The development and evaluation of an introductory course in behaviour therapy for psychiatric nurses

The long-stay psychiatric patient represents one of the major problems to the N.H.S. and to hospital staff. On the one hand there are the multiple 'problems' as presented by the patient, such as loss of basic self-help skills and the development of inappropriate behaviour; on the other hand there is the 'institutionalizing' hospital system, which often seems designed to nullify staff initiatives intended to 'rehabilitate' these patients. This parallel, between the predicament of staff and patients, is associated with the general absence of any systematic programmes that promote the 'rehabilitation' of either group. There is, therefore, a profound and depressing atmosphere in these 'back-wards'. This seems to have removed any interest in a thorough examination of the issues, far less have promoted a systematic attempt to alter matters. One is reminded of 'depression' and 'learned helplessness' by the prevalent apathy and inertia. The research reported in this thesis represents an attempt to deal with both points. Firstly, however, there is an analysis of the Psychiatric Hospital, in terms of the difficulties presented in researching and intervening in that context. This illustrates, from such perspectives as patients' problems and nurses' roles, the complex nature of this system. It leads to the adoption of an 'ecological' orientation, which is then reflected throughout the research. For example, this perspective dictates that attention is focussed on the environment and particularly its social features. As the nurses are the main social agents in longstay rehabilitation wards, they occupy a key position amidst the interdependencies of this complex social system. This position is elaborated below in terms of the findings and predictions deriving from a behavioural analysis. In turn, this suggests the importance of making nurses and not patients the initial focus of an intervention. Following a review of literature concerned with previous attempts to apply this 'triadic' model, and more generally to innovate, there is a detailed analysis, of the nurse training research. This clearly shows that very few studies have even approximated to the degree of rigour associated with other topics in thelbehavioural literature, and that there remains a great need to thoroughly evaluate the effects of applying this model within a British Psychiatric Hospital. In addition, issues such as the maintenance and generalisation of training effects need to be evaluated. [...continues]