The Psychiatric Nurse as a Behavioral Engineer1

The behavior which leads to a person's admission to a mental hospital often involves danger to himself or others, withdrawal from normal social functions, or a dramatic change from his usual mode of behaving.The professional staff of the psychiatric hospital directs its major efforts toward the discovery of the flaw in the patient's mental apparatus which presumably underlies his disturbing and dangerous behavior.Following the medical para- digm, it is presumed that once the basic disfunction has been properly identified the ap- propriate treatment will be undertaken and the various manifestations of the disfunction will disappear.While diagnosis is being made and during subsequent treatment, the patient is under the daily care of the psychiatric nurses3 in the ward.There, he often exhibits annoying and disrupting behavior which is usually regarded as a further manifestation of his basic difficulty.This behavior is sometimes identical with that which led to his admission; but at other times it seems to originate and develop within the hospital setting.Although it is still regarded as a reflection of his basic problem, this disruptive behavior may become so persistent that it engages the full energies of the nurses, and postpones, sometimes per- manently, any effort on their part to deal with the so-called basic problem.Disrupting behaviors usually consist in the patient's failure to engage in activities which are considered normal and necessary; or his persistent engagement in activities that are harmful to himself or other patients, or disrupting in other ways.For example, failures to eat, dress, bathe, interact socially with other patients, and walk without being led are invariably disruptive.Hoarding various objects, hitting, pinching, spitting on other patients, constant attention-seeking actions with respect to the nurses, upsetting chairs in the day- room, scraping paint from the walls, breaking windows, stuffing paper in the mouth and ears, walking on haunches or while in a squatting position are disruptive when they occur frequently and persistently.At present, no systematic approach to such problems is available to the nurses.A psycho- dynamic interpretation is often given by psychiatrists and psychologists; and, for that matter, the nurses sometimes construct "depth" interpretations themselves.These interpre- tations seldom suggest any specific remedial actions to the nurses, who then have no other recourse than to act on the basis of common sense, or to take advantage of the physical therapy in vogue.From the point of view of modern behavior theory, such strong behaviors, or behavioral deficits, may be considered the result of events occurring in the patient's immediate or historical environment rather than the manifestations of his mental disorder.The present research represents an attempt to discover and manipulate some of these en- vironmental variables for the purpose of modifying the problem behavior.'This paper contains a portion of the data from a doctoral dissertation submitted to the Department of Psy- chology, University of Houston, in partial fulfillment of the requirements for the Ph.D. degree, in August, 1959.