The effect of staff stress on patient behavior.

A "natural experiment" examined the effects of staff turmoil caused by personal and group issues during and after the merger of two formerly separate neuropsychiatric evaluation units, on patient acting-out behaviors. Interviews with staff members identified the periods of high staff stress, and then two periods of personal resolution (3 to 4 months after the merger) and group reconstitution (8 to 12 months later). Patient acting-out behaviors (1:1 supervision, length of time on 1:1, use of the quiet room, seclusion, and restraints) tended to peak at times of staff peace. Behaviors under patient control (72-hour notices and discharges against medical advice) were also frequent during these periods, but showed additional activity in the time between personal and organizational resolution. While the relationship between staff issues and patient behavior is by no means straightforward, analysis of quantitative and qualitative data gathered here provides some support to the "reverse hypothesis" that when staff are upset, patients will not act out and vice versa. Implications for management, clinical practice, and research are presented.