bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acuity-Adaptable Nursing Care: Exploring Its Place in Designing the Future Patient Room
Authors: Kwan Melissa A. 
Published: February 2015

Aim: To substantiate the anticipated benefits of the original acuity-adaptable care delivery model as defined by innovator Ann Hendrich. Background: In today's conveyor belt approach to healthcare, upon admission and through discharge, patients are commonly transferred based on changing acuity needs. Wasted time and money and inefficiencies in hospital operations often result—in addition to jeopardizing patient safety. In the last decade, a handful of hospitals pioneered the implementation of the acuity-adaptable care delivery model. Built on the concept of eliminating patient transfers, the projected outcomes of acuity-adaptable units—decreased average lengths of stay, increased patient safety and satisfaction, and increased nurses' satisfaction from reduced walking distances—make a good case for a model patient room. Conclusion: Although some hospitals experienced the projected benefits of the acuity-adaptable care delivery model, sustaining the outcomes proved to be difficult; hence, the original definition of acuity-adaptable units has not fared well. Variations on the original concept demonstrate that eliminating patient transfers has not been completely abandoned in healthcare redesign and construction initiatives. Terms such as flex-up, flex-down, universal room, and single-stay unit have since emerged. These variations convolute the search for empirical evidence to support the anticipated benefits of the original concept. To determine the future of this concept and its variants, a significant amount of outcome data must be generated by piloting the concept in different hospital settings. As further refinements and adjustments to the concept emerge, the acuity-adaptable room may find a place in future hospitals.
Impact of Imaging Room Environment: Staff Job Stress and Satisfaction, Patient Satisfaction, and Willingness to Recommend
Authors: Quan Xiaobo , Joseph Anjali , Ensign Janet C. 
Published: February 2015

Background: The built environment significantly affects the healthcare experiences of patients and staff. Healthcare administrators and building designers face the opportunity and challenge of improving healthcare experience and satisfaction through better environmental design. Objective: The purpose of the study was to evaluate how a novel environmental intervention for imaging rooms, which integrated multiple elements of healing environments including positive distractions and personal control over environment, affects the perceptions and satisfactions of its primary users—patients and staff. Methods: Anonymous questionnaire surveys were conducted to compare patient and staff perceptions of the physical environment, satisfaction, and stress in two types of imaging rooms: imaging rooms with the intervention installed (intervention rooms) and traditionally designed rooms without the intervention (comparison rooms). Results: Imaging technologists and patients perceived the intervention rooms to be significantly more pleasant-looking. Patients in the intervention rooms reported significantly higher levels of environmental control and were significantly more willing to recommend the intervention rooms to others. Conclusions: The environmental intervention was effective in improving certain aspects of the imaging environment: pleasantness and environmental control. Further improvement of the imaging environment is needed to address problematic areas such as noise.
The Challenge of Innovation and the High-Performance Team
Authors: Tam David A. , Chessum Thomas , Leopold Jay 
Published: February 2015

Purpose: This paper describes the use of a high-performance team model in the leadership of a healthcare construction project with a vision of fostering innovation in the design and building process. This model facilitated the effective implementation of = Lean principles and a joint governance model combining stakeholders under a shared vision. Background: The healthcare facility discussed is a California healthcare district in San Diego. Because of state seismic safety legislation, the district elected to build a replacement hospital for its tertiary care trauma facility. The organization's leadership decided to pursue a course that demanded innovation in both the design and construction process. The owner, architects, construction manager, and trade contractors adopted a high-performance team model to meet this challenge. Conclusions and Recommendations: The governance and leadership of a construction project should reflect the design and ultimate intent of the facility. The vision of building the most innovative hospital under constrained resources required the implementation of an innovative approach to leading the construction process.
A Cottage Model for Eldercare
Authors: Thistleton William , Warmuth Jacqueline , Joseph Joanne M. 
Published: February 2015

Objective: An overview of medical, cognitive, and affective changes experienced by geriatric long-term care residents during a migration from traditional healthcare delivery to a cottage-based model. Background: New architectural models hold great promise for improving health and social outcomes for residents. New studies must explore the resident, family, and staff outcomes across transformations, as well as the business case for change. Methods: A longitudinal, quasi-experimental design was employed, with an emphasis on regularly acquired institutional data, including the Minimum Data Set, as well as commonly available survey instruments including the MOSES, the 2005 NSWHN, and Castle's Job Satisfaction Questionnaire. Descriptive statistics, McNemar's Exact Test, repeated measures ANOVA, and t-tests were used as well as narratives from families, staff, and management. Results: Staff perceived enhanced institutional respect ( t(72) = 2.38, p = 0.02) and work environment, and families perceived more staff cooperation and a better bond between staff and residents. No changes were discerned in a resident's prevalence of pain (odds ratio 0.43, p = .34, 95% CI [0.07, 1.88]), mobility (odds ratio 0.50, p =.19, 95% CI [0.17, 1.32]), range of motion(odds ratio 0.57, p = .55, 95% CI [0.12, 2.25]), or depression and anxiety (odds ratio 2.33, p =.11, 95% CI [0.84, 7.41]). A modest decline in residents' systolic ( t (101) = 3.74, p < .001) and diastolic ( t (101) = 2.870, p < .01) blood pressures was demonstrated. The rate at which a resident's Activities of Daily Living score declined was attenuated ( t (57) = 3.37, p <.001). Operational costs remained constant across the move. Conclusions: Cottage settings were aesthetically appealing to residents, family, and staff. Modest improvements in health outcomes were observed, and operational costs remained stable.
The Role of Flooring as a Design Element Affecting Patient and Healthcare Worker Safety
Authors: Harris Debra D. , Detke Laura A. 
Published: February 2015

OBJECTIVE: The objective of this study was to review, identify, and synthesize the literature on patient and healthcare worker safety related to flooring. The topic of flooring in the design of healthcare facilities is complex: healthcare associated infections, push/pull limitations, falls and fall injuries, and noise as a contributing factor to quality of care. BACKGROUND: Most hospitals have not been explicitly designed to enhance patient safety. Recommendations from the Agency for Healthcare Research and Quality (AHRQ) include preventing patient falls, reducing infections, and preventing medication errors as the areas of emphasis of evidence-based design to improve patient safety and quality of care. METHODS: A review of the literature was conducted through search engines using a predefined list of keywords to identify studies about flooring and the safety of patients and healthcare workers. Inclusion criteria included peer-reviewed theoretical and empirical studies published in English from 1982 to 2012. Final inclusion was obtained based on an analysis of research design. RESULTS: Of those 27 articles that met inclusion, 7 focused on healthcare associated infections; 9 focused on slips, trips and falls; 7 articles focused on noise; and 4 focused on fatigue. The studies are profiled in tables and organized by environmental variable. CONCLUSIONS: Though a limited number of studies met the criteria for this review, the evidence base is emerging to design for safety. Recommendations for future research and practical application of design are provided.
Clinic Exam Room Design: Present and Future
Authors: Freihoefer Kara , Nyberg Gary , Vickery Christine 
Published: February 2015

OBJECTIVE: This article aims to deconstruct various design qualities and strategies of clinic exam rooms, and discuss how they influence users' interaction and behavior in the space. Relevant literature supports the advantages and disadvantages of different design strategies. Annotated exam room prototypes illustrate the design qualities and strategies discussed. BACKGROUND: Advancements in technology and medicine, along with new legislative policies, are influencing the way care providers deliver care and ultimately clinic exam room designs. The patient-centered medical home model has encouraged primary care providers to make patients more active leaders of their health plan which will influence the overall functionality and configuration of clinic exam rooms. Specific design qualities discussed include overall size, location of doors and privacy curtains, positioning of exam tables, influence of technology in the consultation area, types of seating, and placement of sink and hand sanitizing dispensers. In addition, future trends of exam room prototypes are presented. CONCLUSIONS: There is a general lack of published evidence to support design professionals' design solutions for outpatient exam rooms. Future research should investigate such topics as the location of exam tables and privacy curtains as they relate to patient privacy; typical size and location of consultation table as it relates to patient connection and communication; and placement of sinks and sanitization dispensers as they relate to frequency and patterns of usage.
Color Perception in Pediatric Patient Room Design: American versus Korean Pediatric Patients
Authors: Park Jin Gyu “Phillip” , Park Changbae 
Published: February 2015

OBJECTIVE: This study simultaneously addresses the issues of the scarcity of information about pediatric patient color preferences, conflicting findings about the impact of culture on color preferences, and limitations of previous research instruments. Effects of culture and gender on color preferences were investigated using American and Korean pediatric patients. BACKGROUND: Much of the existing research in environmental design has focused on environments for healthy children and adults, but those findings cannot be confidently applied to environments for pediatric patients. In previous studies, the impact of culture on color preferences has been suggested, though the effects appear to vary. Moreover, the results of previous studies were typically based on perceptions of small color chips, which are different from seeing a color on wall surfaces. Previous studies also failed to control for confounding variables such as color attributes and light sources. METHODS: Instead of using color chips, this study used physical model simulation to investigate environmental color preferences in real contexts. RESULTS: Cultural difference was found in white. Other than white, no significant cultural difference was found. Gender differences were found across both of the groups. CONCLUSIONS: Korean pediatric patients showed significantly higher preference scores for white than Americans did. Other than white, both groups reported blue and green as their most preferred colors; white was the least preferred. Both groups reported similar gender effects. Overall, male patients reported significantly lower preference scores for red and purple than female patients did. These results can help healthcare providers and professionals better understand appropriate colors for pediatric populations.
Design for the Post-Antibiotic Era: Experiences from a New Building for Infectious Diseases in Malmö, Sweden
Authors: Holmdahl Torsten , Lanbeck Peter 
Published: February 2015

OBJECTIVE: To describe the experience of planning and designing a new facility for infectious diseases in Sweden and to discuss underlying theories relating to infection prevention and evidence-based design. BACKGROUND: Departments of Infectious Diseases are common in healthcare facililties in Sweden. In 2005, a decision was made to build a new facility. The program required spacious single rooms, with a high ventilation standard, and anterooms. METHODS: In this article we present an analysis of the future of infectious diseases. Underlying theories are discussed. We also describe how a program was outlined using literature studies, including evidence-based healthcare design, focus groups of staff, and study visits. RESULTS: Active involvement of users and infection control specialists was important in the building process. A full-scale patient room mock-up was built with ventilation, electrical, and other systems. The mock-up was cost effective because it avoided costly mistakes during the building process. The mock-up also was a place where staff could assess and begin adapting to their future work environment. Separate ventilation and separate entrances to patient rooms from the building exterior allowed placement of isolation units in the main hospital area. CONCLUSIONS: Antimicrobial resistance, emerging diseases, healthcare associated infections, and outbreaks highlight the need for infection control measures in all hospital design. Infection control should be integrated in all hospital planning and be part of contracts. In this study we describe a specialized unit where a high degree of standardization and flexibility has made it possible to have a unique standard of preparedness for the post-antibiotic era.
When the World Is Closing In: Effects of Perceived Room Brightness and Communicated Threat During Patient-Physician Interaction
Authors: Okken Vanessa , van Rompay Thomas , Pruyn Ad 
Published: February 2015

OBJECTIVE: The study proposes that room brightness creates impressions of a more spacious environment and that this perception positively impacts feelings and behaviors during high-threat conversations in particular. BACKGROUND: To a large extent healthcare providers depend on their patients' willingness to disclose information. In addition to characteristics related to the physician and topic of conversation, research indicates that environmental factors influence patients' affective experiences and self-disclosure. METHODS: A two-factor between-subjects experimental design was used in which participants ( n = 90) were presented with a scenario describing a patient–physician encounter varying in communicated threat. Subsequently, participants were exposed to a picture in which room brightness was manipulated. Next, patient comfort, experienced spaciousness, and self-disclosure intentions were measured. RESULTS: An effect of brightness was found on affective experiences and self-disclosure intentions. In addition, the predicted interaction was obtained between brightness and communicated threat on these measures. Analyses confirmed that perceived spaciousness mediates the relationship between room brightness and self-disclosure intentions. CONCLUSIONS: The study confirms that brightness impacts self-disclosure intentions. Additionally, this relationship is influenced by psychological circumstances, with a more pronounced need for spaciousness when in an anxious state of mind. The results suggest that the physical environment can be used as a tool to improve active participation. In addition, the results stress the importance of attending to the patient's state of mind in creating the right atmosphere.
Expert Opinions on the Role of Facility Design in the Acquisition and Prevention of Healthcare-Associated Infections
Authors: Lenfestey Nancy F. , Denham Megan E. , Hall Kendall K. , Kamerow Douglas B. 
Published: February 2015

OBJECTIVE: To assess expert knowledge, perceptions, and experience on the role of the built environment in the acquisition and transmission of healthcare-associated infections (HAIs), facility design decision-making considerations, and strategies for intervention through facility design and technologies. BACKGROUND: Healthcare-associated infections pose a serious and costly threat to public health in the United States. A growing evidence base suggests that the built environment can play a role in interrupting the chain of infection. METHODS: Semi-structured individual interviews and triads were conducted with 26 experts in hospital administration, architecture, interior design, infection control, and air and water quality. A grounded theory approach was used for interview coding and interpretation. RESULTS: Participants characterized the shift in thinking about the relationship between the built environment and HAI transmission as a “progression,” as accountability for infection prevention has expanded beyond clinicians. Organizational leaders aim to make informed design decisions, but this can be challenging due to the paucity of efficacy and return on investment data. Emerging interventions include copper impregnated materials, seamless flooring, and chilled beams. CONCLUSIONS: No single intervention is entirely effective in mitigating HAI risk; multiple interventions are needed. In addition to the built environment, human behavior must be considered, as noncompliance can render even the best designs ineffective. Increased multidisciplinary collaboration is needed to improve the application of evidence and experience in healthcare facility design. In the absence of conclusive evidence regarding interventions aimed at reducing HAI transmission, a combination of research data and practical experience should be used to inform design decisions.
The Role of the Hospital Environment in Preventing Healthcare-Associated Infections Caused by Pathogens Transmitted through the Air
Authors: Jacob Jesse T. , Kasali Altug , Steinberg James P. , Zimring Craig , Denham Megan E. 
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 the air that cause healthcare-associated infections (HAIs). BACKGROUND: Air can serve as a route for transmission of important HAI pathogens, including Mycobacterium tuberculosis and influenza, and may play a role for others typically transmitted by contact, including Staphylococcus aureus and Clostridium difficile. TOPICAL HEADINGS: Four primary interventions can be used interrupt the transmission of pathogens in air: ventilation, filtration, decontamination, and isolation. Many studies demonstrate that unidirectional airflows, when combined with very clean air and frequent air changes, reduce bacterial counts in the air, though mostly focused on the operating room. A high-efficiency particulate air filter removes almost all particles from the air and is used in protective environments such as the operating room, but little evidence supports its broader application. Ultraviolet germicidal radiation can augment the performance of heating, ventilation, and air conditioning systems. Isolation with negative pressure ventilation prevents spread of airborne pathogens such as tuberculosis. CONCLUSIONS: Current evidence is limited by the complexity of the interactions between pathogens and potential hosts, and in the methods used to assess impact of these strategies. Because the factors that affect transmission of the pathogens are complex and transcend disciplines, a collaborative approach among the key stakeholders in healthcare facility design should be actively pursued from planning to completion of construction and in rigorous research to best determine how design can reduce HAIs.
Space Allocation in the Award-Winning Adult ICUs of the Last Two Decades (1993–2012): An Exploratory Study
Authors: Rashid Mahbub 
Published: February 2015

OBJECTIVE: This exploratory study describes space allocation among different generic categories of functions in adult intensive care units (ICUs) showing how the amount of space of any one functional category is related to that of another functional category, and how different strategic choices, such as size, construction type, specialty type, and layout type, affect space allocation in these ICUs. BACKGROUND: Even though critical care practice has already undergone significant changes in the last few decades, it is still an evolving domain of medical practice. As a result, ICU design is also evolving as new regulatory standards, new technologies, and new clinical models are being introduced. A good understanding of the above issues regarding space allocation may help us better guide the evolution of ICU design. METHODS: The study includes a set of 25 adult ICUs that were recognized between 1993 and 2012 by the Society of Critical Care Medicine (SCCM), the American Association of Critical Care Nurses (AACCN), and the American Institute of Architects Academy of Architecture for Health (AIA AAH) for their efforts to promote healing of the critically ill and injured patients through the design of the critical care unit environment. RESULTS: The study finds notable differences in space allocation among different generic categories of functions between the ICUs of the first decade (1993–2002) and the second decade (2003–2012). The study also finds notable differences in space allocation among different generic categories of functions in relation to size, construction type, specialty type, and layout type. CONCLUSIONS: Despite several limitations, the study should help design better adult ICUs based on an evidence-based understanding of the relationships between space allocation and strategic choices.
A Comparative Evaluation of Swedish Intensive Care Patient Rooms
Authors: Apple Michael 
Published: February 2015

OBJECTIVE: This study investigates how design strategies in three recent intensive care units in Sweden impact patients, families, and staff. The area of focus is the patient room “module,” usually consisting of a pair of patient rooms and a joint location for monitoring and documentation. BACKGROUND: Many countries are expanding their number of intensive care beds and are also in the process of incorporating evidence-based design strategies such as single-bed patient rooms and access to daylight and nature. This situation provides a significant opportunity to review and learn from facilities leading the way in these areas. METHODS: Three intensive care units completed since 2010 were evaluated in relation to a combination of criteria. Methods included plan drawing analysis, staff questionnaires ( n = 72), staff interviews ( n = 9), and systematic observation (6 hours). RESULTS: In some patient rooms, access to daylight and/or outdoor views was excellent, while in other rooms such access was hindered by frosted glass or adjacent bushes or buildings. Single-bed rooms gave family members improved privacy and greater ability to stay in the patient room. Some patient room modules provided efficient patient observation and staff collaboration, but more noise and reduced patient privacy. Other modules provided a calm patient room environment, but caused some staff to feel isolated and have difficulty in getting assistance. CONCLUSIONS: The evaluation of the three projects reveals variation in whether design strategies successfully achieve their desired outcomes. Varying designs of the patient room module affect users in unique ways and must balance privacy, visibility, quietness, and staff access to assistance.