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Nursing Staff Attitudes and the Clinical Course of Psychotic Patients

SHEPPARD G. KELLAM, MD; JACK DURELL, MD; RICHARD I. SHADER, MD
Arch Gen Psychiatry. 1966;14(2):190-202. doi:10.1001/archpsyc.1966.01730080078012.
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IN THE LAST several years, particularly since the publication of The Mental Hospital, by Stanton and Schwartz, there has been an increased interest in studying the ways in which various aspects of the sociocultural field of the psychiatric ward are related to the clinical course of mentally ill patients. This paper is a report of further studies of the relationship between the attitudinal climate of the ward and the clinical course of patients.

Stanton and Schwartz, Caudill, Tudor, and others have indicated that staff conflicts concerning organizational hierarchy, status, and power can cause covert tension.1-3 These authors have concluded that such tension at times appears to cause exacerbations of disturbed behavior in patients. Caudill has observed the occurrence of "ground swells" of health or illness on wards and has suggested that a source of such group exacerbations of illness might rest in the

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