i v e r v i e w H o s p i t a l S o c i a l S e r v i c e Dept. I t was deemed n e c e s s a r y t o a s c e r t a i n i f t h i s i n f o r m a t i o n was i n f a c t communicated t o t h e p a t i e n t s . I t was d e c i d e d t o do t h i s by open ended q u e s t i o n s i n a s e m i - - s t r u c t u r e d i n t e r v i e w w i t h the p a t i e n t . I t was t h ought t h a t a sample o f 40 t o 60 p a t i e n t s would g i v e us a f a i r l y a c c u r a t e a s s e s s -ment f o r p u r p o s e s o f c h i - s q u a r e a n a l y s i s . We would e x p e c t t h a t t h e p a t i e n t s would v a r y a g r e a t d e a l i n terms o f t h e amount o f i n f o r m a t i o n t h a t t h e y r e c e i v e . I t was t h o u g h t t h a t t h e s e f i n d i n g s c o u l d be r e l a t e d t o s i g n i f i c a n t v a r i a b l e s and h o p e f u l l y we may come up w i t h s u g g e s t i o n s as t o what f a c t o r s a r e r e l e v a n t t o the h i g h and low r e c e p t i o n o f i n f o r m a t i o n by t h e p a t i e n t . PURPOSE OF STUDY I n t h i s s t u d y we were concerned t h a t the p a t i e n t s i n f o r m a t i o n a l needs f a l l i n g w i t h i n t h e j u r i s d i c t i o n of t h e S o c i a l Workers r o l e were n o t b e i n g c o m p l e t e l y s a t i s f i e d . I s i n f o r m a t i o n t r a n s m i t t e d by the S o c i a l Worker b e i n g r e c e i v e d by the p a t i e n t ? I s t h i s a r e s u l t o f f a c t o r s a f f e c t i n g the communication p r o c e s s ? B e s i d e s t h e o b v i o u s f a c t o r o f needed s t a f f i n c r e a s e s the S o c i a l S e r v i c e Dept. of R i v e r v i e w H o s p i t a l w i s h e d t o know i f t h e r e were o t h e r f a c t o r s t h a t c o u l d be improved or changed i n o r d e r t o improve or enhance the S o c i a l Worker's a b i l i t y t o communicate i n f o r m a t i o n e f f e c t i v e l y . I t was t h e r e f o r e our p u r p o s e i n the o r i g i n a l d e s i g n t o e v a l u a t e s p e c i f i c f a c t o r s a f f e c t i n g the i n f o r m a t i o n a l f l o w between S o c i a l Worker and p a t i e n t . Through a p p r o p r i a t e r e s e a r c h p r o c e d u r e s we i n t e n d e d t o d e t e r m i n e i f t h e r e was any s t a t i s t i c a l s i g n i f i c a n c e i n t h e r e l a t i o n s h i p s o f t h e s e e x t e r n a l f a c t o r s t o l a c k of i n f o r m a t i o n r e c e p t i o n by the p a t i e n t s . Second-l y i t was d e c i d e d t h a t s u g g e s t i o n would be r a i s e d as t o the i m p l e m e n t a t i o n o f c e r t a i n p l a n s o r c o r r e c t i v e a c t i o n s d e s i g n e d t o enhance t h e S o c i a l Worker - p a t i e n t communication p r o c e s s . T h i r d l y i t was deemed i m p o r t a n t t o s u g g e s t , i f n e c e s s a r y , f u r t h e r r e s e a r c h development i n the a r e a o f s t u d y . 10. REVIEW OF THE LITERATURE There i s a c o n s i d e r a b l e l a c k of l i t e r a t u r e a v a i l a b l e w h i c h a p p l i e s t o our r e s e a r c h s t u d y . S c h wartz has i n d i c a t e d a g r o w i n g emphasis on t h e i m p o r t a n c e of s t u d y i n g c o m m unication and the s e n d i n g and r e c e i v i n g o f i n f o r m a t i o n w i t h i n a m e n t a l h o s p i t a l (31) b u t as y e t t h i s has n o t m a t e r i a l -i z e d t o the degree where i t can be u t i l i z e d and a p p l i e d t o our r e s e a r c h p u r p o s e . However, t h e r e i s a g r o w i n g l i t e r a t u r e f o c u s s e d on the t h e o r -e t i c a l a s p e c t s of i n f o r m a t i o n f l o w as a p a r t o f t h e communication p r o c e s s and where p o s s i b l e we have drawn on t h i s m a t e r i a l i n our s t u d y . ORGANIZATION OF THE RESEARCH REPORT Chapt e r I The f i r s t c h a p t e r i s concerned w i t h the frame of r e f e r e n c e t o w h i c h t h e o r i g i n a l s t u d y d e s i g n a p p l i e d . The i m p o r t a n c e of a p p r o p r i a t e i n f o r m a t i o n s e n d i n g and r e c e p t i o n i s s t r e s s e d w i t h an emphasis on the e f f e c t s of enhanced i n f o r m a t i o n f l o w and the f a c t o r s w h i c h a f f e c t t h i s enhancement. The o b j e c t i v e s and g e n e r a l p u r p o s e s o f t h e s t u d y a r e d i s c u s s e d b o t h i n r e l a t i o n t o t h e s t u d y i t s e l f b u t a l s o t h e r e l e v a n c e o f the s t u d y t o d i f f e r e n t groups such as p o l i c y makers c l i e n t g r o u p s , p r a c t i t i o n e r s e t c . The a l t e r n a t i v e s open t o r e s e a r c h s t u d y a r e d i s c u s s e d . C h a p t e r I I The second c h a p t e r i s c o n c e r n e d w i t h the a c t u a l o r i g i n a l s t u d y d e s i g n o f t h e p r o j e c t . A s s u m p t i o n s and v a r i a b l e s a r e d i s c u s s e d . The l e v e l o f r e s e a r c h d e s i g n i s i d e n t i f i e d w i t h t h e p l a n o f d a t a a n a l y s i s o u t -l i n e d . S a m p l i n g p r o c e d u r e s and methods of g a t h e r i n g d a t a a r e b r i e f l y d i s c u s s e d . The q u e s t i o n n a i r e s u t i l i z e d i n t h e s t u d y a r e i l l u s t r a t e d w i t h r e f e r e n c e t o t h e p r e l i m i n a r y t e s t i n g of t h e i n s t r u m e n t . The r e s u l t s of the p i l o t s t u d y a r e d e s c r i b e d . 11. C h a p t e r I I I The t h i r d c h a p t e r i s concerned w i t h a c r i t i q u e o f the o r i g i n a l d e s i g n . An i n t r o d u c t i o n i s g i v e n . T h e r e i s a c r i t i c i s m o f the methods o f d a t a c o l l e c t i o n as t h e y a p p l y t o the o r i g i n a l d e s i g n . The d i v e r s e r e s e a r c h i n s t r u m e n t s w h i c h have been used a r e c r i t i c i z e d . The e x t r a n e o u s v a r i a b l e s - i n s t i t u t i o n a l , w o r k e r s , p a t i e n t s , r e s e a r c h e r s , a r e c r i t i c i z e d . T h ere i s a d i s c u s s i o n of the method of d a t a c o l l e c t i o n and a c r i t i c i s m o f t h i s as i t a p p l i e s t o t h e o r i g i n a l r e s e a r c h d e s i g n . C h a p t e r IV The f o u r t h c h a p t e r i s concerned w i t h the t h e o r e t i c a l framework of t h e new r e s e a r c h d e s i g n . An i n t r o d u c t i o n i s g i v e n . The r o l e o f i n f o r m a t i o n i n a m e n t a l h o s p i t a l i s d i s c u s s e d w i t h an o u t l i n e o f i n f o r m a t i o n g i v i n g and r e c e p t i o n on a h o s p i t a l ward. There i s a d i s c u s s i o n as t o the p o s s i b l e e f f e c t s o f i n d e p e n d e n t v a r i a b l e s on dependent v a r i a b l e s w i t h i n t h e c o n t e x t o f the new d e s i g n . C h a p t e r V The f i f t h c h a p t e r i s c o n c e r n e d w i t h the p r o p o s e d new r e s e a r c h d e s i g n . The p r o p o s e d h y p o t h e s i s and v a r i a b l e s a r e d e v e l o p e d . The new d e s i g n f o r m a t i s d i s c u s s e d . S u g g e s t i o n s a r e made r e l a t i n g t o t h e i m p l e m e n t a t i o n o f the p r o p o s e d new d e s i g n . There i s a c a t e g o r i z a t i o n of i n f o r m a t i o n a l i t e m s . An o u t l i n e of t h e p r o p o s e d p a t i e n t sample t o be u t i l i z e d i s d i s c u s s e d . There i s a p r e s e n t a t i o n of the r e s e a r c h i n s t r u m e n t t o be used. F i n a l l y t h e r e i s an o u t l i n e of how the d a t a c o l l e c t e d may be a n a l y z e d . CHAPTER I I PILOT STUDY DESIGN AND FINDINGS ASSUMPTIONS OF THE STUDY As has been i n d i c a t e d i n C h a p t e r I , t h i s s t u d y was c oncerned w i t h impediments i n t h e c ommunication p r o c e s s between t h e s o c i a l worker and t h e p a t i e n t , e f f e c t i n g the amount of i n f o r m a t i o n r e c e i v e d by the p a t i e n t . The i m p o r t a n c e o f i n f o r m a t i o n i n t h e t h e r a p e u t i c i n t e r a c t i o n between p a t i e n t and s t a f f has been s t r e s s e d , p o i n t i n g out the n e c e s s i t y o f an e f f e c t i v e exchange between each i n d i v i d u a l . I t was o b s e r v e d t h a t such a p r o c e s s o p e r a t e s between t h e p a t i e n t s and a l l s t a f f members, t h r o u g h t h e v a r i o u s l e v e l s o f h i e r a r c h i a l p o s i t i o n s , but i s n o t as e f f i c i e n t as i t s h o u l d be. T h i s communicative p r o c e s s can be impeded by numerous f a c t o r s or v a r i a b l e s p r e s e n t i n t h e s e s e t t i n g s and t h e s e v a r i a b l e s need t o be i d e n t i f -i e d and c o n f i r m e d b e f o r e a s t u d y o f an e x p e r i m e n t a l n a t u r e can be d e s i g n e d . We were concerned w i t h t h e e f f i c i e n c y o f t h i s p r o c e s s , but f o r the p u r p o s e o f t h i s p i l o t p r o j e c t , i t was d e c i d e d t o c o n c e n t r a t e on t h e q u a n t i t y , r a t h e r t h a n t h e q u a l i t y , o f the i n f o r m a t i o n b e i n g s e n t . We were, a l s o , aware t h a t impediments t o the amount of i n f o r m a t i o n b e i n g r e c e i v e d c o u l d a r i s e a t many p o i n t s d u r i n g t h e p r o c e s s . To l i m i t the e x a m i n a t i o n of the p r o c e s s , c e r t a i n a s s u m p t i o n s were made. We f e l t t h a t i t was n o t f e a s i b l e t o be c oncerned w i t h f a c t o r s w h i c h m i g h t d i s t o r t the w o r k e r ' s i n t e r p r e t a t i o n o f , (29 - 510) or h i s a b i l i t y t o g i v e i n f o r m a t i o n t o the p a t i e n t . We assumed, t h e r e f o r e , t h a t the i n f o r m a t i o n - g i v i n g a s p e c t o f the w o r k e r ' s r o l e was p e r f o r m e d e f f i c i e n t l y and t h a t t h e n e c e s s a r y i n f o r m a t i o n was b e i n g i m p a r t e d t o t h e p a t i e n t . We f e l t , a l s o , t h a t we were n o t i n a p o s i t i o n t o examine p r o p e r l y t h e p a t i e n t ' s a b i l i t y t o i n t e r p r e t a c c u r a t e l y t h e i n f o r m a t i o n r e c e i v e d . I n an a t t e m p t t o l i m i t t h e e f f e c t s o f t h i s a s p e c t , we f o c u s e d the s t u d y on t h a t p a r t of t h e p r o c e s s o c c u r r i n g j u s t b e f o r e t h i s i n t e r p r e t i v e phase - t h e m e s s a g e - r e c e i v e d phase. I t was assumed t h a t the amount of i n f o r m a t i o n r e c e i v e d by the p a t i e n t would be an i n d i c a t i o n o f t h e e f f i c i e n c y o f the c o m municative p r o c e s s t o t h i s p o i n t . Any d i s c r e p a n c i e s i n t h e number o f messages r e c e i v e d by t h e p a t i e n t , when compared t o the number o f messages s e n t by t h e w o r k e r , c o u l d be r e l a t e d t o v a r i a b l e s o c c u r r i n g w i t h i n t h e i n s t i t u t i o n a l s e t t i n g . INFORMATION AREAS Ward s o c i a l w o r k e r s a r e p a r t o f a t r e a t m e n t team i n the h o s p i t a l , a l o n g w i t h p s y c h i a t r i s t s , n u r s e s , o c c u p a t i o n a l t h e r a p i s t s , r e c r e a t i o n a l ^ t h e r a p i s t s ^ and each member o f t h e team "'has a s s i g n m e n t s t o f u l f i l l w i t h r e l a t i o n t o t h e p a t i e n t ' s t r e a t m e n t . Some a s s i g n m e n t s a r e the r e s p o n s i b -i l i t y o f a p a r t i c u l a r d i s c i p l i n e , w h i l e o t h e r s a r e s h a r e d by two or more team members. S o c i a l w o r k e r s g i v e c e r t a i n t y p e s o f i n f o r m a t i o n w h i c h i n v o l v e a t t i t u d e s and f e e l i n g s of t h e p a t i e n t , r e l a t i v e s and o t h e r member's of the p a t i e n t ' s community. (24) They a r e r e s p o n s i b l e f o r t h e i m p a r t i n g o f such i n f o r m a t i o n because o f t h e i r s p e c i a l s k i l l and knowledge o f t h e s o c i a l e l e ments o f a p a t i e n t ' s l i f e . To d e t e r m i n e the amount o f i n f o r m a t i o n a p a t i e n t r e c e i v e d from t h e s o c i a l w o r k e r , i t was n e c e s s a r y t o i d e n t i f y i n f o r m a t i o n a l a r e a s e x c l u s i v e l y c o v e r e d by t h i s d i s c i p l i n e . F o r t h i s p u r p o s e seven i n f o r m a t i o n a l a r e a s were d e v e l o p e d , w h i c h were c o n s i d e r e d i m p o r t a n t t o t h e p a t i e n t ' s t r e a t m e n t , and s h o u l d be c o v e r e d by t h e s o c i a l w o r k e r i n each c a s e . These seven a r e a s i n c l u d e d ; r o l e of the s o c i a l w o r k e r ; awareness o f the team a p p r o a c h ; r e a s o n s f o r .coming t o the h o s p i t a l ( s o c i a l i m p l i c a t i o n s ) ; f i n a n c i a l and l e g a l c o n c e r n s ; f a m i l y f u n c t i o n i n g ; m a t e r i a l - p h y s i c a l a s p e c t s o f d i s c h a r g e p l a n s ; and s o c i a l - e m o t i o n a l p l a n n i n g around d i s c h a r g e and the p a t i e n t ' s r e t u r n t o t h e community. D e f i n i t i o n o f each a r e a , t o a s s i s t i n s c o r i n g i n f o r m a t i o n r e c e i v e d from the p a t i e n t i n t e r v i e w , were i n c l u d e d i n each i n t e r v i e w g u i d e , and a copy o f t h i s g u i d e w i l l be found i n t h e a p p e n d i x . INDEPENDENT VARIABLES A u t o b i o g r a p h i e s o f forme r m e n t a l h o s p i t a l p a t i e n t s (20) were h e l p -f u l i n s u g g e s t i n g numerous v a r i a b l e s . These, p l u s o b s e r v a t i o n s made by some members of the r e s e a r c h group w h i l e employed i n t h e m e n t a l h o s p i t a l , were d i s c u s s e d w i t h the a d v i s o r y committee, and a number were i d e n t i f i e d as b e i n g o f p r o b a b l e i m p o r t a n c e t o t h e communicative p r o c e s s . A l t h o u g h o t h e r p e r t i n e n t v a r i a b l e s d o u b t l e s s l y e x i s t , t h e f o l l o w i n g a r e t h e independent v a r i a b l e s s e l e c t e d f o r the purpose o f t h i s s t u d y ; 1. Number o f c o n t a c t s between s o c i a l w o r k e r and p a t i e n t . B e f o r e we were a b l e t o examine the e f f e c t o f independent v a r i a b l e s on t h e amount o f i n f o r m a t i o n r e c e i v e d by the p a t i e n t , we had t o d e t e r m i n e i f t h e r e had been any o p p o r t u n i t y f o r such messages t o have been s e n t . We were i n t e r e s t e d o n l y i n messages of a m e a n i n g f u l n a t u r e , o f some i m p o r t a n c e t o the p a t i e n t ' s t r e a t m e n t , and we d e f i n e d such c o n t a c t s as t h o s e c o n t a i n i n g some element o f i n f o r m a t i o n -g i v i n g o t h e r t h a n a g r e e t i n g o r exchange o f p l e a s a n t r i e s . The g r e a t e r the number o f such c o n t a c t s , t h e g r e a t e r t h e amount o f i n f o r m a t i o n the p a t i e n t s h o u l d have r e c e i v e d . 2. Number o f p r e v i o u s a d m i s s i o n s t o a m e n t a l h o s p i t a l . P r e v i o u s e x p e r i e n c e as a p a t i e n t i n a m e n t a l h o s p i t a l , e i t h e r R i v e r v i e w H o s p i t a l o r any o t h e r , c o u l d e f f e c t t h e i r m o t i v a t i o n t o r e c e i v e 15. i n f o r m a t i o n from s t a f f members. 3. L e n g t h o f time o f c u r r e n t a d m i s s i o n . T h i s was f e l t t o be i m p o r t a n t because as t h e c o n f i n e m e n t l e n g t h e n s t h e r e a r e more o p p o r t u n i t i e s f o r m e a n i n g f u l c o n t a c t s t o have been c o m p l e t e d . 4. Type o f a d m i s s i o n - v o l u n t a r y o r i n v o l u n t a r y . The t y p e o f a d m i s s i o n p r o c e d u r e used w i t h i n d i v i d u a l p a t i e n t s c o u l d e f f e c t t h e i r r e c e p t i v i t y t o i n f o r m a t i o n g i v e n by s t a f f members. An i n v o l u n t a r y a d m i s s i o n c o u l d be a n e g a t i v e e x p e r i e n c e f o r the p a t i e n t , w i t h a p o s s i b l e n e g a t i v e i n f l u e n c e on t h e i r r e l a t i o n s h i p w i t h s t a f f members. 5. The n a t u r e o f any p r e v i o u s s o c i a l work c o n t a c t s b e f q r e t h e c u r r e n t c o n f i n e m e n t - p o s i t i v e o r n e g a t i v e . The n a t u r e o f t h e s e c o n t a c t s , i f any, c o u l d i n f l u e n c e t h e p a t i e n t ' s r e c e p t i v i t y t o i n f o r m a t i o n o f f e r e d by the h o s p i t a l s o c i a l w o r k e r . 6. D i a g n o s i s o f t h e p a t i e n t 1 s i l l n e s s a t the t i m e o f a d m i s s i o n . Two v e r y b r o a d c a t e g o r i e s were f e l t t o be s u f f i c i e n t t o d e s c r i b e t h e i l l n e s s e s a t t h a t t i m e ; one, p s y c h o t i c and t h e o t h e r , n o n p s y c h o t i c . P s y c h o t i c p a t i e n t s e x p e r i e n c i n g an a c u t e phase of t h e i r i l l n e s s a t the time o f a d m i s s i o n would p r o b a b l y be u n a b l e t o r e c e i v e any i n f o r m a t i o n b e f o r e the p s y c h o t i c a s p e c t s o f t h i s had begun t o wane. N o n p s y c h o t i c p a t i e n t s would be a b l e t o r e c e i v e i n f o r m a t i o n a t the time of a d m i s s i o n as t h e y a r e r e l a t i v e l y i n t o u c h w i t h r e a l i t y . 7. Range, h i g h or low, of p a t i e n t ' s a b i l i t y t o r e a c h out f o r i n f o r m a t i o n . Some p a t i e n t s r e a c h out f o r c o n t a c t w i t h s t a f f , w h i l e o t h e r s a r e r e l u c t a n t t o i n i t i a t e t h i s s t e p . 16. Wards i n a m e n t a l h o s p i t a l a r e e x t r e m e l y busy and s h o r t a g e s o f p e r s o n n e l i n c r e a s e s t h e p r e s s u r e p l a c e d on t h e s t a f f . P a t i e n t s may have t o ask f o r i n f o r m a t i o n v e r b a l l y r a t h e r t h a n w a i t f o r t h e need t o be r e c o g n i z e d and met by the r e s p o n s i b l e s t a f f member. 8. Who i n i t i a t e d t h e f i r s t c o n t a c t between t h e p a t i e n t and th e s o c i a l worker? T h i s i s c l o s e l y r e l a t e d t o the p a t i e n t s , a b i l i t y t o r e a c h out f o r i n f o r m a t i o n . Some p a t i e n t s , w i t h a h i g h range of a b i l i t y t o reaeheijcmt, w i l l seek out the s o c i a l w o r k e r and make t h e i r r e q u e s t s known. O t h e r p a t i e n t s , w i t h a low range of a b i l i t y , w i l l w a i t f o r t h e s o c i a l worker t o c o n t a c t them, or have someone e l s e a p proach t h e w o r k e r f o r them. 9. Source of r e f e r r a l o f p a t i e n t t o s o c i a l w o r k e r . The p r e s t i g e w h i c h a p a t i e n t may p l a c e on a r e f e r r a l t o the s o c i a l worker would v a r y w i t h t h e degree of esteem w i t h w h i c h t h a t p a t i e n t h o l d s t h e r e f e r r i n g p e r s o n and h i s p o s i t i o n . T h i s p r e s t i g e would i n f l u e n c e a p a t i e n t ' s a t t i t u d e towards the s o c i a l w o r k e r and e f f e c t the amount o f i n f o r m a t i o n she would r e c e i v e . 10. L o c a t i o n o f t h e ward s o c i a l w o r k e r ' s o f f i c e . I n R i v e r v i e w H o s p i t a l , ward s o c i a l w o r k e r s ' o f f i c e s a r e e i t h e r on t h e ward o r o f f the ward i n a n o t h e r p a r t o f the same b u i l d i n g . T h i s would have an e f f e c t on the c o n v e n i e n c e f o r the p a t i e n t i n c o n t a c t i n g the w o r k e r , and a l s o the degree o f p r i v a c y a v a i l a b l e f o r i n t e r v i e w s i f t h e y were h e l d on t h e ward i n someone e l s e ' s o f f i c e , i n the l o u n g e or d o r m i t o r y . 11. The n a t u r e of m e n t a l h o s p i t a l e x p e r i e n c e , i f any, o f r e l a t i v e s o f f r i e n d s o f the p a t i e n t - p o s i t i v e o r n e g a t i v e . A l l p e o p l e 17 . have p r e c o n c e i v e d n o t i o n s o f l i f e i n a m e n t a l h o s p i t a l , thcough l i t e r a t u r e , movies or r e p o r t s from o t h e r s . The n a t u r e o f t h e s e n o t i o n s would have an e f f e c t on the p a t i e n t ' s a t t i t u d e towards h o s p i t a l i z a t i o n and t h e i r r e c e p t i v i t y o f i n f o r m a t i o n . 12. The n a t u r e o f the i n f l u e n c e o f r e l a t i v e s ' a t t i t u d e s towards the p a t i e n t ' s h o s p i t a l i z a t i o n - p o s i t i v e o r n e g a t i v e . The a t t i t u d e o f r e l a t i v e s towards h o s p i t a l i z a t i o n w i l l i n f l u e n c e t h e p a t i e n t ' s a t t i t u d e and her r e c e p t i v i t y o f i n f o r m a t i o n . 13. The S o c i o - e c o n o m i c c l a s s of the p a t i e n t . I t was r e c o g n i z e d t h a t d i f f e r e n t s o c i o - e c o n o m i c c l a s s e s have d i f f e r e n t v a l u e a s s u m p t i o n s w i t h r e g a r d t o m e n t a l i l l n e s s . Any c l a s s d i f f e r e n c e between the s o c i a l w o r k e r and p a t i e n t c o u l d e f f e c t t he p a t i e n t ' s r e c e p t i v i t y o f i n f o r m a t i o n from t h e w o r k e r . 14. Number o f c h i l d r e n , t h e i r ages and whether o r n o t t h e y were a t home. T h i s v a r i a b l e would n o t a p p l y t o the e n t i r e p a t i e n t p o p u l a t i o n , b u t was a p p l i c a b l e t o young m a r r i e d m o t h e r s , t h e sample p o p u l a t i o n t h a t was chosen f o r t h i s s t u d y . M o t h e r s , w i t h a l a r g e f a m i l y and/or young c h i l d r e n , f r e q u e n t l y c o n s u l t the ward s o c i a l w o r k e r f o r i n f o r m a t i o n about the c h i l d r e n and t h e i r c a r e w h i l s t t h e y a r e s e p a r a t e d from them by t h e i r h o s p i t a l i z a t i o n . LEVEL OF RESEARCH DESIGN B e f o r e a f i e l d s t u d y o f an e x p e r i m e n t a l d e s i g n t o t e s t s p e c i f i c h y p o t h e s e s and t o d e t e r m i n e p r i o r i t i e s among v a r i a b l e s c o u l d be l a u n c h e d , 18. such h y p o t h e s e s needed t o be d e v e l o p e d . We were c e r t a i n o n l y of a need f o r such a s t u d y due t o the c o n c e r n of v a r i o u s members of the s o c i a l s e r v i c e d e p a r t m e n t . A f o r m u l a t i v e - e x p l o r a t o r y s t u d y was t h o u g h t t o be needed t o d e v e l o p sound p r o b l e m f o r m u l a t i o n s , p r o m i s i n g c o n c e p t s and p r e l i m i n a r y h y p o t h e s e s . (25 - 51) T h i s s t u d y was a p i l o t p r o j e c t t o s u g g e s t l e a d s f o r e x p l o r a t i o n and t o d e v e l o p r e s e a r c h i n s t r u m e n t s t o a s s i s t i n the g a t h e r i n g of n e c e s s a r y d a t a . We were n o t r e a d y f o r a d e s c r i p t i v e - d i a g n o s t i c s t u d y t o a s s e s s f u l l y the c h a r a c t e r i s t i c s o f t h e communicative p r o c e s s as we were n o t aware of a l l such c h a r a c t e r i s t i c s a t t h a t t i m e , and we d i d n o t f e e l we would p l a c e t h e n e c e s s a r y emphasis on a l l the v a r i o u s components. We were, t h e r e f o r e , c o n t e n t t o d e v e l o p t e s t i n g i n s t r u m e n t s and t o d e t e r m i n e t h e i r e f f i c i e n c y i n g a t h e r i n g d a t a when a p p l i e d t o a sample p o p u l a t i o n . The c o n t r o l of t h e r e c o g n i z e d i ndependent v a r i a b l e s was a t t e m p t e d by a c a r e f u l s e l e c t i o n of t h e dependent v a r i a b l e s i n t h i s s t u d y . C l o s e a t t e n t i o n was p a i d t o the s e l e c t i o n of t h e sample p o p u l a t i o n t o i n s u r e c o n s i s t e n c y i n t h e degree of i n v o l v e m e n t w i t h the ward s o c i a l w o r k e r s and t h e amount of i n f o r m a t i o n t h a t s h o u l d be g i v e n . The s e l e c t i o n o f the ward s o c i a l w o r k e r s t h e m s e l v e s was i m p o r t a n t , and o n l y wards w i t h s o c i a l w o r k e r s o f s i m i l a r q u a l i f i c a t i o n s and e x p e r i e n c e were i n c l u d e d . Long hours o f s e a r c h i n g and d i s c u s s i o n went i n t o the s e l e c t i o n o f the i n f o r m a t i o n a r e a s used t o d e t e r m i n e the amount o f i n f o r m a t i o n r e c e i v e d by the p a t i e n t . D i r e c t c o n t r o l o f the i ndependent v a r i a b l e s , w i t h the use of c o n t r o l g r o u p s , was n o t a t t e m p t e d . These v a r i a b l e s were r e c o g n i z e d and each case was examined c l o s e l y t o d e t e r m i n e whether o r n o t each v a r i a b l e was o p e r a t i n g . The p l a n of d a t a a n a l y s i s was s t a t i s t i c a l i n n a t u r e . I f we were a b l e t o d e t e r m i n e a h i g h and low range o f i n f o r m a t i o n r e c e i v e d and t h e n com-p a r e t h e s e dependent v a r i a b l e s w i t h a h i g h and low range of o p e r a t i o n f o r each o b s e r v e d i n d e p e n d e n t v a r i a b l e i t s h o u l d b e p o s s i b l e t o d e t e r m i n e any a s s o c i a t i o n s . S t a t i s t i c a l s i g n i f i c a n c e i n each a s s o c i a t i o n c o u l d be c a l c u l a t e d w i t h the use of the c h i - s q u a r e d i s t r i b u t i o n f o r m u l a . SAMPLING PROCEDURES. The sample group was s e l e c t e d on a random b a s i s from a s p e c i f i c p a t i e n t p o p u l a t i o n of the h o s p i t a l . T h i s s p e c i f i c group was chosen on t h e b a s i s of (1) t h e l a r g e s t i d e n t i f i a b l e group of p a t i e n t s h a v i n g as many c h a r a c t e r i s t i c s as p o s s i b l e i n common and (2) t h e group w i t h an e x p e c t e d h i g h degree o f i n v o l v e m e n t w i t h the ward s o c i a l w o r k e r s . T h i s group was the n l i m i t e d t o : (1) p a t i e n t s r e a d y f o r d i s c h a r g e , thus h a v i n g completed the most m e a n i n g f u l p a r t o f t h e i r i n v o l v e m e n t w i t h the w o r k e r ; (2) p a t i e n t s who were n o t s u f f e r i n g from any form o f b r a i n damage, as t h i s t y p e o f p a t h o l o g y has an u n p r e d i c t a b l e e f f e c t on t h e p e r s o n ' s a b i l i t y t o r e c e i v e any s t i m u l i , i n c l u d i n g i n f o r m a t i o n ; (3) t h e p a t i e n t ' s a b i l i t y t o speak t h e E n g l i s h l a n g u a g e ; and (4) r e s i d e n c e i n one o f the f o u r wards chosen f o r e x a m i n a t i o n i n t h i s s t u d y . I t was agreed t h a t the l a r g e s t s p e c i f i c p o p u l a t i o n f i t t i n g t he above c r i t e r i a would be the m a r r i e d mothers between twenty and f o r t y - f i v e y e a r s o f age. T h i s i s a group who have a h i g h p r i o r i t y f o r i n v o l v e m e n t w i t h t h e s o c i a l work department a c c o r d i n g t o h o s p i t a l p o l i c y , due t o t h e i r c o n c e r n as t o the w e l f a r e of t h e i r c h i l d r e n . We were i n t e r e s t e d i n g a t h e r i n g t h e sample from f o u r s e p a r a t e wards, d i v i d e d e q u a l l y between the two a c u t e i l l n e s s u n i t s o f the h o s p i t a l p a t i e n t p o p u l a t i o n . T h i s would a l l o w c o m p a r i s o n between the two a r e a s and f u r t h e r c o m p a r i s o n between t h e two wards i n each a r e a and the f o u r wards s e p a r a t e l y . The s e l e c t e d p o p u l a t i o n o f young m a r r i e d m o t h e r s , on each ward b e i n g c o n s i d e r e d , w e r e - l a r g e enough t o a l l o w random s e l e c t i o n 20 based on t h e c r i t e r i a o f p e n d i n g d i s c h a r g e , l a c k o f b r a i n damage and r e s i d e n c e on a s p e c i f i c ward. A sample o f f o r t y p a t i e n t s was a n t i c i p a t e d - t h i s b e i n g the minimum number r e q u i r e d b e f o r e a s t a t i s t i c a l a n a l y s i s based on t h e c h i -s q u are d i s t r i b u t i o n c o u l d be c o m p l e t e d . D a t a c o l l e c t i o n was l i m i t e d t o s i x weeks t o a l l o w s u f f i c i e n t t i m e f o r s t a t i s t i c a l a n a l y s i s . I t was d e c i d e d t o a c c e p t e v e r y e l i g i b l e p a t i e n t f o r i n t e r v i e w as i t was n o t known j u s t how many p a t i e n t s c o u l d be e x p e c t e d from each ward d u r i n g t h i s p e r i o d o f t i m e . The c o o p e r a t i o n of the charge n u r s e i n each ward was r e q u e s t e d , t o r e f e r e l i g i b l e p a t i e n t s t o the r e s e a r c h tfeam. The charge n u r s e was r e q u i r e d t o n o t i f y a s p e c i f i e d member o f t h i s team o f any d i s c h a r g e s . METHODS'OF GATHERING DATA The p a t i e n t would be u n a b l e t o s u p p l y i n f o r m a t i o n r e g a r d i n g a l l t h e v a r i a b l e s we were i n t e r e s t e d i n e x a m i n i n g . Other s o u r c e s of d a t a would be r e q u i r e d , and any d u p l i c a t i o n o f i n f o r m a t i o n r e c e i v e d from more t h a n one s o u r c e c o u l d s e r v e as an a u t h e n t i c i t y check on t h e s e i t e m s w i t h a r e s u l t i n g i n d i c a t i o n of v a l i d a t i o n w i t h r e g a r d t o o t h e r i t e m s . D a t a was g a t h e r e d from t h r e e s o u r c e s - the p a t i e n t , t h e ward s o c i a l w o r k e r and t h e p a t i e n t ' s f i l e . An i n t e r v i e w g u i d e was a d m i n i s t e r e d by a r e s e a r c h e r t o each s e l e c t e d p a t i e n t j u s t b e f o r e h e r d i s c h a r g e from h o s p i t a l . An a t t e m p t was made t o c o n t r o l any p o s s i b l e b i a s towards s o c i a l w o r k e r s on the p a r t o t h e p a t i e n t by i n t r o d u c i n g t h e i n t e r v i e w e r as a r e s e a r c h e r from U.B.C., r a t h e r t h a n as a s t u d e n t s o c i a l w o r k e r . We were i n t e r e s t i n t h e p a t i e n t 1 c o o p e r a t i o n , b u t wanted t o keep the f o c u s o f the i n t e r v i e w away from the s o c i a l w o r k e r as much as p o s s i b l e . T h i s approach c o u l d c r e a t e a n x i e t y i n 21. some p a t i e n t s , b u t t h i s a n x i e t y would be r e d u c e d i f the p u r p o s e of the s t u d y was e x p l a i n e d b e f o r e the i n t e r v i e w . We e n l i s t e d t h e a i d o f t h e charge n u r s e t o make the s u g g e s t e d i n t r o d u c t i o n and t o e x p l a i n t o each p a t i e n t t h a t t h i s was a s t u d y of s e l e c t e d a s p e c t s of p a t i e n t l i f e i n the h o s p i t a l . The second s o u r c e o f d a t a was a q u e s t i o n n a i r e on each p a t i e n t i n t e r v i e w e d and was g i v e n t o the ward s o c i a l w o r k e r f o r c o m p l e t i o n . T h i s s u p p l i e d i n f o r m a t i o n p e r t a i n i n g t o some o f the v a r i a b l e s i n w h i c h we were i n t e r e s t e d . A t h i r d s o u r c e o f i n f o r m a t i o n was each p a t i e n t ' s d i a g n o s t i c and t r e a t m e n t f i l e . A l i s t o f s e l e c t e d items was p r e p a r e d t o g u i d e the c o l l e c -t i o n of i n f o r m a t i o n , p e r t a i n i n g t o the i n d e p e n d e n t v a r i a b l e s . When i t became e v i d e n t t h a t the number o f s e l e c t e d p a t i e n t s would no t be l a r g e enough t o p r o v i d e s u f f i c i e n t d a t a f o r c h i - s q u a r e a n a l y s i s , i t was d e c i d e d t o use what d a t a we had o b t a i n e d by 2 8 t h F e b r u a r y , 1967 t o d e t e r m i n e i f any t r e n d s were d i s c e r n a b l e . I t had been assumed e a r l i e r t h a t the s o c i a l w o r k e r c o v e r e d a l l the i n f o r m a t i o n a r e a s w i t h each p a t i e n t . A t t h i s t ime the r e s e a r c h e r s became aware o f t h e f a c t t h a t t h i s was an i n a c c u r a t e a s s u m p t i o n . T h e r e f o r e i t became n e c e s s a r y t o d e t e r m i n e how many of the i n f o r m a t i o n a r e a s the s o c i a l w o r k e r had c o v e r e d w i t h i n d i v i d u a l p a t i e n t s . A S o c i a l Worker I n t e r v i e w Guide was p r e p a r e d and a d m i n i s t e r e d t o the ward s o c i a l w o r k e r s i n v o l v e d . T h i s d a t a would p r o v i d e us w i t h a b a s i s of c o m p a r i s o n t o the amount of i n f o r m a t i o n r e c e i v e d by each p a t i e n t . T h i s r a t i o c o u l d t h e n be c o r r e l a t e d w i t h each i d e n t i f i e d i n d e p e n d e n t v a r i a b l e . DATA COLLECTION INSTRUMENTS P a t i e n t I n t e r v i e w Guide (Appendix A) T h i s g u i d e was d e s i g n e d to p r o v i d e some s t r u c t u r e f o r the 22. i n t e r v i e w e r and the i n t e r v i e w e e , t o be c e r t a i n t h a t a l l the n e c e s s a r y a r e a s o f i n f o r m a t i o n were c o v e r e d , and t o i n s u r e t h a t each q u e s t i o n was asked i n an o r d e r e d sequence. The e x a c t w o r d i n g of each q u e s t i o n , when asked o f t h e p a t i e n t , was l e f t t o the d i s c r e t i o n of the i n t e r v i e w e r . He was i n f o r m e d o n l y o f the g e n e r a l w o r d i n g of t h e q u e s t i o n and what i n f o r m a t i o n was b e i n g sought i n t h e answer. The sequence o f the q u e s t i o n s was t o be adhered t o , however, because of the p e r s o n a l i t y o f t h e sample p o p u l a t i o n . I t was c o n s i d -e r e d i m p o r t a n t t o b e g i n the i n t e r v i e w w i t h the n o n - t h r e a t e n i n g q u e s t i o n s , p r o c e e d t o t h e more t h r e a t e n i n g m a t e r i a l and a t t e m p t t o f i n i s h w i t h l e s s t h r e a t e n i n g q u e s t i o n s a g a i n , t o l e s s e n t h e a n x i e t y w h i c h may have been r a i s e d i n each p a t i e n t . R o l e p l a y i n g was used t o f a m i l i a r i z e i n t e r v i e w e r s w i t h t h e g u i d e and i t s p r o p e r a p p l i c a t i o n t o t h e i n t e r v i e w . Each group member took t u r n s p l a y i n g t h e i n t e r v i e w e r and i n t e r v i e w e e , and asked a l l t h e q u e s t i o n s . T h i s p e r m i t t e d some e x p e r i m e n t a t i o n w i t h v a r i o u s w o r d i n g s o f the q u e s t i o n s and e l i m i n a t e d t h e need f o r the i n t e r v i e w e r t o do t h i s w i t h the i n t e r v i e w e e d u r i n g the f i r s t i n t e r v i e w . The g u i d e c o n t a i n e d q u e s t i o n s t o d e t e r m i n e what i n f o r m a t i o n t h e p a t i e n t had r e c e i v e d i n s p e c i f i c a s p e c t s o f t h e i r l i f e , and from whom t h i s i n f o r m a t i o n had been o b t a i n e d . Q u e s t i o n s as t o some v a r i a b l e s were a l s o i n c l u d e d . Other q u e s t i o n s were o f a n a t u r e t o a s s i s t the p a t i e n t t o c o n s i d e r a l l members of the t r e a t m e n t team, n o t j u s t the s o c i a l w o r k e r , so t h a t the theme o f i n f o r m a t i o n b e i n g sought would n o t be t o o e v i d e n t t o the i n t e r v i e w e e . We were co n c e r n e d w i t h the over c o o p e r a t i v e n e s s of some p a t i e n t s who c o u l d be e x p e c t e d t o answer q u e s t i o n s i n t h e manner th e y a n t i c i p a t e d we would e x p e c t , i f t h e q u e s t i o n s were t o o d i r e c t as t o a s p e c i f i c t o p i c . S o c i a l Worker Q u e s t i o n n a i r e ( A ppendix B) The q u e s t i o n n a i r e t o be completed by each ward s o c i a l w o r k e r 2 3 . c o n t a i n e d e i g h t i t e m s . Answers t o each i t e m were e i t h e r m u l t i - c h o i c e or o f one or two words o n l y . The i n f o r m a t i o n t o be o b t a i n e d r e f e r r e d t o v a r i a b l e s o n l y and d i d n o t c o v e r any o f t h e i n f o r m a t i o n a r e a s g i v e n each p a t i e n t . F i l e I n f o r m a t i o n Guide (Appendix C) F i l e i n f o r m a t i o n a l s o p e r t a i n e d t o v a r i a b l e s and c o n s i s t e d o f n i n e i t e m s , answers t o each of w h i c h c o u l d be o b t a i n e d from the p a t i e n t s ' f i l e s and n o t e d i n one o f two words.. T h i s g u i d e was t o be completed by the r e s e a r c h e r . S o c i a l Worker I n t e r v i e w Guide (Appendix D) The i n t e r v i e w g u i d e , w h i c h was d e v e l o p e d n e a r the end o f the d a t a c o l l e c t i o n p h a s e , c o v e r e d t h e same i n f o r m a t i o n a r e a s as g i v e n t o t h e p a t i e n t s . The i n t e r v i e w was a d m i n i s t e r e d by a r e s e a r c h e r , who d e f i n e d each i n f o r m a t i o n a r e a , and q u e s t i o n e d the s o c i a l w o r k e r as t o whether the i n f o r m a t i o n had been g i v e n , or had been checked i f i t was assumed t h a t the p a t i e n t a l r e a d y had knowledge i n t h i s a r e a , or was n o t g i v e n or checked by the w o r k e r . PRE-TEST OF PATIENT INTERVIEW GUIDE A f t e r c o m p l e t i o n o f t h e P a t i e n t I n t e r v i e w Guide i t was p r e t e s t e d w i t h a group of p a t i e n t s n o t co n n e c t e d i n any way w i t h t h e f o u r wards p r e v i o u s l y chosen. The same c r i t e r i a used t o s e l e c t t h e sample group were r e p e a t e d i n t h i s s e l e c t i o n w i t h one e x c e p t i o n - two wards from one a c u t e u n i t were used i n s t e a d o f one from each u n i t . The i n t e r v i e w g u i d e was a d m i n i s t e r e d t o e i g h t p a t i e n t s , d u r i n g the same a f t e r n o o n , by a l l f i v e r e s e a r c h e r s . The p r e - t e s t f i n d i c a t e d s e v e r a l changes needed t o be made i n t h e g u i d e . A new i n t r o d u c t i o n of t h e s t u d y , by t h e r e s e a r c h e r s t o t h e p a t i e n t , was w r i t t e n , s p e l l i n g o u t the s t a t e d p u r p o s e i n more d e t a i l . Some q u e s t i o n s r e q u i t e d c l a r i f i c a t i o n and were 24. r e w r i t t e n and f i v e q u e s t i o n s , c o v e r i n g p e r s o n a l i n f o r m a t i o n were added. The sequence of the q u e s t i o n s was r e o r d e r e d t o p r o v i d e more c o n t i n u i t y . The o t h e r d e v i c e s , t h e s o c i a l worker q u e s t i o n n a i r e , f i l e i n f o r m a t i o n o u t l i n e , and t h e s o c i a l w o r k e r i n t e r v i e w g u i d e , were n o t p r e -t e s t e d , but a p p l i e d d i r e c t l y t o d a t a c o l l e c t i o n . PILOT STUDY The g u i d e s and q u e s t i o n n a i r e were a d m i n i s t e r e d t o t h i r t e e n cases b e f o r e the d a t a c o l l e c t i o n t i m e l i m i t e l a p s e d . The a n t i c i p a t e d number of r e f e r r a l s d i d n o t m a t e r i a l i z e . There was some i n i t i a l c o n f u s i o n among the ward s o c i a l w o r k e r s as t o whom th e sample p o p u l a t i o n i n c l u d e d , and a s m a l l number of n o n - e l i g i b l e i n t e r v i e w e e s were r e f e r r e d . The h o s p i t a l i s l o c a t e d t h i r t y m i l e s from the u n i v e r s i t y and i t was not p o s s i b l e f o r an i n t e r v i e w e r t o be a v a i l a b l e on s h o r t n o t i c e . Some p o t e n t i a l i n t e r v i e w e e s were r e l e a s e d a l m o s t i m m e d i a t e l y f o l l o w i n g the d e c i s i o n t o d i s c h a r g e them as t h e y had r e l a t i v e s w a i t i n g f o r them or t r a n s p o r t a t i o n d e a d l i n e s t o meet. D i f f i c u l t y was a l s o e x p e r i e n c e d i n n o t i f y i n g the r e s e a r c h e r s when an e l i g i b l e p a t i e n t was d i s c h a r g e d . The c h a r g e n u r s e s were r e q u i r e d t o t e l e p h o n e the names of r e f e r r a l s t o an a s s i g n e d r e s e a r c h e r , as t h e r e s e a r c h e r was p r o h i b i t e d from c o n t a c t i n g each charge n u r s e by t e l e p h o n e because of a h o s p i t a l r e g u l a t i o n . The c h a r g e n u r s e s were a l l v e r y busy w i t h o t h e r d u t i e s and such t e l e p h o n e c o n t a c t s were an added i n c o n v e n c i e n c e . The ward s o c i a l w o r k e r s a t t e m p t e d t h e same r e s p o n s i b i l i t y , b u t u t h e y , t o o , were t o o busy. A s o c i a l work s u p e r v i s o r i n one a c u t e t r e a t m e n t u n i t assumed t h i s t a s k , b u t the time l i m i t was r e a c h e d b e f o r e t h i s p r o c e d u r e was f u l l y e s t a b l i s h e d . I n a d d i t i o n , t h e p o p u l a t i o n and d i s c h a r g e r a t e of t h e sample group were b o t h very, low d u r i n g t h i s p e r i o d of t i m e . Of t h e t h i r t e e n p a t i e n t s i n t e r v i e w e d o n l y e i g h t were s u i t a b l e f o r d a t a a n a l y s i s . T h r e e of the f i v e r e j e c t e d were e x c l u d e d because t h e y d i d 25. n o t meet t h e age r e q u i r e m e n t . The f o u r t h was n o t b e i n g d i s c h a r g e d w i t h i n t h e s p e c i f i e d time l i m i t , and the f i f t h was n o t i n c l u d e d because of incomple d a t a . The sample o b t a i n e d was t o o s m a l l f o r d a t a a n a l y s i s , b u t a c h a r t s howing the breakdown of t h e d a t a c o l l e c t e d was p r e p a r e d and i s i n c l u d e d i n t h i s r e p o r t . T h i s d a t a does s u g g e s t t h e r e may be some i n t e r e s t i n g c o r r e l a t i o n s , between t h e amount of i n f o r m a t i o n r e c e i v e d and some v a r i a b l e s , t h a t w a r r a n t f u r t h e r s t u d y : 1. G e n e r a l l y a h i g h amount of i n f o r m a t i o n was s e n t by the s o c i a l w o r k e r and t h e r e was v e r y l i t t l e v a r i a t i o n between c a s e s . 2. S o c i a l w o r k e r s s c o r e d low i n t h e number o f p a t i e n t s t o whom the y gave i n f o r m a t i o n r e g a r d i n g f i n a n c i a l and l e g a l m a t t e r s , s u g g e s t i n g t h e s e m a t t e r s do n o t r e c e i v e t h e same a t t e n t i o n as t h e o t h e r i n f o r m a t i o n a l a r e a s . 3. There i s a wide v a r i a t i o n i n the amount of i n f o r m a t i o n r e c e i v e d by each p a t i e n t . 4. The r a t i o o f i n f o r m a t i o n r e c e i v e d / i n f o r m a t i o n s e n t v a r i e s f rom h i g h t o low and d i v i d e s ^ e a s i l y i n t o two groups w i t h f o u r cases i n each. 5. Comparison o f the range of i n f o r m a t i o n r e c e i v e d / i n f o r m a t i o n s e n t r a t i o w i t h some v a r i a b l e s s u g g e s t s c e r t a i n r e l a t i o n s h i p s . These i n c l u d e : (a) T h e r e i s a d i r e c t r e l a t i o n s h i p between the p a t i e n t ' s d i a g n o s i s and t h e i n f o r m a t i o n r a t i o . The n o n - p s y c h o t i c group r e c e i v e d more i n f o r m a t i o n t h e n the p s y c h o t i c group. (b) P a t i e n t s who were a l s o i n v o l v e d i n group s e s s i o n s , as w e l l as i n d i v i d u a l s e s s i o n s , w i t h t h e i r s o c i a l worker r e c e i v e d more i n f o r m a t i o n . P a t i e n t s who r e a c h e d out f o r i n f o r m a t i o n r e c e i v e d more i n f o r m a t i o n . P a t i e n t s who d i s c u s s e d t h e i r h o s p i t a l i z a t i o n w i t h a d o c t o r b e f o r e a d m i s s i o n r e c e i v e d more i n f o r m a t i o n . P a t i e n t s w i t h no p r e v i o u s m e n t a l h o s p i t a l e x p e r i e n c e r e c e i v e d more i n f o r m a t i o n . 27. CHAPTER I I I CRITIQUE OF PILOT STUDY INTRODUCTION I t i s customary i n any such c r i t i q u e o r e v a l u a t i o n , t o emphasise b o t h the p r o c e d u r e s and f i n d i n g s i n v o l v e d i n the s t u d y . As a l r e a d y d e s c r i b e d , however, t h e l a t t e r were i n s u f f i c i e n t t o s u g g e s t many m e a n i n g f u l c o r r e l a t i o n s and i n s t e a d s e r v e d more t o i l l u m i n a t e t h e p o s i t i v e and n e g a t i v e aspects of t h e methodology employed. T h i s c h a p t e r , t h e n , w i l l d w e l l b u t b r i e f l y on t h e p o s s i b l e i n f e r e n c e s o r c o n c l u s i o n s t o be o b t a i n e d from t h e r e s u l t s and w i l l i n s t e a d , f o c u s on t h e l i m i t a t i o n s and v a l i d i t y o f such f i n d i n g s , as d e t e r m i n e d by the p r o c e d u r e s employed, w i t h a v i e w towards b e t t e r m e t h o d o l o g i c a l i n n o v a t i o n s . STUDY DESIGN 1. G e n e r a l l y s p e a k i n g , the purpose o r o b j e c t i v e o f the o r i g i n a l s t u d y was t o d e t e r m i n e i f c e r t a i n f a c t o r s were s i g n i f i c a n t l y a s s o c i a t e d w i t h t h e l e v e l o f e f f i c i e n c y of t h e communication c h a n n e l between s o c i a l w o r k e r and p a t i e n t a t R i v e r v i e w h o s p i t a l . (a) ilpcommunication c h a n n e l was the term used t o r e f e r t o t h e communication p r o c e s s i n v o l v i n g t r a n s m i s s i o n o f i n f o r m a t i o n from s o c i a l w o r k e r t o p a t i e n t . (b) The l e v e l o f e f f i c i e n c y o f t h e communication p r o c e s s was d e f i n e d i n terms o f a h i g h o r low amount o f i n f o r m a t i o n r e c e i v e d by t h e p a t i e n t . Thus an e f f i c i e n t c o mmunication c h a n n e l would be one where a p a t i e n t r e c e i v e d a l a r g e amount of i n f o r m a t i o n from the s o c i a l w o r k e r , w h i l e an i n e f f i c i e n t c h a n n e l would be one where a low amount o f i n f o r m a t i o n would be r e c e i v e d . 28. 2. As an i n d e x of t h e l e v e l o f e f f i c i e n c y of any communication c h a n n e l t h e amount of i n f o r m a t i o n r e c e i v e d i s dependent on two m ain f a c t o r s , t h e y a r e (a) the amount of i n f o r m a t i o n g i v e n , and (b) t h e e f f i c i e n c y o f - t h e t o t a l c ommunicative p r o c e s s . I n o t h e r words, the a b i l i t y o f t h e t r a n s m i t t e r t o send t h e message, t h e f i e l d i n w h i c h the message i s s e n t , and t h e a b i l i t y o f t h e r e c e p t o r t o r e c e i v e the message. I f amount of i n f o r m a t i o n r e c e i v e d i s used as an i n d e x , b o t h f a c t o r s must be t a k e n i n t o a c c o u n t . 3. U n f o r t u n a t e l y , t h e r e s e a r c h e r s d i d n o t d i s t i n g u i s h between t h e s e two f a c t o r s a t t h e t i m e of d e s i g n c o n s t r u c t i o n . Three members of t h e r e s e a r c h t e a m n n e g l e c t e d the "amount o f i n f o r m a t i o n g i v e n ' as b e i n g i m p o r t a n t , f e e l i n g t h a t d i f f e r e n c e s i n amount of i n f o r m a t i o n r e c e i v e d by p a t i e n t s would be due t o the v a r i a b l e s a f f e c t i n g the t r a n s m i s s i o n ^ a n d r e c e p t i o n phases o f t h e communication p r o c e s s . Thus a v e r y s e r i o u s p r o c e d u r a l b l u n d e r was made. The r e a s o n why t h i s b l u n d e r was made was because the r e s e a r c h e r s had been f o r e w a r n e d t h a t t h e h o s p i t a l a d m i n i s t r a t i o n d i d n o t want any e v a l u a t i o n made of t h e i r w o r k e r ' s p e r f o r m a n c e . Of c o u r s e , t h e amount of i n f o r m a t i o n given t o p a t i e n t s by s o c i a l w o r k e r s would be a d i r e c t e v a l u a t i o n o f t h e w o r k e r ' s j o b p e r f o r m a n c e . The r e s e a r c h e r s h a n d l e d t h i s p r e s s u r e by d e n y i n g t h e amount o f i n f o r m a t i o n g i v e n as b e i n g of i m p o r t a n c e . Two members o f the r e s e a r c h team d i d n o t deny t h a t the amount o f i n f o r m a t i o n g i v e n was i m p o r t a n t . I n s t e a d , t h e y h a n d l e d the p r o b l e m o f n o t e v a l u a t i n g t h e w o r k e r s by assuming t h a t t h e s o c i a l w o r k e r s gave a l l i n f o r m a t i o n p o s s i b l e . Thus, o n l y t h e f a c t o r s a f f e c t i n g t h e t r a n s m i s s i o n and r e c e p t i o n o f i n f o r m a t i o n c o u l d a f f e c t e i t h e r a h i g h or low amount o f i n f o r m a t i o n r e c e i v e d . T h i s a s s u m p t i o n ( t h a t a l l i n f o r m a t i o n was g i v e n by t h e s o c i a l w o r k e r s ) was, t o say the l e a s t , r i d i c u l o u s . I n f a c t , one o f t h e r e a s o n s why t h e r e s e a r c h e r s wanted t o do t h e s t u d y i n t h e f i r s t p l a c e , a r o s e out of a c o n c e r n t h a t t h e p a t i e n t s were o f t e n n o t g i v e n needed i n f o r m a t i o n . U n f o r t u n a t e l y , none o f the r e s e a r c h e r s were aware o f t h i s d i s c r e p a n c y i n a s s u m p t i o n s u n t i l the end o f the s t u d y . 4. The v a r i a b l e s the r e s e a r c h e r s s e l e c t e d were thought t o a f f e c t the outcome of t h e t o t a l c ommunicative p r o c e s s , n o t because t h e y m i g h t a f f e c t any p a r t i c u l a r phase of t h e p r o c e s s . I n o t h e r words, t h e r e s e a r c h e r s had hunches, based on e x p e r i e n c e and a r e a d i n g o f the l i t e r a t u r e , t h a t c e r t a i n v a r i a b l e s or f a c t o r s m i g h t a f f e c t t h e amount o f i n f o r m a t i o n r e c e i v e d by p a t i e n t s . Because o f c o n f u s i o n i n the r e s e a r c h group as t o the most i m p o r t a n t v a r i a b l e ( t h e amount o f i n f o r m a t i o n g i v e n ) t h e segment o f t h e group t h a t d e n i e d ( i m p l i c i t l y ) t h e i m p o r t a n c e o f t h e amount o f i n f o r m a t i o n g i v e n as a s i g n i f i c a n t v a r i a b l e a l s o i n c l u d e d ( e x p l i c i t l y ) v a r i a b l e s t h a t t h e y t h o u g h t would a f f e c t the amount of i n f o r m a t i o n g i v e n ( e . g . l o c a t i o n of w o r k e r ' s o f f i c e - on o r o f f t h e w a r d ) . I n o t h e r words, f o r f e a r o f e v a l u a t i n g the s o c i a l work s t a f f , t h e y came t o v i e w t h e amount of i n f o r m a t i o n g i v e n as b o t h i m p o r t a n t and u n i m p o r t a n t a t one and t h e same t i m e . They saw t h e amount of i n f o r m a t i o n g i v e n as i m p o r t a n t when s e l e c t i n g t h e v a r i a b l e s b u t n o t i n ( c o l l e c t i n g and a n a l y s i n g the d a t a . METHODS OF DATA COLLECTION There were t h r e e main s o u r c e s f o r the d a t a c o l l e c t e d i n t h i s s t u d y : -the p a t i e n t s , the case f i l e s and the s o c i a l w o r k e r s a s s i g n e d t o t h e s e p a t i e n t ' s w a rds. I n t u r n , t h e s e s o u r c e s of d a t a were used f o r two p u r p o s e s : -one b e i n g t o c o l l e c t t h e n e c e s s a r y d a t a t o r . a c h i e v e some m e a n i n g f u l c o r r e l a t i o n s and the second b e i n g t o check t h e answers from one s o u r c e w i t h t h o s e from a n o t h e r (a v a l i d i t y c h e c k ) . One o f the m a j o r problems e n c o u n t e r e d i n the development of t h e s e t o o l s f o r c o l l e c t i n g d a t a was c l o s e l y a s s o c i a t e d w i t h our f a i l u r e t o . • . .u... 30. d i s t i n g u i s h t h e q u a l i t y o f p u r p o s e i m p l i c i t i t i n our s t u d y d e s i g n . T h i s c o n f u s i o n among the r e s e a r c h e r s p e r m i t t e d i n t o a l l a r e a s o f t h e s t u d y b u t was most n o t i c e a b l e i n t h e a r e a o f d a t a c o l l e c t i o n . Here, t h e q u e s t i o n s w h i c h were d e v e l o p e d f o r the q u e s t i o n n a i r e s tended t o be vague, u n d e f i n e d and l a c k i n g i n s i n g l e n e s s o f p u r p o s e . T h i s i n t u r n t e s u l t e d i n f i n d i n g s t h a t l a c k e d v a l i d i t y o r a p p l i c a b i l i t y , ( i ) P a t i e n t I n t e r v i e w Guide The p a t i e n t q u e s t i o n n a i r e was d e v e l o p e d t o d e t e r m i n e how much o f the i n f o r m a t i o n t r a n s m i t t e d by the worker was r e c e i v e d by the p a t i e n t and u s i n g the r e s u l t s , we hoped t o show some r e l a t i o n s h i p s t o our dependent v a r i a b l e s . I n p r a c t i s e , s e v e r a l weaknesses e v o l v e d i n t h i s a r e a . The a c t u a l i n t e r v i e w i n g , however w e l l r e h e a r s e d , s t i l l p e r m i t t e d f o r i n d i v i d u a l v a r i a t i o n i n c o n d u c t i n g the p a t i e n t i n t e r v i e w s . Awareness o f the d e s i r e d r e s p o n s e s and t h e tend e n c y o f a l l r e s e a r c h e r s t o p e r c e i v e o n l y t h a t w h i c h s u p p o r t s ones b e l i e f s ( h y p o t h e s i s ) may have r e s u l t e d i n an u n c o n s c i o u s l e a d -i n g o f the p a t i e n t s i n t h e i r v e r b a l r e s p o n s e s or i n a f a u l t y i n t e r p r e t a t i o n of them. The s e m i - s t r u c t u r e d d e s i g n o f the i n t e r v i e w g u i d e f a c i l i t a t e d t h i s by p e r m i t t i n g g r e a t e r i n d i v i d u a l freedom t o d e v e l o p b i a s e s t h a n would a more s t r u c t u r e d a p p r o a c h . The former was chosen m a i n l y because of the u n c e r t a i n t y as t o t h e e f f e c t o f the p a t i e n t ' s i l l n e s s on h e r answers or h e r a b i l i t y t o comprehend t h e q u e s t i o n s . I t was rea s o n e d t h a t as p r o f e s s i o n a l p e o p l e , the r e s e a r c h e r s c o u l d be h e l d r e s p o n s i b l e i n the c o n t r o l of t h e i r biase.sc w h i l e d e v e l o p i n g an a c c u r a t e a c c o u n t of t h e p a t i e n t ' s p e r c e p t i o n s . Because o f t h e vagueness of the q u e s t i o n s and t h e i r g e n e r a l i t y , the s t u d y f i n d i n g s tended t o be l e s s i n d i c a t i v e t h a n o t h e r w i s e p o s s i b l e . The r e s p o n s e s r e q u i r e d from each p a t i e n t were n o t c l e a r l y s p e l l e d out and t h e scope o f t h e q u e s t i o n n a i r e was t o o b r o a d and a l l - e n c o m p a s s i n g . N o n - s p e c i f i c q u e s t i o n s encouraged n o n - s p e c i f i c r e s p o n s e s . A l s o , i f one i s concerned w i t h 31. t h e e f f i c i e n c y o f t h e communication p r o c e s s o r amount o f i n f o r m a t i o n r e c e i v e d , such b r o a d c a t e g o r i e s a r e n o t r e q u i r e d . ( i i ) Case F i l e s The f i l e i n f o r m a t i o n was c o l l e c t e d t o t e s t our v a r i a b l e s and a s c e r t a i n t he g e n e r a l v a l i d i t y o f the p a t i e n t ' s r e s p o n s e s as w e l l as t h e i r p e r c e p t i o n o f r e a l i t y . I n e x t r a c t i n g t h e n e c e s s a r y d a t a from t h e f i l e s however, s e v e r a l e r r o r s r e s u l t e d . When d e t e r m i n i n g t h e number o f p r e v i o u s a d m i s s i o n s and l e n g t h o f h o s p i t a l s t a y , t h e u n i t s o f measurement were o v e r -l o o k e d and n o t d e c i d e d u n t i l a f t e r a l l d a t a had been c o l l e c t e d . W i t h r e s p e c t t o t h e m e d i c a l d i a g n o s i s o f t h e p a t i e n t , t h e r e was l i t t l e d i s c u s s i o n as t o what t h i s i n v o l v e d . T h i s r e s u l t e d i n each member u s i n g d i f f e r e n t c r i t e r i a t o d e t e r m i n e t h e r e a l i t y c o n t a c t o f each p a t i e n t and thus c o n t r i b u t e t o t h e l a c k of u n i f o r m i t y i n d a t a c o l l e c t i o n . An a d d i t i o n a l v a r i a b l e t h a t c o u l d n o t be c o n t r o l l e d l a y i n t h e f a c t t h a t c u r r e n t r e c o r d i n g was o f t e n n o t on the f i l e . ( i i i ) S o c i a l Work Q u e s t i o n n a i r e T h i s q u e s t i o n n a i r e was p r e p a r e d i n o r d e r t o e s t a b l i s h the e x i s t a n c e of s e v e r a l dependent and in d e p e n d e n t v a r i a b l e s w h i c h we had h y p o t h e s i z e d m i g h t i n f l u e n c e the amount of i n f o r m a t i o n r e c e i v e d by p a t i e n t s . I t was r i g i d l y s t r u c t u r e d and the q u e s t i o n s were n o n - t h r e a t e n i n g , thus e n c o u r a g i n g few b i a s e s from t h e w o r k e r s . I t s weakness l a y however, i n t h e f a c t t h a t t h e v a r i o u s terms used i n p o s i n g the q u e s t i o n s were n o t c l a r i f i e d o r d e f i n e d , ( e . g . V e r b a l a c c e s s a b i l i t y - no c l e a r d e f i n i t i o n as t o how t h i s was t o be meas u r e d ) . ( i v ) S o c i a l Work I n t e r v i e w Guide I t was n o t u n t i l t h e end of the d a t a c o l l e c t i o n p e r i o d t h a t we r e a l i z e d t h e d i f f i c u l i t i e s i n assuming t h a t e v e r y w o r k e r had g i v e n ' a l l i n f o r m a t i o n p o s s i b l e ' ( a l l s e v e n i n f o r m a t i o n a l a r e a s ) . A t t h i s p o i n t a s o c i a l worker i n t e r v i e w g u i d e was d e v e l o p e d t o r e c t i f y t h i s s i t u a t i o n and a c h i e v e some degree o f v a l i d a t i o n t o our former a s s u m p t i o n . Here a g a i n i t i s f e l t t h a t t h e w o r k e r s may have p e r c e i v e d t h i s q u e s t i o n n a i r e as p a r t of an e v a l u a t i v e r e s e a r c h s t u d y and thus p o s s i b l y have b i a s e d t h e i r answers. L i t t l e a t t e m p t was made t o c o n c e a l the f a c t t h a t we had p r e v i o u s l y assumed t h a t t h e s e a r e a s would be c o v e r e d by them. STUDY PROCEDURE E x t r a n e o u s V a r i a b l e s The need t o c o n t r o l s p e c i f i c e x t r a n e o u s v a r i a b l e s , thus e s t a b l i s h -i n g some degree o f v a l i d i t y t o our f i n d i n g s , p r e s e n t e d many d i f f i c u l t i e s a r i s i n g a t e v e r y s t a g e i n the development o f t h e s t u d y . F o r c o n v e n i e n c e and c l a r i t y , t h e more i m p o r t a n t of t h e s e w i l l now be e l a b o r a t e d upon under d e s c r i p t i v e h e a d i n g s r a t h e r t h a n i n c h r o n o l o g i c a l o r d e r , ( i ) I n s t i t u t i o n a l - a d m i n i s t r a t i o n & s t a f f W i t h i n the R i v e r v i e w H o s p i t a l , t h e r e a r e numerous departments and o c c u p a t i o n s ( r e f e r A p p e n d i x E) employed i n t h e t r e a t m e n t o f p a t i e n t s and t h e s e t h e n a r e o r g a n i z e d under a c e n t r a l a d m i n i s t r a t i o n . A l t h o u g h such a system has advantages f o r t h o s e f u n c t i o n i n g w i t h i n i t s power s t r u c t u r e , i t posed c e r t a i n d i f f i c u l t i e s t o t h i s s t u d y . The number o f o c c u p a t i o n s and the c o m p l e x i t y o f t h e a d m i n i s t r a t i o n c r e a t e d an immediate p r o b l e m o f communication between the r e s e a r c h team and s p e c i f i c members of t h e h o s p i t a l s t a f f whose c o - o p e r a t i o n was v i t a l i n c o n d u c t i n g the s t u d y . Thus i t was n e c e s s a r y t o i n v o l v e the h o s p i t a l a d m i n i s t r a t i o n , w h i c h u n d o u b t a b l y d i d n o t r e p r e s e n t a consensus on the p a r t o f a l l r e l e v a n t p e o p l e i n v o l v e d w i t h t h e s t u d y and w h i c h , t h r o u g h i t s d i r e c t i v e s , e f f e c t i v e l y p r e v e n t e d our d i r e c t i n v o l v e m e n t w i t h o t h e r p r o f e s s i o n s i n t h e t r e a t m e n t team. The n e c e s s i t y f o r such i n v o l v e m e n t was a t s e v e r a l t i m e s c r i t i c a l t o t h e r e s e a r c h s t u d y and i t s l a c k q u i t e p o s s i b l y i n f l u e n c e d the s t u d y f i n d i n g s . A t t e m p t s t o meet w i t h the 33. n u r s i n g s t a f f i n o r d e r t o e x p l a i n t h e p u rposes o f t h e s t u d y and a c q u i r e t h e i r s u p p o r t added t o t h e i r a l r e a d y heavy r e s p o n s i b i l i t y as i t tended t o u p s e t t h e r o u t i n e on t h e wards f o r w h i c h t h e y were r e s p o n s i b l e . Our one m e e t i n g w i t h the n u r s i n g s t a f f was t h e r e f o r e h u r r i e d and l i t t l e t i me was a v a i l a b l e f o r them t o q u e s t i o n t h e s t u d y or g a i n a f e e l i n g f o r the n e c e s s i t y o f such r e s e a r c h . T h i s l a t t e r f a c t was q u i t e e v i d e n t when a ward n u r s e was r e q u i r e d t o i n t r o d u c e members of t h e r e s e a r c h team t o t h e p a t i e n t . I n v a r i a b l y she f a i l e d t o be a c c u r a t e or c o n s i s t e n t i n h e r a p p orach. T h i s l a c k of conform-i t y t o a p r e v i o u s l y l a i d down p r o c e d u r e was o b s e r v e d t o i n i t i a t e i n many p a t i e n t s a f e e l i n g of i n s e c u r i t y and a p p r e h e n s i o n as t o t h e p u r p o s e o f t h e i r i n v o l v e m e n t . The r e s u l t i n g a n x i e t y no doubt i n f l u e n c e d t h e i r answers t o t h e q u e s t i o n s posed by the r e s e a r c h e r s . D i r e c t phone c o n t a c t w i t h the wards t o g a i n i n f o r m a t i o n r e g a r d i n g p a t i e n t d i s c h a r g e s c o u l d n o t be p e r m i t t e d , as i t was c o n t r a r y t o e s t a b l i s h e d p o l i c y and m i g h t l e a d t o abuses. T h i s r e s t r i c t i o n a f f e c t e d the s t u d y i n s e v e r a l ways as we were now r e q u i r e d t o r e l y on a t h i r d p a r t ( s o c i a l w o r k e r s t o r e l a y i n f o r m a t i o n . These w o r k e r s were n o t always aware of d i s c h a r g e s w h i c h m i g h t be d e c i d e d upon b u t a few hours b e f o r e h a n d and o f t e n t h e y were to o i n v o l v e d w i t h t h e i r own w o r k l o a d t o p e r m i t them t o c o n t a c t us r e g u l a r l y about p a t i e n t d i s c h a r g e s . A l s o , such d i s c h a r g e s tended t o be more the c o n c e r n of t h e ward n u r s e who was the f i r s t t o be i n f o r m e d by the d o c t o r o f such d e c i s i o n s and t h e r e f o r e i n a b e t t e r p o s i t i o n t o r e l a y the r e q u i r e d i n f o r m a t i o n . L a t e r , r e s u l t s showed t h a t many p a t i e n t s were r e l e a s e d from t h wards s t u d i e s , w i t h o u t our f i r s t b e i n g n o t i f i e d , a f a c t w h i c h c o n t r i b u t e d t o t h e e x t r e m e l y s m a l l sample o b t a i n e d and may have l e d t o a b i a s i n t h e s e l e c t -i o n o f t h o s e who were r e f e r r e d . Many p r o f e s s i o n s have c o n t a c t w i t h the p a t i e n t d u r i n g h i s h o s p i t a l -i z a t i o n and as such c o n s t i t u t e p o t e n t i a l e x t r a n e o u s v a r i a b l e s w h i c h m i g h t 34. have c o n s i d e r a b l e i n f l u e n c e on t h e s t u d y f i n d i n g s . D o c t o r s , p s y c h i a t r i s t s , n u r s e s , e t c . , a r e a l l p o t e n t i a l s o u r c e s o f i n f o r m a t i o n f o r t he p a t i e n t and have as p a r t o f t h e i r f u n c t i o n t he r e s p o n s i b i l i t y t o p r o v i d e such i n f o r m a t i o n as i s r e q u i r e d f o r t r e a t m e n t . Such an o v e r l a p s e r v e s t o c o m p l i c a t e any s t u d y w h i c h f o c u s e d on b u t one o f the h o s p i t a l p r o f e s s i o n s (eg. s o c i a l work) as i t i n c r e a s e s t he d i f f i c u l t y i n d e t e r m i n i n g who gave what i n f o r m a t i o n t o whom. S i n c e t h e h o s p i t a l a d m i n i s t r a t i o n s p e c i f i c a l l y r e q u e s t e d t h a t our r e s e a r c h be c o n f i n e d s o l e l y t o the p a t i e n t and n o t " i n t e r f e r e " w i t h t he o t h e r d i s c i p l i n e s t h e r e was no way i n w h i c h we c o u l d c o n t r o l the e f f e c t or p r e v e n t t he o c c u r r e n c e o f t h e s e v a r i a b l e s and now acknowledge t h e i r p o s s i b l e e f f e c t on the s t u d y f i n d i n g s . A f i n a l c r i t i c i s m l i e s i n the manner i n w h i c h the s t u d y was p r e s e n t -ed t o t h e h o s p i t a l a d v i s o r y committee. As t h e r e s e a r c h e r s were c o n f u s e d i n the s t u d y d e s i g n t h i s c o n f u s i o n was no doubt p a s s e d on t o the a d v i s o r y comm-i t t e e thus p r e v e n t i n g them from becoming f u l l y a c t i v e i n t h e p r o j e c t , ( i i ) Workers From t h e s t u d y f i n d i n g s , we n o t e d t h a t o f the 13 p a t i e n t s r e f e r r e d t o u s , 8 o r i g i n a t e d from one wor k e r ^ T h i s f i g u r e , o b t a i n e d over a 6 week p e r i o d , was i n c o n s i s t e n t w i t h t h e e x p e c t e d r e s u l t w h i c h had been based on the c u r r e n t m o n t h l y d i s c h a r g e f i g u r e s f o r s e v e r a l p r e c e d i n g ^ ; months and a p r e v i o u s s t u d y . We were t h e r e f o r e l e d t o s p e c u l a t e t h a t our f a i l u r e t o o b t a i n t h e r e q u i r e d sample may have been r e l a t e d t o the w o r k e r ' s w i t h d r a w a l from what was p e r c e i v e d as e v a l u a t i v e r e s e a r c h . T h i s r e a c t i o n m i g h t t h e n be a s s o c i a t e d w i t h t h e i r f e e l i n g s o f e i t h e r a n x i e t y o r a m b i v o l e n c e . T h i s l a t t e r f e e l i n g m i g h t i n t u r n be r e l a t e d t o the i n c r e a s e t he s t u d y made i n t h e a l r e a d y heavy work l o a d o f the s o c i a l work s t a f f as w e l l as t h e i r l a c k o f awareness as t o the pu r p o s e s and use o f t h e s t u d y . I t i s a l s o p o s s i b l e t h a t c e r t a i n b i a s e s may have been p r e v a l e n t i n 35. our sample s e l e c t i o n . P erhaps t h o s e p a t i e n t s r e f e r r e d by the w o r k e r s were o n l y t h e ones w i t h whom casework i n t e r v e n t i o n had been i n t e n s e and s u c c e s s -f u l . Thus our i n a b i l i t y t o communicate d i r e c t l y w i t h t he wards r e g a r d i n g f o r t h c o m i n g d i s c h a r g e s , may have c o n t r i b u t e d t o such a sample b i a s on t h e p a r t o f the c a s e w o r k e r s . A g a i n , t h e r e was no way t o c o n t r o l t h i s v a r i a b l e d i r e c t l y and r e l i a n c e on t h e p r o f e s s i o n a l competence o f t h e worker was a n e c e s s i t y . I t would be p o s s i b l e , however, t o a c h i e v e some i n d i c a t i o n of v a r i a t i o n between a c t u a l d i s c h a r g e s and th o s e r e f e r r e d , by comparing the s t u d y f i g u r e s w i t h t h o s e c o n t a i n e d i n the h o s p i t a l ' s m ain f i l e , ( i i i ) P a t i e n t s I n our a t t e m p t t o a s s e s s the v a r i o u s f a c t o r s a f f e c t i n g the amount o f i n f o r m a t i o n r e c e i v e d by the p a t i e n t , we found the p a t i e n t ' s i l l n e s s t o be a p r o m i n e n t v a r i a b l e . Not o n l y does the n a t u r e o f the p a t i e n t ' s i l l n e s s compound the p r o b l e m o f a s s e s s i n g the v a l i d i t y o f t h e i r answers, b u t t h e r e i s a l s o t h e f a c t t h a t t he i l l n e s s i s o f t e n a t r a n s i t o r y and f l u c t u a t i n g v a r i a b l e w h i c h d i f f e r s from p a t i e n t t o p a t i e n t and r e s i s t s d e f i n i t i v e c l a s s i f i c a t i o n . O f t e n , the f i r s t few s o c i a l work c o n t a c t s a r e made when the p a t i e n t i s a t the a c u t e phase o f h e r i l l n e s s and l i t t l e i n f o r m a t i o n i s r e t a i n e d f o r t h i s r e a s o n . Thus i t i s d i f f i c u l t f o r t h e worker t o d e t e r m i n e how much i n f o r m a t i o n t h e p a t i e n t has r e c e i v e d and s i m i l a r i l y i t was d i f f i c u l t f o r t h e r e s e a r c h e r s t o d e t e r m i n e the e x t e n t t o w h i c h t h e y c o u l d r e l y on t h e p a t i e n t ' s p e r c e p t i o n o f what t r a n s p i r e d d u r i n g t h o s e c o n t a c t s . The o n l y t r u l y adequate method o f c o u n t e r a c t i n g t h i s p r o b l e m would have been t o p e r s o n a l l y o b s e r v e a l l w o r k e r - p a t i e n t c o n t a c t s d u r i n g h o s p i t a l i z a t i o n and i n t h i s way have l e s s need t o rejjry on t h e p e r c e p t i o n s and r e c o l l e c t i o n s o f b o t h p a t i e n t s and w o r k e r s f o r whom i t i s t h e n n e c e s s a r y t o i n f e r b i a s e s . Such a p r o c e d u r e was however, i m p r a c t i c a l i n t h i s s t u d y f o r many r e a s o n s such as: th e i n c o n v e n i e n c e t o s t a f f and p a t i e n t ; l a c k o f a v a i l a b l e t i m e ; and 36. u n w i l l i n g n e s s of t h e a d m i n i s t r a t i o n t o a l t e r i t s normal r o u t i n e , ( i v ) R e s e a r c h e r s W i t h i n t h e r e s e a r c h team c o n s i d e r a b l e e f f o r t wasc.exerted towards c o n t r o l of p o s s i b l e i n t e r v e n i n g v a r i a b l e s . The q u e s t i o n n a i r e was d e v e l o p -ed by a l l members and i t s p u r p o s e s gone over i n d e t a i l t o e nsure t h a t each was aware of the i n f o r m a t i o n t h e y were r e q u i r e d t o o b t a i n from each p a t i e n t . R o l e p l a y i n g was conducted among the team members and a p r e t e s t was runi. w h i c h h e l p e d c o r r e c t many f a u l t s i n our d e l i v e r y o f t h e q u e s t i o n n a i r e s . N e v e r t h e l e s s , as has a l r e a d y been p o i n t e d o u t , c e r t a i n d i s c r e p a n c i e s d i d a r i s e i n s p i t e of a l l p r e c a u t i o n s t a k e n . O ther d i f f i c u l t i e s i n c o n d u c t i n g t h i s s t u d y were concerned w i t h t i m e and d i s t a n c e . D u r i n g our d a t a c o l l e c t i o n p e r i o d (6 weeks) we had a t t e m p t e d to p r o v i d e an i n t e r v i e w e r f o r e v e r y day o f the week but f e l l s h o r t o f t h i s g o a l as c l a s s e s and f i e l d p l a c e m e n t s c o n f l i c t e d . S e v e r a l t i m e s p a t i e n t s were d i s c h a r g e d from t h e h o s p i t a l w i t h o u t b e i n g c o n t a c t e d , w h i l e t h e i r p l a c e o f r e s i d e n c e b e i n g o u t s i d e Vancouver p r e v e n t e d us from making a home i n t e r v i e w . Such d i f f i c u l t i e s were f u r t h e r enhanced by such p r a c t -i c a l r e q u i r e m e n t s as the d i s t a n c e s i n v o l v e d i n t r a v e l l i n g t o and from R i v e r v i e w H o s p i t a l . The 32 m i l e s i n v o l v e d p r e v e n t e d e a s y or q u i c k a c c e s s t o p a t i e n t s whose d i s c h a r g e was imminent. METHOD OF DATA ANALYSIS I n i t i a l l y we had d e c i d e d t o use t h e Chi-sq'uare i n d e t e r m i n i n g t h e l e v e l o f s i g n i f i c a n c e o f the s t u d y f i n d i n g s and c a l c u l a t e d the minimum number (40) o f p a t i e n t s n e c e s s a r y t o v a l i d a t e our r e s u l t s and a c h i e v e some m e a n i n g f u l c o r r e l a t i o n s between our v a r i a b l e s . T h i s sample was n o t , however, o b t a i n e d and t o e v a l u a t e the d a t a c o l l e c t e d , the o n l y a l t e r n a t i v e was t o use p e r c e n t a g e s . Such r e s u l t s as were o b t a i n e d by t h i s method a r e n o t c o n c l u s i v e i n t h a t t h e sample i t s e l f was not n e a r l y r e p r e s e n t a t i v e o f the t o t a l p o p u l a t i o n ( n e i t h e r by s e l e c t i o n n o r number). N e v e r t h e l e s s , a few c o r r e l a t i o n s were o b t a i n e d and a l t h o u g h the v a l i d i t y o f such f i n d i n g s i s q u e s t i o n a b l e , t h e y a r e n o n e t h e l e s s i n d i c a t i v e o f new approaches and m o d i f -i c a t i o n s t o the p r o b l e m and w i l l be d i s c u s s e d i n Chapter IV. 38. CHAPTER IV THEORETICAL BASIS FOR A NEW. DESIGN INTRODUCTION As has been s t a t e d i n the p r e v i o u s c h a p t e r the r e s e a r c h group e n c o u n t e r e d a number of d i f f i c u l t i e s i n c l e a r l y f o r m u l a t i n g the p r o b l e m t o be s t u d i e d . As a r e s u l t the main q u e s t i o n s o f the s t u d y were so vague t h a t i n d i v i d u a l members of the r e s e a r c h group i n t e r p r e t e d them d i f f e r e n t l y . The d e s i g n t h a t d e v e l o p e d t h e r e f o r e r e f l e c t e d t h i s c o n f u s i o n among the r e s e a r e r s r e g a r d i n g the main q u e s t i o n s of the s t u d y . There i s l i t t l e doubt t h a t t h i s c o n f u s i o n was p e r c e i v e d by the h o s p i t a l a d v i s o r y committee and t h a t t h i s a d v e r s e l y a f f e c t e d the i m p l e m e n t a t i o n o f the s t u d y d e s i g n . I n l o o k i n g back i t seems t h a t a l a c k of a sound t h e o r e t i c a l frame-work l e d t o the c o n f u s e d r e s e a r c h p r o c e s s o u t l i n e d above. T h i s s i t u a t i o n must be remedied i n the new s t u d y and i t i s t o t h i s p u r p o s e t h a t we now d i r e c t our a t t e n t i o n . THEORETICAL FRAMEWORK The R o l e Of I n f o r m a t i o n I n a H o s p i t a l S e t t i n g S i n c e the g e n e r a l p u r p o s e s o f t h e new s t u d y a r e t o a s s e s s t h e p r e s e n t s i t u a t i o n a t R i v e r v i e w H o s p i t a l i n r e g a r d t o p a t i e n t s r e c e i v i n g need-ed i n f o r m a t i o n and t o d e t e r m i n e t h e degree of i m p o r t a n c e of some of t h e f a c t o r s b e l i e v e d t o be i n f l u e n c i n g such a s i t u a t i o n , t h e n we must f i r s t document the r o l e o f i n f o r m a t i o n i n the h o s p i t a l s e t t i n g . The t h e o r e t i c a l framework t h a t w i l l be employed i n e x p l a i n i n g t h i s w i l l be t h a t of g e n e r a l b e h a v i o r systems t h e o r y . However, as the r e a d e r w i l l soon d i s c o v e r , we have a l s o borrowed c e r t a i n c o n c e p t s from communication t h e o r y and r o l e t h e o r y "Systems a r e bounded r e g i o n s i n s p a c e - t i m e , i n v o l v i n g energy i n t e r -change among t h e i r p a r t s , w h i c h a r e a s s o c i a t e d i n f u n c t i o n a l r e l a t i o n s h i p s , and w i t h t h e i r e n v i r o n m e n t s . " (23,433) R i v e r v i e w H o s p i t a l i s such a system f u n c t i o n a l l y i n t e r r e l a t e d w i t h o t h e r systems i n s o c i e t y ( e . g . govern-m e n t a l , l e g a l , e t c . ) . However, as t h e above d e f i n i t i o n s u g g e s t s , any s y stem, i n t h i s case R i v e r v i e w H o s p i t a l , i s composed o f a number o f p a r t s or s u b s y s t e m s . S i n c e t h i s s t u d y i s concerned w i t h p a t i e n t r e c e p t i o n o f i n f o r m -a t i o n g i v e n by s t a f f t h e two l a r g e subsystems t h a t must be c o n s i d e r e d a r e the s t a f f system and t h e p a t i e n t system. L e t us now d e s c r i b e t h e s e systems. The p a t i e n t system o f R i v e r v i e w H o s p i t a l i s composed o f i n d i v i d u a l s (male and f e m a l e ) who have been e i t h e r i n f o r m a l l y or i n v o l u n t a r i l y a d m i t t e d t o h o s p i t a l and who conform:1; t o the d e f i n i t i o n o f a ' m e n t a l l y i l l p e r s o n ' o u t l i n e d i n the M e n t a l H e a l t h A c t . These i n d i v i d u a l s a r e a s s i g n e d t o d i f f -e r e n t u n i t s and wards w i t h i n t h e h o s p i t a l a c c o r d i n g t o t h r e e c r i t e r i a . They a r e as f o l l o w s : (1) t y p e o f i l l n e s s ( a c u t e or c h r o n i c ) ; sex; and (3) g e o g r a p h i c a l r e s i d e n c e . Thus E a s t Lawn U n i t i s composed of c h r o n i c a l l y i l l f e m a l e p a t i e n t s ; West Lawn U n i t t a k e s i n c h r o n i c a l l y i l l male p a t i e n t s ; N o r t h Lawn U n i t i s concerned w i t h male and f e m a l e p a t i e n t s m a n i f e s t i n g acute-p h y s i c a l a i l m e n t s ; C r e a s e U n i t d e a l s w i t h a c u t e l y d i s t u r b e d male and f e m a l e p a t i e n t s from Vancouver C i t y , t h e M u n i c i p a l i t i e s o f N o r t h and West Va n c o u v e r , and Burnaby, w h i l e C e n t e r Lawn U n i t d e a l s w i t h a c u t e l y d i s t u r b e d male and f e -male p a t i e n t s from a l l o t h e r a r e a s of B r i t i s h C o l u m b i a , and R i v e r s i d e U n i t i s c o ncerned w i t h male p a t i e n t s from any a r e a o f B r i t i s h C o l umbia a d m i t t e d t o h o s p i t a l e i t h e r from p e n a l i n s t i t u t i o n s f o r a p e r i o d of p s y c h i a t r i c o b s e r v a t i o n o r from c o u r t s o f law. The s t a f f s ystem of R i v e r v i e w H o s p i t a l can be b r o k e n down i n t o d e p a r t m e n t s or o c c u p a t i o n s . They i n c l u d e the b u s i n e s s or p e r s o n n e l d e p a r t m e n t s , the m e d i c a l d e p a r t m e n t , t h e o c c u p a t i o n a l and r e c r e a t i o n a l t h e r a p y d e p a r t m e n t s , t h e n u r s i n g d e p a r t m e n t , the s o c i a l s e r v i c e department, and so on. These departments tend t o be t h e most d i r e c t l y i n v o l v e d w i t h i n d i v i d u a l p a t i e n t s . But how a r e t h e s e departments i n t e r r e l a t e d w i t h each 40. o t h e r and w i t h the p a t i e n t system? The s t a f f subsystems ( d e p a r t m e n t s ) a r e r e l a t e d t o each o t h e r and t o t h e p a t i e n t system because t h e y have common g o a l s . I f we t a k e t h e s o c i a l s e r v i c e department as a p o i n t of r e f e r e n c e we can soon see t h a t i t does n o t a c t a c c o r d i n g t o i t s own whims, b u t r a t h e r a t t e m p t s t o have i t s f u n c t i o n s i n t e r r e l a t e w i t h t h o s e of o t h e r departments so h o s p i t a l g o a l s such as s u c c e s s f u l t r e a t m e n t of t h e p a t i e n t , p r o t e c t i o n o f t h e community, and t h e m a i n t e n a n c e of t h e t o t a l h o s p i t a l system a r e a c h i e v e d . A l t h o u g h the i n d i v i d u a l s of the p a t i e n t system do n o t n e c e s s a r i l y have the g o a l of e n s u r i n g p r o t e c t i o n f o r the community t h e y are c oncerned w i t h g e t t i n g b e t t e r , and once th e y have been i n h o s p i t a l f o r a w h i l e t h e y a l s o o f t e n become concerned w i t h m a k ing s u r e the system c o n t i n u e s t o f u n c t i o n i n a smooth and o r d e r e d manner (maintenance of the t o t a l h o s p i t a l s y s t e m ) . The h o s p i t a l ward may be c o n s i d e r e d as the u n i t o f s o c i a l s t r u c t u r e where th e g o a l s of the h o s p i t a l a r e a c h i e v e d . A l t h o u g h d i f f e r e n t s t a f f members on t h e ward have d i f f e r e n t f u n c t i o n s , t h e r e s u l t of a complex d i v i s i o n o f l a b o r , t h e y a r e a l l c oncerned w i t h a c h i e v i n g h o s p i t a l g o a l s . F u r t h e r m o r e any s t a f f member a t t e m p t s t o i n t e g r a t e h i s p a r t i c u l a r f u n c t i o n s w i t h t h o s e o f o t h e r s t a f f members so t h a t h o s p i t a l g o a l s a r e r e a l i z e d . As f a r as t h e g o a l o f s u c c e s s f u l t r e a t m e n t i s c o n c e r n e d , i t i s assumed t h a t such c o o p e r a t i o n w i l l have a g r e a t e r t h e r a p e u t i c impact on the p a t i e n t t h a n i f each s t a f f member c a r r i e d out h i s f u n c t i o n s i n d e p e n d e n t l y . Thus th e s t a f f team approach w i t h i t s c o l l e c t i v e d e c i s i o n m a k i n g r e g a r d i n g p a t i e n t s ' t h e r a p e u t i c needs w h i l e i n h o s p i t a l , i s used on m e n t a l h o s p i t a l wards. I n o r d e r t o a c h i e v e p a t i e n t and h o s p i t a l g o a l s o u t l i n e d above b o t h t h e s t a f f and p a t i e n t systems on t h e ward a r e f a c e d w i t h a number o f problems t o be s o l v e d . F o r the i n d i v i d u a l coming i n t o h o s p i t a l " t h e p r o b l e m i s a d a p t a t i o n t o the r o l e of p a t i e n t due t o p h y s i c a l or p s y c h o l o g i c a l i l l n e s s " . 41. ( 2 , 113) I n o t h e r words an i n d i v i d u a l under the s t r e s s of a m e n t a l d i s o r d e r must l e a r n what i s e x p e c t e d of him ( p a t i e n t r o l e ) by the s t a f f s ystem. I n a v e r y s h o r t p e r i o d o f t i m e he must l e a r n a g r e a t d e a l about a w h o le new way o f l i v i n g . Of c o u r s e when the p a t i e n t l e a r n s t h i s , o n e . g o a l o f t h e h o s p i t a l - a smooth r u n n i n g ward-has been r e a l i z e d . C o n v e r s e l y t h e p r o b l e m t h a t s t a f f must overcome i s the l a c k o f u n d e r s t a n d i n g the i n d i v i d u a l has o f what i s e x p e c t e d o f him. I t i s o n l y when th e i n d i v i d u a l has such an u n d e r s t a n d i n g t h a t he i s a b l e t o t a k e advantage of t r e a t m e n t o p p o r t u n i t i e s p r o v i d e d by t h e h o s p i t a l . F o r i n s t a n c e the p a t i e n t w i l l n o t be a b l e t o t a k e advantage of t r e a t m e n t measures such as group t h e r a p y s e s s i o n s i f s t a f f do n o t e x p l a i n t h a t he i s e x p e c t e d t o a t t e n d i n o r d e r t h a t he m i g h t be s u c c e s s -f u l l y t r e a t e d . A t any r a t e t h i s whole p r o c e s s o f a d j u s t i n g t o a new e n v i ronment tends t o be a d i f f i c u l t one f o r p a t i e n t s . A n o t h e r p r o b l e m t h a t p a t i e n t s need s t a f f a s s i s t a n c e i n o v e r c o m i n g i s r e l a t e d " t o r o l e changes and p o s s i b l e impairment and l o s s of r o l e and s t a t u s due t o t h e a s s u m p t i o n of the r o l e o f p a t i e n t . . . . A b s e n c e or r e l i n q u i s h -ment o f accustomed h a b i t u a l r o l e s such as the r o l e s o f husband, f a t h e r , wage e a r n e r and so on, can be s t r e s s f u l i n a d d i t i o n t o t h e p h y s i c a l and p s y c h o l o g -i c a l f a c t o r s w h i c h c r e a t e the r o l e o f p a t i e n t " . ( 2 , 113) A t h i r d p r o b l e m t h a t must be f a c e d i s the i n d i v i d u a l ' s a n x i e t y r e l a t e d t o the r e l i n q u i s h -ment o f the p a t i e n t r o l e and t h e r e t u r n t o h i s r o l e s i n the community. S i n c e t h e h o s p i t a l g o a l of s u c c e s s f u l t r e a t m e n t i m p l i e s the p a t i e n t ' s b e i n g a b l e t o conform to s o c i e t a l r o l e s , the s u c c e s s f u l t r a n s i t i o n from p a t i e n t t o community r o l e s i s most i m p o r t a n t . I n o r d e r t o overcome the above mentioned problems t h e s t a f f system p r o v i d e s p a t i e n t s w i t h a number o f s u p p o r t i v e s e r v i c e s . S t a n t o n and S c h w a r t z , i n t h e i r s t u d y of need f u l f i l l m e n t on a h o s p i t a l ward, o u t l i n e a number of such s e r v i c e s the most i m p o r t a n t o f w h i c h , f o r t h e p u r p o s e s o f t h i s s t u d y , a r e 42. as f o l l o w s : (1) p r o v i s i o n o f someone w i t h whom the p a t i e n t can d i s c u s s h i s p r o b l e m s ; and (2) t h e p r o v i s i o n of i n f o r m a t i o n r e g a r d i n g e i t h e r ward r o u t i n e or p e r s o n a l m a t t e r s . (34, 223-242) I t i s l i k e l y t h a t the i n f o r m a t i o n a l needs of p a t i e n t s a r e r e l a t e d t o t h e i r t h r e e s t a g e s o r phases of h o s p i t a l i z a t i o n . F i r s t l y , i n f o r m a t i o n i s r e q u i r e d a t t h e t i m e o f t h e i r a d m i s s i o n . F o r i n s t a n c e i n f o r m a t i o n r e g a r d i n g arrangements made f o r the c a r e o f c h i l d r e n , t h e d i s p o s i t i o n of b e l o n g i n g s b r o u g h t by the p a t i e n t t o h o s p i t a l , m a t t e r s o f ward r o u t i n e ( e . g . t i m e of e a t i n g , s l e e p i n g , t a k i n g of m e d i c a t i o n s , e t c . ) , and so on. S e c o n d l y , i n f o r m a t i o n r e g a r d i n g t r e a t m e n t i s r e q u i r e d by p a t i e n t s . T h i s would i n c l u d e k n owing who t h e d o c t o r i s and when he c o u l d be seen, i n f o r m a t i o n r e g a r d i n g the n a t u r e and p r p g n o s i s of t h e i r i l l n e s s , t h e i m p o r t a n c e o f v a r i o u s t r e a t -ment measures ( e . g . group t h e r a p y , e l e c t r o c o n v u l s i v e t h e r a p y , e t c . ) f o r t h e i r e v e n t u a l r e c o v e r y , and so on. F i n a l l y y p a t i e n t s r e q u i r e i n f o r m a t i o n r e g a r d i n g t h e i r d i s c h a r g e from h o s p i t a l . F o r i n s t a n c e i n f o r m a t i o n r e g a r d i n g p r oblems t o be f a c e d i n assuming s o c i e t a l r o l e s and ways of o v e r c o m i n g such p r o b l e m s , t h e i m p o r t a n c e of t a k i n g m e d i c a t i o n , appointment t i m e s f o r a f t e r c a r e s e r v i c e s and the i m p o r t a n c e o f such s e r v i c e s t o s u c c e s s f u l a d j u s t m e n t i n t h e community,.and so on. As f a r as i n f o r m a t i o n i s c oncerned t h e r e i s l i k e l y an i d e a l amount t h a t each i n d i v i d u a l p a t i e n t s h o u l d have i n o r d e r t h a t optimum b e n e f i t f r o m h o s p i t a l i z a t i o n may be r e a l i z e d . Some p a r t i c u l a r items o f i n f o r m a t i o n needed" tend t o be h i g h l y i n d i v i d u a l i z e d because o f u n i q u e p e r s o n a l c i r c u m -s t a n c e s ( e . g . t h e d e a t h of a r e l a t i v e w h i l e the p a t i e n t i s i n h o s p i t a l ) , w h i l e o t h e r s a p p l y t o a l l p a t i e n t s ( m a t t e r s c o n c e r n i n g ward r o u t i n e ) or groups o f p a t i e n t s ( e . g . c a r e o f c h i l d r e n ) , because of s i t u a t i o n s t h e y have i n common. I n f o r m a t i o n G i v i n g on a H o s p i t a l Ward A l t h o u g h s t a f f members have c e r t a i n f u n c t i o n s t o p e r f o r m i n r e l a t i o n 43. i t o t h e i r p a r t i c u l a r o c c u p a t i o n a l r o l e on t h e ward, i n f o r m a t i o n g i v i n g i s n o t s o l e l y dependent on r o l e c o n s i d e r a t i o n s . I t i s t r u e t h a t a p a r t i c u l a r o c c u p a t i o n may have a r e s p o n s i b i l i t y t o g i v e c e r t a i n items o f i n f o r m a t i o n , b u t a t h e y a r e n o t c o n s i d e r e d t o have the e x c l u s i v e r i g h t t o g i v e such i n f o r m a t i o n . (The e x c e p t i o n t o t h i s m i g h t be the d o c t o r ' s s o l e p e r o g a t i v e i n g i v i n g m e d i c a l i n f o r m a t i o n t o the p a t i e n t ) . I n some ways the e x i s t e n c e of such a s i t u a t i o n i s q u i t e p r a c t i c a l . F o r i n s t a n c e on crowded h o s p i t a l wards no s i n g l e o c c u p a t i o n has t h e time t o g i v e e v e r y i t e m of i n f o r m a t i o n t o p a t i e n t s f o r w h i c h i t i s r e s p o n s i b l e . The a s s i s t a n c e o f o t h e r o c c u p a t i o n s i s t h e r e f o r e n e c e s s a r y . F u r t h e r m o r e the p a t i e n t p o p u l a t i o n would l i k e l y s u f f e r i f c e r t a i n i n f o r m a t i o n a l a r e a s were made the s o l e p e r o g a t i v e o f a p a r t i c u l a r o c c u p a t i o n t o g i v e s i n c e many o c c u p a t i o n s would n o t be r e p r e s e n t e d on t h e ward when t h e p a t i e n t needed t h e i n f o r m a t i o n ( e . g . d o c t o r , s o c i a l w o r k e r ) . F o r t h e s e r e a s o n s t h e s t a f f t r e a t m e n t team composed of d o c t o r , s o c i a l w o r k e r , and n u r s e u s u a l l y d e v e l o p t h e i r own system o f i n f o r m a t i o n g i v i n g . The c o n c e r n i s n o t so much w i t h who g i v e s the i n f o r m a t i o n b u t r a t h e r t h a t t h e p a t i e n t g e t s i t from somebody. However on crowded wards a t R i v e r v i e w H o s p i t a l t h i s more i n f o r m a l method of i n f o r m a t i o n g i v i n g l i k e l y has the e f f e c t o f l e a v i n g many p a t i e n t s w i t h o u t needed i n f o r m a t i o n s i n c e t h e g i v i n g o f s p e c i f i c i t e m s o f i n f o r m a t i o n a r e n o t t h e s o l e r e s p o n s i b i l i t y o f any p a r t i c u l a r s t a f f member. I n a d d i t i o n i t i s l i k e l y t h a t t h i s i n f o r m a l method l e a d s t o c e r t a i n s t a f f b i a s e s i n g i v i n g i n f o r m a t i o n . I n o t h e r words when r e s p o n s i b i l i t y f o r g i v i n g i n f o r m -a t i o n based on r o l e c o n s i d e r a t i o n s i s 'pl a y e d down', t h e p e r s o n a l p r e f e r e n c e s o f s t a f f members f o r p a r t i c u l a r p a t i e n t s i s a l l o w e d t o come t o t h e f o r e . The p e r s o n a l c h a r a c t e r i s t i c s o f t h e p a t i e n t ( e . g . t y p e o f i l l n e s s , d e s i r e t o o b t a i n i n f o r m a t i o n , s o c i o e c o n o m i c s t a t u s , e t c . ) a l s o b e g i n t o be a more i m p o r t a n t c o n s i d e r a t i o n t h a n does the i n d i v i d u a l p a t i e n t ' s need f o r i n f o r m a t i o n . 44. Thus some p a t i e n t s get more needed i n f o r m a t i o n t h a n o t h e r s . I t i s t h e o p i n i o n of the a u t h o r s o f t h i s s t u d y t h a t h o s p i t a l g o a l s c annot be r e a l i z e d when, i n t h e g i v i n g of i n f o r m a t i o n , p a t i e n t c h a r a c t e r -i s t i c s and p e r s o n a l p r e f e r e n c e s of s t a f f f o r p a r t i c u l a r p a t i e n t s a r e g i v e n more i m p o r t a n c e t h a n t h e a c t u a l needs o f i n d i v i d u a l p a t i e n t s . F o r i n s t a n c e f rom r e a d i n g the l i t e r a t u r e and from p e r s o n a l e x p e r i e n c e o f the r e s e a r c h e r s on h o s p i t a l wards i t seems t h a t p a t i e n t s and groups of p a t i e n t s become u n c o o p e r a t i v e when t h e y a r e n o t g i v e n i n f o r m a t i o n . T h i s may be r e l a t e d t o t h e f a c t chat t h e y have n o t been i n f o r m e d as t o how t h e y m i g h t be c o o p e r a t i v e , or because t h e y f e e l t h a t t h e y were s l i g h t e d i n n o t b e i n g g i v e n i n f o r m a t i o n t h e y c o n s i d e r e d i m p o r t a n t . A t any r a t e t h e i r u n c o o p e r a t i v e n e s s p r o d uces many d i f f i c u l t i e s f o r s t a f f , and c o n s e q u e n t l y one g o a l o f the h o s p i t a l - a smooth r u n n i n g w a r d - i s n o t r e a l i z e d . I n a d d i t i o n t h e l a c k o f i n f o r m a t i o n r e g a r d i n g t r e a t m e n t o p p o r t u n i t i e s o f t e n makes i t i m p o s s i b l e f o r many p a t i e n t s t o t a k e advantage of such o p p o r t u n i t i e s . Thus th e h o s p i t a l g o a l of s u c c e s s f u l t r e a t m e n t f o r p a t i e n t s i s n o t r e a l i z e d . I t i s f o r t h e s e r e a s o n s o u t l i n e d above t h a t the r e s e a r c h group f e e l s t h a t the f i r s t p u r p o s e o f any new s t u d y i n t h i s a r e a s h o u l d be t o d e t e r m i n e the e x t e n d t o w h i c h the s t a f f system ( t h e team composed o f d o c t o r , s o c i a l w o r k e r and n u r s e ) on the wards a t R i v e r v i e w H o s p i t a l g i v e i n f o r m a t i o n t o t h e p a t i e n t system. T h i s p u r p o s e i s o f p a r t i c u l a r i m p o r t a n c e i f one i s concerned w i t h p a t i e n t s ' r e c e p t i o n of i n f o r m a t i o n , s i n c e the amount r e c e i v e d (and t h e r e f o r e t h e amount a v a i l a b l e f o r use i n d e r i v i n g b e n e f i t from t h e h o s p i t a l e x p e r i e n c e ) i s dependent to a l a r g e degree on the amount g i v e n . As has been p o i n t e d out t h e r e a r e a number of f a c t o r s t h a t a f f e c t t h e amount of i n f o r m a t i o n g i v e n by the s t a f f s ystem t o the p a t i e n t system. These f a c t o r s m i g h t be d i v i d e d i n t o t h r e e b r o a d c a t e g o r i e s , r e a l i z i n g o f c o u r s e t h a t each c a t e g o r y i s so i n t e r r e l a t e d as t o be m u t u a l l y r e i n f o r c i n g . They 45. a r e as f o l l o w s : (1) p s y c h o l o g i c a l f a c t o r s w i t h i n the i n d i v i d u a l s t a f f member system ( e . g . h i s m o t i v a t i o n t o g i v e i n f o r m a t i o n ) ; (2) f a c t o r s w i t h i n the t o t a l s t a f f s ystem on t h e ward (e . g . l e n g t h o f t i m e i n d i v i d u a l s on the team have been w o r k i n g t o g e t h e r ) ; and (3) p e r s o n a l c h a r a c t e r i s t i c s o f i n d i v i d u a l p a t i e n t s ( e . g . t h e degree t o w h i c h a p a t i e n t r e a c h e s out f o r i n f o r m a t i o n e t c . ) There a r e l i t e r a l l y dozens of f a c t o r s t h a t m i g h t a f f e c t the amount o f i n f o r m -a t i o n g i v e n by s t a f f . A t our p r e s e n t l e v e l o f knowledge we can o n l y s p e c u l a t e as t o what f a c t o r s m i g h t be more i m p o r t a n t . The second purpose of the new s t u d y becomes one o f d e t e r m i n i n g i f c e r t a i n s p e c i f i c f a c t o r s a r e s i g n i f i c a n t l y a s s o c i a t e d w i t h t h e amount o f i n f o r m a t i o n g i v e n by the s t a f f s y s t e m t o the p a t i e n t system. The R e c e p t i o n of I n f o r m a t i o n on a H o s p i t a l Ward I f one b e l i e v e s t h a t p a t i e n t s need t o have c e r t a i n i n f o r m a t i o n i n o r d e r t h a t t h e y m i g h t r e c e i v e optimum b e n e f i t from t h e i r h o s p i t a l i z a t i o n , the amount of i n f o r m a t i o n g i v e n by the s t a f f system i s o n l y one f a c t o r t h a t must be t a k e n i n t o c o n s i d e r a t i o n . F o r even though i n d i v i d u a l s o f the s t a f f team m i g h t g i v e a l l t h e i n f o r m a t i o n needed by a p a r t i c u l a r p a t i e n t , t h a t p a t i e n t m i g h t . n o t r e c e i v e i t . I n o t h e r words t h e r e i s o f t e n a g r e a t d i f f e r -ence between srimething s e n t and s o m e t h i n g r e c e i v e d . Whenever we s t a r t c o n s i d e r i n g f a c t o r s t h a t m i g h t a f f e c t the way a p i e c e o f i n f o r m a t i o n i s g i v e n i n r e l a t i o n t o the way i n w h i c h i t i s r e c e i v e d we n e c e s s a r i l y r e q u i r e an u n d e r s t a n d i n g of communication t h e o r y . As i n d i c a t e d e a r l i e r , systems a r e bounded r e g i o n s i n t i m e - s p a c e i n v o l v i n g e nergy i n t e r c h a n g e among t h e i r p a r t s . Communication can be v i e w e d as s u c h an i n t e r c h a n g e o f e n e r g y . The p a r t s , f o r the p u r p o s e s of t h i s s t u d y , a r e t h e s t a f f s ystem and t h e p a t i e n t system. E x p l i c i t i n any t r a n s m i s s i o n of i n f o r m a t i o n from i n d i v i d u a l s o f t h e s t a f f system t o i n d i v i d u a l s o f t h e p a t i e n t system a r e a t l e a s t t h r e e e l e m e n t s . 46. They a r e t h e s o u r c e ( s t a f f member), t h e message ( i t e m o f i n f o r m a t i o n , ) a n d the d e s t i n a t i o n ( p a t i e n t ) . I n the communication p r o c e s s t h e s o u r c e f i r s t encodes h i s message. " t h a t i s , he t a k e s t h e i n f o r m a t i o n or f e e l i n g he wants t o s h a r e and p u t s i t i n t o a form t h a t can be t r a n s m i t t e d . " (29,507) S e c o n d l y he t r a n s m i t s the i n f o r m a t i o n i n t h e form o f v e r b a l s i g n a l s ( l a n g u a g e ) . The t h i r d s t e p i s where t h e i n d i v i d u a l f o r whom t h e message was i n t e n d e d decodes and i n t e r p r e t s the i n f o r m a t i o n o b t a i n e d . I n e n g i n e e r i n g terms t h e r e may be f i l t e r i n g o r d i s t o r t i o n a t any of the t h r e e s t a g e s . . " I n human ter m s , i f t h e s o u r c e does n o t g i v e adequate o r c l e a r i n f o r m a t i o n ; i f the message i s n o t encoded f u l l y , a c u r a t e l y , e f f e c t i v e l y i n t r a n s m i t t a b l e s i g n s ; i f t h e s e a r e n o t t r a n s m i t t e d f a s t enough and a c c u r a t e l y enough, d e s p i t e i n t e r f e r e n c e and c o m p e t i t i o n , t o the d e s i r e d r e c e i v e r ; i f t h e message i s n o t decoded i n a p a t t e r n t h a t c o r r e s p o n d s t o the e n c o d i n g . . . t h e n , o b v i o u s l y t h e system i s w o r k i n g a t l e s s t h a n top e f f i c i e n c y " . (29, 508) Of c o u r s e i f the communication system i s o p e r a t i n g a t low e f f i c i e n c y i t i s h i g h l y u n l i k e l y t h a t the d e s t i n a t i o n i s o b t a i n i n g needed i n f o r m a t i o n . I n terms o f t h e i a n e n t a l h o s p i t a l , i f the p a t i e n t system i s n o t r e c e i v i n g i n f o r m a t i o n t r a n s m i t t e d by the s t a f f system because o f d i s t o r t i o n o c c u r r i n g i n any u n i t o f the p r o c e s s ( s o u r c e , message, d e s t i n a t i o n ) , t h e n t h e p a t i e n t system w i l l u n l i k e l y r e a l i z e optimum b e n e f i t from h o s p i t a l i z a t i o n . C o n c e i v a b l y one c o u l d measure t h e e f f i c i e n c y of any s i n g l e system o f c o m m unication ( i n d i v i d u a l s t a f f - i n d i v i d u a l p a t i e n t ) by n o t i n g the d i f f e r e n c e between what was g i v e n as compared t o what was r e c e i v e d . Sim-i l a r l y , a t a h i g h e r l e v e l o f a b s t r a c t i o n , one c o u l d measure t h e e f f i c i e n c y o f any l a r g e r s y s t e m o f communication (ward t e a m - p a t i e n t system) by c a l c u -l a t i n g t h e sum o f t h e d i s c r e p a n c i e s between what each i n d i v i d u a l s t a f f member gave i n t h e way o f i n f o r m a t i o n and what each i n d i v i d u a l p a t i e n t 47. r e c e i v e d and d i v i d e by the t o t a l number o f i n f o r m a t i o n a l items g i v e n . A l t h o u g h t h i s would be a v e r y d i f f i c u l t assessment t o c a r r y out f o r t h e w hole h o s p i t a l i t would u n d o u b t e d l y be v e r y v e r y v a l u a b l e . A l t h o u g h d e t e r m i n i n g the e f f i c i e n c y o f any system o f communication i n v o l v e s p r o c e d u r a l d i f f i c u l t i e s , t h e r e a r e even more d i f f i c u l t i e s e n c o u n t e r -ed when one a t t e m p t s t o a c c o u n t f o r the r e a s o n s why a p a r t i c u l a r system i s o p e r a t i n g a t a s p e c i f i c l e v e l o f e f f i c i e n c y . As s t a t e d above, d i s t o r t i o n may o c c u r a t any s t a g e of the c ommunication p r o c e s s . I n c o n s i d e r i n g the p r o s p e c t o f t r a n s m i t t i n g one p i e c e o f i n f o r m a t i o n one can l i t e r a l l y t h i n k of hundreds o f f a c t o r s t h a t may a f f e c t whether or n o t t h e p a r t i c u l a r p i e c e o f i n f o r m a t i o n i s r e c e i v e d by the p a t i e n t i n t h e form i n w h i c h i t was g i v e n . Some, o f c o u r s e , a r e l i k e l y more i m p o r t a n t t h a n o t h e r s , and the t r u t h i s t h a t a t our p r e s e n t l e v e l o f knowledge we r e a l l y do n o t know w h i c h ones a r e t h e most i m p o r t a n t . T h e r e f o r e i f one i s concerned w i t h somehow f i n d i n g out why a p a r t i c u l a r c h a n n e l i s i n e f f i c i e n t he must n e c e s s a r i l y s e l e c t d i s t o r t i o n f a c t o r s t h a t a r e assumed t o be i m p o r t a n t . The t h i r d p u r p o s e of the s t u d y becomes one of d e t e r m i n i n g the l e v e l of e f f i c i e n c y o f the c ommunication p r o c e s s between the s t a f f team on t h e wards and t h e p a t i e n t s a t R i v e r v i e w . H o s p i t a l . I n o t h e r words the degree o f d i f f e r e n c e between what the s t a f f system gave and what the p a t i e n t system r e c e i v e d . The f o u r t h p u r p o s e i s t o d e t e r m i n e i f c e r t a i n s p e c i f i c v a r i a b l e s or f a c t o r s a r e s i g n i f i c a n t l y a s s o c i a t e d w i t h e i t h e r h i g h or low e f f i c i e n c y . VARIABLES The i ndependent v a r i a b l e s a r e the f a c t o r s t h a t m i g h t a f f e c t (a) t h e amount o f i n f o r m a t i o n g i v e n by the s t a f f team on the wards and (b) the e x t e n t t o w h i c h t h e p a t i e n t r e c e i v e s t h e i n f o r m a t i o n t r a n s m i t t e d by the ward s t a f f team ( e f f i c i e n c y of c o m m u n i c a t i o n ) . I n d i s c u s s i n g each v a r i a b l e i n t u r n we 48. w i l l d e s i g n a t e as t o whether i t a f f e c t s (a) or ( b ) . The f i r s t f i v e v a r i a b l e s t o be d i s c u s s e d were found t o be s i g n i f i c a n t l y a s s o c i a t e d w i t h a h i g h r a t i o of i n f o r m a t i o n r e c e i v e d i n the p i l o t s t u d y . 1. Number of p r e v i o u s R i v e r v i e w or o t h e r m e n t a l h o s p i t a l a d m i s s i o n s . (a) , One would e x p e c t t h a t the g r e a t e r the number of a d m i s s i o n s a p a t i e n t has had t o a m e n t a l h o s p i t a l t h e l e s s i n f o r m a t i o n ward s t a f f would g i v e . They would l i k e l y assume t h a t the p a t i e n t a l r e a d y had t h i s i n f o r m a t i o n so t h e y would n o t f e e l the need t o c o v e r much of t h e same ground. (b) I f the i n f o r m a t i o n were g i v e n , i t i s l i k e l y t h a t i n the case o f a p a t i e n t w i t h a h i g h number o f a d m i s s i o n s t h a t such i n f o r m a t i o n . would n o t be r e c e i v e d t o t h e same e x t e n t as i n the case of the p a t i e n t w i t h a low number of a d m i s s i o n s . The r e a s o n f o r t h i s r e v o l v e s around t h e f a c t t h a t the g r e a t e r the number of a d m i s s i o n s t h e more l i k e l i h o o d o f damaged c o g n i t i v e p r o c e s s e s . F u r t h e r m o r e th e g r e a t e r the number o f a d m i s s i o n s the more l i k e l i h o o d o f a p e s s i m i s t i c a t t i t u d e towards the p o s s i b i l i t y of improvement from h o s p i t a l i z a t i o n on t h e p a r t of the p a t i e n t . T h e r e f o r e a d e c r e a s e d i n t e r e s t as t o what the ward s t a f f have t o say. 2. The degree t o w h i c h the i n d i v i d u a l p a t i e n t r e a c h e s out f o r i n f o r m a t i o n . (a) On crowded h o s p i t a l wards where the s t a f f - p a t i e n t r a t i o i s low, the amount o f i n f o r m a t i o n t h a t the s t a f f g i v e t o a p a t i e n t w i l l be t o some e x t e n t dependent upon the degree t o w h i c h a p a r t i c u l a r p a t i e n t r e q u e s t s i n f o r m a t i o n . I n a s t u d y by S t a n t o n and Schwartz i t was shown t h a t t h e most p e r s i s t e n t p a t i e n t s r e c e i v e the g r e a t e s t amount o f i n f o r m a t i o n . (6, 241) 49. (b) I t i s p r o b a b l y t r u e t h a t the more a p a t i e n t r e a c h e s out f o r i n f o r m a t i o n the more he or she i s l i k e l y t o r e c e i v e t h a t i n f o r m a t i o n i n the form i n w h i c h i t was g i v e n . I n o t h e r words the g r e a t e r the c o n c e r n on the p a r t o f the p a t i e n t f o r a p a r t i c u l a r i t e m o f i n f o r m a t i o n , t h e g r e a t e r t h e l i k e l i h o o d t h a t he or she w i l l r e c e i v e i t i n t h e form i n wh i c h i t was g i v e n . 3. P s y c h o t i c and Non P s y c h o t i c (a) I t i s l i k e l y t h a t ward s t a f f w i l l g i v e l e s s i n f o r m a t i o n t o a p a t i e n t who i s d i a g n o s e d as h a v i n g some form o f p s y c h o t i c r e a c t i o n s i n c e i t i s g e n e r a l l y f e l t t h a t the p e r s o n i n such a s t a t e i s u n a b l e t o use the i n f o r m a t i o n t r a n s m i t t e d . Of c o u r s e the d i a g n o s i s changes t h r o u g h the c o u r s e o f a p a t i e n t ' s h o s p i t a l i z a t i o n , because o f t h e improvement i n h i s or h e r c o n d i t i o n , b u t t h i s o f t e n happens so s u d d e n l y t h a t ward s t a f f a r e u n a b l e t o g i v e much needed i n f o r m a t i o n b e f o r e t h e p a t i e n t i s d i s c h a r g e d . (b) There i s a g r e a t e r l i k e l i h o o d , i n cases o f p s y c h o t i c p a t i e n t s , t h a t i n f o r m a t i o n g i v e n w i l l n o t be r e c e i v e d i n the form i n w h i c h i t was g i v e n . T h i s i s due t o t h e f a c t t h a t t h e r e a r e d i s t u r b a n c e s i n t h o ught w i t h t h o s e s u f f e r i n g from p s y c h o t i c d i s o r d e r s , and such d i s t u r b a n c e s i n t h o u g h t p r e v e n t an i n d i v i d u a l from c o r r e c t l y p e r c e i v i n g e x t e r n a l r e a l i t y ( i n f o r m a t i o n g i v e n by ward s t a f f ) . The two br o a d c l a s s i f i c a t i o n s o f p s y c h o t i c and non p s y c h o t i c can be b r o k e n down i n t o t y p e o f i l l n e s s ( e . g . s c h i z o p h r e n i c , n e u r o t i c , e t c . ) and c o r r e l a t e d w i t h b o t h amount of i n f o r m a t i o n g i v e n and r e c e i v e d . 4. Frequency o f group m e e t i n g s on the ward. The c o n c e r n h e r e i s whether a team f u n c t i o n i n g on a ward w h i c h uses t o a g r e a t e x t e n t the t e c h n i q u e o f group m e e t i n g s between p a t i e n t and s t a f f do g i v e more i n f o r m a t i o n t o p a t i e n t s than does a team f u n c t i o n i n g on 50. a ward where such a t e c h n i q u e i s o n l y minimumly used. (a) The a s s u m p t i o n i s t h a t the team on a 'high number of group m e e t i n g s ward' w i l l show up as h a v i n g g i v e n a g r e a t e r amount of i n f o r m a t i o n t h a n the team on a 'low number o f group m e e t i n g s ward'. Where s t a f f t i m e i s a t a premium the group m e e t i n g t e c h n i q u e w i l l enhance t h e amount of i n f o r m a t i o n g i v e n . 5. P a t i e n t u n d e r s t a n d i n g o f r e a s o n s f o r h o s p i t a l i z a t i o n p r i o r t o admiss i o n . (a) P a t i e n t s who have d i s c u s s e d the r e a s o n s f o r t h e i r h o s p i t a l -i z a t i o n w i t h a p r o f e s s i o n a l p e r s o n ( d o c t o r , , s o c i a l w o r k e r , e t c ) p r i o r t o a d m i s s i o n w i l l be g i v e n more i n f o r m a t i o n by t h e ward s t a f f . Such p a t i e n t s w i l l have a more p o s i t i v e a t t i t u d e towards h o s p i t a l i z a t i o n because of t h e i r u n d e r s t a n d i n g o f t h e i r need f o r i t , and c o n s e q u e n t l y w i l l have a g r e a t e r m o t i v a t i o n t o o b t a i n needed i n f o r m a t i o n . (b) I f the m o t i v a t i o n t o o b t a i n i n f o r m a t i o n i s g r e a t e r t h e r e i s a l s o a g r e a t e r l i k e l i h o o d t h a t such p a t i e n t s w i l l r e c e i v e i n f o r m -a t i o n i n t h e form i n w h i c h i t was g i v e n . 6. The p a t i e n t ' s a t t i t u d e ( p o s i t i v e o r n e g a t i v e ) towards c e r t a i n ward s t a f f ( s o c i a l w o r k e r , d o c t o r , n u r s e ) based upon c o n t a c t w i t h such s t a f f p r i o r t o h i s or h e r most r e c e n t a d m i s s i o n t o h o s p i t a l . (a) The more p o s i t i v e the p a t i e n t ' s a t t i t u d e towards ward s t a f f based on p r e v i o u s e x p e r i e n c e , t h e more i n f o r m a t i o n he or she i s l i k e l y t o get from such ward s t a f f w h i l e i n h o s p i t a l . I n o t h e r words ward s t a f f tend t o g i v e more i n f o r m a t i o n t o a f r i e n d l y p a t i e n t t h a n t o one who i s more h o s t i l e towards o r a l o o f from the ward s t a f f . O f t e n such b e h a v i o r on t h e p a r t o f t h e p a t i e n t towards ward s t a f f i s r e l a t e d t o a p r e v i o u s p o s i t i v e o r n e g a t i v e e x p e r i e n c e w i t h such s t a f f . (b) The more n e g a t i v e the p a t i e n t ' s a t t i t u d e towards ward s t a f f , t h e l e s s l i k e l i h o o d t h a t he w i l l r e c e i v e the i n f o r m a t i o n g i v e n by such ward s t a f f i n the form i n w h i c h i t was s e n t . I n o t h e r words i f the p a t i e n t d i s l i k e s t h e ward s t a f f he i s more l i k e l y t o 'tune them o u t ' and t h u s n o t r e c e i v e the i n f o r m a t i o n g i v e n . 7. I n f o r m a l o r i n v o l u n t a r y a d m i s s i o n (a) The ward s t a f f w i l l l i k e l y g i v e more i n f o r m a t i o n t o the i n f o r m a l l y a d m i t t e d p a t i e n t p r i m a r i l y because he or she i s more c o o p e r a t i v e and open t o d i s c u s s i o n . (b) I t i s l i k e l y t h a t t h e i n d i v i d u a l who sees siome need f o r h o s p i t a l i z a t i o n ( i n f o r m a l p a t i e n t ) w i l l tiadd t o r e c e i v e more i n f o r m a t i o n g i v e n by s t a f f i n t h e form i n w h i c h i t was g i v e n . The r e a s o n h e h i n d t h i s i s t h a t the v o l u n t a r i l y a d m i t t e d p a t i e n t has a h i g h e r d e g r e e o f m o t i v a t i o n t o 'get b e t t e r ' and thus w i l l be open t o any i n f o r m a t i o n g i v e n by ward s t a f f . The g r e a t e r the m o t i v a t i o n t h e g r e a t e r t h e r e c e p t i v i t y of i n f o r m a t i o n . 8. Lengh of time i n h o s p i t a l (a) I t i s l i k e l y t h a t the l o n g e r a p a t i e n t has been i n h o s p i t a l t h e more i n f o r m a t i o n he i s l i k e l y t o fee g i v e n by w a r d . s t a f f . 9. S o c i o e c o n o m i c s t a t u s of t h e p a t i e n t (a) The a s s u m p t i o n h e r e i s t h a t the l o w e r t h e s o c i o e c o n o m i c s t a t u s o f t h e p a t i e n t , the l e s s i n f o r m a t i o n he w i l l be g i v e n by the ward s t a f f . The r e a s o n i n g b e h i n d t h i s i s t h a t s t a f f members tend t o p r e f e r t o i n t e r a c t w i t h p a t i e n t s o f t h e i r own c l a s s background ( m i d d l e c l a s s ) , and c o n s e q u e n t l y t h e l o w e r c l a s s p e r s o n i s s l i g h t e d as f a r as the g i v i n g o f i n f o r m a t i o n i s c o n c e r n e d . (b) The l o w e r t h e s o c i o e c o n o m i c p o s i t i o n o f the p a t i e n t the g r e a t e r 52. t h e l i k e l i h o o d t h a t the i n f o r m a t i o n g i v e n by ward s t a f f w i l l n o t be p e r c e i v e d by the p a t i e n t i n the form i n w h i c h i t was g i v e n . The r e a s o n f o r t h i s i s t h a t l o w e r s t a t u s p a t i e n t s o f t e n do n o t have t h e v e r b a l a b i l i t y t o u n d e r s t a n d t h e language i n w h i c h a p a r t i c u l a r i t e m o f i n f o r m a t i o n i s t r a n s m i t t e d by s t a f f . I n a d d i t i o n any s u c c e s s f u l r e c e p t i o n o f i n f o r m a t i o n ( r e c e p t i o n of i n f o r m a t i o n as i t was t r a n s m i t t e d ) r e q u i r e s t h a t the two p a r t i e s ( s t a f f and p a t i e n t s ) s h a r e common ass u m p t i o n s as t o t h e n a t u r e o f t h i n g s . The g r e a t e r the d i f f e r e n c e i n c l a s s between the two t h e l e s s l i k e l i h o o d t h a t t h e s e a s sumptions w i l l be s h a r e d . (J10) The l e n g t h o f t i m e the team has been t o g e t h e r on a h o s p i t a l ward. (a) The a s s u m p t i o n h e r e i s t h a t the l o n g e r i n d i v i d u a l team members have been w o r k i n g t o g e t h e r t h e g r e a t e r the l i k e l i h o o d t h a t t h e y have d e v e l o p e d an e f f e c t i v e system of i n f o r m a t i o n g i v i n g . Thus i t i s more l i k e l y chance t h a t a g r e a t e r amount o f i n f o r m a t i o n w i l l be g i v e n t o a l l p a t i e n t s on a ward. (11) Ward m o r a l e (a) The team on a ward w i t h h i g h m o r a l e w i l l g i v e more i n f o r m a t i o n t o p a t i e n t s t h a n a team on a ward w i t h low m o r a l e . S t a n t o n and Schwartz have shown t h a t on a ward w i t h low m o r a l e i n d i v i d u a l s t a f f members tend t o w i t h d r a w from c o n t a c t w i t h p a t i e n t s . (32, 337-353) Thus l e s s i n f o r m a t i o n i s g i v e n . 53. CHAPTER V THE PROPOSED DESIGN INTRODUCTION A l t h o u g h t h i s p r o p o s e d r e s e a r c h d e s i g n m i g h t be c a r r i e d out by any r e s e a r c h e r , i t has been w r i t t e n p a r t i c u l a r l y w i t h the s t u d e n t s a t t h e U.B.C. S c h o o l of S o c i a l Work i n mind. Because o f t h e v e r y l i m i t e d n a t u r e o f the p i l o t s t u d y , the p r o p o s e d d e s i g n may a l s o be g e n e r a l l y c o n s i d e r e d t o be a t t h e l e v e l o f an e x p l o r a t o r y - f o r m u l a t i v e s t u d y . THE.PROPOSED HYPOTHESES From the m a t e r i a l p r e s e n t e d i n c h a p t e r f o u r , i t can be r e s t a t e d t h a t the m ain c o n c e r n o f the p r opdsed s t u d y i s t o whether p a t i e n t s a r e r e c e i v i n g the amount of i n f o r m a t i o n t h e y r e q u i r e i n o r d e r t o o p t i m a l l y b e n e f i t from t h e i r h o s p i t a l i z a t i o n . I n o r d e r t o d e t e r m i n e what i n f o r m a t i o n a p a t i e n t s h o u l d r e c e i v e , we must assume t h a t t h e r e i s an i d e a l amount o f i n f o r m a t i o n t h a t a p a t i e n t s h o u l d be g i v e n . Then, t h e amount o f i n f o r m a t i o n t h a t a p a t i e n t i s g i v e n by the t r e a t m e n t team may be compared w i t h t h i s i d e a l amount. T h i s may be seen as a measure o f t h e t h e o r e t i c a l e f f e c t i v e -ness o f the t r e a t m e n t team t o g i v e i n f o r m a t i o n . T h i s l e a d s t o h y p o t h e s i s number one. 1. There i s a d i f f e r e n c e between the i d e a l amount o f i n f o r m a t i o n a p a t i e n t r e q u i r e s f o r o p t i m a l b e n e f i t from h i s h o s p i t a l i z a t i o n and the a c t u a l amount of i n f o r m a t i o n g i v e n t o him by members of t h e t r e a t m e n t team. The amount o f i n f o r m a t i o n t h a t the team s t a t e s t h a t i t g i v e s t o a p a t i e n t compared w i t h the amount of i n f o r m a t i o n a p a t i e n t says he r e c e i v e s can be seen t o r e p r e s e n t t h e e f f i c i e n c y of the communication p r o c e s s . 54. H y p o t h e s i s number two w i l l be 2. There i s a d i f f e r e n c e between the amount of i n f o r m a t i o n t h e members of the t r e a t m e n t team say t h e y have g i v e n t o a p a t i e n t and the amount o f i n f o r m a t i o n t h a t the p a t i e n t s ays he has r e c e i v e d . A number of f a c t o r s m i g h t be e x p e c t e d t o a f f e c t the amount of i n f o r m a t i o n g i v e n by t h e t r e a t m e n t team and the amount o f i n f o r m a t i o n r e c e i v e d by t h e p a t i e n t s . Some o f t h e s e f a c t o r s a r e the independent v a r i a b l e s r e f e r r e d t o i n c h a p t e r f o u r . On the b a s i s of t h i s , h y p o t h e s i s number t h r e e w i l l be 3. C e r t a i n o f the f o l l o w i n g v a r i a b l e s w i l l be found t o be s i g n i f i c a n t l y a s s o c i a t e d w i t h the h y p o t h e s i z e d d i f f e r e n c e s r e f e r r e d t o i n h y p o t h e s i s 1 and 2. V a r i a b l e s . (a) number of p r e v i o u s R i v e r v i e w or o t h e r m e n t a l h o s p i t a l a d m i s s i o n s (b) p s y c h o t i c o r non p s y c h o t i c ( c ) i n f o r m a l o r i n v o l u n t a r y a d m i s s i o n (d) l e n g t h o f t i m e i n h o s p i t a l (e) s o c i o e c o n o m i c s t a t u s ( f ) t h e degree t o w h i c h t h e i n d i v i d u a l p a t i e n t r e a c h e s out f o r i n f o r m a t i o n (g) f r e q u e n c y o f group m e e t i n g s on the ward (h) p a t i e n t s ' a t t i t u d e ( p o s i t i v e o r n e g a t i v e ) a t a d m i s s i o n t o p a r t i c u l a r s t a f f ( d o c t o r , s o c i a l w o r k e r , charge n u r s e ) based on p r e v i o u s h o s p i t a l i z a t i o n . ( i ) l e n g t h o f t i m e t h e t r e a t m e n t team has been w o r k i n g t o g e t h e r on t h e h o s p i t a l ward. 55. ( j ) ward m o r a l e (k) e x p l a n a t i o n of r e a s o n s f o r h o s p i t a l i z a t i o n g i v e n by p r o f e s s i o n a l s t a f f i n t h e community b e f o r e h o s p i t a l i z a t i o n . DEVELOPING A.DESIGN FORMAT The f o l l o w i n g w i l l be a b r i e f o u t l i n e o f the t h r e e major a s p e c t s o f the p r o p o s e d d e s i g n . Under the h e a d i n g , I m p l e m e n t a t i o n of D e s i g n , we w i l l d i s c u s s t h e d e t a i l s and p r o c e d u r a l a s p e c t s of t h i s d e s i g n . 1. T a b u l a t i o n of the d i f f e r e n c e between the i d e a l amount of i n f o r m a t i o n a p a t i e n t r e q u i r e s f o r o p t i m a l b e n e f i t from h o s p i t a l i z a t i o n and t h e a c t u a l amount o f i n f o r m a t i o n g i v e n t o a p a t i e n t . (a) The i d e a l amount o f i n f o r m a t i o n r e q u i r e d may be o b t a i n e d by: ( i ) t h e r e s e a r c h e r s w i l l d e v e l o p a l i s t o f i n f o r m a t i o n i t e m s w h i c h t h e y b e l i e v e t o be e s s e n t i a l f o r the p a r t i c u l a r group o f p a t i e n t s under s t u d y , ( i i ) t h i s l i s t w i l l be p r e s e n t e d t o a h o s p i t a l committee composed o f two d o c t o r s , two n u r s e s , and two s o c i a l w o r k e r s . Because t h e i r knowledge and e x p e r i e n c e i s g r e a t e r t h a n t h e r e s e a r c h e r s , t h e y w i l l be e x p e c t e d t o add t o o r d e l e t e from the l i s t as i t would a p p l y t o a h y p o t h e t i c a l p a t i e n t i n an i d e a l h o s p i t a l s e t t i n g , i I n a d d i t i o n , t h e y w i l l be asked t o d i s t r i b u t e t h e i t e m s i n the l i s t a l o n g a s i n g l e continuum r a n g i n g from "most i m p o r t a n t " t o " l e a s t i m p o r t a n t " . From these- l i s t i n g s o f each of the s i x members of t h e committee, t h e r e s e a r c h e r s w i l l t h e n be a b l e t o d e t e r m i n e a w e i g h t i n g f o r each i t e m on the l i s t . 56. ( i i i ) f o r each p a t i e n t w i t h i n t h e sample, the r e s e a r c h e r s w i l l e l i m i n a t e t h o s e i t e m s i n the l i s t t h a t a r e not a p p l i c a b l e t o h i s p a r t i c u l a r c a s e . Thus, f o r each p a t i e n t t h e r e w i l l be a number of items o f i n f o r m a t i o n t h a t he s h o u l d i d e a l l y r e c e i v e and t h i s number may v a r y from p a t i e n t t o p a t i e n t . (b) D etermine from t h e t r e a t m e n t team what i n f o r m a t i o n was a c t u a l l y g i v e n t o each p a t i e n t i n t h e sample. ( c ) F o r each p a t i e n t , a r a t i o or p e r c e n t a g e may be d e t e r m i n e d a c t u a l . T h i s r a t i o i s assumed t o be a measure of the i d e a l t h e o r e t i c a l e f f e c t i v e n e s s o f t h e t r e a t m e n t team t o g i v e i n f o r m a t i o n t o p a t i e n t s . 2. T a b u l a t i o n o f the d i f f e r e n c e between the a c t u a l i n f o r m a t i o n g i v e n t o t h e p a t i e n t and the a c t u a l i n f o r m a t i o n the p a t i e n t says he has r e c e i v e d . (a) By i n t e r v i e w i n g the p a t i e n t , the r e s e a r c h e r s w i l l d e t e r m i n e Che number o f i t e m s t h a t the p a t i e n t says he has r e c e i v e d from t h e t r e a t m e n t team. (b) Thus, f o r each p a t i e n t , a r a t i o or p e r c e n t a g e may be d e t e r m i n e d i n f o r m a t i o n r e c e i v e d . T h i s r a t i o i s assumed i n f o r m a t i o n g i v e n t o be a measure of the e f f i c i e n c y of the communication p r o c e s s . 3. T a b u l a t i o n of t h e d a t a r e g a r d i n g each of t h e v a r i a b l e s under s t u d y f o r each o f the p a t i e n t s and r e l a t i n g i t (a) t o the amount of i n f o r m a t i o n g i v e n t o t h a t p a t i e n t by the t r e a t m e n t team. (b) t o t h e amount of i n f o r m a t i o n r e c e i v e d by t h a t p a t i e n t . 57. IMPLEMENTATION OF DESIGN B e f o r e any r e s e a r c h can be c a r r i e d out i n the h o s p i t a l , t h i s d e s i g n w i l l have t o be approved by th e h o s p i t a l a d m i n i s t r a t i o n . Because t h i s d e s i g n i n v o l v e s p e r s o n n e l from t h r e e p r o f e s s i o n s , a p p r o v a l must be o b t a i n e d f r o m t h e d i r e c t o r s o f each d i s c i p l i n e f o r t he i n v o l v e m e n t o f t h e i r s t a f f . U n d e r s t a f f i n g and heavy work l o a d s o f t h e s e p e r s o n n e l make any f u r t h e r demands on t h e i r time an i m p o s i t i o n u n l e s s an o b v i o u s v a l u e can be seen i n t h i s r e s e a r c h . T h e r e f o r e , one of t h e f i r s t t a s k s o f th e r e s e a r c h e r s w i l l be t o i n d i c a t e what v a l u e s may come from t h i s r e s e a r c h and thus g e n e r a t e e n t h u s i a s m f o r i t . The second t a s k w i l l be t o m a i n t a i n t h a t e n t h u s i a s m tlairtjSHaghout the p r o j e c t . The p r e l i m i n a r y s t u d y has a l r e a d y s t i m u l a t e d an i n t e r e s t i n t h i s r e s e a r c h p r o b l e m . E n t h u s i a s m w i l l be e a s i e r t o m a i n t a i n i f one or more members o f t h e r e s e a r c h team a r e f a m i l i a r w i t h the p e r s o n n e l , f u n c t i o n i n g , and r o u t i n e s o f t h e h o s p i t a l . Because o f the n a t u r e o f t h e r e s e a r c h d e s i g n , t he t r e a t m e n t team w i l l be aware o f many a s p e c t s o f the r e s e a r c h and t h i s may p o s i t i v e l y b i a s t he amount o f i n f o r m a t i o n g i v e n t o the p a t i e n t s . On t h e o t h e r hand, because o f t h i s awareness, the r e s e a r c h -e r s w i l l be a b l e t o s h a r e m a t e r i a l w i t h them t h r o u g h o u t t h e p r o j e c t . T h i s would be one r j a j o r way o f m a i n t a i n i n g e n t h u s i a s m . A n o t h e r m a j o r p o i n t i n th e m a i n t e n a n c e o f i n t e r e s t o f the h o s p i t a l i s t h a t t h e r e s e a r c h e r s s h o u l d be f a r more e x p l i c i t i n t h e i r d e a l i n g s w i t h t h e h o s p i t a l a d m i n i s t r a t i o n t h a n t h o s e who were i n v o l v e d i n th e p r e s e n t s t u d y . F o r example, the r e s e a r c h e r s s h o u l d t a k e r e s p o n s i b i l i t y f o r d e v e l o p i n g an agenda f o r any m e e t i n g and g i v i n g t h i s t o th e p a r t i c i p a n t s b e f o r e h a n d . THE LIST OF INFORMATION ITEMS The f i r s t r e s e a r c h i n s t r u m e n t i n t h i s d e s i g n i s t h e l i s t o f i n f o r m a t i o n i t e m s f e l t t o be e s s e n t i a l t o th e h y p o t h e t i c a l p a t i e n t i n an i d e a l h o s p i t a l s e t t i n g i n o r d e r f o r him t o o b t a i n o p t i m a l b e n e f i t from h i s 58. h o s p i t a l i z a t i o n . We a r e a ssuming t h a t t h e r e i s a body o f i n f o r m a t i o n t h a t a p a t i e n t r e q u i r e s and t h a t t h i s w i l l v a r y d e p e n d i n g upon th e p a t i e n t ' s age, sex and c i r c u m s t a n c e s . To a r r i v e a t an i d e a l amount o f i n f o r m a t i o n t o be g i v e n , we must p o s t u l a t e a h y p o t h e t i c a l p a t i e n t w i t h the c h a r a c t e r i s t i c s t h a t w i l l match t h e p a t i e n t sample group. I n a d d i t i o n , t h e r e may be c i r c u m s t a n c e s i n t h e h o s p i t a l , beyond t h e c o n t r o l of the t r e a t m e n t team, w h i c h m i g h t p r e v e n t a p a t i e n t from b e i n g g i v e n a l l t h e i n f o r m a t i o n w h i c h he s h o u l d t h e o r e t i c a l l y have. T h e r e f o r e , i n i t e m s e l e c t i o n we must p o s t u l a t e an i d e a l h o s p i t a l s e t t i n g ( e . g . a v a i l a b i l i t y o f s t a f f , e f f e c t i v e ward o r g a n i z a t i o n ) . Thus, t o o b t a i n a l i s t o f i n f o r m a t i o n i t e m s t h a t a p a t i e n t s h o u l d i d e a l l y be g i v e n , i t i s n e c e s s a r y t o ask the committee t o c o n s i d e r a case of a h y p o t h e t i c a l p a t i e n t i n an i d e a l h o s p i t a l s e t t i n g . Some o f the a r e a s from w h i c h items would be i n c l u d e d i n t h i s l i s t a r e : 1. I n f o r m a t i o n r e q u i r e d on a d m i s s i o n c a r e and management o f o t h e r f a m i l y members n a t u r e o f a d m i s s i o n ( v o l u n t a r y , i n v o l u n t a r y ) t y p e o f ward p a t i e n t i s on i m p o r t a n t ward r o u t i n e s systems o f p r i v i l e g e s , c a r e of v a l u a b l e s , e t c . 2. I n f o r m a t i o n r e q u i r e d r e g a r d i n g t r e a t m e n t who the d o c t o r i s and when he may be seen what the n u r s e s r e s p o n s i b i l i t i e s a r e n a t u r e o f the i l l n e s s n a t u r e of t h e t r e a t m e n t n a t u r e of the p r o g n o s i s 3. I n f o r m a t i o n r e q u i r e d r e g a r d i n g d i s c h a r g e use of m e d i c a t i o n use o f a f t e r - c a r e , o r o t h e r f o l l o w - u p r e s o u r c e s t h e e x t e n t t o w h i c h s t a f f d i s c u s s e d p a t i e n t ' s i l l n e s s w i t h r e l a t i v e s what t o do i f symptons o f i l l n e s s s t a r t r e c u r r i n g p o s s i b l e community r e a c t i o n t o a former m e n t a l h o s p i t a l p a t i e n t . B e f o r e p r e s e n t i n g t o the committee, the l i s t s h o u l d be as complete a n d . p r e c i s e as the r e s e a r c h e r s a r e a b l e t o make i t . B e s i d e s t h e o b v i o u s s o u r c e s ( p r o f e s s i o n a l l i t e r a t u r e ) , i t w i l l be v e r y h e l p f u l f o r the r e s e a r c h -e r s t o r e a d s e v e r a l p a t i e n t a u t o b i o g r a p h i e s i n o r d e r t o f a m i l i a r i z e t h e m s e l -ves w i t h t h e problems and co n c e r n s o f m e n t a l h o s p i t a l p a t i e n t s . (20) THE COMMITTEE S e l e c t i o n o f the s i x committee members would be a t t h e d i s c r e t i o n o f t h e d i r e c t o r s o f each o f the t h r e e d i s c i p l i n e s . However, because o f t h e n a t u r e o f t h e i r t a s k , h i g h l y t r a i n e d p e r s o n s w i t h c o n s i d e r a b l e e x p e r i e n c e i n a m e n t a l h o s p i t a l s e t t i n g s h o u l d be r e q u e s t e d . I n a d d i t i o n , because o f the p o s s i b l e b i a s , t h e y s h o u l d be p e r s o n s who a r e not members o f the t r e a t m e n t teams of any o f the wards or u n i t s under s t u d y . A s u g g e s t e d committee would be: 1. The C l i n i c a l D i r e c t o r o f R i v e r v i e w H o s p i t a l 2. A U n i t D i r e c t o r , n o t from t h e u n i t s under s t u d y 3. The D i r e c t o r o f S o c i a l S e r v i c e s 4. A S u p e r v i s o r o f S o c i a l Work, n o t from t h e u n i t s under s t u d y . 5. The D i r e c t o r s o f N u r s i n g 6. A. S u p e r v i s o r o f N u r s e s , n o t from t h e u n i t s under s t u d y . Because of t h e time l i m i t a t i o n s , each member w i l l p r o b a b l y r e v i e w t h e l i s t a t h i s own c o n v e n i e n c e r a t h e r t h a n a t a committee m e e t i n g . I t w i l l be t h e r e s p o n s i b i l i t y o f the r e s e a r c h e r s t o make c l e a r t o t h e members of the committee 60. t h a t t h e y a r e t o c o n s i d e r the i d e a l case r a t h e r t h a n what i s p r a c t i c a l a t t h i s h o s p i t a l . B e s i d e s a p p r o v i n g the l i s t o f i t e m s , the members o f the committee w i l l a l s o be asked t o r a t e the items a c c o r d i n g t o t h e i r degree of i m p o r t a n c e f o r the p a t i e n t ' s o p t i m a l b e n e f i t from h o s p i t a l i z a t i o n ( i . e . the Q - s o r t t e c h n i q u e ) . Thus, i f t h e r e a r e 40 i t e m s , the most i m p o r t a n t i t e m would be g i v e n - a v a l u e of 40. By a v e r a g i n g the v a l u e s g i v e n each i t e m by t h e s i x members, a w e i g h t i n g can be o b t a i n e d by t h e o r e s e a r c h e r s t h a t i n d i c a t e s the i m p o r t a n c e of each i t e m . THE PATIENT SAMPLE The c h o i c e of a p a t i e n t group t o be s t u d i e d must be d e c i d e d b e f o r e the c o m p i l a t i o n o f the l i s t o f i n f o r m a t i o n i t e m s , s i n c e t h e c h a r a c t e r i s t i c s o f t h e group w i l l a f f e c t the n a t u r e o f a number of items on t h e l i s t . I n s e l e c t i n g a sample, t h e f o l l o w i n g p o i n t s ; s h o u l d be t a k e n i n t o c o n s i d e r a t i o n : (a) t h e number of p a t i e n t s r e q u i r e d f o r the s t u d y (b) the number of wards t o be used ( c ) t h e a p p r o x i m a t e number of d i s c h a r g e s p e r month o f v a r i o u s p a t i e n t groups (d) t h e r e s e a r c h e r s ' t i m e a v a i l a b l e t o c o l l e c t d a t a F o r example, from our knowledge o f t h e h o s p i t a l , n o t w i t h s t a n d i n g our p i l o t s t u d y e x p e r i e n c e , 20 p a t i e n t s p e r month i n the m o t h e r - w i t h - c h i l d r e n group s h o u l d be d i s c h a r g e d from each ward. However, as marked v a r i a t i o n s may o c c u r from the e s t i m a t e d number, a l a r g e m a r g i n o f s a f e t y i n the form of e x t r a time a v a i l a b l e t o c o l l e c t d a t a s h o u l d be p l a n n e d f o r . As any sample group w i l l have some i n d i v i d u a l d i f f e r e n c e s , t h i s w i l l r e f l e c t i n the a p p r o p r i a t e n e s s o f the Items on the i n f o r m a t i o n l i s t as i t p e r t a i n s t o each i n d i v i d u a l p a t i e n t . T h e r e f o r e , t h e r e s e a r c h e r s w i l l 61. have t o remove f o r t h a t p a r t i c u l a r p a t i e n t t h o s e items t h a t a r e n o t a p p l i c a b l e . T h i s w i l l have t o be d e t e r m i n e d by a r e v i e w o f the p a t i e n t ' s f i l e and i f the f i l e i n f o r m a t i o n i s l a c k i n g , t h e n by c h e c k i n g w i t h one o f t h e t r e a t m e n t team members. The r e s u l t t h e n w i l l be an i n d i v i d u a l i z e d l i s t o f i n f o r m a t i o n i t e m s f o r each p a t i e n t . THE TREATMENT TEAM CHECK LIST The second r e s e a r c h i n s t r u m e n t i n t h i s d e s i g n i s an i n s t r u m e n t f o r d e t e r m i n i n g what i n f o r m a t i o n was a c t u a l l y g i v e n t o i n d i v i d u a l p a t i e n t s . Because of demands on s t a f f t i m e , i t would appear t h a t a check l i s t , w i t h a l l i t s d i s a d v a n t a g e s would be the most p r a c t i c a l i n s t r u m e n t . A d m i n i s t e r i n g t h e check l i s t t o t h e d o c t o r and s o c i a l w o r k e r p r e s e n t s no p a r t i c u l a r d i f f i c u l -t y as t h e r e i s u s u a l l y one on each ward. However, t h e r e may be as many as 20 n u r s i n g s t a f f who w i l l have c o n t a c t w i t h one p a t i e n t d u r i n g h i s h o s p i t a l -i z a t i o n . I d e a l l y , e v e r y n u r s e on the ward s h o u l d be c o n t a c t e d more th a n once i n r e g a r d t o each p a t i e n t i n the sample. One may s t r o n g l y q u e s t i o n whether i n f a c t , the charge n u r s e knows tohat i n f o r m a t i o n t h e o t h e r n u r s i n g s t a f f g i v e t o a p a r t i c u l a r p a t i e n t , though she would appear t o be the b e s t i n f o r m e d . A g a i n , when a p a t i e n t has been on t h e ward f o r 2 months or more, i t i s v e r y d i f f i c u l t t o remember what t h a t p a t i e n t was t o l d a t the time of a d m i s s i o n . However, because o f the time l i m i t a t i o n , t h e check l i s t can be g i v e n o n l y once, o n l y t o the charge n u r s e , and p r e s u m a b l y t h i s would have t o be a t t h e t i m e of d i s c h a r g e . The r e s e a r c h e r s must r e c o g n i z e t h a t t h i s w i l l be a weak i n s t r u m e n t and t h a t t h e y a r e m e a s u r i n g o n l y t h e t r e a t m e n t team members ' memories, w i t h a l l t h e i r o m i s s i o n s and i n c l u s i o n s , o f what i n f o r m a t i o n was g i v e n . T h i s check l i s t must be g i v e n t o each of the t h r e e c e n t r a l members o f t h e t r e a t m e n t team f o r each of the p a t i e n t s i n t h e sample and a c o m p i l a t i o n o f the t h r e e l i s t s be made t o a r r i v e a t a team l i s t o f i n f o r m a t i o n items r e p o r t e d t o have been a c t u a l l y g i v e n . 62. THE PATIENT INTERVIEW GUIDE The t h i r d r e s e a r c h i n s t r u m e n t i n t h i s d e s i g n i s an i n s t r u m e n t f o r d e t e r m i n i n g the i n f o r m a t i o n t h a t the p a t i e n t i s aware o f h a v i n g r e c e i v e d f rom t h e members of the t r e a t m e n t team. Because of i n d i v i d u a l d i f f e r e n c e s among p a t i e n t s , a q u e s t i o n n a i r e i s not p r a c t i c a l . Because o f d i f f e r e n c e s among the r e s e a r c h e r s , a n o n - s t r u c t u r e d i n t e r v i e w would a l l o w f o r t o o much i n d i v i d u a l v a r i a t i o n ; t h u s , a. s e m i - s t r u c t u r e d i n t e r v i e w based on an i n t e r v i e w g u i d e would seem t o be t h e most a p p r o p r i a t e i n s t r u m e n t . T h i s i n t e r v i e w g u i d e would be based on a l l t h e i n f o r m a t i o n items i n the i n d i v i d u a l i z e d l i s t f o r a p a r t i c u l a r p a t i e n t . T h i s h y p o t h e t i c a l l i s t i s u s e d, r a t h e r t h a n the a c t u a l l i s t o f items t h a t the t r e a t m e n t team gave t o the p a t i e n t , - because t i m e l i m i t a t i o n s would p r o b a b l y p r e v e n t d r a w i n g up t h e a c t u a l l i s t b e f o r e the p a t i e n t l e a v e s t h e h o s p i t a l . T h e r e f o r e , t h e l i s t o f items t h e p a t i e n t r e p o r t s t o have r e c e i v e d must be checked a g a i n s t t h e l i s t o f i t e m s t h e team r e p o r t t h e y gave i n o r d e r t o remove- from t h e p a t i e n t ' s l i s t t h o s e items t h a t t h e y r e c e i v e d from s o u r c e s o t h e r t h a n the t r e a t m e n t team. T h i s r e v i s e d 1-Lst w i l l c o m p r i s e t h e i n f o r m a t i o n t h a t t h e p a t i e n t says he has r e c e i v e d from t h e t r e a t m e n t team. Assuming t h a t the p a t i e n t w i l l a c c u r a t e l y r e p o r t t h e i n f o r m a t i o n t h e y a r e aware o f , p r o v i d e d t h a t the i n t e r v i e w i n g p r o c e s s i s a c c o m p l i s h e d s k i l f u l l y enough, i t becomes e x t r e m e l y i m p o r t a n t t h a t t h e r e s e a r c h e r s d e v e l o p a competent and c o n s i s t e n t i n t e r v i e w i n g t e c h n i q u e . S e v e r a l p o i n t s s h o u l d be k e p t i n mind: (a) t h e r e s e a r c h e r s must have a t h o r o u g h knowledge o f the items on t h e i n t e r v i e w g u i d e and t h e method of s c o r i n g t o be used, (b) because of p a t i e n t a n x i e t y and p o s s i b l e r e s i d u a l e f f e c t s of t h e i r i l l n e s s , t o a v o i d communication problems r e s e a r c h e r s must become p r o f i c i e n t a t u s i n g s i m p l e l a n g u a g e , s l o w l y spoken. 63. ( c ) r e s e a r c h e r s may be h e l p e d t o d e v e l o p a c o n s i s t e n c y o f approach t o p a t i e n t s t h r o u g h r o l e p l a y i n g s e s s i o n s . O t h e r p r a c t i c a l problems t o be r e s o l v e d by t h e r e s e a r c h e r s a r e : d e v e l o p i n g a s i m p l e , e f f i c i e n t s ystem f o r b e i n g n o t i f i e d when a p a t i e n t i s r e a d y f o r d i s c h a r g e , d e v e l o p i n g a sriimple, l o g i c a l , and n o n - t h r e a t e n i n g e x p l a n a t i o n f o r t h e p a t i e n t o f t h e r e s e a r c h e r ' s p u r p o s e i n c o n d u c t i n g the i n t e r v i e w , and d e v e l o p i n g f o r t h e n u r s e s a s h o r t b u t p o s i t i v e i n t r o d u c t i o n o f the r e s e a r c h e r s t o t h e p a t i e n t . THE LIST OF VARIABLES The f o u r t h r e s e a r c h i n s t r u m e n t i n t h i s d e s i g n i s the development o f a l i s t o f t h e v a r i a b l e s under s t u d y i n such a form t h a t i n f o r m a t i o n about them may be c o l l e c t e d f o r each p a t i e n t . Of a l l t h e v a r i a b l e s l i s t e d under THE PROPOSED HYPOTHESIS, v a r i a b l e s (a) t o (e) may be o b t a i n e d from t h e p a t i e n t ' s f i l e . I t i s s u g g e s t e d t h a t the charge n u r s e may be the b e s t s o u r c e o f i n f o r m a t i o n r e g a r d i n g v a r i a b l e s ( f ) t o ( i ) . A p o s s i b l e i n f o r m a t i o n f o r v a r i a b l e ( k ) c o u l d be a s c e r t a i n e d from t h e p a t i e n t . ANALYSIS OF THE DATA I n d i s c u s s i n g the work of the committee, r e f e r e n c e was made t o the use o f a w e i g h t i n g system f o r a l l i n f o r m a t i o n items ( i . e . t h e Q - s o r t t e c h n i q u e ) . I n d i s c u s s i n g the p r o p o s e d d e s i g n , r e f e r e n c e was made t o t h r e e l i s t s o f i n f o r m a t i o n items f o r each p a t i e n t : (a) t h e i d e a l l i s t o f i n f o r m a t i o n items t h a t c o u l d b& g i v e n (b) t h e a c t u a l l i s t o f i n f o r m a t i o n items r e p o r t e d t o have been g i v e n by t h e t r e a t m e n t team ( c ) t h e l i s t o f i n f o r m a t i o n items t h e p a t i e n t says he has r e c e i v e d from t h e t r e a t m e n t team A n u m e r i c a l v a l u e r e p r e s e n t i n g each o f t h e l i s t s may be o b t a i n e d by a d d i n g 64. t h e w e i g h t e d v a l u e s of each of t h e items on t h e l i s t . H y p o t h e s i s one. The t h e o r e t i c a l e f f e c t i v e n e s s o f the t r e a t m e n t team i n g i v i n g i n f o r m a t i o n t o a p a r t i c u l a r p a t i e n t would t h e r e f o r e be r e p r e s e n t e d by t h e r a t i o : w e i g h t e d v a l u e o f a c t u a l i n f o r m a t i o n g i v e n w e i g h t e d v a l u e o f i d e a l i n f o r m a t i o n H y p o t h e s i s two. The e f f i c i e n c y o f the communication p r o c e s s would t h e r e f o r e be r e p r e s e n t e d by the r a t i o : w e i g h t e d v a l u e o f i n f o r m a t i o n r e c e i v e d  w e i g h t e d v a l u e o f a c t u a l i n f o r m a t i o n g i v e n Each of t h e r e l e v a n t v a r i a b l e s under s t u d y may be r e l a t e d t o each of the h y p o t h e s i s by means o f t h e c h i s q u a r e . • S i n c e t h e c h i s q uare method i s used t o compare f r e q u e n c y d i s t r i b u t i o n s r a t h e r t h a n s t a t i s t i c s (37, p . 6 6 ) , t h e p a t i e n t sample w i l l have t o be d i v i d e d i n t o two or more g r o u p i n g s . F o r example, t h o s e o b t a i n i n g h i g h e s t e f f i c i e n c y - o f - c o m m u n i c a t i o n r a t i o s v e r s u s t h o s e o b t a i n i n g l o w e s t e f f i c i e n c y - o f - c o m m u n i c a t i o n r a t i o s . L i k e w i s e , f r e q u e n c i e s may be o b t a i n e d f o r the d a t a r e l a t i n g t o each o f the v a r i a b l e s under s t u d y . I n t e r e s t i n g i n t e r r e l a t i o n s h i p s between p r o m i s i n g v a r i a b l e s may a l s o be examined by the use of the c h i s q uare method. However, the sample would have t o be s u f f i c i e n t l y l a r g e t o p e r m i t t h i s . T here a r e v a r i o u s p o s s i b l e s e c o n d a r y s t u d i e s t h a t m i g h t be done from t h e d a t a c o l l e c t e d . An o b v i o u s one would be t o examine the amount and t h e k i n d of i n f o r m a t i o n w h i c h p a t i e n t s r e p o r t e d t h a t t h e y r e c e i v e d but w h i c h was n o t g i v e n by the t r e a t m e n t team. A n o t h e r s e c o n d a r y s t u d y t h a t c o u l d be done i n v o l v e s the development of t h e r a t i o : w e i g h t e d v a l u e o f i n f o r m a t i o n r e c e i v e d w e i g h t e d v a l u e o f i d e a l i n f o r m a t i o n 65. T h i s r a t i o m i g h t be compared t o each o f the o t h e r two r a t i o s and may a l s o be r e l a t e d t o some of t h e independent v a r i a b l e s t h r o u g h the c h i square method. 66. BIBLIOGRAPHY B e l k n a p , I v a n . Human Problems of a S t a t e M e n t a l H o s p i t a l . New York, M c G r a w - H i l l Book Co., 1956. Boehm, Werner W. The S o c i a l Casework Method i n S o c i a l Work E d u c a t i o n . New, Y o r k , C o u n c i l on S o c i a l Work E d u c a t i o n , V o l . 10, 1959. Brandon,. M i l d r e d G. and o t h e r s . E x p l o r i n g S o c i a l S e r v i c e D i s c h a r g e P l a n s  f o r M e n t a l P a t i e n t s . Osawatomie S t a t e H o s p i t a l P u b l i c a t i o n , December, 1961. B r e t o n , L.C. and Henning, D.A. P l a n n i n g Theory. New York,, P r e n t i c e - H a l l , 1961. Brown, B. and I s h i y a m a , T. " O b s e r v a t i o n s of p a t i e n t - s t a f f M e e t i n g s . " M e n t a l H o s p i t a l s , A p r i l 1966, pp. 107-109. C a u d i l l , W. The P s y c h i a t r i c H o s p i t a l as a S m a l l S o c i e t y . Cambridge, Mass., H a r v a r d U n i v e r s i t y P r e s s , 1958. C h e r r y , C o l i n . On Human Communication. New York,. S c i e n c e E d i t i o n s , I n c . , 1961. Coleman, James C , ed. P e r s o n a l i t y Dynamics and. E f f e c t i v e B e h a v i o r . C h i c a g o , S c o t t , Foresman and Co., 1960. Coser,. Rose. L i f e i n the Ward. E a s t L a n s i n g , M i c h . , M i c h i g a n S t a t e U n i v e r s i t y P r e s s , 1962. Dunham, H.W. andWeinberg,. S.K. The C u l t u r e of the S t a t e M e n t a l H o s p i t a l . D e t r o i t , Wayne S t a t e U n i v e r s i t y P r e s s , 1960. E s s e n t i a l s o f a S o c i a l S e r v i c e Department i n H o s p i t a l s and R e l a t e d I n s t i t u t i o n s . C h i c a g o , A m e r i c a n H o s p i t a l A s s o c i a t i o n P u b l i c a t i o n , 1961. F r e i d s o n , E l i o t . P a t i e n t s ' Views of M e d i c a l P r a c t i c e . New Y o r k , R u s s e l l Sage F o u n d a t i o n , 1961. G l u e c k , B.C. " R e s e a r c h i n M e n t a l H o s p i t a l s " . M e n t a l H o s p i t a l s , V o l . 14, 1963, pp. 93-97. Goffman, E. A s y l u m s . New. Y o r k , Anchor Books, 1961. Green, Hannah. I Never P r o m i s e d You a Rose G a r d e n . S i g n e t Books, 1964. G r e e n b l a t t , M i l t o n , ed. The P a t i e n t and t h e ' M e n t a l H o s p i t a l . G l e n c o e , 111., F r e e P r e s s , 1957. G r e e n b l a t t , W i l l i a m and o t h e r s . The P r e v e n t i o n of H o s p i t a l i z a t i o n . New Y o r k , Grune and. S t r a t t o n ; ) , I n c . , 1963. 67. 18. " I n t e r p e r s o n a l Communication and H o s p i t a l E f f i c i e n c y " . C a n a dian M e d i c a l A s s o c i a t i o n , J u l y 18, 1964. 19. J o n e s , M a x w e l l . The T h e r a p e u t i c Community. New Y o r k , B a s i c Books, I n c . , 1953. 20. K a p l a n , B., ed. The W o r l d o f M e n t a l I l l n e s s . New Y o r k , Harper and Row, 1964. 21. Kesey, Ken. . One Flew. Over the Cuckoo's N e s t . S i g n e t Books, 1962. 22. L e i p o l d , W. and W i l s o n , , M. "Are we Communicating". M e n t a l H o s p i t a l s , August 1963, pp. 448-453. 23. M i l l e r , James G. "Toward a G e n e r a l Theory f o r t h e B e h a v i o r a l S c i e n c e s " . . P e r s o n a l i t y Dynamics and E f f e c t i v e B e h a v i o r , ed. James C. Coleman, S c o t t , Foresman and Co., 1960, pp. 433-436. 24. More f o r t h e M i n d . T o r o n t o , Canadian M e n t a l H e a l t h A s s o c i a t i o n P u b l i c -a t i o n , 1963. 25. P o l a n s k y , N.A.. S o c i a l Work R e s e a r c h . C h i c a g o , U n i v e r s i t y of C h i c a g o P r e s s , 1960. 26. Revans, E. "The M o r a l e and E f f e c t i v e n e s s of G e n e r a l H o s p i t a l s " . Problems and p r o g r e s s i n M e d i c a l C a r e , ed. G. M c L a c h l a n , • O x f o r d U n i v e r s i t y P r e s s , 1964. 27. Riessman, F., ed. M e n t a l H e a l t h o f the P o o r . New York, F r e e P r e s s , 1964. 28. Rose, A r n o l d , ed. M e n t a l H e a l t h and M e n t a l D i s o r d e r . New York, W.W. N o r t o n , 1955. 29. Schramm, W i l b u r . "Communication t h e o r y " . P e r s o n a l i t y Dynamics and E f f e c t i v e B e h a v i o r , ed. James C. Coleman, S c o t t , Foresman and Co., 1960, pp. 507-513. 30. S e l l i t z , C , J a h o d a , M. , Deutch, M. , and Cook, S. R e s e a r c h Method I n S o c i a l R e l a t i o n s . New Y o r k , H o l t R i r i a h a r t and W i n s t o n , 1965. 31. S c h w a r t z M. S. " S o c i a l R e s e a r c h i n the M e n t a l H o s p i t a l " . M e n t a l H e a l t h and M e n t a l D i s o r d e r , ed. A r n o l d Rose, W.W. N o r t o n and Co., 1955. 32. S c h w a r t z , M o r r i s a n d - W i l l , Gwen Tudor. "Low. M o r a l e and M u t u a l W i t h d r a w a l on a m e n t a l H o s p i t a l Ward". . P s y c h i a t r y , V o l . 16, 1953, pp.337-353. 33. S t a n t o n , A.H. and S c h w a r t z , $t>S. . The M e n t a l H o s p i t a l . New Y o r k , B a s i c Books, 1954. 34. S t a n t o n , A.H. and S c h w a r t z , M.S. "Need F u l f i l l m e n t on a H o s p i t a l Ward". P s y c h i a t r y , V o l . 14, 1951, pp. 223-242. 35. V a i l , D. " F a c e t s o f I n s t i t u t i o n a l L i v i n g " . M e n t a l H o s p i t a l s , November 1964, pp. 599-601. 68. 36. Varnon, E d i t h . "Communication: C l i e n t , Community and Agency". S o c i a l Work, V o l . 9, A p r i l 1964, pp. 51-57. 37. Y u k e r , H. A Guide t o S t a t i s t i c a l A n a l y s i s . T o r o n t o , G.P. Putnam's Sons, 1958. 69. APPENDIX A PATIENT INTERVIEW GUIDE INTRODUCTION: R e s e a r c h e r from U.B.C. d o i n g a s t u d y on h o s p i t a l s e r v i c e s . A l l r e s p o n s e s a r e c o n f i d e n t i a l . P a r t i c i p a t i o n i s on a v o l u n t a r y b a s i s and the p a t i e n t ' s c o - o p e r a t i o n i s a p p r e c i a t e d . 1. . L e n g t h o f time i n h o s p i t a l (V) 2. Who i s y o u r d o c t o r ? Who i s your charge nurse? Who i s y o u r s o c i a l w o rker? ( o n l y need 3/5) • Who i s y o u r o c c u p a t i o n a l t h e r a p i s t ? Who i s y o u r r e c r e a t i o n a l t h e r a p i s t ? 3. Have you had any ( m e a n i n g f u l ) c o n v e r s a t i o n s w i t h each one? I f s o , how many? 4. What do t h e s e p e o p l e do? ( r o l e awareness) IA. #1 5. How d i d you l e a r n t h i s ? ( f r o m S.W.) IA #2 6. Do t h e s e s t a f f members d i s c u s s t h e i r p a t i e n t s w i t h each o t h e r ? (awareness o f team) 7. How many p r e v i o u s a d m i s s i o n s ? 8. Any f r i e n d s or r e l a t i v e s h o s p i t a l i z e d now or i n t h e p a s t ? ( e x p e r i e n c e p o s i t i v e o r n e g a t i v e ) 9. Who d i s c u s s e d y o u r h o s p i t a l i z a t i o n w i t h you b e f o r e y o u r a d m i s s i o n ? IA #3 10. A f t e r a d m i s s i o n , who t a l k e d w i t h you about the a f f e c t s o f your i l l n e s s on o t h e r s ? IA #4 11. Were you w o r r i e d about money m a t t e r s e i t h e r a t home o r i n the h o s p i t a l ? D i d you w o r r y about y o u r r i g h t s as a p a t i e n t ? I f so,, who d i d you d i s c u s s t h e s e w i t h o r who would you have d i s c u s s e d them w i t h ? 11.(a) D i d anyone ask you about such m a t t e r s ? IA #5 12. Who d i s c u s s e d w i t h you how you r f a m i l y was managing d u r i n g y o u r absence? I A #6 13. Who d i s c u s s e d y o u r p l a n s a f t e r d i s c h a r g e - w i t h you? ( f i n a n c e s ) ( l i v i n g a r rangements) IA.#7 14. Who d i s c u s s e d w i t h you some o f t h e d i f f i c u l i t i e s you may f a c e w i t h y o u r f a m i l y and n e i g h b o u r s when you go home? 70. 15. How d i d you r f i r s t meet t h e S.W.? 16. Have you met w i t h any o t h e r s o c i a l w o r k e r s b e f o r e coming i n t o t h e h o s p i t a l ? ( e s s e n t i a l l y neg. or p o s t , a t t i t u d e ) 16. (a) D u r i n g y o u r c o n t a c t w i t h the S.W. what did you t a l k about? 17. Age o f p a t i e n t ? 18. M a r i t a l s t a t u s ? ( d i v o r c e d , sep.) 19. C h i l d r e n : age o f each whether a t home or n o t . (under 18) 20. E d u c a t i o n , income and o c c u p a t i o n o f f a m i l y head. SCORING OF INFORMATIONAL AREAS 1. R o l e o f S o c i a l Worker: P a t i e n t must show some awareness o f e i t h e r the t r e a t m e n t o r l i a s o n w i t h t h e community or f a m i l y r o l e s o f t h e s o c i a l w o r k e r . 2. Awareness of t h e team approach : Any awareness t h a t s t a f f members d i s c u s s p a t i e n t s o r t h a t a w o r k i n g t o g e t h e r o c c u r s among p r o f e s s i o n a l s t a f f . 3. Reasons f o r coming t o h o s p i t a l : s o c i a l i m p l i c a t i o n s : P a t i e n t must have some awareness t h a t she " f a i l e d t o conform t o r o l e o b l i g a t i o n s " and t h a t o t h e r s r e a c t e d t o t h i s r o l e f a i l u r e . T h i s would i n c l u d e s i c k n e s s i f p a t i e n t i s aware t h a t the i l l n e s s had n e g a t i v e l y a f f e c t e d r o l e f u n c t i o n i n g . 4. F i n a n c i a l and l e g a l c o n c e r n s : T h i s would i n c l u d e any l e g a l and/or f i n a n c i a l m a t t e r s such as c o m f o r t s a l l o w a n c e , c o s t o f h o s p i t a l i z a t i o n , p u b l i c t r u s t e e , f a m i l y a l l o w a n c e , f a m i l y f i n a n c e s w h i l e p a t i e n t i n h o s p i t a l , l e g a l r i g h t s as a p a t i e n t , e t c . 5. . F a m i l y f u n c t i o n i n g : Any i n f o r m a t i o n p e r t a i n i n g t o the w e l f a r e and f u n c t i o n i n g o f an i n d i v i d u a l o r f a m i l y group w h i c h composes t h e f a m i l y i n w h i c h the p a t i e n t 1 i v e s . 6. . M a t e r i a l - p h y s i c a l a s p e c t s o f d i s c h a r g e p l a n s : T h i s w i l l i n c l u d e f i n a n c e s , l i v i n g a r r a n g e m e n t s , e t c . 7. S o c i a l - e m o t i o n a l p l a n n i n g : T h i s w i l l i n c l u d e any i n f o r m a t i o n r e g a r d i n g a d a p t i o n t o r o l e s , s t r e n g t h e n i n g o f r o l e s (agency c o n t a c t ) , t h e f a c i n g of n e g a t i v e community a t t i t u d e s , t h e f a c i n g of i n t e r p e r s o n a l o r e m o t i o n a l d i f f i c u l t i e s i n the f a m i l y , e t c . APPENDIX B SOCIAL WORKER QUESTIONNAIRE Name of P a t i e n t : Date: Ward: P l e a s e U n d e r l i n e , check, or answer t h e f o l l o w i n g : 1. Degree t o w h i c h p a t i e n t r e a c h e s out f o r i n f o r m a t i o n : H i g h Low 2. Number o f p a t i e n t - s o c i a l work c o n t a c t s w h i l e i n h o s p i t a l : Ans . 3. A t t i t u d i n a l i n f l u e n c e o f r e l a t i v e s on p a t i e n t : (a) e s s e n t i a l l y p o s i t i v e (b) e s s e n t i a l l y n e g a t i v e 4. By whom f i r s t c o n t a c t i n i t i a t e d : (a) s o c i a l w o r k e r (b) p a t i e n t 5. L o c a t i o n o f o f f i c e s : (a) on ward (b) o f f ward 6. Number o f s o c i a l work c o n t a c t s w i t h r e l a t i v e s : Ans. 7. S p e c i f i c r e a s o n f o r s e e i n g p a t i e n t : Ans. 8. Who r e f e r r e d p a t i e n t t o s o c i a l w o r k e r : (a) d o c t o r (b) p a t i e n t ( c ) n u r s e (d) s e l f APPENDIX C F I L E INFORMATION GUIDE. Number of p r e v i o u s a d m i s s i o n s . D i a g n o s i s a t ti m e o f a d m i s s i o n . Type of a d m i s s i o n . B i r t h d a t e . M a r i t a l s t a t u s . A d m i s s i o n d a t e . T r eatment u n i t . Ward. P r o b a b l e d i s c h a r g e d a t e . 73. APPENDIX D SOCIAL WORKER INTERVIEW GUIDE Fo r the p u r p o s e o f t h i s r e s e a r c h p r o j e c t , we have i n t e r v i e w e d each p a t i e n t w i t h r e g a r d s t o t h e f o l l o w i n g seven i n f o r m a t i o n a r e a s . To e v a l u a t e the p a t i e n t ' s r e c e p t i o n and awareness of t h e s e i n f o r m a t i o n a r e a s , we need the s o c i a l w o r k e r ' s d e c i s i o n as t o whether each i n f o r m a t i o n a r e a was c o v e r e d w i t h t h e p a t i e n t . 1. R o l e of S o c i a l Worker: P a t i e n t must show some awareness o f e i t h e r the t r e a t m e n t or l i a i s o n w i t h the community o r f a m i l y r o l e s o f t h e s o c i a l w o r k e r . (a) Did you g i v e an e x p l a n a t i o n o f y o u r r o l e ? (b) I f n o t , d i d you check t o see i f t h e y under-s t o o d y o u r r o l e ? YES NO YES NO Awareness o f the team approach : Any awareness t h a t s t a f f members d i s c u s s p a t i e n t s or t h a t a w o r k i n g t o g e t h e r o c c u r s among p r o f e s s i o n a l p e o p l e . (a) Did you g i v e any e x p l a n a t i o n of the team approach? (b) I f n o t , d i d you check t o see i f t h e y u n d e r s t o o d the c o n c e p t of the team approach? YES NO YES NO Reasons f o r coming t o h o s p i t a l : s o c i a l i m p l i c a t i o n s : P a t i e n t must have some awareness t h a t she " f a i l e d t o conform t o r o l e o b l i g a t i o n s " and t h a t o t h e r s r e a c t e d t o t h i s r o l e f a i l u r e . T h i s would i n c l u d e s i c k n e s s i f p a t i e n t i s aware t h a t t h e i l l n e s s had n e g a t i v e l y a f f e c t e d r o l e f u n c t i o n i n g . (a) D i d you d i s c u s s the s o c i a l i m p l i c a t i o n s o f t h e i r coming t o h o s p i t a l ? (b) I f n o t , d i d you check t o see i f t h e y u n d e r s t o o d such i m p l i c a t i o n s ? YES NO YES NO F i n a n c i a l and L e g a l Concerns: T h i s would i n c l u d e any l e g a l and/or f i n a n c i a l m a t t e r s such as c o m f o r t s a l l o w a n c e , c o s t o f h o s p i t a l i z a t i o n , p u b l i c t r u s t e e , , f a m i l y a l l o w a n c e , f a m i l y f i n a n c e s w h i l e p a t i e n t i n h o s p i t a l , l e g a l r i g h t s as a p a t i e n t , e t c . (a) D i d you d i s c u s s any f i n a n c i a l and/or l e g a l c o n c e r n s ? (b) I f n o t d i d you check t o see whether t h e y had such c o n c e r n s ? YES NO YES NO 74. F a m i l y f u n c t i o n i n g : Any i n f o r m a t i o n p e r t a i n i n g t o the w e l f a r e and f u n c t i o n i n g of an i n d i v i d u a l or f a m i l y group w h i c h composes the f a m i l y i n w h i c h the p a t i e n t l i v e s . (a) D i d you g i v e any i n f o r m a t i o n c o n c e r n i n g t h e i r f a m i l y ' s f u n c t i o n i n g ? (b) I f n o t d i d you check t o see whether t h e y r e q u i r e such i n f o r m a t i o n ? YES NO YES NO M a t e r i a l - p h y s i c a l a s p e c t s o f d i s c h a r g e p l a n s : T h i s w i l l i n c l u d e f i n a n c e s , l i v i n g a r r a n g e m e n t s , e t c . (a) D i d you d i s c u s s the m a t e r i a l p h y s i c a l a s p e c t s of d i s c h a r g e p l a n s w i t h them? (b) I f n o t , d i d you check t o see whether t h e s e arrangements were made? YES YES NO NO S o c i a l - e m o t i o n a l p l a n n i n g : T h i s w i l l i n c l u d e any i n f o r m a t i o n r e g a r d i n g a d a p t i o n t o r o l e s , s t r e n g t h -e n i n g o f r o l e s (agency c o n t a c t ) , the f a c i n g of n e g a t i v e community a t t i t u d e s , t h e f a c i n g of i n t e r p e r s o n a l or e m o t i o n a l d i f f i c u l t i e s i n t h e f a m i l y , e t c . (a) Did you g i v e any i n f o r m a t i o n around s o c i a l , e m o t i o n a l a r e a s of p l a n n i n g ? (b) Did you check t o see i f t h e y had i n f o r m a t i o n about t h i s area? YES J 1 N 0 1 YES | 1 N 0 1 APPENDIX E RIVERVIEW HOSPITAL - ORGANIZATION CHART SUPERINTENDENT ASSISTANT SUPERINTENDENT BUSINESS ADMINISTRATOR DIRECTOR BUSINESS OFFICE COMMISSIONAIRES DIETARY HAIRDRESSING 6. BARBERING HOUSEKEEPING INDUSTRIAL THERAPY & AUDIO-VISUAL INFORMATION DESKS LAUNDRY PAY & PERSONNEL PODIATRY POSTMASTER TRANSPORTATION PUBLIC WORKS LIAISON R.C.M.P. LIAISON PURCHASING LIAISON STORES LIAISON OF NURSING DEPARTMENT OF NURSING ORGANIZATION (SEE ATTACHED CHART) CLINICAL DIRECTOR r CHAPLAINS DENTISTRY LABORATORIES LIBRARY MEDICAL RECORDS NEUROLOGY OCCUPATIONAL THERAPY PATIENT'S SCHOOL PHARMACY PHYSIOTHERAPY PHYSHOLOGY RADIOLOGY RECREATIONAL THERAPY REHABILITATION SOCIAL SERVICE VOLUNTEERS CONSULTING STAFF SURGICAL RESIDENT MEDICAL STAFF ORGANIZATION (SEE ATTACHED CHART) Note: This Organization Chart has not yet been approved by the Deputy Minister's o f f i c e , and w i l l probably be subject to extensive changes in the near future. December 12, 1966 76. TABLE NO. I COMPILATION OF DATA COLLECTED P a t i e n t #1 #2 . #3 #4 #5 #6 #7 #8 I n f o r e c e i v e d s c o r e 6 5 4 4 3 2 1 1 I n f o s e n t s c o r e 7 6 7 7 6 6 5 6 I n f o A r e a #1 r e c e i v e d / / s e n t 1 / / 1 1 / / 1 / 1 0 / / 1 1 / / 1 0 / / 1 0 / / 0 0 / / 1 #2 1 / / 1 1 / / 1 0 / / 1 0 / / 1 0 / / 1 0 / 1 0 / / o 1 / / 1 . #3 1 / / 1 0 / / 1 1 / / 1 0 / / 1 0 / / 1 0 X / 1 1 / / 1 0 / / 1 #4 0 / / 1 0 / / 0 0 / / 1 1 / / 1 0 / / 0 1 / / 0 0 / / 1 0 / / 0 #5 1 / / 1 1 / / 1 1 / / 1 1 / / 1 1 / / 1 0 / / 1 0 / / 1 0 / / 1 #6 1 / / 1 1 / / 1 1 / / 1 1 / / 1 1 / / 1 1 / / 1 0 / / 1 0 / / 1 #7 1 / / 1 1 / / 1 1 / / 1 1 / / 1 0 / / 1 0 X / 1 0 / / 1 0 / / 1 Age of P a t i e n t - P t . 36 29 25 36 28 41 44 43 Age o f P a t i e n t - F i l e 36 29 25 36 28 41 44 43 M a r i t a l S t a t u s ^ M M M W M M W M No. o f C h i l d r e n / / a t home 3 / / 0 6 / / 6 1 / / 1 4 / / 4 3 / / 3 3 / / 3 6 / / 6 2 / / 2 Time i n H o s p i t a l - P t . 2mns 4wks 2wks 3wks 5wks 2mns 3wks lmn Time i n H o s p i t a l - F i l e 2mns 4wks 2wks 3wks 6wks 2mns. 5wks 3wks No. o f S.W. c o n t a c t s - P t . 2 2 4 3 2 1 2 0+gr No. o f S.W. c o n t a c t s - S.W. 4+gr 2+gr 4+gr 3+gr 2 3 2 2+gr P r e v i o u s A d m i s s i o n s - P t . 6 0 0 0 1 5 0 2 P r e v i o u s A d m i s s i o n s - F i l e 5 0 0 0 1 5 0 2 R e f e r r e d t o S.W. by Dr. S.W. Nurse P t . Dr. Dr. Dr. S.W. Who I n i t i a t e d c o n t a c t - P t . Dr. P t . S.W. - S.W. P t . P t . Group Who I n i t i a t e d c o n t a c t - S.W. P t . S.W. S.W. . P t . S.W. P t . P t . S.W. TABLE NO. I P a t i e n t #1 #2 #3 #4 . #5 • #6 #7 #8 D i a g n o s i s N N N N P P N P Type o f A d m i s s i o n V . V V . ' V .: t I .. V V P e r s o n who d i s c u s s e d h o s p i t a l i z a t i o n b e f o r e admiss i o n Dr. Dr. Dr v 3 w / / D r . None None None Dr. P a t i e n t ' s a b i l i t y t o r e a c h out f o r i n f o r m a t i o n H H H H L L H L L o c a t i o n o f S.W. O f f i c e on on on on o f f on on on P r e v i o u s S.W. C o n t a c t s None + + + + None + None I n f l u e n c e o f r e l a t i v e s 1 h o s p i t a l i z a t i o n + None None None None None + I n f l u e n c e o f r e l a t i v e s on P t s . h o s p i t a l i z a t i o n + + . + . + + None No. of S.W. c o n t a c t s w i t h r e l a t i v e s 1 0 1 0 1 3 0 . 1 (1) M - m a r r i e d W - widowed (2) P - p s y c h o t i c N - n o n p s y c h o t i c (3) V I v o l u n t a r y i n v o l u n t a r y (4) H - h i g h a b i l i t y L - low a b i l i t y 

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