Using data from a recent study on the outcomes of child psychiatric hospitalization, the author presents a critique of the intervention-outcome movement that dominates the health care agenda. Employing an exploratory descriptive study design and Denzin’s interpretive interactionism method, she presents data that illustrate how interventions can become distorted by contextual factors, conflicting ideologies, agendas, and failure to thoughtfully consider patient needs. She posits that research agendas are heavily tilted toward outcomes research that often discount the nature of structure and process. The marketplace emphasis of health care may result in environments in which a structure and process of caring is replaced by a focus of profits over patients. The value of focusing on interventions and outcomes in research without addressing broader ecosystem variables that influence practice is questioned in view of in-depth data that emerge from practice settings.
Get full access to this article
View all access options for this article.
References
1.
American Psychiatric Association . (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
2.
Baier, A. (1986). Trust and anti-trust. Ethics, 96(1), 259.
3.
Bandura, A. (1969). Principles of behavior modification. New York: Holt Rinehart & Winston.
4.
Baudrillard, J. (1983). Simulations. New York: Semiotext.
5.
Borreson, S. (1997). Fraud suits still haunt hospital giant. Texas Lawyer, 12(46), 24-28.
6.
Brooten, D. , & Naylor, M. D. (1995). Nurses’ effect on changing patient outcomes. Image: Journal of Nursing Scholarship, 27(2): 95-99.
7.
Colaizzi, P. (1978). Psychological research as the phenomenologist views it. In R. Valle & M. King (Eds.), Existential phenomenological alternatives for psychology (pp. 48-71). New York: Oxford University Press.
8.
Darnton, N. (1989, July 31) Committed youth. Newsweek, pp. 66-72.
9.
Denzin, N. (1989). Interpretive interactionism. Newbury Park, CA: Sage.
10.
Egan, G. (1975). The skilled helper. Monterrey, CA: Brooks-Cole.
11.
Ex-psychiatric patients will get $120 million. (1997, July 30), Dallas Morning News, pp. 1A, 16A.
12.
Goren, S. , Singh, N. N., & Best, A. M. (1993). The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital. Journal of Child and Family Studies, 2(1), 61-73.
13.
Gunderson, J. G. , Will, D. A., Mosher, L. R. (1983). Principles and practice of milieu therapy. New York: Jason Aronson.
14.
Habermas, J. (1970). On systematically distorted communication. Inquiry, 13, 205-218.
15.
Habermas, J. (1984). The theory of communicative action. Boston: Beacon.
16.
Hauser, S. , Powers, S., Noam, G., Jacobson, A., Weiss, B., & Follansbee, D. (1984). Familial contexts of adolescent ego development. Child Development, 55, 195-213.
17.
Hegevary, S. (1992). Ourcomes research: Integrating nursing practice into the world view. In Patient outcomes research: Examining the effectiveness of nursing practice. Proceedings of the state of the art (pp. 17-24) (NIH Publication No. 93-3411). Bethesda, MD: National Institute of Health.
18.
Horkeimer, M. , & Adorno, T. W. (1994). Dialectic of enlightenment (J. Cummings, Trans.). New York: Continuum Press. (Original work published 1944)
19.
Jennings, B. M. (1991). Patient outcomes research: Seizing the opportunity. Advances in Nursing Science, 14(2) 59-72.
20.
Kerr, P. (1991, October 22). Chain of mental hospitals face inquiry in four states. The New York Times p. A1.
21.
Konopka, G. (1963). Social group work. Englewood Cliffs, NJ: Prentice-Hall.
22.
Lincoln, Y. , & Guba, E. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.
23.
Locked wards open door to booming business. (1997, May 11). Boston Sunday Globe, p. A1, A18.
24.
Mark, B. A. (1995). The black box of nursing outcome research. Image: Journal of Nursing Scholarship, 27(1), 42-43.
25.
Miller, D. (1986). The management of misbehavior by seclusion. Residential Treatment for Children and Youth, 4(1), 63-73.
26.
Mohr, W. K. (1994). The private psychiatric hospital scandal: A critical social approach. Archives of Psychiatric Nursing, 8(1), 3-8.
27.
Mohr, W. K. (1996). Psychiatric nursing in troubled environmental contexts. Archives of Psychiatric Nursing, 10(4), 197-206.
28.
Mohr, W. K. (1997). Interpretive interactionism: Denzin’s potential contribution to intervention and outcomes research. Qualitative Health Research, 7(2), 270-286.
29.
Mohr, W. K. & Fantuzzo, J. W. (1998). Creating thoughtful research agendas. Archives of Psychiatric Nursing, 12(1), 1-9.
30.
Mohr, W. K. & Mahon, M. M. (1996). Dirty hands: The underside of marketplace health care. Advances in Nursing Science, 19(1), 28-37.
31.
Morrison, E. F. (1990). The tradition of toughness: A study of nonprofessional nursing care in psychiatric settings. Image: Journal of Nursing Scholarship, 22(1), 32-38.
32.
Morrison, E. F. (1998). The culture of caregiving and aggression in psychiatric settings. Archives of Psychiatric Nursing, 12(1), 21-32.
33.
Noble, H. B. (1995, February 24). Ten Texas psychiatrists sue ex-patients over fraud accusations. The New York Times, pp. A18, A19.
34.
Parmalee, D. , (1996). Child and adolescent psychiatry. St. Louis, MO: Mosby.
35.
Sandelowski, M. (1986). The problem of rigor in qualitative research. Advances in Nursing Science, 8(3), 27-37.
36.
Sharkey, J. (1994). Bedlam. New York: St. Martin’s.
37.
Skinner, B. F. (1969). Contingencies of reinforcement: A theoretical analysis. New York: Appleton-Century-Crofts.
38.
Smith, M. (1997, March 24). Few doctors lost licenses over scandal: Psychiatric hospitals accused of filling beds fiat any cost.fl Houston Chronicle, pp. 1, 8A.
39.
Strumwasser, I. , Paranjpe, N. V., Udow, M., Share, D., Wisgerhof, M., Ronis, D. L., Bartzack, C., & Saad, A. N. (1991). Appropriateness of psychiatric and substance abuse hospitalization: Implications for payment and utilization management. Medical Care, 29(8), 277-291.
40.
U.S. Government Printing Office . (1992). The profits of misery: How inpatient psychiatric treatment bilks the system and betrays our trust. Washington, DC: Author.
41.
van Manen, M. (1990). Researching lived experience. Albany: State University of New York Press.
42.
Verran, J. A. , & Mark, B. A. (1992). Contextual factors influencing patient outcomes. In Patient outcomes research: Examining the effectiveness of nursing practice (DHHS Publication 93-3411, pp. 121-143). Washington, DC: U.S. Government Printing Office.
43.
Weithorn, L. A. (1988). Mental hospitalization of troublesome youth: An analysis of skyrocketing admission rates. Stanford Law Review, 40, 753, 773-838.
44.
Yalom, I. (1985). The theory and practice of group psychotherapy (3rd ed.). New York: Basic Books.
45.
Yang, C. (1993, October 18). Put the head in the bed and keep it there. Business Week, pp. 68-70.
