oth the nature of the patient, and hospital/caring factors. First, the authors note that psychiatric patients with substance abuse problems have certain commonalities. They tend to be males with a history of violence, co-dependent relationships (especially with their spouses or girlfriends) who are often poor and sometimes homeless.
In the health care setting, these patients will typically display strange, bizarre behavior that alienates staff. In addition, they are often angry people with a sense of entitlement and a generally demanding nature.
Confronted with this personality which itself is subject to aggressiveness, the hospital and nursing staff, unfortunately, then take several actions that can operate to exacerbate the problem. With respect to these actions, Morrison et. al (2000a), state that the hospital will often tend to focus on the physical problem requiring surgery (e.g., a gunshot wound, the physical repercussions of an auto accident, etc.) rather than on the substance withdrawals the patient is going through in addition to his injuries. Further the hospital will under-treat pain thereby increasing patient anger and lowering the already flagging compliance levels arising as a result of their personality and the substance abuse.
In addition, the nursing staff will often respond to the behavior of these patients with active dislike and alienation, which increases the already fairly high tension between the patient and the nursing staff. Melia, Moran and Maston (1999) state that the dislike and alienation arise because nurses simply do not feel safe with these patients who are bristling with hostility. However, as a consequence of these feelings, patients and nurses are never able to develop the kind of therapeutic relationship that produces high quality care.
Adding to the difficulty of this situation is the co-dependent relationship the psychiatric surgical patient with a substance abuse problem often ha...