An examination of the relationship between hospital ward behaviors and post-discharge behaviors in spinal cord injury patients

This study was an exploration of the relationship between spinal cord patients' non-cooperative and depressive behaviors during their hospitalization and their posthospitalization behaviors. The data measuring non-cooperation and depression (the independent variables) were derived from the patient's hospital chart of his first admission to the hospital following his injury. From the reports of the Kurses, Occupational Therapists (O.T.) and Physical Therapists (P.T.), every statement in the hospital chart which indicated a refusal to carry out what was expected of the patient (both therapeutically and custodially), and every statement that reflected a quality of sadness, mourning or a downcast mood, was recorded. The outpatient data for this study (the dependent variables), came from diaries kept by the patients. The patients recorded all of their activities for one week, the time they occurred and with whom they did them. The diaries were analyzed into eleven outcome variables. Twenty-four, white, male, spinal cord injured patients who were totally wheelchair dependent served as subjects for this study. The major findings of this study were: A significant inverse relationship was found only between the degree of ward non-cooperation and the patient's involvement in employment/school. All other associations between non-cooperation and the dependent variables were not significant. No significant associations were found between the degree of ward depression and the eleven outcome variables . When however the patients' data were divided along social class lines the following results were found: For the middle socioeconomic class (SEC) patient, ward non-cooperation correlated positively and significantly with the patient's range of behaviors (settings, activities and persons encountered). Moreover, all of the associations between the independent and dependent variables tended in a positive direction. The degree of depression expressed by the middle SEC patient was unrelated to the eleven outcome variables. For the low SEC patient, depression correlated significantly and negatively with all eleven outcome- variables. Ward non-cooperation for the low SEC patient did not significantly correlate with ten of the dependent variables but did correlate negatively and significantly with the patient's involvement in school/employment. Social class by itself was not a good predictor of the patient's non-cooperative or depressive behaviors in the hospital, nor of the patient's post-hospitalization behaviors. However, when knowledge of the patient's social class was combined with knowledge of his behavior in the hospital, predictions could be made to the patient's posthospitalization behaviors. No significant differences were found between the three time periods of hospitalization in the amount of noncooperation expressed. Similarly, depression was not found to be significantly different for the three time periods of hospitalization. However, patients were not consistent in expressing their depression over the three time periods. No relationship was found, in either SEC group, between non-cooperative and depressive behaviors throughout hospitalization. No statistical relationship was found between the level of spinal injury and the amount of non-cooperative and depressive behavior displayed during hospitalization, the range of behavior (settings, activities and people encountered) after discharge, or employment/school participation. A significant relationship was found between the patient's level of education and employment after discharge. For the spinal cord patient, a college education is an important requirement for employment.