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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 study of s o c i a l worker's information-giving and p a t i e n t ' s information-receiving i n acute treatment units at Riverview 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 c o m p r e h e n s i v e study of s t a f f - p a t i e n t communication.  by  Lyle  Bogren  Wendell Robert  Coady Gilliland  Reginald. Peters David  Turner  A Thesis Submitted 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 D e g r e e of. MASTER OF SOCIAL WORK i n the  We a c c e p t t h i s t h e s i s  School of Social  Work  as c o n f o r m i n g t o t h e r e q u i r e d  standard.  School of Social 1967 The U n i v e r s i t y  of B r i t i s h  Columbia  Work  In  presenting  for  an  that  advanced  the I  thesis  for  Department  shall  further  agree  at  in  partial  the  make  it  that  freely  or  representatives.  his  of  my w r i t t e n  this  thesis  may  for  permission.  Department The U n i v e r s i t y o f B r i t i s h V a n c o u v e r 8, C a n a d a  Columbia  be  of  British  available  permission  purposes  by  f u l f i l m e n t of  University  scholarly  publication  without  thesis  degree  Library  study.  or  this  granted is  financial  by  the  requirements  Columbia,  I  reference  and  extensive  for  It  for  the  copying  Head  understood gain  shall  this  my  of that  not  of  agree  be  copying allowed  ii  ABSTRACT  This  study  communication.  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 study  I t investigates  i n the area  the o p e r a t i o n of the s o c i a l  communication process w i t h respect to s e l e c t e d v a r i a b l e s influence  this The  the c r i t i q u e  study  consists  of three p a r t s ;  of the o r i g i n a l  thought  to  d e s i g n , and  the o r i g i n a l  t h e new  research design,  design.  The  Crease  Clinic  involves both  p r o j e c t takes and  Centre  units. The  underlines  original  the need  Unfortunately, a f f e c t i n g the  i s formed around a frame of r e f e r e n c e  f o r c o m m u n i c a t i o n by p a t i e n t s a t a m e n t a l d e s i g n , which  i n v o l v e d a study of  i n f o r m a t i o n f l o w b e t w e e n s o c i a l w o r k e r and  The original  design  the o r i g i n a l  to achieve a c l e a r  It  worker-patient  process.  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 Lawn  of  focus  i n i t s p u r p o s e and  c r i t i q u e p o i n t e d out  s t u d y and  which  problem  revision  i n c l u d e s a comprehensive o u t l i n e of the extraneous  encountered  in this  the v a l i d i t y  of the study  The original treatment  new  team  more s p e c i f i c  suggests  was  enlarged  influencing  the  of the study  design.  v a r i a b l e s which t h e y may  were affect  and  implications  of  t o i n c l u d e communication between the  worker,  charge  nurse)  f r a m e o f r e f e r e n c e was  f o r implementation  a r e f e r e n c e p o i n t f o r any  failed  findings.  (doctor, social theoretical  factors  patient,  the e x t e n t to which  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  d e s i g n , and  suggestions  s t u d y and  hospital.  formulation.  the v a r i o u s f a c t o r s  l e d to the necessary  which  o f t h e new  and  the p a t i e n t .  developed  and  d e s i g n a r e made and  continuing studies in this  area.  the staff A  in addition can  serve  as  iii.  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 parts;  the o r i g i n a l  suggested  design, a critique  new d e s i g n .  research process  Originally,  of the o r i g i n a l  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  of purpose i n terms o f a s p e c i f i c study.  levels his  developed  own p o i n t o f v i e w .  became  a full  scale  of research  difficulties  design.  i n posing a  statement  f o r m u l a t i o n o f t h e p r o b l e m w h i c h we  As t h e r e were f i v e r e s e a r c h e r s  of understanding  consists of three  d e s i g n , and a  o u r a i m was t o p e r f o r m  H o w e v e r , f r o m t h e b e g i n n i n g we e n c o u n t e r e d  to  thesis  engaged i n t h i s p r o j e c t d i f f e r e n t  w i t h each r e s e a r c h e r  Difficulties  intended  tending t o develop  o f c o m m u n i c a t i o n among us  subsequently  apparent. This  t h e s i s was c o n d u c t e d  p e c u l i a r problems of implementing were unique t o t h i s " s e t t i n g . .  w i t h i n a mental h o s p i t a l  t h e r e s e a r c h d e s i g n were encountered  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  w i t h many s t a f f members f r o m s e v e r a l p r o f e s s i o n s . research design d i d not permit  and as a r e s u l t  Implementation  which  contact o f our  a n e x p l a n a t i o n o f o u r p u r p o s e too t h e p a t i e n t s  a d d i n g m o r e c o n f u s i o n t o o u r 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 to  o u r p u r p o s e we r e a l i z e d  and i n c r e a s e d a w a r e n e s s was g a i n e d  t h a t many o f o u r o r i g i n a l  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 w h i c h we w e r e c u r r e n t l y due t o t h e t i m e to  i n the process  available  relating  a s s u m p t i o n s had been t o the research  of implementing.  At this  design  stage,  f o r t h e r e s e a r c h p r o j e c t we w e r e n o t i n a p o s i t i o n  c o r r e c t many o f t h e e r r o r s a n d 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 .  Subsequently  we d e c i d e d  to consider our o r i g i n a l  pilot  p r o j e c t , containing a test o f the research  pilot  study  d e s i g n as e s s e n t i a l l y  a  i n s t r u m e n t s , and a s m a l l  of 8 p a t i e n t s .  A s e c o n d p a r t o f o u r t h e s i s was d e v o t e d  (  to a critique  of our o r i g i n a l  iv.  design which enabled made e a r l i e r i n the  and  a new  to formally recognize  a t t h e same t i m e  f u t u r e may  suggested  us  encounter  t h e e r r o r s w h i c h had  been  s e r v e as a n a i d t o o t h e r r e s e a r c h e r s  s i m i l a r problems to ours.  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  A l s o the  theoretical  who  critique frame  of  reference. The  s e c t i o n devoted  recommended i n t h e we  critique.  c o u l d h a v e d o n e i f we  a f a s h i o n that another  our  the necessary  research study not  p a r t s , r a t h e r i t was  experience  our  and  e a c h member was  assigned  draft  o f one  changes  such  leave o f f .  t o d i v i d e our  thesis  o r g a n i z a t i o n a l method from t h i s  in  to  into organize  study.  THESIS  a g r o u p 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 .  f i v e members p a r t i c i p a t e d  of each chapter  aim  have gained  THE  I t i s organized  c o n t i n u e w h e r e we  original  AUTHORSHIP OF  Each of the  can  time.  u s e d as an  i n r e s e a r c h w h i c h we  T h i s s t u d y was  r e s e a r c h d e s i g n embodies the  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  had  I n summary i t was three broad  t o t h e new  i n t h e p r e p a r a t i o n and  criticism  t h e o r g a n i z a t i o n o f t h e t h e s i s as a w h o l e . responsibility  f o r the completion  chapter. Chapter  I  R.  Turner  Chapter  II  R.  Peters  Chapter  III  W.  Coady  Chapter  IV  L.  Bogren  Chapter  V  R.  Gilliland  o f the  However, final  V .  T A B L E OF  Chapter I .  THE  CONTENTS  INTRODUCTION  Introduction. F a c t o r s A f f e c t i n g the Flow of Information. Relevance of the Study. A l t e r n a t i v e s to Research. Research 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 Information. Purpose of the Study. 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 of the Research Report p. 1  Chapter I I .  P I L O T STUDY DESIGN AND  FINDINGS  Assumptions of the Study. Information Areas. Independent Variables. Level of Research Design. S a m p l i n g P r o c e d u r e s . Methods of G a t h e r i n g Data. Data C o l l e c t i o n Instruments. P r e - t e s t of P a t i e n t Interview Guide. P i l o t Study  p.  12  p.  27  p.  38  Introduction. The P r o p o s e d H y p o t h e s e s . Developing a Design Format. Implementation of Design. L i s t of Information Items. The Committee. The P a t i e n t S a m p l e . T r e a t m e n t Team C h e c k L i s t . Patient Interview Guide. L i s t of V a r i a b l e s . A n a l y s i s of the Data  p-  53  Bibliography  p.  66  p.  69  Chapter I I I .  CRITIQUE.OF P I L O T STUDY  Introduction. Study D e s i g n . Methods of Data C o l l e c t i o n . Study Procedure. Extraneous V a r i a b l e s . Method o f . A n a l y s i s  Chapter IV.  THEORETICAL B A S I S FOR  A NEW  DESIGN  Introduction. T h e o r e t i c a l Framework. R o l e o f Information 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 W a r d . The R e c e p t i o n n o f I n f o r m a t i o n on a H o s p i t a l W a r d . V a r i a b l e s  C h a p t e r V.  THE  PROPOSED DESIGN  A p p e n d i x A; - P a t i e n t  Interview  Guide  Appendix  B - S o c i a l Worker Q u e s t i o n n a i r e  p.  71  Appendix  C - File  p.  72  Appendix  D - S o c i a l Worker I n t e r v i e w  p.  73  p.  75  Information  Appendix E - Organizational  Guide Guide  Chart of R i v e r v i e w H o s p i t a l  L I S T OF  Table I - Compilation  of Data  TABLES  Collected  vii.  ACKNOWLEDGEMENTS  This of  research  p r o j e c t was made p o s s i b l e b y t h e k i n d  the administration of the Riverview  offered  their  staff, patients  H o s p i t a l , who  and f a c i l i t i e s  understandingly  t o a s s i s t i n the study.  individual  s t a f f members, t o o n u m e r o u s t o m e n t i o n h e r e , o f f e r e d  assistance  and d i s p l a y e d Our  cooperated  i s extended  full  always c h e e r f u l  appreciation  schedules of t h e i r  of material, often  The  is  together  own.  cooperation  We w o u l d l i k e  this  diffiault  assistance  of our Advisory  and a s s i s t a n c e i n t o acknowledge t h e  Our s p e c i a l  time i n t h e i r  t o M i s s D.R. B e g g , M i s s B e r n i e  and i n d i v i d u a l l y ,  Reid  their  lives.  i f not impossible,  Committee.  We  s t a f f , who a s s i s t e d  at short notice.  s t u d y w o u l d h a v e b e e n more d i f f i c u l t ,  invaluable expressed  workers,  t o t h e p a t i e n t s who p a r t i c i p a t e d i n t h e s t u d y b y s h a r i n g  t h o u g h t s and f e e l i n g s d u r i n g  the  t o t h e ward s o c i a 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  in thepreparation  invaluable  i n t h e 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 .  w i s h t o t h a n k t h e c h a r g e n u r s e s who g a v e t h e i r spite of very  Many  i n t e r e s t i n our endeavours.  grateful appreciation  who w i l l i n g l y  permission  Our s p e c i a l  without  gratitude  and M r . R.M. R o s s , who,  shared 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  counsel. Wives and f a m i l i e s o f t h e r e s e a r c h e r s Their  gave i n i n n u m e r a b l e ways.  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  researchers  added t o o u r r e s o l v e  Finally,  to the  and g a v e us i m p e t u s when i t was n e e d e d .  s p e c i a l thanks t o our s u p e r v i s o r  H a m i l t o n , who g a v e o f h i s k n o w l e d g e o f r e s e a r c h , we g r a t e f u l l y a p p r e c i a t e .  offered  o f s t u d i e s , Dr. Glen  advice  a n d s u p p o r t and t h i s  STAFF-PATIENT COMMUNICATION:IN.A MENTAL HOSPITAL  CHAPTER I  INTRODUCTION  THE IMPORTANCE OF INFORMATION Communication between s t a f f is  s u r p r i s i n g l y complex and i n o r d e r  of  information  with  only  process  and p a t i e n t s  i n any l a r g e  t o address ourselves  to the study  i n t h e t i 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  a small  sub-system o f the t o t a l  ourselves  communication network - the  o f c o m m u n i c a t i o n o c c u r r i n g b e t w e e n t h e s o c i a l w o r k e r and t h e p a t i e n t .  M o r e s p e c i f i c a l l y we d e c i d e d communication w i t h i n t h i s  t o focus  specifc  Schwartz i n a study  on t h e i n f o r m a t i o n a l component o f  context.  i n v o l v i n g S o c i a l Research  drew a t t e n t i o n t o t h e 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 communication process which tended  to interfere with  i n a mental h o s p i t a l and o m i s s i o n s  communicative o r g a n i z a t i o n , breakdowns, b l o c k s , transmission  of information,  the passing  i n the  t h e t r a n s m i s s i o n and  reception of information w i t h i n a mental h o s p i t a l s e t t i n g .  all  institution  "Defects  distortion,  on o f a c c u r a t e  in  omissions  i nthe  or inaccurate  data,  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 b e t w e e n a n d among h o s p i t a l p a r t i c -  ipants.  These m i s u n d e r s t a n d i n g s  ( 3 1 , p . 19.3)  tend  to perpetuate  Implicit  i n this  cation of factors hindering therapeutic  and e x c i t e m e n t t e n d t o  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 -  the flow of information w i l l  course of the p a t i e n t .  independently  enhance t h e  T h e s e f a c t o r s o r v a r i a b l e s may  o r c o m b i n e a n d a c t as a t o t a l i t y  Information  manifested  i n their  i n patient  their  interaction with  need f o r i n f o r m a t i o n .  operate  to influence the information  f l o w b e t w e e n t h e s o c i a l w o r k e r and t h e p a t i e n t .  gratify  illness".  S c 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 t h e r e m o v a l o f  blockages t o communication the p a t i e n t s a n x i e t y decrease.  the p a t i e n t s  each other  The dangers o f t h i s  flow i s  attempts t o type of i n f o r m a t i o n a l  flow  is illustrated The  i n the p a s s i n g  amount o f  s o c i a l w o r k e r was  information  considered  i c a t i o n p r o c e s s had  on  an  of  inaccurate  received  index of  b e e n a f f e c t e d by  by  the  information.  the p a t i e n t  from  degree to which  specific  the  the commun-  f a c t o r s i n f r i n g i n g on  the  process. This appropriate necessary  s t u d y was  informational  by  treatment but  a l s o to the  The  e f f i c i e n c y of  FLOW OF  i s exceedingly  s o c i a l w o r k e r and value  e x p e r i e n c e s on  the p a r t  the  information  d e p e n d on  differences.  work toward s u g g e s t i n g  has  only  patient  accurate  is a  reception  to the p r o g r e s s of  i t s a p p l i c a t i o n by  the  of  his  social  worker.  INFORMATION  complex.  p a t i e n t may  of  An  The  of  active organization  information.  r e l a t i o n s h i p s and  informational  which would  tend  the  communication process  s u c h v a r i a b l e s as  t h e p a t i e n t was  terms of p a t i e n t r e c e p t i o n  i n f r i n g i n g on  import not  The  that  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  information  and  the r e c o g n i t i o n  f l o w b e t w e e n s o c i a l w o r k e r and  t h e p a t i e n t has  FACTORS A F F E C T I N G THE  status  a r e s u l t of  c o r r e l a t e of e f f e c t i v e treatment.  information  of  partially  spatial  distance,  of past reactions  a l s o p r e s u m e d t o be I t was  between  considered  operative  in  important  to  h y p o t h e s e s among s p e c i f i c  f l o w b e t w e e n s o c i a l w o r k e r and to ameliorate  patient  appropriately  received  by  The  specific  factors affecting informational  anxiety  and  factors  patient. not  Why  been  patient. flow  studies  in  this  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 .Service  Dept. of R i v e r v i e w  exhaustive  list,  but  Hospital  rather,  the  and  the  supervisory  was  not  s e l e c t i o n was  w e r e t h o u g h t t o h a v e t h e m o s t i n f l u e n c e on the  patient.  the  staff  considered  of the  t o be  Social  an  based upon t h o s e f a c t o r s  which  reception  by  of  information  O B J E C T I V E S OF STUDY There has been v e r y quently,  i t was d e c i d e d  that  little  research  the general  purpose of t h i s  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 that,  "The o b j e c t i v e i s t h e i d e n t i f i c a t i o n  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 d e v e l o p m e n t and t h e r e f o r e  study of  formulative  study  correlated design, i n  promising  w h i c h , as y e t , has had l i m i t e d  Initially  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  Subse-  research  f o relaborate  (25, p.51)  area.  o f sound q u e s t i o n s  ina field  i s not prepared  to t e s t complex hypotheses".  done i n t h i s  experimental  design  the objective of this  f a c t o r s on p a t i e n t  receptivity  information. It  i s t o b e r e m e m b e r e d t h a t o u r p u r p o s e was n o t t o condemn  e x i s t i n g processes rather  t h e r e was a n a t t e m p t a t e x p l o r a t i o n and  We w e r e n o t c o n c e r n e d w i t h perception  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  of the information  t o be s e n t  suggestion.  the workers  to the patient.  RELEVANCE OF THE STUDY TO DIFFERENT GROUPS The  original  research  design  importance t o a number o f s e c t o r s  a n d p u r p o s e was b e l i e v e d  of the population.  t o be o f  With the i n s t i t u t i o n  o f a new d e s i g n  a n d s u b s e q u e n t r e o r g a n i z a t i o n o f p u r p o s e and m e t h o d we  still  this  of  feel  that  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 g r o u p s  people. P o l i c y m a k e r s o n t h e g o v e r n m e n t a l l e v e l s a r e l i n k e d i n many ways  to the a d m i n i s t r a t i o n of the h o s p i t a l . extension  of Mental Health  naturally  concerned w i t h  purely  best  both a t Riverview  i n planned  and o t h e r  a therapeutic m i l i e u f o rthe patient.  areas a r e This  study,  o n a n 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 s u c h c h a n g e s a s o f f i c e l o c a t i o n ,  t o be p l a n n e d be  facilities  Individuals involved  i n s u c h a way t h a t  facilitated.  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 would  Some S o c i a l Work o f f i c e s  are located at a  great  distance  from t h e ward served  which are placed The  on o r n e a r t h e w a r d .  o p t i m u m number o f S o c i a l W o r k e r s e m p l o y e d  areas of the Riverview presently  as  H o s p i t a l , n a m e l y C r e a s e and C e n t e r Lawn U n i t s i s  this  study w i l l  have a b e a r i n g  professional  status  of client  fessional  But  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  groups o p e r a t i n g  concerned w i t h  social  functioning.  as p a r t  Other p r o -  o f t h e t r e a t m e n t team.  This  study i s  t h e c o m m u n i c a t i o n b e t w e e n S o c i a l W o r k e r and p a t i e n t .  by the necessary d e l i n e a t i o n of treatment f u n c t i o n  treatment of the p a t i e n t .  inherent  i n the  groups a r e n e c e s s a r i l y concerned w i t h Better  the t o t a l  use o f time a v a i l a b l e t o S o c i a l Workers  of concern t o t h e S o c i a l Worker h i m s e l f  efficient  t h e optimum  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  Worker's e f f e c t i v e n e s s  S o c i a l Worker's r o l e other  are  on t h e i m p l e m e n t a t i o n o f s u c h  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  enhancement o f t h e i n d i v i d u a l p a t i e n t ' s  only  staff.  these. Practitioners  Social  i n t h e two a c u t e  u n d e r c o n s i d e r a t i o n b y 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  Hopefully, plans  and a r e n o t a s a c c e s s i b l e a s t h o s e o f f i c e s  i n t e r m s a o f e f f e c t i v e and  c a s e l o a d s and a l s o t o p o l i c y m a k e r s and d e c i s i o n m a k e r s .  effective reception correlates  of information  by the p a t i e n t  of e f f e c t i v e treatment.  flow decreases anxiety  Enhanced  which increases  The  i s one o f t h e m a i n  c o m m u n i c a t i o n and  the patient's  information  accessibility to  treatment. Client  groups have a v e s t e d  i n t e r e s t i n t h e s t u d y as i t attempts  t o d e t e r m i n e f a c t o r s w h i c h may h a v e a d e t r i m e n t a l in  treatment.  poorly  I t has been our e x p e r i e n c e  e f f e c t on t h e i r  that patients  i n general  i n f o r m e d a s t o w h i c h s t a f f member i s m o r e a p p r o p r i a t e  patients  informational This  progress are  to s a t i s f y the  needs.  s t u d y may  i n general,  support r e o r g a n i z a t i o n  of the S o c i a l  Worker's communicative o r g a n i z a t i o n , s t a f f members b e n e f i t t i n g t h e With the  this  facilitation  therapeutic  We  the  believe  conducting research h o s p i t a l s are  the p a t i e n t  that  s t u d y has  b e i n g u s e d as  for  growth  and  A h o s p i t a l w a r d may  4.  Variables  5.  Patient  The  which are  be  mentally be  disturbed  avoided  the  researchers  who  is  more m e n t a l special  advantages reasons  by  research  subjects;  v i r t u e of  limited physical  a small  scale  social  space  system  as many  patients  them;  b e h a v i o u r may  help  explain  convent7  impact of S o c i a l R e s e a r c h upon ward  are  also  concerned w i t h  i t s h e u r i s t i c exploratory h y p o t h e s e s b e i n g an  i n other research  r o l e s and  the  possible  research  studies.  period  individuals will  in future  researcher  by  staff  sub-systems.  encountered during  in defining staff  also  organizations.  o f more f r u i t f u l  useful  to the  M o r e and  v i e w e d as  of deviant  illustrate  believe  captive  to c o n t a i n  structured  s t u d y by v i r t u e o f  study w i l l  S o c i a l Workers, but  in  more e a s i l y r e s t r i c t e d ;  ability  evaluation  s t u d y may  formulation  be  be  person.  to engage h i m s e l f  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  other professional  this  may  of  other  activity:  3.  We of  research  Observation is f a c i l i t a t e d  the  a total  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  2.  ional  as  s i t e s by v i r t u e o f  Ready a c c e s s i b i l i t y  lack  this  research  i n i n t e r e s t and  An  by  value  1.  6.  able  w i t h i n a mental h o s p i t a l .  in i t s structure.  Also  only  team.  this  the p a t i e n t  is better  treatment  inherent this  t e n t a t i v e a p p l i c a t i o n to  treatment of  e n d e a v o u r s made, n o t  o t h e r members o f  with  of  the  skewing of be  studies.  formulative inherent  s t u d y , s u c h as  results  design.  goal  Definite research  of  this  problems  difficulties  objective data received  illustrative The  the p o s s i b l e  of p o s s i b l e p i t f a l l s  literature  on  information  from to flow  in  a mental h o s p i t a l of  contribute  to the The  this  general  s i z e i s not  fund  of knowledge i n t h i s  p u b l i c at l a r g e are m a n i f e s t i n g  treatment of mental p a t i e n t s . popularity  as  there  illness  cost  the  be  confined  concern of  A L T E R N A T I V E S TO  a large  the  original  the  difficulties  identified  research  in providing  particularly  upon d i s c h a r g e i n f o r m a t i o n may  may  the  al  needs of  We  assumed t h a t  have s t a t e d  from the h o s p i t a l . be  This  h e l p f u l to p a t i e n t s  the p a t i e n t  This  stressed as  an  to p a t i e n t s  words the  that  w o u l d be  the  in  large  out  at  one  of every  ten  organ-  i n c i d e n t l y reduce  the  Hospital.  able  which r e l a t e d  of  information  needed  although  e s s e n t i a l to t h e i r  the  identified  satisfying total  by  plan.  the  i m p r o v e d upon by  survey  information-  treatment  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 .  treat-  a  the  as p r o v i d i n g  cure  information  would s t a t e that  contra-indicated  c o m m u n i c a t i v e s i t u a t i o n w o u l d be  that  treatment would  t o secure the  importance of of  to  b a s i c p r o b l e m was  physical  i t i s not  work  patients.  viewpoint  integral part  social  the p a t i e n t s need f o r  s o l u t i o n was the  the  to the  C h e m i c a l and  A n o t h e r p o s s i b l e s o l u t i o n was  other  growing  s t r u c t u r a l and  d i s c u s s i o n and  information  s u b s e q u e n t l y he  l i t e r a t u r e which  information  also  the  interest in  a l t e r n a t i v e s o l u t i o n s to the  important.  ment r e g i m e n i n h o s p i t a l . of  a vested  s u c h as R i v e r v i e w  i n previous  design.  L o g i c a l l y , we  and  to reorganize  Possible  s t u d y may  will  RESEARCH  p r o b l e m w h i c h was  the p a t i e n t  are  l a r g e number o f p e o p l e who  institution  T h e r e w e r e a number o f  i s not  studies  i n a m e n t a l h o s p i t a l , (one  this  study  area.  research  the p u b l i c .  changes s u g g e s t e d by  of m a i n t a i n i n g  The  this  increasing interest in  p u b l i c pressure  i t s treatment.  time or another w i l l  izational  an  S i m p l y t h e p u b l i c a t l a r g e has  and  Canadians), are  Constructive  is a increased  mental h o s p i t a l s . mental  large, hopefully  needed In  freeing  the  S o c i a l Worker o f o t h e r available c o u l d be by  the  t o g i v e the needed increased.  This  chronic nature  when i t was to give  responsibilities  deduced  member.  shortages.  that perhaps  i t was  that this  d e p e n d e n t upon h i s r o l e w h i c h H e n c e t h i s was  valid  is partially  negated  A n o t h e r s o l u t i o n became a p p a r e n t  be  assigned  i n f o r m a t i o n g i v e n by  S o c i a l Worker  to another  the  S o c i a l Worker i s  logically  identified  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  ious e f f e c t s of s t a f f  shortages  r e j e c t e d as with  i n that  T h i s no  i n a more f o r m a l  and  m e a n i n g may  be  other  doubt occurs  purposeful  amount o f e r r o r i n t h e  of the present  issued  for deleter-  staff-patient  time.  s e e n as r e l y i n g on  information.  a result  and  needed  subsequent r e d u c t i o n of  A n o t h e r s o l u t i o n t h r o u g h the use was  and  deemed i m p r a c t i c a l .  T h i s was  processes  staff  i s b a s e d upon p r o f e s s i o n a l k n o w l e d g e  information giving.  at the present  more  number 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 t h a t a S o c i a l W o r k e r g i v e s m i g h t be p u b l i s h e d  to p a t i e n t s which would  contact  make h i m  unnecessary f o r the  r o l e may  A n o t h e r p o s s i b l e s o l u t i o n was needed  The  s o l u t i o n although  H o w e v e r , much o f t h e  experience.  to otherwise  information.  of s t a f f  i n f o r m a t i o n and  or  now.  manner.  of d i f f e r e n t  p a t i e n t s t o communicate needed Perhaps t h i s  c o u l d be  H o w e v e r , t h i s may  i n f o r m a t i o n g i v e n ; much o f t h e  l o s t when i n f o r m a t i o n  communicative  increase  original  i s c o m m u n i c a t e d by  ill  instituted  and  the  content  and  untrained  people.  RESEARCH I D E N T I F I C A T I O N OF A  c e r t a i n amount o f  Unfortunately We  t h e r e has  SOCIAL WORK PROBLEM i n f o r m a t i o n may  been l i t t l e  noted however, t h a t t h i s We  THE  a r e a has  w e r e u n c e r t a i n as  research  be  gathered  i n the a r e a  b e e n s u g g e s t e d as  from the of our  one  literature.  thesis project.  requiring research.  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  the  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 e r e was a l a c k o f i n f o r m a t i o n was b a s e d o n l y o n p e r s o n a l readings  of communication problems i n other  been v a l i d a t e d by r e s e a r c h original  research  information  design  at Riverview  w o u l d be a b l e  Hospital. t o show:  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  on t h e b a s i s  We  demonstrate trends  which would  in  the o r i g i n a l This  interview office  design  be  able  This  These v a r i a b l e s had been look  a t the problem. i t possible to  on t h e ward.  i s an o f f i c e  was t h e a c c e s s a b i l i t y o f t h e w o r k e r t o t h e  I t had been noted there  appeared  on t h e w a r d .  t o o f f e r some v a l i d  data  factors  One o f t h e v a r i a b l e s t o b e e m p l o y e d  i n p a r t , w o u l d be measured by t h e a v a i l a b i l i t y  d i s c u s s i o n with workers that when t h e r e  of the lack of  suggest the importance o f s p e c i f i c  the communication of i n f o r m a t i o n . research  that the  t h e s i g n i f i c a n c e o f some o f  o f o u r c o l l e c t e d d a t a we c o n s i d e r e d  in  patients.  surmised  the extent  o f a common s e n s e o r r a t i o n a l  On t h e b a s i s  and  h o s p i t a l s a n d b$s. n o t y e t  t h e 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 . selected  experience  that  o f an  from o b s e r v a t i o n  and  t o be m o r e w o r k . d o n e w i t h  I t was t h o u g h t t h a t r e s e a r c h  f o r the confirmation  patients should  or r e f u t a t i o n of t h i s .  i n t u r n may w e l l h a v e a n i n f l u e n c e o n w h e t h e r o r n o t t h e S o c i a l  Service  D e p t . p u s h e d f o r S o c i a l Work o f f i c e s  on t h e ward.  THE NATURE OF S O C I A L WORK INFORMATION Initially  i t was b e l i e v e d - . n e c e s s a r y  o f a S o c i a l Work n a t u r e hospital. obtained  w i t h i n t h e r o l e o f a S o c i a l Worker  I t was t h o u g h t t h a t  information  from the p r o f e s s i o n a l l i t e r a t u r e  supervisory  staff  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 the Riverview  o f a S o c i a l Work n a t u r e  communicated t o t h e p a t i e n t s .  could  be  o f S o c i a l Work and f r o m t h e  Hospital Social Service  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 fact  i n a mental  I t was d e c i d e d  Dept.  i n f o r m a t i o n was i n  t o do t h i s b y o p e n ended  questions  i n a semi--structured  t h a t a sample of  40  t o 60 p a t i e n t s w o u l d  ment f o r p u r p o s e s o f p a t i e n t s would v a r y they r e c e i v e .  interview with  chi-square a great  I t was  h o p e f u l l y we  what f a c t o r s are  t o the h i g h  s t u d y we  needs f a l l i n g w i t h i n the being  completely  being  received  low  by  Is  amount o f  reception  could  be  therefore  our  f a c t o r s a f f e c t i n g the  patient.  Through a p p r o p r i a t e  t h e r e was  i t was  the  be  assessthe  information related  that  to  s u g g e s t i o n s as  to  of  by  information  any  statistical  f a c t o r s to l a c k of decided  that  transmitted  a r e s u l t of  changed  by  the  informational research  S o c i a l Worker  i n order  to  improve  or  corrective actions  Worker - p a t i e n t  communication process.  i f necessary, further research  design  effectively. to  to  r e l a t i o n s h i p s of  r e c e p t i o n by r a i s e d as  designed  intended  evaluate  these Second-  implementation  t o enhance the  T h i r d l y i t was  and  determine  the p a t i e n t s . to the  were  or  f l o w between S o c i a l Worker  p r o c e d u r e s we  w o u l d be  increases  t o know i f t h e r e  original  s i g n i f i c a n c e i n the information  not  f a c t o r s a f f e c t i n g the  to communicate i n f o r m a t i o n  purpose i n the  suggestion  informational  S o c i a l Workers r o l e were  H o s p i t a l wished  of c e r t a i n plans  suggest,  the  the p a t i e n t s  o b v i o u s f a c t o r o f needed s t a f f  improved or  specific  external  Is t h i s  Besides  that  information  S o c i a l Worker's a b i l i t y  I t was  of  Dept. of R i v e r v i e w  factors that  enhance the  jurisdiction  the p a t i e n t ?  Social Service  other  were concerned  satisfied.  communication process?  ly  would expect that  come up w i t h  and  accurate  thought  STUDY In this  if  may  I t was  patient.  PURPOSE OF  the  a fairly  these f i n d i n g s could  s i g n i f i c a n t v a r i a b l e s and  the  We  i n terms of the  thought that  relevant  g i v e us  analysis.  deal  the p a t i e n t .  Social  deemed i m p o r t a n t  development i n the  area of  study.  to  10.  REVIEW OF  THE  LITERATURE  There i s a considerable t o our  research  study.  l a c k of l i t e r a t u r e  S c h w a r t z has  the  sending  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 t o t h e d e g r e e w h e r e i t c a n be  purpose. etical  However, t h e r e  aspects  of  ORGANIZATION OF Chapter  THE  first  chapter study  information sending  this material  t h i s has  not m a t e r i a l -  a p p l i e d t o our focussed  a p a r t of the  and  i s concerned w i t h  design  research  on  the  i n our  to the  general  study  applied.  the  The  frame of r e f e r e n c e  importance of  the  purposes of the  itself  but  e m p h a s i s on  f a c t o r s which a f f e c t study  this  are d i s c u s s e d  a l s o the r e l e v a n c e  of the  are  Chapter  of research  The  design  A s s u m p t i o n s and is identified  to  different  The  questionnaires  are  described.  with  utilized  the a c t u a l o r i g i n a l  study  v a r i a b l e s are d i s c u s s e d .  methods of  to the p r e l i m i n a r y t e s t i n g of  study  in  discussed.  i s concerned w i t h  S a m p l i n g p r o c e d u r e s and  reference pilot  second chapter  of the p r o j e c t .  discussed.  both  II  The  lined.  study  the e f f e c t s  enhancement.  study  alternatives  open t o r e s e a r c h  to  appropriate  groups, p r a c t i t i o n e r s e t c .  level  and  study.  g r o u p s s u c h as p o l i c y m a k e r s c l i e n t  design  theor-  communication process  r e c e p t i o n i s s t r e s s e d w i t h an  i n f o r m a t i o n f l o w and  o b j e c t i v e s and  relation  and  r e c e i v i n g of  RESEARCH REPORT  which the o r i g i n a l  The  as y e t  i s a growing l i t e r a t u r e  h a v e d r a w n on  and  the  I  The  of enhanced  utilized  i n f o r m a t i o n f l o w as  w h e r e p o s s i b l e we  applies  i n d i c a t e d a g r o w i n g e m p h a s i s on  i m p o r t a n c e o f s t u d y i n g c o m m u n i c a t i o n and  ized  a v a i l a b l e which  the p l a n of data gathering data  i n the the  study  are  instrument.  The  analysis  are  out-  briefly  illustrated  with  The  of  results  the  11.  Chapter I I I The design. of data  An  third  chapter  introduction i s given.  c o l l e c t i o n as  research  instruments  variables  they  f o u r t h chapter design.  i n a mental h o s p i t a l  t h e new  An  criticized.  a criticism  of  design.  the  theoretical  i n t r o d u c t i o n i s given.  i s discussed with  The  role  framework of  information  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  T h e r e i s a d i s c u s s i o n as  to  of  and  the p o s s i b l e context  V fifth  chapter  proposed hypothesis discussed.  p r o p o s e d new An  extraneous  design.  The  is  are  diverse  i n d e p e n d e n t v a r i a b l e s on d e p e n d e n t v a r i a b l e s w i t h i n t h e  Chapter  The  The  c o l l e c t i o n and  i s concerned w i t h  r e c e p t i o n on a h o s p i t a l w a r d .  of  research  o f the methods The  criticized.  original  IV  research  of  design.  patients, researchers,  the method of d a t a  i t a p p l i e s to the o r i g i n a l  The  effects  to the o r i g i n a l  - i n s t i t u t i o n a l , workers,  Chapter  t h e new  apply  There i s a c r i t i c i s m  w h i c h have been used are  There i s a d i s c u s s i o n of t h i s as  i s concerned w i t h a c r i t i q u e of the  and  Suggestions design.  i s concerned w i t h  t h e p r o p o s e d new  v a r i a b l e s are developed. a r e made r e l a t i n g  to the  There i s a c a t e g o r i z a t i o n of  o u t l i n e o f t h e p r o p o s e d p a t i e n t s a m p l e t o be  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  there  the d a t a  i s an  The  o u t l i n e o f how  c o l l e c t e d may  design  implementation informational  utilized  instrument  new  research  t o be be  of  design.  format the  items.  i s discussed. used.  analyzed.  Finally  CHAPTER I I  P I L O T STUDY DESIGN AND  ASSUMPTIONS OF As with  THE  has  STUDY  been i n d i c a t e d i n Chapter I , t h i s  impediments  i n the  The  importance of  and  s t a f f has  amount o f  information  i n the  exchange between each i n d i v i d u a l .  therapeutic  p o s i t i o n s , but  communicative process  impeded by  were concerned w i t h  of  t h i s p i l o t p r o j e c t , i t was  rather  the  efficiency  impediments to the  a r i s e a t many p o i n t s d u r i n g process, t o be of,  concerned w i t h  (29  - 510)  performed  imparted  be  experimental  to concentrate  information being  amount o f  We  that  efficiently  the and  i t should  on  To We  felt  information  the  that  can  but  be  designed. purpose  quantity,  We  were, a l s o ,  received  could  e x a m i n a t i o n of i t was  not  the necessary  the  feasible  the worker's i n t e r p r e t a t i o n to the p a t i e n t .  We  i n f o r m a t i o n - g i v i n g aspect of the worker's that  or  identif-  f o r the  the  sent.  limit  be.  numerous f a c t o r s  information being  f a c t o r s which might d i s t o r t to give  as  nature  of t h i s process,  the process.  or h i s a b i l i t y  to the  efficient  various  t h e s e v a r i a b l e s n e e d t o be  c e r t a i n a s s u m p t i o n s w e r e made.  assumed, t h e r e f o r e , was  decided  than the q u a l i t y , of the  aware t h a t  o f an  patient.  t h a t such a process  can  before  We  observed  as  ied  a study  the  and  i n t e r a c t i o n between p a t i e n t  i s not  i n t h e s e s e t t i n g s and  confirmed  s o c i a l worker  a l l s t a f f members, t h r o u g h t h e  v a r i a b l e s present and  concerned  t h e n e c e s s i t y o f an e f f e c t i v e  I t was  o p e r a t e s b e t w e e n t h e p a t i e n t s and  This  was  i n f o r m a t i o n r e c e i v e d by  been s t r e s s e d , p o i n t i n g out  of h i e r a r c h i a l  study  communication p r o c e s s between the  the p a t i e n t , e f f e c t i n g the  levels  FINDINGS  i n f o r m a t i o n was  role  being  patient.  felt,  a l s o , t h a t we  the p a t i e n t ' s a b i l i t y  to  were not  i n a p o s i t i o n t o examine  i n t e r p r e t a c c u r a t e l y the  information  properly  received.  In  an  attempt to l i m i t  part  of  the e f f e c t s of  this  the process o c c u r r i n g j u s t b e f o r e  message-received phase. received  by  I t was  t h e p a t i e n t w o u l d be  messages r e c e i v e d by  by  an  we  focused  study  on  i n t e r p r e t i v e phase the  amount o f  i n d i c a t i o n of the Any  the  the  information  efficiency  discrepancies  that  of  the  i n t h e number  of  t h e p a t i e n t , when c o m p a r e d t o t h e number o f m e s s a g e s  the worker, could  institutional  this  assumed t h a t  communicative process to t h i s p o i n t .  sent  aspect,  be  r e l a t e d to v a r i a b l e s o c c u r r i n g w i t h i n  the  setting.  INFORMATION AREAS Ward s o c i a l w o r k e r s a r e p a r t along with  psychiatrists,  therapists^ relation ility  and  nurses,  e a c h member o f  occupational  the  t e a m "'has  to the p a t i e n t ' s treatment.  of a p a r t i c u l a r  o f a t r e a t m e n t team i n t h e h o s p i t a l , therapists, recreational^  assignments to f u l f i l l  Some a s s i g n m e n t s a r e  discipline, while  others  are  the  s h a r e d by  with  responsib-  two  o r more  information which  involve  team members. S o c i a l workers attitudes  and  give c e r t a i n types of  f e e l i n g s of  the p a t i e n t ' s community.  the p a t i e n t , r e l a t i v e s (24)  such i n f o r m a t i o n because of elements of a p a t i e n t ' s To the  exclusively  i t was  c o v e r e d by  They are r e s p o n s i b l e  their  special s k i l l  amount o f  and  should  necessary to i d e n t i f y  this discipline.  be  c o v e r e d by  These seven areas of  the  and  information  For  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 treatment,  o t h e r member's f o r the  of  imparting  knowledge of the  of  social  life.  determine the  s o c i a l worker,  and  the  included;  a patient received informational  s o c i a l worker r o l e of  areas  t h i s purpose seven  important  the  to the i n each  from  informational  patient's case.  s o c i a l worker;  awareness  team a p p r o a c h ; r e a s o n s f o r .coming t o t h e 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 ) ;  financial  and l e g a l  of discharge  concerns;  plans;  family functioning; material-physical  and s o c i a l - e m o t i o n a l p l a n n i n g  p a t i e n t ' s r e t u r n t o t h e community. scoring  information received  each i n t e r v i e w guide,  around d i s c h a r g e  D e f i n i t i o n o f each a r e a ,  aspects and t h e  to assist i n  from t h e 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  and a copy o f t h i s  guide w i l l  be f o u n d  i n the appendix.  INDEPENDENT V A R I A B L E S Autobiographies ful  i n suggesting  o f former mental h o s p i t a l p a t i e n t s  numerous v a r i a b l e s .  some members o f t h e r e s e a r c h were d i s c u s s e d being  with  of probable Although  are  These, plus observations  group w h i l e  the advisory  ( 2 0 ) were  employed  made b y  i n the mental  hospital,  c o m m i t t e e , and a number w e r e i d e n t i f i e d  as  importance t o the communicative process . other  pertinent variables doubtlessly exist,  the independent v a r i a b l e s s e l e c t e d f o r the purpose of t h i s 1.  help-  Number o f c o n t a c t s Before  study;  b e t w e e n s o c i a l w o r k e r and p a t i e n t .  we w e r e a b l e  variables  the following  t o examine t h e e f f e c t  o f independent  o n 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 b y t h e  p a t i e n t , we h a d t o d e t e r m i n e i f t h e r e h a d b e e n a n y opportunity interested  f o r such messages t o have been s e n t . only  i n messages o f a m e a n i n g f u l n a t u r e ,  importance to the p a t i e n t ' s treatment, contacts  as those  g i v i n g other The  greater  Hospital  such  c o n t a i n i n g some e l e m e n t o f i n f o r m a t i o n -  than 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 . t h e number o f s u c h c o n t a c t s ,  Number o f p r e v i o u s experience  o f some  and we d e f i n e d  amount o f i n f o r m a t i o n t h e p a t i e n t s h o u l d 2.  We w e r e  admissions  the greater the have  t o a mental h o s p i t a l .  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 ,  o r any o t h e r ,  could  received.  effect  either  their motivation  Previous Riverview to receive  15.  i n f o r m a t i o n from s t a f f 3.  Length o f time of c u r r e n t admission. to be i m p o r t a n t there  b e c a u s e as t h e c o n f i n e m e n t  contacts to  completed. - voluntary or involuntary.  type  p r o c e d u r e used w i t h  of admission effect  their  s t a f f members.  receptivity  experience  negative  i n f l u e n c e on t h e i r  The n a t u r e  these  confinement contacts,  receptivity  patients  t o i n f o r m a t i o n given by  f o r the p a t i e n t , with  o f any p r e v i o u s  The  individual  An i n v o l u n t a r y a d m i s s i o n  negative  current  felt  lengthens  Type o f a d m i s s i o n  could  5.  T h i s was  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  have been 4.  members.  relationship  c o u l d be a a possible with  staff  members.  s o c i a l work c o n t a c t s b e f q r e t h e  - positive  i f any, could  or negative.  The n a t u r e  of  influence the patient's  to 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  social  worker. 6.  Diagnosis  of the p a t i e n t s i l l n e s s at the time of 1  Two v e r y b r o a d describe  c a t e g o r i e s were f e l t  the i l l n e s s e s  other, nonpsychotic. acute  phase of t h e i r  probably  a t t h a t time;  o n e , p s y c h o t i c and t h e  Psychotic patients experiencing i l l n e s s a t the time of admission  o f t h i s h a d b e g u n t o wane.  p a t i e n t s w o u l d be a b l e  7.  t o be s u f f i c i e n t t o  an would  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 t h e  psychotic aspects  admission  admission.  as t h e y  Range, h i g h information. staff, while  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  are r e l a t i v e l y  i n touch  or low, of p a t i e n t ' s a b i l i t y Some p a t i e n t s r e a c h others  Nonpsychotic  with  reality.  to reach  out f o r contact  are reluctant to i n i t i a t e  this  out f o r with step.  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 b u s y and s h o r t a g e s of personnel  increases  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  than wait  f o r t h e need  responsible 8.  initiated  the  social  a high  placed  t o be r e c o g n i z e d  staff.  verbally  rather  and met  the f i r s t  worker?  contact  This  between  by  the  range of a b i l i t y  w o r k e r and make t h e i r  t o reaeheijcmt,  requests  a low range of a b i l i t y ,  the p a t i e n t  and  i s c l o s e l y r e l a t e d to the p a t i e n t s ,  to reach out f o r i n f o r m a t i o n .  contact  on t h e  s t a f f member.  Who  ability  the pressure  will  Some p a t i e n t s , will  known.  wait  with  seek out the  social  Other p a t i e n t s ,  f o r the s o c i a l  with  worker  to  t h e m , o r h a v e someone e l s e a p p r o a c h t h e w o r k e r f o r  them. 9.  Source of r e f e r r a l  of p a t i e n t  w h i c h a p a t i e n t may would v a r y  the degree of esteem w i t h w h i c h t h a t  would  influence a patient's  a t t i t u d e towards  and e f f e c t t h e amount o f i n f o r m a t i o n  Location  The  o f the ward  This the  social  In  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  This  w o u l d h a v e a n e f f e c t on t h e c o n v e n i e n c e f o r t h e  available  someone e l s e ' s The of  office,  i f t h e y were h e l d  i n the lounge or  nature of mental h o s p i t a l experience, f r i e n d s of the p a t i e n t  the  o f t h e same b u i l d i n g .  t h e w o r k e r , and a l s o t h e d e g r e e o f  for interviews  receive.  Riverview  o r o f f the ward  contacting  patient prestige  ward  in  worker  she w o u l d  s o c i a l worker's o f f i c e .  i n another part  prestige  t o the s o c i a l  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 .  H o s p i t a l , ward  11.  on a r e f e r r a l  holds  worker 10.  with  place  to s o c i a l worker.  patient  privacy  on t h e w a r d  in  dormitory. i f any, o f r e l a t i v e s  - p o s i t i v e or negative.  A l l people  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 mental  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 .  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 patient's  attitude  receptivity 12.  towards h o s p i t a l i z a t i o n  The  on t h e  and t h e i r  of information.  The n a t u r e o f t h e i n f l u e n c e the  patient's  The  attitude  influence  hospital,  of r e l a t i v e s ' attitudes  hospitalization of relatives  the patient's  - positive  or negative.  towards h o s p i t a l i z a t i o n  attitude  towards  will  and h e r r e c e p t i v i t y o f  information. 13.  The S o c i o - e c o n o m i c c l a s s that different  effect  I t was  recognized  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  assumptions w i t h difference  of the p a t i e n t .  regard  to mental  illness.  Any  b e t w e e n t h e s o c i a l w o r k e r and p a t i e n t  the patient's  value  class could  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 the  worker. 14.  Number o f c h i l d r e n , a t home. patient  t h e i r ages and w h e t h e r o r n o t t h e y were  This variable  would n o t apply t o the e n t i r e  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  mothers, t h e sample p o p u l a t i o n  t h a t was c h o s e n f o r t h i s  study.  family  Mothers, with a large  and/or young  children,  frequently consult  t h e 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  f r o m them b y t h e i r  hospitalization.  care w h i l s t  they are separated  L E V E L OF RESEARCH DESIGN Before 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  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  specific  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 such a study  due  department.  t o be  to the  developed.  We  were c e r t a i n o n l y of a need  c o n c e r n o f v a r i o u s members o f  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  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 hypotheses.  (25  This and  -  fully  We  study  the  were not  was  a pilot  of the  in  e m p h a s i s on  to develop  by  to a s s i s t  at  that time,  and  a l l the v a r i o u s  testing  instruments  a c a r e f u l s e l e c t i o n of  consistency  paid  to the  workers of s i m i l a r q u a l i f i c a t i o n s  control not  of the  attempted.  closely  able  and  amount o f  of d a t a  and  low  given.  the  The  and  place  efficiency  study. to  insure  use  social  low  Long hours  the p a t i e n t .  of c o n t r o l groups,  and  and  the  information  e a c h c a s e was  areas Direct was  examined  operating. i n nature.  information received and  Close  s e l e c t i o n of  s e l e c t i o n of the  the  attempted  were i n c l u d e d .  statistical  a high  aware  therefore,  o n l y wards w i t h  e a c h v a r i a b l e was  range of  dependent v a r i a b l e s w i t h  would  the ward s o c i a l w o r k e r s  experience  a n a l y s i s was  were not  were,  sample p o p u l a t i o n  These v a r i a b l e s were r e c o g n i z e d  to determine a high  pare these  be  independent v a r i a b l e s , w i t h  plan  assess  f e e l we We  i n f o r m a t i o n r e c e i v e d by  to determine whether or not The  d i d not  necessary  population.  important,  d i s c u s s i o n went i n t o  used t o d e t e r m i n e the  we  as we  of  to  to determine t h e i r  involvement with  information that should  and  preliminary  i n d e p e n d e n t v a r i a b l e s was  s e l e c t i o n of the  w a r d s o c i a l w o r k e r s t h e m s e l v e s was  of searching  to  for exploration  the dependent v a r i a b l e s i n t h i s  i n the degree of  t h e amount o f  service needed  gathering  components.  and  c o n t r o l of the r e c o g n i z e d  a t t e n t i o n was  i n the  communicative process  g a t h e r i n g d a t a when a p p l i e d t o a s a m p l e The  c o n c e p t s and  ready 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 study  of a l l such c h a r a c t e r i s t i c s  content  t h o u g h t t o be  p r o j e c t to suggest leads  instruments  characteristics  the necessary  social  51)  to develop research  data.  the  for  I f we and  were  t h e n com-  range of o p e r a t i o n  for  each observed  independent v a r i a b l e  i t shouldbe p o s s i b l e  significance  t o d e t e r m i n e any  associations.  Statistical  i n each a s s o c i a t i o n  c o u l d be  calculated with  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  g r o u p was s e l e c t e d  on a r a n d o m b a s i s  p a t i e n t population of the h o s p i t a l .  This specific  basis  group  of (1) t h e l a r g e s t  characteristics degree limited  identifiable  as p o s s i b l e  of involvement with to:  from a s p e c i f i c  g r o u p was c h o s e n o n t h e  o f p a t i e n t s h a v i n g a s many  i n common a n d ( 2 ) t h e g r o u p w i t h a n e x p e c t e d h i g h t h e ward s o c i a l  workers.  T h i s g r o u p was t h e n  (1) p a t i e n t s ready 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  of their  who w e r e n o t s u f f e r i n g  involvement with  the worker;  (2) p a t i e n t s  f r o m a n y f o r m o f b r a i n damage, a s t h i s  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 any  stimuli,  the E n g l i s h  including  information;  language;  with  be t h e m a r r i e d m o t h e r s  We w e r e i n t e r e s t e d  further  due t o t h e i r  children.  i n g a t h e r i n g t h e sample  T h i s would  f o r involvement  according to hospital policy,  e q u a l l y b e t w e e n t h e two a c u t e i l l n e s s  patient population. and  b e t w e e n t w e n t y and f o r t y - f i v e  T h i s i s a g r o u p who h a v e a h i g h p r i o r i t y  c o n c e r n as t o t h e w e l f a r e o f t h e i r  divided  chosen  the largest s p e c i f i c population f i t t i n g the  t h e s o c i a l work department  wards,  t o speak  study.  I t was a g r e e d t h a t  years of age.  ability  to receive  a n d ( 4 ) r e s i d e n c e i n one o f t h e f o u r w a r d s  for examination i n this  above c r i t e r i a would  (3) the p a t i e n t ' s  type o f  from four s e p a r a t e units of the h o s p i t a l  a l l o w c o m p a r i s o n b e t w e e n t h e two a r e a s  c o m p a r i s o n b e t w e e n t h e two w a r d s i n e a c h a r e a a n d t h e 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 mothers,  e a c h 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  on  selection  20  b a s e d on  the  residence  criteria  on A  of pending discharge,  a specific sample of  s i x weeks t o a l l o w decided  f o r t y p a t i e n t s was  of  before  could  be  completed.  sufficient  many p a t i e n t s  could  anticipated - this being  a statistical  a n a l y s i s b a s e d on  D a t a c o l l e c t i o n was  time f o r s t a t i s t i c a l  to accept every e l i g i b l e patient  j u s t how  and  ward.  m i n i m u m number r e q u i r e d square d i s t r i b u t i o n  l a c k o f b r a i n damage  be  the  chi-  l i m i t e d to  analysis.  f o r i n t e r v i e w as  the  It  i t was  e x p e c t e d from each ward d u r i n g  was not  known  this  period  time. The  cooperation  of  to r e f e r e l i g i b l e p a t i e n t s required  the  charge nurse  to the  research  t o n o t i f y a s p e c i f i e d member o f  i n e a c h w a r d was  tfeam.  this  The  requested,  charge nurse  team o f any  was  discharges.  METHODS'OF GATHERING DATA The  p a t i e n t w o u l d be  t h e v a r i a b l e s we  unable to supply  were i n t e r e s t e d  w o u l d be  required,  and  t h a n one  source could  any  i n examining.  d u p l i c a t i o n of  s e r v e as  an  gathered  from three  the p a t i e n t ' s An  interview  regard  j u s t before  administered  her  discharge  possible bias  from more  these items  to other  items.  introducing  rather  a student s o c i a l worker.  t h a n as  but  wanted  w o r k e r as much as  the  to keep  interviewer  the  possible.  by  a researcher  with Data  from h o s p i t a l .  to  An  t o w a r d s s o c i a l w o r k e r s on  t h e p a t i e n t by  social  received  - the p a t i e n t , the ward s o c i a l w o r k e r  g u i d e was  made t o c o n t r o l any  cooperation,  information  data  and  file.  selected patient was  sources  regarding a l l  Other sources of  a u t h e n t i c i t y c h e c k on  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 was  information  as We  focus of This  a researcher  each  attempt the p a r t  f r o m U.B.C.,  were i n t e r e s t i n the the  patient  i n t e r v i e w away f r o m  approach could  o  create  1  the  anxiety  in  21.  some p a t i e n t s , b u t was  explained  this  before  n u r s e t o make t h e that  t h i s was  supplied  the  w o u l d be  interview.  suggested  a study of  The interviewed  anxiety  We  i n t r o d u c t i o n and  selected  was  given  information  i f the purpose of  enlisted  the  a i d of  the  to e x p l a i n to each  a s p e c t s of p a t i e n t  s e c o n d s o u r c e o f d a t a was  and  reduced  life  a questionnaire  i n the  on  each  the  study  charge patient hospital. patient  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 .  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  This  i n w h i c h we  were  interested. A  third  source of  treatment f i l e . tion  of  A list  information,  information  of s e l e c t e d  not  be  l a r g e enough t o p r o v i d e  was  decided  determine  the  t o use  had  trends  It  b e e n assumed e a r l i e r  information  areas with  it  t o d e t e r m i n e how  w o r k e r had G u i d e was  involved.  This  amount o f  prepared  that  t h i s was  by  the  and  received  Interview  This  Guide  g u i d e was  to  s o c i a l worker covered a l l this  time the  many o f  the  assumption.  information  patients.  us w i t h  researchers  A  areas  each p a t i e n t .  of  This  workers  comparison to ratio  could  independent v a r i a b l e .  (Appendix  designed  A)  to p r o v i d e  the  S o c i a l Worker  to the ward s o c i a l a basis  Therefore  DATA COLLECTION INSTRUMENTS Patient  would  analysis, i t  2 8 t h F e b r u a r y , 1967  inaccurate  administered  by  each i d e n t i f i e d  At  an  individual  data would provide  information  correlated with  that  covered w i t h  Interview  data for chi-square  each p a t i e n t .  fact  social  collec-  discernable.  became a w a r e o f t h e became n e c e s s a r y  to guide the  t h e number o f s e l e c t e d p a t i e n t s  obtained  i f any had  were  that  prepared  and  independent v a r i a b l e s .  sufficient  w h a t d a t a we  each p a t i e n t ' s d i a g n o s t i c  i t e m s was  p e r t a i n i n g to the  When i t became e v i d e n t  was  some s t r u c t u r e f o r  the  the  then  be  22.  interviewer  and t h e i n t e r v i e w e e ,  of  i n f o r m a t i o n were covered,  an  ordered  sequence.  p a t i e n t , was l e f t only  t o be c e r t a i n t h a t a l l t h e n e c e s s a r y  a n d t o i n s u r e t h a t e a c h q u e s t i o n was a s k e d i n  The e x a c t  w o r d i n g o f e a c h q u e s t i o n , when a s k e d o f t h e  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 .  of the general wording of the question  sought i n t h e answer.  He was  important  The s e q u e n c e o f t h e q u e s t i o n s  proceed  to begin  questions, less  p l a y i n g was u s e d  to familiarize  interviewers with  the guide  E a c h g r o u p member t o o k  turns  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 a s k e d a l l t h e q u e s t i o n s .  permitted  some e x p e r i m e n t a t i o n  eliminated during  consid-  t o l e s s e n t h e a n x i e t y w h i c h may h a v e b e e n  i t s proper a p p l i c a t i o n to the interview.  playing  t h e need  the f i r s t The  with various wordings of the questions  f o r t h e i n t e r v i e w e r t o do t h i s w i t h  guide contained  questions  in specific  i n f o r m a t i o n had been o b t a i n e d . included.  Other questions  theme o f i n f o r m a t i o n b e i n g We w e r e c o n c e r n e d w i t h  the interviewee  of t h e i r  and f r o m whom  to assist  the p a t i e n t to consider  the s o c i a l worker, so t h a t the  i n t h e manner they  were t o o d i r e c t  this  Q u e s t i o n s as t o some v a r i a b l e s w e r e a l s o  the over cooperativeness  questionnaire  life,  s o u g h t w o u l d n o t be t o o e v i d e n t  S o c i a l Worker Q u e s t i o n n a i r e The  aspects  team, n o t j u s t  t o answer q u e s t i o n s  the questions  and  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  were o f a n a t u r e  a l l members o f t h e t r e a t m e n t  expected  This  interview.  p a t i e n t had r e c e i v e d  if  the non-threatening  I t was  i n each p a t i e n t . Role  and  again,  being  was t o b e a d h e r e d t o ,  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  threatening questions raised  the i n t e r v i e w w i t h  informed  and w h a t i n f o r m a t i o n was  however, because o f t h e 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 . ered  areas  o f some p a t i e n t s who c o u l d be a n t i c i p a t e d we w o u l d  as t o a s p e c i f i c (Appendix  to the interviewee.  expect,  topic.  B)  t o be c o m p l e t e d by each ward s o c i a l  worker  23.  contained  eight items.  Answers t o each item were e i t h e r m u l t i - c h o i c e or  o f one o r two w o r d s o n l y . variables  The i n f o r m a t i o n t o be o b t a i n e d  o n l y and d i d n o t c o v e r  referred to  any o f t h e i n f o r m a t i o n a r e a s  given  each  patient. File  Information File  nine  items,  files the  Guide  (Appendix  C)  information also pertained  t o v a r i a b l e s and c o n s i s t e d o f  answers t o each o f w h i c h c o u l d be o b t a i n e d  and n o t e d  i n one o f two w o r d s . .  This  from t h e p a t i e n t s '  g u i d e was t o be c o m p l e t e d by  researcher. S o c i a l Worker I n t e r v i e w Guide The  data  i n t e r v i e w guide,  D)  w h i c h was d e v e l o p e d  c o l l e c t i o n phase, covered  patients.  (Appendix  t h e same i n f o r m a t i o n a r e a s  The i n t e r v i e w was a d m i n i s t e r e d  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  as g i v e n  to the  b y a r e s e a r c h e r , who d e f i n e d  each  t h e s o c i a l w o r k e r as t o w h e t h e r t h e  i n f o r m a t i o n had b e e n g i v e n , o r had been c h e c k e d patient  n e a r t h e end o f t h e  a l r e a d y had k n o w l e d g e i n t h i s  area,  i f i t was assumed t h a t t h e  o r was n o t g i v e n o r c h e c k e d b y t h e  worker.  PRE-TEST OF PATIENT INTERVIEW After  completion  GUIDE  o f t h e P a t i e n t I n t e r v i e w G u i d e i t was p r e t e s t e d  w i t h a group o f p a t i e n t s n o t connected previously repeated  chosen.  i n this  were used  The same c r i t e r i a u s e d t o s e l e c t  selection with  one e x c e p t i o n  i n s t e a d o f one f r o m e a c h The  i n a n y way w i t h t h e f o u r w a r d s  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  c h a n g e s n e e d e d t o b e made i n t h e g u i d e . the researchers  purpose  - two w a r d s f r o m one a c u t e  to eight p a t i e n t s , during the  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 A new i n t r o d u c t i o n o f t h e s t u d y ,  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 t h e s t a t e d  i n more d e t a i l .  unit  unit.  same a f t e r n o o n , b y a l l f i v e r e s e a r c h e r s .  by  t h e sample group were  Some q u e s t i o n s  requited c l a r i f i c a t i o n  and w e r e  24.  r e w r i t t e n and The  five questions,  sequence of the q u e s t i o n s The  other  devices,  information outline, t e s t e d , but  and  the  applied directly  covering personal was  reordered  the  i n f o r m a t i o n were added.  t o p r o v i d e more c o n t i n u i t y .  s o c i a l worker q u e s t i o n n a i r e ,  s o c i a l worker to data  interview guide,  file  were not  pre-  collection.  P I L O T STUDY The before  the d a t a  referrals ward  guides  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  collection  time l i m i t  d i d not m a t e r i a l i z e .  s o c i a l w o r k e r s as  T h e r e was  t o whom t h e  to  be  from the  a v a i l a b l e on  almost  immediately  a n t i c i p a t e d number  some i n i t i a l  were r e f e r r e d .  u n i v e r s i t y and  short notice.  The  sample p o p u l a t i o n  number o f n o n - e l i g i b l e i n t e r v i e w e e s t h i r t y miles  elapsed.  i t was  not  The  Some p o t e n t i a l i n t e r v i e w e e s  discharged. referrals  The  t o an  in notifying  charge n u r s e s were r e q u i r e d  assigned  researcher,  c o n t a c t i n g each c h a r g e n u r s e by The  i n one  and  this period Of  of  treatment  r a t e of  small  were  released  they  had  Difficulty  eligible patient  was  t h e names  of  p r o h i b i t e d from  The  d u t i e s and  ward s o c i a l w o r k e r s  u n i t assumed t h i s fully  such  A  social  task, but  established.  the  telephone attempted work time  limit  In a d d i t i o n , the  the sample group were b o t h very, low  during  time. thirteen patients interviewed Three of  the  was  because of a h o s p i t a l r e g u l a t i o n .  t o o , were t o o b u s y .  t h i s p r o c e d u r e was  discharge  the  analysis.  bututhey,  a  the  interviewer  t o meet.  when an  the r e s e a r c h e r  telephone  inconvencience.  acute  reached before  population  data  added  same r e s p o n s i b i l i t y ,  supervisor was  as  them as  to telephone  charge n u r s e s were a l l v e r y busy w i t h o t h e r  c o n t a c t s w e r e an the  the r e s e a r c h e r s  among  of  hospital is located  p o s s i b l e f o r an  f o l l o w i n g the d e c i s i o n to d i s c h a r g e  also experienced  confusion  i n c l u d e d , and  r e l a t i v e s w a i t i n g f o r them o r t r a n s p o r t a t i o n d e a d l i n e s was  to t h i r t e e n cases  o n l y e i g h t were s u i t a b l e f o r  f i v e r e j e c t e d were e x c l u d e d  because they  did  25.  n o t m e e t t h e age r e q u i r e m e n t . the  s p e c i f i e d time l i m i t ,  data.  The f o u r t h was n o t b e i n g  was t o o s m a l l  showing the breakdown of t h e data This  data  f o r data  a n a l y s i s , but a  c o l l e c t e d was p r e p a r e d  1.  chart  and i s i n c l u d e d i n  d o e s 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 , b e t w e e n 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 that warrant further  within  and t h e f i f t h was n o t i n c l u d e d b e c a u s e o f i n c o m p l e  The sample o b t a i n e d  this report.  discharged  and some v a r i a b l e s ,  study:  Generally  a high  amount o f i n f o r m a t i o n was s e n t  s o c i a l w o r k e r and t h e r e was v e r y  little  by the  v a r i a t i o n between  cases. 2.  S o c i a l workers scored  l o w i n t h e number o f p a t i e n t s t o whom  they gave i n f o r m a t i o n  regarding  suggesting as 3.  informational  and l e g a l  areas.  of information  from high  t o l o w and d i v i d e s ^ e a s i l y  cases  received/information  (a)  varies with  i n each.  ratio with  received/information  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 .  include: There 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 diagnosis  (b)  sent  i n t o two g r o u p s  Comparison of the range of i n f o r m a t i o n  These  information  by each p a t i e n t .  The r a t i o  sent  matters,  t h e same a t t e n t i o n  T h e r e i s a w i d e v a r i a t i o n i n t h e amount o f  four 5.  t h e s e m a t t e r s do n o t r e c e i v e  the other  received 4.  financial  and t h e i n f o r m a t i o n  ratio.  The  non-psychotic  g r o u p r e c e i v e d more i n f o r m a t i o n  then the p s y c h o t i c  P a t i e n t s who w e r e a l s o i n v o l v e d  i n g r o u p s e s s i o n s , as  well  as i n d i v i d u a l  r e c e i v e d more  sessions, with  information.  their  social  group.  worker  P a t i e n t s who r e a c h e d o u t f o r i n f o r m a t i o n more  information.  P a t i e n t s who d i s c u s s e d doctor  received  before  their hospitalization with  a d m i s s i o n r e c e i v e d more  P a t i e n t s w i t h no p r e v i o u s r e c e i v e d more  information.  a  information.  mental h o s p i t a l  experience  27.  CHAPTER I I I  CRITIQUE OF P I L O T STUDY  INTRODUCTION It both  i s customary i n any such c r i t i q u e  t h e 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  or e v a l u a t i o n , t o emphasise  i n the study.  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 correlations  t o s u g g e s t many m e a n i n g f u l  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 o f t h e m e t h o d o l o g y e m p l o y e d . briefly  on t h e p o s s i b l e i n f e r e n c e s  results  and w i l l  findings,  As a l r e a d y  i n s t e a d , focus  This  chapter,  or conclusions  on t h e l i m i t a t i o n s  then, w i l l  t o be o b t a i n e d and v a l i d i t y  as d e t e r m i n e d b y t h e p r o c e d u r e s e m p l o y e d , w i t h  better methodological  dwell but  a view  from the o f such towards  innovations.  STUDY DESIGN 1.  Generally  s t u d y was t o d e t e r m i n e  speaking,  the purpose or o b j e c t i v e o f the o r i g i n a l  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  the  level  of efficiency  and  patient at Riverview  of t h e communication channel  associated  between s o c i a l  with  worker  hospital.  (a) ilpcommunication  channel  communication process  was t h e t e r m u s e d  to refer tothe  involving transmission of information  from  s o c i a l worker t o p a t i e n t . (b)  The l e v e l  defined  of efficiency  i n terms o f a h i g h  o f the communication process  o r l o w amount o f i n f o r m a t i o n  by  the patient.  Thus an e f f i c i e n t  be  one w h e r e a p a t i e n t r e c e i v e d  from the s o c i a l worker, w h i l e one  communication channel  was received would  a l a r g e amount o f i n f o r m a t i o n  an i n e f f i c i e n t  channel  would be  w h e r e a l o w amount o f i n f o r m a t i o n w o u l d b e r e c e i v e d .  28.  2. channel  the  they are total  of the  (a)  the  of the  receptor an  amount o f  t h e s e two research feeling  at the  teamnneglected  the  forewarned  that  was  the h o s p i t a l  amount o f  The  information Two  information  given  members o f g i v e n was  received.  the  could  This  w o r k e r s ) was,  Of  the  researchers  affect  the  handled  research  either  w a n t e d t o do  the  ability  received  between  w a n t any  amount o f  the  important,  p a t i e n t s would  blunder  was  had  of made.  been  e v a l u a t i o n made  i n f o r m a t i o n given  e v a l u a t i o n of the by  worker's  denying  the  importance.  team d i d n o t  the  deny t h a t  they handled  the  of not  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 transmission  a high  amount o f  or  ridiculous. i n the  c o n c e r n t h a t the p a t i e n t s were o f t e n not  amount  the problem of  a f f e c t i n g the  study  the  being  researchers  low  ( t h a t a l l i n f o r m a t i o n was  least,  transmitter  r e c e p t i o n phases  this pressure  Instead,  factors  assumption  t o say  a direct  of  as  serious procedural  the  and  r e c e i v e d by  because the  assuming that  the  of the  T h r e e members o f  transmission^and  course,  being  important.  Thus, o n l y  information  as  of-the  distinguish  given'  a d m i n i s t r a t i o n d i d not  researchers  e v a l u a t i n g t h e w o r k e r s by possible.  the  s o c i a l w o r k e r s w o u l d be  job performance.  efficiency  account.  d i d not  information  made was  of t h e i r worker's performance. t o p a t i e n t s by  taken into  information  Thus a v e r y  t h i s blunder  factors,  information  construction.  "amount o f  to the v a r i a b l e s a f f e c t i n g  r e a s o n why  two m a i n  ability  I f amount o f  researchers  t h a t d i f f e r e n c e s i n amount o f  The  (b) the  communication  i n w h i c h the message i s s e n t ,  time of d e s i g n  communication process.  and  words, the  the message.  the  o f any  i s d e p e n d e n t on  given,  b o t h f a c t o r s m u s t be  the  of  received  In other  field  Unfortunately,  factors  of e f f i c i e n c y  information  to receive  index,  level  information  the message, the  u s e d as  due  index  amount o f  3.  be  an  communicative process.  t o send  is  As  In f a c t ,  given one  f i r s t place,  g i v e n needed  and  reception  information by  the  social  of the reasons a r o s e out  information.  of  a  why  U n f o r t u n a t e l y , none o f discrepancy  i n assumptions u n t i l  4. affect  The  any  r e s e a r c h e r s had  t h e end  of the  v a r i a b l e s the r e s e a r c h e r s  the outcome o f t h e  might a f f e c t  that  the r e s e a r c h e r s were aware o f  total  this  study.  s e l e c t e d were thought  to  communicative p r o c e s s , not because  p a r t i c u l a r phase of the p r o c e s s . h u n c h e s , b a s e d on  experience  and  c e r t a i n v a r i a b l e s or f a c t o r s might a f f e c t  they  In other words, a r e a d i n g of the  t h e amount o f  the  literature,  information  r e c e i v e d by p a t i e n t s . B e c a u s e o f c o n f u s i o n i n t h e r e s e a r c h g r o u p as variable denied  ( t h e amount o f  (implicitly)  the  information given) importance  t o the most  t h e segment o f t h e group  would a f f e c t  worker's o f f i c e evaluating  the  g i v e n as b o t h saw  information given  - on o r o f f t h e w a r d ) . s o c i a l work s t a f f ,  t h e amount o f  v a r i a b l e s but not  METHODS OF  t h e amount o f  important  and  they  a t one  i n f o r m a t i o n g i v e n as i n ( c o l l e c t i n g and  and  important  the  of information  same t i m e .  when s e l e c t i n g  a n a l y s i n g the  of  They  the  data.  DATA COLLECTION  the p a t i e n t s , the  case  p a t i e n t ' s wards. being  to c o l l e c t  and  the second b e i n g (a v a l i d i t y One  files  and  f o r the data  collected  the s o c i a l workers a s s i g n e d  In t u r n , these  one  tools  (e.g. l o c a t i o n  came t o v i e w t h e amount o f  unimportant  as  they  In other words, f o r f e a r  There were t h r e e main s o u r c e s  another  that  o f t h e amount o f i n f o r m a t i o n g i v e n  a significant variable also included ( e x p l i c i t l y ) variables that thought  important  the necessary  sources data  to  in this these  o f d a t a w e r e u s e d f o r two  t o r . a c h i e v e some m e a n i n g f u l  t o c h e c k t h e a n s w e r s f r o m one  source  study:-  purposes:correlations  w i t h those  from  check).  of the major problems encountered  f o r c o l l e c t i n g d a t a was  closely  i n the development of  a s s o c i a t e d w i t h our  failure  these  to . • .  .u...  30.  distinguish confusion  the q u a l i t y of purpose i m p l i c i t i t  among t h e r e s e a r c h e r s  was m o s t n o t i c e a b l e i n t h e a r e a w h i c h were d e v e l o p e d and  (i)  of purpose.  This  collection. tended  This  Here, the questions t o be vague,  undefined  i n turn tesulted i n findings  or a p p l i c a b i l i t y ,  Patient Interview The  of data  design.  i n t o a l l areas of the study but  f o r the questionnaires  lacking i n singleness  that lacked v a l i d i t y  permitted  i n our study  Guide  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 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 b y t h e w o r k e r was r e c e i v e d b y t h e p a t i e n t and using  t h e r e s u l t s , we h o p e d t o show some r e l a t i o n s h i p s t o o u r d e p e n d e n t  variables. actual  I n p r a c t i s e , s e v e r a l weaknesses evolved  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 ,  variation  i n conducting  the p a t i e n t interviews.  r e s p o n s e s and t h e t e n d e n c y o f a l l r e s e a r c h e r s supports  ones b e l i e f s  still  i n this  permitted  area.  The  for individual  Awareness o f the d e s i r e d  to perceive  only  that which  ( h y p o t h e s i s ) may h a v e r e s u l t e d i n an u n c o n s c i o u s  lead-  ing of the p a t i e n t s i n t h e i r v e r b a l responses or i n a f a u l t y i n t e r p r e t a t i o n o f them.  The s e m i - s t r u c t u r e d  t h i s by p e r m i t t i n g g r e a t e r  design  individual  a more s t r u c t u r e d a p p r o a c h . u n c e r t a i n t y as t o t h e e f f e c t  of the p a t i e n t ' s i l l n e s s  t o comprehend t h e q u e s t i o n s .  people,  the researchers  c o u l d be h e l d  developing  an a c c u r a t e  responsible  The  f i n d i n g s tended  responses required  because of the  t h a t as p r o f e s s i o n a l  i n the c o n t r o l of t h e i r  account of the p a t i e n t ' s  t o be l e s s i n d i c a t i v e  than otherwise  from each p a t i e n t were n o t c l e a r l y  encouraged n o n - s p e c i f i c responses.  Also,  perceptions.  and t h e i r g e n e r a l i t y , possible.  s p e l l e d o u t and t h e  s c o p e 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 a n d a l l - e n c o m p a s s i n g . questions  than would  on h e r answers o r h e r  I t was r e a s o n e d  Because o f t h e vagueness of the questions the study  facilitated  freedom t o develop b i a s e s  The f o r m e r was c h o s e n m a i n l y  ability  biase.sc w h i l e  of the i n t e r v i e w guide  Non-specific  i f one i s c o n c e r n e d  with  31.  the  efficiency  such broad (ii)  o f t h e c o m m u n i c a t i o n p r o c e s s o r amount o f i n f o r m a t i o n  categories  Case  are not required.  Files  The  file  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 o u r v a r i a b l e s a n d  a s c e r t a i n the general perception  validity  of r e a l i t y .  o f t h e p a t i e n t ' s r e s p o n s e s as w e l l a s t h e i r  In e x t r a c t i n g the necessary data  however, s e v e r a l e r r o r s r e s u l t e d . a d m i s s i o n s and l e n g t h looked  and n o t d e c i d e d  to the medical what t h i s  until  diagnosis  involved.  be  of uniformity  When d e t e r m i n i n g  o f t h e p a t i e n t , t h e r e was l i t t l e  This  This  few  collection.  An a d d i t i o n a l v a r i a b l e t h a t could n o t  current  r e c o r d i n g was o f t e n n o t o n t h e f i l e .  Questionnaire  questionnaire  was p r e p a r e d  s t r u c t u r e d and t h e q u e s t i o n s  biases  from t h e workers.  the v a r i o u s  terms used  (e.g. Verbal  respect  o f e a c h p a t i e n t and t h u s c o n t r i b u t e t o t h e  i n f l u e n c e t h e amount o f i n f o r m a t i o n  rigidly  With  d i s c u s s i o n as t o  i n order  to e s t a b l i s h the existance  o f s e v e r a l d e p e n d e n t and i n d e p e n d e n t v a r i a b l e s w h i c h we h a d might  over-  r e s u l t e d i n e a c h member u s i n g d i f f e r e n t c r i t e r i a  contact  i n data  S o c i a l Work  t h e number o f p r e v i o u s  a f t e r a l l d a t a had been c o l l e c t e d .  controlled l a y i n the fact that (iii)  from t h e f i l e s  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  to determine the r e a l i t y lack  received,  received  hypothesized  by p a t i e n t s .  were n o n - t h r e a t e n i n g ,  thus  I t was encouraging  I t s weakness l a y however, i n t h e f a c t  i n posing  the q u e s t i o n s  were n o t c l a r i f i e d  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  that  or defined,  as t o how t h i s was t o b e  measured). (iv)  S o c i a l Work I n t e r v i e w It  realized  was n o t u n t i l  the d i f f i c u l i t i e s  Guide  t h e end o f t h e d a t a  collection period  i n assuming t h a t e v e r y worker 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 seven i n f o r m a t i o n a l a r e a s ) . social  worker  t h a t we  i n t e r v i e w g u i d e was d e v e l o p e d  to r e c t i f y  At this point this  a  s i t u a t i o n and  a c h i e v e some d e g r e e  of v a l i d a t i o n  Here a g a i n i t i s f e l t  t o our former  assumption.  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  q u e s t i o n n a i r e as p a r t o f 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 biased had  their  answers.  Little  p r e v i o u s l y assumed t h a t  a t t e m p t was  thus p o s s i b l y  made t o c o n c e a l t h e f a c t  these areas would  be  this  c o v e r e d by  have  that  we  them.  STUDY PROCEDURE Extraneous The ing  need  some d e g r e e  arising and  Variables to control  of v a l i d i t y  specific  t o our  clarity,  (i)  t h e more i m p o r t a n t o f t h e s e w i l l rather  Institutional Within  occupations  than  - administration &  the R i v e r v i e w H o s p i t a l ,  ( r e f e r Appendix  advantages  E) e m p l o y e d  to this  study.  complexity of the a d m i n i s t r a t i o n b e t w e e n t h e r e s e a r c h team and c o - o p e r a t i o n was  the h o s p i t a l  consensus which, with  vital  on  The  quite possibly  influenced  convenience  order,  problem  of  s p e c i f i c members o f t h e h o s p i t a l T h u s i t was  undoubtably  times  critical  the  communication  staff  whose  necessary  The  to  d i d not r e p r e s e n t a  our d i r e c t  and  involvement  n e c e s s i t y f o r such  t o t h e r e s e a r c h s t u d y and  the study f i n d i n g s .  system  involved w i t h the study  e f f e c t i v e l y prevented  these  i t posed  number o f o c c u p a t i o n s and immediate  and  and  A l t h o u g h such a  i t s power s t r u c t u r e ,  c r e a t e d an  a d m i n i s t r a t i o n , which  at several  For  e l a b o r a t e d upon under  administration.  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.  i n v o l v e m e n t was  difficulties  i n the treatment of p a t i e n t s  i n c o n d u c t i n g the study.  i t s directives,  establish-  t h e r e a r e numerous d e p a r t m e n t s  the p a r t of a l l r e l e v a n t people  through  be  thus  staff  f o r those f u n c t i o n i n g w i t h i n  certain difficulties  now  in chronological  then are o r g a n i z e d under a c e n t r a l  involve  f i n d i n g s , p r e s e n t e d many  at every stage i n the development of the study.  d e s c r i p t i v e headings  has  extraneous v a r i a b l e s ,  Attempts  i t s lack  t o meet w i t h  the  33.  nursing  staff  i n order  to e x p l a i n the purposes of  s u p p o r t added t o t h e i r the  r o u t i n e on  with for  to  ity  s t a f f was  them t o q u e s t i o n This  the  latter  t o be  accurate  a f e e l i n g of  involvement. questions  The  t h e r e f o r e h u r r i e d and study  the  or  research  i n s e c u r i t y and  the  patient discharges  s e v e r a l ways as we  too  w e r e now  decided  involved with  their  be  upon b u t own  available  observed  extremely small  ion  o f t h o s e who  our  This  as  i t was  restriction  to r e l y  a few  Also,  Invariably l a c k of  to i n i t i a t e  she  conform-  i n many  to the purpose of their  their  answers t o  on  was  a  information contrary  to  a f f e c t e d the third part  the  hours beforehand  and  t o p e r m i t them t o c o n t a c t  the  i n f o r m e d by  first  t o be  established study  being and  notified, may  workers  they were  us r e g u l a r l y  t o be more  the  the d o c t o r  i n a b e t t e r p o s i t i o n to r e l a y the  first  in  discharges  often  tended  regarding  (social  always aware of  such d i s c h a r g e s  sample o b t a i n e d  required from  a f a c t which contributed  have l e d to a b i a s  of  th to  i n the s e l e c t -  were r e f e r r e d .  Many p r o f e s s i o n s as  such required  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 w e r e r e l e a s e d  the  and  meeting  n e c e s s i t y of  This  doubt i n f l u e n c e d  permitted,  workload  therefore  wards s t u d i e s , w i t h o u t  ization  apporach.  These w o r k e r s were not  c o n c e r n o f t h e w a r d n u r s e who  information.  t i m e was  upset  when a w a r d n u r s e was  the wards t o g a i n  required  about p a t i e n t d i s c h a r g e s .  s u c h d e c i s i o n s and  with  to abuses.  to relay information. w h i c h m i g h t be  one  their  researchers.  could not  might lead  little  a p p r e h e n s i o n as  r e s u l t i n g a n x i e t y no  p o s e d by  and  i n her  acquire  Our  team t o t h e p a t i e n t .  down p r o c e d u r e was  D i r e c t phone c o n t a c t  policy  quite evident  and  i t tended to  or g a i n a f e e l i n g f o r the  consistent  to a p r e v i o u s l y l a i d  patients  h e a v y r e s p o n s i b i l i t y as  f a c t was  i n t r o d u c e members o f  failed  study  the wards f o r w h i c h they were r e s p o n s i b l e .  the n u r s i n g  research.  already  the  have c o n t a c t  with  the p a t i e n t d u r i n g  his hospital-  such c o n s t i t u t e p o t e n t i a l extraneous v a r i a b l e s which might  34.  have c o n s i d e r a b l e nurses,  e t c . , a r e a l l p o t e n t i a l sources  have as p a r t as  i n f l u e n c e on t h e s t u d y  of their  i s required  as  i t increases  whom.  Since  research other  effect  ed  solely  ittee  on t h e study final  design  t o c o m p l i c a t e any (eg. s o c i a l  criticism  this  lies  that our  c o n t r o l the e f f e c t or  i n t h e manner i n w h i c h t h e s t u d y  committee.  As t h e researchers  them f r o m b e c o m i n g f u l l y  were confused i n comm-  active i n theproject,  f i n d i n g s , we n o t e d This  t h a t o f t h e 13 p a t i e n t s r e f e r r e d figure,  obtained  o v e r a 6 week  t h e e x p e c t e d r e s u l t w h i c h h a d b e e n b a s e d on t h e  f i g u r e s f o r s e v e r a l preceding^; months and a p r e v i o u s  study.  We w e r e t h e r e f o r e l e d t o s p e c u l a t e  required  s a m p l e may h a v e b e e n r e l a t e d t o t h e w o r k e r ' s w i t h d r a w a l as e v a l u a t i v e r e s e a r c h .  This  that our f a i l u r e  o f t h e s o c i a l work s t a f f  to obtain the f r o m w h a t was  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  f e e l i n g s of e i t h e r anxiety or ambivolence.  t u r n be r e l a t e d t o t h e i n c r e a s e  load  was p r e s e n t -  Workers  current monthly discharge  in  possible  c o n f u s i o n was n o d o u b t p a s s e d on t o t h e a d v i s o r y  p e r i o d , was i n c o n s i s t e n t w i t h  their  work)  who g a v e w h a t i n f o r m a t i o n t o  v a r i a b l e s and now a c k n o w l e d g e t h e i r  u s , 8 o r i g i n a t e d f r o m one w o r k e r ^  perceived  information  t o t h e 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 h e  of these  From t h e s t u d y to  i ndetermining  such  findings.  thus p r e v e n t i n g  (ii)  serves  t h e r e was n o way i n w h i c h we c o u l d  the occurrence  study  psychiatrists,  the 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 requested  to thehospital advisory  the  to provide  o n b u t one o f t h e h o s p i t a l p r o f e s s i o n s  be c o n f i n e d  A  Such an o v e r l a p  the d i f f i c u l t y  disciplines  prevent  Doctors,  o f i n f o r m a t i o n f o r t h e p a t i e n t and  function the r e s p o n s i b i l i t y  f o r treatment.  study which focused  findings.  This  latter  f e e l i n g might  t h e s t u d y made i n t h e a l r e a d y  as w e l l as t h e i r  with  heavy work  l a c k o f awareness as t o t h e  p u r p o s e s and u s e o f t h e s t u d y . It  i salso possible that  c e r t a i n b i a s e s may h a v e b e e n p r e v a l e n t i n  35.  our  sample s e l e c t i o n .  Perhaps those  p a t i e n t s r e f e r r e d by t h e w o r k e r s were  o n l y t h e o n e s w i t h whom c a s e w o r k i n t e r v e n t i o n h a d b e e n i n t e n s e a n d s u c c e s s ful .  Thus o u r i n a b i l i t y  forthcoming part  t o communicate d i r e c t l y w i t h  Again,  t h e r e was n o way t o c o n t r o l t h i s v a r i a b l e  a n d r e l i a n c e on t h e p r o f e s s i o n a l c o m p e t e n c e o f t h e w o r k e r was a  necessity.  I t w o u l d be p o s s i b l e , h o w e v e r , t o a c h i e v e  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 study  figures with  (iii)  those  contained  and t h o s e  some i n d i c a t i o n o f  r e f e r r e d , by comparing the  i n the h o s p i t a l ' s main  file,  Patients In our attempt t o assess  of  regarding  d i s c h a r g e s , may h a v e c o n t r i b u t e d t o s u c h a s a m p l e b i a s o n t h e  of the caseworkers.  directly  t h e wards  the various  factors affecting  i n f o r m a t i o n r e c e i v e d b y t h e p a t i e n t , we f o u n d  a prominent v a r i a b l e .  N o t o n l y does t h e n a t u r e  t h e amount  thepatient's i l l n e s s of thepatient's  illness  compound t h e 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  is  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  also the fact  that the i l l n e s s  v a r i a b l e which d i f f e r s classification.  of their  t o be  answers, b u t there  f r o m p a t i e n t t o p a t i e n t and r e s i s t s  Often,  the f i r s t  few s o c i a l  definitive  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 t h e acute  phase o f h e r i l l n e s s  and l i t t l e  retained  Thus i t i s d i f f i c u l t  f o r t h e worker t o determine  for this  reason.  how much i n f o r m a t i o n t h e p a t i e n t h a s r e c e i v e d for  the researchers  patient's perception truly  to determine the extent  t o which they  o f what t r a n s p i r e d d u r i n g  adequate method o f c o u n t e r a c t i n g  personally  and s i m i l a r i l y  observe a l l worker-patient  those  information i s  i t was d i f f i c u l t  could  contacts.  rely  on t h e  The o n l y  t h i s p r o b l e m would have been t o contacts  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 h a v e l e s s n e e d 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  of both  patients  to infer biases.  Such  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  a p r o c e d u r e was h o w e v e r , i m p r a c t i c a l i n t h i s the  inconvenience  to staff  and p a t i e n t ;  study  f o r many r e a s o n s s u c h a s :  l a c k o f a v a i l a b l e time;  and  36.  u n w i l l i n g n e s s of the (iv)  ed b y was  the r e s e a r c h  a l l members and  which helped  i t s p u r p o s e s gone o v e r  c o n d u c t e d among t h e  c o r r e c t many f a u l t s  Nevertheless,  as has  Other d i f f i c u l t i e s t i m e and  distance.  attempted of t h i s  During  to p r o v i d e  g o a l as  in detail  an  to o b t a i n from each p a t i e n t .  data  study  day  being  Riverview to  the d i s t a n c e s  Hospital.  32 m i l e s  p a t i e n t s whose d i s c h a r g e  METHOD OF  level number  was  had  (40)  study  of p a t i e n t s necessary  us  involved i n t r a v e l l i n g involved prevented  times while  from making  w e r e f u r t h e r e n h a n c e d by  t o use  the  such p r a c t -  t o and  from  easy or q u i c k  Chi-sq'uare  f i n d i n g s and  access  and  percentages.  to evaluate  the data  Such r e s u l t s  i n determining  the  c a l c u l a t e d t h e minimum  t o v a l i d a t e our  c o r r e l a t i o n s between our v a r i a b l e s .  however, obtained t o use  contacted,  short  imminent.  decided  of s i g n i f i c a n c e of the  meaningful  being  had  DATA A N A L Y S I S I n i t i a l l y we  was  The  with  fell  Several  o u t s i d e Vancouver prevented  Such d i f f i c u l t i e s  r e q u i r e m e n t s as  did  (6 w e e k s ) we  f i e l d placements c o n f l i c t e d .  their place  ical  questionnaires.  o f t h e week b u t  from the h o s p i t a l without  a home i n t e r v i e w .  runi.  were concerned  collection period  p a t i e n t s were d i s c h a r g e d of residence  a p r e t e s t was  certain discrepancies  this  i n t e r v i e w e r f o r every  c l a s s e s and  each  taken.  i n conducting our  out,  develop-  to ensure that  d e l i v e r y of the  a l r e a d y been p o i n t e d  towards  q u e s t i o n n a i r e was  team members and  i n our  i n s p i t e of a l l p r e c a u t i o n s  e f f o r t wasc.exerted  The  i n f o r m a t i o n they were r e q u i r e d  p l a y i n g was  arise  team c o n s i d e r a b l e  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 .  aware of the  Role  i t s normal r o u t i n e ,  Researchers Within  control  a d m i n i s t r a t i o n to a l t e r  results This  collected,  and  achieve  s a m p l e was the  as w e r e o b t a i n e d  by  some  not,  only a l t e r n a t i v e t h i s method a r e  not  conclusive total  i n that  population  the  sample i t s e l f  ( n e i t h e r by  c o r r e l a t i o n s were o b t a i n e d questionable, ications  they are  not  s e l e c t i o n nor  and  although  nonetheless  t o t h e p r o b l e m and  was  will  nearly representative  number).  the v a l i d i t y  i n d i c a t i v e o f new be  discussed  Nevertheless,  of  the  a  few  of such f i n d i n g s i s a p p r o a c h e s and  i n Chapter  IV.  modif-  38.  CHAPTER  IV  THEORETICAL B A S I S FOR  A NEW.  DESIGN  INTRODUCTION As encountered to  be  that  has  been s t a t e d i n the p r e v i o u s  a number o f d i f f i c u l t i e s  studied.  As  a result  in clearly  the main q u e s t i o n s  i n d i v i d u a l members o f t h e r e s e a r c h g r o u p  The  design  ers  r e g a r d i n g the main q u e s t i o n s  this  chapter  that developed  c o n f u s i o n was  a d v e r s e l y a f f e c t e d the In  direct  remedied our  this  of the study. the h o s p i t a l  implementation  of the  confused  research process  i n t h e new  s t u d y and  group  problem  o f t h e s t u d y w e r e so v a g u e differently.  c o n f u s i o n among t h e  There i s l i t t l e  study  outlined  resear  doubt  a d v i s o r y c o m m i t t e e and  that  that  this  design.  l o o k i n g b a c k i t seems t h a t a l a c k o f a s o u n d  work l e d to the m u s t be  f o r m u l a t i n g the  i n t e r p r e t e d them  therefore reflected  p e r c e i v e d by  the r e s e a r c h  theoretical  above.  This  frame-  situation  i t i s t o t h i s p u r p o s e t h a t we  now  attention.  THEORETICAL FRAMEWORK The  R o l e Of Since  present ed  Information In a Hospital S e t t i n g t h e g e n e r a l p u r p o s e s o f t h e new  s i t u a t i o n at Riverview H o s p i t a l i n regard  i n f o r m a t i o n and  to determine  f a c t o r s b e l i e v e d t o be  the degree of  i n f l u e n c i n g such  framework t h a t w i l l  be  employed  systems theory.  have a l s o borrowed  are  a situation,  c e r t a i n concepts  setting.  the reader w i l l  be  must The  i n space-time,  need-  the  first  theoretical  t h a t of  general  soon d i s c o v e r ,  f r o m c o m m u n i c a t i o n t h e o r y and  "Systems a r e bounded r e g i o n s  the  o f some o f  t h e n we  in explaining this w i l l  H o w e v e r , as  to assess  to p a t i e n t s r e c e i v i n g  importance  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  behavior  study  we  role  theory  i n v o l v i n g energy  inter-  c h a n g e 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  relationships,  and  with  their  e n v i r o n m e n t s . " (23,433)  system f u n c t i o n a l l y  interrelated with  mental, l e g a l , e t c . ) .  H o w e v e r , as  system, i n t h i s subsystems.  case R i v e r v i e w  Since  ation  g i v e n by  staff  s y s t e m and The  ( m a l e and to  erent are  staff  who  geographical  l a r g e subsystems  type  of  from Vancouver C i t y ,  Burnaby, w h i l e  illness  takes  (acute  to  h o s p i t a l e i t h e r from penal  departments, the m e d i c a l  area  institutions  to three  to  i s composed o f  and  (3)  chronically i l l  how  and  C o l u m b i a , and of B r i t i s h  for a period  H o s p i t a l c a n be  department, the o c c u p a t i o n a l  But  They  acutefemale  West V a n c o u v e r ,  a c u t e l y d i s t u r b e d m a l e and  They i n c l u d e the b u s i n e s s  These departments tend  individual patients.  diff-  criteria.  c h r o n i c ) ; sex;  departments, the n u r s i n g department, the  so on.  i l l person'  Riverside  Columbia  fe-  Unit  admitted  of p s y c h i a t r i c  law.  system of R i v e r v i e w  departments or o c c u p a t i o n s .  and  'mentally  admitted  female p a t i e n t s m a n i f e s t i n g  areas of B r i t i s h  c o n c e r n e d w i t h m a l e p a t i e n t s f r o m any  therapy  or  C e n t e r Lawn U n i t d e a l s w i t h  staff  the  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 ;  is  The  are  systems.  involuntarily  the M u n i c i p a l i t i e s of North  or from courts of  or  inform-  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 m a l e and  male p a t i e n t s from a l l other  observation  these  These i n d i v i d u a l s are a s s i g n e d  i s c o n c e r n e d w i t h m a l e and  patients  any  H o s p i t a l i s composed o f i n d i v i d u a l s  T h u s E a s t Lawn U n i t  ailments;  govern-  considered  describe  wards w i t h i n the h o s p i t a l a c c o r d i n g  residence.  Lawn U n i t  us now  1  physical  and  Let  conform: ; t o t h e d e f i n i t i o n o f a  (1)  suggests,  t h a t m u s t be  have been e i t h e r i n f o r m a l l y or  f e m a l e p a t i e n t s ; West Lawn U n i t North  systems i n s o c i e t y (e.g.  i s concerned w i t h p a t i e n t r e c e p t i o n of  i n the M e n t a l H e a l t h A c t .  follows:  a  H o s p i t a l , i s composed o f a number o f p a r t s  study two  H o s p i t a l i s such  the above d e f i n i t i o n  the p a t i e n t system.  f e m a l e ) who  u n i t s and  as  the  other  p a t i e n t system of R i v e r v i e w  h o s p i t a l and  outlined  this  Riverview  are  t o be these  b r o k e n down or  personnel  and r e c r e a t i o n a l  social  s e r v i c e department,  the most d i r e c t l y departments  into  involved  with  interrelated with  each  40.  other  and  with The  and  staff  to the p a t i e n t  social  system?  subsystems  act according  functions  treatment of  maintenance of  the  individuals  the p a t i e n t  of  a point  t o i t s own  interrelate with  successful  (departments) are  of r e f e r e n c e  whims, but  t h o s e of o t h e r  s y s t e m do  not  community they are  m a k i n g s u r e the  system continues  (maintenance of  the  members on of l a b o r , any  they are  have a g r e a t e r  member c a r r i e d o u t with  Although  the  the  goal  of  ensuring  g e t t i n g b e t t e r , and  i n a s m o o t h and  considered achieved.  as  the  once with  o r d e r e d manner  u n i t of s o c i a l  structure  Although d i f f e r e n t s t a f f r e s u l t of a complex  achieving h o s p i t a l goals.  are  realized.  i s c o n c e r n e d , i t i s assumed t h a t  therapeutic  such  c o m m u n i t y , and  i m p a c t on  the p a t i e n t  independently.  As such  those  f a r as  the  of  goal  cooperation  than i f each  Thus the  division  Furthermore  integrate his p a r t i c u l a r functions with  his functions  staff  s t a f f team  patients' therapeutic  approach  needs  i n h o s p i t a l , i s u s e d on m e n t a l h o s p i t a l w a r d s . In order  staff  t o be  that i t  t h e y a l s o o f t e n become c o n c e r n e d  i t s c o l l e c t i v e d e c i s i o n making regarding  while  the  concerned w i t h  that h o s p i t a l goals  treatment  the  system).  a l l concerned w i t h  s t a f f members so  take  attempts to have i t s  achieved.  the ward have d i f f e r e n t f u n c t i o n s , the  successful  will  be  the h o s p i t a l are  s t a f f member a t t e m p t s t o  other of  of  s o o n see  n e c e s s a r i l y have the  to function  total hospital  h o s p i t a l w a r d may  goals  rather  can  I f we  the p a t i e n t , p r o t e c t i o n of the  they have been i n h o s p i t a l f o r awhile  where the  we  other  d e p a r t m e n t s so h o s p i t a l g o a l s  t o t a l h o s p i t a l system are  p r o t e c t i o n f o r the  The  r e l a t e d to each  s y s t e m b e c a u s e t h e y h a v e common g o a l s .  s e r v i c e d e p a r t m e n t as  does n o t  as  the p a t i e n t  and  solved.  adaptation  to achieve patient  patient For  t o the  s y s t e m s on  the  and  h o s p i t a l goals  the ward a r e  faced  with  o u t l i n e d above b o t h a number o f  i n d i v i d u a l coming i n t o h o s p i t a l "the  r o l e o f p a t i e n t due  problems  problem i s  to p h y s i c a l or p s y c h o l o g i c a l  illness".  41.  ( 2 , 113)  I n o t h e r w o r d s an  disorder  must l e a r n what i s e x p e c t e d of him  system.  In a v e r y  w h o l e new  way  of  i n d i v i d u a l under the  of  short  period  living.  Of  of  ( p a t i e n t r o l e ) by  has  c o u r s e when t h e p a t i e n t  s t a f f must overcome i s the  o f what i s e x p e c t e d o f him.  u n d e r s t a n d i n g t h a t he provided  by  the  advantage of not  hospital.  learns  I t i s o n l y when t h e  to take advantage of  For  treated.  At  i s expected any  rate  e n v i r o n m e n t t e n d s t o be  instance  status  the  assumption of  ment o f a c c u s t o m e d h a b i t u a l e a r n e r and ical  so  can  be  ment o f  faced  the p a t i e n t  S i n c e the  i s the  i s most  In order  the  return  of s u c c e s s f u l  a number o f  t h e i r s t u d y of need f u l f i l l m e n t  such s e r v i c e s  able  to  i f staff  to a  take do  successnew  i n overcoming  l o s s of r o l e  and  r o l e s of husband, f a t h e r ,  ( 2 , 113) related  to h i s r o l e s  treatment  third  psychologproblem  t o the r e l i n q u i s h -  i n the  implies  successful  A  and  wage  community.  the p a t i e n t ' s  being  t r a n s i t i o n from p a t i e n t  to  important.  to overcome the  provides patients with  the  r o l e of p a t i e n t " .  to conform to s o c i e t a l r o l e s , the  community r o l e s  be  r o l e of 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 -  individual's anxiety  r o l e and  h o s p i t a l goal  not  assistance  i m p a i r m e n t and  r o l e s s u c h as  the  an  opportunities  s t r e s s f u l i n a d d i t i o n to the p h y s i c a l  f a c t o r s which create  t h a t m u s t be  able  on,  such  patients.  need s t a f f  possible  the  individual  i n o r d e r t h a t he m i g h t be  for  i s r e l a t e d " t o r o l e c h a n g e s and to the  treatment  a  one.goal  i n d i v i d u a l has  t h i s whole process of a d j u s t i n g one  about  this,  group t h e r a p y s e s s i o n s  Another problem that p a t i e n t s  due  deal  Conversely  the p a t i e n t w i l l  to attend  a difficult  staff  l a c k of u n d e r s t a n d i n g the  t r e a t m e n t m e a s u r e s s u c h as  e x p l a i n t h a t he  fully  i s able  the  t i m e he m u s t l e a r n a g r e a t  the 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 .  problem that  in  s t r e s s of a mental  above mentioned problems the supportive on  services.  staff  S t a n t o n and  system Schwartz,  a h o s p i t a l w a r d , o u t l i n e a number  the most i m p o r t a n t of w h i c h , f o r the p u r p o s e s of  this  of  study,  are  42.  as  follows:  ( 1 ) p r o v i s i o n o f someone w i t h whom t h e p a t i e n t c a n  p r o b l e m s ; and or p e r s o n a l  (2) the p r o v i s i o n of  matters.  It  (34,  is likely  to t h e i r  three  stages  required  at the  eating,  time of  k n o w i n g who  the doctor  nature  and  ment m e a s u r e s  their  eventual  care  i s and of  For  recovery,  faced  As  i s r e q u i r e d by  when he  their  and  so  could  illness,  the  f a r as  t o be  (e.g.  patients  information  on.  For  etc.)  information  of  treatfor  information  information  regarding  ways o f o v e r c o m i n g  such  appointment times f o r a f t e r  i s concerned  be  realized.  there  is likely  have i n order  Some p a r t i c u l a r  an  in  ideal  t h a t optimum b e n e f i t items of  information  h i g h l y i n d i v i d u a l i z e d because of unique personal  care  include  regarding  importance of v a r i o u s  instance  of  on.  to a l l p a t i e n t s  Information  time  This would  seen, i n f o r m a t i o n  r o l e s and  the death of a r e l a t i v e w h i l e  (e.g.  regarding  Secondly,  Finallyypatients require  from h o s p i t a l .  is  belongings  (e.g.  s o on.  patients.  related  importance of such s e r v i c e s to s u c c e s s f u l adjustment  f r o m h o s p i t a l i z a t i o n may  apply  be  and  the  amount t h a t e a c h i n d i v i d u a l p a t i e n t s h o u l d  needed" t e n d  routine  information  e l e c t r o c o n v u l s i v e therapy,  i n assuming s o c i e t a l  community,.and so  others  instance  etc.),  importance of t a k i n g m e d i c a t i o n ,  s e r v i c e s and  stances  Firstly,  of c h i l d r e n , the d i s p o s i t i o n of  group t h e r a p y ,  their discharge  problems, the  the  admission.  treatment  prpgnosis (e.g.  p r o b l e m s t o be  care  i n f o r m a t i o n a l needs of p a t i e n t s are  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 ,  regarding  e i t h e r ward  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 of ward r o u t i n e  regarding  their  the  or phases of h o s p i t a l i z a t i o n .  information  the  regarding  his  223-242)  that  a r r a n g e m e n t s made f o r t h e b r o u g h t by  information  discuss  (matters  the p a t i e n t  concerning  circum-  is in hospital),  ward r o u t i n e )  or groups  while of  c h i l d r e n ) , b e c a u s e o f s i t u a t i o n s t h e y h a v e i n common.  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 h a v e c e r t a i n f u n c t i o n s  to perform  in  relation  43. i  to t h e i r p a r t i c u l a r  occupational  r o l e on t h e w a r d , i n f o r m a t i o n  s o l e l y d e p e n d e n t on r o l e c o n s i d e r a t i o n s . occupation  may h a v e a r e s p o n s i b i l i t y  butathey are not considered information. in  g i v i n g medical  of  such a s i t u a t i o n  information  patients is  f o r which  t o the p a t i e n t ) .  occupation  worker).  For instance  has t h e time t o g i v e e v e r y  t o g i v e s i n c e many o c c u p a t i o n s  method o f i n f o r m a t i o n  occupations  would  likely  needed  is likely  giving likely  information  that  this  information.  a t i o n based  important  represented  doctor,  social  the information but rather  H o s p i t a l t h i s more  i n f o r m a l method l e a d s In other  informal  h a s t h e e f f e c t o f l e a v i n g many p a t i e n t s  o f any p a r t i c u l a r  In addition  forgiving  down', t h e p e r s o n a l  i s allowed  c h a r a c t e r i s t i c s of the patient  information  to certain staff biases i n  i s 'played  patients  items o f  s t a f f member.  w o r d s when r e s p o n s i b i l i t y  on r o l e c o n s i d e r a t i o n s  information,  (e.g.  since the g i v i n g of s p e c i f i c  o f s t a f f members f o r p a r t i c u l a r personal  w o u l d n o t be  of a  i t f r o m somebody.  are not the s o l e r e s p o n s i b i l i t y  obtain  of other  own s y s t e m o f i n f o r m a t i o n  However on crowded wards a t R i v e r v i e w  The  of information t o  t r e a t m e n t team composed o f d o c t o r ,  T h e c o n c e r n i s n o t s o much w i t h who g i v e s  the p a t i e n t gets  giving  item  Furthermore the p a t i e n t population  For these reasons the s t a f f  giving.  it  perogative  on crowded h o s p i t a l  The a s s i s t a n c e  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  without  sole  I n some w a y s t h e e x i s t e n c e  t h e w a r d when t h e p a t i e n t n e e d e d t h e i n f o r m a t i o n  that  such  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 w e r e made t h e s o l e p e r o g a t i v e  particular on  to give  t o t h i s m i g h t be t h e d o c t o r ' s  i t i s responsible.  therefore necessary.  suffer  t o give c e r t a i n items o f i n f o r m a t i o n ,  i s quite practical.  w a r d s no s i n g l e o c c u p a t i o n  I t i s true that a p a r t i c u l a r  t o have t h e e x c l u s i v e r i g h t  (The e x c e p t i o n  giving i s not  preferences  t o come t o t h e f o r e .  (e.g.type of i l l n e s s ,  socioeconomic status, etc.)  inform-  also begin  desire to  t o be a more  c o n s i d e r a t i o n t h a n does t h e 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.  T h u s some p a t i e n t s g e t m o r e n e e d e d It c a n n o t be istics  i s the  o p i n i o n of  the  r e a l i z e d when, i n t h e  and  personal  from r e a d i n g  the  of s t a f f  a c t u a l needs of  literature  and  the  f a c t chat they have not  or because they f e e l they considered difficulties running  that  w a r d - i s not  and  advantage of  that the  the  p u r p o s e o f any  extend t o w h i c h the  patient  n u r s e ) on  system.  staff  the  goal  In a d d i t i o n the  new  study  system  in this  the  amount o f  information  T h e s e f a c t o r s m i g h t be t h a t each category  i s so  out  g i v e n by  divided  researchers  be  related  t h e y m i g h t be being  given  to  cooperative, information  of  the h o s p i t a l - a smooth  l a c k of  information  regarding  f o r many p a t i e n t s t o of  take  successful  area  the  research  should  be  to  ( t h e team composed o f d o c t o r ,  information,  been p o i n t e d  instance  realized.  amount a v a i l a b l e f o r use  has  of the  Thus t h e h o s p i t a l g o a l  Hospital give  group f e e l s determine social  information  i m p o r t a n c e i f one  s i n c e the  amount r e c e i v e d  to  the  i s concerned (and  i n d e r i v i n g b e n e f i t from the h o s p i t a l  e x p e r i e n c e ) i s d e p e n d e n t t o a l a r g e d e g r e e on As  given  u n c o o p e r a t i v e n e s s p r o d u c e s many  purpose i s of p a r t i c u l a r  w i t h p a t i e n t s ' r e c e p t i o n of therefore  t o how  rate their  the wards a t R i v e r v i e w  This  character-  For  T h i s may  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  first  w o r k e r and  information.  o f t e n makes i t i m p o s s i b l e  i s not  goals  g r o u p s o f p a t i e n t s become  c o n s e q u e n t l y one  such o p p o r t u n i t i e s .  treatment f o r p a t i e n t s It  any  realized.  treatment opportunities  experience  they were s l i g h t e d i n not At  that hospital  individual patients.  b e e n i n f o r m e d as  important.  for staff,  given  study  f o r p a r t i c u l a r p a t i e n t s are  from p e r s o n a l  when t h e y a r e n o t  others.  information, patient  on h o s p i t a l w a r d s i t seems t h a t p a t i e n t s and uncooperative  than  authors of t h i s  g i v i n g of  preferences  more i m p o r t a n c e t h a n t h e  information  there  are  the  staff  the  a number o f  given. factors that a f f e c t  system to the p a t i e n t  i n t o three broad  i n t e r r e l a t e d as  amount  system.  c a t e g o r i e s , r e a l i z i n g of  t o be m u t u a l l y  reinforcing.  course  They  45.  are  as f o l l o w s :  system total  (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  (e.g. h i s motivation staff  to give  s y s t e m on t h e w a r d  have been w o r k i n g t o g e t h e r ) ; patients  (e.g. the degree  There  are l i t e r a l l y  ation  g i v e n by  speculate the  new  study  associated  The R e c e p t i o n  individual  level  a f f e c t t h e amount o f  of knowledge  of determining with  we  The  i f certain specific  t h e amount o f i n f o r m a t i o n  can  t h a t p a t i e n t s need  given  by  only  second purpose  patient might.not receive  understanding As  sent  and  indicated earlier, interchange  as s u c h an i n t e r c h a n g e the s t a f f  i n which  of communication  i n v o l v i n g energy  g i v e n by  the  staff  t o have c e r t a i n i n f o r m a t i o n  i s only  For even  though  i n d i v i d u a l s of the  In other  i n any  words t h e r e  something r e c e i v e d . a f f e c t t h e way  a piece  i t i s r e c e i v e d we  in  hospitalization,  system  one  factor  staff  that  i s often a great W h e n e v e r we  that  differ-  start  of information  i s given  necessarily require  an  theory. systems  a r e bounded r e g i o n s  among t h e i r p a r t s .  of energy.  s y s t e m and  Explicit system  i t .  f a c t o r s that might  i n r e l a t i o n t o t h e way  of  f a c t o r s are  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 ,  considering  inform-  the s t a f f  taken i n t o consideration.  ence between srimething  etc.)  on a H o s p i t a l Ward  r e c e i v e optimum b e n e f i t f r o m t h e i r  amount o f i n f o r m a t i o n  staff  of f a c t o r s t h a t might  of I n f o r m a t i o n  that they might  team m i g h t  are  c h a r a c t e r i s t i c s of  system.  I f one b e l i e v e s  m u s t be  (3) p e r s o n a l  A t our p r e s e n t  becomes one  system to the p a t i e n t  the  and  the  o f t i m e i n d i v i d u a l s on t h e team  as t o w h a t f a c t o r s m i g h t be m o r e i m p o r t a n t .  significantly  order  (e.g. length  (2) f a c t o r s w i t h i n  to which a p a t i e n t reaches out f o r i n f o r m a t i o n  dozens  staff.  information);  s t a f f member  the p a t i e n t  The  i n time-space  Communication  p a r t s , f o r the purposes  c a n be of t h i s  viewed study,  system.  transmission  of i n f o r m a t i o n  from i n d i v i d u a l s of the  to i n d i v i d u a l s of the p a t i e n t system are a t l e a s t three  elements.  46.  They a r e t h e s o u r c e destination  ( s t a f f member), t h e message  (patient).  encodes h i s message.  I n the communication process the source "that  w a n t s t o s h a r e and p u t s S e c o n d l y he t r a n s m i t s The  third  step  i s , he takes  the information  In engineering  or  clear information;  effectively and  i f t h e message i s n o t encoded  encoding...then, obviously  efficiency  acurately,  that  f a s t enough  to the desired  corresponds t o  (29, 508) course  i f the communication system i s o p e r a t i n g  at low  the d e s t i n a t i o n i s obtaining  needed  I n terms o f theianental h o s p i t a l , i f the p a t i e n t system i s n o t  occurring  i n any u n i t o f t h e p r o c e s s  transmitted  the p a t i e n t system w i l l Conceivably communication  system because o f d i s t o r t i o n  ( s o u r c e , message, d e s t i n a t i o n ) , then optimum b e n e f i t f r o m  one c o u l d measure t h e e f f i c i e n c y  (individual  at a higher  by t h e s t a f f  unlikely realize  staff-individual  d i f f e r e n c e b e t w e e n w h a t was g i v e n level  hospitalization.  o f any s i n g l e system  p a t i e n t ) by n o t i n g t h e  a s c o m p a r e d t o w h a t was r e c e i v e d .  Sim-  o f a b s t r a c t i o n , one c o u l d m e a s u r e t h e e f f i c i e n c y  of any l a r g e r system o f communication lating  i n a pattern  adequate  the system i s working a t l e s s than top  information  ilarly,  fully,  i n t e r f e r e n c e and c o m p e t i t i o n ,  receiving  of  intended  o r d i s t o r t i o n a t any  i f these are n o t transmitted  i ti s highly u n l i k e l y that  information.  (language).  obtained.  i f t h e message i s n o t decoded  Of  (29,507)  . " I n human t e r m s , i f t h e s o u r c e d o e s n o t g i v e  i n transmittable signs;  efficiency".  first  signals  f o r whom t h e m e s s a g e was  t e r m s t h e r e may b e f i l t e r i n g  a c c u r a t e l y enough, d e s p i t e  receiver; the  stages.  the  o r f e e l i n g he  i n t h e form of v e r b a l  d e c o d e s and i n t e r p r e t s t h e i n f o r m a t i o n  the three  the information  i t i n t o a f o r m t h a t c a n be t r a n s m i t t e d . "  i s where t h e i n d i v i d u a l  of  (item of information,)and  t h e sum o f t h e d i s c r e p a n c i e s  (ward t e a m - p a t i e n t s y s t e m ) by c a l c u -  between what each i n d i v i d u a l  member g a v e i n t h e way o f i n f o r m a t i o n  and what e a c h  individual  staff  patient  47.  received  and  d i v i d e by  Although  t h i s w o u l d be  the  total  a very  number o f  difficult  informational  assessment t o c a r r y out  w h o l e h o s p i t a l i t w o u l d u n d o u b t e d l y be v e r y Although determining involves procedural ed  when one  operating may  difficulties,  o c c u r a t any  level  stage of  piece  f a c t o r s t h a t may  of  i s received  information  course, are  t h a t at our  present level  that are The  or  f a c t o r s are  i n the  the  i f one  encounter-  a p a r t i c u l a r system i s stated  above,  distortion  In c o n s i d e r i n g  one  can  literally  the  think  the p a r t i c u l a r p i e c e  f o r m i n w h i c h i t was  r e a l l y do  and  not  the  given.  truth is  know w h i c h ones  i s concerned w i t h  are  somehow f i n d i n g  out  distortion  important. the  s t u d y becomes one  of d e t e r m i n i n g  communication p r o c e s s between the at Riverview. H o s p i t a l . staff  staff  In other  s y s t e m g a v e and  associated  with  the  team on  words the  either high  level  the  degree  what the p a t i e n t  f o u r t h purpose i s to determine i f c e r t a i n s p e c i f i c significantly  the  communication  i s i n e f f i c i e n t he m u s t n e c e s s a r i l y s e l e c t  o f d i f f e r e n c e between what the The  As  information  o f k n o w l e d g e we  a s s u m e d t o be  the p a t i e n t s  received.  r e a s o n s why  the p a t i e n t  t h i r d purpose of  of e f f i c i e n c y o f w a r d s and  by  of  for  even more d i f f i c u l t i e s  a f f e c t whether or not  Therefore  a p a r t i c u l a r channel  factors  system of  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 ,  the most i m p o r t a n t . why  are  given.  valuable.  communication process.  of hundreds of  Some, o f  there  of e f f i c i e n c y .  the  t r a n s m i t t i n g one  very  e f f i c i e n c y o f any  attempts to account f o r the  at a s p e c i f i c  p r o s p e c t of  the  items  system  variables  or low e f f i c i e n c y .  VARIABLES The amount o f  information  to which the team  independent v a r i a b l e s are g i v e n by  patient receives  ( e f f i c i e n c y of  the the  staff  the  f a c t o r s t h a t m i g h t a f f e c t (a)  team on  information  communication).  t h e w a r d s and  transmitted  by  (b)  the  the ward  the  extent staff  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.  will  designate  variables high  as  t o be  ratio  of 1.  to whether  discussed  i t a f f e c t s (a) or  were found  information  received  Number o f p r e v i o u s  t o be  (b).  significantly  i n the p i l o t  Riverview  The  first  five  associated with  a  study.  or o t h e r m e n t a l h o s p i t a l  admissions. ( a ) , One  would expect  a p a t i e n t has  had  had  this  I f the  information  be  revolves  a high  a low  around the  t h e more l i k e l i h o o d the  greater  less information  assume t h a t  The  on  ward  patient  the  need  that  i n the  number o f a d m i s s i o n s t h a t s u c h  to the  same e x t e n t  as  number o f a d m i s s i o n s . fact that  the  greater  i n the The  case of  reason for  t h e number o f  o f damaged c o g n i t i v e p r o c e s s e s .  the p a r t  i n t e r e s t as  of  the p a t i e n t .  of  degree to w h i c h the  the this  admissions  Furthermore of  a  improvement  Therefore  to what the ward s t a f f have t o  case  information  t h e number o f a d m i s s i o n s t h e m o r e l i k e l i h o o d  hospitalization  2.  the  feel  i t is likely  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  decreased  admissions  same g r o u n d .  received  patient with  t h e number o f  so t h e y w o u l d n o t  i n f o r m a t i o n were g i v e n ,  of a p a t i e n t w i t h . would not  greater  They would l i k e l y  t o c o v e r much o f t h e (b)  the  to a mental h o s p i t a l the  s t a f f would g i v e . already  that  from  a  say.  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  for  information. (a) the  On  crowded h o s p i t a l wards where the  amount o f  t o some e x t e n t  information  the  staff  give  information.  In a study  by  information.  (6,  241)  low, be  particular  S t a n t o n and  shown t h a t t h e m o s t 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  amount o f  is  to a p a t i e n t w i l l  dependent upon the degree to w h i c h a  p a t i e n t requests i t was  that  staff-patient ratio  Schwartz  the  greatest  49.  (b)  I t i s probably true  for  information  that  t h e more a p a t i e n t r e a c h e s o u t  t h e more he o r s h e i s l i k e l y  information  i n the form  the  t h e c o n c e r n on t h e p a r t  greater  particular  item  he o r s h e w i l l 3.  Psychotic  (a)  of information, receive  and Non  It is likely  p a t i e n t who since  i n which  t h a t ward  staff will  the l i k e l i h o o d  changes  that  given.  give less  information  that  There  t h e p e r s o n i n such a s t a t e i s  transmitted.  Of c o u r s e t h e  through the course of a p a t i e n t ' s  i s a greater  that  information  hospitalization,  a r e u n a b l e t o g i v e much n e e d e d  i n cases of p s y c h o t i c  n o t be r e c e i v e d  This  in  those s u f f e r i n g from p s y c h o t i c  disturbances  i s due t o t h e f a c t  two b r o a d  that  there  i n thought p r e v e n t an i n d i v i d u a l  perceiving external reality  b r o k e n down i n t o  of psychotic  type of i l l n e s s  correctly staff).  and n o n p s y c h o t i c  (e.g. schizophrenic,  c o r r e l a t e d w i t h b o t h amount o f i n f o r m a t i o n  4.  Frequency  The  concern here i s whether  o f group m e e t i n g s  disturbances  d i s o r d e r s , and s u c h from  and  given  neurotic, etc.) and r e c e i v e d .  a team f u n c t i o n i n g on a w a r d  to patients  c a n be  on t h e w a r d .  e x t e n t t h e t e c h n i q u e o f group m e e t i n g s  s t a f f do g i v e more i n f o r m a t i o n  are  ( i n f o r m a t i o n g i v e n by ward  classifications  patients,  i n the form i n which  i t was g i v e n . thought w i t h  often  i s discharged.  likelihood,  given w i l l  to a  reaction  o f t h e improvement i n h i s o r h e r c o n d i t i o n , b u t t h i s  (b)  to a great  i t was  i s d i a g n o s e d a s h a v i n g some f o r m o f p s y c h o t i c  information before the patient  uses  I n o t h e r words  of the p a t i e n t f o r a  the greater  happens so s u d d e n l y t h a t ward s t a f f  The  that  Psychotic  unable t o use the i n f o r m a t i o n  because  i t was g i v e n .  i t i n t h e form i n which  i t i s generally felt  diagnosis  to receive  which  b e t w e e n p a t i e n t and  t h a n d o e s a team f u n c t i o n i n g o n  50.  a ward where such a t e c h n i q u e (a)  i s only minimumly  used.  T h e a s s u m p t i o n i s t h a t t h e team on a ' h i g h number o f g r o u p  meetings ward' w i l l  show up as h a v i n g  given a greater  amount o f  i n f o r m a t i o n t h a n t h e team on a ' l o w number o f g r o u p m e e t i n g s ward'.  Where s t a f f  technique 5.  will  t i m e i s a t a premium t h e group m e e t i n g  e n h a n c e t h e amount o f i n f o r m a t i o n  Patient understanding  given.  of reasons f o r h o s p i t a l i z a t i o n  prior  to  admiss i o n . (a)  P a t i e n t s who h a v e d i s c u s s e d  ization with prior  a p r o f e s s i o n a l person  t o admission  staff.  (b)  prior  have a more p o s i t i v e  likelihood  towards  of t h e i r  need f o r  to obtain  t o h i s o r h e r most r e c e n t The more p o s i t i v e  b a s e d on p r e v i o u s  i t was  (positive  or negative)  to  t h a n t o one who Often  ward s t a f f  towards  certain  such  towards ward  staff  i n hospital.  I n other  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  such behavior  staff  t h e m o r e i n f o r m a t i o n he o r s h e i s  i s more h o s t i l e  i s related  inform-  hospital.  the p a t i e n t ' s a t t i t u d e  experience,  tend  receive  n u r s e ) b a s e d upon c o n t a c t w i t h  admission  there i s  given.  t o get from such ward s t a f f w h i l e  words ward s t a f f  i s greater  t h a t such p a t i e n t s w i l l  The p a t i e n t ' s a t t i t u d e  staff.  understanding  attitude  have a g r e a t e r m o t i v a t i o n  i n t h e form i n which  likely  (doctor,, s o c i a l worker, e t c )  to obtain information  ( s o c i a l worker, doctor,  (a)  hospital-  information.  also a greater  ward s t a f f  will  I f the motivation  ation  for their  b e g i v e n more i n f o r m a t i o n b y t h e w a r d  because of t h e i r  and c o n s e q u e n t l y  needed  6.  will  Such p a t i e n t s w i l l  hospitalization it,  the reasons  patient  towards o r a l o o f from t h e ward  on t h e p a r t o f t h e p a t i e n t  to a previous  positive  or negative  towards experience  with  such  (b)  The more n e g a t i v e  the  staff.  less likelihood  such ward s t a f f  t h e p a t i e n t ' s a t t i t u d e towards ward  t h a t he w i l l  receive  i n the form i n which  words i f t h e p a t i e n t d i s l i k e s  (a)  Informal  or involuntary  The w a r d s t a f f w i l l  i n f o r m a l l y admitted cooperative (b)  hospitalization information  a higher  g i v e more i n f o r m a t i o n  t o the  this  i s that the v o l u n t a r i l y  degree o f m o t i v a t i o n  the greater  tiadd t o r e c e i v e m o r e  i n t h e f o r m i n w h i c h i t was admitted  given. patient  t o ' g e t b e t t e r ' and t h u s w i l l  g i v e n by ward s t a f f . the r e c e p t i v i t y  of  be  The g r e a t e r t h e  information.  Lengh of time i n h o s p i t a l I t i s likely  that the longer  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 b y  ward.staff.  Socioeconomic status of the p a t i e n t The a s s u m p t i o n h e r e  i s that  the lower the socioeconomic  o f t h e p a t i e n t , t h e l e s s i n f o r m a t i o n he w i l l staff. prefer  The r e a s o n i n g  behind  this  slighted  class),  status  be g i v e n by t h e ward  i s t h a t s t a f f members t e n d  to i n t e r a c t with p a t i e n t s of t h e i r  (middle  (b)  given.  t h e i n d i v i d u a l who s e e s siome n e e d f o r  open t o any i n f o r m a t i o n  (a)  to  admission  likely  given by s t a f f  has  9.  the information  (informal patient) w i l l  reason hehind  (a)  I n other  p a t i e n t p r i m a r i l y b e c a u s e he o r she i s more  that  The  8.  by  and o p e n t o d i s c u s s i o n .  It i s likely  motivation  i t was s e n t .  given  t h e w a r d s t a f f he i s more l i k e l y  ' t u n e them o u t ' and t h u s n o t r e c e i v e 7.  the information  staff,  to  own c l a s s b a c k g r o u n d  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  as f a r as t h e g i v i n g o f i n f o r m a t i o n  i s concerned.  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 t h e p a t i e n t t h e g r e a t e r  52.  the  likelihood  not  be p e r c e i v e d  given.  that  the information  by t h e p a t i e n t  The r e a s o n f o r t h i s  g i v e n by ward s t a f f  i n the form i n which  i s that lower s t a t u s  o f t e n do n o t h a v e t h e v e r b a l a b i l i t y in which a p a r t i c u l a r staff.  item  the as  two p a r t i e s  as i t was  transmitted)  of t h i n g s .  The  greater  c l a s s b e t w e e n t h e two t h e l e s s l i k e l i h o o d  (J10)  be  i s transmitted  by  information requires  that  ( s t a f f and p a t i e n t s ) s h a r e common a s s u m p t i o n s  to the nature  will  the language  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  ( r e c e p t i o n of i n f o r m a t i o n  i t was  patients  to understand  of information  will  the d i f f e r e n c e i n that  these  assumptions  shared.  The l e n g t h  o f t i m e t h e team h a s b e e n 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 t h e l o n g e r  members h a v e b e e n w o r k i n g t o g e t h e r that  T h u s i t i s more l i k e l y  of  information w i l l  (11)  Ward m o r a l e  (a)  the greater  t h e y have d e v e l o p e d an e f f e c t i v e  giving.  be g i v e n  individual  the l i k e l i h o o d  system of  information  chance t h a t a g r e a t e r  g i v e more  t o p a t i e n t s t h a n a team on a w a r d w i t h  low morale.  S t a n t o n and S c h w a r t z h a v e shown t h a t on a w a r d w i t h morale  individual  s t a f f members t e n d  w i t h p a t i e n t s . (32, 337-353)  amount  t o a l l p a t i e n t s on a w a r d .  T h e team on a w a r d w i t h h i g h m o r a l e w i l l  information  team  low  t o withdraw from  Thus l e s s  information  contact i s given.  53.  CHAPTER V  THE  PROPOSED DESIGN  INTRODUCTION Although any  researcher,  U.B.C. S c h o o l of  the p i l o t  t o be  t h i s proposed research  i t has  at the  level  m i g h t be  been w r i t t e n p a r t i c u l a r l y w i t h  of S o c i a l study,  design  Work i n m i n d .  may  a l s o be  exploratory-formulative  out  students  Because of the v e r y  the proposed d e s i g n o f an  the  carried  at  limited  generally  by the  nature  considered  study.  THE.PROPOSED HYPOTHESES From the m a t e r i a l p r e s e n t e d that  the main concern of  receiving benefit  the  amount o f  the propdsed study information  information  i s g i v e n by  amount. the  number  one.  T h i s may  the  be  s e e n as  The  can  be  Then, the  for optimal  a c t u a l amount o f  of  the  treatment  compared w i t h  seen to represent  to  optimally  ideal  ideal  amount  amount o f  leads  this  effective-  to  hypothesis  amount o f  given  of  information  theoretical  b e n e f i t from h i s  information  information  compared w i t h  This  are  information hospitalization  t o him  by  members  team.  information  the  be  information.  There i s a d i f f e r e n c e between the  amount o f  i s an  a measure of the  the  restated  t o d e t e r m i n e what there  given.  and  i t c a n be  i n order  t r e a t m e n t team may  a patient requires  patient  be  t r e a t m e n t team t o g i v e  1.  In order  m u s t assume t h a t  that a p a t i e n t should  that a patient  ness of  r e c e i v e , we  four,  i s to whether p a t i e n t s  they r e q u i r e  from t h e i r h o s p i t a l i z a t i o n .  a p a t i e n t should  ideal  i n chapter  amount o f  t h a t the  team s t a t e s t h a t  information  the e f f i c i e n c y  of  the  i t gives  a p a t i e n t s a y s he communication  to  receives  process.  a  54.  H y p o t h e s i s number two w i l l 2.  be  T h e r e i s a d i f f e r e n c e b e t w e e n t h e amount o f  information  t h e members o f t h e t r e a t m e n t team s a y t h e y h a v e g i v e n t o a p a t i e n t and t h e amount o f i n f o r m a t i o n  that the p a t i e n t  s a y s he h a s r e c e i v e d . A number o f f a c t o r s m i g h t b e e x p e c t e d information  g i v e n b y t h e t r e a t m e n t team a n d t h e amount o f  r e c e i v e d by t h e p a t i e n t s . referred will  t o a f f e c t t h e amount o f  to i n chapter  information  Some o f t h e s e f a c t o r s a r e t h e i n d e p e n d e n t v a r i a b l e s  four.  On t h e b a s i s  of t h i s ,  hypothesis  number  three  be 3.  C e r t a i n of the f o l l o w i n g v a r i a b l e s w i l l significantly referred  associated with  to i n hypothesis  be f o u n d t o b e  the hypothesized  differences  1 and 2.  Variables. (a)  number o f p r e v i o u s  Riverview  or other mental h o s p i t a l  admissions (b)  psychotic  (c)  informal  (d)  length  (e)  socioeconomic  (f)  the degree to which the i n d i v i d u a l p a t i e n t reaches out for  o r non  psychotic  or involuntary  admission  o f time i n h o s p i t a l status  information  (g)  f r e q u e n c y o f g r o u p m e e t i n g s on t h e w a r d  (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 or negative) particular  staff  b a s e d on p r e v i o u s (i)  length on  (doctor,  at admission to  s o c i a l worker, charge  nurse)  hospitalization.  o f t i m e t h e t r e a t m e n t team h a s b e e n w o r k i n g  the h o s p i t a l ward.  together  55.  (j)  ward m o r a l e  (k)  e x p l a n a t i o n of reasons professional  staff  for hospitalization  given  i n t h e community b e f o r e  by  hospitalization.  DEVELOPING A.DESIGN FORMAT The  following w i l l  of the proposed d e s i g n . will  d i s c u s s the d e t a i l s 1.  be  a brief  o u t l i n e of the  Under the h e a d i n g , and  three major  Implementation  procedural aspects  of t h i s  T a b u l a t i o n of the d i f f e r e n c e between the  of Design,  we  design. ideal  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 and  aspects  amount o f  hospitalization  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  ideal  amount o f i n f o r m a t i o n r e q u i r e d may  be  obtained  by: (i)  the r e s e a r c h e r s w i l l  develop  a list  i t e m s w h i c h t h e y b e l i e v e t o be particular (ii)  this  list  composed o f two workers. greater  i  be p r e s e n t e d d o c t o r s , two  nurses,  and  to or d e l e t e from the l i s t  to  a h y p o t h e t i c a l p a t i e n t i n an  In addition,  they w i l l  i n the l i s t  asked  to "least  social  be  i t would  ideal  a weighting  to d i s t r i b u t e  the  From  able the  setting,  ranging  important".  f o r e a c h i t e m on  apply  hospital  t h e n be  is  expected  o f e a c h o f t h e s i x members o f  committee, the r e s e a r c h e r s w i l l determine  two  along a s i n g l e continuum  f r o m "most i m p o r t a n t " these- l i s t i n g s  be  as  committee  experience  the r e s e a r c h e r s , they w i l l  add  the  study,  B e c a u s e t h e i r k n o w l e d g e and than  for  to a h o s p i t a l  to  items  information  essential  group of p a t i e n t s under will  of  the to  list.  56.  (iii)  f o r each p a t i e n t w i t h i n the will  eliminate  sample, the  those items i n the  applicable to h i s p a r t i c u l a r patient  there w i l l  t h a t he  should  vary (b)  (c)  For  given  2. given  a number o f  This  t o each p a t i e n t  ratio  i n the  information  t h i s number  may  i s assumed t o be  information  to p a t i e n t s .  of the  the  be  determined  a measure of  t r e a t m e n t team t o  d i f f e r e n c e between the  actual information  was  sample.  o r p e r c e n t a g e may  e f f e c t i v e n e s s of the  t o t h e p a t i e n t and  items of  t r e a t m e n t team w h a t i n f o r m a t i o n  theoretical  Tabulation  not  Thus, f o r each  i d e a l l y r e c e i v e and  each p a t i e n t , a r a t i o  actual. ideal  case.  that are  from p a t i e n t to p a t i e n t .  Determine from the actually  be  list  researchers  actual  the  give  information  t h e p a t i e n t s a y s he  has  received. (a)  By Che  i n t e r v i e w i n g the p a t i e n t , the number o f  from the (b)  items that  treatment  t o be  information  study  f o r each of (a)  of the  data  t h e p a t i e n t s and  t o the the  (b)  a measure of the  Tabulation  amount o f  treatment  to the  will has  determine received  team.  information  3.  t h e p a t i e n t s a y s he  Thus, f o r each p a t i e n t , a r a t i o determined  researchers  o r p e r c e n t a g e may  received.  This  ratio  be i s assumed  given  efficiency regarding  relating  information  of  the  each of  communication  the v a r i a b l e s under  it given  to that p a t i e n t  by  team.  amount o f  i n f o r m a t i o n r e c e i v e d by  process.  that patient.  57.  IMPLEMENTATION OF DESIGN Before will  any research  can be c a r r i e d  have t o be approved by the h o s p i t a l  design  involves personnel  from the d i r e c t o r s  o u t i n the h o s p i t a l ,  administration.  Because  this this  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  o f each d i s c i p l i n e  f o r the involvement  of their  staff.  U n d e r s t a f f i n g and heavy work l o a d s o f these p e r s o n n e l  make a n y f u r t h e r  demands o n t h e i r  time an i m p o s i t i o n u n l e s s an obvious  value  this research.  Therefore,  be  for i t .  The second  tlairtjSHaghout t h e p r o j e c t . interest if  one o f t h e f i r s t  i nthis  task w i l l  c a n be seen i n  tasks o f the r e s e a r c h e r s  t o i n d i c a t e w h a t v a l u e s may come f r o m t h i s  enthusiasm  design  r e s e a r c h and thus  be t o m a i n t a i n  that  will  generate enthusiasm  The p r e l i m i n a r y s t u d y h a s a l r e a d y s t i m u l a t e d a n  research problem.  Enthusiasm  will  o n e o r m o r e members o f t h e r e s e a r c h team a r e  f u n c t i o n i n g , and r o u t i n e s o f the h o s p i t a l . research design, the treatment  team w i l l  be e a s i e r t o m a i n t a i n  f a m i l i a r w i t h the  Because o f the nature  b e a w a r e o f many a s p e c t s  personnel, of the o f the  r e s e a r c h a n d t h i s may p o s i t i v e l y b i a s t h e 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 . ers  will  On t h e o t h e r h a n d , b e c a u s e o f t h i s  b e 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  w o u l d b e 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 . the maintenance o f i n t e r e s t be  f a r more e x p l i c i t  than  of the hospital  should  the p r o j e c t .  This  Another major p o i n t i n  i sthat t h eresearchers  should  i n t h e i r d e a l i n g s w i t h the h o s p i t a l a d m i n i s t r a t i o n  t h o s e who w e r e i n v o l v e d i n t h e p r e s e n t  researchers  take r e s p o n s i b i l i t y  m e e t i n g and g i v i n g t h i s  THE  awareness, t h e r e s e a r c h -  study.  F o r example, t h e  f o r d e v e l o p i n g an agenda f o r any  t o the p a r t i c i p a n t s  beforehand.  L I S T OF INFORMATION ITEMS The  information  first  items  ideal hospital  research  felt  setting  instrument  t o be e s s e n t i a l i norder  i nthis design  i sthel i s t of  t o the h y p o t h e t i c a l p a t i e n t i n an  f o r him t o o b t a i n optimal b e n e f i t from h i s  58.  hospitalization.  We  a patient requires  and  sex  and  are  assuming that  that this w i l l  circumstances.  To  there  vary  a r r i v e a t an  must p o s t u l a t e  that w i l l  match the p a t i e n t sample group.  should an  t h e o r e t i c a l l y have.  Therefore,  i d e a l h o s p i t a l s e t t i n g (e.g.  should  i d e a l l y be  a case of  the  a l l the  availability  i n an  areas from which  treatment  information the  must  Information care  required  and  nature  on  of admission  committee to setting.  i t e m s w o u l d be  included  in  admission  t y p e of ward p a t i e n t important  ward  is  Information who  required  the d o c t o r  on  care  regarding  i s and  of v a l u a b l e s , treatment  when he may  what the n u r s e s r e s p o n s i b i l i t i e s  3.  nature  of  nature  of the  treatment  nature  of  prognosis  Information use  of  the  the  involuntary)  routines  systems of p r i v i l e g e s , 2.  f a m i l y members  (voluntary,  be are  illness  required medication  regarding  discharge  be team, he  postulate  items that a p a t i e n t  ideal hospital  management o f o t h e r  be  e f f e c t i v e ward  are: 1.  to  age,  information which  s e l e c t i o n we  of s t a f f ,  i t i s n e c e s s a r y t o ask  a hypothetical patient Some o f  list  given,  given  of  that  the c h a r a c t e r i s t i c s  c o n t r o l of the  i n item  Thus, t o o b t a i n a l i s t  information  I n a d d i t i o n , t h e r e may  i n the h o s p i t a l , beyond the  organization).  amount o f  a hypothetical patient with  which might prevent a p a t i e n t from b e i n g  information  d e p e n d i n g upon t h e p a t i e n t ' s  ideal  g i v e n , we  circumstances  i s a body of  seen  etc.  consider  this  use  of after-care,  or other  follow-up  the extent t o which s t a f f d i s c u s s e d  resources  patient's  illness with relatives w h a t t o do i f s y m p t o n s o f i l l n e s s  Before and.precise sources  possible  community r e a c t i o n  hospital  patient.  as t h e r e s e a r c h e r s  (professional several  a r e a b l e t o make i t .  literature),  t o read  patient  ves  w i t h t h e p r o b l e m s and c o n c e r n s  i t will  recurring  t o a former  p r e s e n t i n g t o the committee, the l i s t  ers  THE  start  mental  s h o u l d be as c o m p l e t e Besides  the obvious  be v e r y h e l p f u l f o r t h e r e s e a r c h -  autobiographies  i n order  t o f a m i l i a r i z e themsel-  of mental h o s p i t a l p a t i e n t s .  (20)  COMMITTEE Selection  of t h e d i r e c t o r s nature  o f t h e s i x c o m m i t t e e members w o u l d b e a t t h e d i s c r e t i o n  o f each of the three d i s c i p l i n e s .  of their task, highly  a mental h o s p i t a l possible  bias,  t r a i n e d persons  with considerable experience i n  s e t t i n g s h o u l d be r e q u e s t e d .  they  s h o u l d be p e r s o n s  teams o f a n y o f t h e w a r d s o r u n i t s  However, b e c a u s e o f t h e  I n a d d i t i o n , because o f the  who a r e n o t members o f t h e t r e a t m e n t  under study.  A suggested  committee  would be: 1.  The C l i n i c 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  3.  The D i r e c t o r  4.  A S u p e r v i s o r o f S o c i a l Work, n o t f r o m t h e u n i t s  5.  The D i r e c t o r s  6.  A. S u p e r v i s o r o f N u r s e s ,  Because of t h e time  of Riverview  of Social  Hospital under  study  Services under  study.  of Nursing n o t from t h e u n i t s  l i m i t a t i o n s , e a c h member w i l l  a t h i s own c o n v e n i e n c e responsibility  Director  rather  than  of the researchers  under  probably  a t a committee meeting. t o make c l e a r  study.  review  the l i s t  I twill  be t h e  t o t h e members o f t h e c o m m i t t e e  60.  that they this  are  to c o n s i d e r the  will  a l s o be  approving  asked  the l i s t  to r a t e the  of  items  Thus, i f t h e r e are  given-a value  o f 40.  By  six  members, a w e i g h t i n g  the  importance  THE  P A T I E N T SAMPLE The  before  of each  items,  t h e members o f t h e  at  40  ( i . e . the  the most i m p o r t a n t  the v a l u e s  o b t a i n e d by  importance Q-sort  item would  g i v e n each i t e m by  theoresearchers  the  that indicates  item.  the c o m p i l a t i o n of the l i s t  the l i s t .  items,  averaging  c a n be  committee  a c c o r d i n g to t h e i r degree of  c h o i c e o f a p a t i e n t g r o u p t o be  characteristics on  r a t h e r t h a n what i s p r a c t i c a l  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  technique). be  case  hospital. Besides  for  ideal  o f t h e group w i l l  of  s t u d i e d m u s t be  information items,  affect  the nature  since  decided the  o f a number o f  items  I n s e l e c t i n g a s a m p l e , 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  taken  into consideration: (a)  t h e number o f p a t i e n t s r e q u i r e d f o r t h e  (b)  t h e number o f w a r d s t o be  (c)  t h e a p p r o x i m a t e number o f d i s c h a r g e s p e r m o n t h o f v a r i o u s patient  (d) For  used  groups  the r e s e a r c h e r s ' time  available  to c o l l e c t  data  example, from our knowledge of 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  study  experience,  s h o u l d be occur  discharged  available As  will  20 p a t i e n t s p e r m o n t h i n t h e m o t h e r - w i t h - c h i l d r e n from each ward.  from the estimated  e x t r a time  as  study  reflect  any  H o w e v e r , as m a r k e d v a r i a t i o n s  number, a l a r g e m a r g i n o f s a f e t y i n t h e f o r m  to 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  sample group w i l l  i n the a p p r o p r i a t e n e s s  h a v e some i n d i v i d u a l of the  i t p e r t a i n s to each i n d i v i d u a l p a t i e n t .  I t e m s on  the  Therefore,  pilot group may of  for. differences, this information  list  the r e s e a r c h e r s  will  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  applicable.  a review  file the  and  This w i l l  i f the  treatment  file  items  is lacking,  The  result  t h e n by  then w i l l  of the  checking  be  an  patient's  w i t h one  of  individualized  list  f o r each p a t i e n t .  second r e s e a r c h  determining  instrument  w h a t i n f o r m a t i o n was  B e c a u s e o f demands on  staff  all  i t s disadvantages  w o u l d be  the  check l i s t  ty  d e t e r m i n e d by  not  TREATMENT TEAM CHECK L I S T The  for  information  team members.  of i n f o r m a t i o n  THE  h a v e t o be  that are  as  there  to the doctor  i s u s u a l l y one  20 n u r s i n g s t a f f who ization.  time,  Ideally,  will every  actually  design  given  instrument.  s o c i a l worker presents  each ward.  n u r s e on  one  the ward s h o u l d  to  a p a r t i c u l a r p a t i e n t , t h o u g h she w o u l d a p p e a r t o be  difficult  once, o n l y  t o the  time of d i s c h a r g e . instrument  and  The  that they  memories, w i t h a l l t h e i r given.  This  of the  treatment  of the  three  and  lists  the  told  omissions  at the  must r e c o g n i z e  and  given  nursing  whether  staff  give  informed.  time of c a n be  that  treatment  inclusions,  admission. given  only  to each of  given.  this w i l l  at  be  the  a t a team l i s t  of  the  a weak  team members '  of what i n f o r m a t i o n  the p a t i e n t s i n the  be made t o a r r i v e  t o have been a c t u a l l y  more t h a n o n c e  the b e s t  check l i s t  are measuring only the  team f o r e a c h o f  as  hospital-  p r e s u m a b l y t h i s w o u l d h a v e t o be  researchers  c h e c k l i s t m u s t be  as many  strongly question other  difficul-  the ward f o r 2 months or more, i t i s v e r y  time l i m i t a t i o n ,  charge nurse,  may  i n f o r m a t i o n the  t o remember w h a t t h a t p a t i e n t was  However, because o f the  reported  b e e n on  be  contacted  fact,  when a p a t i e n t has  One  be  in  Again,  sample. tohat  particular  patient during his  regard  c h a r g e n u r s e knows  no  with  Administering  H o w e v e r , t h e r e may  have c o n t a c t w i t h  to each p a t i e n t i n the  instrument  to i n d i v i d u a l p a t i e n t s .  in  the  i s an  i t would appear t h a t a check l i s t ,  the most p r a c t i c a l  and  on  in this  three  was  c e n t r a l members  s a m p l e and  a  information  compilation items  62.  THE  PATIENT INTERVIEW GUIDE The  determining  third  the  research  information  f r o m t h e members o f  the  instrument i n t h i s design that  t r e a t m e n t team.  among p a t i e n t s , a q u e s t i o n n a i r e among t h e  researchers,  individual variation;  b a s e d on  particular  thus,  list  of  items t h a t  practical.  a. s e m i - s t r u c t u r e d  information  This the  items  hypothetical  instrument. i n the  list  list  received  the h o s p i t a l . m u s t be  treatment  skilfully a  the the  list  t o remove- f r o m t h e p a t i e n t ' s  information  an  interview  individualized  list  than the  that  of  list  t r e a t m e n t team.  the p a t i e n t  s a y s he  the  team  revised  received  from  reports  report  items t h a t  This  has  time  items the p a t i e n t  those  a  actual  before  items the  guide  for  than the  actual l i s t of  interview  they  1-Lst  will  the  team. Assuming that  they are  Therefore,  checked a g a i n s t  from sources other  comprise the  f o r t o o much  t r e a t m e n t team gave t o the p a t i e n t , - b e c a u s e  patient  t h e y gave i n o r d e r  differences  This  i s used, r a t h e r  the  to have r e c e i v e d  differences  i n t e r v i e w b a s e d on  l i m i t a t i o n s w o u l d p r o b a b l y p r e v e n t d r a w i n g up leaves  Because of  for  received  individual  i n t e r v i e w would a l l o w  the most a p p r o p r i a t e  a l l the  patient.  i s not  instrument  i s aware o f h a v i n g  Because of  a non-structured  g u i d e w o u l d seem t o be w o u l d be  the p a t i e n t  i s an  the p a t i e n t w i l l  aware o f , p r o v i d e d  that  the  consistent  report  interviewing process  e n o u g h , i t becomes e x t r e m e l y  c o m p e t e n t and  accurately  important that  i n t e r v i e w i n g technique.  the  the  information  i s accomplished researchers  Several  points  develop should  k e p t i n mind: (a) on  the the  (b) their  researchers  must have a t h o r o u g h knowledge of the  i n t e r v i e w g u i d e and  because of p a t i e n t illness,  to avoid  become p r o f i c i e n t  the method of  anxiety  and  s c o r i n g t o be  possible residual  used, effects  communication problems researchers  at using  simple  language, slowly  items  spoken.  of  must  be  63.  (c)  r e s e a r c h e r s may b e h e l p e d  approach t o p a t i e n t s through Other p r a c t i c a l developing  t o develop  a consistency of  role playing sessions.  p r o b l e m s 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 :  a simple, e f f i c i e n t  system f o r being n o t i f i e d  ready f o rdischarge, developing  a sriimple, l o g i c a l ,  and  when a p a t i e n t i s non-threatening  e x p l a n a t i o n f o r the p a t i e n t of the researcher's purpose i n conducting the i n t e r v i e w , and d e v e l o p i n g the r e s e a r c h e r s  f o r the nurses  a short but p o s i t i v e  introduction of  to the patient.  THE L I S T OF V A R I A B L E S The of a l i s t  fourth research  instrument  o f t h e v a r i a b l e s under study  them may b e c o l l e c t e d  i n this design  i s the development  i n such a form t h a t i n f o r m a t i o n about  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  THE PROPOSED HYPOTHESIS, v a r i a b l e s ( a ) t o ( e ) may b e o b t a i n e d patient's source for  file.  I t i s suggested  under  from t h e  t h a t t h e c h a r g e n u r s e may b e t h e b e s t  of information regarding variables (f) to ( i ) .  A possible information  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 .  A N A L Y S I S OF THE DATA In use In  d i s c u s s i n g t h e w o r k o f t h e c o m m i t t e e , r e f e r e n c e was made t o t h e  of a weighting  system f o r a l l i n f o r m a t i o n items  d i s c u s s i n g the proposed design,  information  items  the ideal  (b)  the actual l i s t  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  list  o f i n f o r m a t i o n items o f i n f o r m a t i o n items  been g i v e n by t h e treatment the l i s t  received A numerical  value  technique).  f o r each p a t i e n t :  (a)  (c)  ( i . e . the Q-sort  reported  given  t o have  team  o f i n f o r m a t i o n items  from t h e treatment  t h a t c o u l d b&  t h e p a t i e n t says  he has  team  r e p r e s e n t i n g e a c h o f t h e l i s t s may b e o b t a i n e d  by  adding  64.  the weighted values  of each of the  H y p o t h e s i s one.  The  team i n g i v i n g i n f o r m a t i o n represented  by  the  represented  t h e o r e t i c a l e f f e c t i v e n e s s of the  by  of a c t u a l i n f o r m a t i o n of i d e a l i n f o r m a t i o n The  efficiency  the  ratio:  weighted value  of  weighted value  of a c t u a l  Each of the  method  of  the  r a t i o s versus  information  b y means o f t h e  c h i square.  each of  those o b t a i n i n g lowest frequencies  the v a r i a b l e s under Interesting  examined by  h a v e t o be  h a v e t o be  the  • Since  may  sufficiently  from the data the k i n d  w h i c h was  not  of  be  obtained  An  statistics  i n t o two  o r more  data  ratios.  relating  to  treatment  However, the  w o u l d be  of of  also  sample would  t h a t m i g h t be  to examine the that  done  amount  they received  but  team.  that could  be  done i n v o l v e s  ratio: weighted value weighted value  v a r i a b l e s may  this.  o b v i o u s one  Another secondary study of the  than  f o r the  c h i square method.  l a r g e to permit  the  c h i square  efficiency-of-communication  information which p a t i e n t s reported  g i v e n by  the  to  study.  of the  collected.  related  efficiency-of-communication  There are v a r i o u s p o s s i b l e secondary studies  and  be  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  use  would  given  divided  example, those o b t a i n i n g h i g h e s t  Likewise,  be  communication process  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  For  therefore  given  r e l e v a n t v a r i a b l e s u n d e r s t u d y may  the h y p o t h e s i s  groupings.  treatment  information received  (37, p . 6 6 ) , the p a t i e n t sample w i l l  be  list.  ratio:  H y p o t h e s i s two.  each of  the  to a p a r t i c u l a r p a t i e n t would  weighted value weighted value  t h e r e f o r e be  i t e m s on  information received ideal information  the  development  65.  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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 D e p a r t m e n t i n H o s p i t a l s and R e l a t e d Institutions. Chicago, American 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. Freidson, 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 . Sage F o u n d a t i o n , 1 9 6 1 . G l u e c k , B.C. " R e s e a r c h 1 9 6 3 , pp. 9 3 - 9 7 . G o f f m a n , E. A s y l u m s . Green,  Hannah.  New  York,  Russell  i n Mental H o s p i t a l s " . Mental H o s p i t a l s , V o l .  New. Y o r k , A n c h o r B o o k s ,  I Never Promised  You  1961.  a Rose Garden.Signet  G r e e n b l a t t , M i l t o n , e d . The P a t i e n t and 111., F r e e P r e s s , 1957.  14,  Books,  the'Mental H o s p i t a l .  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 o f New Y o r k , G r u n e and. S t r a t t o n ; ) , I n c . , 1 9 6 3 .  1964.  Glencoe,  Hospitalization.  67.  18.  " I n t e r p e r s o n a l C o m m u n i c a t i o n and H o s p i t a l E f f i c i e n c y " . 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.  Jones, Maxwell. The I n c . , 1953.  20.  K a p l a n , B., Row, Ken.  T h e r a p e u t i c C o m m u n i t y.  e d . The W o r l d  New  of Mental I l l n e s s .  Canadian  York, Basic  New  Books,  York, Harper  and  1964.  21.  Kesey,  . One  Flew. Over the Cuckoo's N e s t .  22.  L e i p o l d , W. August  23.  M i l l e r , James G. "Toward a G e n e r a l T h e o r y 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 D y n a m i c s and E f f e c t i v e B e h a v i o r , e d . James C. C o l e m a n , S c o t t , F o r e s m a n and Co., 1 9 6 0 , p p . 4 3 3 - 4 3 6 .  24.  More f o r the Mind. 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 . P r e s s , 1960.  26.  R e v a n s , E. "The M o r a l e and E f f e c t i v e n e s s o f G e n e r a l H o s p i t a l s " . P r o b l e m s and p r o g r e s s i n M e d i c a l C a r e , e d . 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.  R i e s s m a n , F., 1964.  28.  Rose, A r n o l d , ed. W.W. Norton,  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 E f f e c t i v e B e h a v i o r , ed. James C. C o l e m a n , S c o t t , F o r e s m a n Co., 1 9 6 0 , p p . 5 0 7 - 5 1 3 .  30.  S e l l i t z , C , J a h o d a , M. , D e u t c h , M. , and Cook, S. R e s e a r c h M e t h o d In Social Relations. 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 , 1 9 6 5 .  31.  Schwartz M. S. " S o c i a l Research i n the Mental H o s p i t a l " . Mental H e a l t h and M e n t a l D i s o r d e r , e d . A r n o l d R o s e , W.W. N o r t o n and Co., 1 9 5 5 .  32.  S c h w a r t z , M o r r i s a n d - W i l l , Gwen T u d o r . "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 W a r d " . . P s y c h i a t r y , V o l . 16, 1 9 5 3 , p p . 3 3 7 - 3 5 3 .  33.  S t a n t o n , A.H. and B a s i c Books,  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 Ward". P s y c h i a t r y , V o l . 14, 1 9 5 1 , p p . 2 2 3 - 2 4 2 .  35.  Vail,  and W i l s o n , , M. " A r e we 1963, pp. 448-453.  S i g n e t Books,  Communicating".  Mental  1962.  Hospitals,  Toronto, Canadian Mental H e a l t h A s s o c i a t i o n  Chicago, U n i v e r s i t y of  ed. M e n t a l H e a l t h o f the Poor.  New  Mental H o s p i t a l .  D. "Facets of I n s t i t u t i o n a l L i v i n g " . November 1964, p p . 5 9 9 - 6 0 1 .  Chicago  York, Free P r e s s ,  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 . 1955.  S c h w a r t z , $t>S. . The 1954.  Public-  Mental  New  New  York,  and and  York,  Hospital  Hospitals,  68.  36.  Varnon, E d i t h . " C o m m u n i c a t i o n : C l i e n t , Community and S o c i a l Work, V o l . 9, A p r i l 1 9 6 4 , p p . 5 1 - 5 7 .  37.  Y u k e r , H. A Guide t o S t a t i s t i c a l Sons, 1958.  Analysis.  Agency".  T o r o n t o , G.P.  Putnam's  69.  APPENDIX A  PATIENT INTERVIEW GUIDE  INTRODUCTION: R e s e a r c h e r f r o m 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 responses are 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 t h e 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 t i m e i n h o s p i t a l 2.  Who Who Who • Who Who  i s your i s your i s your i s your i s your  (V)  doctor? charge nurse? s o c i a l worker? occupational therapist? recreational therapist?  ( o n l y need  3/5)  3.  Have y o u h a d a n y ( 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 e a c h I f s o , how many?  4.  What do t h e s e p e o p l e do?  (role  awareness)  IA. #1  5.  How d i d y o u l e a r n  (from  S.W.)  IA  6.  Do t h e s e s t a f f members d i s c u s s  #2  this?  their patients with  (awareness  one?  each o t h e r ?  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.  A n y f r i e n d s o r r e l a t i v e s h o s p i t a l i z e d now o r i n t h e p a s t ? (experience p o s i t i v e or negative) 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 y o u b e f o r e y o u r admission?  9.  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 y o u a b o u t y o u r i l l n e s s on o t h e r s ?  IA  #4  11.  Were y o u w o r r i e d a b o u t 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 y o u 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 y o u d i s c u s s t h e s e w i t h o r who w o u l d y o u h a v e d i s c u s s e d them w i t h ?  11.(a) D i d anyone ask y o u about  the a f f e c t s of  such matters?  IA  #5  12.  Who d i s c u s s e d w i t h y o u how y o u r f a m i l y was m a n a g i n g your absence?  IA  #6  13.  Who  IA.#7  14.  Who d i s c u s s e d w i t h y o u some o f t h e d i f f i c u l i t i e s y o u 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 y o u go home?  discussed your plans a f t e r  during  d i s c h a r g e - w i t h you? (finances) ( l i v i n g arrangements)  70.  15.  How d i d y o u r f i r s t m e e t t h e S.W.?  16.  Have y o u met w i t h  any o t h e r  into the hospital? 16. ( a ) D u r i n g y o u r c o n t a c t  s o c i a l workers before  coming  ( e s s e n t i a l l y neg. or post, with  t h e S.W.  attitude)  what did y o u t a l k about?  17.  Age o f p a t i e n t ?  18.  M a r i t a l status?  19.  Children:  a g e o f e a c h w h e t h e r a t home o r n o t . ( u n d e r 1 8 )  20.  Education,  income and o c c u p a t i o n o f f a m i l y  (divorced, sep.)  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 m u s t show some a w a r e n e s s o f e i t h e r t h e 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 o r f a m i l y r o l e s of the s o c i a l worker.  2.  A w a r e n e s s o f t h e team a p p r o a c h : Any a w a r e n e s s 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 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 .  or that  a working  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 m u s t h a v e some a w a r e n e s s t h a t s h e " f a i l e d t o c o n f o r m 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 . This 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 affected role functioning.  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 allowance, cost of h o s p i t a l i z a t i o n , p u b l i c trustee, family allowance, 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 , etc.  5.  .Family functioning: Any i n f o r m a t i o n p e r t a i n i n g t o t h e w e l f a r e a n d 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 g r o u p w h i c h composes t h e f a m i l y i n w h i c h t h e p a t i e n t 1 ives.  6. . M a t e r i a l - p h y s i c a l This w i l l include 7.  aspects of discharge plans: finances, l i v i n g arrangements, e t c .  Social-emotional planning: This 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 o f n e g a t i v e community a t t i t u d e s , the f a c i n g of i n t e r p e r s o n a l or emotional d i f f i c u l t i e s i n the family, e t c .  APPENDIX B  SOCIAL WORKER QUESTIONNAIRE  Name o f P a t i e n t :  Date:  Ward:  Please Underline,  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 o u t f o r i n f o r m a t i o n :  2.  Number o f p a t i e n t - s o c i a l  3.  Attitudinal  4.  By whom f i r s t  5.  Location of offices:  6.  Number o f s o c i a l w o r k c o n t a c t s w i t h  7.  Specific  work c o n t a c t s w h i l e  influence of relatives  contact  initiated:  i n hospital: Ans .  on p a t i e n t :  (a) e s s e n t i a l l y (b) e s s e n t i a l l y  (a) s o c i a l worker (b) patient  ( a ) on ward (b) o f f ward  reason f o r seeing  relatives: Ans.  patient: Ans.  8.  Who r e f e r r e d  patient  t o s o c i a l worker:  (a) (b) (c) (d)  High Low  doctor patient nurse self  positive negative  APPENDIX C  F I L E INFORMATION GUIDE.  Number o f p r e v i o u s  admissions.  Diagnosis at time of admission. Type of a d m i s s i o n . Birthdate. Marital  status.  Admission  date.  Treatment  unit.  Ward. Probable discharge date.  73.  APPENDIX  D  SOCIAL WORKER INTERVIEW GUIDE  F o r t h e 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 h a v e i n t e r v i e w e d e a c h p a t i e n t w i t h regards to the f o l l o w i n g seven i n f o r m a t i o n areas. To e v a l u a t e t h e p a t i e n t ' s r e c e p t i o n and a w a r e n e s s o f t h e s e i n f o r m a t i o n a r e a s , we n e e d t h e s o c i a l w o r k e r ' s d e c i s i o n as t o w h e t h e r e a c h 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 m u s t show some a w a r e n e s s o f e i t h e r t h e t r e a t m e n t o r w i t h the community or f a m i l y r o l e s of the s o c i a l w o r k e r .  liaison  ( a ) D i d y o u 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 understood your r o l e ? A w a r e n e s s o f t h e team a p p r o a c h : Any a w a r e n e s s 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 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) (b)  or  that  YES  NO  YES  NO  a working  D i d y o u g i v e any e x p l a n a t i o n o f t h e team a p p r o a c h ? 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 t h e c o n c e p t o f t h e team a p p r o a c h ?  YES  NO  YES  NO  Reasons f o r coming to 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 m u s t h a v e some a w a r e n e s s t h a t she " f a i l e d t o c o n f o r m 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 . This 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 a w a r e t h a t t h e i l l n e s s had negatively affected role functioning. (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 of t h e i r coming to 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 C o n c e r n s : T h i s w o u l d i n c l u d e any l e g a l a n d / o r f i n a n c i a l m a t t e r s s u c h as c o m f o r t s allowance, cost of h o s p i t a l i z a t i o n , p u b l i c trustee,, f a m i l y allowance, 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 , etc. ( a ) D i d y o u d i s c u s s any f i n a n c i a l a n d / o r l e g a l c o n c e r n s ? ( b ) I f n o t d i d y o u c h e c k t o s e e w h e t h e r t h e y had s u c h concerns?  YES  NO  YES  NO  74.  Family functioning: Any i n f o r m a t i o n p e r t a i n i n g t o t h e w e l f a r e and i n d i v i d u a l o r f a m i l y g r o u p w h i c h composes t h e patient lives.  f u n c t i o n i n g o f an f a m i l y i n which the  ( a ) D i d y o u 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 their family's functioning? (b) I f n o t d i d you check t o see w h e t h e r t h e y r e q u i r e such i n f o r m a t i o n ? M a t e r i a l - p h y s i c a l aspects of discharge plans: This 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 arrangements,  YES  NO  YES  NO  YES  NO  YES  NO  etc.  (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 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 y o u c h e c k t o s e e w h e t h e r t h e s e a r r a n g e m e n t s w e r e made?  of  Social-emotional planning: 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 of 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 , the 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 the f a m i l y , e t c . ( a ) D i d y o u g i v e any i n f o r m a t i o n a r o u n d s o c i a l , emotional YES J 1 areas of planning? ( b ) D i d y o u c h e c k t o s e e i f t h e y had i n f o r m a t i o n a b o u t t h i s area? YES | 1  N  0  1  N  0  1  APPENDIX E RIVERVIEW HOSPITAL - ORGANIZATION CHART  SUPERINTENDENT  ASSISTANT SUPERINTENDENT  BUSINESS ADMINISTRATOR BUSINESS OFFICE  DIRECTOR OF NURSING DEPARTMENT OF NURSING ORGANIZATION  COMMISSIONAIRES  CLINICAL DIRECTOR CHAPLAINS  r  CONSULTING STAFF  MEDICAL STAFF ORGANIZATION  DENTISTRY (SEE ATTACHED CHART)  DIETARY  LABORATORIES  HAIRDRESSING 6. BARBERING  LIBRARY  HOUSEKEEPING  MEDICAL RECORDS  INDUSTRIAL THERAPY & AUDIO-VISUAL  NEUROLOGY  INFORMATION DESKS  OCCUPATIONAL THERAPY  LAUNDRY  PATIENT'S SCHOOL  PAY & PERSONNEL  PHARMACY  PODIATRY  PHYSIOTHERAPY  POSTMASTER  PHYSHOLOGY  TRANSPORTATION  RADIOLOGY  PUBLIC WORKS LIAISON  RECREATIONAL THERAPY  R.C.M.P. LIAISON  REHABILITATION  PURCHASING LIAISON  SOCIAL SERVICE  STORES LIAISON  VOLUNTEERS  SURGICAL RESIDENT  (SEE ATTACHED CHART)  Note: This Organization Chart has not yet been approved by the Deputy M i n i s t e r ' s o f f i c e , and w i l l probably be subject to extensive changes i n the near f u t u r e .  December 12, 1966  76.  TABLE NO. I  COMPILATION OF DATA COLLECTED  Patient  #2  #1  Info received I n f o sent  score  6  5  4  7  6  7  1 /  1 /  1 /  / 1 1 /  1 /  / 0 1 /  0 /  / 0 / 1 / 0  1  score  I n f o A r e a #1 r e c e i v e d / / sent #2  . #3  #4  1 / /  #5  #6  4  #7  #8  3  2  1  1  7  6  6  5  6  0 1 /  / 1 1 /  / 0 1 /  / 1  0 /  / 0 1 /  / 0 1 /  / 0 1 /  / 0 1 /  1  /  / 1 1 /  / 0 1 /  / 0 1 /  / 0 1 /  X  1  1  /  1 /  / 1  / 1 1 /  / 1 1 /  / 1 1 /  / 1 1 /  1  / 1 1 /  / 1 1 /  / 1 1 /  / 1 1 /  1  / 1 1 /  / 1 1 /  / 1 / 0 1 / 1 /  /  #6  #5  / 1 1 /  / #7  #4  0 /  /  Age o f P a t i e n t  . #3  0 /  /  / 0 / 0 / 1  0 /  1 /  o  / 1  / 1  0 / / 1  0 0 /  / 0 1 /  / 0 1 /  / 1  / 0 / 1 / 1  / 1 1 /  / 0 1 /  0  1 /  /  0 /  / 0 X 0 1 / 1 /  / 0  / 0 1 /  / 1  / 0 /  / 1  1  -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  Marital  M  M  M  W  M  M  W  M  Status  ^  No. o f C h i l d r e n / /at  3  /  /  home  0  6  /  / 6  1 /  / 1  / 3 /  4  /  4  / 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  2  2  4  3  2  1  2  0+gr  4+gr  2+gr  4+gr  3+gr  2  3  2  2+gr  No. o f S.W.  contacts  -Pt.  No. o f S.W.  contacts -  S.W.  Previous Admissions  -Pt.  6  0  0  0  1  5  0  2  Previous Admissions  - File  5  0  0  0  1  5  0  2  Referred  t o S.W.  by  Dr.  S.W.  Nurse  Who I n i t i a t e d  contact  -Pt.  Dr.  Pt.  S.W.  Who I n i t i a t e d  contact  -  Pt.  S.W.  S.W.  S.W.  Pt.  Dr.  Dr.  Dr.  S.W.  -  S.W.  Pt.  Pt.  Group  S.W.  Pt.  Pt.  S.W.  .Pt.  TABLE NO.  I  Patient  #1  #2  #3  #4  . #5  • #6  #7  #8  Diagnosis  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  Dr.  Dr.  Patient's a b i l i t y to reach out f o r information  H  H  H  H  L o c a t i o n o f S.W.  on  on  on  on  +  +  +  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 before admiss i o n  Previous  S.W.  Office  Contacts  Influence of r e l a t i v e s hospitalization  None  Dr  v  3w/ /Dr.  None  None  L  L  H  L  on  on  on  off  +  None  None  +  Dr.  None  1  Influence of relatives on P t s . h o s p i t a l i z a t i o n No. o f S.W. contacts with relatives  + +  +  1  0  None  None  .+  .+  1  0  None  1  None  None  +  None  3  (1)  M - married W - widowed  (3)  V I  voluntary involuntary  (2)  P - psychotic N - nonpsychotic  (4)  H - high a b i l i t y L - low a b i l i t y  0  +  .1  

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