Changes in patterns of care of the mentally handicapped: implications for nurses' perceptions of their roles and hospital decision making processes.

This paper reports on the findings of a longitudinal study of a mental subnormality hospital in the North of England. The focus is upon how nurses have experienced a major change in care and treatment of residents from 1978 to 1980. We explore, through the eyes of nurses, the change in their role from a predominantly nurturing/custodial one to a mainly educational/community orientated role. The research findings demonstrate that this change has increased nurses' self-esteem and their satisfaction with important areas of their work. There is some evidence also that nurses/resident relationships have improved in spite of reservations felt about new forms of treatment and community care. We suggest that such reservations may be linked to critical views expressed by nurses, particularly sisters and charge nurses, that decisions were taken about residents by other more senior personnel who had little contact with residents. One important conclusion of this study is that the traditional processes of decision making in the hospital appears to impede the full implementation of a major change which requires nurses to be involved in a potentially threatening process of altering their perceptions of themselves and residents.