ulrich 1984
TRANSCRIPT
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8/10/2019 Ulrich 1984
1/3
DOI: 10.1126/science.6143402, 420 (1984);224Science
et al.RS Ulrich,from surgeryView through a window may influence recovery
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8/10/2019 Ulrich 1984
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V i e w
T h r o u g h
a
Window
May I n f l u e n c e R e c o v e r y f r o m
S u r g e r y
A b s t r a c t . R e c o r d s recovery
a f t e r
c h o l e c y s t e c t o m y
o f p a t i e n t s i n
a s u b u r b a n
P e n n s y l v a n i a h o s p i t a l
b e t w e e n 1 9 7 2
a n d
1 9 8 1
were e x a m i n e d t o d e t er mi n e w h et h e r
a s s i g n m e n t
t o a
room
w i t h a
w i n d o w
v i e w o f
a n a t u r a l s e t t i n g m i g h t
h a v e
r e s t o r a t i v e
i n f l u e n c e s . T w e n t y - t h r e e s u r g i c a l p a t i e n t s a s s i g n e d t o rooms
w i t h
w i n d o w s l o o k i n g
o u t on
a
n a t u r a l scene h a d s h o r t e r
p o s t o p e r a t i v e h o s p i t a l
s t a y s ,
r e c e i v e d
f e w -
er
n e g a t i v e
e v a l u a t i v e
comments
i n
n u r s e s
n o t e s , a n d t o o k f e w e r
potent
a n a l g e -
s i c s t h a n 2 3 m a t c h e d p a t i e n t s
i n
s i m i l a r
rooms w i t h w i n d o w s
f a c i n g
a b r i c k b u i l d i n g
w a l l .
I n v e s t i g a t i o n s
o f
a e s t h e t i c a n d a f f e c -
t i v e responses t o o u t d o o r v i s u a l e n v i r o n -
ments h a v e s h o w n a
s t r o n g
t e n d e n c y
f o r
A m er i c a n a n d E u r o p e a n groups
t o
p r e f e r
n a t u r a l scenes more t h a n u rb a n v ie w s
t h a t l a c k n a t u r a l
e l e m e n t s
1 , 2 ) .
V i e w s
o f
v e g e t a t i o n , a n d e s p e c i a l l y w a t e r , ap
pear t o
s u s t a i n i n t e r e s t
a n d
a t t e n t i o n
more
e f f e c t i v e l y
t h a n u r b a n
v i e w s
o f
e q u i v a l e n t i n f o r m a t i o n r a t e ( 2 ) . B e c a u s e
most n a t u r a l v i e w s a p p a r e n t l y e l i c i t
p o s i -
t i v e f e e l i n g s ,
r e d u c e
f e a r
i n
s t r e s s e d
s u b -
j e c t s ,
h o l d
i n t e r e s t , a n d may
b l o c k or
r e d u c e
s t r e s s f u l
t h o u g h t s , t h e y m i g h t
a l s o
f o s t e r r e s t o r a t i o n
f r o m a n x i e t y
or
s t r e s s ( 3 ) .
T h e r e s t o r a t i v e e f f e c t o f n a t u r a l v i e w s
o n s u r g i c a l
p a t i e n t s
was e x a m i n e d
i n
a
s u b u r b a n
P e n n s y l v a n i a
h o s p i t a l
( 2 0 0
b e d s ) .
S u c h
p a t i e n t s
o f t e n
e x p e r i e n c e
c o n s i d e r a b l e
a n x i e t y
4 , 5 ) ,
a n d h o s p i t a l
c o n f i n e m e n t
l i m i t s
t h e i r
access t o o u t -
d o o r
e n v i r o n m e n t s a l m o s t
e n t i r e l y t o
v i e w s t h r o u g h w i n d o w s . V i e w s
t o
t h e
o u t s i d e
may
b e
e s p e c i a l l y
i m p o r t a n t
t o
i n d i v i d u a l s who
h a v e u n v a r y i n g
s c h e d -
u l e s
a n d
s p e n d
a g r e a t d e a l o f t i me i n t h e
same room
( 6 ) ,
s u c h
as
s u r g i c a l p a t i e n t s .
I t i s p o s s i b l e t h a t a
h o s p i t a l
w i n d o w
v i e w
c o u l d
i n f l u e n c e a
p a t i e n t s
e m o t i o n a l
s t a t e
a n d
m i g h t a c c o r d i n g l y
a f f e c t recov
e r y .
R e c o r d s
o f
p a t i e n t s
a s s i g n e d t o r o o ms
o n t h e
s e c o n d
a n d t h i r d
f l o o r s o f
a t h r e e -
s t o r y w i n g
o f t h e
h o s p i t a l
b e t w e e n 1 9 7 2
a n d 1 9 8 1 were o b t a i n e d .
Windows o n
o n e
s i d e o f t h e
w i n g
l o o k o u t o n e i t h e r a
s m a l l
s t a n d
o f
d e c i d u o u s
t r e e s
or a
b r o w n
b r i c k w a l l
( F i g .
1 .
T h e same
nurses
are
a s s i g n e d
t o t h e r o o ms o n
a
g i v e n
f l o o r ;
t he n u r se s s t a t i o n s
are
l o -
c a t e d
s o m e w h a t c l o s e r t o
t h e w a l l - v i e w
rooms o n b o t h
f l o o r s .
T h e
r o o ms
are a l l
f o r
d o u b l e occupancy
a n d
ar e
n e a r l y
i d e n t i c a l i n t e r m s o f d i m e n s i o n s , w i n d o w
s i z e ,
a r r a n g e m e n t o f b e ds ,
f u r n i t u r e ,
a n d
o t h e r
m a j o r
p h y s i c a l
c h a r a c t e r i s t i c s .
E a c h room h a s a s i n g l e
window
1 . 8 3
h i g h a n d
1 . 2 2
w i d e w i t h t h e l o w e r
e d g e
7 4
cm
a b o v e
t h e f l o o r .
The s i z e
a n d
p l a c e m e n t
o f
t h e window a l l o w an
u n o b -
s t r u c t e d
v i e w
o u t f o r a
p a t i e n t
l y i n g
i n
b e d
o n
e i t h e r s i d e
o f
t h e
room
T h e
r o o ms
d i f f e r ,
t h e r e f o r e , e s s e n t i a l l y o n l y
i n
w h a t
i s
seen
t h r o u g h t h e
w i n d o w .
P a t i e n t s are a s s i g n e d
t o
rooms as t h e y
b e c o m e v a c a n t .
T h e
s a m p l e
c o n s i s t e d
e x c l u s i v e l y o f
p a t i e n t s
who h a d
u n d e r g o n e c h o l e c y s -
t e c t o m y ,
a common
t y p e
o f
g a l l
b l a d d e r
s u r g e r y .
T h i s
i s a
c o m p a r a t i v e l y
s t a n -
d a r d i z e d
p r o c e d u r e
w i t h s i m i l i a r
p o s t o p -
e r a t i v e
management
i n
t h e
u n c o m p l i c a t -
e d
c a s e s .
O n l y c h o l e c y s t e c t o m i e s per
f o r m e d b e t we e n
1
May
a n d
2 0
O c t o b e r
( 1 9 7 2
t h r o u g h
1 9 8 1 )
were
i d e n t i f i e d
b e -
cause
t h e
t r e e s h a v e
f o l i a g e d u r i n g
t h o s e
m o n t h s . P a t i e n t s
younger
t h a n
2 0
years
or o l d e r
t h a n
6 9 , p a t i e n t s
who
d e v e l o p e d
s e r i o u s c o m p l i c a t i o n s ,
a n d t h o s e
w i t h a
h i s t o r y
o f
p s y c h o l o g i c a l
d i s t u r b a n c e s
were
e x c l u d e d .
P a t i e n t s
were
t h e n
m a t c h e d
so
t h a t
o n e
member o f
e a c h
p a i r
h a d
a
v i e w
o f
t h e t r e e s a n d t h e o t h e r , t h e
b r i c k
w a l l .
T h e
c r i t e r i a
f o r
m a t c h i n g
were s e x ,
ag e ( w i t h i n 5 y e a r s ) , b e i n g
a
s m o k e r or
n o n s m o k e r , b e i n g o b e s e or
w i t h i n
n o r m a l w e i g h t l i m i t s ,
g e n e r a l
na
t u r e
o f p r e v i o u s
h o s p i t a l i z a t i o n ,
year
o f
surgery ( w i t h i n
6 y e a r s ) ,
a n d
f l o o r
l e v e l .
P a t i e n t s o n
t h e
s e c o n d
f l o o r ,
a
s u r g i c a l
f l o o r ,
were
a l s o
m a t c h e d b y
t he c ol o r
o f
T a b l e
1 .
C o m p a r i s o n
o f
a n a l g e s i c
d o s e s
p e r
p a t i e n t
f o r
w a l l - v i e w
a n d
t r e e - v i e w
g r o u p s .
Number o f d o se s
A n a l g e s i c D a y s 0 - 1
D a y s 2 - 5 D a y s
6 - 7
s t r e n g t h
W a l l
T r e e
W a l l T r e e
W a l l
T r e e
g r o u p g r o u p
g r o u p g r o u p g r o u p
g r o u p
S t r o n g
2 . 5 6
2 4 0 2 . 4 8
0 . 9 6 0 . 2 2
0 . 1 7
M o d e r a t e 4 . 0 0 5 . 0 0
3 . 6 5
1 . 7 4
0 . 3 5
0 . 1 7
Weak 0 . 2 3 0 . 3 0
2 . 5 7 5 . 3 9 0 . 9 6
1 . 0 9
4 2 0
t h e i r
r o o m ( r o o m s
o n t h a t
f l o o r a l t e r n a t e
b e t w e e n b l u e
a n d
g r e e n ) .
T h e
6 - y e a r
i n t e r v a l
f o r
y e a r o f s u r g e r y w a s e s t a b -
l i s h e d o n t h e b a s i s o f i n q u i r i e s c o n c e r n -
i n g
p o s s i b l e
c h a n g e s
i n
p r o c e d u r e s .
T h e r e
w a s
n o s t a t i s t i c a l l y s i g n i f i c a n t
d i f -
f e r e n c e
i n
t h e s a m p l i n g d i s t r i b u t i o n s
b y
y e a r
o f s u r g e r y
b e t w e e n t h e
w a l l - v i e w
a n d t r e e - v i e w
g r o u p s .
T h e f i n a l
d a t a b a s e
c o n s i s t e d o f
r e c o r d s
o f
4 6
p a t i e n t s
g r o u p e d i n t o
2 3
p a i r s ( 1 5
f e m a l e
a n d 8
m a l e ) .
An
a t t e m p t w a s m a d e
t o
m a t c h
p a t i e n t s b y p h y s i c i a n ,
b u t
t h i s w a s
p o s s i -
b l e f o r o n l y s ev e n p a i r s
b e c a u s e t h e
n u m b e r o f d oc t o rs w a s l a r g e .
H o w e v e r ,
f o r t h e
r e m a i n i n g p a i r s
t h e d i s t r i b u t i o n o f
d i f f e r e n t p h y s i c i a n s
w a s s i m i l a r
i n
t h e
t w o
g r o u p s .
T h e r e w a s n o
i n s t a n c e ,
f o r
e x a m p l e ,
w h e n
p a t i e n t s
o f t h e
s a m e
d o c -
t o r
a l l h a d r o o m s w i t h s a m e
v i e w .
R e c o v e r y d a t a w e r e
e x t r a c t e d f r o m
t h e
r e c o r d s
b y
a n u r s e w i t h e x t e n s i v e
s u r g i c a l f l o o r e x p e r i e n c e .
T h e
n u r s e d i d
n o t
k n o w w h i c h s c e n e
w a s v i s i b l e f r o m
a
p a t i e n t s
w i n d o w .
F i v e
t y p e s
o f
i n f o r m a -
t i o n w e r e t a k e n
f r o m e a c h
r e c o r d :
n u m -
b e r o f
d a y s
o f
h o s p i t a l i z a t i o n ;
n u m b e r
a n d
s t r e n g t h
o f a n a l g e s i c s
e a c h
d a y
7 ;
n u m b e r
a n d
s t r e n g t h o f d o s e s
f o r a n x i -
e t y ,
i n c l u d i n g
t r a n q u i l i z e r s
a n d
b a r b i t u -
r a t e s , e a c h
d a y ( 8 ) ;
m i n o r
c o m p l i c a t i o n s ,
s u c h a s p e r s i s t e n t
h ea d a ch e a n d n a u s e a
r e q u i r i n g
m e d i c a t i o n - s y m p t o m s
w h i c h
a r e
c o n s i d e r e d t o
r e s u l t
f r e q u e n t l y
f r o m
c o n v e r s i o n
r e a c t i o n s
9 ;
a n d
a l l
n u r s e s
n o t e s
r e l a t i n g
t o
a
p a t i e n t s
c o n d i t i o n
o r
c o u r s e
o f
r e c o v e r y .
L e n g t h
o f
h o s p i t a l i z a t i o n
was
d e f i n e d
a s
d a y
o f
s u r g e r y
t o
d a y
o f
d i s c h a r g e .
T h e s e d a t a
w e r e a s s u m e d t o
b e
o n l y
o r d i n a l b e c a u s e
s u r g e r y
was
p e r f o r m e d
a t d i f f e r e n t
t i m e s o f
d a y
a n d
d i s c h a r g e
t i m e s
w e r e
s o m e w h a t
d i f f e r e n t .
T h e r e c -
o r d s s h o w e d
t h a t
p a t i e n t s
w i t h w i n d o w
v i e w s o f t h e
t r e e s
s p e n t
l e s s
t i m e
i n
t h e
h o s p i t a l
t ha n t ho s e w i t h
v ie w s o f t h e
b r i c k w a l l :
7 . 9 6
d a y s c o m p a r e d
w i t h
8 . 7 0
d a y s p e r
p a t i e n t [ W i l c o x o n
m a t c h e d -
p a i r s s i g n e d - r a n k s a n a l y s i s , T ( 1 7 )
=
3 5 ,
z
=
1 . 9 6 5 ,
P
=
0 . 0 2 5 ] .
N u r s e s
n o t e s
c o n s i s t e d
o f
comments
a b o u t
t h e
p a t i e n t s
c o n d i t i o n
w r i t t e n d u r -
i n g t h e p o s t s u r g i c a l p e r i o d
e n d i n g
a t m i d -
n i g h t
o f t h e s e v e n t h
r e c o v e r y d a y
a f t e r
t h e d a y
o f
s u r g e r y .
N o t e s w e r e c l a s s i f i e d
a s
n e g a t i v e
o r
p o s i t i v e - f o r e x a m p l e
n e g a t i v e
n o t e s
i n c l u d e d
u p s e t
a n d
c r y -
i n g o r
n e e d s much
e n c o u r a g e m e n t ,
a n d
p o s i t i v e
n o t e s
i n c l u d e d i n
g o o d
s p i r i t s
a n d
m o v i n g
w e l l . More
n e g a -
t i v e
n o t e s w e r e
m a d e
o n
p a t i e n t s
w i t h
t h e b r i c k
w a l l
v i e w : 3 . 9 6
p e r
p a t i e n t
c o m p a r e d
t o 1 . 1 3
p e r
p a t i e n t
w i t h
t h e
t r e e
v i e w
[ W i l c o x o n
m a t c h e d - p a i r s
s i g n e d - r a n k s a n a l y s i s ,
T ( 2 1 )
=
1 5 ,
z
=
3 . 4 9 ,
P