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by Lau Ming Ho Victor. / Thesis submitted in: Dec. 1998. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves [111-120]). / Abstract also in Chinese. / Chapter Chapter 1: --- Introduction --- p.1 / Chapter Chapter 2: --- Review of Literature --- p.3 / Chapter 2.1 --- The Learning Disability Hospital as an institution --- p.3 / Chapter 2.2 --- Social Policy --- p.4 / Chapter 2.3 --- Findings of The Interpretative Studies --- p.10 / Chapter 2.3.1 --- Institutional context for staff practice --- p.10 / Chapter 2.3.2 --- Critique of Goffman work --- p.12 / Chapter 2.3.3 --- Theoretical studies in learning disability hospitals: residents as objects --- p.13 / Chapter 2.3.4 --- Institutionally-oriented practice --- p.15 / Chapter 2.3.5 --- Instrumental control --- p.15 / Chapter 2.3.6 --- A ffective control --- p.16 / Chapter 2.4 --- Observational Studies in Hospital Wards for People with Learning Disability --- p.19 / Chapter 2.5 --- Institutional Influences --- p.21 / Chapter 2.6 --- Role Redefinition of Ward Nurses --- p.22 / Chapter 2.7 --- Staff-Resident Dynamic --- p.23 / Chapter 2.8 --- Summary of Literature Review --- p.24 / Chapter 2.9 --- Aims and Objectives of Study --- p.25 / Chapter Chapter 3: --- Methods --- p.26 / Chapter 3.1 --- Operational Definition of Interaction --- p.26 / Chapter 3.2 --- Research Design --- p.26 / Chapter 3.3 --- Setting --- p.28 / Chapter 3.4 --- Data Collection Method: Systematic Observation --- p.30 / Chapter 3.4.1 --- Staff-Resident Interaction Chronograph (SRIC) --- p.30 / Chapter 3.4.2 --- Conducting the observations --- p.34 / Chapter 3.5 --- Data Collection Method: Qualitative Interview --- p.35 / Chapter 3.5.1 --- Conducting the qualitative interviews --- p.35 / Chapter 3.6 --- Sampling for Observation --- p.35 / Chapter 3.7 --- Sampling for Qualitative Interview --- p.36 / Chapter 3.8 --- Ethical issues --- p.39 / Chapter 3.9 --- Pilot Work --- p.40 / Chapter 3.10 --- Major Changes in The Main Study --- p.41 / Chapter Chapter 4: --- Reliability and Validity Issues --- p.44 / Chapter 4.1 --- Validity and Reliability of Systematic Observation --- p.44 / Chapter 4.1.1 --- Observer training --- p.44 / Chapter 4.1.2 --- Enhancement of inter-observer reliability --- p.45 / Chapter 4.1.3 --- Evidence of inter-observer reliability --- p.45 / Chapter 4.1.4 --- Validity of observational data --- p.46 / Chapter 4.2 --- Reliability and Validity of Interview Data --- p.47 / Chapter 4.2.1 --- Strategies to secure validity and reliability of interview data --- p.48 / Chapter Chapter 5: --- Data Analysis --- p.50 / Chapter 5.1 --- Analysis of Observational Data --- p.50 / Chapter 5.1.1 --- Treatment of written description of nursing behaviours --- p.50 / Chapter 5.1.2 --- Interaction and non-interaction cells --- p.51 / Chapter 5.1.3 --- Calculation of interaction rate --- p.51 / Chapter 5.2 --- Qualitative Data Analysis --- p.52 / Chapter 5.2.1 --- Immersion in the data --- p.52 / Chapter 5.2.2 --- Category building --- p.52 / Chapter Chapter 6: --- Results of Observation Data --- p.54 / Chapter 6.1 --- Overall Findings --- p.54 / Chapter 6.1.1 --- Nursing behaviours towards 'Appropriate 226}0ة resident behavior --- p.56 / Chapter 6.1.2 --- Nursing behaviours Towards 226}0بInappropriate Failure' resident behaviour --- p.57 / Chapter 6.1.3 --- Nursing behaviours Towards 226}0بInappropriate Crazy 226}0ب resident behaviour --- p.58 / Chapter 6.1.4 --- "Nursing behaviours towards 226}0بRequest, resident behaviour" --- p.59 / Chapter 6.1.5 --- Nursing behaviours towards 226}0بNeutral 226}0ة resident behaviour --- p.60 / Chapter 6.1.6 --- Resident behavioural profile in the ward and the Training Center --- p.61 / Chapter 6.2 --- Nurse-Resident Interactions in Ward --- p.62 / Chapter 6.2.1 --- Communication with residents --- p.62 / Chapter 6.2.2 --- Doing nursing care --- p.64 / Chapter 6.3 --- Not Interacting With Residents --- p.65 / Chapter 6.3.1 --- Ward activities --- p.66 / Chapter 6.3.2 --- Self-engaged activities --- p.67 / Chapter 6.3.3 --- Nursing activities --- p.68 / Chapter 6.4 --- Summary of Observational Results --- p.70 / Chapter Chapter 7: --- Results of Interview Data --- p.71 / Chapter 7.1 --- Orientation to A New Clinical Setting --- p.72 / Chapter 7.1.1 --- Meeting with residents 226}0ب disabilities --- p.72 / Chapter 7.1.2 --- Perceptions of residents lives --- p.73 / Chapter 7.1.3 --- Sense of a difference --- p.74 / Chapter 7.2 --- Stressors in Care Setting --- p.75 / Chapter 7.2.1 --- Powerless in caring --- p.75 / Chapter 7.2.2 --- Sense of frustration --- p.77 / Chapter 7.2.3 --- Relative-related stress --- p.78 / Chapter 7.3 --- Experiencing Contextual Constraints --- p.79 / Chapter 7.3.1 --- System constraints --- p.80 / Chapter 7.3.2 --- Managerial constraint --- p.81 / Chapter 7.3.3 --- Time constraint --- p.82 / Chapter 7.4 --- Personal Resolution --- p.83 / Chapter 7.4.1 --- Work attitude --- p.83 / Chapter 7.4.2 --- Self-determination --- p.84 / Chapter 7.5 --- Priority of Care --- p.85 / Chapter 7.5.1 --- Interpretation of care --- p.86 / Chapter 7.5.2 --- Dissimilar approach --- p.87 / Chapter 7.5.3 --- Preference to residents --- p.88 / Chapter Chapter 8: --- Discussion --- p.89 / Chapter 8.1 --- Comparison of present results and previous findings --- p.89 / Chapter 8.2 --- Convergence --- p.91 / Chapter 8.2.1 --- Extrinsic Factors --- p.92 / Chapter 8.2.1.1 --- Contextual constraints --- p.92 / Chapter 8.2.1.2 --- Care Problems --- p.94 / Chapter 8.2.1.2.1 --- Feeding Problems --- p.94 / Chapter 8.2.1.2.2 --- Communication Problem --- p.95 / Chapter 8.2.2 --- Intrinsic Factors --- p.96 / Chapter 8.2.2.1 --- Frustration and powerlessness --- p.97 / Chapter 8.2.2.2 --- Stress coping --- p.99 / Chapter 8.2.2.3 --- Individual work style --- p.101 / Chapter 8.2.3 --- A summary of intrinsic and extrinsic factors --- p.102 / Chapter Chapter 9: --- Recommendations and Conclusion --- p.105 / Chapter 9.1 --- Training Issues --- p.105 / Chapter 9.2 --- Implications for Organisational Change --- p.106 / Chapter 9.3 --- Conclusion --- p.107 / Chapter 9.4 --- Need For Further Research --- p.108 / Chapter 9.5 --- Limitation of the Study --- p.109 / References / Appendices / Appendix A. Geographic map of ward setting / Appendix B. A section of modified behaviour checklist / Appendix C. Interview guides / Appendix D. Observation time-table / Appendix E. Ethical approval / Appendix F. Consent form / Appendix G. Nursing behaviour codes / Appendix H. A section of interview transcript / Appendix I. Sample of interview notes / Appendix J. Sample of matrix method

Background: The amount of elderly patients who’s suffering from dementhia increases every year. Many of these patients develop and decrease in their cognitive ability. The development can lead to people's communication skills deteriorate. It can be a problem for the nurse to communicate with these patients. It´s there fore of great importance for the nurse to learn communiations skills that can increase the communication with elderly patiants suffering from dementia. Aim: The aim of this study is to illuminate the significance of communication in nursing care of elderly patients with dementia. Which communication strategies can the nurse use and what are the consequences for nursing care? Method: To study the selected study area a litterature review was selected. This review was based on five qualitative articles, five quantitative articles and one qualitative-quantitative article. The authors looked for differences and similarites in results of the articles. Results: The results showed that the communication was of great significance in the nursing care between nursing staff and older patients with dementia. It showed that specific communication strategies increaseed many of the patients security, participation and facilitated cooperation between nursing staff and the patients with dementia. Three main themes emerged from the articles: the spoken language, music and pictures. Conclusion: By using specific communication strategies nurses could help patients to express themselves and participate in nursing care and conversations.

Nursing is uniquely demanding work and occupational stress in the nursing profession has been well-documented. Many theories of stress-related disruptions among helping professionals have been proposed. Although these theories differ slightly in their origin of stress, they share similarities in nurses’ response to the patient relationship. Depersonalization, withdrawal, and avoidance all serve to create relational distance between the nurse and the patient. Despite the prevalence of these responses, there are not any theories on the nurses’ process of disengagement from patient relationships. Using Strauss and Corbin’s (1990) grounded theory method, this study explored acute care nurses’ experience of disengagement in patient relationships. The purpose of the study was to develop a mid-range theory of nurses’ process of disengagement from patient relationships as it occurred in acute care. Through purposive and theoretical sampling, 12 acute care nurses participated in open-ended individual interviews. The process of open, axial and selective coding discovered seven categories related to nurses’ experience of disengagement from patient relationships. These categories were emotional experience, behavioural expression, environmental influences, relational distance, professional identity and work spillover. Although these categories were exclusive, conceptual elements were interwoven into more than one category. The categories were interrelated around the core category, ‘Doing and Being’, and the process of nurses’ disengagement from patient relationships was delineated. Participants in the study experienced dissonance when they were unable to act in accordance to their caring beliefs. Conditions in the work environment, such as the lack of time, the culture of productivity and patient characteristics influenced and promoted their process of disengagement. Disengagement was manifested in the nurse-patient relationship by decreased eye contact, increased physical distance and increased task focused behaviour. These behaviours increased relational distance between the nurse and the patient. Nurses’ experience of dissonance had the potential to foster feelings of professional dissatisfaction and alienation from self, leading to increased turnover behaviour and depression. Implications and recommendations for practice and future research are discussed.

Nursing is uniquely demanding work and occupational stress in the nursing profession has been well-documented. Many theories of stress-related disruptions among helping professionals have been proposed. Although these theories differ slightly in their origin of stress, they share similarities in nurses’ response to the patient relationship. Depersonalization, withdrawal, and avoidance all serve to create relational distance between the nurse and the patient. Despite the prevalence of these responses, there are not any theories on the nurses’ process of disengagement from patient relationships. Using Strauss and Corbin’s (1990) grounded theory method, this study explored acute care nurses’ experience of disengagement in patient relationships. The purpose of the study was to develop a mid-range theory of nurses’ process of disengagement from patient relationships as it occurred in acute care. Through purposive and theoretical sampling, 12 acute care nurses participated in open-ended individual interviews. The process of open, axial and selective coding discovered seven categories related to nurses’ experience of disengagement from patient relationships. These categories were emotional experience, behavioural expression, environmental influences, relational distance, professional identity and work spillover. Although these categories were exclusive, conceptual elements were interwoven into more than one category. The categories were interrelated around the core category, ‘Doing and Being’, and the process of nurses’ disengagement from patient relationships was delineated. Participants in the study experienced dissonance when they were unable to act in accordance to their caring beliefs. Conditions in the work environment, such as the lack of time, the culture of productivity and patient characteristics influenced and promoted their process of disengagement. Disengagement was manifested in the nurse-patient relationship by decreased eye contact, increased physical distance and increased task focused behaviour. These behaviours increased relational distance between the nurse and the patient. Nurses’ experience of dissonance had the potential to foster feelings of professional dissatisfaction and alienation from self, leading to increased turnover behaviour and depression. Implications and recommendations for practice and future research are discussed.

The purpose of this study was to develop a substantive theory or at least a set of theoretical propositions explaining the process of nurse-patient interaction in the presence of technology. This study was undertaken in Perth, Western Australia. The grounded theory method was chosen to undertake this research.The study's informants consisted of nurses. Theoretical sampling led to the inclusion of patients and patients' relatives. Purposive and theoretical sampling were used to choose the informants. Data were obtained using field observations and formal and informal interviews with nurses and post-discharge patients. Data analysis was conducted using the constant comparative method (Glaser and Strauss, 1967), writing memos and drawing a schema. The Ethnograph software package (Seidel, 1988) was used to organize and manage the data.The findings of the study indicated that nurses were stymied in their person-centered interactions with patients in the presence of technology. Nurses used the process of navigating the course of interaction to deal with this problem. The process of navigating the course of interaction consisted of three phases. These were the phases of embarking, steering and veering and disembarking. The action/interaction of the process occurred during the steering and veering phase and four specific strategies of interaction became evident in this research. These strategies of interaction were steadying, demurring, coasting and maximizing. The strategies of interaction used by nurses did not center on one type. There was rather a movement between strategies during and between interactions with patients in the presence of technology. This movement was termed oscillating connections. Conditions that modified the core process of navigating the course of interaction were also identified. The findings of the study provide an understanding of the problem ++ / encountered by nurses in their interaction with patients in the presence of technology and the process used by the nurses to deal with this problem.

Thesis (M.S.)--University of Wisconsin--1981. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 75-78).

Thesis (M.S.)--University of Wisconsin, School of Nursing. / eContent provider-neutral record in process. Description based on print version record.

Thesis (M.S.)--University of Wisconsin, School of Nursing, 1966. / Typewritten. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (M.S.)--University of Wisconsin-Madison. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves : 35-39).