The Role of Theory in Furthering Evidence-Based Practice:

This issue of HERD presents a fascinating array of research ranging from the development of substantive findings, to measurement development, to meta-analysis. All of these research purposes are exceptionally important for the development of a robust research base for evidence-based design. In these articles, the authors note the limitations of their work in regard to generalizability, measurement problems, and so forth, all of which remain symptomatic of much research in this domain. Simultaneously, the studies reflect a willingness to push the domain ahead, whether in terms of research strategy (e.g., retrospective data analysis or meta-analysis) or instrument development. There is much to learn from this collection of articles; a brief discussion of each follows.Brooks and colleagues conducted a two-part, highly exploratory pilot study regarding the design of nightstands. The first study involved 28 participants in assisted living or rehabilitation settings who were interviewed in regard to their use and perceptions of nightstands. The second study involved interviews of 36 university students and 36 older adults regarding perceptions of a "smart" design for a nightstand or side table. One should be circumspect about drawing conclusions from such an exploratory study because of sample size, problems of construct validity, and issues associated with research design.Lorenz and Dreher conducted a retrospective study that compared private and shared hospital rooms with regard to the occurrence of falls, hospital-acquired infection (HAI) rates, and risk for social isolation. Unfortunately the sample was extremely small (five falls in 166 patients; nine occurrences of HAI); thus, empirical conclusions in the study should be considered with caution. The authors acknowledge this limitation.Foureur and colleagues provide an update on the ongoing development of the Birth Unit Design Spatial Evaluation Tool (BUDSET), designed to assess the optimality of birth settings. The intriguing conceptual model underlying the development of this tool posits that optimal birth settings both facilitate effective communication and decrease patient and staff stress, which are mediated by the design of the birth unit as well as the model of care employed. The authors identify four critical spatial domains for birthing units: responses to the "fear cascade," and facility characteristics, aesthetics, and support. Each of these is manifested by multiple characteristics, which are assessed through specific observable phenomena. The tool could discriminate between labor ward settings and birth centers, but the internal validity of half of the characteristics was unacceptable, suggesting the need for significant refinement of the tool.Algase and colleagues report on a cross-sectional observational study that compares two approaches to assessing the experiential attribute of crowding in long-term care settings. Crowding was assessed in two ways: first, by a simple count of people present in the room or area being observed; second, by means of the Long-Term Care Crowding Index (LTC-CI) developed by the authors. This study highlights different levels of crowding between nursing homes and assisted living facilities as well as variations between types of room and time of day. The LTC-CI advances the body of knowledge by attempting to account for density and to identify the role proximity plays in the assessment of crowding.Marquardt's contribution is a meta-analysis of the literature on spatial wayfinding for people with dementia. This extensive literature review makes clear a tangible connection between neuroscience and architectural design by suggesting that the optimization of spatial configuration and environmental cueing affects the orientation processes of people with dementia. Marquardt determines that limiting choice points, making environmental amenities visually accessible, and reinforcing wayfinding through appropriate environmental cues and signage are likely to provide a more supportive wayfinding environment. …