THE ADJUSTMENT OF AGED PERSONS IN NURSING HOMES. II. THE NURSES‘ REPORT*

: A study was made of the nurses' perception of nursing-care factors related to the successful adjustment of patients to nursing homes. Three groups of 20 nurses each—one group consisting of registered nurses, another of licensed practical nurses, and the third of nurse's aides—were compared with each other for differences in response to questions concerning 5 categories of patients' behavior: adjustment to transfer, interactions, observance of rules, nurse-patient relationships, and the patient's personality. Each of the 60 nurses was given an open-ended interview involving 26 questions about the foregoing 5 categories of behavior. Each nurse was also asked to characterize the patients from mental hospitals, the patients from general hospitals, and the patients from the community by checking the adjectives appropriately descriptive for each group. Interview responses were scored and classified for fourfold chi-square analysis. For registered nurses versus licensed practical nurses, no significant differences were found. However, there were significant differences between these two groups of trained nurses and the nurse's aides, reflecting in part the training and experience of the skilled nurses and their corresponding levels of authority and responsibility. Trained nurses were somewhat more distant from patients, largely because of record-keeping and administrative work which kept them from talking to the patients as often as they wanted to. The trained nurses dealt with the patients' personal problems and illnesses directly, whereas the aides left these functions to the trained nurses. Nurses characteristically regarded patients as holding negative attitudes toward nursing homes at the time of admission. Adjustment to the home was felt to be easier for lonely and dependent patients, because of their increased need for care and companionship. According to the nurses, the adjustment of former mental-hospital patients was facilitated by their prior exposure to institutional care. According to the information obtained by using the adjective list for the patients' behaviors, the nurses perceived the mental-hospital patients as being more disturbed than the other two groups, as manifested by these symptoms: confusion, disorientation, destructiveness, assaultiveness, and withdrawal. The general-hospital patients were regarded as less able to perform self-care functions. The patients admitted directly from the community were perceived as lonely, depressed, and overly dependent. An earlier study of the patients' responses indicated that successfully adjusted mental-hospital patients were at least as well, if not better, adjusted than their counterparts admitted directly from their homes or from general hospitals. The nurses' description of mental-hospital patients implies that the nurses' perceptions of such patients are distorted by over-generalizations based on the behavior of poorly adjusted patients. These distortions may result in restrictive, fearful attitudes toward the mentally ill and may lead, at critical times, to dispositional decisions unfavorable to the patients and disastrous to programs of aftercare in which nursing homes are considered a major resource.