Reactions of Staff Members to the Relocation of a Psychiatric Department to a New Building

Our study examined staff members' psychological reactions to the relocation of three closed psychiatric wards to a new building. Before the move, the psychiatric wards were housed in old buildings, which had been improved and altered over the years to adjust to changing needs. A special effort was made and resources were invested to update the hospital by renovating old buildings and erecting new ones, on the assumption that physical structures affect both patients' behavior and the therapeutic environment. Although the relocation was associated with better physical conditions, it also affected the existing habits of staff members and was therefore likely to impose stress (1,2). For patients, the need to establish new patterns and the loss of a familiar background can be sources of pressure. Patients may express these feelings of pressure by acting more agitated and violent and attempting self-injury; they may experience a general deterioration of mental state (1,2,3,4). Patients' stress, in turn, has a direct impact on staff members' sensations of anxiety and uncertainty, which may affect staff members' behavior and well-being (1,2,3,4,5,6).

A previous study examined how patients' preoperative levels of anxiety and uncertainty affected patients' postoperative perceptions of the success of the operation (7). The study found that perceptions of the success of the operation were influenced by levels of anxiety and uncertainty before the operation. On the basis of these findings we hypothesized that staff members' perceptions of relocation success would be influenced by their levels of anxiety and uncertainty before and after the relocation.

Our study investigated the degree to which psychiatric staff members felt anxiety and uncertainty before and after the relocation, whether there was a relationship between anxiety levels before and after the relocation, whether there was a relationship between uncertainty levels before and after the relocation, and whether levels of anxiety and uncertainty were associated with the subjective appraisal of the success of the relocation. We hypothesized that the relocation would raise levels of uncertainty and anxiety, which would, in turn, affect perceptions of the success of the relocation.

Methods

During June 2000 three wards in a psychiatric hospital in central Israel were relocated to new premises. The new premises were more comfortable and patient oriented. For example, the old wards had one bathroom for ten to 12 inpatients, whereas the new premises had one bathroom for one to four patients. The new premises were significantly larger and had more public space and supporting rooms. During the relocation no substantive organizational change was implemented other than that of the change entailed by the relocation itself. Of 90 questionnaires that were distributed to all of the staff members who were involved in the relocation, 81 (90 percent) were returned, and 20 of these were discarded as incomplete, leaving 61 completed questionnaires (68 percent). Of the 61 staff members with completed questionnairs, 35 (57 percent) were women. The participants' mean±SD age was 38.25±8.59 years. Nine participants (15 percent) were psychiatrists, 33 (54 percent) were nurses, 14 (23 percent) were auxiliary and maintenance staff members, two (3 percent) were psychologists, two (3 percent) were social workers, and one (2 percent) was an occupational therapist. Seniority of the participants ranged from 10 months to 37 years (10.83±9.51 years).

Two structured questionnaires were used for data collection. Staff members were given a questionnaire one to two weeks before the relocation to measure their levels of anxiety and uncertainty. Another questionnaire was given six to eight weeks after the relocation to measure staff members' levels of anxiety and uncertainty and their perceptions of the relocation's success.

The section of the questionnaire that measured levels of anxiety used a Hebrew version of Spielberger's State-Trait Anxiety Inventory questionnaire, which consists of 20 statements that express a range of emotional states (8,9). Respondents were asked to respond to statements on a scale of 1 (not at all) to 4 (very much). Levels of anxiety were measured by the sum of all items. Cronbach's alpha for internal consistency and reliability ranged between .80 and .86.

Researchers constructed a section of the questionnaire to measured uncertainty. This section consisted of 12 statements that related to the general state of uncertainty before and after the relocation. Participants were asked to respond to statements on a scale of 1 (not at all) to 5 (very much). An outside researcher who specialized in the different aspects of uncertainty tested the section's face validity. We designed the questionnaire so as to relate to the specific event of the relocation and to the phases before and after the relocation. For example, statements such as "I have many questions about the coming period," "The plan of relocation is clear to me," or "The explanations we receive are ambiguous" were used to examine the uncertainty variable. Levels of uncertainty were measured by the mean score of all items. Cronbach's alpha coefficient ranged between .72 and .75.

Researchers also constructed a section of the questionnaire to measure the success of the relocation. This section consisted of six statements that respondents were asked to score on a scale of 1 (not at all) to 5 (very much). Statements such as "Since the relocation the ward atmosphere is calmer" and "The relocation process was successful" were used to examine the relocation success variable. Cronbach's alpha coefficient was .6.

Results

Participants demonstrated higher levels of anxiety before the relocation than after the relocation (scores of 32.8±11.2 and 30.2±10.4, respectively); scores ranged from 20 to 80, with lower scores indicating less anxiety. Similarly, they also showed higher levels of uncertainty before the relocation than after the relocation (scores of 2.42±.72 and 1.98±.81, respectively); scores ranged from 1 to 5, with lower scores indicating less uncertainty. To test whether these changes were significant, we used paired t tests. We found that after the relocation uncertainty levels decreased significantly (t=3.32, df=59, p<.01) and anxiety levels decreased marginally. In addition, participants demonstrated high levels of perceived success of the relocation (score of 4.54±.49); scores ranged from 1 to 5, with higher scores indicating a greater level of perceived success. As shown in Table 1, a significant positive correlation was found between anxiety levels and uncertainty before the relocation. Also, significant correlations were found between and anxiety levels after the relocation and uncertainty levels both before and after the relocation. Finally, no significant correlation was found between the perceived success of the relocation and the other study variables.

Discussion and conclusions

Our study examined staff members' psychological reactions to the relocation of three closed psychiatric wards to a new building. The results of our study showed that levels of anxiety and uncertainty were higher before the relocation, which indicated that six to eight weeks was sufficient time for staff members to recover from the relocation.

The correlational analysis demonstrated that the anxiety levels before and after the relocation were significantly positively related to uncertainty levels before the relocation. That is, reducing uncertainty before relocation may have a positive effect not only on anxiety levels before the relocation but also on anxiety levels two months after the stressful event. Thus our study emphasizes the importance of preparing staff members for the relocation by carefully planning the technical arrangements and by providing staff with guidance and emotional support.

Even though we found that staff members were affected by the relocation, we did not find support for our hypothesis about the negative correlation between levels of anxiety and uncertainty and measurement of the perceived success of the relocation. This finding may be explained by the high agreement among the participants about the complete success of the relocation and the low variability of answers on this scale. Furthermore, the direct influence of the new, comfortable environment and improved physical milieu may have made it easier for staff members to perceive the relocation as a success.

The limitations of our study included its relatively small sample and lack of a control group.

Our study addressed the importance of uncertainty as a contributing factor to staff members' distress during and after the psychiatric ward relocation to the new premises.

Mr. Kagan is affiliated with the infectious disease unit at Assaf-Ha-Rofeh Medical Center, Tzrifin, Beer Yaakov, 70300, Israel (e-mail, [email protected]) and the nursing department at Tel-Aviv University. Ms. Kigli-Shemesh is director of nursing at Ness-Ziyona Mental Health Center in Ness-Ziyona, Israel, and is with the nursing department at Tel-Aviv University. Dr. Bar-Tal is associate professor at the department of nursing at Tel-Aviv University School of Health Professions.

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