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Rodríguez-Labajos L, Kinloch J, Grant S, O’Brien G. The Role of the Built Environment as a Therapeutic Intervention in Mental Health Facilities: A Systematic Literature Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:281-308. [PMID: 38385552 PMCID: PMC11080396 DOI: 10.1177/19375867231219031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES This systematic literature review synthesizes and assesses empirical research concerning the use of the built environment as a therapeutic intervention in adult mental health inpatient facilities. The review explores the impact of facility design on patient outcomes. BACKGROUND There is a growing recognition that the built environment in mental health facilities must strike a balance between ensuring safety and providing a therapeutic atmosphere. A review addressing how facility design contributes to this therapeutic environment is warranted. METHODS Database searches were conducted in CINAHL, Embase, PsychInfo, PubMed, and Web of Science from inception up to March 10, 2022. The Scottish Intercollegiate Guidelines Network (SIGN50) critical appraisal checklists were used to assess the quality of included studies. RESULTS Of the 44 peer-reviewed studies identified from nine countries, several factors emerged as vital for the therapeutic environment in mental health inpatient facilities. These included personal spaces prioritizing privacy and control of the environment, daylight-optimized spaces, versatile communal areas promoting activities and interaction, designated areas for visits and spiritual/contemplative reflection, homelike environments, the inclusion of artwork in units, open nursing stations, and dedicated female-only areas. Yet, there is a need for research yielding stronger evidence-based designs harmonizing with therapeutic needs. CONCLUSION This review offers initial guidance on designing mental health facilities that foster a therapeutic environment, while highlighting that the influence of facility design on mental health inpatients is considerably under-researched.
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Affiliation(s)
| | - Joanne Kinloch
- Research Service, NHSScotland Assure, NHS National Services Scotland, Glasgow, Scotland
| | - Susan Grant
- Procurement, Commissioning and Facilities, NHSScotland Assure, NHS National Services Scotland, Glasgow, Scotland
| | - Geraldine O’Brien
- Research Service, NHSScotland Assure, NHS National Services Scotland, Glasgow, Scotland
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Rodríguez-Labajos L, Kinloch J, Nicol L, Grant S, O'Brien G. Impact of the design of adult mental health inpatient facilities on healthcare staff: a mixed methods systematic review. BMJ Open 2024; 14:e074368. [PMID: 38448069 PMCID: PMC10916155 DOI: 10.1136/bmjopen-2023-074368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES Mental health inpatient facilities are increasingly focusing on creating therapeutic, person-centred care environments. However, research shows that this focus may have unintended consequences for healthcare staff. Designs that do not pay attention to staff needs may risk contributing to stress, burnout, job dissatisfaction and mental exhaustion in the work environment. This systematic review aims to identify and synthesise current research on the design factors of adult mental health inpatient facilities that impact healthcare staff. DESIGN A mixed method systematic review was conducted to search for empirical, peer-reviewed studies using the databases CINAHL, Embase, PsycINFO, PubMed and Web of Science from their inception up to 5 September 2023. The Joanna Briggs Institute's critical appraisal checklists were used to assess the methodological quality of the eligible studies. Data were extracted and grouped based on the facility design factors. RESULTS In our review, we included 29 peer-reviewed empirical studies that identified crucial design factors impacting healthcare staff in adult mental health inpatient facilities. Key factors included layouts providing optimal visibility, designated work and respite areas, and centrally located nursing stations. Notably, mixed perceptions regarding the benefits and challenges of open and glass-enclosed nursing stations suggest areas requiring further research. Facilities in geographically remote locations also emerged as a factor influencing staff dynamics. Additionally, although only supported by a limited number of studies, the significance of artwork, sensory rooms for respite, appropriate furniture and equipment, and access to alarms was acknowledged as contributory factors. CONCLUSION Through the synthesis of existing research, this review identified that the design of mental health facilities significantly impacts staff well-being, satisfaction, performance and perception of safety. Concluding that, in order to create a well-designed therapeutic environment, it is essential to account for both service users and staff user needs. PROSPERO REGISTRATION NUMBER CRD42022368155.
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Affiliation(s)
| | - Joanne Kinloch
- NHSScotland Assure, Research Service, NHS National Services Scotland, Glasgow, UK
| | - Louise Nicol
- NHSScotland Assure, Research Service, NHS National Services Scotland, Glasgow, UK
| | - Susan Grant
- NHSScotland Assure, Procurement, Commissioning and Facilities, NHS National Services Scotland, Glasgow, UK
| | - Geraldine O'Brien
- NHSScotland Assure, Research Service, NHS National Services Scotland, Glasgow, UK
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3
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Gebczynska-Janowicz A, Janowicz R, Targowski W, Cudnik R, Paszko K, Zielinska-Dabkowska KM. Evaluation of Medical Staff Satisfaction for Workplace Architecture in Temporary COVID-19 Hospital: A Case Study in Gdańsk, Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:639. [PMID: 36612960 PMCID: PMC9819390 DOI: 10.3390/ijerph20010639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
This article analyses the architecture that was used in the temporary AmberExpo hospital in Gdańsk, Poland which was installed during the COVID-19 pandemic. The construction of this type of facility is often based on experimental approaches, aimed at caring for patients suffering from an infectious disease in emergency conditions. In order to assess the level of employee satisfaction with the architectural and technical elements used in the first period of the hospital's activity, medical staff were asked to fill out a questionnaire. The analysis of the survey's results indicated that the majority of employees expressed satisfaction with the architectural and technical elements, with the design of the spatial layout of the individual medical zones receiving the most positive feedback. However, frequently selected drawbacks in the design included the lack of natural daylight, the artificial light that was used and the acoustics of the facility. This detailed examination of the satisfaction and feedback from medical employees working in this type of emergency facility enables the development of solutions that in the future will allow for the improved adaptive reuse and implementation of such structures, with enhanced time and economic efficiency, and most importantly, the ability to provide a safer workplace.
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Affiliation(s)
| | - Rafal Janowicz
- Faculty of Architecture, Gdańsk University of Technology, 80-233 Gdansk, Poland
| | - Wojciech Targowski
- Faculty of Architecture, Gdańsk University of Technology, 80-233 Gdansk, Poland
| | - Rafal Cudnik
- Copernicus Podmiot Leczniczy Sp. z o. o., 80-803 Gdansk, Poland
| | - Krystyna Paszko
- Institute of Nursing and Midwifery, Medical University of Gdańsk, 80-210 Gdansk, Poland
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Johanna B, Noora G, Kaisa M, Heikki E, Mari L. Nurses' and Patients' Perceptions about Psychiatric Intensive Care-An Integrative Literature Review. Issues Ment Health Nurs 2022; 43:983-995. [PMID: 35980786 DOI: 10.1080/01612840.2022.2101079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
This integrative literature review describes nurses's and patients' perceptions of care in psychiatric intensive care units (PICU). The database search was conducted in April 2020. PRISMA checklist and Mixed Method Appraisal Tool guided the identification and evaluation of the studies (n = 21). Data was analyzed with qualitative content analysis. Nurses perceived PICU as a challenging work environment where their primary task was to ensure the unit's safety. Patients views on their treatment varied from positive to negative. Patients wished to have more privacy and supportive interaction. Findings can be used as a basis in developing care practices and staff's further education in PICUs.
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Affiliation(s)
- Berg Johanna
- Health and Well-Being, Turku University of Applied Sciences, Turku, Finland
| | | | - Mishina Kaisa
- Department of Nursing Science, University of Turku, Turku, Finland.,Department of Child Psychiatry, University of Turku; INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Ellilä Heikki
- Health and Well-Being, Turku University of Applied Sciences, Turku, Finland
| | - Lahti Mari
- Health and Well-Being, Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
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5
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McLaughlan R, Richards K, Lipson-Smith R, Collins A, Philip J. Designing Palliative Care Facilities to Better Support Patient and Family Care: A Staff Perspective. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:149-162. [PMID: 35021917 DOI: 10.1177/19375867211059078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To contribute staff perspectives on the design of palliative care facilities to better align with the philosophy of palliative care, in support of patient, family, and staff well-being. BACKGROUND The receipt of palliative care differs from other inpatient experiences owing to its distinct philosophy of care, longer lengths of stay, a greater presence of family members, and more frequent end-of-life events. While research regarding the optimal design of palliative care environments recognizes these differences, this knowledge has been slow to exert change on the guidelines and procurement processes that determine the design solutions possible within these settings. Sustained research attention is required. METHODS An online survey, comprising a series of open-ended questions, elicited the perceptions of palliative care staff regarding the relationship between the physical environment and the distinct philosophy of palliative care. RESULTS Responses from 89 Australian-based palliative care professionals confirmed the high value that staff place on environments that offer privacy, homeliness, safety, and access to gardens to assist the delivery of optimum care. CONCLUSIONS Our findings illustrate that the implications of privacy and homeliness extend far beyond the patient room and that homeliness is about more than an aesthetic of comfort. This highlights a broader capacity for design to better support the philosophy of palliative care. Importantly, the data reveal a key relationship between staff well-being and the environments in which they work; environments that are unable to match the quality of care that staff aspire to deliver can engender frustration and distress.
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Affiliation(s)
- Rebecca McLaughlan
- School of Architecture and the Built Environment, University of Newcastle, Callaghan, Australia
| | - Kieran Richards
- School of Architecture and the Built Environment, University of Newcastle, Callaghan, Australia
| | - Ruby Lipson-Smith
- School of Architecture and the Built Environment, University of Newcastle, Callaghan, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Anna Collins
- Department of Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Jennifer Philip
- Department of Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Australia
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Mclaughlan R, Lyon C, Jaskolska D. Architecture as change-agent? Looking for innovation in contemporary forensic psychiatric hospital design. MEDICAL HUMANITIES 2021; 47:e11. [PMID: 33106241 DOI: 10.1136/medhum-2020-011887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
History suggests that departures from accepted design practice can contribute to positive change in the delivery of mental healthcare, the daily experience of hospitalised patients and public perceptions of mental illness. Yet the question of how architecture can support the therapeutic journey of patients remains a critical one. The availability of evidence-based design literature to guide architects cannot keep pace with growing global demand for new forensic psychiatric hospital facilities. This article reports a global survey of current design practice to speculate on the potential of three new hospitals to positively improve patient experience. A desktop survey was conducted of 31 psychiatric hospitals (24 forensic, 7 non-forensic) constructed or scheduled for completion between 2006 and 2022. This was supplemented by advisory panel sessions with clinical/facilities staff, alongside architectural knowledge obtained through workshops with architects from the UK and the USA, and the inclusion of Australian architects on the research team. Data analysis draws on knowledge from architectural practice, architectural history and environmental psychology, arguing that there is a responsibility to integrate knowledge from across these disciplines in respect of such a pressing and important problem.
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Affiliation(s)
- Rebecca Mclaughlan
- School of Architecture and the Built Environment, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Codey Lyon
- NTC Architects, Melbourne, Victoria, Australia
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Molin J, Strömbäck M, Lundström M, Lindgren BM. It's Not Just in the Walls: Patient and Staff Experiences of a New Spatial Design for Psychiatric Inpatient Care. Issues Ment Health Nurs 2021; 42:1114-1122. [PMID: 34142934 DOI: 10.1080/01612840.2021.1931585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The environment in psychiatric inpatient care is key to patient recovery and staff job satisfaction. In this qualitative study of patient and staff experiences of a new spatial design in psychiatric inpatient care, we analysed data from 11 semi-structured interviews with patients and five focus group discussions with staff using qualitative content analysis. The new design contributed to feelings of safety and recovery, but patients and staff also reported some frustration and added stress. The results lead us to conclude that while the new spatial design improves some conditions for recovery and job satisfaction, the design itself is simply not enough. Changes in care environments require that both patients and staff be informed and involved in the renovation to ensure that patients feel respected and staff feel confident in using the new environment before and during treatment and follow-ups.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Maria Strömbäck
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.,Department of Community Medicine and Rehabilitation, Division of Physiotherapy, Umeå University, Umeå, Sweden
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The HDR CARE Scale, Inpatient Version: A validated survey instrument to measure environmental affordance for nursing tasks in inpatient healthcare settings. PLoS One 2021; 16:e0258815. [PMID: 34669741 PMCID: PMC8528276 DOI: 10.1371/journal.pone.0258815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
Rigorous healthcare design research is critical to inform design decisions that improve human experience. Current limitations in the field include a lack of consistent and valid measures that provide feedback about the role of the built environment in producing desirable outcomes. Research findings about nurses’ efficiency, quality of care, and satisfaction related to inpatient unit designs have been mixed, and there was previously no validated instrument available to quantitatively measure nurses’ ability to work efficiently and effectively in their environment. The objective of this study was to develop, refine, and validate a survey instrument to measure affordance of the care environment to nurse practice, based on various aspects of their work in inpatient units. The HDR Clinical Activities Related to the Environment (CARE) Scale Inpatient Version was developed using item design, refinement, and reliability and validity testing. Psychometric methods from classical test theory and item response theory, along with statistical analyses involving correlations and factor analysis, and thematic summaries of qualitative data were conducted. The four-phase process included (1) an initial pilot study, (2) a content validation survey, (3) cognitive interviews, and (4) a final pilot study. Results from the first three phases of analysis were combined to inform survey scale revisions before the second pilot survey, such as a reduction in the number and rewording of response options, and refinement of scale items. The updated 9-item scale showed excellent internal consistency and improved response distribution and discrimination. The factor analysis revealed a unidimensional measure of nurse practice, as well as potential subscales related to integration, efficiency, and patient care. Within the healthcare design industry, this scale is much needed to generate quantitative and standardized data and will facilitate greater understanding about the aspects of an inpatient healthcare facility that best support nurses’ ability to provide quality patient care.
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Mokarami H, Eskandari S, Cousins R, Salesi M, Kazemi R, Razeghi M, Choobineh A. Development and validation of a Nurse Station Ergonomics Assessment (NSEA) tool. BMC Nurs 2021; 20:83. [PMID: 34059027 PMCID: PMC8165804 DOI: 10.1186/s12912-021-00600-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nurse stations are one of the primary units for supporting effective functioning of any hospital. They are important working environments that demand adherence to known ergonomic principles for the well-being of both staff and patients. The aim of this study was to develop a psychometrically tested tool for the assessment of the ergonomic conditions of nurse workstations in hospitals. Methods Ten hospitals, with a total of 133 nurse stations participated in this mixed-methods research. The domains and items of the tool were developed based on a literature review, an experts’ panel, and interviews with nurses. Results The final nurse station ergonomic assessment (NSEA) tool has good psychometric properties. Validity was assessed by face validity and content validity. Reliability was evaluated using inter-rater agreement and test-retest reliability analyses with a four-week interval between assessments. The NSEA is comprised of 64 items across eight domains: layout and location (7 items), workspace (11 items), security-safety (5 items), environmental conditions (8 items), counter (8 items), chair (13 items), desk (9 items), and monitor (3 items). Conclusions The NSEA adds to the literature a tool for managers to ensure they comply with legal requirements and support best practice for those working on hospital wards. The NSEA can be used to identify challenges for healthcare professionals who use nurse stations and support the execution of targeted interventions to improve human-environment interactions. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00600-8.
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Affiliation(s)
- Hamidreza Mokarami
- Departemt of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Eskandari
- Departemt of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rosanna Cousins
- Department of Psychology, Liverpool Hope University, Liverpool, UK
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Reza Kazemi
- Departemt of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Choobineh
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, PO Box 71645-111, Shiraz, Iran.
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10
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Mutual visibility and interaction: staff reactions to the ‘healing architecture’ of psychiatric inpatient wards in Denmark. BIOSOCIETIES 2020. [DOI: 10.1057/s41292-020-00195-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Liddicoat S. The Therapeutic Waiting Room: Therapist and Service User Perspectives on the Psychologically Supportive Dimensions of Architectural Space. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 13:103-118. [PMID: 32054326 DOI: 10.1177/1937586720904805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Waiting areas in healthcare settings play an important role in reassuring or potentially further distressing service users. The effects of the designed environment on mental health service users specifically are regarded by health professionals as having a considerable influence on treatment outcomes, experiences, and perceptions of care. PURPOSE The purpose of this article is to explore service user and practicing therapist perspectives of waiting areas in mental health service settings and how the design of these spaces affects anxiety levels, comfort, therapeutic relationships, outcomes, and perceptions of care. METHODS The methodology for this exploratory phenomenological study was developed in order to preserve the integrity of participant voices in the essences of experiences, during explorations of their encounters with therapeutic waiting areas. Fieldwork undertaken by the author involved a series of focused in-depth interviews with service users of mental health services and practicing therapists, counselors, and psychologists. RESULTS Key themes identified through data analysis include (1) space acting as symbolism, (2) interpersonal relations which are threatening, and (3) sensory modulation. Design implications in relation to each theme are presented. CONCLUSIONS This study uncovered a set of findings in relation to symbolic content inferred by spatial design aspects and the ways in which design can afford, or mitigate, development of interpersonal agencies, psychological safety, and negative stigmas. Future transdisciplinary research directions are suggested, including (1) examination of other relationships, beyond the service user-therapist dyad, which may influence waiting area experiences and (2) examination of the applicability of design suggestions to different contexts.
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Affiliation(s)
- Stephanie Liddicoat
- Faculty of Architecture, Building and Planning, The University of Melbourne, Victoria, Australia
- School of Design, Faculty of Health, Arts and Design, Swinburne University, Melbourne, Victoria, Australia
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Jovanović N, Campbell J, Priebe S. How to design psychiatric facilities to foster positive social interaction – A systematic review. Eur Psychiatry 2020; 60:49-62. [DOI: 10.1016/j.eurpsy.2019.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/15/2022] Open
Abstract
AbstractPsychiatric facilities are often criticised of being poorly designed which may contribute to violent incidents and patients’ complaints of feeling bored and lacking meaningful interactions with peers and staff. There is a lack of understanding how to design environments for staff, patients and visitors to engage in positive social interactions (e.g. conversation, sharing, peer support). We conducted a systematic literature review on which architectural typologies and design solutions facilitate helpful social interactions between users of psychiatric facilities. Several interventions were identified such as choosing a community location; building smaller (up to 20 beds) homelike and well integrated facilities with single/double bedrooms and wide range of communal areas; provision of open nursing stations; ensuring good balance between private and shared spaces for patients and staff; and specific interior design interventions such as arranging furniture in small, flexible groupings, introduction of plants on wards, and installing private conversation booths. These interventions range from simple and non-costly to very complex ones. The evidence should inform the design of new hospitals and the retrofitting of existing ones.
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Yasin YM, Kerr MS, Wong CA, Bélanger CH. Factors affecting nurses' job satisfaction in rural and urban acute care settings: A PRISMA systematic review. J Adv Nurs 2019; 76:963-979. [PMID: 31840301 DOI: 10.1111/jan.14293] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/06/2019] [Accepted: 12/10/2019] [Indexed: 12/01/2022]
Abstract
AIMS This review aimed to systematically assess the findings of primary studies to identify the factors associated with nurse job satisfaction in rural and urban contexts while analysing the findings according to Herzberg's theory. BACKGROUND While there is evidence linking several factors to nurses' job satisfaction, gaps still exist in understanding the differences between factors affecting job satisfaction for nurses working in rural and urban settings. DESIGN Systematic review with narrative summary. DATA SOURCES Six databases were used to identify original studies that discuss the factors associated with the nurse's job satisfaction between 1998-2018. REVIEW METHODS Two authors independently reviewed each study using the Joanna Briggs Institute's critical appraisal checklists. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to report and examine the study biases systematically. RESULTS A total of 38 studies were selected for this review. Physical working environment and authority and freedom were the most frequently reported factors associated with nurses' job satisfaction. Several extrinsic, intrinsic, personal, and community factors were also found to be associated with nurses' job satisfaction. Urban studies tended to focus on extrinsic factors, whereas there was more balance between the two sets of factors in rural studies. CONCLUSION Both intrinsic and extrinsic factors play an essential role in nurses' job satisfaction. Future research should use more robust research methods and pay more attention to contrasting rural and urban contexts. Herzberg's theory can provide conceptual clarity when investigating the factors associated with nurses' job satisfaction. IMPACT This review discussed the factors associated with nurses' job satisfaction in rural and urban settings. The findings linked several extrinsic and intrinsic factors to nurses' job satisfaction. Nursing management should search for the perfect blend of intrinsic and extrinsic factors based on nurses' needs and organizational commitment to improve nurses' job satisfaction.
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15
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Camuccio CA, Sanavia M, Cutrone F, Marella I, Gregio M, Cabbia C, Cocchio S, Baldo V. Noise Levels in an Acute Psychiatric Unit: An Exploratory Observational Study. Issues Ment Health Nurs 2019; 40:493-502. [PMID: 30946621 DOI: 10.1080/01612840.2018.1557301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Noise is an important aspect of the ward atmosphere climate - the combination of the architectural solutions, organizational features, the psychological traits of the operators and their interactions, and the patients' characteristics. Despite its importance noise levels have been less analyzed than other aspects of the ward atmosphere climate. Aim: In this study the aim is to identify the sources of noise and the sound pressure level in an acute psychiatric ward, and secondly to ascertain whether this is perceived by inpatients as disturbing. Method: The sound pressure levels were measured during three nonconsecutive mornings, three afternoons, and three nights. A questionnaire was administered to ascertain patients' opinions about the noise in the ward. Results: The average noise level in the ward was 62.5 dB(A)eq in the morning, 55.8 in the afternoon, and 51.5 at night. A total of 23 patients took part in the study: 65.2% of this sample did not perceive the noise in the ward as disturbing. Conclusion: In a psychiatric ward, the main source of noise is the verbal communication, and acoustic pressure also derived from care activities based around relationships. Other sources of noise perceived as disturbing came from the opening and closing of doors and the entry doorbell. Adopting relational and architectural-structural measures could reduce the sound pressure, with a view to further improving the ambience in the ward.
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Affiliation(s)
- C A Camuccio
- a Nursing School of Venice/Mestre , School of Medicine, University of Padua , Venezia/Mestre , Italy
| | - M Sanavia
- b Medical Department , Casa di Cura "Policlinico San Marco" , Venezia/Mestre , Italy
| | - F Cutrone
- c Department of Mental Health of Venice , Azienda Unità Locale Socio Sanitaria 3 Serenissima , Venezia , Italy
| | - I Marella
- d Department of Epidemiology and Environmental Hygiene , Azienda Unità Locale Socio Sanitaria 3 Serenissima , Venezia/Mestre , Italy
| | - M Gregio
- d Department of Epidemiology and Environmental Hygiene , Azienda Unità Locale Socio Sanitaria 3 Serenissima , Venezia/Mestre , Italy
| | - C Cabbia
- e Department of Cardiac, Thoracic and Vascular Sciences , School of Medicine, University of Padua , Padova , Italy
| | - S Cocchio
- e Department of Cardiac, Thoracic and Vascular Sciences , School of Medicine, University of Padua , Padova , Italy
| | - V Baldo
- e Department of Cardiac, Thoracic and Vascular Sciences , School of Medicine, University of Padua , Padova , Italy
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Freihoefer K, Lindval S, Bayramzadeh S, Hanson L. Implications of a Decentralized Postpartum Unit Design and Clinical Operations. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 12:39-52. [PMID: 30654652 DOI: 10.1177/1937586718822065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This postoccupancy study sought to understand whether a decentralized unit design supported a postpartum care delivery model by evaluating nurses' efficiency, staff perception, acoustical conditions, and patient satisfaction. BACKGROUND Today, standardization and decentralization design concepts are being applied to all types of inpatient unit. There have been many studies that investigated how these concepts influence care delivery on medical-surgical units, but no study has evaluated a postpartum unit. METHODS This study utilized a mixed-method approach that involved unobtrusive shadowing (roughly 25 hr) and surveying (n = 19) of nursing staff, physical acoustic readings (eight, 24-hr readings), and comparison of patient satisfaction pre- and postmove. RESULTS On average, nurses spent roughly 36.90% of their time at charting stations. Nurses were observed mostly using the central charting station located at the entry of the unit and adjacent to the well-baby nursery rather than the five decentralized chart stations. This was due to nurses operating with old workflow habits, not fully integrating electronic medical records, and needing to be near the nursery and other nurses. Nurses were satisfied with their ability to interact and their proximity to supplies, patients, and team members while in the central charting station. Additionally, patient satisfaction significantly increased postmove, particularly with the overall hospital's quietness and cleanliness. CONCLUSION This study highlights the importance of aligning administrative operations of the unit with the design intent. Although standardization and decentralization design concepts aimed to improve nurses' workflow, misalignment with the operations may not deliver the most optimal outcomes.
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Affiliation(s)
| | | | | | - Leah Hanson
- Ascension St. Elizabeth Hospital, Appleton, WI, USA
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Transition to a newly constructed single patient room adult intensive care unit - Clinicians' preparation and work experience. J Crit Care 2018; 48:426-432. [PMID: 30321834 DOI: 10.1016/j.jcrc.2018.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/03/2018] [Accepted: 09/20/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe how clinicians were prepared for the transition to a novel single patient room (SPR) intensive care unit (ICU) and their work experience during this transition. MATERIALS AND METHODS In this qualitative descriptive study, four focus groups were conducted six months post-move with a multidisciplinary group of 29 clinicians at a hospital in Montreal, Canada. The interview guide was derived from a readiness for change conceptual framework. Audio recordings were transcribed verbatim and analyzed via thematic analysis. RESULTS Clinicians described preparation strategies such as educational resources, managerial support and personal initiatives, with some variation across professions. Clinicians felt ready for the transition especially in their adaptation to the new physical environment, yet some challenges related to teamwork dynamics and bedside care persisted after the transition. CONCLUSIONS The use of preparation strategies that are tailored to clinicians' roles helped build readiness for transition to a novel SPR ICU and facilitated the adaptation process. Challenges related to teamwork dynamics and practices in an isolating environment persisted beyond the adaptation period and must be addressed and overcome to better meet the needs and expectations of ICU clinicians.
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Satisfaction with caregivers during labour among low risk women in the Netherlands: the association with planned place of birth and transfer of care during labour. BMC Pregnancy Childbirth 2017; 17:229. [PMID: 28705146 PMCID: PMC5513372 DOI: 10.1186/s12884-017-1410-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/05/2017] [Indexed: 11/23/2022] Open
Abstract
Background The caregiver has an important influence on women’s birth experiences. When transfer of care during labour is necessary, care is handed over from one caregiver to the other, and this might influence satisfaction with care. It is speculated that satisfaction with care is affected in particular for women who need to be transferred from home to hospital. We examined the level of satisfaction with the caregiver among women with planned home versus planned hospital birth in midwife-led care. Methods We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Women filled in a postpartum questionnaire which contained elements of the Consumer Quality index. This instrument measures 'general rate of satisfaction with the caregiver’ (scale from 1 to 10, with cut-off of below 9) and ‘quality of treatment by the caregiver’ (containing 7 items on a 4 point Likert scale, with cut-off of mean of 4 or lower). Results Women who planned a home birth (n = 1372) significantly more often rated 'quality of treatment by caregiver' high than women who planned a hospital birth (n = 829). Primiparous women who planned a home birth significantly more often had a high rate (9 or 10) for ‘general satisfaction with caregiver’ (adj.OR 1.48; 95% CI 1.1, 2.0). Also, primiparous women who planned a home birth and had care transferred during labour (331/553; 60%) significantly more often had a high rate (9 or 10) for ‘general satisfaction’ compared to those who planned a hospital birth and who had care transferred (1.44; 1.0–2.1). Furthermore, they significantly more often rated ‘quality of treatment by caregiver’ high, than 276/414 (67%) primiparous women who planned a hospital birth and who had care transferred (1.65; 1.2–2.3). No differences were observed for multiparous women who had planned home or hospital birth and who had care transferred. Conclusions Planning home birth is associated to a good experience of quality of care by the caregiver. Transferred planned home birth compared to a transferred planned hospital birth does not lead to a more negative experience of care received from the caregiver. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1410-9) contains supplementary material, which is available to authorized users.
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Shepley MM, Watson A, Pitts F, Garrity A, Spelman E, Kelkar J, Fronsman A. Mental and behavioral health environments: critical considerations for facility design. Gen Hosp Psychiatry 2016; 42:15-21. [PMID: 27638966 DOI: 10.1016/j.genhosppsych.2016.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/16/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of the study was to identify features in the physical environment that are believed to positively impact staff and patients in psychiatric environments and use these features as the foundation for future research regarding the design of mental and behavioral health facilities. METHODS Pursuant to a broad literature review that produced an interview script, researchers conducted 19 interviews of psychiatric staff, facility administrators and architects. Interview data were analyzed using the highly structured qualitative data analysis process authored by Lincoln and Guba (1985). Seventeen topics were addressed ranging from the importance of a deinstitutionalized environment to social interaction and autonomy. RESULTS The interviewees reinforced the controversy that exists around the implications of a deinstitutionalized environment, when the resulting setting diminishes patient and staff safety. Respondents tended to support open nurse stations vs. enclosed stations. Support for access to nature and the provision of an aesthetic environment was strong. Most interviewees asserted that private rooms were highly desirable because lower room density reduces the institutional character of a unit. However, a few interviewees adamantly opposed private rooms because they considered the increased supervision of one patient by another to be a deterrent to self-harm. The need to address smoking rooms in future research received the least support of all topics. CONCLUSION Responses of interviews illustrate current opinion regarding best practice in the design of psychiatric facilities. The findings emphasize the need for more substantive research on appropriate physical environments in mental and behavioral health settings.
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Affiliation(s)
| | - Angela Watson
- Shepley Bulfinch Architects, 2 Seaport Lane, Boston, MA, 02210, USA
| | - Francis Pitts
- Architecture Plus, 297 River Street, Troy, NY, 12180, USA
| | - Anne Garrity
- Shepley Bulfinch Architects, 2 Seaport Lane, Boston, MA, 02210, USA
| | | | - Janhawi Kelkar
- College of Human Ecology, Cornell University, Ithaca, NY, 14850, USA
| | - Andrea Fronsman
- College of Human Ecology, Cornell University, Ithaca, NY, 14850, USA
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Reconciling concepts of space and person-centred care of the older person with cognitive impairment in the acute care setting. Nurs Philos 2016; 18. [DOI: 10.1111/nup.12142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Andrews GJ. Geographical thinking in nursing inquiry, part one: locations, contents, meanings. Nurs Philos 2016; 17:262-81. [DOI: 10.1111/nup.12133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gavin J. Andrews
- Department of Health, Aging and Society McMaster University Hamilton ON Canada
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Csipke E, Papoulias C, Vitoratou S, Williams P, Rose D, Wykes T. Design in mind: eliciting service user and frontline staff perspectives on psychiatric ward design through participatory methods. J Ment Health 2016; 25:114-21. [PMID: 26886239 PMCID: PMC4819846 DOI: 10.3109/09638237.2016.1139061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/04/2015] [Accepted: 12/23/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. METHOD User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. RESULTS Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. CONCLUSIONS Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users.
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Affiliation(s)
| | | | | | | | - Diana Rose
- Service User Research Enterprise, Institute of Psychiatry, Psychology & Neuroscience, King’s College London,
London,
UK
| | - Til Wykes
- Department of Psychology
- Service User Research Enterprise, Institute of Psychiatry, Psychology & Neuroscience, King’s College London,
London,
UK
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Ahern CC, Bieling P, McKinnon MC, McNeely HE, Langstaff K. A Recovery-Oriented Care Approach: Weighing the Pros and Cons of a Newly Built Mental Health Facility. J Psychosoc Nurs Ment Health Serv 2016; 54:39-48. [DOI: 10.3928/02793695-20160119-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/09/2015] [Indexed: 11/20/2022]
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Marcheschi E, Johansson M, Laike T, Brunt D. Housing design and people with severe mental illness: An observational approach to the investigation of supported housing facilities. Scand J Psychol 2016. [DOI: 10.1111/sjop.12259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Maria Johansson
- Department of Architecture and Built Environment; Lund University; Lund Sweden
| | - Thorbjörn Laike
- Department of Architecture and Built Environment; Lund University; Lund Sweden
| | - David Brunt
- School of Health and Caring Science; Linnaeus University; Växjö Sweden
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Shattell M, Bartlett R, Beres K, Southard K, Bell C, Judge CA, Duke P. How Patients and Nurses Experience an Open Versus an Enclosed Nursing Station on an Inpatient Psychiatric Unit. J Am Psychiatr Nurses Assoc 2015; 21:398-405. [PMID: 26597907 DOI: 10.1177/1078390315617038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The inpatient environment is a critical space for nurses and patients in psychiatric settings. In this article, we describe nurses' and patients' perceptions of the inpatient environment both before the removal of a Plexiglas enclosure around a nurses' station and after its removal. Nurses had mixed feelings about the enclosure, reporting that it provided for confidentiality and a concentrated work space but also acknowledged the challenge of the barrier for communication with their patients. Patients unanimously preferred the nurses' station without the barrier, reporting increased feelings of freedom, safety, and connection with the nurses after its removal. It is important to consider the implications of environmental decisions in inpatient settings in order to promote a healthy workplace and healing environment for all community members.
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Affiliation(s)
- Mona Shattell
- Mona Shattell, PhD, RN, FAAN, DePaul University, Chicago, IL, USA
| | - Robin Bartlett
- Robin Bartlett, PhD, RN, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Kyle Beres
- Kyle Beres, MS, RN, DePaul University, Chicago, IL, USA
| | - Kelly Southard
- Kelly Southard, RN, BSN, MBA, Cone Health Behavioral Health Hospital, Greensboro, NC, USA
| | - Claire Bell
- Claire Bell, MA, East Carolina University, Greenville, NC, USA
| | - Christine A Judge
- Christine A. Judge, RN, BSN, BC, Cone Health Behavioral Health Hospital, Greensboro, NC, USA
| | - Patricia Duke
- Patricia Duke, RN, BC, Cone Health Behavioral Health Hospital, Greensboro, NC, USA
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Ahern C, McKinnon MC, Bieling PJ, McNeely H, Langstaff K. Overcoming the Challenges Inherent in Conducting Design Research in Mental Health Settings. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2015; 9:119-29. [DOI: 10.1177/1937586715602219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Conducting high-quality design research in a mental health setting presents significant challenges, limiting the availability of high-quality evidence to support design decisions for built environments. Here, we outline key approaches to overcoming these challenges. Background: In conducting a rigorous post-occupancy evaluation of a newly built mental health and addictions facility, St. Joseph’s Healthcare, Hamilton, we identified a number of systematic barriers associated with conducting design research in mental health settings. Methods: Our approach to overcoming these barriers relied heavily upon (i) selecting established measures and methods with demonstrated efficacy in a mental health context, (ii) navigating institutional protocols designed to protect vulnerable members of this population, and (iii) designing innovative data collection strategies to increase participation in research by individuals with mental illness. Each of these approaches drew heavily on the expert knowledge of mental health settings and the experiences with mental health, facilities management, and research of a research team that was well integrated within the parent institution. Conclusions: Engaging multiple stakeholders (e.g., care providers, patients, ethics board, and hospital administrators) contributed their trust and support of the research. Traditionally, post-occupancy evaluation researchers are independent of the facilities they research, yet this is not an effective approach in mental health settings. We found that, in working toward solutions to the three obstacles we described, having team members who were well “networked” within the parent institution was necessary. This approach can turn “gatekeepers” into champions for patients’ engagement in the research, which is essential in generating high-quality evidence.
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Affiliation(s)
| | - Margaret C. McKinnon
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | - Peter J. Bieling
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | - Heather McNeely
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
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Abstract
Purpose
– This paper aims to present an integrative review of the research studies on nursing unit layouts.
Design/methodology/approach
– Studies selected for review were published between 1956 and 2014. For the purpose of this review, a framework for integrative review was developed using research orientations. The three primary dimensions – technical, psychological and social – of the designed environment and various combinations of these dimensions were used to define the research orientations of these studies.
Findings
– Of all the publications reviewed for the paper, 21 presented technical orientations, 16 psychological orientations, 3 social orientations, 20 psychotechnical orientations, 10 sociotechnical orientations, 2 psychosocial orientations and 13 presented psychosociotechnical orientations. With only a few exceptions, several issues related to nursing unit layouts were investigated no more than one time in any one category of research orientations. Several other seemingly important issues including patient and family behavior and perception, health outcomes and social and psychosocial factors in relation to unit layouts have not been studied adequately.
Research limitations/implications
– Future studies on nursing unit layouts will need to focus on patient and family behavior and perception, health outcomes and social and psychosocial factors in different units. They will also need to focus on developing theories concerning the effects of layouts on the technical, psychological and social dimensions of nursing units.
Originality/value
– Despite a long history of research on nursing unit layouts, an integrative review of these studies is still missing in the literature. This review fills in the gap using a novel framework for integrative review developed based on research orientations.
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Papoulias C, Csipke E, Rose D, McKellar S, Wykes T. The psychiatric ward as a therapeutic space: systematic review. Br J Psychiatry 2014; 205:171-6. [PMID: 25179622 DOI: 10.1192/bjp.bp.114.144873] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hospital care is still an integral part of mental healthcare services. But the impact of ward design on treatment outcomes is unclear. AIMS To review the effects of ward design on patient outcomes and patient and staff well-being. METHOD A systematic review of literature was carried out on Medline, Embase and PsycINFO. Papers on psychogeriatric and child and adolescent wards were excluded as these necessitate specific safety features. RESULTS Twenty-three papers were identified. No strong causal links between design and clinical outcomes were found. Private spaces and a homely environment may contribute to patient well-being. Different stakeholders may experience ward design in conflicting ways; design has a symbolic and social dimension for patients. CONCLUSIONS Data on the impact of design on treatment outcomes are inconclusive. Rigorous randomised controlled trials, qualitative studies and novel methods are called for. Different stakeholders' responses to the ward as a symbolic environment merit further investigation.
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Affiliation(s)
- Constantina Papoulias
- Constantina Papoulias, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Emese Csipke, PhD, Department of Psychology, Institute of Psychiatry, King's College London; Diana Rose, PhD, Susie McKellar, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Til Wykes, PhD, Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Emese Csipke
- Constantina Papoulias, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Emese Csipke, PhD, Department of Psychology, Institute of Psychiatry, King's College London; Diana Rose, PhD, Susie McKellar, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Til Wykes, PhD, Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Diana Rose
- Constantina Papoulias, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Emese Csipke, PhD, Department of Psychology, Institute of Psychiatry, King's College London; Diana Rose, PhD, Susie McKellar, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Til Wykes, PhD, Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Susie McKellar
- Constantina Papoulias, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Emese Csipke, PhD, Department of Psychology, Institute of Psychiatry, King's College London; Diana Rose, PhD, Susie McKellar, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Til Wykes, PhD, Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Til Wykes
- Constantina Papoulias, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Emese Csipke, PhD, Department of Psychology, Institute of Psychiatry, King's College London; Diana Rose, PhD, Susie McKellar, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Til Wykes, PhD, Department of Psychology, Institute of Psychiatry, King's College London, UK
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Bayramzadeh S, Alkazemi MF. Centralized vs. Decentralized Nursing Stations: An Evaluation of the Implications of Communication Technologies in Healthcare. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2014; 7:62-80. [DOI: 10.1177/193758671400700406] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: This study aims to explore the relationship between the nursing station design and use of communication technologies by comparing centralized and decentralized nursing stations. BACKGROUND: The rapid changes in communication technologies in healthcare are inevitable. Communication methods can change the way occupants use a space. In the meantime, decentralized nursing stations are emerging as a replacement for the traditional centralized nursing stations; however, not much research has been done on how the design of nursing stations can impact the use of communication technologies. METHODS: A cross sectional study was conducted using an Internet-based survey among registered nurses in a Southeastern hospital in the United States. Two units with centralized nursing stations and two units with decentralized nursing stations were compared in terms of the application of communication technologies. A total of 70 registered nurses completed the survey in a 2-week period. RESULTS: The results revealed no significant differences between centralized and decentralized nursing stations in terms of frequency of communication technologies used. However, a difference was found between perception of nurses toward communication technologies and perceptions of the use of communication technologies in decentralized nursing stations. CONCLUSIONS: Although the study was limited to one hospital, the results indicate that nurses hold positive attitudes toward communication technologies. The results also reveal the strengths and weaknesses of each nursing station design with regard to communication technologies.
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Abstract
Filling an alarming gap in evidence-based data on the post-1978 reformed Italian psychiatric system, two turn-of-millennium nationwide projects, Progetto Residenze (PROGRES) and PROGRES-Acute, provided detailed qualitative-quantitative information about care facilities. In 2000, there were 2.9 residential beds per 10,000 inhabitants, hospital care being delivered through small (15-bed) psychiatric units. Private inpatient facilities had proliferated, private inpatient beds per 10,000 inhabitants outnumbering public beds. In 2002, there were 1.7 acute inpatient beds per 10,000 inhabitants, one of Europe's lowest current ratios. The PROGRES and other subsequent projects showed marked nationwide variation in the provision of residential inpatient and outpatient care, grounds for concern about the quality of such care, and an uneven service use pattern. Although the Italian reform law produced a broad network of facilities to meet diverse mental health care needs, the present overview article confirms that further efforts are required to improve quality, balance public and private sectors, and coordinate resources and agencies.
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Bukh G, Tommerup AMM, Madsen OR. Impact of healthcare design on patients’ perception of a rheumatology outpatient infusion room: an interventional pilot study. Clin Rheumatol 2014; 34:1249-54. [DOI: 10.1007/s10067-014-2592-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/22/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
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Mathew J, Ram D, Bhattacharjee D, Sharma A. Self-Esteem, Job Satisfaction and Burnout between General and Psychiatric Nursing Staff. JOURNAL OF HEALTH MANAGEMENT 2014. [DOI: 10.1177/0972063413516232] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to compare self-esteem, job-satisfaction and burnout between psychiatric and general nurses as well as to determine how these three elements are interrelated to each other. Like other professionals, nurses are also at risk of developing problems like professional burnout and a sense of dissatisfaction regarding their jobs. Causal factors of burnout among professionals are multi-factorial, starting from socio-demographic and occupational background to one’s personality characteristics. In this study, 30 psychiatric nurses and 30 general nurses were selected through a purposive sampling method. This was a one-time cross-sectional hospital-based study, data was collected during the period September, 2008 to November, 2008 and written consent was taken from the subjects. Statistical measures like descriptive statistics, Chi-square test, t-test and Pearson’s correlation-coefficient were used to analyze the data. In this study psychiatric nurses had been found to have higher level of self-esteem than general nurses. Nurses working in a general hospital had been observed to have a higher level of burnout and lower job satisfaction than psychiatric nurses.
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Sadatsafavi H, Walewski J. Corporate Sustainability: The Environmental Design and Human Resource Management Interface in Healthcare Settings. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2013; 6:98-118. [DOI: 10.1177/193758671300600209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose of the Paper: The purpose of this study is to provide healthcare organizations with a new perspective for developing strategies to enrich their human resource capabilities and improve their performance outcomes. The focus of this study is on leveraging the synergy between organizational management strategies and environmental design interventions. Background: This paper proposes a framework for linking the built environment with the human resource management system of healthcare organizations. The framework focuses on the impact of the built environment regarding job attitudes and behaviors of healthcare workers. Research from the disciplines of strategic human resource management, resource-based view of firms, evidence-based design, and green building are utilized to develop the framework. Theoretical Framework: The positive influence of human resource practices on job attitudes and behaviors of employees is one mechanism to improve organizational performance outcomes. Organizational psychologists suggest that human resource practices are effective because they convey that the organization values employee contributions and cares about their well-being. Attention to employee socio-emotional needs can be reciprocated with higher levels of motivation and commitment toward the organization. In line with these findings, healthcare environmental studies imply that physical settings and features can have a positive influence on job attitudes and the behavior of caregivers by providing for their physical and socio-emotional needs. Conclusions: Adding the physical environment as a complementary resource to the array of human resource practices creates synergy in improving caregivers' job attitudes and behaviors and enhances the human capital of healthcare firms.
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Gum LF, Prideaux D, Sweet L, Greenhill J. From the nurses' station to the health team hub: How can design promote interprofessional collaboration? J Interprof Care 2012; 26:21-7. [DOI: 10.3109/13561820.2011.636157] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Novotná G, Urbanoski KA, Rush BR. Client-centered design of residential addiction and mental health care facilities: staff perceptions of their work environment. QUALITATIVE HEALTH RESEARCH 2011; 21:1527-1538. [PMID: 21725027 DOI: 10.1177/1049732311413782] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this article we discuss the findings from a series of focus groups conducted as part of a 3-year, mixed-method evaluation of clinical programs in a large mental health and substance use treatment facility in Canada. We examined the perceptions of clinical personnel on the physical design of new treatment units and the impact on service delivery and the work environment. The new physical design appeared to support client recovery and reduce stigma; however, it brought certain challenges. Participants reported a compromised ability to monitor clients, a lack of designated therapeutic spaces, and insufficient workspace for staff. They also thought that physical design positively facilitated communication and therapeutic relationships among clinicians and clients, and increased team cohesion. We suggest that, from these findings, new avenues for research on achieving the important balance between client and staff needs in health facility design can be explored.
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Zborowsky T, Bunker-Hellmich L, Morelli A, O'Neill M. Centralized vs. decentralized nursing stations: effects on nurses' functional use of space and work environment. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2011; 3:19-42. [PMID: 21165850 DOI: 10.1177/193758671000300404] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Evidence-based findings of the effects of nursing station design on nurses' work environment and work behavior are essential to improve conditions and increase retention among these fundamental members of the healthcare delivery team. The purpose of this exploratory study was to investigate how nursing station design (i.e., centralized and decentralized nursing station layouts) affected nurses' use of space, patient visibility, noise levels, and perceptions of the work environment. BACKGROUND Advances in information technology have enabled nurses to move away from traditional centralized paper-charting stations to smaller decentralized work stations and charting substations located closer to, or inside of, patient rooms. Improved understanding of the trade-offs presented by centralized and decentralized nursing station design has the potential to provide useful information for future nursing station layouts. This information will be critical for understanding the nurse environment "fit." METHODS The study used an exploratory design with both qualitative and quantitative methods. Qualitative data regarding the effects of nursing station design on nurses' health and work environment were gathered by means of focus group interviews. Quantitative data-gathering techniques included place- and person-centered space use observations, patient visibility assessments, sound level measurements, and an online questionnaire regarding perceptions of the work environment. RESULTS Nurses on all units were observed most frequently performing telephone, computer, and administrative duties. Time spent using telephones, computers, and performing other administrative duties was significantly higher in the centralized nursing stations. Consultations with medical staff and social interactions were significantly less frequent in decentralized nursing stations. There were no indications that either centralized or decentralized nursing station designs resulted in superior visibility. Sound levels measured in all nursing stations exceeded recommended levels during all shifts. No significant differences were identified in nurses' perceptions of work control-demand-support in centralized and decentralized nursing station designs. CONCLUSIONS The "hybrid" nursing design model in which decentralized nursing stations are coupled with centralized meeting rooms for consultation between staff members may strike a balance between the increase in computer duties and the ongoing need for communication and consultation that addresses the conflicting demands of technology and direct patient care.
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Symon AG, Dugard P, Butchart M, Carr V, Paul J. Care and environment in midwife-led and obstetric-led units: a comparison of mothers' and birth partners' perceptions. Midwifery 2011; 27:880-6. [PMID: 21251736 DOI: 10.1016/j.midw.2010.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/14/2010] [Accepted: 10/03/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Health-care design recognises the importance of people-environment interactions, and maternity units have responded by encouraging 'homely' environments. Birthing women and birth partners have been separately surveyed about their experiences of the maternity environment and midwifery care, but not to date as dyads. METHOD(S) Postal return survey of mothers and birth partners from nine maternity units (six midwife-led; three obstetric-led) in England, at eight days postnatally in 2004-5. Questions concerned participants' general and specific impressions of the unit environment and of the care given. A repeated measures analysis of variance was used to explore interactions between mothers and partners and different types of unit. The Wilcoxon signed rank test was used for skewed satisfaction scores. Loglinear models were used to analyse mothers' and partners' cited comments, factoring in types of unit. FINDINGS 515 Dyads responded (response rate 50%). Mothers and partners were generally positive, but *mothers were more so. They rated the birth surroundings (Z = -8.083; p < 0.001) and the midwifery care (Z = -7.177; p < 0.001) more highly than their partners; these findings were significant in both types of unit. Loglinear analysis found that mothers especially were more likely to find midwife-led units 'homely' (Z = 2.496; p = 0.013), 'calming' (Z = 9.61; p < 0.001): and 'clean' (Z = 4.08, p < 0.001). Obstetric-led units were more likely to be thought 'stuffy' (Z = -3.51, p < 0.001). Partners were more likely to agree that there was a lack of privacy (Z = 3.401; p = 0.001), and that there was a lack of facilities for them, particularly within obstetric-led units. CONCLUSIONS Although generally positive, birth partners were significantly less positive than the birthing mothers about a range of environmental and care variables. The primary focus is and should be the birthing woman, but the partner nevertheless has an interactive role to play, and improving his experience may assist this function.
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Affiliation(s)
- Andrew G Symon
- School of Nursing & Midwifery, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ Scotland, UK.
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Tanja-Dijkstra K, Pieterse ME. The psychological effects of the physical healthcare environment on healthcare personnel. Cochrane Database Syst Rev 2011:CD006210. [PMID: 21249674 DOI: 10.1002/14651858.cd006210.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The physical healthcare environment is capable of affecting patients. This concept of 'healing environments' refers to the psychological impact of environmental stimuli through sensory perceptions. It excludes more physiological effects such as those produced by ergonomic (i.e. fall prevention) or facilitative (i.e. hygiene-related) variables. The importance of an atmosphere in the healthcare environment that promotes the health and well-being of patients is evident, but this environment should not negatively affect healthcare personnel. The physical healthcare environment is part of the personnel's 'workscape'. This can make the environment an important determinant of subjective work-related outcomes like job satisfaction and well-being, as well as of objective outcomes like absenteeism or quality of care. In order to effectively build or renovate healthcare facilities, it is necessary to pay attention to the needs of both patients and healthcare personnel. OBJECTIVES To assess the psychological effects of the physical healthcare environment on healthcare personnel. SEARCH STRATEGY We searched the Cochrane EPOC Group Specialised Register; Cochrane Central Register of Controlled Trials; Database of Abstracts and Reviews of Effects; MEDLINE; EMBASE; CINAHL; Civil Engineering Database and Compendex. We also searched the reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCT), controlled clinical trials (CCT), controlled before and after studies (CBA), and interrupted time series (ITS) of psychological effects of the physical healthcare environment interventions for healthcare staff. The outcomes included measures of job satisfaction, satisfaction with the physical healthcare environment, quality of life, and quality of care. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed studies for eligibility, extracted data, and assessed methodological quality. MAIN RESULTS We identified one study, which adopted a CBA study design to investigate the simultaneous effects of multiple environmental stimuli. Staff mood improved in this study, while no effects were found on ward atmosphere or unscheduled absences. AUTHORS' CONCLUSIONS One study was included in this review. This review therefore indicates that, at present, there is insufficient evidence to support or refute the impact of the physical healthcare environment on work-related outcomes of healthcare staff. Methodological shortcomings, particularly confounding with other variables and the lack of adequate control conditions, partially account for this lack of evidence. Given these methodological issues, the field is in need of well-conducted controlled trials.
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Affiliation(s)
- Karin Tanja-Dijkstra
- Marketing Communication and Consumer Psychology, University of Twente, Drienerlolaan 5, Enschede, Netherlands, 7522 NB
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Tanja-Dijkstra K, Pieterse ME. Psychologically mediated effects of the physical healthcare environment on work-related outcomes of healthcare personnel. Cochrane Database Syst Rev 2010:CD006210. [PMID: 21154364 DOI: 10.1002/14651858.cd006210.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The physical healthcare environment is capable of affecting patients. This concept of 'healing environments' refers to the psychological impact of environmental stimuli through sensory perceptions. It excludes more physiological effects such as those produced by ergonomic (i.e. fall prevention) or facilitative (i.e. hygiene-related) variables. The importance of an atmosphere in the healthcare environment that promotes the health and well-being of patients is evident, but this environment should not negatively affect healthcare personnel. The physical healthcare environment is part of the personnel's 'workscape'. This can make the environment an important determinant of subjective work-related outcomes like job satisfaction and well-being, as well as of objective outcomes like absenteeism or quality of care. In order to effectively build or renovate healthcare facilities, it is necessary to pay attention to the needs of both patients and healthcare personnel. OBJECTIVES To assess the psychological effects of the physical healthcare environment on healthcare personnel. SEARCH STRATEGY We searched the Cochrane EPOC Group Specialised Register; Cochrane Central Register of Controlled Trials; Database of Abstracts and Reviews of Effects; MEDLINE; EMBASE; CINAHL; Civil Engineering Database and Compendex. We also searched the reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCT), controlled clinical trials (CCT), controlled before and after studies (CBA), and interrupted time series (ITS) of psychological effects of the physical healthcare environment interventions for healthcare staff. The outcomes included measures of job satisfaction, satisfaction with the physical healthcare environment, quality of life, and quality of care. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed studies for eligibility, extracted data, and assessed methodological quality. MAIN RESULTS We identified one study, which adopted a CBA study design to investigate the simultaneous effects of multiple environmental stimuli. Staff mood improved in this study, while no effects were found on ward atmosphere or unscheduled absences. AUTHORS' CONCLUSIONS One study was included in this review. This review therefore indicates that, at present, there is insufficient evidence to support or refute the impact of the physical healthcare environment on work-related outcomes of healthcare staff. Methodological shortcomings, particularly confounding with other variables and the lack of adequate control conditions, partially account for this lack of evidence. Given these methodological issues, the field is in need of well-conducted controlled trials.
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Affiliation(s)
- Karin Tanja-Dijkstra
- Marketing Communication and Consumer Psychology, University of Twente, Drienerlolaan 5, Enschede, Netherlands, 7522 NB
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Edgerton E, Ritchie L, McKechnie J. Objective and subjective evaluation of a redesigned corridor environment in a psychiatric hospital. Issues Ment Health Nurs 2010; 31:306-14. [PMID: 20394476 DOI: 10.3109/01612840903383976] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examined the impact of redesigning a corridor space within a psychiatric hospital on the behaviour of patients with dementia. In addition, patient and staff perceptions of the redesigned corridor were assessed. Data were collected through an observational tool (behavioural mapping) and a specifically design questionnaire. The findings suggest a positive impact of the redesigned corridor on patient behaviour and that patients and staff perceived the change to the environment differentially. These results are discussed in relation to theoretical explanations of the importance of the health care environment and design for dementia.
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Affiliation(s)
- Edward Edgerton
- University of the West of Scotland, Psychology Division, Paisley, PA1 2BE, United Kingdom.
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Hanrahan NP, Aiken LH, McClaine L, Hanlon AL. Relationship between psychiatric nurse work environments and nurse burnout in acute care general hospitals. Issues Ment Health Nurs 2010; 31:198-207. [PMID: 20144031 PMCID: PMC2856615 DOI: 10.3109/01612840903200068] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Following deinstitutionalization, inpatient psychiatric services moved from state institutions to general hospitals. Despite the magnitude of these changes, evaluations of the quality of inpatient care environments in general hospitals are limited. This study examined the extent to which organizational factors of the inpatient psychiatric environments are associated with psychiatric nurse burnout. Organizational factors were measured by an instrument endorsed by the National Quality Forum. Robust clustered regression analysis was used to examine the relationship between organizational factors in 67 hospitals and levels of burnout for 353 psychiatric nurses. Lower levels of psychiatric nurse burnout was significantly associated with inpatient environments that had better overall quality work environments, more effective managers, strong nurse-physician relationships, and higher psychiatric nurse-to-patient staffing ratios. These results suggest that adjustments in organizational management of inpatient psychiatric environments could have a positive effect on psychiatric nurses' capacity to sustain safe and effective patient care environments.
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Affiliation(s)
- Nancy P Hanrahan
- University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, Philadelphia, Pennsylvania 19104, USA.
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Hendrich A, Chow MP, Bafna S, Choudhary R, Heo Y, Skierczynski BA. Unit-Related Factors That Affect Nursing Time with Patients: Spatial Analysis of the Time and Motion Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2009; 2:5-20. [DOI: 10.1177/193758670900200202] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The primary goal of this study was to test the hypothesis that nurses adopt distinct movement strategies based on features of unit topology and nurse assignments. The secondary goal was to identify aspects of unit layout or organization that influence the amount of time nurses spend in the patient room. Background: Previous research has demonstrated a link between nursing hours and patient outcomes. Unit layout may affect direct patient care time by determining aspects of nurse behavior, such as the amount of time nurses spend walking. The recent nurses' Time and Motion study employed multiple technologies to track the movements and activities of 767 medical-surgical nurses. With regard to unit layout, initial analysis of the data set did not detect differences between types of units and time spent in the patient room. The analysis reported here applies novel techniques to this data set to examine the relationship between unit layout and nurse behavior. Methods: Techniques of spatial analysis, borrowed from the architectural theory of spatial syntax, were applied to the Time and Motion data set. Motion data from radio-frequency identification tracking of nurses was combined with architectural drawings of the study units and clinical information such as nurse-patient assignment. Spatial analytic techniques were used to determine the average integration or centrality of nurse assignments for each shift. Results: Nurse assignments with greater average centrality to all assigned rooms were associated with a higher number of entries to patient rooms, as well as to the nurse station. Number of entries to patient rooms was negatively correlated with average time per visit, but positively correlated with total time spent in patient rooms. The data describe two overall strategies of nurse mobility patterns: fewer, longer visits versus more frequent, shorter visits. Conclusions: Results suggest that the spatial qualities of nurse assignments and unit layout affect nurse strategies for moving through units and affect how frequently nurses enter patient rooms and the nurse station.
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van de Glind I, van Dulmen S, Goossensen A. Physician-patient communication in single-bedded versus four-bedded hospital rooms. PATIENT EDUCATION AND COUNSELING 2008; 73:215-9. [PMID: 18701233 DOI: 10.1016/j.pec.2008.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 06/03/2008] [Accepted: 07/01/2008] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To examine whether physician-patient communication in multi-bedded rooms differs from communication in single rooms during ward rounds. METHODS Ward rounds in single-bedded patient rooms and ward rounds in four-bedded rooms were audiotaped and analyzed with an adapted version of MIARS. The researcher completed an observational checklist of each encounter. We measured: the duration of speech time, the types of verbal and nonverbal communication, the extent to which patients and physicians raise intimate subjects. RESULTS Encounters during ward rounds in single rooms significantly took up more time than encounters in four-bedded rooms. The patients asked more questions and made more remarks in single rooms compared to four-bedded rooms. Empathic reactions of the physician were scored significantly more often in single rooms than in four-bedded rooms. No differences were observed concerning the extent to which intimate subjects were brought up. CONCLUSION This study is the first that investigated this subject. Findings suggest that single rooms contribute positively to physician-patient communication. PRACTICE IMPLICATIONS The research findings indicate the relevance of taking account of the context in which physician-patient communication takes place.
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Affiliation(s)
- Irene van de Glind
- Institute of Health Policy and Management, Erasmus Medical Center, Postbus 1738, 3000 DR Rotterdam, The Netherlands.
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Abstract
Although acute inpatient psychiatric care has changed dramatically over the past 2 decades, little is known about how these changes have affected the quality of care, psychiatric nurse staffing, or patient outcomes. The purpose of this report is to explore the quality of care, quality of the practice environment, and adverse events as assessed by psychiatric nurses in the general hospital setting. The study sample consisted of 456 registered nurses permanently assigned to psychiatric units, compared with a larger sample of 11,071 registered nurses who work permanently on medical, surgical, or medical-surgical units. Compared with nonpsychiatric nurses, psychiatric nurse characteristics reveal an older, more experienced workforce, with a higher proportion of male nurses. Nurses rated quality of patient care lower in the psychiatric specialty than in the medical-surgical specialty. Furthermore, psychiatric nurses reported significant concern about the readiness of patients for discharge and higher incidence of adverse events. They also experienced more verbal abuse, physical injuries, and complaints from patients and families. Collectively, the results from this study underscore the organizational problems and quality-of-care issues that cause psychiatric nurses in general hospital settings to evaluate their work environments negatively.
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Shattell MM, Andes M, Thomas SP. How patients and nurses experience the acute care psychiatric environment. Nurs Inq 2008; 15:242-50. [DOI: 10.1111/j.1440-1800.2008.00397.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ulrich RS, Zimring C, Zhu X, DuBose J, Seo HB, Choi YS, Quan X, Joseph A. A Review of the Research Literature on Evidence-Based Healthcare Design. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2008; 1:61-125. [DOI: 10.1177/193758670800100306] [Citation(s) in RCA: 683] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This report surveys and evaluates the scientific research on evidence-based healthcare design and extracts its implications for designing better and safer hospitals. Background: It builds on a literature review conducted by researchers in 2004. Methods: Research teams conducted a new and more exhaustive search for rigorous empirical studies that link the design of hospital physical environments with healthcare outcomes. The review followed a two-step process, including an extensive search for existing literature and a screening of each identified study for the relevance and quality of evidence. Results: This review found a growing body of rigorous studies to guide healthcare design, especially with respect to reducing the frequency of hospital-acquired infections. Results are organized according to three general types of outcomes: patient safety, other patient outcomes, and staff outcomes. The findings further support the importance of improving outcomes for a range of design characteristics or interventions, including single-bed rooms rather than multibed rooms, effective ventilation systems, a good acoustic environment, nature distractions and daylight, appropriate lighting, better ergonomic design, acuity-adaptable rooms, and improved floor layouts and work settings. Directions for future research are also identified. Conclusions: The state of knowledge of evidence-based healthcare design has grown rapidly in recent years. The evidence indicates that well-designed physical settings play an important role in making hospitals safer and more healing for patients, and better places for staff to work.
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Symon A, Paul J, Butchart M, Carr V, Dugard P. Maternity unit design: background to multi-site study in England. ACTA ACUST UNITED AC 2008. [DOI: 10.12968/bjom.2008.16.1.27927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew Symon
- School of Nursing & Midwifery, University of Dundee
| | | | - Maggie Butchart
- PhD candidate, School of Nursing & Midwifery, University of Dundee
| | - Val Carr
- PhD candidate, School of Design, University of Dundee
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De Girolamo G, Barbato A, Bracco R, Gaddini A, Miglio R, Morosini P, Norcio B, Picardi A, Rossi E, Rucci P, Santone G, Dell'Acqua G. Characteristics and activities of acute psychiatric in-patient facilities: national survey in Italy. Br J Psychiatry 2007; 191:170-7. [PMID: 17666503 DOI: 10.1192/bjp.bp.105.020636] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Legislation in 1978 led to the gradual replacement of mental hospitals in Italy with a full range of community-based services, including facilities for acute in-patient care. AIMS To survey the main characteristics of Italian public and private in-patient facilities for acute psychiatric disorders. METHOD Structured interviews were conducted with each facility's head psychiatrist in all Italian regions, with the exception of Sicily. RESULTS Overall, Italy (except Sicily) has a total of 4108 public in-patient beds in 319 facilities, with 0.78 beds for every 10,000 inhabitants, and 4862 beds in 54 private in-patient facilities, with 0.94 beds per 10,000 inhabitants. In 2001 the rates of psychiatric admissions and admitted patients per 10,000 inhabitants were 26.7 and 17.8 respectively. In the same year the percentage of involuntary admissions was 12.9%, for a total of 114,570 hospital days. Many in-patient facilities showed significant limitations in terms of architectural and logistic characteristics. Staffing showed a great variability among facilities. CONCLUSIONS The overall number of acute beds per 10,000 inhabitants is one of the lowest in Europe. The survey has provided evidence of two parallel systems of in-patient care, a public one and a private one, which are not fully interchangeable.
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Affiliation(s)
- Giovanni De Girolamo
- Department of Mental Health, AUSL di Bologna, Viale Pepoli 5, 40123 Bologna, Italy.
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