Social withdrawal among elderly patients in a long-stay psychiatric ward : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing Studies at Massey University

Abstract

Following a review of theories of aging it is argued that social interaction, as it occurs between nurse and patient, may be modified to decrease the withdrawn and apathetic behaviour commonly observed among the elderly patients of long-stay institutions. This presupposes that quality of patient care is closely related to the nature and extent of nurse-patient interaction. The study is designed to demonstrate the presence of social withdrawal in long-stay wards for elderly patients and the effect of an activation group, or programmed recreation, on the degree of withdrawal. It is predicted that following exposure to increased opportunity for social interaction in an activation group there will be measurable changes in behaviour for those directly involved. Measuring instruments have been adapted from an observation schedule described by Moores and Grant (1976), a verbal code developed by Paton and Stirling (1974) and a study by Quilitch (1974). In the study non-participant observation has been used to record the dayroom behaviour and activity of male patients in two long-stay psychiatric wards during three periods of observation. An activation group for 12 selected patients supplemented the ongoing routine of the experimental ward between the first two periods of observation for social withdrawal. Behaviour ratings for group members were obtained using scales presented by Robinson (1974) and Gibson (1967). It is shown that in two psychiatric wards for long-stay patients (mean ages 65.5 and 71.48 years respectively) the degree of social withdrawal of the patients in a dayroom setting varies over time, and variations in social withdrawal are linked with variations in nurse-patient interaction. The hypothesis that increased opportunity for interaction for a section of the patient population of a ward results in an overall increase of interaction in that ward, is partially supported. Participation in a planned group programme is associated with measurable changes in a variety of behaviours identified on selected rating scales, but the results are not statistically significant. Various factors relating to the implementation and conduct of an activation group by nurses in a long-stay ward are identified and discussed. A model of nursing care for the elderly is presented which incorporates interaction as a crucial component within a systems model.