An Exploratory Study of Information Obtained by Observation in the Home of Selected Psychiatric Patients
Creators: name: Harmon, Alice Rae
Publisher: name: University of Utah
Year: 2012

description: The recent trend in psychiatric care has been directed toward treatment of the mentally ill patient in the local community hospital with early discharge and psychotherapy, drug therapy, or electroshock therapy on an outpatient basis.  Increasing emphasis is therefore being placed on the family and environment in relation to precipitating factors and prognosis of the illness.  Some studies are now being done in which family diagnosis and treatment are given concurrently with individual patient care.  This shift in emphasis suggests a need for the psychiatric nurse, who has as one of her concerns the promotion of a therapeutic environment for the patient, to study the patient and family and to begin defining the role of nursing as it relates to care of the psychiatric patient in the home setting.  The present study was designed to discover the kinds of information which may be obtained by observing psychiatric patients in the home setting and which may be significant to psychiatric and mental health nurses and to the psychiatrist in gaining insight into the patient's illness and in planning therapeutic patient care.  A review of the literature in the field of psychiatric nursing, public health nursing and related area indicated a paucity of information about or studies relating to the mentally ill patient in the home.  Some studies have been directed toward diagnosis of the entire family, sometimes with the use of a home visit or a concurrent treatment of other family members in the clinic setting.  No studies were found which were concerned with the specific kinds of information which can be obtained by use of observational home visits, or with patient care in the home setting.  The method selected for this exploratory study was the use of an analysis of insight-stimulating cases.  The patient sample was selected by the psychiatric staff at the Utah Mental Hygiene Clinic.  Twelve observations were made on each of three female patients who were diagnosed as mentally ill, living at home, and being followed in outpatient therapy.  The data was recorded in detail and two hundred and twelve incidents were selected from the mass of raw data for analysis.  These incidents were placed on five-by-eight cards and sent to seven psychiatric and mental health nursing experts for sorting into groups by significance and similarity.  Rating and classifying was complete on five set of incidents and the resulting groupings were used as a basis for evaluating significance of the incidents and for selecting categories which might identify the information collected during the investigation. The incidents considered being "significant" and in "agreement" as to the kind of information they provided were sent, with the categories selected as a result of the original groupings, to three additional psychiatric nursing experts for classifying.  "Agreement" as to the kind of information any incident provide was based on similar categorization by two of these three raters.  All of the incidents, along with the categories, were also given to the psychiatrists of the patient sample for rating as to significance and newness of the information to the psychiatrist and for categorization.  By studying the results of these ratings, it was hoped that the questions formulated for study could be answered.  These questions were:  1. What are the types of information obtained by observation of the psychiatric patient in the home?  2. What kinds of information obtained by such observation are significant to the psychiatric nurse?  3.  Is information obtained by such observation considered to be new and significant to the psychiatrist?   No statistical analysis was done because of the nature of the study and the smallness of the patient sample and rater groups.  Certain generalization were made on the basis of the findings which indicated that the greatest amount and most significant kinds of information which were obtained by the observation in this study were in the are of the patient's relationship with significant other in her immediate environment, and in relation to her self-concept, and her needs, problems and conflicts and the way in which she was attempting to work through or resolve these.