Levinson D F, Crabtree L H
Psychiatry. 1979 Aug;42(3):220-40. doi: 10.1080/00332747.1979.11024026.
Mental health workers on inpatient units spend a great deal of time trying to cope with interpersonal tensions that disrupt ward life. We have focused our attention on two aspects of this problem. The first is clarifying the nature of the social processes that underlie periods of increased tension and conflict on wards. The second is clarifying the kinds of staff leadership required to manage these tensions. We are sure that those who have worked on interactive treatment wards will recognize this situation: for a period of weeks or more there is an uneasy tension; patient cliques form and disruption occurs between cliques and with the staff. Often there is a climax of disruptive behavior, such as a day or weekend when a large number of patients break ward rules. Trouble seems to be contagious. Throughout the period staff members disagree about how to manage the patients and the disruption, and usually this disagreement is tinged with old philosophical or personal differences. No one feels very confident about taking leadership initiatives, and the formal leaders are blamed for various failures and lacks. Eventually, often after a climactic disturbance is resolved, ward life returns to "normal" and people feel much better about living and working on the ward. In this paper we review previous work on this kind of ward process and discuss some of the problems involved in conceptualizing it. We report on two period of ward observation that illustrate the sequence from low to high tension and back to relative calm. We then discuss our ideas about the kinds of staff leadership needed to manage different phases of this sequence and the problems of developing and integrating multiple ward leadership roles.
住院部的心理健康工作者花费大量时间试图应对扰乱病房生活的人际紧张关系。我们将注意力集中在这个问题的两个方面。第一个方面是厘清病房紧张和冲突加剧时期背后的社会过程的本质。第二个方面是厘清管理这些紧张关系所需的员工领导类型。我们确信，那些在互动治疗病房工作过的人会认识到这种情况：在数周或更长时间内存在一种不安的紧张气氛；患者形成小团体，小团体之间以及与工作人员之间出现混乱。通常会出现破坏性行为的高潮，比如在某一天或周末，大量患者违反病房规定。麻烦似乎具有传染性。在整个时期，工作人员对于如何管理患者和处理混乱意见不一，而且这种分歧通常带有旧有的理念或个人差异。没有人对采取领导举措充满信心，正式领导因各种失败和不足而受到指责。最终，通常在一次高潮性的干扰得到解决之后，病房生活恢复“正常”，人们对在病房生活和工作的感觉好多了。在本文中，我们回顾了此前关于这种病房过程的研究，并讨论了在对其进行概念化时涉及的一些问题。我们报告了两个病房观察阶段，它们说明了从低紧张到高紧张再回到相对平静的过程。然后我们讨论了关于管理这个过程不同阶段所需的员工领导类型的想法，以及发展和整合多个病房领导角色的问题。
