Behavior of quadriplegic patients and the hospital environment

The study was an exploration of the relation between the environment of a rehabilitation hospital and quadriplegic patient behavior. Specimen records were utilized in an attempt to determine some of the sources of patient behavior, and some of the qualities of the relationship between patients and hospital staff members. From the specimen records of five quadriplegic patients, one hour observations were selected of each patient in three behavior settings (Occupational Therapy, Physical Therapy, and ward). Two patient groups, one in the early stages of rehabilitation treatment (2 females, 1 male) and one in the late stages of rehabilitation treatment (2 males), provided the sample of 15 hours of recorded behavior in the patient-by-setting design. The recorded behavior was analyzed into units called "episodes" and classified according to 11 behavioral dimensions. The coded data were analyzed by an information analysis model in which behavior settings (institutional effects), patient individuality, and their interaction, were related to patient behavior. The major findings of this study were: 1.) Neither behavior settings, nor patient individuality showed an overwhelming relationship to classifications of episodes. Behavior settings were related to dimensions of patient behavior in the early stages of treatment, but not in the late stages of treatment. 2. ) When at least one of the independent variables (behavior settings, patient individuality) was significantly related to a classification of behavior, the amount of information they provided about patient behavior was compared. Generally, for all episodes, behavior settings provided more information about behavior than did patient individuality; the opposite was true when analysis was restricted to episodes involving staff-patient interaction. 3.) In cases where at least one variable (behavior settings, patient individuality, or their interaction) was significantly related to dimensions of behavior, the interaction variable generally provided more information about behavior of all episodes than any variable by itself. 4.) Within each group, patients differed in the degree to which they evidenced self-assertiveness by initiating and terminating their own behavior. 5.) Behavior of advanced patients was more Individualized, less setting-bound, and more variable than behavior of early patients. 6.) Settings differed with respect to the type of associates (staff, nonstaff, or the two combined) available for interaction with patients. Settings also differed in the degree to which patient individuality accounted for patient behavior. In the early stages of treatment, the Occupational Therapy setting yielded behavior least influenced by patient individuality. In the last stage, lowest patient individuality was displayed in the ward setting.