The design and testing of interactive hospital spaces to meet the needs of waiting children

Child-friendly healthcare: A concept analysis

OBJECTIVE

This study aims to analyze the concept of Child-friendly Healthcare (CFH) using Walker and Avant's conceptual analysis framework to clarify its meaning, attributes, and implications for clinical practice.

METHOD

The study employed Walker and Avant's conceptual analysis method, which involves a systematic process comprising concept selection, setting objectives, exploring potential uses, defining attributes, constructing a model case, identifying contrary cases, determining antecedents and consequences, and examining empirical referents. A scoping review was conducted across multiple sources, including online dictionaries, scientific databases, and grey literature, with a focus on literature relevant to CFH.

RESULT

A total of 37 articles were reviewed, revealing diverse definitions and interpretations of CFH across various contexts. The concept was defined by five key attributes: (1) child interests-prioritized quality services, (2) child-friendly environments and spaces, (3) social interaction, (4) child participation, and (5) development facilitation. The study also identified the antecedents and consequences of CFH, developed model and contrary cases, and examined empirical referents to offer a comprehensive understanding of the concept.

CONCLUSION

This analysis effectively clarified the concept of CFH, highlighting its core attributes and providing valuable insights for clinical nursing practice. The findings suggest that CFH can be used as a framework to guide child-centered healthcare practices, thereby enhancing the quality of care provided to pediatric patients.

IMPLICATIONS

Conducting a concept analysis of CFH can significantly contribute to improving patient health outcomes, supporting institutional development, and fostering future research and practical applications in child healthcare settings.

Opportunities for play in paediatric healthcare environments: a scoping review

Play spaces are important components of paediatric healthcare environments. They provide children with critical opportunities to experience the social, emotional, and developmental benefits of play while in healthcare settings for appointments or hospitalizations. These spaces can help to mitigate stress, provide a sense of normalcy in unfamiliar environments, and facilitate social engagement for children and their families. Given the benefits of play spaces in paediatric healthcare settings, it is important to understand how these spaces can be designed to enhance children's inclusion and quality of care. The aim of this scoping review was to explore the current understanding of paediatric play space design. Using search terms related to children, health care, and play space, six interdisciplinary databases were searched over a 30-year period. The search found 2,533 records from which eighteen were included for review. Findings suggest that although it is well-documented that play spaces offer valuable social and emotional benefits, little is known about the specific design features that can and should be incorporated to enhance play opportunities and ensure that they benefit all children and families. Further, the literature mostly considers play spaces in the context of designated play or recreational rooms. Scholars are encouraged to consider how play opportunities can be incorporated into the designs of paediatric healthcare environments beyond the boundaries of these rooms. Future studies should also consider the diversity of play space users, including children of varying ages and abilities, to create more accessible and inclusive paediatric play spaces for children and their families. Advancing knowledge on play space design can help to optimize the quality of these important spaces and to ensure their designs meaningfully enhance children's play experiences and quality of care.

A Review of Creative Play Interventions to Improve Children's Hospital Experience and Wellbeing

CONTEXT

Being in the hospital can be stressful for children and caregivers. Evidence-based play interventions to reduce this stress, such as play therapy or Child Life services, have been introduced in hospitals globally, with growing awareness of potential benefits.

OBJECTIVES

To evaluate the impact of nonmedical/illness-specific creative or play-based programs in hospital settings on children's (<18 years) and their caregivers' hospital experiences, wellbeing, and other health outcomes.

DATA SOURCES

PubMed, CINAHL, Google Scholar.

METHODS

We conducted a systematic review of original articles published since 2011, screening 2701 de-duplicated articles.

RESULTS

We identified 25 eligible articles, representing 1629 children (57% male), 422 caregivers, and 128 health professionals. Included studies most commonly evaluated professional children's entertainers (n = 8 studies), music therapy (n = 4), unstructured play (n = 3), and humanoid/animal robots (n = 3). Most studies evaluated the impact on the child's level of anxiety (n = 14/25), mostly supporting a reduction (n = 13/14 studies). Several studies provided evidence for a reduction in children's pain (n = 4/6), and negative emotional/behavioral outcomes (eg, sadness, anger, irritability; n = 5/6 studies). There was mixed evidence for the impact of the included interventions on physiologic outcomes (eg, systolic pressure, heart frequency; n = 3/5 studies) and fatigue (n = 1/2 studies). Evidence on caregiver outcomes and the impact on health care services was limited.

CONCLUSIONS

The findings of our review generally supported the value of play-based interventions on children's' wellbeing while in the hospital, particularly reducing anxiety and pain. Further evaluation of their impact on caregivers' outcomes and the health care system is needed.

Using Architectural Mapping to Understand Behavior and Space Utilization in a Surgical Waiting Room of a Safety Net Hospital

OBJECTIVE

To use architectural mapping to understand how patients and families utilize the waiting space at an outpatient surgery clinic in a safety-net hospital.

BACKGROUND

The waiting period is an important component of patient experience and satisfaction. Studies have found that patients value privacy, information transparency and comfort. However, approaches common in the architecture field have rarely been used to investigate interactions between patients and the built environment in a safety-net healthcare setting.

METHODS

This was a prospective observational study in a general surgery outpatient clinic at a safety-net hospital and level 1 trauma center. We used a web-based application generated from the design and architecture industry, to quantitatively track waiting space utilization over 2 months.

RESULTS

A total of 728 observations were recorded across 5 variables: time, location, chair selection, person/object, and activity. There were 536 (74%) observations involving people and 179 (25%) involving personal items. People most frequently occupied chairs facing the door (43%, n = 211), and least frequently occupied seats in the hallway (5%, n = 23), regardless of the time of their appointment (p-value = 0.92). Most common activities included interacting with personal phone, gazing into space, and talking face to face. Thirteen percent of people brought mobility devices, and 64% of objects were placed on an adjacent chair, indicating the desire for increased personal space.

CONCLUSION

Architectural behavioral mapping is an effective information gathering tool to help design waiting space improvement in the safety-net healthcare setting.

Parental Distress and Affective Perception of Hospital Environment after a Pictorial Intervention in a Neonatal Intensive Care Unit

Pictorial humanization is a useful intervention for the improvement of hospitalized patients’ affective states. Despite benefits in many hospital wards having been well documented, so far, no attention was paid to the Neonatal Intensive Care Unit (NICU). The aim of the present study was to evaluate the levels of distress and the affective perception of the environment experienced by parents of infants hospitalized in a NICU after the implementation of an intervention of pictorial humanization. A sample of 48 parents was recruited, 25 before the intervention was performed (Control Group), and 23 after its implementation (Pictorial Humanization Group). All parents completed the “Rapid Stress Assessment Scale” and “Scales of the Affective Quality Attributed to Place” questionnaires. Despite results showing no significant differences on parental distress, after implementation of pictorial intervention parents reported a perception of the NICU as significantly more pleasant, exciting, and arousing, and less distressing, unpleasant, gloomy, and sleepy. A higher level of distress and a perception of the environment as less relaxing was predicted for the Control Group condition. The present study suggests that the pictorial intervention represents a useful technique to create more welcoming hospital environments and to reduce the negative effects associated with infant hospitalization.

Seating in Doctors' Waiting Rooms: Has COVID-19 Changed Our Choices?

OBJECTIVE

This study investigates preference for five different seating arrangements (e.g., rows, clusters) in a doctor's office waiting room, whether these reduce stress and improve judgments of medical care, and how such choices may have changed over the pandemic (2013 vs. 2021).

BACKGROUND

What is called the doctor's office layout, with chairs lining the perimeter of the waiting room, is criticized by designers, yet little empirical evidence exists to support that assessment.

METHOD

Data collected in 2013 and 2021 used sketches of five different seating arrangements; people saw just one of these. The study examined the effect of time and seating arrangement on anxiety, need for privacy, situational awareness, evaluation of the environment, and perception of the doctor.

RESULTS

There was no significant impact of the seating arrangement on any of the dependent variables, but ratings were higher for situational awareness, need for privacy, evaluation of the environment, and aspects related to the physician in 2021. In addition, seating preferences favored end, not middle seats, and chair selections with the chair back to a wall.

CONCLUSION

In this study, no evidence exists that the doctor's office layout is less preferred than four other seating arrangements, but seat choice shows people prefer end seats (not middle seats) across arrangements. The doctor's office layout may offer a supportive familiarity to people; also, given the percentage of people who visit the doctor unaccompanied, layouts designed to encourage social interaction may not always be appropriate.

Evidence-Based Design for Waiting Space Environment of Pediatric Clinics-Three Hospitals in Shenzhen as Case Studies

This study explores the waiting space environment of pediatric clinics in general hospitals and the relationships between the use of space, behavioral activities and overall satisfaction. Patients often spend a lot of time waiting for doctors, and child patients waiting to be seen are particularly likely to feel bored, depressed and anxious, which negatively affects their overall experience of seeking medical attention. Since the launch of China's second-child policy, the number of children born in China has surged. As medical resources for children are in short supply and of uneven quality, it is urgently necessary to carry out research on optimizing the design of children's waiting space in Chinese hospitals to improve their medical environment and experience.

METHOD

This study identified four first-level indicators and twenty-seven second-level indicators in four dimensions: functional layout (layout and area), flow organization, supporting facilities and environmental details (physical and landscape environment). The research combined subjective and objective methods, including comprehensive observation, a questionnaire survey and interviews, taking three hospitals in Shenzhen as case studies.

RESULTS

The study found that the waiting space in pediatric clinics currently fails to meet key patient needs in areas such as mother and infant rooms, children's play areas and drinking water facilities, and there are widespread problems with the creation of natural environments, such as views of natural scenery from windows and indoor green plants. Six factors were found to significantly positively influence overall satisfaction with waiting space, describing 69.76% of the changes in the respondents' degree of satisfaction with the waiting environment. Supporting facilities and aspects of the physical environment had the greatest influence on overall satisfaction with the waiting space.

CONCLUSION

Optimizing the design of the waiting space in pediatric clinics, with a focus on functional layout, flow organization, supporting facilities and environmental details, can improve overall satisfaction with pediatric waiting rooms. The results are preliminary; they need to be further tested in practice to complete the process of evidence-based design. This will lead to suggestions for refining the design of pediatric waiting units which can be used by architects and hospital administrators.

Study of the Physical Environment of Waiting Areas and Its Effects on Patient Satisfaction, Experience, Perceived Waiting Time, and Behavior in China

OBJECTIVES

This study examines the physical environment in the outpatient waiting area and its effects on overall satisfaction, experience, perceived waiting time, and behavior.

BACKGROUND

Waiting can be a frustrating experience for patients. Previous studies on waiting areas in hospitals have been rooted mainly in the Western cultural context, and research focusing on the impact of the physical environment on the waiting experience with the denser patient concentration in China is important.

METHODS

Physical environment measurements, observations, and questionnaire surveys were employed.

RESULTS

The actual lighting intensity and sound level did not meet the national standards. Sound level and satisfaction with the size of the waiting area, signage system, and visual art on the wall were significant predictors (R ² = .463, p = .000) for overall satisfaction. Experiences related to the size of the waiting area, seating, signage system, and restrooms were significant predictors (R ² = .373, p = .000) of overall waiting experience. The experience related to the acoustic environment (β = -.184, p = .006) had a significant relationship with perceived waiting time. The increase in participants' behaviors of looking out of a window and the decrease in looking at other people, looking around, dozing, and looking at a wall might result from a substantial increase in lighting and the availability of a nature view from the window.

CONCLUSIONS

The effect of the physical setting of waiting areas may positively impact patient satisfaction, waiting experience, perceived waiting time, and behavior, which has implications for patient-centered design.

A Scoping Review of the Impact on Children of the Built Environment Design Characteristics of Healing Spaces

AIM

This article elucidates current understanding in pediatric healthcare building design via scoping review of research on the impacts on the health and well-being of children of the architectural and landscape characteristics of healing spaces.

BACKGROUND

Studies indicate that patients' phenomenological experiences of the built environment characteristics of healthcare buildings can impact their healing and well-being. It follows that understanding the healing effects of landscape and architecture can inform the design of healthcare settings for increased health benefits.

METHOD

This method comprises five search stages: (1) research question is formed; (2) key words, search terms, and search strategy are identified; (3) databases are searched, and papers are assessed via inclusion and exclusion criteria; (4) information of the selected articles is extracted and summarized; and (5) key findings are interpreted and reported via comparative tabulation.

RESULTS

One hundred seventy-three papers were found during the first search stage. After screening and evaluating for relevance and quality, 13 articles were selected for study. Analysis indicates that the built environment characteristics of pediatric healthcare environments that have healing benefits include access to nature, music, art and natural light, reduced crowding, reduced noise, and soft, cyclical, and user-controlled artificial lighting.

CONCLUSIONS

While it is important to understand the design variables that influence pediatric healthcare, it is also necessary to contextualize them and to distinguish these variables from each other and appreciate their interaction. In other words, a more rounded understanding of these variables is required via research so that their individual and combined impacts are reflected in holistic design recommendations.

Positive Distractions and Play in the Public Spaces of Pediatric Healthcare Environments: A Literature Review

Background:

A positive distraction is a significant environmental feature that introduces positive feelings by diverting attention from stress or anxious thoughts. Existing research has deemed the application of positive distractions in pediatric environments to be significant. This study investigated the essential positive distractions and the associated health benefits.

Aims:

The aims of this study were to validate and extend evidence on positive distractions and play opportunities in the design of the public spaces in pediatric healthcare environments, translate existing evidence into design suggestions, and identify research gaps in this realm.

Methods:

A four-phased literature review method was employed in the study, including literature search, literature screening and selection, literature appraisal, and thematic analysis and in-depth discussion. Eventually, 27 peer-reviewed publications were reviewed and discussed in detail.

Results/Conclusions:

The gathered materials were grouped into six themes of positive distractions: (1) art and environmental aesthetics, (2) spatial arrangement and atrium, (3) considerations of socialization patterns, (4) play and interactive technologies, (5) sound and lighting interventions, and (6) access to nature. The research indicated that positive distractions in the pediatric healthcare environment provide a series of health benefits for patients, including improved behavioral and emotional well-being, reduced stress and anxiety, enhanced healthcare experience and satisfaction, and facilitated medical procedures and recovery. Yet significant research gaps emerged between positive distractions and play in garden spaces and spatial design to accommodate interactive technology and socialization in the public areas of pediatric healthcare environments. This study organized the understanding on the components of supportive environments and its outcomes for pediatric healthcare design.

Positive Distraction in Pediatric Healthcare Waiting Spaces: Sharing Play Not Germs through Inclusive, Hands-Free Interactive Media

Purpose: To investigate the value of shared opportunities for positive distraction in pediatric healthcare environments. Methods: Self-selected activities of 271 young people (5-19 years) with diverse neurodevelopmental conditions were observed in an ambulatory pediatric rehabilitation clinic. Shared opportunities included hands-free media (nature video or interactive media) and an aquarium. Anxiety was self-reported on the State Trait Anxiety Scale upon arrival and after 10 minutes in the waiting space. Results: Young people engaged more with shared opportunities for distraction (n = 170/271) than personal items brought from home (n = 119/271), p = 0.02. Personal electronic devices were used by 67 young people, but did not positively impact anxiety. Interactive media and the aquarium significantly reduced anxiety (p < 0.04) while the nature video appeared to increase anxiety (p = 0.036). Age influenced activity preference and anxiety. Shared, hands-free interactive media engaged individuals of diverse age and mobility. Conclusion: Shared opportunities for positive distraction in healthcare facilities are valuable, particularly hands-free interactive media.

Humanization interventions in general pediatric wards: a systematic review

Humanization of care (HOC) interventions have rarely been evaluated and compared. We systematically reviewed the outcomes of published interventions aimed to improve the HOC for hospitalized children. PubMed and Scopus were used as data sources. Studies published between January 1, 2000, and February 28, 2018, were considered eligible if they reported analysis of results vs. either a control group or baseline, or if they measured patient/family/staff satisfaction. Neonatal age, emergency departments, and subspecialty settings were excluded. Data were extracted using a standardized data extraction form including study design, sample size, intervention, outcome/objective, and evaluation of results or pre- post-intervention satisfaction. Twenty-eight of the 12,012 retrieved articles met the inclusion criteria. Most studies were of moderate to low quality. Only six studies were of high quality. Areas of interest dealt with environment (n = 4), provider-patient relationship (n = 6), pet therapy (n = 5), technology (n = 5), family-centered rounds (n = 2), psychological support (n = 3), and staff training (n = 3). The overall trend of the results indicated that interventions were mostly effective and likely to have beneficial effects on several aspects of pediatric hospitalization.Conclusions: Pending further studies of better research quality, the findings of this review may have policy and practice implications for planning HOC interventions by pediatric healthcare professionals. What is Known: • In pediatrics, humanization of care (HOC) provides assistance focused not only on the child as a patient, but on the whole family. • HOC programs have been developed, but information on the overall outcome of local projects aiming to improve in a practical way the hospital taking charge of pediatric patients is still lacking. What is New: • Local HOC interventions are mostly effective and have beneficial effects on several aspects of hospitalization in general pediatrics wards. • The findings of this review may have practice implications for planning HOC interventions by pediatric healthcare professionals.

Researching and Designing Health Care Environments: A Systematized Review of Creative Research Methods

In research and design, Creative Research Methods (CRMs) are useful to gain insight into user perspectives. Reviews suggest that CRMs offer potential to engage people, yet little detail is available regarding their use in relation to built health care environments. Consider environments for cancer care, where patients are confronted with particular physical and emotional challenges. This review aims to synthesize what is known from existing literature about CRMs exploring user experience when researching and designing (cancer) care environments. Based on 16 items, we evaluate the potential of CRMs, offering insight into why, how, where, and when they are employed. Generally little consideration is shown for participants' abilities and limitations. Our analysis further emphasizes the importance of reflecting on visual methods, and the need to report research approaches transparently including where CRMs are used. A sophisticated research approach can leverage CRMs' potential to study experience and carry artifacts forward to inform design(ers).

Attractions to Fuel the Imagination: Reframing Understandings of the Role of Distraction Relative to Well-Being in the Pediatric Hospital

OBJECTIVE

Ulrich's (1991) definition of "positive distraction" includes that which "elicits positive feelings and holds attention," implying that the capacity of an environmental feature to hold attention is a necessary component. This article examines whether, in the context of a pediatric hospital, a distraction needs to "hold attention" to secure positive benefits for patient well-being.

BACKGROUND

Data collected from 246 patients at Melbourne's Royal Children's Hospital (Australia) revealed a discrepancy between what children and young people told us they did, and valued, within the hospital, relative to the time they spent engaging in, or paying attention to, these same features. This motivated a closer interrogation of the relationship between well-being, distraction, and socialization within the pediatric context.

METHOD

Data were collected using a mixed-methods approach that included 178 surveys, 43 drawings contributed by patients/siblings within the outpatient waiting room, 25 photo-elicitation interviews with patients, and 100 hr of spatial observations within public and waiting room spaces. This was supplemented by interviews with architects and hospital staff.

CONCLUSIONS

The mechanism by which we have understood positive distraction to contribute to well-being within the pediatric hospital environment is more complex than existing models accept. Within this context, environmental features that can positively transform expectations of visiting the hospital-that can ignite the imagination and incite a desire to return-can offer significant benefits to well-being. This is particularly relevant in the context of absenteeism from outpatient appointments and in reducing patient resistance to future, or ongoing, treatments.

Interactive media as a tool for reducing waiting anxiety at paediatric rehabilitation hospitals: a randomized controlled trial

AIM

To investigate the efficacy of waiting room media for reducing anxiety and increasing satisfaction at a paediatric rehabilitation hospital.

METHOD

In this clustered, parallel, randomized controlled trial, 310 young people with disabilities (age range 5-19y) and their parents attending outpatient clinics were assigned to interactive media (n=113), a silent nature video (n=97), or media-free comparison (n=100) groups. Young person and parent anxiety was reported using the State-Trait Anxiety Inventory (STAI) on arrival and after 10 minutes in the waiting space. Questionnaires measured young person, parent, and staff satisfaction.

RESULTS

Young people exposed to interactive media reported a postexposure state anxiety that was 1.1 raw points (2.7 standardized points) lower on the STAI than the comparison group (95% confidence interval [CI] -1.9 to -0.22). There was no difference in postexposure state anxiety between the passive media and comparison groups (95% CI -0.64 to 1.1). Parents' state anxiety did not differ between conditions, but interactive media were associated with greater satisfaction (p=0.009). Of 120 staff, 119 reported that interactive media improved the clinic experience for families.

INTERPRETATION

Interactive media designed for accessible, hands-free play mitigate waiting anxiety and increases satisfaction. This paper provides evidence to guide design and decision-making around the use of interactive media in health care spaces.

WHAT THIS PAPER ADDS

Interactive media reduced preclinic waiting anxiety for young people with disabilities. Interactive media were accessible to young people with a range of mobility. Interactive media increased parental and staff satisfaction in the clinic. Guidelines for the design of hands-free, inclusive interactive media for health care facilities are presented.

User Evaluation of Neonatology Ward Design

Objective:

The object of this article is to identify the set of affective and emotional factors behind users’ assessments of a space in a neonatology unit and to propose design guidelines based on these.

Background:

The importance of the neonatology service and the variety of users place great demands on the space at all levels. Despite the repercussions, the emotional aspects of the environment have received less attention.

Methods:

To avoid incurring limitations in the user mental scheme, this study uses two complementary methodologies: focus group and semantic differential. The (qualitative) focus group methodology provides exploratory information and concepts. The (quantitative) semantic differential methodology then uses these concepts to extract the conceptual structures that users employ in their assessment of the space. Of the total 175 subjects, 31 took part in focus groups and 144 in semantic differential.

Results:

Five independent concepts were identified: privacy, functionality and professional nature, spaciousness, lighting, and cleanliness. In relation to the importance of the overall positive assessment of the space, the perception of privacy and sensations of dominance and pleasure are fundamental. Six relevant design aspects were also identified: provide spacious surroundings, facilitate sufficient separation between the different posts or cots, use different colors from those usually found in health-care centers, as some aversion was found to white and especially green, design areas with childhood themes, use warm artificial light, and choose user-friendly equipment.

Conclusions:

Results provide design recommendations of interest and show the possibilities offered by combining both systems to analyze user response.

The design and testing of interactive hospital spaces to meet the needs of waiting children

OBJECTIVE

To design an innovative interactive media display in a pediatric hospital clinic waiting space that addresses the growing demand for accessible, contact-surface-free options for play.

BACKGROUND

In healthcare settings, waiting can be anxiety provoking for children and their accompanying family members. Opportunities for positive distraction have been shown to reduce waiting anxiety, leading to positive health outcomes.

METHODS

An interactive media display, ScreenPlay, was created and evaluated using a participatory design approach and a combination of techniques including quality function deployment and mixed data elicitation methods (questionnaires, focus groups, and observations). The user and organizational design requirements were established and used to review contemporary strategies for positive distraction in healthcare waiting spaces and to conceptualize and test ScreenPlay. Ten staff members, 11 children/youths, and 6 parents participated in the design and evaluation of ScreenPlay.

RESULTS

ScreenPlay provided a positive, engaging experience without the use of contact surfaces through which infections can be spread. It was accessible to children, youth, and adults of all motor abilities. All participants strongly agreed that the interactive media display would improve the healthcare waiting experience.

CONCLUSIONS

ScreenPlay is an interactive display that is the result of a successful model for the design of healthcare waiting spaces that is collaborative, interdisciplinary, and responsive to the needs of its community.

KEYWORDS

Design process, healing environments, hospital, interdisciplinary, pediatric.