Teaching coping behaviour to psychiatric patients : a thesis presented in partial fulfilment of the requirements for the Degree of Master of Arts in Nursing at Massey University

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Massey University
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A structured programme has been developed to teach aspects of the concept of "coping" to psychiatric patients. The teaching programme is based on the concepts of coping and adjustment developed by Lehner and Kube (1964); Coleman (1969); Lazarus (1969); Sawrey and Telford (1974); and Coelho, Hamburg and Adams (1974). In order to test the hypothesis that patients perceptions of nurses will affect their learning, the Massey - Patient -Nurse Projective Test (MPN) has been developed as a diagnostic tool. This is used to select patients for the two groups used in the teaching programme which is carried out by a registered general nurse who does not have a psychiatric qualification. The patients' coping behaviour is measured before and after the teaching programme by a coping behaviour test devised by the researcher for this study. The development of both groups has been analysed in the light of Whitaker and Lieberman's theory of group development. A content analysis has been used to define categories of patient and nurse behaviour during the teaching programme. In addition the behaviour of each patient has been studied using an idiographic case study approach. The teaching programme was first tested with eight psychiatric patients at a large psychiatric hospital. The same programme was then given to ten middle-aged psychiatric patients (two men and eight women) at the same hospital. The patients were selected into two groups on the basis of their results on the MPN test. Grouped results show that patients who initially saw the nurse as "helpful" (Group A) did not change their coping behaviour. This group viewed nurses as "less helpful" at the end of the programme. Also, the group shifted its dependency from the nurse to the group members and ended in an early formative phase. On the other hand, the group of patients who viewed nurses as "not helpful" (Group B) did show changes in their coping behaviour at the end of the programme. The group shifted their conflict with the nurse onto one of the group members and ended in a middle formative phase. The content analysis shows that patients in Group B had a higher degree of resistance to learning than patients in Group A and fewer attempts to gain insight. The nurse also showed more stimulation of Group A than Group B to gain insight. The case studies of the patients show a positive change in one Group A patient who developed self-confidence during the sessions, and improvements in two Group B patients who gained confidence in interacting with others, and in planning for future actions.
Behavior therapy, Psychiatric nursing