Thursday, July 22, 2004
This presentation is part of : Chronic Mental Illness
The Value of Community to Stress Prevention in Chronically Ill Psychiatric Clients
Karen Ward, PhD, RN, School of Nursing, Middle Tennessee State University, Murfreesboro, TN, USA and Linda McBride, MSN, RN, C, Department of Mental health, State of Tennessee, Nashville, TN, USA.
Learning Objective #1: Identify the meaning of community for chronically ill psychiatric clients
Learning Objective #2: Analyze possible benefits of community interventions in this population

Objective:. Researchers are discovering connections between a sense of community and stress reduction. A community of psychiatric clients was relocated to a new hospital setting. Previous research found that planned interventions did not prevent behavioral deterioration connected to the move. This study investigated whether certain components of behavior were more affected than others. Design: This was a non-experimental, longitudinal, panel design. Population, Sample, Setting, Years: A sample of 32 chronically ill clients from a relocating state hospital. Fifty-six percent were males; 44% were female. Ages ranged from 19-81; average age was 46. Most clients’ diagnosis was psychosis, the remaining were organicity and mood disorder. Their time in the facility ranged from 4 months to over 22 years; average was 4.7 years. Approximately half were Caucasian and half African-American. Variables in the study: 1. Clients’ stress, measured by the Nurses’ Observation Scale for Inpatient Evaluation (NOSIE); 2. gender; 3. diagnosis, 4. Scores on NOSIE sub-scales Methods: Client behaviors were measured by the NOSIE for 16 weeks. Analysis was conducted on the six subscales (Social competence, Social Interest, Personal Neatness and Irritability, Manifest Psychosis, Retardation) Findings: NOSIE scores ranged from 24 to 178. Mean scores pre and post move were 116.67 and 104.96, respectively (p=.001). Positive sub-scale scores were influenced more than the negative ones by the move. Conclusions: Relocation had a detrimental effect on the population based on the NOSIE scores, despite community building activities and the community remaining together. Possibly there would have been greater decrease without such support. Interestingly, certain patients scored higher after the move. Implications: Communities traditionally support people through tough situations. In this study, even planned interventions were not enough to counteract the effects of stress. Possibly applying the concept of resiliency and its connection to individual “success stories” is useful in this group of clients.

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