The purpose of this study was to examine the identification of patient deviance by staff nurses and the relationship between perceived patient deviance and avoidance/distancing behaviors of nurses. Using a social deviance/labeling theory framework, patient deviance was defined as patient behaviors and attitudes inconsistent with expected patient role behaviors as judged by hospital staff nurses. Empirical indicators for avoidance and distancing were a reduction in the number and duration of nursing contacts with patients, a reduction in the number of nurse-initiated patient contacts, and failure to meet the individualized needs of patients. Fifty-two registered nurses on medical-surgical units used a card sort procedure to classify patients on their units into three study groups: ideal patient, neutral patient, and difficult (deviant) patient. The Psychosocial: Individual, Physical, and General subscales of the Slater Nursing Competencies Rating Scale (Wandelt & Stewart, 1975) were used to measure nurses' performance in meeting individualized psychosocial and physical patient needs during their provision of clinical care. Measurements of duration, number and initiator of nurse-patient contacts were also made. Analysis of variance showed no significant differences for mean number, duration, and initiator of nurse-patient contacts. Significant differences (p $<$.0001) were found, however, in all Slater subscales for the three study groups. Complete (100%) agreement of nurses in their classification of patients occurred for 74.63% of patients. The results suggest that the label of difficult (deviant) patient is well communicated among nurses and that it has a negative influence on the quality of care. The avoidance and distancing accompanying patient labeling may result in reinforcement of deviant behavior as a patient response to non-supportive care. Auxiliary findings demonstrated no significant differences among the three classification groups for age, sex, or private/non-private status. However, significant differences were found in the use of physical restraints (p =.01) with the difficult patient group being restrained most frequently. Perceived physical attractiveness was also found to be significantly related (p $<$.0001) to classification group. Primary diagnoses most frequently found in the difficult patient group were related to socially undesirable conditions (e.g., drug abuse, AIDS) than were those for ideal patients.
Supervisor: Florence S. Downs. Thesis (Ph.D. in Nursing) -- Graduate School of Arts and Sciences, University of Pennsylvania, 1991. Includes bibliography.