bluuebunny/crossref_metadata_2025 huggingface dataset:
Group Differences in Preferences for a Novel Nightstand
Authors: Brooks Johnell O. , Smolentzov Linnea , Mossey Mary E. , Carroll Carson , Kendrick Katherine , Sprogis Kylie , Manganelli Joe , Healy Stan L. , Kopera Kevin , Walker Ian , Green Keith
Published: February 2015

Objective:

Multiple user groups (patients and employees at a rehabilitation facility, community-dwelling seniors, and university students) participated in a study that examined their preferences for the features and functions of three novel nightstand prototypes.

Background:

It is valuable to get input from different user groups in order to improve furniture usefulness and usability, especially furniture prevalent in clinical settings where users of all age groups are found.

Methods:

Feedback was obtained from different user groups in both clinical (rehabilitation facility) and nonclinical (university) settings. This was done using structured interviews to ask participants about multiple features of the novel nightstand designs.

Results:

There were several features that all groups preferred. There were also some distinctly opposing opinions between groups. In general, the patient group showed the most similarities to the other groups.

Conclusion:

This research explores differences and similarities in preferences for nightstand design across a variety of user groups. It yields ideas for improving the nightstand design to be useful for a wider group of people.
Affordances of the Care Environment for People with Dementia—An Assessment Study
Authors: Topo Päivi , Kotilainen Helinä , Eloniemi-Sulkava Ulla
Published: February 2015

Background:

Evidence on the importance of the physical environment for the well-being of people with dementia has been growing steadily.

Objective:

This article aims to (1) introduce an assessment tool for evaluating the physical care environment for people with dementia; (2) describe the method's initial results and the subsequent feedback provided to the 10 care units; and (3) describe the follow-up results 1 year later. The goal has been to provide care workers and managers with information that affects the well-being of people with dementia and to provide this information on the care environment in the context of their own work environment.

Methods:

The assessment was part of a randomized controlled intervention using nonpharmaceutical methods to decrease behavioral and psychological symptoms of people with dementia. During the half-day visits, photographs and field notes were taken, and a final assessment was carried out via the Residential Care Environment Assessment (RCEA) tool developed at the beginning of the study and based on affordance theory. Follow-up data were gathered after 12 months.

Results:

There were several possibilities for improvements in the provision of residential care in a person-centered environment. Improvements were needed mostly in comfort and in providing opportunities for engagement, activity, and expression of identity. However, in practice, it was difficult to achieve the improvements even with an intensive intervention study.

Conclusions:

The authors conclude that the physical care environment involves a complex set of issues and stakeholders in which the impetus to fulfill responsibilities to carry out improvements can easily fall away.
Effects of Nursing Unit Spatial Layout on Nursing Team Communication Patterns, Quality of Care, and Patient Safety
Authors: Hua Ying , Becker Franklin , Wurmser Teri , Bliss-Holtz Jane , Hedges Christine
Published: February 2015

Studies investigating factors contributing to improved quality of care have found that effective team member communication is among the most critical and influential aspects in the delivery of quality care. Relatively little research has examined the role of the physical design of nursing units on communication patterns among care providers. Although the concept of decentralized unit design is intended to increase patient safety, reduce nurse fatigue, and control the noisy, chaotic, and crowded space associated with centralized nursing stations, until recently little attention has been paid to how such nursing unit designs affected communication patterns or other medical and organizational outcomes. Using a pre/post research design comparing more centralized or decentralized unit designs with a new multi-hub design, the aim of this study was to describe the relationship between the clinical spatial environment and its effect on communication patterns, nurse satisfaction, distance walked, organizational outcomes, patient safety, and patient satisfaction. Hospital institutional data indicated that patient satisfaction increased substantially. Few significant changes were found in communication patterns; no significant changes were found in nurse job satisfaction, patient falls, pressure ulcers, or organizational outcomes such as average length of stay or patient census.
The Effect of Hospital Unit Layout on Nurse Walking Behavior
Authors: Yi Lu , Seo Hyun-Bo
Published: February 2015

Objective:

To confirm a new method for the research question, “How do different hospital unit layouts affect nurses' walking behavior and distance?”

Background:

Concern is renewed regarding nurses' long walking distances because of the trend toward larger patient rooms with family areas inside, resulting in a larger overall unit size. Studies have found unit design characteristics that support nurses' efficient walking, but few have done it in units designed for patient- and family-centered care. To examine the effect of unit design on nurses' walking behavior, the authors propose a new method of observing a specific task.

Methods:

The authors observed nurses during the task of medication administration.

Results:

Contrary to their hypotheses, results showed: (1) Experienced nurses had more unnecessary stops and longer walking distances than new nurses because of interactions; and (2) nurses in the smaller wing of the unit walked more than those in the larger wing of the same unit. The authors posit that the closeness between the nurses' path to the medication supply room and the central nurses' station affected the frequency of interactions and prompted a deviation from the shortest and most efficient path during medication administration.

Conclusion:

Observing a specific task to identify the effect of unit layout was effective, determining that overall unit shape or unit layout type might not be a good predictor of nurses' walking behavior; instead the characteristics of the path that connects functional spaces such as patient room and medication area might better predict nurses' walking behavior.
Factors Impeding Flexible Inpatient Unit Design
Authors: Pati Debajyoti , Evans Jennie , Harvey Thomas E. , Bazuin Doug
Published: February 2015

Objective:

To identify and examine factors extraneous to the design decision-making process that could impede the optimization of flexibility on inpatient units.

Background:

A 2006 empirical study to identify domains of design decisions that affect flexibility on inpatient units found some indication in the context of the acuity-adaptable operational model that factors extraneous to the design process could have negatively influenced the successful implementation of the model. This raised questions regarding extraneous factors that might influence the successful optimization of flexibility.

Method:

An exploratory, qualitative method was adopted to examine the question. Stakeholders from five recently built acute care inpatient units participated in the study, which involved three types of data collection: (1) verbal protocol data from a gaming session; (2) in-depth semi-structured interviews; and (3) shadowing frontline personnel. Data collection was conducted between June 2009 and November 2010.

Results:

The study revealed at least nine factors extraneous to the design process that have the potential to hinder the optimization of flexibility in four domains: (1) systemic; (2) cultural; (3) human; and (4) financial.

Conclusions:

Flexibility is critical to hospital operations in the new healthcare climate, where cost reduction constitutes a vital target. From this perspective, flexibility and efficiency strategies can be influenced by (1) return on investment, (2) communication, (3) culture change, and (4) problem definition. Extraneous factors identified in this study could also affect flexibility in other care settings; therefore, these findings may be viewed from the overall context of hospital design.
The Environment of Inpatient Healthcare Delivery and Its Influence on the Outcome of Care
Authors: O'Connor Margaret , O'Brien Anthony , Bloomer Melissa , Morphett Julia , Peters Louise , Hall Helen , Parry Arlene , Recoche Katrina , Lee Susan , Munro Ian
Published: February 2015

Aim:

This paper addresses issues arising in the literature regarding the environmental design of inpatient healthcare settings and their impact on care.

Background:

Environmental design in healthcare settings is an important feature of the holistic delivery of healthcare. The environmental influence of the delivery of care is manifested by such things as lighting, proximity to bedside, technology, family involvement, and space. The need to respond rapidly in places such as emergency and intensive care can override space needs for family support. In some settings with aging buildings, the available space is no longer appropriate to the needs—for example, the need for privacy in emergency departments. Many aspects of care have changed over the last three decades and the environment of care appears not to have been adapted to contemporary healthcare requirements nor involved consumers in ascertaining environmental requirements. The issues found in the literature are addressed under five themes: the design of physical space, family needs, privacy considerations, the impact of technology, and patient safety.

Conclusion:

There is a need for greater input into the design of healthcare spaces from those who use them, to incorporate dignified and expedient care delivery in the care of the person and to meet the needs of family.
Sleep as a Moderating Value in Healthcare Facility Design
Authors: Kennedy Maria Regina Clemesha
Published: February 2015

Background:

Healthcare design is produced by large design teams with vital input from clients and expert consultants. Throughout the design process, choices are made based on evaluations by all parties; however, some of these evaluations cannot be reduced to a common metric. Many complex interactions defy objective evaluation. It is proposed that jointly agreed-on values can be deployed as moderators in subjective evaluations, allowing design teams to work together more harmoniously.

Object:

Design evidence base for one use-value: sleep. A literature review considers the evidence currently found regarding the value of sleep for hospital inpatients and the actual quality of inpatient sleep. Intrinsic and extrinsic reasons for shortened or poor sleep are reviewed, with an emphasis on environmental considerations. There are many manners in which designers and caregivers are aware that good sleeping conditions can be provided; therefore it is by choice, albeit unwittingly, that poor sleeping conditions have arisen.

Conclusion:

The value of sleep to hospital inpatients is very high, even in the short term. Inpatients' sleep is currently not as good as it could or should be. Conflicting views, varied constraints, and requirements might be harmonized and give way to successful innovation if design teams and project stakeholders adopt moderating values as a guide for design evaluations.
The Effect of Garden Designs on Mood and Heart Output in Older Adults Residing in an Assisted Living Facility
Authors: Goto Seiko , Park Bum-Jin , Tsunetsugu Yuko , Herrup Karl , Miyazaki Yoshifumi
Published: February 2015

Objective:

The objective of this study is to trace short-term changes in mood and heart function in elderly individuals in response to exposure to different landscaped spaces.

Background:

Nineteen elderly but cognitively intact residents of an assisted living facility participated in the study. They were exposed to three landscaped spaces: a Japanese style garden, an herb garden, and a simple landscaped area planted with a single tree.

Methods:

To assess the effect of different landscaped spaces on older adults, individuals were monitored for mood and cardiac function in response to short exposures to spaces. Mood state was assessed using Profile of Mood States (POMS) before and after viewing the spaces. Cardiac output was assessed using a portable electrocardiograph monitor before and during the viewing.

Results:

We found that the structured gardens evoked greater responses in all outcome measures. Scores on the POMS improved after observation of the two organized gardens compared to responses to the simple landscaped space with a single tree. During the observation period, heart rate was significantly lower in the Japanese garden than in the other environments, and sympathetic function was significantly lower as well.

Conclusions:

We conclude that exposure to organized gardens can affect both the mood and cardiac physiology of elderly individuals. Our data further suggest that these effects can differ depending on the types of landscape to which an individual is exposed.
An Investigation of Noncompliant Toilet Room Designs for Assisted Toileting
Authors: Sanford Jon , Bosch Sheila J.
Published: February 2015

Objective:

By comparing an Americans with Disabilities Act Accessibility Guidelines (ADAAG) compliant design with alternative designs, this pilot study resulted in recommendations for designing patient bathrooms to facilitate assisted toileting.

Background:

The ADA Accessibility Guidelines were developed primarily to address the needs of disabled populations, such as returning Vietnam veterans, with sufficient upper body strength to transfer independently directly from a wheelchair to the toilet. However, the majority of older persons with disabilities (90%) stand to transfer to the toilet, rather than laterally moving from the wheelchair to the toilet.

Methods:

The research used a repeated measures research design to evaluate caregiver responses during assisted toileting for various toilet configurations. The study included 20 patients who were transferred onto and off of a toilet for each of four different configurations by one or two caregivers. Toileting trials were videotaped and analyzed by an occupational therapist. Additionally, caregivers completed five-question, self-report surveys after each toileting trial.

Results:

Survey data indicate that staff members prefer the largest of the tested configurations, where the centerline of the toilet is 30 inches from the sidewall, rather than the 18 inches required by the ADAAG, and where there are two fold-down grab bars provided. Caregivers perceived the grab bar locations as better for helping them safely transfer subjects in a modified (non-ADAAG) configuration, and also that the grab bar style in a modified configuration (non-ADAAG) improved safety when transferring subjects.

Conclusions:

Although caregivers were observed to safely transfer residents to and from the toilet for all configurations tested, regulations regarding accessibility of patient bathrooms should acknowledge the perceived benefits of increasing the distance from the sidewall to the centerline of the toilet to as much as 30 inches and allowing two fold-down grab bars instead of the required sidewall and back-wall grab bars.
Moderating Role of Interior Amenities on Hospital Medical Directors' Patient-Related Work Stresses
Authors: Lin Blossom Yen-Ju , Lin Yung-Kai , Juan Chi Wen , Lee Suhsing , Lin Cheng-Chieh
Published: February 2015

Objective:

Considering hospital medical directors' work stress, this study aims to examine how interior amenities might moderate the effect of work stress on their health.

Background:

Previous studies have revealed that hospital medical directors—senior physicians in the management positions with high-demand jobs in clinical practices and management—had a lower self-rated health.

Methods:

This was a cross-sectional survey study and 737 hospital medical directors in Taiwan were included. A developed and structured questionnaire covered the dimensions of patient-related work stress (i.e., physician-patient relationship stress and patient condition stress), hospital interior amenities (i.e., indoor plants, aquarium, music, art and exhibitions, and private or personalized spaces that are common or surround the workplace of healthcare professionals), and self-rated health status and health complaints. Hierarchical regressions were performed.

Results:

Hospital medical directors' physician-patient relationship stresses were found to have more negative effects on their self-reported health status and complaints than do their patient condition stresses; however, only indoor plants were found to have moderating effects on their short-term health complaints ( p < 0.05). On the other hand, the hospital medical directors' patient condition stresses were negatively related to their short-term health complaints; however, music, art and exhibitions, and private or personalized spaces in the workplaces had moderating effects ( p < 0.05).

Conclusions:

Considering the unavoidable patient-related work stresses imposed on hospital medical directors, some proposed interior amenities can produce buffering effects on work stress to some extent. Future studies could focus on finding alternatives to relieve hospital medical directors' physician-patient relationship work stresses.
Corporate Sustainability: The Environmental Design and Human Resource Management Interface in Healthcare Settings
Authors: Sadatsafavi Hessam , Walewski John
Published: February 2015

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.
Examination of Overbed Tables: Healthcare Provider and User Preferences
Authors: Manganelli Joe , Threatt Anthony , Brooks Johnell O. , Smolentzov Linnea , Mossey Mary , Healy Stan , Walker Ian , Green Keith
Published: February 2015

OBJECTIVE:

This exploratory study examined the preferences of healthcare providers and patients with respect to overbed table features and functions, as well as how the devices tend to be used.

BACKGROUND:

In order to improve the design of overbed tables, it is important to understand which features and functions of existing models are valued by healthcare providers and patients.

METHODS:

A sample of overbed table models was presented to volunteers, who were asked to choose which models' implementation of specific features and functions they preferred. Structured interviews incorporating both forced choice and free response questions were administered to the volunteers—healthcare providers and patients at a rehabilitation hospital.

RESULTS:

While the overbed tabletop and extendable tray are heavily used, all other features of the overbed table models are rarely used. Usability of the models exhibits the potential for improvement. Healthcare providers' and patients' feature preferences differ and occasionally conflict.

CONCLUSIONS:

Existing overbed tables are valued primarily for the top surface. Other features and functions of the overbed table present opportunities for refinement of design, durability, and usability. There are strong patterns of agreement and disagreement in the preferences of healthcare providers and patients with respect to overbed table design, use, features, and functionality. There is potential to improve overbed table designs from both the perspectives of the staff and the patient.
Design of Admission Medication Reconciliation Technology: A Human Factors Approach to Requirements and Prototyping
Authors: Lesselroth Blake J. , Adams Kathleen , Tallett Stephanie , Wood Scott D. , Keeling Amy , Cheng Karen , Church Victoria L. , Felder Robert , Tran Hanna
Published: February 2015

OBJECTIVE:

Our objectives were to (1) develop an in-depth understanding of the workflow and information flow in medication reconciliation, and (2) design medication reconciliation support technology using a combination of rapid-cycle prototyping and human-centered design.

BACKGROUND:

Although medication reconciliation is a national patient safety goal, limitations both of physical environment and in workflow can make it challenging to implement durable systems. We used several human factors techniques to gather requirements and develop a new process to collect a medication history at hospital admission.

METHODS:

We completed an ethnography and time and motion analysis of pharmacists in order to illustrate the processes used to reconcile medications. We then used the requirements to design prototype multimedia software for collecting a bedside medication history. We observed how pharmacists incorporated the technology into their physical environment and documented usability issues.

RESULTS:

Admissions occurred in three phases: (1) list compilation, (2) order processing, and (3) team coordination. Current medication reconciliation processes at the hospital average 19 minutes to complete and do not include a bedside interview. Use of our technology during a bedside interview required an average of 29 minutes. The software represents a viable proof-of-concept to automate parts of history collection and enhance patient communication. However, we discovered several usability issues that require attention.

CONCLUSIONS:

We designed a patient-centered technology to enhance how clinicians collect a patient's medication history. By using multiple human factors methods, our research team identified system themes and design constraints that influence the quality of the medication reconciliation process and implementation effectiveness of new technology.
Clinician Perceptions of a Changing Hospital Environment
Authors: Maguire Denise J. , Burger Kristina J. , O'Donnell Patricia A. , Parnell Lisa
Published: February 2015

OBJECTIVE:

The purposes of this study were to describe how a move into a new hospital influenced the work environment, how long it takes clinicians to adjust to such a significant change, and how much a new hospital work environment helps the practice shift toward patient- and family-centered care (PFCC).

BACKGROUND:

Creating a healthy work environment to keep patients safe and staff engaged in the mission of the organization is perhaps one of the most important roles of hospital administrators and nursing leaders.

METHODS:

A descriptive and comparative design was used to investigate how clinicians perceive, evaluate, and adjust to a new hospital environment, and how much a healthy work environment helps the practice shift toward patient- and family-centered care.

RESULTS:

Perceived stress was significantly higher than baseline 15 months after the move into the new hospital ( p < 0.0000), and employees with 3 or more years of service had significantly higher stress than others ( p < 0.000). Nurses had the second lowest mean stress score ( x = 12.5). The PFCC score increased significantly ( p < 0.007).

CONCLUSIONS:

The single-patient room model increased the workload of many clinicians, and their stress increased after 15 months. There were additional burdens not measured that also may have added to the stress of the participants. The new hospital enabled a significant practice shift toward PFCC.
Role of a Service Corridor in ICU Noise Control, Staff Stress, and Staff Satisfaction: Environmental Research of an Academic Medical Center
Authors: Wang Zhe , Downs Betsy , Farell Ashley , Cook Kimberly , Hourihan Peter , McCreery Shimby
Published: February 2015

OBJECTIVE:

To investigate the role of a dedicated service corridor in intensive care unit (ICU) noise control and staff stress and satisfaction.

BACKGROUND:

Shared corridors immediately adjacent to patient rooms are generally noisy due to a variety of activities, including service deliveries and pickups. The strategy of providing a dedicated service corridor is thought to reduce noise for patient care, but the extent to which it actually contributes to noise reduction in the patient care environment and in turn improves staff performance has not been previously documented.

METHODS:

A before-and-after comparison was conducted in an adult cardiac ICU. The ICU was relocated from a traditional hospital environment to a new addition with a dedicated service corridor. A total of 118 nursing staff participated in the surveys regarding pre-move and post-move environmental comfort, stress, and satisfaction in the previous and new units. Acoustical measures of noise within the new ICU and a control environment of the previous unit were collected during four work days, along with on-site observations of corridor traffic.

RESULTS:

Independent and paired sample t-tests of survey data showed that the perceived noise level was lower and staff reported less stress and more satisfaction in the new ICU ( p < 0.01). Analyses of acoustical data confirmed that the new ICU was significantly quieter ( p < 0.02). Observations revealed how the service corridor impacted patient care services and traffic.

CONCLUSIONS:

The addition of a dedicated service corridor works in the new unit for improving noise control and staff stress and satisfaction.
Stressed Spaces: Mental Health and Architecture
Authors: Connellan Kathleen , Gaardboe Mads , Riggs Damien , Due Clemence , Reinschmidt Amanda , Mustillo Lauren
Published: February 2015

OBJECTIVE:

To present a comprehensive review of the research literature on the effects of the architectural designs of mental health facilities on the users.

BACKGROUND:

Using a team of cross-disciplinary researchers, this review builds upon previous reviews on general and geriatric healthcare design in order to focus on research undertaken for mental health care facility design.

METHODS:

Sources were gathered in 2010 and 2011. In 2010 a broad search was undertaken across health and architecture; in 2011, using keywords and 13 databases, researchers conducted a systematic search of peer reviewed literature addressing mental health care and architectural design published between 2005 to 2012, as well as a systematic search for academic theses for the period 2000 to 2012. Recurrent themes and subthemes were identified and numerical data that emerged from quantitative studies was tabulated.

RESULTS:

Key themes that emerged were nursing stations, light, therapeutic milieu, security, privacy, designing for the adolescent, forensic facilities, interior detail, patients' rooms, art, dementia, model of care, gardens, post-occupancy evaluation, and user engagement in design process. Of the 165 articles (including conference proceedings, books, and theses), 25 contained numerical data from empirical studies and 7 were review articles.

CONCLUSIONS:

Based on the review results, especially the growing evidence of the benefits of therapeutic design on patient and staff well-being and client length of stay, additional research questions are suggested concerning optimal design considerations, designs to be avoided, and the involvement of major stakeholders in the design process.
Project Coalitions in Healthcare Construction Projects and the Application of Real Options: An Exploratory Survey
Authors: Dortland Maartje van Reedt , Dewulf Geert , Voordijk Hans
Published: February 2015

OBJECTIVE:

Exploring the impact of the type of project coalition on types of flexibility by analyzing considered and exercised flexibilities in separated and integrated project coalitions in the design and construction phase and the operations and maintenance phase of a healthcare construction project.

BACKGROUND:

Flexibility in healthcare construction projects is increasingly needed in order to deal with growing uncertainties. Until now, little research has been carried out on how and to what extent flexibility is incorporated in different types of project coalitions chosen by healthcare organizations.

METHODS:

An exploratory survey was conducted among health organizations in both cure and care. Questions were asked on the position of the real estate department within the organization, the type of project coalitions chosen and the rationale behind this choice, and the extent to which flexibility in terms of a real option was considered and to what extent it had been exercised in a project coalition.

RESULTS:

Integrated project coalitions pay more attention to flexibility in advance in both the process and the product, but exercise them to a lesser extent than separated project coalitions. The economic feasibility of real options is higher in integrated project coalitions.

CONCLUSIONS:

The study shows that real options thinking is already incorporated in real estate management of healthcare organizations, although more flexibility is considered in advance of the project than is actually realized during and after construction.
Senior Living Environments: Evidence-Based Lighting Design Strategies
Authors: White Michael D. , Ancoli-Israel Sonia , Wilson Richard R.
Published: February 2015

OBJECTIVE:

To review from an architectural lighting perspective the effects of indoor lighting on the health and well-being of people in senior living environments.

BACKGROUND:

The role of circadian rhythms in people with chronic disorders continues to be a focus of laboratory research and clinical trials. Beneficial, evidence-based indoor lighting design strategies are being considered for senior living environments, particularly for residents who have limited access to natural bright light.

METHODS:

Articles published 2002–2012 reporting the results of prospective, randomized, controlled clinical trials (RCTs) were accessed using the U.S. National Library of Medicine PubMed site using the following search terms: “light, sleep, circadian, randomized, controlled, nursing home” and “light, sleep, circadian, randomized, controlled, elderly.”

RESULTS:

The search resulted in 48 citations, of which 18 meet our pre-search criteria. Data from these RCTs indicate options such as programmable, 24-hour lighting algorithms that may involve light intensity, lighting duration, spectra (wavelength) and lighting timing sequences

CONCLUSIONS:

Valid and actionable data are available about circadian rhythms, sleep, and human health and well-being that can inform the design of lighting for long-term care. Evidence-based architectural design of a 24-hour light/dark environment for residents may mitigate symptoms of circadian disruption; evidence-based management of darkness is as important as evidence-based management of light. Further research is needed into the long-term circadian health needs of night staff members in order to understand the effects of shift work while, at the same time providing the highest level of care.
Environmental Design in Acute Care Settings: A Case Study of a Neurological Rehabilitation Unit
Authors: McCunn Lindsay J. , Gifford Robert
Published: February 2015

OBJECTIVE:

The purpose of this case study was to examine environmental variables that lead to staff error in acute care settings: noise; lighting; ergonomics, furniture, and equipment; and patient room design and unit layout.

BACKGROUND:

Chaudhury, Mahmood, & Valente (2009) reviewed a number of design considerations related to reducing errors by nursing staff in acute care settings. The Neurological Rehabilitation Unit (NRU) at one hospital served to further examine the design recommendations outlined by Chaudhury et al. (2009).

METHODS:

Based on photographs, a site tour, interviews with the NRU manager and with the son of a patient of 5 months, comparisons were made between the NRU and the acute care setting design considerations reviewed by Chaudhury et al. (2009).

RESULTS:

The NRU appeared to comply with many recommendations: enforced noise reduction was facilitated through limiting both the number of patients per room and the number of patients admitted to the unit. Distinct rooms were used for various tasks that helped to contain activity-based noise. A combination of daylighting and artificial lighting was in place, but efforts to control glare and thermal comfort were not integrated into the design. The ergonomic needs of employees were incorporated in the design of the NRU, and the layouts of patient rooms and the layout of the NRU in general also were compatible with the design recommendations reviewed by Chaudhury et al. (2009).

CONCLUSIONS:

Many of the design attributes advocated by Chaudhury et al. (2009) were included in the NRU. Supplemental research should be undertaken, however, to objectively measure nursing error, efficiency and staff satisfaction with respect to the comparisons and assumptions presented in this study.
Risk Assessment as Standard Work in Design
Authors: Morrill Patricia W.
Published: February 2015

OBJECTIVE:

This case study article examines a formal risk assessment as part of the decision making process for design solutions in high risk areas. The overview of the Failure Modes and Effects Analysis (FMEA) tool with examples of its application in hospital building projects will demonstrate the benefit of those structured conversations.

BACKGROUND:

This article illustrates how two hospitals used FMEA when integrating operational processes with building projects: (1) adjacency decision for Intensive Care Unit (ICU); and (2) distance concern for handling of specimens from Surgery to Lab.

METHODS:

Both case studies involved interviews that exposed facility solution concerns. Just-in-time studies using the FMEA followed the same risk assessment process with the same workshop facilitator involving structured conversations in analyzing risks.

RESULTS:

In both cases, participants uncovered key areas of risk enabling them to take the necessary next steps. While the focus of this article is not the actual design solution, it is apparent that the risk assessment brought clarity to the situations resulting in prompt decision making about facility solutions.

CONCLUSIONS:

Hospitals are inherently risky environments; therefore, use of the formal risk assessment process, FMEA, is an opportunity for design professionals to apply more rigor to design decision making when facility solutions impact operations in high risk areas.
The Role of Water in the Transmission of Healthcare-Associated Infections: Opportunities for Intervention through the Environment
Authors: Denham Megan E. , Kasali Altug , Steinberg James P. , Cowan David Z. , Zimring Craig , Jacob Jesse T.
Published: February 2015

OBJECTIVE:

To assess and synthesize available evidence in the infection control and healthcare design literature on strategies using the built environment to reduce the transmission of pathogens in water that cause healthcare-associated infections (HAIs).

BACKGROUND:

Water can serve as a reservoir or source for pathogens, which can lead to the transmission of healthcare-associated infections (HAIs). Water systems harboring pathogens, such as Legionella and Pseudomonas spp., can also foster the growth of persistent biofilms, presenting a great health risk.

TOPICAL HEADINGS:

Strategies for interrupting the chain of transmission through the built environment can be proactive or reactive, and include three primary approaches: safe plumbing practices (maintaining optimal water temperature and pressure; eliminating dead ends), decontamination of water sources (inactivating or killing pathogens to prevent contamination), and selecting appropriate design elements (fixtures and materials that minimize the potential for contamination).

CONCLUSIONS:

Current evidence clearly identifying the environment's role in the chain of infection is limited by the variance in surveillance strategies and in the methods used to assess impact of these strategies. In order to optimize the built environment to serve as a tool for mitigating infection risk from waterborne pathogens—from selecting appropriate water features to maintaining the water system—multidisciplinary collaboration and planning is essential.
The Role of Facility Design in Preventing Healthcare-Associated Infection: Interventions, Conclusions, and Research Needs
Authors: Zimring Craig , Denham Megan E. , Jacob Jesse T. , Kamerow Douglas B. , Lenfestey Nancy , Hall Kendall K. , Kasali Altug , Cowan David Z. , Steinberg James P.
Published: February 2015

OBJECTIVE:

To summarize the findings and provide recommendations based on the multidisciplinary literature review and industry scan, focusing on the links between the built environment and healthcare-associated infections. To propose a research agenda in order to increase informed design decisions and advance the evidence base.

BACKGROUND:

The HAI-Design project explores the research linking a range of design interventions to healthcare-associated infection. The multidisciplinary team evaluated over 3,800 articles and conducted interviews with a range of stakeholders including CEOs, architects, designers, physicians and other healthcare experts, the results of which are featured in this special Supplement as topical papers.

TOPICAL HEADINGS:

The four topical papers describing the role of the built environment in the acquisition of healthcare-associated infections are summarized. The evidence evaluating the strategies for intervention through the built environment is analyzed, and a research agenda is proposed.

CONCLUSIONS:

While the evidence base supporting the efficacy of strategies and technologies continues to grow, there are currently few data that demonstrate a reduction in infection rates. The need for multidisciplinary collaboration and increased efforts to standardize the evaluation of environmental studies are essential to overcome the many challenges and improve the reliability of data
Challenging Research: Completing Participatory Social Research with Children and Adolescents in a Hospital Setting
Authors: Bishop Katherine
Published: February 2015

OBJECTIVE:

A discussion of the challenges to completing participatory social research with children and adolescents in a hospital setting.

BACKGROUND:

Beginning with the dominant medical culture of hospitals, coupled with a persistent skepticism of social and in particular qualitative research and its contribution to knowledge in medical circles, restrictive contextual challenges also include attitudinal, methodological, and logistical considerations. Together, these challenges hamper good participatory research practice and the capacity to maintain quality data, as well as impede children's participation in research, which has the capacity to contribute to healthcare design, policy, and planning processes.

METHODS:

Two studies in pediatric settings in Australia, one of which was completed in 2008 and the other which was discontinued in 2011, provide the basis for this research discussion. The discussion addresses the issues that persist in inhibiting the completion of participatory social research and the resulting impacts on research, children's right to participate, and the volume of evidence that is ultimately available from children's perspectives to support and inform healthcare design, planning, and policy in pediatric settings.

CONCLUSIONS:

Recommendations for changes that could strengthen and improve this research experience include building awareness of the potential value of this research; increasing its influence; building the capacity and knowledge of gatekeepers, ethics committees, and researchers working in this context; and recognizing and valuing children's competence and participation.
Patient Visibility and ICU Mortality: A Conceptual Replication
Authors: Lu Yi , Ossmann Michelle M. , Leaf David E. , Factor Philip H.
Published: February 2015

OBJECTIVE:

This study reanalyzes the data from a study by Leaf, Homel, and Factor (2010) titled “Relationship between ICU Design and Mortality” by adopting and developing objective visibility measures.

BACKGROUND:

Various studies attribute healthcare outcomes (patient falls, satisfaction) to a vague notion of patient room visibility. The study by Leaf and colleagues was the first to draw an independent association between patient mortality and patient room visibility, however “visibility” remains imprecise.

METHODS:

The original patient dataset was obtained from Dr. Leaf. The 664 patient sample assigned across 12 rooms at the medical ICU at Columbia University Medical Center was reanalyzed in terms of targeted visibility; the unit of analysis was the room, n = 12. Several computer-based visibility measures of patient rooms were used: patient head visibility, patient room visibility, and field of view to nursing station. Patient head visibility was defined as the percentage of area within the central nursing station from which the patient head could be seen; patient room visibility was defined as the percentage of area within the central nursing station that could see the patient room (average value of all patient room grids); field of view was defined as the maximum viewing angle from the patient head to the central nursing station.

RESULTS:

Among the sickest patients (those with Acute Physiology and Chronic Health Evaluation II > 30), field of view accounted for 33.5% of the variance in ICU mortality, p = 0.049

CONCLUSIONS:

Subtle differences in patient room visibility may have important effects on clinical outcomes.
Examination of How and Why Over-the-Bed Tables Are Used: Use Cases and Needs from Healthcare Providers
Authors: Manganelli Joe , Threatt Anthony , Brooks Johnell O. , Healy Stan , Merino Jessica , Yanik Paul , Walker Ian , Green Keith
Published: February 2015

OBJECTIVE:

This article presents the results of an exploratory study in which 14 clinical and staff subject matter experts (SMEs) at a regional rehabilitation hospital were interviewed in order to understand how and why over-the-bed tables are used.

BACKGROUND:

It is important to understand how and why a device or environment is used when designing it, and not just what features and functions are preferred. This knowledge is valuable both for contextualizing user feature and function preferences and for characterizing and prioritizing design challenges and opportunities.

METHODS:

Fourteen hospital clinical and support staff subject-matter experts participated in semi-structured interviews with scenario enactments in a medium-fidelity, full-scale mock-up of a typical patient room. During these interviews, they interacted with two personas played by actors and were asked to enact an example of a normal visit, from entering the room through treatment/service and then exiting. Data were analyzed via methodological triangulation including frequency analysis, content analysis, and affinity diagramming.

RESULTS:

The results include a use-case analysis with illustrative sketches, a list of needs statements, and final observations.

CONCLUSIONS:

Successfully using the over-the-bed table is dependent upon proper positioning, especially in bed during meals. There are fewer problems associated with over-the-bed table use while seated in a chair than when in the bed. The over-the-bed table is a key component in acute care, inpatient therapies. Clinicians are generally open to “smart” furniture in the patient room but question its cost-effectiveness, robustness, and flexibility.
Lessons Learned: Clinicians' Post-Occupancy Perspective of Facility Design Involvement
Authors: Reno Kathy , Okland Kathy , Finis Nanne , LaMantia Gina , Call Roger , Cardon Kerrie , Gerber Deborah , Zeigler Janet
Published: February 2015

OBJECTIVE:

The research was conducted to determine clinician knowledge needs for competent involvement with the facility design process as well as to gather lessons learned on building stronger design teams.

BACKGROUND:

As clinical stakeholders are invited to the healthcare facility design table, the question arises as to the ability of professionally diverse team members to translate each other's comments and ideas accurately. In the past, hospitals were designed by a handful of hospital leaders and architects. More recently, multiple players have become involved throughout the design and construction of new healthcare facilities. Clinical consultants from two international healthcare companies observed that many clinicians were unprepared to effectively translate their needs to the architectural community or to competently utilize architectural tools and documents.

METHODS:

A qualitative, post-occupancy cross-case study was conducted to understand how clinicians could increase their competencies for successful involvement in facility design. Focus group interviews were held with teams from healthcare facilities occupying their new facility for more than 6 months and less than 2 years.

RESULTS:

Curriculum topics were validated and additional areas recommended based on the interviews. Open-ended questioins on lessons learned provided several new dimensions to the research.

CONCLUSIONS:

Although validating the curriculum was the initial intent, the feedback from the focus groups on lessons learned provided rich concepts for practice implications and further research on post-occupancy.