Imagery, stress and noncomplaint behaviour in immobilized hospital patients
Creators: name: Stewart, Norma June
Publisher: name: University of British Columbia
Year: 2010

description: The purpose of this project was to investigate the effects of immobility and environmental stimulation on imagery, stress and noncompliant behaviour in two studies of hospitalized patients. In one study, objectives also included: (1) to test an intervention designed to reduce stress, and (2) to examine life stress and personal control as possible predictors of dependent variables. Moos and Tsu's (1977) model of physical illness as crisis provided a framework for the variables of interest. In Study 1, the 2x2 analysis of variance design had the following factors: (1) external immobility (traction, bedrest) versus mobility, and (2) cognitive reappraisal intervention versus no intervention. The intervention was tape recorded information which provided an expectation for imagery and vivid dreams, a positive set, and an environmental explanation for these effects. The sample of 48 male and female patients, aged 15-65, with no psychiatric history, was obtained as emergencies were admitted to the orthopedic and surgery units at a Saskatchewan hospital. Study 2, which examined the effects of both external and internal (paralysis) immobility, had a 2 x 2 x 2 analysis of variance and covariance design with repeated measures. The factors were: (1) level of injury (quadriplegia vs. paraplegia), (2) degree of neurological deficit (complete vs. incomplete), and (3) environment (intensive care vs. ward), the repeated measures variable. The covariate was injectable analgesics. In both studies, stepwise regression analysis was conducted to examine other predictors of dependent variables. Multivariate analysis of variance was used to compare imagery data across studies. The sample of 50 patients in Study 2, with criteria similar to Study 1, was randomly selected from charts over a five year period on a spinal cord injury unit in a British Columbia hospital. Hypotheses were developed in relation to the five categories of independent variables. Measures of dependent variables included questionnaires, an interview and the chart record. In one study, observational data were obtained on dimensions of social and nonsocial environmental stimulation in patient rooms. Consistent with the Moos and Tsu framework, some support was provided within each category of hypothesis. As predicted, immobility led to increased imagery. This hypothesis was supported for both external and internal immobility. The type of immobilizing apparatus (e.g., cervical tongs) was predictive of imagery, but traction per se and duration of immobility were not predictors of imagery. Contrary to hypothesis, immobility did not lead to increased general stress or noncompliance. However, immobile patients did report greater environmental stress related to personal control and response restriction. The intervention led to reduced stress, as predicted, without increasing the incidence of imagery. Stress related to imagery was unaffected by the intervention. Environmental variables were significant predictors of imagery in both studies. Medications and surgery did not contribute to this effect. Patients had greater imagery in the intensive care unit than on the ward. Sleep deprivation correlated with all three dependent variables. Contrary to the hypothesis that restricted stimulation would lead to imagery effects, high levels of social stimulation dimensions and nonsocial stimulation which had low option for control predicted imagery. High noise levels predicted both stress and noncompliance. Further predictors of stress were high levels of dimensions of social and nonsocial stimulation, whereas noncompliance was predicted by low variety of nonsocial stimulation. In general, these data support an overload explanation of psychological effects, consistent with Zuckerman's (1969) theory of an optimal level of stimulation. Suggestions are made for the development of a theory of optimal level of personal control. As hypothesized, personal control measures were inversely related to stress. With regard to life stress, patients who had a high incidence of life events with a negative impact during the year prior to hospitalization had greater imagery during the hospital stay and lower adjustment (i.e., high stress) on follow-up. Clinical implications of these data are discussed.