Intrainstitutional Relocation Research Articles

Best Practices: Environmental and Therapeutic Issues in Psychiatric Hospital Design: Toward Best Practices

The psychiatric hospital environment plays a significant, though often underappreciated, role in patient and staff functioning. This column reviews the literature on important environmental and therapeutic issues in psychiatric hospital design. Research findings and clinical conjecture reported over the past 50 years indicate that intervening environmentally through clinically informed, patient-centered design can improve functioning both among and between patients and staff. This column identifies specific best practice considerations and recommendations for designing inpatient psychiatric facilities and may serve as a useful planning resource to those interested in adopting a patient-centered, inclusive approach to design and treatment.

When Environmental Re-Design Creates Autonomy Hindrance

ABSTRACT Twenty-three residents were interviewed with the Geriatric Relocation Assessment Inventory (GRAI) to study the consequences of intra-institutional relocation from the residents' perspective. Interviews revealed that institutional relocation was associated with discrete positive and negative changes. Positive changes included brighter lights, new decor, and more privacy. Negative changes concerned restrictive room design and ward location. Responses are considered in light of theory to suggest that the reportedly substantial impact of minor changes can be explained as “autonomy hindrance,” such that seemingly minor losses associated with relocation become significant in a context of decreased opportunities for autonomy and increased environmental dependence. Studies that uncover such local detail may be usefull in understanding conflicting findings in relocation research.

Intrainstitutional relocation. Effects on residents' behavior and psychosocial functioning.

Relocation effects in the elderly have been a topic of gerontologic research for many years. Prior research, however, has focused on individuals who could make a cognitive appraisal of the relocation process. With a greater prevalence of cognitive impairments and/or psychiatric illnesses in long-term care residents, research is needed to clarify the impact of relocation on these individuals. The purpose of this study was to determine how intrainstitutional relocation affects behavior and psychosocial functioning in residents with and without cognitive, mood, and/or psychotic disorders. This prospective study followed 78 residents being relocated intrainstitutionally in a health-related facility that was undergoing major renovations. Medical and nursing information was collected at 1 month pre-move and at 1 and 3 months post-move. Five areas of behavioral and psychosocial functioning (self-care, disoriented behavior, depressed/anxious mood, irritable behavior, and withdrawn behavior) were assessed using the Multidimensional Observation Scale for Elderly Subjects (MOSES). A significant increase was seen in the number of medical visits (p = .04) from time of relocation to 1 month post-move. The groups diagnosed with mood disorder and psychotic disorder had a statistically significant weight loss (p = .04) between 1 month pre-move and 1 month post-move. The study revealed an increase in the number of residents who fell immediately after relocation, but the increase did not reach statistical significance (p = 12). Residents who fell after relocation had resided at the facility for a longer time than the remainder of the sample (p = .08). Residents with a diagnosis of cognitive impairment showed a statistically significant difference in self-care (p = 0.01) and withdrawn behavior (p = 0.01) at 3 months post-move. Extensive relocation preparation and support may have been the main contribution to diminishing the stress of relocation over time and across diagnostic categories.

The Meaning of Relocation among Elderly Religious Sisters

The meaning of involuntary, intra-institutional relocation (a move in primary living space) was constructed in this qualitative study through semistructured interviews with 12 elderly religious sisters. A thematic analysis of the data elicited from audiotape-recorded interviews was conducted. Overall, themes emerging from the sisters' discussion of the relocation included relocation as preparation for the future (to ensure their care in advancing years) and possibilities and consequences (resulting in improved living conditions together with sacrifice, uprooting, isolation, and distancing). Although relocation was seen as a largely positive event, it also had negative meaning for the subjects.

The impact of intrainstitutional relocation on morbidity in an acute care setting.

This study investigated the effects on morbidity of intrainstitutional room changes among stabilized male patients in an acute care setting. Controlling for potential confounders, patients who underwent room changes did not differ post-transfer from control patients in vital sign parameters. Younger movers, however, were found to be taking fewer medications post-transfer and were more likely to be independently ambulatory at discharge than younger controls, while older movers were found to be taking more medications and were less likely to be independently ambulatory at discharge in comparison to older controls. A parallel trend appeared with regard to physician evaluation of patient improvement. These findings suggest that age moderates the impact of intramural relocation on patients' health status; while younger patients experience a room change as beneficial, older patients may find it deleterious. Suggestions are offered for future research.

Responses of nursing home residents to intrainstitutional relocation

Relocation effects may be positive when residents are prepared for the move. The degree to which they exercise control over their environment and participate in the decision-making process influences the outcome of relocation. Planned interventions may offset adverse effects of stress. Prerelocation involvement of the residents we observed in visiting the new facility, and in selecting their bedrooms and roommates, reduced their anxiety to an acceptable, even positive level. These choices had a direct impact on their quality of life. The greater the number of choices the residents had, the more predictable the new environment became. Any stress generated became a positive, rather than a negative, force.

Social Relationships, Psychosocial Adaptation, and Intrainstitutional Relocation of Elderly Men

The intrainstitutional relocation of 40 men aged 53 to 91 years was studied in relation to social integration, and to behavioral and self-report measures of psychosocial adaptation. In both longitudinal and time-lag analyses of pre- and postrelocation data, relocated men scored lower on the attitude toward aging dimension (PGC Morale Scale, Lawton, 1975), had fewer friends, and evidenced better communication behavior (p less than .01) than did unrelocated men. The more sociable men showed more change after relocation than did men who were less sociable.

Intrainstitutional relocation: mortality effects.

Intrainstitutional relocation: mortality effects.

A critical examination of intra-agency relocation effects.

Behavioral effects of intrainstitutional relocation of adults with mental retardation were evaluated over a 12-month period using two independent methods of measurement and a multiple baseline across two relocating groups and one matched control group. Clients grouped together on the basis of relatively high levels of aggressive or destructive behavior exhibited an increase in social isolation following relocation. However, as a whole, relocation effects were subtle and individualized in nature. Behavior adjustment following relocation and methods for avoiding "transition shock" following rapid environmental change are discussed.

The Elderly in Context

Older people must be understood in terms of changes that occur both in themselves and in the world around them. The transactions between older people and their environments are discussed in terms of the support-autonomy dialectic and specific behaviors involving environmental reactivity and proactivity. Three examples of research are discussed to illustrate how autonomy is maintained on one level while necessary support is accepted on another level (environmental multiplexity): shared housing, intrainstitutional relocation, and the household environment of impaired people.

Coping with an intra-institutional relocation: changes in resident and staff behavior patterns.

An intra-institutional relocation of a long-term care facility was studied by documenting changes in the environment and in residents' and staff members' use of space and patterns of behavior. Behavioral changes were conceptualized as attempts to adapt to the larger design and altered layout of the new facility, in particular the separation of care-giving and social spaces. Information obtained from monitoring environmental and behavioral changes can be shared with administrators and staff and used to maximize the positive impact of relocation.

Coping with an intra-institutional relocation: behavioral change as a function of residents' personal resources

A model of person-environment interaction was used to help explain the impact of an intra-institutional relocation on the behavior of residents who varied in mobility and mental status. Environmental measures indicated that the new building provided more prosthetic features, fewer orientational aids, a more complex floorplan, and increased distance between the social areas and the nurses' stations. Behavioral observations of a sample of 17 residents showed varying adaptations to these environmental changes. Wheelchair-mobile residents benefited from the improved accessibility, whereas immobile residents experienced reduced stimulation and further restriction of their spatial range. High mental status residents were drawn out of their bedrooms into social spaces. while low mental status residents spent less time in social areas and more in the halls near the nurses' stations, where they could maintain contact with the staff. Information such as this on the differential impact of a new building can contribute to the design process and to program modification aimed at optimizing resident functioning.

Minimizing the adverse effects of mass relocation among chronic psychiatric inpatients.

Recent studies have reported conflicting results on the impact of intrainstitutional relocation on chronic psychiatric patients. As part of a hospital renovation project, 82 patients were assessed over a period of eight months to determine the effects of mass transfer on physical, mental, and social functioning. Twenty-five staff members also assessed the social climate before and after the transfer. The author found that involuntary relocation of living quarters within the same institution did not significantly affect the functioning of the chronic psychiatric patients. He attributes the lack of disruption to continuity of care in a familiar environment and to a continuous schedule of supportive activities conducted outside of the ward.

Behavioral effects of intra-institutional relocation.

Abstract The developmental progress of 49 institutionalized mentally retarded persons who had recently transferred to different cottages was compared to the developmental progress achieved by a matched group of 49 residents of the same institution. During the six months following relocation, the transferred group evinced a 9.30 point regression on the Part One total score of the ABS. During this same time period, the nontransferred group gained 4.80 points. Significant interaction terms were found for four ABS (Adaptive Behavior Scale) domain scores: Economic Activity, Language Development, Self-Direction, and Socialization. In all cases, the transferred group regressed, while the nontransferred group gained.

Intra-Institutional Relocation: Its Impact on Long-Term Care Patients

Intra-Institutional Relocation: Its Impact on Long-Term Care Patients

Impact of intra-institutional relocation. Special report from the Philadelphia geriatric center. Background and the planning process.

This set of four papers deals with different aspects of the relocation of 48 elderly people from one area to another within the same institution and on the same day. The first paper states the circumstances making the moves necessary, reviews relocation literature, and describes the planning process. The second details the clinical approaches utilized to facilitate the moving process for the residents and their families. In the third paper, findings are reported from a study to evaluate the impact of the change on the residents' over-all adjustment, their pre- and post-move attitudes toward moving, and their emotional reactions. The last paper demonstrates constrictive spatial responses to the stress of moving, together with some indications that these responses may be adaptive.