Perceptual and Behavioural Effects of Immobility and Social Isolation in Hospitalized Orthopedic Patients

Abstract

Although psychological consequences have been attributed to situations where patients are immobilized or isolated, the evidence to date does not provide a clear basis to guide nursing intervention. Both laboratory (Zubek, Aftanas, Kovach, Wilgosh, & Winocur, 1963) and clinical studies (Bolin, 1974: Jackson, 1969; Johnson, 1976) have provided explanations of psychological changes in terms of "sensory deprivation". On the other hand, Suedfeld (1979), who prefers the more accurate term "restricted environmental stimulation", suggests that the critical variable leading to psychological effects in immobile orthopedic patients may be response restriction as opposed to reduced stimuli. To further complicate the picture, recent evidence (Stewart, 1984) suggests that perceptual changes (imagery) are linked to both immobilization and to overload of dimensions of social stimulation in a hospital setting. Interpretations of stimulus restriction, stimulus overload, and response restriction have different, and even opposing, implications for nursing intervention. The literature on social isolation in hospital situations also leaves conflicting bases for intervention. In a study of 77 medical-surgical patients aged 21-86 years, Wood (1977) found that patients in a private room had more cognitive and perceptual changes than those in two-bed rooms. By contrast, Williams et al. (1979) found, in a sample of 91 elderly orthopedic patients, that there was less cognitive disturbance in a private room. Clearly, the problem with making a clinical decision on whether a private room has deleterious or beneficial effects stems from the fact that the hospital environment is a multivariate situation, with numerous confounding variables that may be uncontrolled or uncontrollable in a particular study. The laboratory research on monotonous environments has moved from evidence for negative (Heron, 1957) to positive (Suedfeld, 1975) effects because of changes in intervening variables such as the subject's expectations in a given environment.