bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
Can Better Outdoor Environments Lead to Cost Benefits in Assisted Living Facilities through Increased Word-of-Mouth Referrals?
Authors: Rodiek Susan , Boggess May M. , Lee Chanam , Booth Geoffrey J. , Morris Alisan 
Published: February 2015

Objective: This study explores how better outdoor environments may produce cost benefits for assisted living providers by raising occupancy levels through increased resident satisfaction and word-of-mouth referrals. Background: Older adults who spend even minimal time outdoors may reap substantial health benefits. However, many existing outdoor areas in assisted living facilities are reportedly underutilized, in part because of design issues. Providers may be more willing to improve outdoor areas if they produce cost benefits for provider organizations. Methods: This study used data from a recent assisted living survey to assess the relationship between satisfaction with outdoor spaces, time spent outdoors, and resulting improvements in mood. A financial analysis was developed to estimate potential benefits from improved outdoor areas attributable to increased occupancy and decreased marketing costs associated with increased word-of-mouth referrals. Results: Increasing resident satisfaction with outdoor areas (from approximately 29% to 96%) results in residents spending more time outdoors (increase of 1 1/2 hours per week per resident) and improved psychological well-being (12% increase in feeling better). This greater overall satisfaction leads to 8% more residents willing to refer potential residents to their community. Because word-of-mouth referrals by current residents are a major factor in resident recruitment, improving outdoors areas leads to an estimated 4% increase in new residents, resulting in over $170,000 of increased revenue per year for a community of 100 residents. Conclusions: Improved outdoor space can provide substantial cost benefits for assisted living providers. Increasing resident well-being and satisfaction, and thereby generating additional word-of-mouth referrals, can result in higher occupancy levels.
The Design and Testing of Interactive Hospital Spaces to Meet the Needs of Waiting Children
Authors: Biddiss Elaine , McPherson Amy , Shea Geoffrey , McKeever Patricia 
Published: February 2015

OBJECTIVE: To design an innovative interactive media display in a pediatric hospital clinic waiting space that addresses the growing demand for accessible, contact-surface-free options for play. BACKGROUND: In healthcare settings, waiting can be anxiety provoking for children and their accompanying family members. Opportunities for positive distraction have been shown to reduce waiting anxiety, leading to positive health outcomes. METHODS: An interactive media display, ScreenPlay, was created and evaluated using a participatory design approach and a combination of techniques including quality function deployment and mixed data elicitation methods (questionnaires, focus groups, and observations). The user and organizational design requirements were established and used to review contemporary strategies for positive distraction in healthcare waiting spaces and to conceptualize and test ScreenPlay. Ten staff members, 11 children/youths, and 6 parents participated in the design and evaluation of ScreenPlay. RESULTS: ScreenPlay provided a positive, engaging experience without the use of contact surfaces through which infections can be spread. It was accessible to children, youth, and adults of all motor abilities. All participants strongly agreed that the interactive media display would improve the healthcare waiting experience. CONCLUSIONS: ScreenPlay is an interactive display that is the result of a successful model for the design of healthcare waiting spaces that is collaborative, interdisciplinary, and responsive to the needs of its community.
Advancing Translational Research through Facility Design in Non-AMC Hospitals
Authors: Pati Debajyoti , Pietrzak Michael P. , Harvey Thomas E. , Armstrong Walter B. , Clarke Robert , Weissman Neil J. , Rapp Paul E. , Smith Mark S. , Fairbanks Rollin J. , Collins Jeffrey M.G. 
Published: February 2015

OBJECTIVE: This article aims to explore the future of translational research and its physical design implications for community hospitals and hospitals not attached to large centralized research platforms. BACKGROUND: With a shift in medical services delivery focus to community wellness, continuum of care, and comparative effectiveness research, healthcare research will witness increasing pressure to include community-based practitioners. METHODS: The roundtable discussion group, comprising 14 invited experts from 10 institutions representing the fields of biomedical research, research administration, facility planning and design, facility management, finance, and environmental design research, examined the issue in a structured manner. The discussion was conducted at the Washington Hospital Center, MedStar Health, Washington, D.C. CONCLUSIONS: Institutions outside the AMCs will be increasingly targeted for future research. Three factors are crucial for successful research in non-AMC hospitals: operational culture, financial culture, and information culture. An operating culture geared towards creation, preservation, and protection of spaces needed for research; creative management of spaces for financial accountability; and a flexible information infrastructure at the system level that enables complete link of key programmatic areas to academic IT research infrastructure are critical to success of research endeavors.
Environmental Affordances: Designing for Family Presence and Involvement in Patient Care
Authors: Choi Young-Seon , Bosch Sheila J. 
Published: February 2015

OBJECTIVE: This comparative study in two ICUs examines the impact of the patient-centered unit design on family involvement, operationalized as percentages of family presence and family–patient/family–staff interaction in patient rooms. BACKGROUND: As hospitals have become more patient-centered, there has been a trend toward including a family area inside the patient area to promote family presence, support, and involvement in patient care. There is growing evidence that family members play an important role in supporting patient care, and that the physical environment affects family involvement. However, few empirical studies have attempted to show the effectiveness of the patient-centered design on family members' presence and their behavior. METHODS: This study compared the degree of family presence and family–patient and family–staff interactions in two intensive care units (ICUs) with different physical environmental conditions, but housing patients of similar acuity and disease type. RESULTS: The analysis identified a significant difference in family presence in patient rooms ( t = −2.176; df = 79.0; p = 0.03) between the traditional and the patient-centered units. Patients in the family-centered care unit ( M = 37.77; SD = 34.02) spent significantly more time with their family members in patient rooms than did patients in the traditional unit ( M = 23.89; SD = 21.90). Patient-related variables other than unit design had no significant impact on family presence and interactions. CONCLUSIONS: Findings demonstrated that the patient-centered unit (5K) was associated with increased family presence in the patient rooms and increased family interaction with patients, when compared with the traditionally designed unit.
Barriers to Garden Visitation in Children's Hospitals
Authors: Pasha Samira 
Published: February 2015

OBJECTIVE: This study aimed to identify barriers to use of outdoor spaces in Texas pediatric healthcare facilities. BACKGROUND: Available research on hospital healing gardens and outdoor spaces has indicated that despite several health benefits of garden visitation for staff, patients, and family members, these amenities are not being used to their fullest capacity. Previous researchers have recommended design features such as comfortable seats and adequate shade to increase garden visitation in healthcare setting. However no quantitative data have demonstrated significance of correlation between presence of these design features and garden use. The present study served to statistically support design guidelines suggested by previous researchers and introduce new guidelines. METHODS: Site visits and surveys were conducted in five green outdoor spaces in three pediatric hospitals in east Texas. Hospital visitors, family members, and staff responded to questions concerning barriers to garden visitation, their visitation habits, and satisfaction with the garden features. The study was reviewed and approved by Institutional Review Boards of the relevant hospitals and academic institutions. RESULTS: A negative significant correlation was found between staff garden use and dissatisfaction with quality of seats and poor shade. While quality of seats didn't impact visitor and family member garden visitation, a significant negative correlation was found between poor shade and their garden use. CONCLUSIONS: The study served to statistically support previous design suggestions for hospital gardens, and introduced new design guidelines. Design recommendations include functionality, visibility, accessibility, exclusivity, and availability of shade and seats.