In the July 1982 issue of the JOURNAL OF GERONTOLOGICAL NURSING an article titled "Reality Orientation Therapy for the Institutionalized Elderly" was published. The undersigned were dismayed to read on page 400, "that the staff from the top to the bottom of the hierarchy, did not believe that significant results could be attained. "
It is unfortunate that the one statement which is meant to catch the reader's attention. . .has a negative connotation when, in fact, it is obvious that this study could have never been carried out without a nursing staff dedicated to the improvement of the quality of life of institutionalized disoriented veterans.
The reader is left wondering:
A. if the statement was validated by objective evidence of staff attitudes prior to the initiation of the study and
B. if the investigator could prove there was a positive change in attitude of staff through the staff orientation sessions prior to the experiment.
It would have been far better for the nurse researchers to put the emphasis in the article on the support that they were given by hard-working bedside nurses, which enabled them to conclude that nurses through patient advocacy do, in fact, influence nursing practice by applying findings from nursing research in a practical way.
Margaret Cabriele. RN
Ruth Davis. HNA-I
Jennie Henrickson, HNA-2
Mary Francis, HNB-2
Monica Fritts, LPN, GS-6
Katherine Hardy. HNC-2
Castle Point Medical Center
Castle Point, NY
Virginia Lohmann Nodhturft responds:
1 am very happy to have the opportunity to respond to the concerns expressed by the nurses from the Castle Point VA relating to the statement "The staff from the top to the bottom of the hierarchy, did not believe that significant results could be attained."
First, Fd like to begin by responding to the specific questions asked by the nurses. The study published in the July issue of the JOURNAL OF GERONTOLOGICAL NURSING entitled "Reality Orientation Therapy for the Institutionalized Elderly" was not a measure of staff attitudes. The study measured the mental status of confused elderly patients. Then reality orientation therapy was given to the experimental group and a post measure was done to determine any changes in mental status of the patients. The change in mental status was analyzed and reported in the article.
The statement that "the staff from the top to the bottom of the hierarchy, did not believe that significant results could be attained" was an inference drawn from the attitude questionnaires administered to the multidisciplinary staff participants who attended the reality training sessions. Additionally, the statement was an inference drawn from verbal communication with the Chief of Staff and top service chiefs from services other than nursing, i.e., psychology, medicine, building management, etc. Several of the top service chiefs from other disciplines and some members of the Hospital Research and Development Committee fully supported the implementation of the study, but verbalized that they did not think the investigators would see any significant results.
The term "staff" was not used to mean only nursing staff, but also other multidisciplinary members who interfaced and worked with the elderly patients, both in the Nursing Home Care Unit and the main hospital. The study did not measure changes in attitudes of the nursing staff. However, the post-test exercise following the reality orientation sessions indicated a positive change in the multidisciplinary staff participants' knowledge and use of reality orientation therapy.
The investigators are sorry that some of the nurses perceived the one statement negatively, because in fact it is not a negative statement. The literature has shown that individuals working with confused elderly people do display pessimistic attitudes toward successful rehabilitation of elderly patients. We believe that this study shows a very positive response from those hard-working nurses who participated in the study, which will have meaning for other gerontological nurses. The statement implies that even though many people thought reality orientation would not work, the hard-working bedside nurses played a significant role in making change possible. Without the hardworking bedside nurses in the Nursing Home Care Unit and the main hospital, the valuable results obtained and reported would not have been possible.
Virginia Lohmann Nodhturft, RN
Nursing Service for Education
James A. Haley Veteran's Hospital
and Clinical Associate Professor
University of South Florida
College of Nursing