Perceived patient deviance and avoidance by nurses

Perceived patient deviance and its relationship to avoidance behaviors of nurses was examined using a social deviance/labeling framework. Avoidance included a reduction in the number and duration of nursing contacts with patients, a reduction in the number of nurse-initiated contacts, the use of physical restraints, and failure to meet the individualized needs of patients. Fifty-two registered nurses on adult health units classified known patients into three study groups: ideal patient, neutral patient, and difficult (deviant) patient. Analysis of variance showed no significant differences for mean number, duration, and initiator of nurse-patient contacts. Significant differences were found in the Psychosocial Individual, Physical, and General subscales of the Slater Nursing Competencies Rating Scale and in the use of physical restraints for the three study groups. Agreement of nurses in their classification of patients occurred in 74.63% of cases. 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.