bluuebunny/crossref_metadata_2025 huggingface dataset:
Serious but not solemn: Rebalancing the assessment of risks and benefits of patient recruitment materials
Authors: Armstrong Neil , Price Jonathan , Geddes John
Published: February 2015

Recruiting patients to participate in health research is challenging, and most studies struggle. Failure to recruit can jeopardise the quality of research, and threatens efforts to improve healthcare. Despite this, recruitment materials tend to be conservatively designed and unimaginative. One reason for this is ethical concerns regarding the risk of coercion and offence posed by recruitment materials. The OXTEXT research programme gave patients a leading role in the design of new recruitment materials, in an area (mental health) where stigma and discrimination make ethical risks particularly acute. We discovered that our patient-designed recruitment materials were much bolder than usual, and they put the existing ethical boundaries to the test. The materials were effective and well liked – patients regarded them as neither unacceptable nor coercive. This suggests we may need to rethink the ethics of recruitment to research such that we permit more creative recruitment materials. In addition, it suggests a new role for patient input into research as designers of recruitment materials.
The clinical potential of ramosetron in the treatment of irritable bowel syndrome with diarrhea (IBS-D)
Authors: Min Yang Won , Rhee Poong-Lyul
Published: February 2015

Irritable bowel syndrome (IBS) is a highly prevalent functional bowel disorder. Serotonin (5-HT) is known to play a physiological and pathophysiological role in the regulation of gastrointestinal function. In experimental studies, 5-HT3 receptor antagonists have been reported to slow colon transit, to blunt gastrocolonic reflex, and to reduce rectal sensitivity. Alosetron and cilansetron, potent and selective 5-HT3 receptor antagonists, have proven efficacy in the treatment of IBS with diarrhea (IBS-D). However, alosetron was voluntarily withdrawn due to postmarketing reports of ischemic colitis and complications of constipation, and cilansetron was never marketed. Currently alosetron is available under a risk management program for women with severe IBS-D. Ramosetron is another potent and selective 5-HT3 receptor antagonist, which has been marketed in Japan, South Korea, and Taiwan. In animal studies, ramosetron reduced defecation induced by corticotrophin-releasing hormone and had inhibitory effects on colonic nociception. In two randomized controlled studies including 957 patients with IBS-D, ramosetron increased monthly responder rates of patient-reported global assessment of IBS symptom relief compared with placebo. Ramosetron was also as effective as mebeverine in male patients with IBS-D. In a recent randomized controlled trial with 343 male patients with IBS-D, ramosetron has proved effective in improving stool consistency, relieving abdominal pain/discomfort, and improving health-related quality of life. Regarding safety, ramosetron is associated with a lower incidence of constipation compared with other 5-HT3 receptor antagonists and has not been associated with ischemic colitis. Although further large prospective studies are needed to assess whether ramosetron is effective for female patients with IBS-D and to evaluate its long-term safety, ramosetron appears to be one of the most promising agents for patients with IBS-D.
Long-term survival as a treatment benchmark in melanoma: latest results and clinical implications
Authors: Grossmann Kenneth F. , Margolin Kim
Published: February 2015

Historically, stage III–IV melanoma patients have had few options to achieve long-term survival. For patients with stage III disease, surgery alone may be curative for approximately 50%. Adjuvant treatment with a slightly greater impact on relapse-free survival at the cost of substantial toxicity, and studies are ongoing to test the adjuvant benefit of other immunotherapies that appear more active and less toxic in advanced melanoma. Achieving long term survival for stage IV patients had been rare until recently and progress was painfully slow with traditional cytotoxic chemotherapy; review of multiple phase II studies showed universally poor results. Fortunately, since the approval by the US Food and Drug Administration of agents targeting the cytotoxic T lymphocyte antigen-4 (CTLA-4) receptor, as well as those targeting B-raf and mitogen-activated protein kinase kinase (MEK) in the mitogen-activated protein kinase (MAPK) pathway for patients whose melanoma is ‘driven’ by a BRAF mutation, long-term survival of stage IV melanoma is increasing substantially. Here we review the examples of studies documenting potentially curative approaches to melanoma and propose suggestions for the use of various treatments in achieving this important goal.
More or Less? Multimedia Effects on Perceptions of News Websites
Authors: Tran Hai L.
Published: February 2015

Despite a growing trend of using multimedia to enhance online news and audience engagement, little is known about the actual benefit of such a practice. Empirical evidence regarding multimedia effects on user evaluations of news websites has been mixed and scanty. The current undertaking utilizes theoretical frameworks from modality and vividness effects research as well as the congruency/incongruency literature in an effort to bring greater insight into effects of multimedia enhancements on user responses. A 3 × 3 factorial experiment was conducted with multimedia use and multimedia congruency serving as two between-subjects factors. User perceptions were gauged through attitudes and behavioral intentions toward a news website. As the results indicate, multimedia elements serve to appeal to news consumers. However, online journalists need to consider the limitations of blending multimedia with text, including a ceiling effect on evaluations and possible side effects of incongruent multimedia on news processing.
Nursing Unit Design and Communication Patterns: What is “Real” Work?
Authors: Becker Franklin
Published: February 2015

While considerable attention has been paid to how the design of nursing units can help reduce nurse fatigue, improve safety, and reduce nosocomial infection rates, much less attention has been paid to how nursing unit design influences informal communication patterns, on-the-job learning, and job stress and satisfaction. Yet the literature consistently cites communication among diverse caregivers as a critical component for improving quality of care. This paper reviews relevant literature related to nursing unit design and communication patterns, and suggests an evidence-based design research agenda grounded in the concept of “organizational ecology” for increasing our understanding of how hospital design can contribute to improved quality of care.
The Impact of Facility Improvements on Hospital Nurses
Authors: Berry Leonard L. , Parish Janet T.
Published: February 2015

Objectives:

The primary purpose of the research was to assess differences in nurses' perceptions of their job, hospital, and building features following the opening of a new hospital wing. Secondary purposes included assessing the impact on nurses left behind in the existing facility after the new wing opened and considering ways that nurses could more effectively contribute to facility design decisions that directly affect them.

Background:

Research related to the design of healthcare facilities is growing, yet studies of the impact of facility features on hospital staff is far less common than studies of the impact on patients.

Methods:

Survey data were collected from a hospital's nurses six months before (N=235) and six months after (N=238) some of the nurses (N=65) moved to a new wing. Response rates were 49% and 55% for rounds 1 and 2, respectively. A test study also was conducted two months post-move (N=206) to enable assessment of a novelty effect. Focus groups also were conducted following the completion of round 2 data collection.

Results:

Significant differences were found between the round 1 and 2 samples for quality of patient rooms, safety, pleasantness, quality of workspace, job stress, job satisfaction, and service quality. Findings from the test study held up in round 2.

Conclusion:

The design of the hospital impacts nurses and may impact their job satisfaction and stress, even the decision whether or not to remain a hospital nurse. A well-designed hospital is not only important to patients; it also is important to those who serve them.
Relationships between Exterior Views and Nurse Stress: An Exploratory Examination
Authors: Pati Debajyoti , Harvey Tom E. , Barach Paul
Published: February 2015

Objective:

Examine the relationships between acute stress and alertness of nurse, and duration and content of exterior views from nurse work areas.

Background:

Nursing is a stressful job, and the impacts of stress on performance are well documented. Nursing stress, however, has been typically addressed through operational interventions, although the ability of the physical environment to modulate stress in humans is well known. This study explores the outcomes of exposure to exterior views from nurse work areas.

Methods:

A survey-based method was used to collect data on acute stress, chronic stress, and alertness of nurses before and after 12-hour shifts. Control measures included physical environment stressors (that is, lighting, noise, thermal, and ergonomic), organizational stressors, workload, and personal characteristics (that is, age, experience, and income). Data were collected from 32 nurses on 19 different units at two hospitals (part of Children's Healthcare of Atlanta) in November 2006.

Results:

Among the variables considered in the study view duration is the second most influential factor affecting alertness and acute stress. The association between view duration and alertness and stress is conditional on the exterior view content (that is, nature view, non-nature view). Of all the nurses whose alertness level remained the same or improved, almost 60% had exposure to exterior and nature view. In contrast, of all nurses whose alertness levels deteriorated, 67% were exposed to no view or to only non-nature view. Similarly, of all nurses whose acute stress condition remained the same or reduced, 64% had exposure to views (71% of that 64% were exposed to a nature view). Of nurses whose acute stress levels increased, 56% had no view or only a non-nature view.

Conclusions:

Although long working hours, overtime, and sleep deprivation are problems in healthcare operations, the physical design of units is only now beginning to be considered seriously in evaluating patient outcomes. Access to a nature view and natural light for care-giving staff could bear direct as well as indirect effects on patient outcomes.
Lost in Translation: Bridging Gaps between Design and Evidence-Based Design
Authors: Watkins Nicholas , Keller Amy
Published: February 2015

The healthcare design community is adopting evidence-based design (EBD) at a startling rate. However, the role of research within an architectural practice is unclear. Reasons for the lack of clarity include multiple connotations of EBD, the tension between a research-driven market and market-driven research, and the competing expectations and standards of design practitioners and researchers. Research as part of EBD should be integral with the design process so that research directly contributes to building projects. Characteristics of a comprehensive programming methodology to close the gap between design and EBD are suggested.
Establishing an Acute Care Nursing Bed Unit Size: Employing a Decision Matrix Framework
Authors: Ritchey Terry , Pati Debajyoti
Published: February 2015

Determining the number of patient rooms for an acute care (medical-surgical) patient unit is a challenge for both healthcare architects and hospital administrators when renovating or designing a new patient tower or wing. Discussions on unit bed size and its impact on hospital operations in healthcare design literature are isolated, and clearly there is opportunity for more extensive research. Finding the optimal solution for unit bed size involves many factors, including the dynamics of the site and existing structures. This opinion paper was developed using a “balanced scorecard” concept to provide decision makers a framework for assessing and choosing a customized solution during the early planning and conceptual design phases. The context of a healthcare balanced scorecard with the quadrants of quality, finance, provider outcomes, and patient outcomes is used to compare the impact of these variables on unit bed size.
Facing the Challenge of Patient Transfers: Using Ceiling Lifts in Healthcare Facilities
Authors: Vieira Edgar Ramos , Miller Linda
Published: February 2015

Objective:

The objective was to review the literature on the use of ceiling lifts to perform patient transfers in healthcare settings.

Background:

Manual patient transfers present a high risk of injury. Ceiling lifts are increasingly used in healthcare facilities. Despite this, little is known about the effects of this new technology.

Methods:

Research and review articles were searched on five databases using specific key words and phrases. Literature citations in the articles and gray literature (e.g., technical reports, conference proceedings, magazine articles, Web sites) were also evaluated when relevant for this review. Experts in this area were contacted regarding information on the topic, potential literature, and for their suggestions.

Results:

Few studies evaluated the use of ceiling lifts in healthcare. The studies available and the experiences of the experts contacted support the use of ceiling lifts. The musculoskeletal safety of healthcare workers and patients can be improved by the use of ceiling lifts. Having lifts available, organizing the workflow, and reducing the steps required during transfers and handling tasks can significantly lessen the risk of musculoskeletal injuries.

Conclusions:

Evidence supports the installation of ceiling lifts in patient rooms and recommends their use in bathrooms. However, additional studies are needed because the use of ceiling lifts in healthcare is relatively new.
Integrating Electronic Health Records in the Physical Environment: A Systems Approach
Authors: Rich Carrie R. , Day Tama Duffy
Published: February 2015

Electronic health records (EHRs) are the future of the healthcare industry; however, insufficient attention is paid to where and how the hardware systems that support EHR software are integrated in the existing environment.

The physical implementation of EHRs is an underlying component of the technology program that may pose barriers and/or gateways to EHR adoption in terms of patient safety and satisfaction, clinical usability of the EHR system, cultural acceptance, and organizational workflow. After confirming that environmental interventions are most effective when coupled with cultural programs, this article asserts that hardware is a necessary complement to EHR software implementation if usage is to progress strategically and ergonomically. This article then seeks to explain how, based on evidence-based design (EBD) decisions, the built environment that supports EHR software can enhance or hinder communication. The findings of this paper posit that when EHR hardware is designed ergonomically and with provider-patient communication at the forefront of point-of-care services, EHR usage in the healthcare environment can improve the quality of health services delivery.

This article is the result of a literature review, case studies, academic lectures, healthcare informatics webinars, and discussions with architects, interior design professionals, and corporate EHR leaders.
Mock-Ups as “Interactive Laboratories”: Mixed Methods Research Using Inpatient Unit Room Mock-Ups
Authors: Watkins Nicholas , Myers Donald , Villasante Ronald
Published: February 2015

Objective:

To establish evidence-based design (EBD) guidelines for inpatient rooms at Department of Veterans Affairs (VA) facilities.

Background:

Simulation allows clients, designers, and researchers to visualize how users might interact with a proposed design before actual construction of the design. This study used mock-ups as a simulation technique during a study of the VA inpatient room standards. The participants used the inpatient room mock-ups as “interactive laboratory” environments to maximize opportunities for participatory design, qualitative research, and quantitative research of project-specific EBD solutions.

Methods:

The research used questionnaires, scenarios, on-demand modifications, and observations to evaluate and confirm EBD solutions for inpatient room mock-ups. A total of 71 participants responded to a questionnaire administered across five mock-up work sessions. These 71 participants consisted of administrators, nurses, physicians, support staff, environment and maintenance staff, and patient and staff safety representatives from throughout the VA healthcare system.

Results and Discussion:

EBD solutions were tested, evaluated, and modified for each inpatient room type and were applicable to two or more of the inpatient room types. The latter included the location of patient beds and standard headwall position, technology and spaces for nurse charting activities, clearances (e.g., equipment, wheelchair, and bariatric patient), universal rooms, and patient and family amenities. Also, EBD solutions were tested, validated, and modified to the needs of each inpatient room.

Conclusion:

The mock-ups allowed researchers and designers to evaluate and confirm EBD solutions and strategies for the development of VA inpatient room standards. When used as a means for mixed-methods research, mock-ups can successfully integrate research and design during project-related work. EBD research using mock-ups not only addresses project- or organization-specific concerns, but it may contribute to the knowledge base of the healthcare design community.
Environmental Issues Related to Medication Errors in Long-Term Care: Lessons from the Literature
Authors: Mahmood Atiya , Chaudhury Habib , Gaumont Alana
Published: February 2015

Objective:

Medication errors contribute significantly to patient morbidity and mortality and are associated with a considerable cost to the healthcare system. The purpose of this study was to conduct a review and synthesis of the literature on the effect of physical and organizational aspects of the environment on medication and nursing errors in long-term care environments.

Methods:

Extensive database searches were conducted for relevant publications. In total, 46 empirical and 19 nonempirical (descriptive and conceptual) journal articles, books, book chapters, and reports were analyzed.

Results:

Environmental variables related to medication and nursing errors are: lighting/illumination, noise, inefficient layout or use of space, disorganized medication storage or administration areas, look-alike or sound-alike drugs, and equipment.

Conclusions:

A supportive physical environment is important to reduce factors that may directly or indirectly contribute to errors. Both physical and organizational environments need to be addressed for an effective intervention to reduce medication and nursing errors.
Lessons from Evidence-Based Medicine: What Healthcare Designers Can Learn from the Medical Field
Authors: Viets Elizabeth
Published: February 2015

This paper explores the history of evidence-based medicine (EBM) in comparison to the relatively short history of evidence-based design (EBD). Throughout its development, EBM has encountered a number of challenges, including dealing with initial objections to the concept, creating safeguards to ensure rigor in research, supporting practitioners in their efforts to stay current with a growing body of research data, applying the literature to real-life situations, making decisions when literature to inform decision making is absent, and educating students and professionals to become EBM practitioners. The ways in which the field of EBM has handled these challenges provides a number of lessons for the relatively young field of EBD.
A Theoretical Model for Transforming the Design of Healing Spas: Color and Platonic Solids
Authors: Day Tama Duffy , Rich Carrie
Published: February 2015

An increasing number of clinical treatment modalities feature the therapeutic application of light in wavelengths that correspond to specific colors. How do design professionals connect light and color with form? Until now, such relationships remained largely unexplored. Beginning with accepted contemporary science and tracing the question back to early scientists and philosophers, this paper confronts the skeptic who says that color is situational and cultural and that it cannot be linked to outcomes. By describing modalities that combine specific light wavelengths with color and form, this investigation probes material that does not conform neatly to the research data. By exploring Plato's concepts in the form of an environmental experiment, this paper applies ancient theories of healing to current medical applications in conceptualizing the design of a hypothetical spa. The hypothesis is that patients who visit a spa designed to connect form with light and color will experience more effective and timely outcomes than the same patients who visit an ordinary spa.
Pediatric Art Preferences: Countering the “One-Size-Fits-All” Approach
Authors: Nanda Upali , Chanaud Cheryl M. , Brawn Linda , Hart Robyn , Hathorn Kathy
Published: February 2015

Objective:

To determine the stated art preferences of pediatric patients through an art survey and determine whether preferences vary, with different age groups associated with different stages of cognitive development.

Background:

Exposure to visual art has been shown to have an impact on improved health and satisfaction outcomes. However, there is little literature on the effect of art on pediatric patients. While designing pediatric wards, a common assumption is to use fantasy and Disney-like themes; but research across all age groups on whether children prefer these themes is limited.

Methodology:

A survey including 20 images with a variety of subject matter and styles was administered to 64 pediatric inpatients (ages 5–17) at Memorial Hermann Hospital in Houston, TX. Children were asked to rate the selection of, and their emotional response to, the images in the survey. Qualitative comments were recorded. Results were analyzed for each of the three age groups (5–6, 7–10, and 11–17 years) according to Piaget's developmental stages, as well as across all age groups.

Results:

There were significant differences in art preferences across the different age groups, especially with respect to child art (art created by children). Overall, the results for 5–10-year-olds were more significant than those for 11–17-year-olds (adolescents). Nature elements were preferred across all age groups, but all nature images were not rated similarly. Images that were bright and colorful were rated better than images that were pale. The presence of a strong context that children could associate with was a defining feature of preferred images. Content drove preference more than style, though color was a key determinant. Comments on the artwork tended to be more objective/absolute for the youngest patients and more subjective/relative for the oldest.

Conclusions:

The combination of bright colors, engaging themes, and nature content is consistently highly rated by pediatric patients. However, pediatric preferences vary significantly among the three operational stages, so one should be careful before using the “one-size-fits-all” approach. Child art, typically used in pediatric wards, is better suited for younger children than for older children.
Building Connections: A Clinical Operations View of Activation Planning
Authors: Cuddeback Kelly T. , Redden Pamela
Published: February 2015

The construction trend in healthcare remains strong compared to other construction markets due to the stability of the forces driving the growth. Constructing new healthcare facilities is challenging because of the need to collaborate continuously with the operational components of the organization. Successful planning and activation greatly enhance the outcome of any project. Working with an operational point of view throughout the building activation process, beginning with design, benefits both the construction and operational teams. The result is a more positive outcome for the institution, fewer changes during the project for the construction team, and the ability to minimize costly renovations and/or change orders. Focused and intentional communication throughout the design and construction phase is vital to the activation and success of any project. Developing a communication plan early in the project supports the development of trust and organizational participation. Activation planning must link design and operations to improve project outcomes.
Embracing Change
Authors: Christiansen Carl
Published: February 2015

As the world changes financially, the healthcare architectural design world is following suit. Gone are the straightforward days of designing a hospital based solely on the programming and function of the space. Now, architects must evolve not only to understand healthcare financing and its availability to clients, but to work in a more collaborative way to design projects. Today, fewer projects are moving forward, creating increased competition among architects. This is also generating more scrutiny in regard to cost control and risk management, which has forced architects to consider alternatives to contractual relationships and design/delivery methods. New ways of thinking about bringing a hospital to life foster creativity in both the design and delivery processes. Although these changes can be somewhat uncomfortable, they foster learning, collaboration, and ultimately, benefits for all who participate in the process.
Private Investment in Hospitals: A Comparison of Three Healthcare Systems and Possible Implications for Real Estate Strategies
Authors: van der Zwart Johan , van der Voordt Theo , de Jonge Hans
Published: February 2015

Objectives:

This article explores lessons to be learned from three different healthcare systems and the possible implications for the management of healthcare real estate, in particular in connection to the Dutch system. It discusses similarities and differences among the different systems, in search of possible consequences on cost, financing, and design innovation.

Background:

To keep healthcare affordable in the future, the Dutch government is currently in the process of changing legislation to move from a centrally directed system to a so-called regulated market system. The deregulation of real estate investment that accompanies the new healthcare delivery system offers healthcare organizations new opportunities, but also more responsibility and greater risk in return on investment. Consequently, healthcare organizations must find new methods of financing. Private investment is one of the options.

Methods:

Three healthcare systems were analyzed on the basis of a literature review and document analysis, then schematized to show similarities and dissimilarities with regard to private investment in hospitals. Observations are based on a selection of recently published articles on private-sector financing and its implications for healthcare real estate decision making in the Netherlands, the United Kingdom, and Germany.

Results:

The strengths and weaknesses of three healthcare systems with differing proportions of private and public investment in hospitals were explored. Research revealed a gap between intended effects and actual effects with regard to quality and cost. Costly private finance does not necessarily lead to “value for money.” Transferring real estate decisions to private investors decreases the influence of the healthcare organization on future costs and quality.

Conclusions:

The three healthcare systems show substantial differences between public and private responsibilities. Less governmental involvement affords both opportunities and risks for hospitals. Private investment may lead to innovation, improved efficiency, and cost reduction, provided that the costs and benefits of decisions are not separated between different stakeholders. A missing link between infrastructure provision and healthcare delivery may impede design innovation and optimal adaptation to work processes and could lead to an inefficient allocation of risks and benefits.
The Research-Design Interaction: Lessons Learned from an Evidence-Based Design Studio
Authors: Haq Saif , Pati Debajyoti
Published: February 2015

As evidence-based design (EBD) emerges as a model of design practice, considerable attention has been given to its research component. However, this overshadows another essential component of EBD—the change agent, namely the designer. EBD introduced a new skill set to the practitioner: the ability to interact with scientific evidence. Industry sources suggest adoption of the EBD approach across a large number of design firms. How comfortable are these designers in integrating research with design decision making? Optimizing the interaction between the primary change agent (the designer) and the evidence is crucial to producing the desired outcomes. Preliminary to examining this question, an architectural design studio was used as a surrogate environment to examine how designers interact with evidence. Twelve students enrolled in a healthcare EBD studio during the spring of 2009. A three-phase didactic structure was adopted: knowing a hospital, knowing the evidence, and designing with knowledge and evidence. Products of the studio and questionnaire responses from the students were used as the data for analysis. The data suggest that optimization of the research-design relationship warrants consideration in four domains: (1) a knowledge structure that is easy to comprehend; (2) phase-complemented representation of evidence; (3) access to context and precedence information; and (4) a designer-friendly vocabulary.
Hospital Room Design and Health Outcomes of the Aging Adult
Authors: Lorenz Susan Garzon , Dreher H. Michael
Published: February 2015

Objective:

To determine differences in the rate of falls, healthcare-acquired infections (HAIs), and the degree of social isolation in hospitalized older adults admitted to private versus semiprivate rooms.

Background:

The American Institute of Architects recommends that private rooms become the industry standard for all new construction of acute care hospitals. Healthcare design researchers contend that private rooms decrease infection, facilitate healthcare workers' efficiency, provide space for families, and afford greater access to privacy. Although links between room type and health outcomes have been described in the literature, the actual relationship between these two variables has not been determined, nor is it clear whether a one-size-fits-all approach to hospital design is appropriate for all patient populations, particularly older adults.

Methods:

This retrospective case comparative design utilized a sample of patients admitted to the University Medical Center of Princeton in 2006 and received full internal review board approval. Patient records were randomly selected through the admission/discharge/transfer system of the hospital and then divided into two groups based on room type. Data collected included demographics, incidence of falls, HAIs, and risk of social isolation.

Results:

All patients were more than 65 years old and had been admitted to the hospital for a variety of diagnoses. Length of stay was between 3 and 10 days. There was no significant difference between the type of room and the likelihood of falling ( p = .37), however the relative risk of falling in a private room was 4.01. There was no significant difference in the occurrence of HAIs based on room type ( p = 1.0). The risk-of-social-isolation variable was unable to significantly affect which hospitalized older adults would suffer a negative outcome, fall, or HAI ( p = .52).

Conclusion:

Room type may play a role in the occurrence of falls in hospitalized older adults, but room type alone does not increase the chance of acquiring an infection in the hospital. Nor does the risk of social isolation affect the likelihood of an adverse outcome.
Wayfinding for People with Dementia: A Review of the Role of Architectural Design
Authors: Marquardt Gesine
Published: February 2015

Objective:

This paper provides an overview of the available literature on architectural wayfinding design for people with dementia in nursing homes. The results were to be summarized and substantiated through an interdisciplinary interpretation, taking into account changes in the orientation process of people with dementia.

Background:

Spatial disorientation and declining wayfinding abilities are among the early symptoms of dementia, limiting a person's ability to perform activities of daily living (ADLs) independently and ultimately, perhaps leading to institutionalization. A prerequisite to maintaining residents' quality of life in a nursing home is their ability to orient themselves within their new environment.

Approach:

The available literature on wayfinding design for people with dementia in nursing homes was reviewed. Two aspects of interventions for residents' wayfinding abilities were identified: the design of the floor plan typology and environmental cues.

Results:

The design of the physical environment plays a major role in supporting the wayfinding abilities of people with dementia. The floor plan design of a nursing home in particular has a significant influence on residents' spatial orientation and wayfinding. Additional interventions such as signage, furnishing, lighting, and colors are additional supporting features but they cannot compensate for an adverse architectural design.

Conclusions:

For the creation of a supportive, dementia-friendly environment, both aspects of architectural design must be considered. Design guidelines to support the wayfinding abilities of people with dementia were developed to synthesize both.
Examination of Wireless Technology to Improve Nurse Communication, Response Time to Bed Alarms, and Patient Safety
Authors: Guarascio-Howard Linda
Published: February 2015

Objective:

A medical-surgical unit in a southwestern United States hospital examined the results of adding wireless communication technology to assist nurses in identifying patient bed status changes and enhancing team communication. Following the addition of wireless communication, response time to patient calls and the number of nurse-initiated communications were compared to pre-wireless calls and response time sampling period.

Background:

In the baseline study, nurse-initiated communications and response time to patient calls were investigated for a team nursing model ( Guarascio-Howard & Malloch, 2007 ). At this time, technology consisted of a nurse call system and telephones located at each decentralized nurse station and health unit coordinator (HUC) station. For this follow-up study, a wireless device was given to nurses and their team members following training on device use and privacy issues.

Method:

Four registered nurses (RNs) were shadowed for 8 hours (32 hours total) before and after the introduction of the wireless devices. Data were collected regarding patient room visits, number of patient calls, bed status calls, response time to calls, and the initiator of the communication episodes.

Results:

Follow-up study response time to calls significantly decreased ( t-test p = .03). RNs and licensed practical nurses responded to bed status calls in less than 1 minute—62% of the 37 calls. Communication results indicated a significant shift (One Proportion Z Test) in RN-initiated communications, suggesting an enhanced ability to communicate with team members and to assist in monitoring patient status. Patient falls trended downward, although not significantly ( p > .05), for a 6-month period of wireless technology use compared to the same period the previous year.

Conclusions:

The addition of a wireless device has advantages in team nursing, namely increasing communication with staff members and decreasing response time to patient and bed status calls. Limitations of the study included a change in caregiver team members and issues regarding wireless device and locator badge compliance. Administrative issues that arose during this field study included bed and cable maintenance, device battery charging, and the training of new and floating team members.
Integrating Evidence-Based Design and Experience-Based Approaches in Healthcare Service Design
Authors: Carr Valerie L. , Sangiorgi Daniela , Büscher Monika , Junginger Sabine , Cooper Rachel
Published: February 2015

Objective:

To investigate the connections between, and respective contributions of, evidence-based and experience-based methods in the redesign of healthcare services.

Background:

Evidence-based medicine (EBM) preceded (and inspired) the development of evidence-based design (EBD) for healthcare facilities. A key feature of debate around EBM has been the question of interpretation of the guidance by experienced clinicians, to achieve maximum efficacy for individual patients. This interpretation and translation of guidelines—avoiding a formulaic approach, allowing for divergent cultural and geographical exigencies, creating innovative, context-specific solutions—is the subject of this discussion, which examines the potential for integration of evidence-based and experience-based approaches in the development of creative solutions to healthcare services in England. This paper examines Practice-Based Commissioning (PBC) in England, which devolves responsibility for commissioning new services for patients to frontline clinicians, relying on their understanding of patient needs at the local level.

Methods:

An 18-month project, funded by the Health and Care Infrastructure Research and Innovation Centre (HaCIRIC), examined PBC frameworks in England, investigating the impact of different models of governance on the development of service redesign proposals to answer the following questions: How do clinicians interpret the multiplicity of guidance from government agencies and translate this into knowledge that can be effectively used to redesign patient care pathways aligned with local healthcare priorities? How can understanding patient and staff “experiences” and key “touch points” of interaction with local healthcare services be used to provide a creative, customized solution to the design of healthcare services in a local, community-based framework?
Quantifying the Relationship among Hospital Design, Satisfaction, and Psychosocial Functioning in a Pediatric Hematology Oncology Inpatient Unit
Authors: Sherman-Bien Sandra A. , Malcarne Vanessa L. , Roesch Scott , Varni James W. , Katz Ernest R.
Published: February 2015

Background:

Studies show that hospital built environments can affect physical and psychological outcomes and healthcare satisfaction in adults, but pediatric research is sparse.

Objective:

To investigate the effects of the built environment on hospitalized pediatric hematology-oncology patients and their parents by testing the hypothesis that perceived built environment satisfaction mediates the relationship between the objective built environment and psychosocial functioning, as well as parental healthcare satisfaction.

Methods:

The hospital built environment was evaluated subjectively through the PedsQL™ Hospital Healing Environment Module satisfaction questionnaires and objectively by quantifying environmental features. Outcomes for patients and parents included present functioning and affect. Healthcare satisfaction was also assessed for parents. Structural equation modeling (SEM) was used to test the mediational hypothesis.

Subjects:

Participants were 90 hospitalized pediatric hematology-oncology patients and 149 parents of pediatric hematology-oncology patients.

Results:

For both parents and children, analyses revealed a significant positive relationship between the quality of the objective built environment and built environment satisfaction. For parents, significant relationships emerged in the expected direction between built environment satisfaction and present functioning, healthcare satisfaction, and negative affect.

Conclusions:

Both pediatric hematology-oncology patients and their parents can reliably report their own perceived built environment satisfaction, which is significantly related to the quality of the objective built environment. For parents, results support the mediational hypothesis, highlighting the importance that perceived built environment satisfaction plays in psychosocial functioning and healthcare satisfaction.
Saving Lives following the Expansion of Centralized Remote Telemetry Monitoring
Authors: Rubino Steven , Kracht Kathleen , Burnell Lori , Davidson Judy , Carney Joseph , VanWyk Cynthia , Nadiri Zubair
Published: February 2015

Continuous monitoring of patients throughout the hospital is a desirable method to ensure the continuity of quality care. Hospitals looking to improve the manner in which they maintain such continuity without compromising efficiency must explore the benefits of implementing monitoring technology to its fullest potential. This case study chronicles the journey of a level-one trauma hospital during the expansion of remote wireless telemetry monitoring and the telemetry technician role. The lives saved as a result of this expansion were primarily attributable to the installation of remote wireless telemetry monitoring in the emergency department. The expansion of the telemetry technician role improved not only the quality of the monitoring signal and recognition, but also the ability to identify changes in trended data. The next step for improving care delivery includes the addition of a patient locator system within the facility, which will provide the most accurate information regarding patient location during transfer. Accurately identifying patient location in addition to alerting staff to changes in patient status will ensure that care providers respond promptly and that the highest quality of patient care is delivered while patients are away from the nursing unit.
The Biomechanics of Patient Room Standardization
Authors: Pati Debajyoti , Cason Carolyn , Harvey Thomas E. , Evans Jennie , Erwin Andrea M.
Published: February 2015

Background:

The prevailing focus on cognitive load reduction in healthcare environment standardization excludes a domain of healthcare delivery that could contribute significantly to safety and efficiency through standardization, but it has escaped discussion in the context of the biomechanics of care delivery. Inappropriate biomechanics not only can harm caregivers but compromise care delivery. Little, however, is known regarding the biomechanics of patient care and the way it interacts with the configurational issues typically targeted in healthcare environment standardization.

Objectives:

Examine the types of potentially harmful or stressful actions exhibited by nurses during patient care delivery in an acute medical/surgical setting. Examine the sources influencing unsafe actions.

Method:

Twenty nurses provided three types of simulated care in an experimental setting involving nine care configurations that were systematically manipulated. A kinesiology expert coded 80 simulation segments representing two types of task and two levels of environmental challenge to identify potentially stressful and harmful actions. Exploratory and regression analyses were conducted on the data.

Results:

Analysis suggests that a considerable proportion of potentially harmful and stressful actions are associated with the design of the physical elements as opposed to the configurational factors typically addressed in standardization. Both of these factors interact to produce work-arounds that result in unsafe actions.

Conclusion:

The standardization of healthcare environments needs a larger framework to address both cognitive lapses and the biomechanics of care delivery.
Building the “Fable Hospital”—The CEO's Perspective
Authors: Tam David A.
Published: February 2015

Hospital construction is a significant event in any health system. The financial implications are great, especially at a time of shrinking capital resources. Personnel are affected, as are the processes to perform their tasks. Often, new facilities are catalysts that change organizational culture; it has been clearly shown that new facilities have a positive impact on patient satisfaction scores. The members of the C-suite of a hospital/health system play important roles in construction projects. However, no one is more critical to the success of such major endeavors than the chief executive officer (CEO). The CEO sets the tone for the project, giving direction to the design and construction process that may have implications for the rest of the organization. Palomar Pomerado Health (PPH) is the largest public health district in California. In 2002, the PPH governing board authorized the creation of a new facility master plan for the district, which included the construction of a replacement facility for its tertiary care trauma center. The new Palomar Medical Center is slated to open in August 2012.

HERD had the opportunity to speak with PPH CEO Michael H. Covert on the role of the CEO in the building of this “fable hospital.”
Using Clinical Simulation Centers to Test Design Interventions: A Pilot Study of Lighting and Color Modifications
Authors: Gray Whitney Austin , Kesten Karen S. , Hurst Stephen , Anderko Laura
Published: February 2015

Objective:

The aim of this pilot study was to test design interventions such as lighting, color, and spatial color patterning on nurses' stress, alertness, and satisfaction, and to provide an example of how clinical simulation centers can be used to conduct research.

Background:

The application of evidence-based design research in healthcare settings requires a transdisciplinary approach. Integrating approaches from multiple fields in real-life settings often proves time consuming and experimentally difficult. However, forums for collaboration such as clinical simulation centers may offer a solution. In these settings, identical operating and patient rooms are used to deliver simulated patient care scenarios using automated mannequins.

Methods:

Two identical rooms were modified in the clinical simulation center. Nurses spent 30 minutes in each room performing simulated cardiac resuscitation. Subjective measures of nurses' stress, alertness, and satisfaction were collected and compared between settings and across time using matched-pair t-test analysis.

Results:

Nurses reported feeling less stressed after exposure to the experimental room than nurses who were exposed to the control room (2.22, p = .03). Scores post-session indicated a significant reduction in stress and an increase in alertness after exposure to the experimental room as compared to the control room, with significance levels below .10. (Change in stress scores: 3.44, p = .069); (change in alertness scores: 3.6, p = .071).

Conclusion:

This study reinforces the use of validated survey tools to measure stress, alertness, and satisfaction. Results support human-centered design approaches by evaluating the effect on nurses in an experimental setting.
Space Syntax in Healthcare Facilities Research: A Review
Authors: Haq Saif , Luo Yang
Published: February 2015

Space Syntax is a theory and method that has been developing for the last 40 years. Originally conceived as a theory of “society and space,” it has expanded to other areas. An important aspect of this is technical; it allows the quantification of layouts, and unit spaces within a layout, so that the environment itself can produce independent variables in quantitative research. Increasingly, it is being used to study healthcare facilities. Space Syntax has thereby become relevant to healthcare facilities researchers and designers. This paper attempts to explain Space Syntax to a new audience of healthcare designers, administrators, and researchers; it provides a literature review on the use of Space Syntax in healthcare facility research and suggests some possibilities for future application.