Download AZU_TD_BOX169_E9791_

X
\
THE OCCURRENCE OF BOREDOM IN ADULT PATIENTS
CONFINED FOR LONG-TERM PERIODS IN ACUTE-CARE FACILITIES
by
Natalie Ann Farrell
A Thesis Submitted to the Faculty of the
COLLEGE OF NURSING
In Partial Fulfillment of the Requirements
For the Degree of
MASTER OF SCIENCE
In the Graduate College
THE UNIVERSITY OF ARIZONA
19
8 1
STATEMENT BY AUTHOR
This thesis has been
fillment of requirements for
University of Arizona and is
Library to be made available
the Library.
submitted in partial ful­
an advanced degree at The
deposited in the University
to borrowers under rules of
Brief quotations from this thesis are allowable
without special permission, provided that accurate ack­
nowledgement of source is made.
Requests for permission
for extended quotation from or reproduction of this manu­
script in whole or in part may be granted by the head of
the major department or the Dean of the Graduate College
when in his judgment the proposed use of the material is
in the interests of scholarship.
In all other instances,
however, permission must be obtained from the author.
SIGNED: jjlflkllll ( i M f l
APPROVAL BY THESIS DIRECTOR
This thesis has been approved on the date shown b e l o w :
ALICE OEAN LONGMA#
~~
Associate Professor of Nursing
“
Date
This thesis is lovingly dedicated to my husband,
Major Michael Farrell, who graciously sacrificed over a
year of our home life together so that I could complete
this professional go a l „
ACKNOWLEDGEMENTS
Special appreciation is extended to the members
of my thesis committee for their support and guidance.
To Dr. Alice Longman, Chairman, a sincere thanks for her
patience, encouragement, and unfailing optimism.
To Lois
Prosser and Mary Ellen Hazzard, committee members, my
gratitude for your time, interest, and assistance.
TABLE OF CONTENTS
Page
LIST OF TABLES. . . .. . . .
. . . . . .
. .vii
LIST OF F I G U R E S ......................................... viii
ABSTRACT...................................
ix
CHAPTER
1.
INTRODUCTION.
. . . .
.............
. . . . . . .
1
Statement of the Problem..........
6
Purpose of the Study ^
6
Significance of the Problem .................
7
Conceptual Framework. . . .. . . . . .
. . .13
Reticular Activating System . . . . . . .
15
Psychosocial N e e d .................... . . 1 9
Psychophysiological Responses . . . . . .
20
22
Definition of T e r m s ...................
2.
REVIEW OF THE LITERATURE.
. . . . . . . . . . . .
24
Historical Review . . . . . . . . . . . . . .
25
Animal Experimentation.
. .. . . . . . . . . 2 6
Human Experimentation
...........
29
34
S u m m a r y ................................
3.
METHODOLOGY . . . . . .
36
Research Design ............................... 36
The Setting . . . .
36
The Sample. . . . . . . . . . . . . . . . . .
37
Protection of Human Rights..................... 37
The Instrument.
........................38
Data Collection Methods and Protocols . . . . .45
Data Analysis
......... 47
Assumptions . . . . . . . . . . . . . . . . .
48
Limitations . . . . . .
.............
48
v
vi
TABLE OF CONTENTS —
Continued
Page
4.
PRESENTATION OF THE DATA
..................50
Characteristics of the Sample . . ........... 50
Analysis of the Scores. .
..........
53
5.
DISCUSSION OF FINDINGS.............
61
Findings in Relation to the Conceptual
Framework . .
Findings in Relation to the Review of
the Literature...........
6.
CONCLUSIONS AND RECOMMENDATIONS .
61
65
. . . . . . . . 67
C o n c l u s i o n s ................................ . . 6 7
Implications...................... .............68
Recommendations . . . . . . . . . . . . . . .
70
APPENDIX A:
HUMAN SUBJECTS COMMITTEE
CONSENT FORM.
. . 71
APPENDIX B:
WRITTEN PERMISSION CHIEF
NURSE ..
• • 73
’' j
APPENDIX C : QUESTIONNAIRE DISCLAIMER . . . . . . . . .
75
APPENDIX D:
CHANGE SEEKER INDEX.
77
APPENDIX E:
DEMOGRAPHIC D A T A ......................... 83
SELECTED BIBLIOGRAPHY
...
. . . . . . . . . . .
85
LIST OF TABLES
Table
Page
1.
Characteristics of Subjects by Sex, Age,
Marital Status, Reason for St a y , and
Length of Stay .....................................51
2.
Means and Standard Deviations for Age and
Length of Stay of Subjects Based on Sex
and Reason for Stay „ . „
54
3.
Scores for Individual Subjects on C S I ............. 55
4.
Frequency and Distribution of Test Scores on CSI.
5.
Means and Standard Deviations of Scores on CSI
for Sex, Reason for Stay and Marital Status . . 57
6.
Comparison of CSI Mean Scores by t-Test for
Selected Groups of Subjects .
................. 58
7.
Pearson Correlations and t-Test Significance
Between CSI Scores and Selected Demographic
.............
Variables
59
Comparison of Garlington and Shimota's Original
CSI Mean Scores with Overall Mean Scores of
Current Study
............................
60
8.
vii
56
LIST OF FIGURES
Figure
1.
Conceptual Model
ABSTRACT
The occurrence and significance of boredom as a
problem of modern society has been well documented.
This
study's purpose was to measure boredom as a nursing prob­
lem in patients confined for long periods in acute-care
facilities.
The conceptual framework was based on man's
dual physical and psychosocial need for an optimal level
and variety of sensory input to maintain cortical arousal.
Boredom was conceptualized as the complex behavioral out­
come of decreased, inadequate cerebral stimulation.
Twenty subjects confined to a military medical
facility 14 or more days participated by completing a
95-item questionnaire.(the Change Seeker Index) which
measured a need for change.
A need for change was
equated with a need for sensory inp u t .
The findings demonstrated high mean scores for
the subjects.
A significant difference
(p=.05) between
mean scores of married and unmarried subjects was found.
No correlations were found between mean scores and age or
length of stay.
No significant difference
(p=.05) in
mean scores was found between male and female subjects
with medical and with surgical problems.
Subjects had
significantly higher scores than psychiatric patients
tested by the originators of the instrument.
ix
CHAPTER I
INTRODUCTION
Contemporary investigation of the problem of bore­
dom occurs in multiple areas.
Researchers from various
disciplines are currently interested in its diverse mani­
festations - from its incidence in the workplace to its
existence in space travel.
However, the problem of boredom
is not new or unique; throughout history, the dangers of
boredom and the consequences of monotony have been elabor­
ately written-, discussed, and analyzed.
There is an ancient
and historical awareness of the perils of boredom and the
sequel of monotony.
Goetzle's observation that "boredom,
the transphysiological hunger of man, and its consequences
forms an integral part of civilization" is accurate and
consequential
(1975:91).
Early philosophical and religious writings recog­
nized the evils of boredom and excess leisure.
Ancient
mythology and poetry described the moo d y , irritable, sullen
behavior of Greek gods whose lives were carefee but with­
out diversity
(Bowman, 1975).
The Roman Cassianus wrote
of the illness of "acedia" leading to anxiety and depres­
sion (Altschule, 1965).
The Jews warned of the dangers of
inactivity and lectured on the joys of w o r k .
Medieval
literature referred to boredom as a "demon" and to idle­
ness as an attraction for the devil.
the Middle Ages
The great writers of
(Aquinas, Chaucer, Dante, etc.) continued
the theme that inactivity was sinful and related to hate
and violence.
In the following Renaissance, boredom lost
its sinful stigma but was looked upon as a disease that pre­
vented happiness, threatened achievement, and caused sui­
cide.
Then, during the 19th century, boredom and its
effect on the psyche became the theme of poets, novelists,
and philosophers
(Goetzl, 1975).
By the early twentieth century, the significance
of boredom as a problem of society and human existence was
well recognized.
Early investigators acknowledged the
stupefying sequel of monotonous industrial jobs and their
direct correlation with workplace accidents
1912).
(Bogardus,
Industrial scientists evaluating workers on the
assembly line warned "... that monotony is the cause of
insanity and there is nothing more deadly monotonous than
factory work"
(National Consumers League, 1915:217).
Cur­
rent studies continue to contribute job dislike, social
tension, poor work relationships, and reduced interest to
the boredom of routine work
(Berger, 1964).
Other occupa­
tions are recognizing the dangers of monotony to perfor­
mance; psychologists studying police officers have found
the boredom inherent in many of their tasks contributes
to job stress
(Tucson Citizen, 1981).
In an intimate
biographical review of a cross-section of laborers in the
United States, Terkel tragically referred to the many who
suffer from boredom in their daily employment as "... the
walking wounded among the great many of us"
(1972:xi).
Wars enhanced awareness and spurred study of the
problems created by boredom.
Prolonged inactivity of sol­
diers was found to contribute to increased anxiety and
decreased resistance especially in death threatening situa
tions
(Grinker, 1945).
The conduct of prisoners of war
during the Korean conflict dramatically brought attention
to human behavior when isolated and inactive for long
periods
(Brownfield, 1972) .
Studies of military exper­
iences in isolated combat outposts common in the recent
Vietnam conflict revealed boredom and the behavioral out­
comes to be significant problems
(Emory, 1975) .
Outbursts of mass violence have been suggested to
be traceable to the severe frustrations related to boredom
The desperate use of coercive primitive methods
riots, gang fights, etc.)
(warfare,
is theorized as a means to
achieve stimulation in the face of overwhelming monotony
(Goetzl, 1975).
Larsen dramatically suggested the hysteri
cal Nazi reaction may have been an outcome of the boredom
and monotony induced by Germany's severe economical and
political depression
(1976).
Additionally, he asks, could
the long, h o t , dull Southern summers have contributed to
Negro lynchings
(Larsen, 1976)?
The recent riots and
excessive destruction in major British cities are primarily
thought to be an outcome of inactivity, unemployment, and
social-economical restrictions creating massive incidents
of boredom (Johnson, 1981) .
The current remarkable advances in technology and
science have dramatically enhanced the self-sufficiency
and independence of humans
(Goetz1, 1975).
Along with
push-button lives are puritanical attitudes about touch
y
and a tedious educational system that have resulted in
boredom becoming an endemic social disease of our technetronic age
(Colton, 1975).
With many activities replaced
by machines, the boredom occurring causes a failure to
find meaning in life and a profound loss of self worth
(Pugh, 1977).
Many scientists studying human behavior in
varying circumstances agree with Fried's dramatic observa­
tion that boredom is "... a serious affliction which con­
tributes importantly to the suspension of the life pro­
cesses " (1980:16).
The outcome is widespread boredom which has created
an addiction to ever-changing stimuli in an attempt to
relieve monotony and resolve inactivity.
This frantic
search for stimulation has caused profound problems.
appropriate sexual expression, increased violence, and
In­
growing urban crime are contributed to attempts to escape
boredom (Bernstein, 1975).
Excess use of drugs and alcohol
is theorized as an escape from a dull society
1973).
(Leifer,
Current teenage drug abuse is "... mostly out of
boredom"
(Henry, 1981:68).
The friction between age groups
and destructive teen gangs is credited to excess monotony
in the younger populus
(Goetzl, 1975).
Current health
problems with obesity and cigarette smoking are theorized
as a need for oral stimulation in an attempt to evade
dullness
(Emory, 1972: Rodin, 1975).
Other social problems have been connected with bore
dom.
Because of increased leisure time, decreased disease,
and a prolonged life expectancy boredom is a profound geri­
atric complaint creating one of the main concerns in aged
care
(Still, 1957).
The present high incidence of patho­
logical depression requiring extensive professional atten­
tion and treatment is frequently related to boredom (Fenichel, 1953; Zung, 1973) .
There is growing recognition and agreement that the
prevalent fear of boredom in Western society creates exces­
sive stress and tension that contributes to our many phy­
siological and psychophysiological disorders
(Goetzl, 1975)
Its incidence has become a serious obstruction to the
search for happiness in many lives; and, its omnipotent
influence cannot be ignored or dismissed as trivia.
Bernstein has dramatically warned that boredom "... is so
endemic in our technetronic age that it could help elevate
us into the next higher phase of evolution"
(1975:18).
Obviously then, boredom is not new, unique, or
exclusive to any one discipline or alliance.
No social
group, profession, or class is immune to its menace.
No
one concerned with the well being of man or society can
ignore the multiple threats
of boredom.
Any discipline
dealing with the behavioral health of people must be cog­
nizant of the problems it creates and be prepared to deal
with its complex manifestations.
Statement of the Problem
Is boredom a nursing problem among adult patients
confined for long-term periods in acute-care facilities?
Purpose of the Study
This investigation described the occurrence of
boredom in adults confined for long-term periods in acutecare settings.
Through testing of specific patient popula­
tions, some indication of the existence of boredom as a
significant problem was obtained.
Identification of bore­
dom as a nursing problem in long-term confinement may con­
tribute to current nursing knowledge.
7
Significance of the Problem
The problems, dangers, and seriousness of boredom
are ancient, universal, transcultural, and transhistorical
(Tyler, 1975).
Its significance has been addressed by
scientists, philosophers, and historians; multiple, diverse
disciplines have recognized its existence and acknowledged
its perils.
"The mind of man must be exercised"
1962:425).
(de Grazia,
The literature has abundant references to the
hazards of inactivity, monotony, and boredom.
Perhaps
Goetzl's dramatic description of boredom as a "... sense
of nothingness, of despair, of a vacuum of the spirit," in
which "hope shrivels" and "reality dims", resulting in a
"chaos within" and a "foul emptiness" most accurately
summarizes the pathetic effects it can cause on human be­
havior and emotions
(Goetz1, 1975:56).
The overwhelming and dramatic emotional responses
attest that boredom is a devastating affliction to the
human spirit (Bartlett, 1975).
Negative drives begin to
dominate; values and emotions drift in an opposite direc­
tion (e.g. joy becomes sorrow, irritation becomes anger,
etc.)
(Pugh, 1977).
The sense of helplessness, decreased
goal directed activity, and aggravated withdrawal can lead
to a serious pathological depression (Fried, 1980; Izard,
1972).
The "nothingness" of the conscious mind leads to
loneliness
(Mijaskovic, 1980) .
Loneliness compounds the
distresses of boredom; with less social contacts, self­
esteem and confidence suffer
(Eisenson, 1980).
Stress develops when the inactive mind becomes
frustrated with an unsatiated need for stimulation
side, et a l . , 1979; Hartog, 1980).
(Burn­
Overwhelming monotony
may drive individuals to acts of aggression and destruc­
tiveness in a frantic search for stimulation
(Fromm, 1973) .
Most dangerous is that boredom spawns more bore­
dom.
The inactive mind anticipates no stimulation causing
a hazardous cycle of decreased responsiveness and apathy
(Brownfield, 1972).
These disastrous effects to human behavior attest
to its significance.
Obviously, such an unsatisfactory
emotive state cannot legitimately be ignored.
Nursing has long recognized the occurrence and
seriousness of boredom.
Nightingale addressed the consid­
eration of stimulation and need for variety in her early
writings on patient care.
She chastised nurses for letting
"... him (the patient) be there staring at a dead wall,
without any change of object to enable him to bury his
thoughts ..." and was appalled that "... it never occurs
to them (the nurses) at least to move his bed so that he
can look out the window."
(Nightingale, 1912:62-63).
rently, nursing texts are beginning to recognize and
Cur­
address boredom as a specific patient problem requiring
imaginative and active interventions.
Patient studies evaluating the effects of decreased
or altered sensory input emphasize that patient boredom
is a significant potential problem.
Cognitive impairment,
episodes of organic delirium, and other abnormal psycho^
logical reactions in patients have been definitely con­
nected with the limited, monotonous sensory environment
that characterizes an acute-care setting
(Katz, et a l .,
1972; Maron, et al., 1973; Wilson, 1972).
Symptoms similar
to those occurring in laboratory sensory deprivation exper­
iments
(i.e. confusion, imagery, perceptual malfunction,
disorientation, etc.) have been identified in post-cardiac
surgery patients
(Olin, et al., 1968; Heller, et al.,
1970; Trace, 1974).
In an overview of studies on cardiac
intensive therapy, Bowden warns "... there are unique
psychological hazards
surgery
..." inherent following heart
(1975:85).
Other patient situations produced similar observa­
tions.
Pre-operative cataract surgery patients reported
frequent hallucinations which disappeared after surgery
when normal visual stimulation was returned
(Levine, 1980).
Confusion, aggressiveness, and disorientation in a post­
burn patient was significantly reduced when the environment
contained sensory characteristics of a normal milieu
10
(Richert and Cheatwood, 1976),
Recovery after brain in­
jury is improved if the frequency, intensity and duration
of sensory input is exaggerated
1978).
(Lewinn and Dimancescu,
Increased alertness and attention was noted in
psychiatric patients whose units had color and light
effectively used to avoid monotonous stimulation
1975).
(Faber,
Thus, boredom is a realistic patient threat.
Experimentation and study of subjects in restricted
environments paralleling a hospital atmosphere revealed
behavioral outcomes characteristic of boredom.
Volunteers
placed on enforced bedrest reported increased anxiety, dis­
ruptive dreams; excessive anger; and, demonstrated de­
creased performance on cognitive tests
1971).
(Ryback, et a l .,
An experiment comparing ambulatory controls to
recumbent subjects revealed increased complaints of bore-.
dom with changes in self-appraisal; vivid dreams; amplified
reports of worry and fright; and, vague restless appre­
hension
(Zubek and MacNeill, 1967).
Volunteers spending
extended periods of time in isolation rooms equipped and
arranged similar to hospital suites complained of hallucinations, delusions, tactile and olfactory distortions,
disorientation, diminished concentration, and increased
bodily discomforts
confinement
(Downs, 1974).
Prisoners in solitary
(similar to patient isolation settings)
one week demonstrated reduced electroencephalogram
after
11
frequency and decreased visual potentials
(Gendreau, et a l . ,
1972) .
It is readily apparent from these various studies
that the hospital and the patient's room can create an
ideal setting for sensory deprivation and the resultant
phenomenon of boredom.
There is a decrease in the amount
of intensity of all sensations and a diminished pattern
and meaningfulness to existing stimuli.
Social isolation
and bodily restrictions enhance the deprivation phenomenon.
Finally, sensory input is foreign, threatening, and un­
wanted
(Roberts, 1978).
Changing philosophies of care and of hospitaliza­
tion may limit a patient's confinement and thus decrease
the threat of boredom.
More stringent governmental regu­
lations and increased attention to cost containment have
dramatically shortened the length of patients' hospital
stays.
Additionally, more procedures can be accomplished
on an out-patient basis or with increasingly less restric­
tion to a medical facility required.
However, most hos­
pitals still have the unfortunate few patients who must
remain confined for weeks and months to receive essential
care and treatment.
Because of their unique situation and particular
mission, military medical facilities have an even greater
number of patients confined for longer periods than general
12
civilian treatment centers.
The patients' dislocation
from home and family, possible isolation in an overseas
setting, eating and living arrangements, and active-duty
status all result in the need for longer hospitalizations.
The current average length of stay in a civilian community
hospital is 5.8 to 6.2 days for patients 65 years and under
(Cohen, 1981:51).
However, a world-wide quarterly average
for length of stay in all types of military medical facili­
ties is 6.8 days
(Headquarter's Report, 1981).
Major mili­
tary treatment centers have an even longer quarterly aver­
age length of stay of 11.5 days with a 15.7 day average
not uncommon at some major referral and treatment facili­
ties
(Headquarters Report, 1981).
Obviously then, the
unique situations within a military hospital with fre­
quently increased confinements could dramatically enhance
the development of boredom.
Conscientious health care workers regardless of
affiliations must realize the potential problems that
altered sensory input create.
Reduced or monotonous stim­
uli fail to maintain an appropriately responsive cerebrum
and result in the complex psychophysiological responses of
boredom.
Hospital settings provide a unique atmosphere
that can readily produce this problem.
Nurses must per­
ceive the significance of this intricate interaction if
they intend to provide comprehensive, thorough care.
Conceptual Framework
Man has both a psychological and physiological need
for a continuous, varied sensory input that formulates the
conceptual basis for boredom.
An organic mass, the reticu­
lar activating system (RAS) requires a certain level of
sensory stimulation for adequate function.
Concurrently,
a hum a n 1s psychosocial need for sensory input must be
satisfied.
Together, they contribute to maintaining homeo­
static cerebral performance.
As modeled in Figure 1, when an optimal amount of
stimulation as well as an appropriate variety is available
to satisfy both requirements
(RAS and psychosocial), essen­
tial cerebral arousal is achieved.
vide insufficient stimulation
amounts
Situations that pro­
(deprivation), excessive
(over-load), and/or an insufficient variety con­
tribute to cortical malfunction and the occurrence of the
complex psychophysiological phenomenon recognized as bore­
dom .
These two interdependent assumptions form a con­
ceptual approach that affirms that "sensory variety is
not just the spice of life, it is the bread of life"
bek, 1969:432).
(Zu-
A review of each related concept follows:
a separate discussion of the psychophysiological behavioral
responses induced when the body's stimulus needs are un ­
satisfied is included.
14
Amount of
Stimuli
Optimal
Performance
Reticular
Activating
System
Cerebral
Arousal
Psychosocial
Variety of
Stimuli
Boredom
Figure 1.
Conceptual Model
Reticular Activating System (RAS)
The reticular formation is essentially a network
of interneurons occupying the mid-line of the brain stem
between the medulla and the thalamus
(Newman, 1980).
This
dense nerve cell mass was first demonstrated to be con­
nected with arousal, alertness and awakeness in animals
70 years ago.
Current research strongly supports the
hypothesis that this unique organ structure has a contin­
ued need for stimuli that is directly related to cerebral
performance.
Essentially a structureless "reticulum" of cells,
the RAS contains some of the largest single neurons in the
central nervous system.
Its complex network of multiple
short synaptic chains provides opportunities for rapid
interaction and transfer of sensory messages
1978).
(Uttal,
Although lacking the usual linear ordering with
typical clearly defined afferent pathways, the RAS receives
afferent connections by collateral branches from all the
ascending sensory tracts of the spinal cord and cranial
nerve roots
(Wyke, 1969).
Additionally, fibers descend
from this reticulum that influence the autonomic nervous
system and body musculature.
Most significantly, via a
reticulocortical system of fibers, the reticular cells
project to nearly all areas of the cerebral cortex and,
in return, can receive impulses from the brain
(Wyke,
16
1969) .
T h u s , there exists a functioning "control center"
that both receives input from all peripheral sense organs,
contributes impulses that influence their activity, and
has direct connections to the cerebral surface
(Carter,
1976).
Modern physiological studies have proven the mutual
interdependence of the activity of the cortical neuronal
system and the reticular complex.
Experimentation has
demonstrated that input received from all primary sense
organs
(i.e. visual, auditory, olfactory, etc.) activates
the RAS.
The reticular system then, through its diffuse
ascending projections has been shown to activate the
neuronal networks of almost the entire cerebral cortex
(Schulz, 1965; W y k e , 1969).
Local stimulation of the
RAS in a sleeping cat causes immediate arousal and atten­
tion with electroencephalogram activity shifting from highvoltage slow waves characteristic of sleep:to the desyn­
chronized low-voltage patterns typifying alert attention
(Leukel, 1976).
Conversely, experimentation with electrical
stimulation of the cerebral cortex leads to electrical re­
sponse in the reticular body proving az reciprocal relation­
ship (Brownfield, 1972) .
T h u s , there exists a physio­
logical organ system that forms a vital, intermediary link
between the cortex and peripheral nervous system.
17
The cerebral cortex is responsible for thinking,
learning, and emotional activities that are vital to man's
adaptation and survival.
It is obvious, then, that this
higher brain area must be kept in an aroused readiness
to insure immediate, appropriate responsiveness that will
accommodate man's needs.
The reticular activating system's
primary role is to "keep the brain awake"
298).
(Leukel, 1976:
Through its vast, non-specific connections to the
cerebral surface, the RAS "sprays" the cortical neuronal
area with signals to keep the brain conscious and maintain
arousal
(French, 1957).
Through its unique ability to re­
ceive input from all sensory and motor nerves, it thus
prepares the higher brain.for performance by exciting
the cells of the cerebral cortex
(Carter, 1976).
Experimentation with alterations in sensory input
(either restriction or overload) has proven the RAS has an
i
adaptive level and becomes accustomed to a certain degree
of stimulation.
This level is projected to the cortical
areas concerned with perception, learning, anti emotion
(Schulz, 1965).
Lindsley, in some experiments, recognized
as definitive classics, noted marked behavioral distur­
bances under conditions of both sensory deprivation or
overload.
He concluded that RAS was a "barometer" with a
specific adaptive level that became attuned to certain
levels of activity which in turn, were reflected on the
18
cortex (Brownfield, 1972) .
The optimal level set by the
RA.S shifts and adjusts over time dependent upon the level
of stimulation in the organism's immediate history but
cortical efficiency is still dependent upon a specific
range of input.
Extensive experimentation in sensory
altered situations provides conclusive evidence that the
cortical neuronal network needs meaningful amounts of
sensory input to promote normal development and to main­
tain efficiency
(Fiske and M a d d i , 1961; Boddy, 1978).
A related and important additional conclusion
reached by researchers in sensory-altering studies was
the need for a variety of stimuli.
Repetitious, redundant,
innocuous, or irrelevant stimuli inhibit the RAS and con­
sequently the cerebral cortex
(Ellis, 1973).
Outcomes of
multiple studies in sensory deprivation revealed repeti­
tive stimuli altered RAS adaptation through habituation
creating cortical depression causing decreased responsive­
ness, diminished alertness, and impaired cognitive per­
formance
(Brownfield, 1972; Schultz, 1965).
Since the most
dramatic effects have been seen in situations with a reduc­
tion in the variety of sensory input, it has been the gen­
eral conclusion of researchers that a change in stimulation
is most significant to cerebral performance
(Hebb, 1958;
Berlyne, 1960; Fiske and Maddi, 1961; Brownfield, 1972).
19
Psychosocial Need
Related to the reticular activating system's func­
tional dependency on a varied level of generated sensory
input is the drive concept developed by psychologists and
behavioral scientists.
Research during the past two de­
cades in sensory deprivation has generated conclusions
that sensory stimulation is a distinct motivational force;
abnormal inappropriate stimuli can be as specific a physio­
logical impulse as hunger, thirst, or pain (Zubek, 196 9).
A general agreement exists that "there is a drive to main­
tain a constant range of varied sensory input in order to
maintain cortical arousal at an optimal level"
(Brownfield,
1972:112).
Various behavioral researchers have addressed the
issue but probably Schultz's "sensoristasis" most clearly
presents the concept.
He sensibly argues that the multi­
ple behavioral, non-visceral drives postulated
(e.g. explor­
ation, curiosity, manipulation, etc.) all have the same
ends - "the bringing about of an optimal level of sensory
variation"
(Schultz, 1965:30).
Sensoristasis
(a drive
state of cortical arousal that impels the organisms to
maintain an optimal level of sensory variation).is similar
to homeostasis in that the organism attempts to maintain
an internal balance of sufficiently varied sensory input
to maintain cortical excitement and function
(Schultz, 1965).
20
Sensoristasis is. concerned with sustaining a
fluctuating constant of stimuli within an optimal range
that can adapt to the situation and subjective variables.
Balance is disturbed by sensory reduction or overload.
Based on this m o d e l , Schultz proposed specific behavioral
predictions connected with insufficient or excess stimula­
tion.
When sensory restriction occurs, cortical balance
is disturbed; the organism exhibits gross disturbances in
cerebral functioning
etc.).
(e.g. perception, cognition, learning,
Reduction or deprivation of variation in stimuli
(rather than amount per se) causes an even more severe
upset in the sensoristatic drive state
(Schultz, 1965).
Psychophysi.ological Responses
Multiple experiments especially in the last two
decades, subjecting both human and animal subjects to
situations of reduced environmental stimuli, substantiate
that for optimal cortical function, specific levels of
meaningful sensory stimuli are necessary.
Results have
shown a normally functioning brain depends on a constant,
varied sensory bombardment
(Gorney, 1972; H e r o n , 1957).
Without sufficient or appropriately varied sensory input,
cortical efficiency is impossible.
Varied manifestations of cerebral imbalance and
malfunction have been documented.
Cognitive functions
falter with decreased ability to perform tasks; increased
errors in problem solving; diminished mental clarity; and
a decreased ability to concentrate and organize thoughts
(Berlyne, 1960; Heron, 1957; Zubek, 1964)„
Hallucinatory
experiences have occurred with "mescal-like symptoms" of
visual illusions, distorted body image, and inappropriate
auditory reports
(Zubek, 1964).
Emotive responses further
support cerebral maladaptive performance with reports of
aggression and" mild violence; sudden anger or inappropriate
amusement; apathy, depression or withdrawal; a n d , com­
plaints of excessive stress and anxiety (Berlyne, 1960;
Engel, 1962; Heron, 1957; Lennart, 1972).
Mental deter­
ioration with introversion, non-productivity, reduced
self-esteem, and cognitive ineffectiveness result from an
unstimulated ego
(Fisk and M a d d i , 1961; Goetzl, 1975).
There is a "paralysis of will" with complaints of empti­
ness, passivity, longing, and alienation
125).
(Thompson, 1975:
Restless, erratic, impulsive behavior occurs in the
subject's desperate search for sensory nourishment
(Hokan-
son, 1969; Ellis, 197 3; Goetzl, 1975).
Actual physiological changes in cerebral structure
and the neuronal network accompany behavioral changes when
modifications in stimulation occur.
Prolonged stimulus
deprivation produces measurable decrements in the composi­
tion and chemistry of the brain
(Boddy, 1978).
Comparison
of brains of animals reared in more complex sensory envir­
onments revealed increased total cholinesterase and
22
acetylcholinesterase enzyme activity; slightly greater RNA
concentration and DNA production; a n d , larger protein pre­
cursor uptake
(Walsh, 1980).
Other physiological changes
are evident in decreased electroencephlogram activity;
diminished electrical frequencies within the occipital
lobe; a n d , an increased output of adrenalin and norepinepherine by the medulla in response to stress
(Zubek, 1964).
These multiple, varied behavioral and emotional
manifestations, a result of inadequate or unvaried stimuli
evoking faltered cerebral performance constitute the
phenomenon of boredom.
The dulled, unstimulated cortex!s
failure to function becomes apparent in the diverse in­
appropriate emotional and cognitive responses that occur.
It is obvious that meaningful sensory input is vital for
psychic adjustment and to prevent the heinous outcomes of
boredom.
Without an optimal level and variety of stimuli,
human adjustment and survival would be threatened.
Thus,
it is obvious "the continuous encounter with continually
changing conditions is the very substance of living"
(Menninger, 1959:5).
Definition of Terms
1)
Long-term:
Fourteen or more days of uninter­
rupted confinement in an acute care medical
facility.
23
2)
Boredom:
Psychophysiological behavioral
responses to an alteration in sensory input.
3)
Acute-care Facility:
Medical center or hospital
with a primary goal of diagnosis and treatment
of serious, emergent health problems and
illnesses.
4)
Patient:
Any person receiving services within
a medical treatment facility.
5)
Adult:
Individual 18 years of age or older.
CHAPTER 2
REVIEW OF THE LITERATURE
No published studies are available that specific­
ally measure boredom in hospitalized patients.
However,
laboratory experimentation with both humans and animal
subjects exposed to decreased sensory environments closely
parallels this research proposal.
The observations and
conclusions presented are comparable to probable patient
reactions to boredom that could occur in an acute care
setting.
Sensory alteration testing generally can be cate­
gorized into two types depending on the technique of
stimuli alteration.
Sensory deprivation involves a reduc­
tion to a minimum of all or selected sensory input
visual)
from the external world.
(e.g.
Perceptual deprivation
entails a decrease in the pattern and organization of
stimuli while maintaining input near normal
(e.g. goggles
may be worn that allow light penetration but with blurring)
(Zubek, 1964; Schultz, 1965).
Both methodologies utiliz­
ing human or animal subjects have revealed consistent
behavioral alterations.
The following review includes discussions of both
animals and human behavior after exposure to sensory and/or
24
25
perceptual deprivation.
A brief historical summary of
experimentation is first provided for a more adequate
perspective of current research.
Historical Review
Early studies and discussions on the effects of
sensory deprivation during the 1 9 3 0 1s and 1940's w e r e , for
the most p a r t , confined to observations, case histories,
and other less scientific situations.
One of the few
laboratory demonstrations conducted in the late 1 9 2 0 ’s
revealed that repetitive, monotonous tasks caused rapidly
deteriorating performance . (Schulz, 1965).
In the late
1940's, animal and infant studies were conducted to measure
effects and influence of altered sensory input on neuro­
logical and behavioral development
(Brownfield, 1972).
Probably the most significant and disciplined research
began with Hebb in 1951 at McGill University; his work
laid the groundwork and theoretical formulations for
future studies.
The Princeton University investigations,
begun in .1955, established exact definitions to fit the
growing scientific body of knowledge and developed definite
classifications for the behavioral effects observed.
Through the 1960's, frequent studies with both human and
animal subjects were conducted at large universities
associated with medical schools
(e.g. Rutgers, Case Western,
New York University, etc.) that contributed to comprehensive
publications and beginning theoretical framworks
1969).
(Zubek,
Current concerns with behavioral reponses to
stressful, monotonous environments
submarines, radar stations, etc.)
(e.g. space vehicles,
and advances in neuro­
physiology related to the role of the RAS have continued
the impetus for study
(Schultz, 1965).
A common, general
conclusion of all these early observations was that ex­
tended periods of solitary confinement "... have disturbing
effects and can obviously disrupt human organization and
behavior"
(Flske and Maddi, 1961:122).
Animal Experimentation
Animal subjects inflicted with perceptually altered
environmental conditions to include reduced social stimuli
evidenced multiple, varied, and inappropriate behavioral
changes.
Chimpanzees observed during play behavior were
found less active when exposed continuously to similar
objects in a repetitious environment
(Welker, 1956).
Cats
reared in a restricted environment had decreased explora­
tory behavior; increased passivity to physical restraint;
and, larger autonomic responses to brief novel stimuli
(Konrad and Bagshaw, 1970).
Fish isolated for various
periods demonstrated decreased sexual activity and in­
creased attack rates resulting from an alteration in their
motivational systems attributed to inadequate stimuli
(Fern, 1978).
Rats cut off from social and visual contact
27
with other rats evidenced increased nervousness , difficulty
in group relationships, inappropriate aggression, and
heightened blood pressure and pulse rates
(Houlihan and
Delaney, 1969).
Studies in sensory deprived situations indicated a
"stimulus hunger" existed in animal subjects.
Rats repeat­
edly exposed to a novel stimulus showed diminished interest;
however, over time enthusiasm returned when a new, unfamil­
iar stimulus source was provided
(Berlyne, 1955) .
Monkeys
deprived of visual experiences for periods of time fre­
quently sought a light stimulus with greater frequency than
control groups
(Butler, 1957; Jones, et a l ., 1961).
With
increased deprivation the monkey's drive for visual novelty
was found to increase proportionately
(Butler, 1957).
A
greater incentive for exploratory behavior to obtain stim­
ulation was found in rats exposed to more complex stimuli
after deprivation periods
(Taylor, 1974).
Actual cerebral cellular changes have been noted
in animals exposed to
altered sensory situations.
Compar­
ing pathological findings between rats from a stimulating
environment with those from a monotonous milieu revealed
the stimulated rats' brains had a two percent higher amount
of acetylcholinesterase; weighed four percent more; had a
six percent deeper cortex with larger blood vessels; had
larger neurons; and, showed an increased number of glia
28
cells
(Krech, 1966).
Eterovic and Ferchim found the brain
weights of rats existing in environmentally complex situa­
tions were greater than the brain weights of rats existing
in impoverished conditions
(1974).
Two groups of investi­
gators, in separate experimental situations, found rats
reared in enriched sensory environments had a greater
forebrain:hindbrain ratio; greater brain weight; and,
increased amounts of DNA and RNA (Rosenzweig, et a l ., 1978;
Walsh and Cummins, 1979).
Testing situations with animal subjects involving
a single sensory deprivation
(e.g. visual)
abnormal behavioral adaptations.
also revealed
Hamsters in environments
with patterned but indistinct light had altered visual
discrimination and delayed responsiveness
1978).
(Chapula, et al.,
Rats in continuously dark environments had a de­
creased number of neuron dendrite spikes on microscopic
examination which altered their visual synaptic abilities
(Ruiz-Marcos, et al., 1979).
Hooded rats revealed de­
creased depth discrimination
(Walk and Walters, 1973).
Rats in sound-proof cages had increased blood pressure
which was theorized as a stress response due to the altered
input to the RAS
(Lockett, 1973).
Interesting physiological responses to an altera­
tion of a specific sensory input have been found.
transmitter chemicals
Neuro-
(P-like peptides) were released in
29
decreased amounts in visually deprived rats
et a l ., 1979).
(Pradelles,
Visual deprivation in dogs caused a reduced
stomach acid output, a diminished pepsin concentration, and
a depressed height of fundic mucosa
1970).
(Schapiro, et al.,
Dogs exposed to auditory, vestibular, olfactory,
as well as visual deprivation showed similar results which
were felt to be an outcome of the interference in sensory
modalities on the central nervous system (Schapiro, et al.,
- July-August, 1970; Schapiro, et al., September-October,
1970; Schapiro, et al., 1971; Schapiro, et al., 1973).
Human Experimentation
Probably the most impressive data on the behavioral
outcomes induced by sensory or perceptual isolation have
been with human subjects.
The psychosocial reactions to
altered or reduced stimuli documented are comparable to
the behavioral manifestations a bored patient may exper­
ience in the monotonous, restricted milieu of a medical
facility.
The perceptual deprivation studies provide the
most significant and meaningful data since these environ­
ments most closely resemble health care settings.
Human
subjects in laboratory situations with altered and/or
unusual sensory loads consistently demonstrated the detri­
mental influence these surroundings have on emotions,
and performance.
Unpatterned, meaningless noise evoked
30
complaints of sleep-wake confusion, emotional lability,
impaired reality responses, imperfect visual retention,
and generally impaired cognitive functions in ten volunteer
subjects
(Rosenzweig and Gardner, 1966).
Similar experi­
mentation by Rossi, et al., evidenced comparable mental,
cognitive impairments with poor judgement, inaccurate
reports, and slow responses in 10 subjects exposed to six
hours of controlled sensory deprivation
(1967) .
These
researchers felt a decreased cerebral arousal from insuf­
ficient stimuli contributed to the ineffectual thought
processes.
Curtis and Zuckerman reported a dramatic situa­
tion in which a subject voluntarily underwent perceptual
deprivation experiments then experienced an acute psychotic
reaction requiring psychiatric intervention.
His sympto­
matology included dramatically exaggerated responses to his
experience
(i.e. altered body sensations, delusions atnd
hallucinations, depression with suicidal thoughts, e t c .)
(1968).
Experimental situations with nearly total sensory
deprivation produced excessive disturbances in 13 volun­
teers with pronounced alterations in visual, auditory,
olfactory, kinesthetic, and body-image responses in a
study by Schulman, et al.,
(1967).
Performance and behavior have been shown to be
dependent upon adequate sensory stimulation in human sub­
jects.
Sixty-four undergraduates demonstrated greater
31
recall and improved accuracy when exposed to a varied
string of letters as opposed to monotonous sets
et al. , 1974)
(Ellis,
An opposite but related study of 10 sub­
jects from isolated Norwegian farms compared to 10 urban
dwellers matched for sex, age, schooling, and intelligence
revealed the farmers tolerated sensory deprived situations
better.
The researchers theorized that a reduced cortical
acclimatization and less stimulus requirement accounted
for the differences
(As, et al., 1970).
Specific physiological changes in response to a de­
creased sensory load have been reported.
Sixteen female
nursing students experiencing short periods of isolation
had electrical encephalogram with decreased amplitude,
increased frequency, and, a diminished voltage-frequency
ratio as well as more frequent vertical eye movements.
These effects were theorized as boredom "starving" the
brain of a normal input causing loss of appropriate cere­
bral responsiveness
(Serafetinides, et al., 1972).
The
psychophysiological stress symptoms induced by eight hours
of perceptual isolation produced increased 17-ketogenic
steroid release; magnified 17-ketosteroid production;
and, heightened plasma thyroid-stimulating hormone pre­
sence in 18 male volunteers
(Zuckerman, et al., 1966).
Repetitive arid reduced auditory stimuli rapidly diminished
cortical responsiveness in 28 college students showing
32
decreased EEG frequency and reduced electrodermal measures
for cerebral alertness
(Siddle and Smith, 1974) .
Some isolated studies measuring singular sensory
restrictions on humans evidenced altered performance of
the specific sense organ.
Fourteen volunteers blindfolded
and allowed to exist in an otherwise normal atmosphere
for seven days demonstrated increased pain and pressure
sensitivity as compared to a similar control group
(Zubek,
et a l ., 1973).
(108 to
Long periods of visual deprivation
128 hours) produced random experiences of abnormal color,
perceptual, and patterning events in a 32-year-old male
physician observed on two separate occasions over a year
apart (Heinemann, 1970) .
Man's need for an optimal level of stimulus has
been demonstrated in some experimentation that provided
reduced sensory environments with controlled stimulus
inputs.
Thirty-six Naval enlisted men were exposed to 24
hours of near total sensory deprivation and then to 24
hours of a "cafeteria" of stimuli to demonstrate indi­
vidual stimulus needs.
After exposure to the deprived
environment, subjects complained of boredom, unhappiness,
depression, and decreased alertness.
Most significant was
their demonstrated "stimulus-hunger" displayed in their
repeated request to hear a repetitious stockmarket report
which was the only novelty offered
(Smith and Myers, 1966).
A similar experimental situation with extended .isolation
periods revealed even a greater stimulus seeking propensity
with time.
The behaviors of 4 0 male subjects confined to
a small dark space were compared to a control group of
20 men allowed to exist in a laboratory area with normal
amounts of stimuli for seven d a y s .
A recorded stock report
was the only diversional stimulus offered; although no
subjects were interested in the stock m a r k e t , they repeat­
edly requested the report to "hear a voice" or "hear a
sound".
Smith, et a l . concluded this strongly supported
arguments that humans have a decided need for cortical
arousal
(1967).
A desire for stimuli was supported by the
experiences of 80 college undergraduates exposed to rela­
tively repetitious and then varied background sensations.
The subjects complained of less tedium and increased
"favorability" with the changing, shifting stimulation
(Harrison and Tutone, 1974) .
Zuckerman, a recognized authority on sensory alter­
ing testing, concluded in a review of current research that
there is a need for an optimal level of stimuli.
Either
reduced or excess amounts can have a derogatory effect on
human behavior with an occurrence of the multiple psycho­
logical and physiological manifestations outlined
man, et al., 1970).
(Zucker­
Experimentation on behavior, espe­
cially with humans as reviewed in the preceding sections
34
strongly supports man's need for stimulus input to main­
tain cerebral arousal.
.
Summary
Burney, a POW who experienced eighteen months of
solitary confinement dpring World War I I , poignantly stated
that "Variety is the very stuff of li f e .
We need the con­
stant ebb and flow of sensations, thought, perception,
action, and emotion - keeping even our stability in the
ocean of reality"
(Brownfield, 1972:21).
These reports of
experiments with modified or altered sensory inputs ob­
viously and dramatically confirm the importance of varietal
stimuli on man's performance.
Lilly in reporting on his
autobiographical review of people who experienced severely
insular situations concluded "... that persons in isolation
experience m a n y , if not a l l , of the symptoms of the men­
tally ill"
(Gottlieb, 1956:4).
Summaries and reviews of experimentation with re­
duced and unchanging sensory input agree that physiological,
cognitive, perceptual and affective impairments occur
(Zubek, 1964; Schulz, 1965; Goetzl, 1975; E n g e l , 1962;
Csikszentmihalyi, 1975; Berlyne, 1960; Gorney, 1972;
Heron, 1957).
It is apparent that humans depend upon con­
tinually varied and changing sensory stimulation to main­
tain normal, intelligent, coordinated, adaptive behavior
35
and mental functioning.
The hospitalized patient's envi­
ronment closely parallels these experimental situations
and it is not difficult to conclude similar behavioral
and emotional responses could be anticipated.
CHAPTER 3
METHODOLOGY
This study measured a need for change in subjects
confined for long periods in an acute-care setting as an
indicator that the problem of boredom may exi s t .
This
chapter describes the research design, the setting, the
sample, the data collection protocols and methodology, and
the tool used to collect the data.
Research Design
A descriptive study was conducted to ask the ques­
tion:
Is boredom a nursing problem for adult patients
confined for long-term periods in acute-care treatment
facilities?
Conceptually, the psychophysiological phenom­
enon of boredom is an outcome of a decrease in the amount
and variety of stimuli necessary to maintain adequate
cerebral arousal.
Measurement of a need for variety,
stimuli, or alterations in sensory input of confined sub­
jects should indicate decreased cortical activity and the
probable existence of boredom.
The Setting
Subjects for this study were selected from a 300bed regional military medical factility located in an urban
37
southeastern community.
All active duty armed forces
personnel and their dependents, retired military personnel
and their dependents, and selected government employees are
eligible for treatment at this facility.
Subjects were
selected from general medical-surgical units.
No require­
ments were imposed limiting what location or room a parti­
cipant had; subjects had private rooms, two and four-bed
rooms as well as occupied beds in the 20-bed w a r d s .
No
control over the variety dr level of stimulus each parti­
cipant received through available sources
(i.e. visitors,
occupational therapy, etc.) was attempted.
The Sample
A convenience sample of 20 subjects was used.
The
subjects who met the following criteria were included in
the sample:
1.
Either sex at least 18 years of age or older.
2.
Able to speak, read, and write English.
3.
Met the definition of long-term confinement
(14 or more days).
4.
Had no problem which involved impairment of
their mental capacity.
Protection of Human Rights
The research proposal outlining the purpose and
method of the study was submitted to The University of
38
Arizona Human Subjects Committee.
It was approved as
exempt from University review by the College of Nursing
Ethical Review Subcommittee and the Director of Research
(Appendix A).
A copy of the research proposal and exemp­
tion was then submitted to the chief nurse of the medical
facility for her review.
Additionally, the investigator
reviewed and outlined the research project with the
hospital commander to clarify the intent of the study.
Verbal authorization from the hospital commander and
written permission from the chief nurse
(Appendix B) were
subsequently obtained.
Prior to a subject's completing the questionnaire,
a verbal explanation was provided that emphasized:
1)
the purpose of the study; 2) that participation was com­
pletely voluntary, 3) that all information would remain
anonymous and confidential with names and data coded, and
4) that participation would take approximately 30 minutes
and no risks would be involved.
A disclaimer statement
at the beginning of the questionnaire reaffirmed this and
informed the subjects that their participation implied
consent (Appendix C ) .
The Instrument
Since the conceptual framework for this research
proposal was based on the premise that a changing stimulus
39
is necessary for effective human functioning, a tool
measuring a need for change was required.
The Change
Seeker Index (CSX) developed by Garlington and Shimota
was appropriate since their instrument was based on an
identical framework
(Appendix D ) .
Their observations of
personality and human behavior concluded that "... all
humans require some stimulus variability ..." and that
there is a "... need for variation in one's stimulus
input in order to maintain optimum functioning"
ton and Shimota, 1964:919).
(Garling­
Because this concept was be­
coming a recognized, important part of motivational
studies and there were limited, convenient, or reliable
tools available,
they developed the CSI that specifically
"... measures o n e 1s need for change or variation in
stimuli" ' (Garlington and Shimota, 1964:920).
The 95-item self-report tool has brief, succinct
statements that probe an individual's need and interest
in change.
completion.
Simple true-false answers are required for
Basic point scoring provides an indication
of "change seeking" clearly and concisely defined by
Garlington and Shimota as "... a habitual, consistent
pattern of behavior which acts to control the amount
and kind of stimulus input a given organism receives
(1964:920).
40
Garlington and Shimota did some initial reliability
and validity testing on their instrument.
Further applica­
tion by various behavioral researchers has enhanced their
early conclusions on the t o o l 1s value and u s e .
During their beginning development, the authors
measured reliability via internal-consistency through the
split-half method for two groups
(n=80 and n=50)
for an
average reliability between the two groups of .90.
Further
reliability was initially calculated with the test-retest
method between hospitalized psychiatric patients, college
students
(n=48). and soldiers
respectively
(n=44)
for r's of .91 and .77
(Garlington and Shimota, 1964).
Other test-
retest reliability was later achieved when Farley found
scores obtained in administering the CSI to college
students closely comparable to those reported by Garling­
ton and Shimota
(1971).
Equivalence reliability using parallel instruments
to assess the same subjects was accomplished by Acker and
MeReynolds who tested 104 college students enrolled in
undergraduate psychology classes.
Using four personality
inventories that all measured a "need/for novelty", they
obtained positive and moderately significant r's from
.45 to .62 (1967).
Similar reliability testing was
accomplished by Stock and Looft who used three inventories
developed to measure optimal or preferred levels of
41
stimulus input
(1969).
The authors found the CSI had a .82
Pearson relationship with the other two tests concluding
that the three scales were measuring the same phenomenon
(stimulus-variation seeking)
it best"
and "... that the CSI measures
(Stock and Looft, 1969:1011).
Further equivalence
reliability was achieved in another similar research study
with three measures of stimulation seeking administered
to undergraduate college students
(n=225).
Correlations
computed indicate a strong relationship among the scales
(McCarroll, et a l ., 1967).
Another study was designed to obtain estimates of
the degree of interrelationship among four measures of
stimulation seeking.
f's of .63,
The CSI intercorrelated with Pearson
.44, and .55 with the three other scales indi­
cating a moderate relationship
(Farley, 1971).
Another
analysis of five measures of sensation seeking showed
"moderately high" intercorrelations among three question­
naire, paper-pencil tests
(Looft and Baranowski, 1971).
Considering these limited samples, reliability for
the CSI is generally adequate.
For group-level compari­
sons or judgements on a group's characteristics, coeffi­
cients in the vicinity of .70 or .60 are sufficient (Polit
and Hungler, 1978).
Solid evidence supporting the validity of most
psychologically-oriented measures is difficult to
42
establish and often not available
(Polit and Hunglet, 1978).
The CSI does, however, have a reasonably respectable col­
lection of data attesting to its validity.
Some initial content validity was achieved when
Garlington and Shimota selected items from existing per­
sonality questionnaires that reflected "change seeking"
(1964).
Unfortunately, they do not mention which specific
items or what personality tests were used which would
have helped enhance content validity.
items were administered to three groups
The original 211
(total n=302);
items correlating at p=.05 were retained creating a final
list of 95 statements.
Further face and content validity was achieved
through the test's recognition by various experts in psy­
chological and behavioral science research.
Farley men­
tioned, the CSI as one of the acknowledged measures of
stimulation seeking moderately to highly correlated with
other accepted tests
(1974).
Various articles on novelty
and sensation seeking identify Garlington and Shimota1s
tool as one common measure
Waters, 1974).
(Mehrabian, 1975; Pearson, 1970;
In creating a broad sensation-need measure,
over one-half of the items in the CSI were used in a test
developed by Harris and Hilf contributing expert opinion
to content validity
(1970).
i
I
■S'
.
43
During their development of the C S I , Garlington and
Shimota began validity testing by comparing CSI scores
to scores on the Graves Design Judgement Test and the
Welsh Revised Art Test both utilized to measure novelty
and change needs.
Correlations were .30 (n=71, p=.02)
and .30 (n=74, p=.01) respectively on undergraduate college
students enrolled in psychology classes
(Garlington and
Shimota, 1964) .
More current criterion-related validity is pro­
vided through various studies that utilized the CSI to
predict the occurrence of certain behaviors considered
as typical of a need for variety in stimulation.
Farley
and Farley used the CSI in testing 290 college undergrad­
uate students to ascertain the relationship of stimulationseeking to the impulsiveness and sociability components of
extraverted personalities
(1970) .
The CSI correlated
positively to the variables of extraversion, impulsive­
ness, and sociability with product moment correlations of
.46,
.69 and .35 respectively
(Farley and Farley, 1970).
Further criterion-related validity was established .
by McReynolds who tested 32 college students with the
Change Seeker Index and Sensation-Seeking Scale to assess
their motivation to seek novelty
(1971).
He offered the
subjects an opportunity to participate in an admittedly
stressful experiment but one that would also be stimulating
44
and provide novelty.
He successfully predicted that the
two change seeking measures would correlate positively with
the choice to participate
(Pearson r=.40 and .35).
Again,
significant correlations between the two sensation-seeking
scales occurred
(r=.72)
(MeReynolds, 1971).
CSI scores, in another report, correlated with
reported incidents of behavior ranked high in stimulationseeking characteristics
(i.e. drug use, eating spicy foods,
attending X-rated films, etc.).
Drug use and CSI scores
showed significant positive correlations and the other
behaviors reached significance at .05 or less
a l ., 1974).
(Brown, et
Another study revealed both originality and
fluency in timed tests was slightly related
significantly)
to CSI scores
(Farley, 1976).
(although not
Further .
criterion validity was proved when scores on the Graves
Design Judgement Test measuring creativity and art educa­
tion "correlated significantly" with the CSI indicating an
ability in art was related to an individual's need for
variety and stimulation (Rump, 1977).
Although the CSI is not a new test, continued
application in various situations and circumstances has
contributed to its validity and reliability.
A l s o , the
items' content has not changed in val u e , importance, or
significance over time; no current social trends or
attitudes have altered the CSI's basic purpose.
The test
45
has been consistently used over the past 17 years for
evaluating a need for change.
In a recent phone conversa­
tion, Garlington revealed the CSI is currently being used
in consumer testing to measure changing needs related to
product interests
(1981).
The CSI had other attractive features that facili­
tated its use with patients.
Although it contains 95
items, they are brief, succinct, and relatively simple.
Since only true or false answers are required, completion
in less than 30 minutes was easily managed.
Objectivity
was easily achieved; the simple application and scoring
avoids disagreements or conflicts among various researchers
using the tool.
Previous utilization with patient popu­
lations was additionally reassuring.
Because the test had been published and was avail­
able in the public domain, no written authorization by
Garlington or Shimota was necessary.
Data Collection Methods and Protocols
After exemption by the College of Nursing Ethical
Review Subcommittee and sanction by the chief nurse and
hospital commander, data collection was initiated.
Since
unit work loads and activities are less intense during the
evening shift (3 to 11), data collection was accomplished
during this period.
Initial contact with the evening
46
supervisor provided information on units that would most
likely have subjects.
Confirmation of eligibility was
determined from individual medical records and from unit
nursing staff by the investigator.
The investigator individually approached patients
at their bedside; introduced herself; explained her posi­
tion; and, discussed her purpose and interest in being
there.
An effort was made to keep the introduction brief,
uniform and concise; the topic "boredom" was purposely not
specifically mentioned to avoid suggestability and intro­
duce possible bias.
Instead, the investigator explained
she was interested in a patient's interest in change after
being in the hospital for awhile.
The disclaimer state­
ment was verbally explained and clarified; any questions
were answered.
The questionnaire was then left with the subject
for a minimum of 30 minutes, however the investigator in­
formed the subject she was available at the nurse's station
should questions arise.
While the subject was completing
the questionnaire, the investigator obtained the demo­
graphic data
(Appendix E) from the subject's medical record.
On completion of the test, a code number was assigned to
the questionnaire and corresponding demographic data sheet.
47
Data Analysis
Scoring of the true-false answers on the CSI was
on a single-point system.
Starred items were scored high
for change seeking if answered false; one point was
assigned to these.
All non-starred questions with a
true response also indicated a high propensity for change
and were given one poi n t .
no points.
All other responses received
The total possible score was 95 (Garlington,
1981) .
Since this was a descriptive study with one basic
score obtained from participants, data analysis was pri­
marily descriptive to derive conclusions about the stimu­
lus needs of the group.
An overall summary of the sample's
characteristics was conducted with distribution percentages
according to the demographic variables obtained and by
measures of central tendency
and range).
(mean, standard deviation,
Central tendency analysis of scores was com­
puted to reveal significant trends.
The t-test and Pearson
product moment correlation were used to determine whether
any significant difference in mean scores existed between
various demographic variables.
The 0.05 level of signifi­
cance was used as a decision criteria for these computa­
tions .
To answer the study's primary question:
Is boredom
a nursing problem among adult patients confined for longterm
I
48
periods in acute care facilities, the final score means
were analyzed to determine if an unusual need for change
was evident.
Assuming the original mean scores obtained
by Garlington and Shimota indicated a normal or average
need for change, mean scores of this study were compared
for a significant relationship.
Again a 0.05 level of
significance was used as a criteria.
Assumptions
1.
Every individual answered honestly and to the
best of his ability.
2.
The hospital situation can create an environ­
ment of altered sensory input similar to deprivation ex­
periments .
3.
All individuals require a specific level of
variegated sensory stimuli to maintain adequate cortical
arousal.
4.
Without adequate arousal, inappropriate cere­
bral function is manifested with the emotional behavioral
response of boredom.
Limitations
1.
Speculation on boredom as a problem in other
long-term hospitalized patients of different ethno-cultural
groups was not possible since only English speaking sub­
jects were included.
49
2.
No effort was made to control or consider va r ­
iables that might influence the amount of sensory input
patients might be receiving
(i.e. family/social visits,
occupational therapy visits, etc.).
3.
Since subjects with a variety of diagnoses
participated, no generalizations related to specific
medical problems are possible.
4.
Since participants were selected exclusively
from a military medical facility, no generalizations to
populations in non-military settings are possible.
CHAPTER 4
PRESENTATION OF THE DATA
The findings of the study are presented in this
chapter and include a summary of the sample's character­
istics, an analysis of the subjects' scores a n d , statis­
tical comparisons with previously obtained Change Seeker
Index (CSI) scores.
Characteristics of the Sample
The sample consisted of 20 subjects who met the
criteria for the study and who were receiving treatment
in a southeastern military medical facility.
the subjects were male
were female
Sixteen of
(80 percent) and four subjects
(20 percent).
Eleven of the subjects
percent) were 18 to 24 years o l d .
(55
Nine of the subjects
(45 percent) had never married although eight subjects
(40 percent) were married at the time the study was com­
pleted.
Sixteen subjects
(80 percent) were receiving
treatment for surgical problems.
Seven subjects
(35 per­
cent) had been in the hospital from 14 to 16 days.
Table
1 summarizes the characteristics of the sample based on
the demographic information collected.
50
Table 1.
Characteristics of Subjects by Sex, Age, Marital
Status, Reason for Stay,, and Length of Stay.
Variable
Number of Subjects
Percent of Total
Sex
Male
Female
Total
16
4
20
80
20
100
Male
Female
Total
9
3
1
0
2
1
16
2
1
1
0
0
0
4
11
4
2
0
2
1
20
55
20
10
0
10
5
100
8
6
1
1
16
1
2
1
0
4
9
8
2
1
20
45
40
10
5
100
Age
(years)
18-24
25-34
35-44
45-54
55-64
65-74
Total
\
Marital
Status
Never Married
Married
Divorced
Separated
Total
.
Table 1
Continued
Reason for
Stay
Medical Problem
Surgical Problem
Total
4
12
16
0
4
4
4
16
20
20
80
100
4
4
3
2
3
16
3
0
1
0
0
4
7
4
4
2
3
20
35
20
20
10
15
100
Length of
Stay
(days)
14-16
17-19
20-22
23-25
26 + over
Total
Ul
53
The ages of the subjects ranged from 18 to 65 years
with a mean of 30.55 years and a standard deviation of
14.19 years.
years)
Male subjects were older
than female subjects
(mean age 31.50
(mean age 26.75 years).
mean age for subjects with medical problems
The
(41.50 years)
was higher than the mean age of subjects with surgical
problems
(26.69 years).
The overall length of stay for
all subjects ranged from 17 to 79 days with a mean of 23.05
days and a standard deviation of 14.53 days.
Male subjects
were confined to the treatment facility longer (mean 24.81
days) than female subjects
(mean 16.00 days).
Subjects
with surgical problems had the higher mean length of stay
(25.31 days) as compared to subjects with medical problems
(18.50 days).
Table 2 presents a summary of the means and
standard deviations for the age and length of stay of sub­
jects based on their sex and reason for stay.
Analysis of Scores
Reponses to the CSI questionnaire were scored by
a single-point system with one point for starred items
answered false, one point for all true responses to non­
starred items, and no points for other answers.
The total
possible score was 95 with a potential range of 0 to 95
points.
The total range of scores for the subjects was
from 17 to 78 points.
Table 3 provides a review of the
scores for the individual subjects.
54
Table 2.
Means and Standard Deviations for
Age and Length of Stay of Subjects
Based on Sex and Reason for Stay
n=20
Sex of Subject
Reason for Stay
Male
Medical
Problem
Surgical
Problem
Female
Age
(years)
Mean
Standard
Deviation
31.50
15.53
26.75
4.82
41.50
19.70
26 .69
10.53
24 .81
15.71
16.00
2.35
18.50
2.06
25.31
16.37
Length of
Stay
(days)
Mean
Standard
Deviation
55
Table 3.
Scores for Individual Subjects on CSI
Subject
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Score
50
55
17
44
67
23
52
32
50
54
43
78
53
27
72
47
69
67
32
57
Scores between 41 points to 60 points occurred 50
percent of the time.
Frequency distribution of scores was
generally symmetrical.
Table 4 provides the frequency and
distribution of the test scores obtained by the subjects
on the C S I .
Table 4.
Frequency and Distribution
of Test Scores on CSI
Score
Frequency
Percent
0-5
6-10
11-15
16-20
21-30
31-40
41-50
51-60
61-70
71-80
81-90
91-95
0
0
0
1
2
2
5
5
3
2
0
0
0
0
0
5
10
10
25
25
15
10
0
. 0
20
100
Total
The overall scores obtained by subjects on the CSI
ranged from 17 to 78 points with a mean of 4 9.45 points and
a standard deviation of 16.42 points.
There was only a .25
point difference between the male mean score
and the female mean score
(49.25 poi n t s ) .
for subjects with surgical problems
(49.50 points)
The mean score
(50.75 points) was
6.5 points higher than the mean score for subjects with
medical problems
(44.25 points).
An 18.03 point difference
occurred in the mean scores between married and unmarried
subjects
(39.75 and 57.78 points respectively).
Divorced
and separated subjects were not included in either group
due to the small n.
Table 5 presents the mean and stan­
dard deviations of scores for subjects according to sex,
reason for stay, and marital status.
Table 5.
Means and Standard Deviations of.
Scores on CSI for Sex, Reason for
Stay, and Marital Status
Reason
. For Stay
Sex
Male
Medical
Female Problem
Marital
Status
Surgical
Problem Married Unmarried
Mean
49.50
49.25
44.25
50.75
39.75
57.78
Standard
Devia­
tion
16.21
17.25
20.22
15.05
15.37
12.65
The t-test was applied to the mean scores of male
and female subjects and to the mean score of subjects with
medical and surgical problems.
At a critical value of
p = .05 in a two-tailed test with 18 degrees of freedom,
there was no significant difference between the mean scores
of male and female subjects.
There was no significant
difference between mean score of subjects with medical
or surgical problems at a critical value of p = .05, with
58
18 degrees of
freedom using a two-tailed test.
With the
same critical value and degrees of freedom, there was a
significant difference between the mean scores of the
married and unmarried subjects.
These results are summar­
ized in Table 6.
T a b l e .6.
Comparison of CSI Mean Scores by
t-Test for Selected Groups of Subjects
t-Test
Calculated
Variable
.05 Critical
Degrees
Value
of Freedom
Male/Female
.03
2.10
18
Medical Problem/
Surgical Problem
.68
1.73
18
Married/Unmarried
2.49
2.13
15
The direction and magnitude of the relationship
between scores and selected demographic variables was
determined by computing the product moment correlation
coefficient
(Pearson r ) .
The Pearson r value has a range
of -1 to +1 with the sign indicating the direction of the
.</
.
-
value and the numerical value indicating the magnitude of
the correlation.
In general, this magnitude is often in­
terpreted as follows:
0.7 to 1 = high correlation,
0.4 -
0.69 = moderate correlation, below . 3 9 = low correlation,
and zero signifies no correlation
(Kolstoe, 1973).
59
No significant correlation was found between age
and score with p=.05 for a two-tailed test at 18 degrees of
freedom with a t of -1.10 obta i n e d .
No significant cor­
relation between length of stay and score was found.with
p = .05 using a two-tailed test at 18 degrees of freedom.
Table 7 summarizes these computations.
Table 7.
Pearson Correlations and t-Test
Significance Between CSI Scores
and Selected Demographic Variables
t-Test
Calculated
.05 Critical
Value
Degrees
of Freedom
Variables
r
Age/Score
-0.25
-1.10
2.10
18
0.15
.65
2.10
18
Length Stay/
Score
T-tests were used to compare the overall mean score
obtained in the current study
(49.45 points) with the orig­
inal overall mean scores obtained by Garlington and Shimota
for psychiatric patients
dents
(39.31 points), for college stu­
(47.70 points), and for U.S. Army males
points)
(1964).
(43.30
There was a significant difference between
the mean score of psychiatric patients and the mean score
of subjects in the current study
(with p = .05 using a two-
tailed test at 195 degrees of freedom).
At a p=.05, there
was no significant difference between the mean scores of
60
subjects in this study with the mean scores of college
students or with the mean scores of U.S. Army males.
Table
8 presents the comparisons of these selected mean scores.
Table 8.
Comparison of Garlington and
Shimota1s Original CSI Mean
Scores with Overall Mean Score
of Current Study
Group
Psychiatric Patients/
Current Study
College Students
Current Study
Army Males/
Current Study
t-Test
Calculated
.05 Critical
Degrees
Value
of Freedom
3.12
1.96
195.
.58
1.96
445
1.70
2.00
78
CHAPTER 5
DISCUSSION OF FINDINGS
This chapter presents a discussion of t h e .findings
of this study in relation to the conceptual framework and
the review of the literature.
Findings in Relation to the
Conceptual Framework
Boredom is conceptualized as the multiple, complex
behavioral manifestation that occurs as an outcome of in­
adequate cortical arousal.
Optimal cerebral excitation
is dependent upon satisfaction of man's dual psychological
and physiological need for continued, varied sensory i n p u t «
Without adequate levels of sufficiently diverse stimuli,
either or both requirements are ineffectively satisfied
with resultant incomplete cerebral stimulation.
The
phenomenon of boredom is the c o m m o n l y .recognized outcome.
The reticular activating system (RAS)
is a well
recognized physiological organ system of interneurons
whose continued need for stimuli is directly related to
cerebral performance.
Not only does it receive and send
impulses to and from most of the body's sensory systems,
but most significantly, it projects to nearly all areas of
the cerebral cortex.
Neurophysiologists, through study
61
62
and experimentation, universally agree on the mutual inter­
dependence between the cerebral neuronal system and the
reticular complex and commonly conclude that the R A S 1s
major role is to contribute to cerebral arousal.
Paralleling this distinct physical requirement for
specific amounts of varied stimuli, is the psychosocial
need for sensory input presented by psychologists and
behavioral scientists.
Research in human behavior,
especially in situations of sensory or perceptual depri­
vation and isolation have strongly supported arguments
by various investigators that a need for sensory stimu­
lation is a distinct motivational force.
Although there
are various theories and multiple conceptualizations,
as Brownfield emphasized, there is general agreement that
man has a distinct need/drive to seek and maintain a
constant range of sensory input to optionally maintain
cortical arousal
(1972).
This study's intent was to measure a need for
change utilizing the Change Seeker Index
(CSI) developed
by Garlington and Shimota based on an identical conceptual
framework that man needs a specific, varied stimulus
input to maintain optimum functioning
(1964).
The CSI
only measures a need for change and variety in stimuli with
no differentiation between the pyschosocial or physio­
logical requirements.
63
The high mean scores obtained by the subjects in
this study seem to indicate a definite need for change.
Comparing the mean scores of the subjects in this study to
the various mean scores Garlington and Shimota obtained in
their original project suggests that patients confined
within a military medical facility may have a high change
need.
It was found at a significant level
(p = .05) that
the subjects in this study tend to have higher change
needs than the psychiatric patients originally tested by
Garlington and Shimota
(1964) .
No statistically signifi­
cant difference was found between the original mean score
of the two other groups tested by Garlington and Shimota
i
(college students and U.S. Army males)
overall mean score.
and this study's
Howev e r , the t-value computed between
the mean score for this study and the mean score for U.S.
Army males
(1.70) was very close to the critical value
(2.0) at a p of .05.
Perhaps with a larger n of confined
patients, the difference may have become significant.
Farley, in testing college undergraduate psychology stu­
dents using the CSI categorized a mean of 49.10 points as
indicating "intermediate stimulation-seeking"
(1976:705)
which is nearly the same as the overall mean of 49.45
points obtained in this project.
He determined a mean of
6 2.48 points means "high stimulation-seeking" and the
64
unmarried subjects' mean in this study
certainly is close
of 57.78 points
(Farley, 1976:705).
Consideration of some demographic variables
relation to mean scores suggests a possible trend.
in
Sub­
jects with surgical problems had a higher mean score, were
confined for longer periods, and were younger.
Although
no significant differences were obtained in this study be ­
tween subjects with medical and surgical problems, with
a larger n there might be a significant difference be- tween the two groups.
A larger sample
cate a significant correlation between
size may also indi­
mean scores and
and between mean score and length of s t a y .
age
Although there
was only a .25 point difference between male and female
mean scores in this study, since malei were confined for
longer periods than females
(24.81. days versus 16.00 days) ,
a larger n may demonstrate a significant difference.
There
was a significant difference between the mean scores of ;
married and unmarried subjects in this study.
It is
possible to assume that unmarried subjects have a greater
need for change and may have more tendency to experience
boredom with lengthy confinements.
Based on the conceptual approach of this project,
a high need for change may indicate a less-than-adequate
amount of current stimuli input and a resultant decreased
cerebral performance.
The multiple behavioral manifestations
65
or inadequate cortical arousal, collectively known as
boredom, may tend to occur.
This may present a nursing
problem that needs consideration in developing a thorough
plan of c a r e .
Findings in Relation to the
Review of the Literature
Although there have been no specific studies
published that specifically measure the occurrence of
boredom or need for change in hospitalized patients, con­
siderable laboratory experimentation with both human and
animal subjects exposed to decreased sensory environments
has been performed.
While many of these identify and
categorize the behavioral manifestations that an altered
or decreased sensory load produces,
some did reveal the
existence of a stimulus need.
Particular animal experiments with subjects con­
fined first to dull, repetitious environments then pro­
vided with a novel stimuli indicated a stimulus hunger may
exist
(Berlyne, 1955; Butler,
1957; Jones, et a ! ., 1961;
.(>■
Taylor, 1974).
The efforts of this project to identify
a need for change in confined subjects certainly parallels
these animal studies.
The high need for change evidenced
by the subjects' mean scores supports the theoretical
arguments that a probable motivational drive for stimulus
may exist.
66
Many investigations studying the responses of
humans to situations of decreased or altered sensory stim­
ulation were primarily concerned with behavioral outcomes
and manifestations.
However, man's stimulus hunger has
been demonstrated in some experimental situations that
deprived sensory input then offered controlled stimuli
(Smith and Myers, 1966; Smith, et a l ., 1967; Harrison and
Tutone,
1974).
This study's goal to measure a need for
change is similar to these published investigations.
The
high mean scores even for this study's small n of confined
subjects show a tendency for greater stimulus needs sup­
porting the stimulus-hunger concept.
Would a larger n
demonstrate these subjects as having a significantly high
stimulus hunger?
Would parallel studies of similarly
confined subjects with a controlled stimuli available
indicate a higher need for the stimuli in an attempt to
satisfy their sensory needs?
Measuring a need for change
in confined subjects helps substantiate experimentation
in the literature that man will purposely seek stimuli.
CHAPTER 6
CONCLUSIONS AND RECOMMENDATIONS
This chapter presents the conclusions of the s t u d y ,
general implications, and recommendations for future
investigation.
Conclusions
The purpose of this study was to determine if bore­
dom was a nursing p r o b l e m .among adult patients confined
for long-term periods in acute-care facilities.
for change measured by the Change Seeker Index
A need
(CSI) would
suggest that subjects may need a greater sensory input.
Insufficient input could hinder cortical arousal and
function; the problem of boredom could occur.
From the data presented in the preceding chapters ,
the following conclusions are formed:
1)
The wide range of individual scores from 17 to
78 points suggest that there may be a great variability in
the individual subject1s need for cha n g e .
2)
The data indicated there was a significant
difference in the need for change between unmarried and
married subjects.
A greater need for change was indicated
by the unmarried subjects.
67
68
• 3)
The data indicated a significant difference in
the need for change between the subjects of this study
and a group of psychiatric patients originally tested by
Garlington and Shimota
(1964).
The subjects of this study
have a greater need for change than those psychiatric
patients tested.
4)
The data indicated there was no correlation
between length of stay or age and the need.for change.
Additionally, no difference in a need for change was noted
between male and female subjects or subjects with medical
problems and subjects with surgical problems.
5)
Trends in the data suggest that there may be
a greater need for change among subjects with surgical
problems.
Implications
This research project may provide further insight
into one of the multiple problems encountered by patients
confined for long periods within a medical treatment
facility.
Too frequently, health care workers become
overwhelmed and distracted by the many physical and medical
needs of patients forgetting these clients may have other
essential and significant requirements.
A total under­
standing of the multiple factors that influence patient
behavior may encourage the nurse to provide appropriate
■
69
interventions that would enhance adjustment to health
problems, adaptation to hospitalization, and perhaps
shorten convalescence.
Since optimal cerebral performance and appropriate
behavioral responses depend on regular amounts of varied
stimulus input, nurses must consider this patient need in
effective care.
The high mean scores of subjects in this,
study suggest that long-term patients on wards of military
hospitals may well be experiencing decreased cortical
arousal and possibly suffering the consequences of boredom.
The significantly higher mean score of unmarried subjects
and the trend suggested by the higher need for change
scores of patients with surgical problems suggests these
groups may require greater amounts and variety of sensory
input.
Conscientious care providers should insure vulner­
able patients have sufficient sensory stimulation.
Con­
sideration of this need is essential in developing optimal
care strategies.
No current research is available that measures
boredom or the effects of an altered or a decreased sensory
load on patients confined to care units for extended periods.
While this study has a small sample size and limitations
for generalization, it may be a beginning exploratory step.
As additional research is conducted, concepts and ideas
may emerge that influence nursing care problem solving.
Recommendations
Recommendations for further study incl u d e :
1)
Conduct a study with a larger, more homo­
geneous sample and subjects from more varied healthcare
facilities.
2)
Further testing to determine if there might be
a significant difference between a need for change in male
and female subjects and subjects with medical dr surgical
problems.
3)
Further investigation with a larger sample size
to determine if a significant correlation may occur b e ­
tween mean scores and length of stay and a g e .
4)
Exploration to compare scores with other cul­
tural and socioeconomic variables
(e.g. nearness of family,
educational background, previous health history, etc.).
5)
Collection of data at various time periods
during subject's confinement to determine if there is a
significant alteration in a measured need for change.
6)
Replication of design using a variety of
instruments developed to measure a need for change and
sensory stimulation that would include measurements of
the behavioral manifestations of boredom.
7)
Investigation to determine how patients would
utilize controlled stimulus inputs.
APPENDIX A
HUMAN SUBJECTS COMMITTEE CONSENT FORM
71
THE UNIVERSITY OF ARIZONA COLLEGE OF NURSING
MEMORANDUM
TO:
Natalie A. Farrell _ _ _ _ _
■ ________
6835 Uppingham Drive, Fayetteville, NC .28304
FROM:
DATE:
RE:
Ada Sue Hinshaw, R.N., Ph.D. - Margarita Kay, R.N., Ph.D.
Director of Research
Chairman, Research Committee
October 6, 1981
Human Subjects Review:
"The Occurrence, of Boredom in Adult
Patients Confined for Long-Term Periods in Acute Care Settings"
Your project has been reviewed and approved as exempt from University
review by the College of Nursing Ethical Review Sub-committee of the
Research Committee, and the Director of Research. A consent form with
subject signature is not required for projects exempt from full
University review. Please use only a disclaimer format for subjects
to read before giving their oral consent to the research. The Human
Subjects Project Approval Form is filed in the office of the Director
of Research, if you need access to it.
We wish you a valuable and stimulating experience with your research.
ASH:ss
1981
APPENDIX B
WRITTEN PERMISSION CHIEF NURSE
73
D E P A R T M E N T OF T H E ARMY
U.S. ARMY M E D ICA L D E P A R T M E N T A C T IV IT Y
F O R T BRAGG, NORTH C A R O L IN A 28307
AFZA-MA-NU
SUBJECT:
21 October 1981
Permission to Conduct Study
TO WHOM IT May CCNCERN
May this letter serve to certify that Major Natalie A. Farrell has received
permission from the Medical Department Activity Carmander and Chief,
Department of Nursing, to conduct a study on the data collected frcm
inpatients at this medical facility.
Many cy grace
Colonel, ANC
Chief, Department of Nursing
APPENDIX C
QUESTIONNAIRE DISCLAIMER
75.
76
DISCLAIMER
I am a graduate student at the University of
Arizona College of Nursing studying patients' interest
and need for change and variety after being in the hos­
pital for awhile.
The information I gather will help
nurses in their efforts to care for patients confined
to hospitals for long periods.
You are being asked to voluntarily give about 30
minutes of time to reply to the statements in this ques­
tionnaire.
By responding to the questions, you will be
giving your consent to participate in the s t u d y . You
may choose not to answer some of the questions or you
may withdraw at anytime if you so desire.
I will be
available to answer any questions you may have while
completing the questionnaire. Whatever you d e c i d e , your
care will not be affected in any way.
All the information will be kept confidential;
no names will be used.
Your answers will be studied along
with the responses of others who answered the questions.
The information will be used for ,my study, future publi­
cations, and will be presented to a group of nurses.
NATALIE A. FARRELL
Graduate Student
College of Nursing
University of Arizona
APPENDIX D
CHANGE SEEKER INDEX
77
78
.QUESTIONNAIRE
DIRECTION:
Put a T for "true" or F for "false" in the space in front
of each statement depending how you presently feel about each topic;
there are no right or wrong answers.
___ *1.
I think a strong will power is a more valuable gift than a
well-informed imagination,
.2 o
I like toread newspaper accounts' of murder and other forms
of violence,
*3,
I like to conform to custom and to avoid doing things that
people I respect might consider unconventional,
4,
___ *5.
6.
I would like to see a bullfight in Spain„
-
I would prefer to spend vacations in this country 5 where you
know you can get a good holiday than in foreign lands that
are colorful and different.
I often take pleasure in certain non-conforming attitudes and
behaviors.
___ *7.. In general, I would prefer a job with a modest salary, but
guaranteed security rather than one with large, but uncertain
earnings. •
_ _ _ 8.
___ *9.
*10.
*11.
I like to feel free to do what I want to do.
I like to follow instructions and to do what is expected of me.
Because I become bored easily, I need plenty of excitement,
stimulation, and fun.
I like to complete a single job or task at a time before
taking on others.
12.
I like to be independent of others in deciding what I want
to do.
13.
I am well described as a meditative person, given to. finding
my own solutions instead of acting on conventional rules.
*14.
I much prefer symmetry to asymmetry,
15,
I often do whatever makes me feel cheerful here and now, even
at the cost-of some distant goal.
16.
I can be friendly with people who do things which I consider
wrong.
17.
I tend to act impulsively.
79
_*18.
I like to do routine work using a good piece of machinery
or apparatus.
__19 o
People view me as a quite unpredictable person.
___
20 •
I think society should be quicker to adopt new customs and
throw aside old habits and mere traditions.
^2-1 o
I prefer to spend most of my leisure hours with my family.
^22.
In traveling abroad I would rather go on an organized tour
than plan for myself the places I will visit.
__23.
I like to have lots of lively people around me.
__24,
I like to move about the country and to live in different
places.
^25.
I feel that what this world needs is more steady and "solid”
citizens rather than "idealists" with plans for a better
world.
__26.
I like to dabble in a number of different hobbies and
interests.
__27o
I like to avoid situations where I am expected to do things
in a conventional way.
_*28.
I like to have my life arranged so that it runs smoothly and
without much change in my plans.
_^29
I like to continue doing the same old things rather than to
try new and different things.
•
__30.
I would like to hunt lions in Africa.
__31.
I find myself bored by most tasks after a short time.
*32.
I believe that it is not a good idea to think too much.
_*33,
I always follow the rule:
_34.
I enjoy gambling for small stakes.
__35.
Nearly always I have a craving for more excitement.
___36.
I enjoy doing "daring", foolhardy things "just for fun".
*37.
I see myself as an efficient, businesslike person.
business before pleasure.
80
__38. I like to wear clothing that will attract attention.
__39.
I cannot keep my mind on one thing for any length of
_40.
I enjoy arguing even if the issue isn’t very important;,
M l .
It bothers me if people think I am being too unconventional
or odd.
M2.
I see myself as a practical person.
M3.
I never take medicine on my o w n , without a doctor’s ordering
it.
_44.
From time to time I like to get completely away from work and
anything that reminds me of it.
__45.
At times I have been very anxious to get away from my family.
_46.
My parents have often disapproved of my friends.
__47.
There are several areas in which I am prone to doing things
quite unexpectedly.
M8.
I would prefer to be a steady and dependable worker than a
brilliant but unstable one.
M9
In going places, eating, working, etc., I seem to go in a
very deliberate, methodical fashion rather than rush from
one thing to another.
__50.
It annoys me to have to/wait for someone.
_51.
I get mad easily and then get over it soon.
__52.
I find it hard to keep my mind on a task or job unless it is
terribly interesting.
__53.
For me planning, o n e ’s activities well
likely to take most of the fun out of
__54.
I like to go to parties and other affairs where
lots of loud fun.
__55.
I enjoy lots of social activity.
_56.
I enjoy thinking up unusual or different
everyday events.
_57.
I seek out fun and enjoyment.
in advance is
my life.
time.
-
very
there is
ideas toexplain
81
__58.
I like to experience novelty and change in my daily routines.
_59.
I like a job that offers change9variety, and
it involves some danger.
_60.
In my job I appreciate constant change in the type of work
to be done.
__61 o
I have the wanderlust and am never happy unles I am roaming
or traveling about.
_62.
I have periods of such great restlessness that I cannot sit
long in a chair. •
__63o
I like
*64..
I like to plan out. my activities in advance, and then
the plan.
__65.
I like to be the center of attention in a group.
_6 6 .
When I get bored I like to stir up some excitement.
_67.
I experience periods of boredom with respect to my job.
*68.
I admire a person who has a strong sense of duty to the things
he believes in more than a person who is brilliantly intelli­
gent and creative.
*69.
I like a job that is steady enough for me to become expert at
it rather than one that constantly challenges me.
*_70.
1 like to finish any job or task that I begin.
_*71.
I feel better when I give in and avoid a fight, than I would
if I tried to have my own way.
_*72.
I d o n ’t like things to be uncertain and unpredictable.
_*73.
I am known as a hard and steady worker.
__74.
I would like the job of a foreign correspondent for a news­
paper .
_75.
I used to feel sometimes that I would like to leave home.
__76.
I find my interests change quite rapidly,
77.
travel, even if
to travel and see the country.
i am continually seeking new ideas and experiences.
follow
82
__78.
I like continually changing activities.
_79 o
I get a lot of bright ideas about all sorts of things - too
many to put into practice.
_80o
I like being amidst a great deal of excitement and bustle.
^81 o
I feel a person just can1t be too careful.
__82.
I try to avoid any work which involves patient persistence.
_83o
Quite often I get "all steamed up" about a project9 but then
lose interest in it.
*84.
I would rather drive 5 miles under the speed limit than 5
miles over it.
_85.
Most people bore me.
_ 86. I like to find myself in new situations where I can explore
all the possibilities.
_87.
I much prefer familiar people and places.
_88 o
When things get boring9 I like to find some new and unfamiliar
experience..
_89.
If I d o n ’t like something, I let people know about it.
*90.
I prefer a routine way of life to an unpredictable one full
of change.
*91.
I feel that people should avoid behavior or situations that
will call undue attention to themselves.
*92.
I am quite content with my life as I am now living it.
_93.
I would like to be absent from work (school) more often than
I actually am.
* ■
__94 o
Sometimes I wanted to leave home, just to explore the world.
95.
My life is full of change because I make it so.
*Starred questions indicate a strong need for change when
answered false.
The asterisks did not appear on the
questionaires given to the participants.
APPENDIX E
DEMOGRAPHIC DATA
83
DEMOGRAPHIC DATA
Age
Sex
Marital Status
Reason for Stay:
Length of Stay
Medical or Surgical Problem
SELECTED BIBLIOGRAPHY
Acker, Mary and Paul McReynolds. "The Need For N o v e l t y :
A Comparison of Six Instruments," The Psychological
Record, 17:177-182, 1967.
Altschule, Mark Do
"Acedia:
Its Evolution From Deadly
Sin to Psychiatric Syndrome," The British Journal
of Psychiatry ,- 111:117-119, February, 1965.
As, Arvid, Cart-Martin Borgen, and Ernest Haggard.
"Social
Isolates and Urbanites in Perceptual Isolation,"
The Journal of Abnormal Psychology, 76:1-9, A u g u s t ,
1970.
Bartlett,/Josiah H.
"The Mythology of Creation," In Frank
R. Goetzl (Ed.), B o r e d o m . Berkeley-: Grizzly Peak
Pre s s , 1975.
Berger, Peter L . , Ed.
The Human Shape of W o r k .
Macmillan Company, 1964.
New Y o r k :
Berlyne, D.E.
"The Arousal and Satiation of Perceptual
Curiosity in the Rat,"
The Journal of Comparative
and Physiological Psychology, 48:238-246, February,
1955.
'
.
Berlyne D.E.
Conflict, Arousal, and Curiosity.
McGraw-Hill, 1960.
New Y o r k :
Bernstein, Haskell.
"Boredom and the Ready-Made Life,"
Social Research, 42:512-537 , A u t u m n , 1975.
B o ddy, J o h n . Brain Systems and Psychological Concepts.
Chichester:
John Wiley and S o n s , 1978.
Bogardus, Emory S .
Accidents.
The Relation of Fatigue to Industrial
Chicago: Chicago Press, 1912.
Bowden, Paul P.. "The Psychiatric Aspects of Cardiac Inten­
sive Therapy:
A Review,"
European Journal of
Intensive C a r e , 1:85-91, M a y , 1975.
Bowman, Andrew L.
"Poor, Nasty, Brutish, and Short - But
Seldom Boring,"
In Frank F. Goetzl (Ed.), B o r e d o m ,
Berkeley: Grizzley Peak Press, 1975.
85
86
B r o w n , Larry T . , Valerie G . R u d e r , Jesse E. Rud e r , and
Stephen:D. Y o u n g . "Stimulation Seeking and the
Change Seeker Index," Journal of Consulting and
Clinical Psychology, 42(2): 311, May, 197 4.
Brownfield, Charles A.
The Brain Benders.
Y o r k : Exposition Press,.1972.
2nd Ed., New
Burnside, Irene Mortenson, Priscilla Ebersole, and Helen
Elena Monea.
Psychosocial Caring Throughout The
Life S p a n . New York:
McGraw-Hill, 1979.
Butler, Robert A. "The Effect of Deprivation of Visual
incentives on Visual Exploration Motivation in
Mo nkeys," The Journal of Comparative and Physio­
logical Psychology, 50:177-7 9, February, 1957.
Butler,
Robert A. "The Effect of Deprivation of Visual
Incentives on Visual Exploration Motivation in
Mo nkeys," The Journal of Comparative and Physio­
logical Psychology, 50:177-179, April, 1957.
Carter, Frances M o n e t . Psychosocial N u r s i n g .
New York:
MacMillan Company, 1976.
2nd E d . ,
Chalupa, Leo M . , A. Leslie Morrow, and Robert W. Rhoades.
"Behavioral Consequences of Visual Deprivation
and Restriction in the Golden H a m s t e r ," Explora­
tory Neurology, 61:442-454, September, 1961.
Cohen, Carol Faye.
"Selected Hospital Statistics for
September, 1980
Hospital, 55 (1) :51-54 , January,
1981.
Colton, Helen.
"Boredom - New Disease of the Technetronic Era," The Human i s t , 35:16-18, NovemberDecember, 1975.
Csikszentmihalyi, Mihaly.
Beyond Boredom and Anxi e t y .
San Francisco:Jossey-Bass, 1975.
Curtis, George and Marvin Zuckerman. "A Psychopathological
Reaction Precipitated by Sensory Deprivation,"
The American Journal of Psychiatry, 125:151^260,
August, 1968.
de Grazia, Sebastian.
Of Time, Work, and L e i s u r e .
Y o r k : The Twentieth Century Fund, 1962.
New
87
Dow n s , Florence S.
"Bed Rest and Sensory Disturbances,"
The American Journal of Nur s i n g , 74:434-43 8,
March, 1974.
Eisenson, Jon.
"LonelinesES and the Divorced Post-MiddleAged Male,"
In Joseph Eartog, J. Ralph Audy,
and Yehudi A. Cohen (Eds.), The Anatomy of Lonelin e s s . New Y o r k : International Universities Press,
1980.
Ellis, Michael J. Why People P l a y .
Prentice-Hall, 1973.
Englewood C l i f f s :
Ellis, Henry C . , Frederick Par e n t e , and Craig W. Walker.
"Coding and Varied Input Versus Repetition in
Human Memory," The Journal of Experimental
Psychology, 102:284-290, February, 1974.
Emory, Hamlin.
"The Military Experience," Ih Frank R.
Goetzl (Ed.), B o r e d o m , Berk e l e y : Grizzley Peak
Press, 1975.
Engel, George L.
Disease.
Psychological Development in Health and
Philadelphia:
W.B. Saunders, 1962.
Eterovic, V.A. and P.A. Ferchmin.
"Interaction of
Environment and Injections in Brain Weights in
Rats,"
Developmental Psychobiology, 7:515-7,
July, 1974.
Faber, Birren.
"A Colorful Environment for the Mentally
Disturbed,"
Psychological Abstracts, 54:1254,
July-December, 1975.
Farley, Frank H.
"Measures of Individual Differences in
Stimulation Seeking and:the ■Tendency Toward
V a riety," Journal of Consulting and Clinical
Psychology, 37 (3) :394-396, December, 1971.
Farley, Frank H.
"Measuring the Stimulation-Seeking
Motive by Global Self-Rating," Perceptual and
Motor S k ills, 39 :101-102 , August, 1974.
Parley, Frank H.
"Arousal and Congition:
Creative
Performance, Arousal and the Stimulation-Seeking
. M o t i v e ," Perceptual and Motor Skills, 43:703-708,
August-December, 1976.
88
Farley, Frank H. and Sonja V. F a r l e y , "Impulsiveness,
Sociability, and the Preference for Varied Exper­
ience," Perceptual and Motor Skills, 31(1) :47-50,
A u g u s t , 1970.
Fenichel, O t t o . "On the Psychology of Boredom," In The
Collected Papers of Otto Fenichel. New Y o r k :
W.W. Norton, 1953.
Fern, A.
"The Effect of Social Isolation on the Aggressive
and Sexual Behavior of a Cichlict Fish, Haplochromis
B u rtoni," Behavior, 65:46-61, January-February,
1978.
Fiske, Donald W. and Salvatore R. M a d d i . Functions of
Varied Experience. H o m e w o o d : Dorsey Press, 1961.
French, J.D.
"The Reticular Formation,” Scientific Ameri­
can , 196:54-60, May, 1957.
Fried, Edrita.
The Courage to C h a n g e .
Mazel, 1980.
New Y o r k :
Brunner-
Fromm, Erich.
The Anatomy of Human Destructiveness.
New York:
Holt, Rinehart and Winston., 1973 .
Garlington, Warren K.
Phone Conversation.
Washington, 23 September 1981.
Pullman,
Garlington, Warren K. and Helen E. Shimota.
"The Change
Seeker Index:
A Measure of the Need for Variable
Stimulus Input/'Psychological Reports, 14:919-924,
June, 1964.
Gendreau, Paul, N.L. Freedman, G.J. Wilde, and G.D. Scott.
"Changes in EEG Alpha Frequency and Evoked Re­
sponse Latency During Solitary Confinement,"
Journal of Abnormal Psychology, 79 (ill), 54-59, •
February, 1972.
'
Goetz1, Frank R. ■ "Root of Discontent and Aggression,"
In Frank R. Goetzl (Ed.), Boredom. Berkeley:
Grizzly Peak Pre s s , 1975 .
Gorney, Roderic. The Human A g e n d a .
and Schuster, 1972.
New Y o r k :
Simon
Gottlieb, Jacques S.
Psychiatric Research Repo r t s , No. 5.
Summit: CIBA, 1956.
89
Grinker, Roy R. and John P. Spiegel.
War N e u r o s e s .
Philadelphia:
Blakiston, 1945.
Harris, Richard J. and Frank D. Hilf.
"MMPI Scales Versus
Interviewer Ratings of Paranoia," Psychological
Reports, 27:447-450, October, 1970.
Harrison, Albert A. and Robert M. Tutone. "Effects of.
Background Variation on Positive Habituation and
Tedium," Psychological Abstracts, 52:28.8, JulyDecember, 19,7 4.
Hartog, Joseph, J. Ralph Audy, Yehudi D. Cohen, Eds. The
Anatomy of Loneliness. New York:
International
Universities Press, 1980.
Headquarters Report.
Monthly Selected Workload Data by
Health Care Organization, U.S. Army MEDDAC unpub­
lished report, June, 1981.
Hebb, D.O.
"The Motivating Effects of Extroceptive Stim­
ulation,"
American Psychology, 13:109-113, Jan­
uary, 1958.
Heineman, Ludwig G.
"Visual Phenomena in Long Sensory
Deprivation," Perceptual and Motor Skills, 30:
563-570, April, 1970.
v
Heller, Stanley, S., Kenneth A. Frank, James R. Malm,.
Frederick 0. Bowan and others.
"Psychiatric
Complications of Open-Heart Surgery,"
The New
England Journal of M e d i c i n e , 283:1015-1020,
November 5, 1970.
Henry,
William A.
"Get High on Yourself,"
September 21, 1981.
T i m e , 118:68,
Heron, Woodburn.
"The Pathology of Boredom,"
American, 196:52-56, January, 1957.
Hokanson, Jack E.
New York:
Scientific
The Physiological Bases of Motivation.
John Wiley and Sons, 1969.
Houlihan, R.T. and R.G. Delaney. "Effect of Isolation on
Blood Pressure, Behavior, and Response to Epine­
phrine in the Rat," Aerospace M e d i c i n e , 69:491-5,
May, 196 9.
Izard, Carrol E. ' Patterns of Emotions.
Academic Press, 1972.
New York:
90
Johnson, Marguerite. "Anger in the Streets," T i m e , 118:
30-32, July 20, 1981.
Jones, Austin, H. Jean Wilkinson, and Ina Braden.
"Infor­
mation Deprivation as a Motivational Variable,"
Journal of Experimental Psychology, 62:126-137,
February, 1 9 6 1 .
Katz, Nevin Mi, David P. A g l e , Ralph G. D e P a l m a , Jerome
J. DeCosse.
"Delirium in Surgical Patients Under
Intensive Care.
Utility of Mental Status Examina­
tion,"
Archives of Surgery, 104:310-313, March,
1972.
Kolstoe, Ralph H . . Introduction to Statistics for the
Behavioral Sciences. Homewood, Illinois:
Dorsey
Press, 1973.
Konrad, Karl W..
Stimuli
ment."
157-64,
and Muriel M. Bagshaw.
"Effect of Novel
on Cats Reared in a Restricted Environ­
Journal of Comparative Psychology, 70:
January, 1970.
Krech, David.
"In Search of the Engram." Medical Opinion
and Review, 1:20-24, A u g u s t , 1966.
Larsen, Knud S. Aggression Myths and M o d e l s .
Nelson Hall, 1976.
Chicago:
Leifer, Ronald.
"The Ethics of Drug Prohibition."
Psychological Abstracts, 50-510q:550, JulyDecember, 1973.
Lennart, Levi (Ed.).
Stress and Distress to Psychosocial
Stimuli. Oxford: ' Pergamon Press, 197 2.
Leukel, Francis.
Introduction to Physiological Psychology.
3rd Ed.
St. Louis:
C.V. MosbyV 1976.
Levine, Alan M.
"Visual Hallucinations and Cataracts."
Opthalmic Surgery, 11:95-98, February, 1980.
LeWinn, Edward B. and Mihai D. Dimancescu.
"Environmental
Deprivation and Enrichment in C o m a ," Lancet,
2:156-157, July 15, 1978.
Lockett, Mary F . "Sound Deprivation Causes Hypertension
in Rats,"
Federation Proceedings, 32:2111-4,
November, 1973.
91
Loo f t , William R. and Marc D.
Baranowski. "An Analysis
of Five Measures of Sensation Seeking and Prefer­
ence for Complexity,"
The Journal of General
Psychology, 85:307-313, October, 1971.
Maron,
Louise, Christopher W.
Bryan-Brown, and William C.
Shoemaker.
"Toward a Unified Approach to Psycho­
logical Factors in the ICU,"
Critical Care Medi­
cine , 1:81-84, March-April, 1973.
McCarroll, James E., Kevin M. Mitchell, Ronda J. Carpenter.
and J.P. Anderson.
"Analysis of Three Stimulation
Seeking Scales,"
Psychological Reports, 21:853856, December, 1967.
McReynolds, Paul.
"Behavioral Choice as a Function of
Novelty-Seeking and Anxiety-Avoidance Motivations,"
Psychological Reports, 29(1) :3-6, August, 1971.
Mehrabian, Albert.
"Affiliation as a Function of Attitude
Discrepancy with Another and Arousal-Seeking
Tendency, " Journal of Personality, 43 (4) :582-586,
December, 1975.
Menninger, K a r l . A Psychiatrist's World - The Selected
Papers of Karl Menninger, Hall Bernard (Ed.).
New York:
Viking Press, 1959.
Mijaskovic, Ben.
"Loneliness:
An Interdisciplinary
Approach,"
In Joseph Eartog, J. Ralph Audy, and
Yehudi A. Cohen (Eds.), The Anatomy of Loneliness.
New York:
International University Press, 1980.
National Consumer1s Leagu e . The Case for the Shorter
-Work Day - Supreme Court of The United States,
October Term 19 1 5 . New York:
National Consumer's
League, 1915.
Newmann, P.P.
Neurophysiology. New York:
and Scientific Books, 1980.
Nightingale, Florence.
ton, 1912.
Notes on Nurs i n g .
S.P. Medical
New York: Apple­
Olin, Barney, M . , H. Keith Fischer, Benjamin Huddell.
"Psychologic Adaption to Pacemaker and OpenHeart Surgery," Archives of General Psychiatry,
19:599-610, November, 1968.
92
Pearson, P.H.
"Relationships Between Global and Specified
Measures of Novelty Seeking," Journal of Consulting
and Clinical Psychology, 34:199-204, January, 1970.
Polit, Denise F., Bernadette P. Hung l e r . Nursing Research:
Principles and Meth o d s . Philadelphia: J.B.
Lippincott, 1978.
Pradelles, P., 'C. Cros, J . H u m b e r t , F . D r a y , and Y . B e n - A r i ,
"Visual Deprivation Decreases Met-enkephalin and
Substance P Content of Various Forebrain Struct
tures."
Brain Research, 20:191-193, April, 1979.
Pugh, George E d g i n . The Biological Origin of Human V a l u e s .
New York:
Basic B o o k s , 1977.
Rickert, Lenora and Lynn Cheatwood.
"The Perfect Explana­
tion May Not be Right at All; Nursing Grand R o u n d s ,1
Nursing, 6:52-57, September, 1976.
Roberts, Sharon L.
Behavioral Concepts and Nursing
Throughout the Life S p a n . Englewood Clif f s :
Prentice Hall, 197 8.
Rodin, Judith.
"Cause and Consequences of Time Perception
Differences inxOverweight and Normal Weight Peo p l e ,"
Psychological Abstracts, 31:898-904, July-December,
1975.
Rosenweig, Norman and La Maurice Gardner.
"The Role of
Input Relevance in Sensory Isolation," The
American Journal of Psychiatry, 122 :920-928,
February, 1966.
Rosenzweig, M.R., E.L. Benn e t t , M. Hebert, and H. Morim o t o . "Social Grouping Cannot Account for Cerebral
Effects of Enriched Environments," Brain Research
29:563-76, September 29, 1978.
Rossi, Michael A., Allan Furh m a n , and Philip Solomon.
"Arousal Levels and Thought Processes During
Sensory Deprivation," The Journal of Abnormal
Psychology, 72:166-173, April, 1967.
Ruiz-Marcos, Antonio, Jose Sala, and Raquel A l v a r e z .
"Effect of Specific and Non-Specific Stimuli on
the Visual and Motor Cortex of the Rat,"
Brain
Research, 170 :61-6 9, July, 197 9.
93
Ru m p , E.E.
"Study of Graves Design Judgement Test and
Barron-Welsh Revised Art Scale,"
Perceptual and
Motor Skills, 45 :843-847, August-December, 1977.
Ryback, Ral p h , Ralph W. Trimble, Oliver F . Lewis and
Charles L. Jennings.
"Psychobiologic Effects of
Prolonged Weightlessness (Bedrest) in Young,
Healthy Volunteers,"
Aerospace Medicine, 42:
408-415, April, 1971.
Schapiro, H . , L.D. W r u b l e , L.G. Britt, and T.A. Bell.
"Sensory Deprivation on Visceral Activity,"
Psychosomatic Medicine, 70:379-396, JulyAugust, 1970.
Schapiro, H ., C.W. Gross, T. Nakamura, L.D. Wruble, and
L.G. Britt.
"Sensory Deprivation on Visceral
Activity," Psychosomatic Medic i n e , 70:515-521,
September-October, 1970.
Schapiro, H., L.G. Britt, C.W. Gross, and K.J. Gaines.
"Sensory Deprivation on Visceral Activity,"
Psychosomatic Medi c i n e , 71:429-435, SeptemberOctober, 1971.
Schapiro, H . , L.G. Britt, and R . H . Dohrn.
"Sensory
Deprivation on Visceral Activity."
The American
Journal of Digestive Diseases, 73 :573-575 , J u l y ,
1973.
Schulman, Carol A . , Milton Richlin, and Sidney Weinstein.
"Hallucinations and Disturbances of Affect,
Cognition, and Physical State as a Function of
Sensory Deprivation,"
Perceptual and Motor Ski l l s ,
25:1001-1024, December, 1967.
Schultz, Duane P.
Sensory Restriction - Effects on Be ­
havior . New Y o r k : Academic Press, 1965.
Serafetinides, E.A., J.T. Shurley, R. Brooks, and W.P.
Gideon.
"Electrophysiological Changes in Humans
During Perceptual Isolation,"
Aerospace Medicine,
43:432-434, April, 1972.
Siddle, David A. and David G. S m i t h . "Effects of Monoto­
nous Stimulation on Cortical Alertness in Fast
and Slow Habituation Gro u p s ," Psychological
Abstracts, 53:1363, J a n u a r y - J u n e , 1974.
94
Smith, Seward and Thomas I.-Myers.
"Stimulation Seeking
During Sensory Deprivation," Perceptual and Motor
Skills, 2 3 : 1 1 5 1 - 1 1 6 3 , December, 1 966.
Smith, Seward, Thomas I. Myers, Eugene John s o n , III.
"Stimulation Seeking Throughout Seven Days of
Sensory Deprivation,"
Perceptual and Motor Skills,
2 5 : 2 6 1 - 2 7 1 , August, 1967.
Still, Joseph Wo. "Boredom - The Psychosocial Disease of
Aging,"
Geriatrics, 1 2 : 5 5 7 - 5 6 0 , September, 1957.
Stock, William A. and William R. Looft.
"Relationships
Among Several Demographic Variables and The Change
Seeker Index," Perceptual and Motor Skills, 29:
1 0 1 1 - 1 0 1 4 , December, 196 9.
Taylor, George T.
"Stimulus Change and Complexity in
Exploratory Behavior," Psychological Abstracts,
5 3 : 9 7 , January-June, 1 9 7 4 .
Terkel, Studs.
W o rking.
New Y o r k :
Pantheon Books, 1972.
Thompson, Leonti. "An Epidemiological Approach," In Frank
R. Goetz l e , (Ed.), B o r e d o m , Berkeley.:
Grizzley
Peak P r e s s , 1975.
Trace, David.
"Psychiatric Side-Effects of Cardiothoracic
Surgery, " Nursing Mirror, 139 :71 -72 , November." 14 ,
1974.
Tucson Citizen.
"Boredom Causes Stress Among Police
Officers,"
July 17, 1981.
Tyler, Robert L.
"Boredom and the Treadmill of Doing,"
The Humanist, 3 5 : 5 - 6 , November-December, 1975.
Uttal, William R.
The Psychobiology of M i n d .
Lawrence Erlbaum, 1978.
Hillsdale:
Walk, Richard D. amd Clarence P. Walters.
"Effect of
Visual Deprivation on Depth Discrimination of
Hooded R a t s ," The Journal of Comparative and
Physiological Psychology, 8 5 : 5 5 9 - 5 6 3 , December,
1973.
W a l s h , R.N.
"Effects of Environmental Complexity and De ­
privation on Brain Chemistry and P hysiology: A
Review," International Journal of Neuroscience,
11:77-89, February, 1980.
95
Walsh, R . N . and R.A. Cummins. "Changes in Hippocampal
Neuronal Nuclei in Response to Environmental
Stimulation," International Journal, of Neurosciences , 9:20 9-12, April, 197 9.
Waters, Carrie W h e r r y . "Multi-Dimensional Measures of
Novelty Experiencing, Sensation. Seeking, and
Ab i l i t y : Correlational Analysis for Male and
Female College Students," Psychological Reports,
34(1), 43-46, February, 1974.
Welker, W.I.
"Variability of Play and Exploratory B e ­
havior in Chimpanzees," The Journal of Compara­
tive and Physiological Psychology, 4 9 :18.1-185 ,
January, 1956.
Wilson, Larkin M.
"Intensive Care Delirium - The Effeet
of Outside Deprivation in a Windowless Unit,"
Archives of Internal M e d i c i n e , 130 :225-226,
August, 1972.
W y k e , Barry.
dam:
Principles of General Neurology.
Elsevier, 1969.
Amster­
Zubek, John P.
"Effects of Prolonged Sensory and Per.ceptual Deprivation," British Medical Bulletin,
20 (1) :38-42, January, 1964.
Zubek, John P. and M. MacNeil.
"Perceptual Deprivation
Phenomena:
Role of the Recumbent Position,"
Journal of Abnormal Psychology, 72 :147-150,
April, 1967.
Zubek, John P.
Sensory Deprivation:
Fifteen Years of
Research.
New Y o r k : Appleton-Century-Crofts,
1969.
Zubek, John P., Michael Bross, and W. Gelfant.
"Cuta­
neous Sensitivity During Prolonged Visual Depriva­
tion:
Role of Interpolated Testing."
Perceptual
and Motor Skills, 36:823-826, June, 1973.
Zuckerman, Marvin, Harold P e r s k y , Robert Hopkins, Thomas
Murtaugh, G.K. Basu, and Mary Schilling.
"Com­
parison of Stress Effects of Perceptual and Social
Isolation," The Archives of General Psychiatry,
14:356-365, April, 1966.
96
Zuckerman, Marvin M . , Harold H . Persky, Lynn Miller, and
Bernard Levine.
"Sensory Deprivation Versus
Sensory Variation,"
The Journal of Abnormal
Psychology, 76:76-82, August, 1970.
Zung, William K.
"From Art to Science - The Diagnosis
and Treatment of Depression," Archives of General
Psychiatry, 29:328-337, September, 1973.
I