| 1. |
- Anåker, Anna, et al.
(author)
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A comparative study of patients' activities and interactions in a stroke unit before and after reconstruction-The significance of the built environment
- 2017
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203 .- 1932-6203. ; 12:7, s. Article no e0177477-
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Journal article (peer-reviewed)abstract
- Early mobilization and rehabilitation, multidisciplinary stroke expertise and comprehensive therapies are fundamental in a stroke unit. To achieve effective and safe stroke care, the physical environment in modern stroke units should facilitate the delivery of evidence-based care. Therefore, the purpose of this study was to explore patients' activities and interactions in a stroke unit before the reconstruction of the physical environment, while in a temporary location and after reconstruction. This case study examined a stroke unit as an integrated whole. The data were collected using a behavioral mapping technique at three different time points: in the original unit, in the temporary unit and in the new unit. A total of 59 patients were included. The analysis included field notes from observations of the physical environment and examples from planning and design documents. The findings indicated that in the new unit, the patients spent more time in their rooms, were less active, and had fewer interactions with staff and family than the patients in the original unit. The reconstruction involved a change from a primarily multi-bed room design to single-room accommodations. In the new unit, the patients' lounge was located in a far corner of the unit with a smaller entrance than the patients' lounge in the old unit, which was located at the end of a corridor with a noticeable entrance. Changes in the design of the stroke unit may have influenced the patients' activities and interactions. This study raises the question of how the physical environment should be designed in the future to facilitate the delivery of health care and improve outcomes for stroke patients. This research is based on a case study, and although the results should be interpreted with caution, we strongly recommend that environmental considerations be included in future stroke guidelines.
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| 2. |
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| 3. |
- Anåker, Anna
(author)
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Fysisk miljö på strokeenheter : betydelse för vården
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Bakgrund: Den fysiska miljön har betydelse för människors hälsa och välbefinnande. Rehabilitering som påbörjas på strokeenheter i ett tidigt skede, kan förbättra återhämtning och minska risken för funktionshinder. Hur den fysiska miljön på en strokeenhet ska vara utformad för att utgöra ett stöd för patientens aktiviteter och vård är i begränsad omfattning studerat. Vidare är kunskapen begränsad gällande hur utformningen av den fysiska miljön kan påverka det multidisciplinära teamets arbete på en strokeenhet.Syfte: Det övergripande syftet var att generera kunskap om den fysiska miljön på strokeenheter och den komplexa relationen mellan utformningen av miljön, vården och användarens erfarenhet av den fysiska miljön.Metod: Avhandlingen baserades på fyra delstudier. Delstudierna hade en beskrivande och explorativ design. Tre nybyggda strokeenheter studerades, varav en strokeenhet följdes från den ursprungliga, via den temporära till den nybyggda enheten. I delstudie I, II och IV användes strukturerade observationer för att dokumentera patientens aktivitetsnivå, det fysiska rummet för aktiviteten, samt vilken eller vilka personer som var med patienten i rummet. I delstudie I, II och IV användes även icke-strukturerade observationer. De icke-strukturerade observationerna syftade till att utforska stöd och hinder i den fysiska miljön för patienter och det multidisciplinära teamet. För delstudie III användes en kvalitativ metod som med hjälp av intervjuer syftade till att studera patienternas erfarenheter av den fysiska miljön.Resultat: Delstudie I visade att på den nybyggda strokeenheten tillbringade patienterna mer tid på sina rum, hade lägre aktivitetsnivå och hade färre interaktioner med personal och anhöriga, än på den gamla strokeenheten. Förändringar av den fysiska miljön kan ha påverkat patienternas aktiviteter och interaktioner. Delstudie II visade att strokeenheterna skilde sig åt gällande patienternas aktivitetsnivå och proportion av dagen som patienterna var ensamma på sina rum. Patienterna hade högre aktivitetsnivå på en strokeenhet med en kombination av enkelrum och flerbäddsrum jämfört med en strokeenhet med uteslutande enkelrum. En flexibel, lättorienterad och omväxlande miljö utgjorde ett stöd för vård och aktiviteter. I delstudie III framkom två teman: (i) inkongruens mellan gemenskap och avskildhet och (ii) förbindelse med världen utanför ger distraktion och en känsla av normaltillstånd. I enkelrummen upplevde patienterna ensamhet och en frånvaro av social gemenskap. Patienterna blev positivt distraherade när de tittade på natur eller på aktiviteter som fortgick utanför deras fönster. Delstudie IV visade att det multidisciplinära teamet inte arbetade tillsammans i mötet med patienten. Vidare framkom i resultatet olika stöd och hinder i den fysisk miljö som påverkade teamets aktiviteter, exempelvis hinder i form av en fysiskt uppdelad miljö för teamet.Konklusion: Denna avhandling har bidragit till att öka förståelsen och kunskapen om den fysiska miljön på strokeenheter. Att använda ett evidensbaserat kunskapsunderlag när det gäller planering och design av nya strokeenheter är centralt. Den fysiska miljön kan vara ett stöd både för den person som insjuknat i en stroke och för det multidisciplinära teamet. Den fysiska miljön bör utformas för att minska inaktiviteten och upplevelsen av ensamhet, samt bidra till att det multidisciplinära teamet har lämpliga lokaler där teamet kan arbeta tillsammans.
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| 4. |
- Anåker, Anna, et al.
(author)
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“It’s Lonely”: Patients’ Experiences of the Physical Environment at a Newly Built Stroke Unit
- 2019
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In: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 12:3, s. 141-152
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Journal article (peer-reviewed)abstract
- Objective: The aim of this study was to explore patients’ experiences of the physical environment at a newly built stroke unit. Background: For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients’ health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce. Method: This study used a qualitative design. Patients (n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis. Results: Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows. Conclusions: The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients’ experiences could be a starting point when designing new healthcare environments and inform evidence-based design.
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| 5. |
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| 6. |
- Anåker, Anna, et al.
(author)
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The physical environment and patients' activities and care. A comparative case study at three newly built stroke units
- 2018
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 74
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Journal article (peer-reviewed)abstract
- AIM: To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units.BACKGROUND: Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce.DESIGN: This work is a comparative descriptive case study.METHOD: Patients (N=55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioral mapping analyzed with descriptive statistics and field note taking analyzed with deductive content analysis. Data were collected from April 2013 - December 2015.RESULTS: The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care.CONCLUSIONS: Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment.
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| 7. |
- Eldh, Ann Catrine, et al.
(author)
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Supporting first-line managers in implementing oral care guidelines in nursing homes
- 2018
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In: Nordic Journal of Nursing Research. - : SAGE Publications. - 2057-1585 .- 2057-1593. ; 38:2, s. 87-95
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Journal article (peer-reviewed)abstract
- This study investigated first-line managers’ experience of and responses to a concise leadership intervention to facilitate the implementation of oral care clinical practice guidelines (CPGs) in nursing homes. Leadership is known to be an important element in knowledge implementation but little is known as to what supports managers to facilitate the process. By means of a process evaluation with mixed methods, the context and a three-month leadership program was explored, including activities during and in relation to the program, and the effects in terms of oral care CPG implementation plans. While the managers appreciated the intervention and considered improved oral care to be a priority, their implementation plans mainly focused the dissemination of an oral care checklist. The findings suggest that extended implementation interventions engaging both managers and clinical staff are needed, and that a concise intervention does not facilitate first-line managers to adopt behaviors known to facilitate knowledge implementation.
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| 8. |
- Elf, Marie, 1962-, et al.
(author)
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A study of relationships between content in documents from the health service operational plan and documents from the planning of new healthcare environments
- 2019
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In: Health Environments Research & Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 12:3, s. 107-118
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Journal article (peer-reviewed)abstract
- Aim: The aim was to investigate the content and quality of the governing documents created in the planning and design phase of new healthcare environments and in the related healthcare strategic and operational plans.Background: Quality deficits in buildings can often be traced back to the initial stages in the planning and design phase. Although, large investments have been made to improve the process of planning new healthcare environments and linking the requirements to health service strategies, healthcare organizations rarely relate their strategy goals to the built environment.Methods: A retrospective review of documents created in the planning and design stages of new healthcare environments and the operational plans of the target organizations was conducted.Results: The organizational operational plans did not contain any statements or information about the built environment or how a building could or should support the organization's goals. Important information was frequently absent from the documents governing the planning and design of buildings. The documents lacked information about what and how to follow-up and what to measure once a construction project had been completed. There were no references to evidence.Conclusions: Poor documentation might undermine the quality of the planning and design phase and ultimately the opportunity to create environments that support health outcomes. Therefore, more emphasis must be placed on the importance of documentation but above all to strengthen and clarify the relationship between the healthcare organization strategy to achieve an effective and efficient care process and the intention made in the planning and design process.
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| 9. |
- Elf, Marie, 1962, et al.
(author)
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A systematic review of the psychometric properties of instruments for assessing the quality of the physical environment in healthcare
- 2017
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 73:12, s. 2796-2816
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Journal article (peer-reviewed)abstract
- Aim. To identify instruments measuring the quality of the physical healthcare environment, describe their psychometric properties. Background. The physical healthcare environment is regarded as a quality factor for health care. To facilitate evidence-based design there is a need for valid and usable instruments that can evaluate the design of the healthcare environment. Data sources. A systematic literature search in Medline, CINAHL, Psychinfo, Avery index and reference lists of eligible papers (1990-2016). Review method. Consensus based standards for selection of health measurement instruments guidelines were used to evaluate psychometric data reported. Results. Twenty-three instruments were included. Most of the instruments are intended for healthcare environments related to the care of older people. Many of the instruments were old, lacked strong, contemporary theoretical foundations, varied in the extent to which they had been used in empirical studies and in the degree to which their validity and reliability had been evaluated. Conclusions. Although we found many instruments for measuring the quality of the physical healthcare environment, none met all of our criteria for robustness. Of the instruments, The Multiphasic environmental assessment procedure, The Professional environment assessment protocol and The therapeutic environment screening have been used and tested most frequently. The Perceived hospital quality indicators are user centred and combine aspects of the physical and social environment. The Sheffield care environment assessment matrix has potential as it is comprehensive developed using a theoretical framework that has the needs of older people at the centre. However, further psychometric and user-evaluation of the instrument is required.
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| 10. |
- Elf, Marie, 1962-, et al.
(author)
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The Swedish version of the Normalization Process Theory Measure S-NoMAD : translation, adaptation, and pilot testing
- 2018
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In: Implementation Science. - : Springer. - 1748-5908. ; 13:1
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Journal article (peer-reviewed)abstract
- BackgroundThe original British instrument the Normalization Process Theory Measure (NoMAD) is based on the four core constructs of the Normalization Process Theory: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring. They represent ways of thinking about implementation and are focused on how interventions can become part of everyday practice.AimTo translate and adapt the original NoMAD into the Swedish version S-NoMAD and to evaluate its psychometric properties based on a pilot test in a health care context including in-hospital, primary, and community care contexts.MethodsA systematic approach with a four-step process was utilized, including forward and backward translation and expert reviews for the test and improvement of content validity of the S-NoMAD in different stages of development. The final S-NoMAD version was then used for process evaluation in a pilot study aimed at the implementation of a new working method for individualized care planning. The pilot was executed in two hospitals, four health care centres, and two municipalities in a region in northern Sweden. The S-NoMAD pilot results were analysed for validity using confirmatory factor analysis, i.e. a one-factor model fitted for each of the four constructs of the S-NoMAD. Cronbach’s alpha was used to ascertain the internal consistency reliability.ResultsIn the pilot, S-NoMAD data were collected from 144 individuals who were different health care professionals or managers. The initial factor analysis model showed good fit for two of the constructs (Coherence and Cognitive Participation) and unsatisfactory fit for the remaining two (Collective Action and Reflexive Monitoring) based on three items. Deleting those items from the model yielded a good fit and good internal consistency (alphas between 0.78 and 0.83). However, the estimation of correlations between the factors showed that the factor Reflexive Monitoring was highly correlated (around 0.9) with the factors Coherence and Collective Action.ConclusionsThe results show initial satisfactory psychometric properties for the translation and first validation of the S-NoMAD. However, development of a highly valid and reliable instrument is an iterative process, requiring more extensive validation in various settings and populations. Thus, in order to establish the validity and reliability of the S-NoMAD, additional psychometric testing is needed.
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| 11. |
- Elke Miedema, Elke, et al.
(author)
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Health-promotive ambitions related to building design : The case of Angered Nearby Hospital
- 2017
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In: ARCH17. - 9788793585003 ; , s. 331-344
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Conference paper (peer-reviewed)abstract
- The potential of the built environment to mediate effects on patient and caregiver physical, cognitive and social health continues to be advocated. Evidence indicates that well-designed physical settings play an important role in making healthcare facilities safer and more healing for patients, and better working places for staff. Collaboration between researchers from varied disciplines is now adding to our understanding of the range of impacts on patient health and well-being. For instance, health architecture and interior designers are involving users of healthcare built environments in the design process using inclusive design or patient-centred care frameworks. Neuroscience researchers are exploring relationships between the environment and recovery from brain injury, often using a model of enriched environments. An overview of the range of theoretical frameworks used in empirical research to test built environment attributes is now warranted. In this paper, we present a mapping of the field showing the use of theories in built environment research. This would enable better selection of theoretical frameworks in order to evaluate the effect of specific design solutions on patient and care-giver health. Today, there are no comprehensive summaries of theories and conceptual frameworks applied in studies of healthcare architecture that could serve as a guide to future research. The aim of this scop- 378 ing review was to (i) identify theories and frameworks used in research of the physical environment in health care, (ii) describe their core constructs, assumptions, scientific utility, (iii) assess their applicability and feasibility for use in research. The basic principles of Arksey and O’Malley’s model of scoping review design were used to identify the theories and frameworks. 15 theories/frameworks were included and described in terms of general characteristics (purpose, country and year of development, discipline), core construct and applicability and feasibility.
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| 12. |
- Kylén, Maya, et al.
(author)
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The importance of the built environment in person-centred rehabilitation at home : study protocol
- 2019
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In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 16:13
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Journal article (peer-reviewed)abstract
- Health services will change dramatically as the prevalence of home healthcare increases. Only technologically advanced acute care will be performed in hospitals. This-along with the increased healthcare needs of people with long-term conditions such as stroke and the rising demand for services to be more person-centred-will place pressure on healthcare to consider quality across the continuum of care. Research indicates that planned discharge tailored to individual needs can reduce adverse events and promote competence in self-management. However, the environmental factors that may play a role in a patient's recovery process remain unexplored. This paper presents a protocol with the purpose to explore factors in the built environment that can facilitate/hinder a person-centred rehabilitation process in the home. The project uses a convergent parallel mixed-methods design, with ICF (International Classification of Functioning, Disability and Health) and person-environment theories as conceptual frameworks. Data will be collected during home visits 3 months after stroke onset. Medical records, questionnaires, interviews and observations will be used. Workshops will be held to identify what experts and users (patients, significant others, staff) consider important in the built environment. Data will be used to synthesise the contexts, mechanisms and outcomes that are important to support the rehabilitation process at home.
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| 13. |
- Kylén, Maya, et al.
(author)
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The importance of the built environment in person-centred stroke rehabilitation at home
- 2019
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In: The importance of the built environment in person-centred stroke rehabilitation at home.
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Conference paper (other academic/artistic)abstract
- Introduction: Health services will change dramatically as the prevalence of home healthcare increases. Only technologically advanced stroke acute care will be performed in hospitals. This, along with the rising demand for services to be more person-centred will place pressure on healthcare to consider quality across the continuum of care. Research indicates that planned discharge tailored to individual needs can reduce adverse events and promote competence in self-management. However, the environmental factors that may play a role in a patient’s recovery process remain unexplored. In this presentation, experiences and emerging findings from a research project targeting such issues will be presented. The purpose is to explore factors in the built environment that can facilitate/hinder a person-centred rehabilitation process in the home. Methods: The study uses a mixed methods design, with the ICF and person-environment theories as conceptual frameworks. Qualitative and quantitative data are currently collected from medical records and during home visits three months after stroke by use of questionnaires, interviews and observations. Workshops will be held to identify what experts and users (patients, significant others, staff) consider important in the built environment. Results: Emerging findings concerning the contexts and mechanisms that are important to support the rehabilitation process at home will be presented. Conclusions: Providing scientific knowledge that support patients’ recovery process in the home poses challenges for research that requires multidisciplinary knowledge. By bringing together international experts committed to improve care models and design, we will contribute to this under researched field and build capacity for the future.
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| 14. |
- Lawrence, Maggie, et al.
(author)
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Stroke secondary prevention, a non-surgical and non-pharmacological consensus definition: results of a Delphi study
- 2019
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In: BMC Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 12:1
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Evidence supporting lifestyle modification in vascular risk reduction is limited, drawn largely from primary prevention studies. To advance the evidence base for non-pharmacological and non-surgical stroke secondary prevention (SSP), empirical research is needed, informed by a consensus-derived definition of SSP. To date, no such definition has been published. We used Delphi methods to generate an evidence-based definition of non-pharmacological and non-surgical SSP. RESULTS: The 16 participants were members of INSsPiRE (International Network of Stroke Secondary Prevention Researchers), a multidisciplinary group of trialists, academics and clinicians. The Elicitation stage identified 49 key elements, grouped into 3 overarching domains: Risk factors, Education, and Theory before being subjected to iterative stages of elicitation, ranking, discussion, and anonymous voting. In the Action stage, following an experience-based engagement with key stakeholders, a consensus-derived definition, complementing current pharmacological and surgical SSP pathways, was finalised: Non-pharmacological and non-surgical stroke secondary prevention supports and improves long-term health and well-being in everyday life and reduces the risk of another stroke, by drawing from a spectrum of theoretically informed interventions and educational strategies. Interventions to self-manage modifiable lifestyle risk factors are contextualized and individualized to the capacities, needs, and personally meaningful priorities of individuals with stroke and their families.
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| 15. |
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| 16. |
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| 17. |
- Marcheschi, Elizabeth, 1980, et al.
(author)
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Development and test of a methodology for the investigation of stroke patients’ rehabilitation in home settings
- 2017
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In: European Healthcare Design 2017 - Research, policy and practice.
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Conference paper (peer-reviewed)abstract
- A transformation in the way that healthcare systems and nursing services are delivered to patients can be seen at national and international levels. In Sweden, one of the major challenges regards the transfer and effectiveness of services outside specialized hospital units 1. This is the case, for instance, of care and support provide to stroke patients, whom rehabilitation activities are no longer performed within stroke units, but often, occur in home settings 2.Positive outcomes of home-based nursing and treatments for stroke patients have been acknowledge across diverse disciplines and often have been associated with early support discharge (ESD) approaches. The beneficial effects of ESD are explained by means of investigation addressing the importance of, patients’ centrality and participation in the rehabilitation process, social interactions and atmosphere, treatments planning and coordination 3.The framework provide by the International Classification of Functioning suggests also the importance of considering the role played by the physical environment in supporting the individual functioning 4. However, at present, a paucity of knowledge regarding what physical aspects of home settings facilitate rehabilitation processes of stroke patients is found 5.The aim of the present work was thus, to reduce such knowledge gap by developing and testing a methodology that could advance our understanding about the interaction between the physical environment of home settings and patients with stroke experience of it. The individual experience of the environment was here conceptualized in line with knowledge from the field of environmental psychology, which entails information regarding emotional - cognitive responses and well-being related outcomes 6.
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| 18. |
- Marcheschi, Elizabeth, 1980, et al.
(author)
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Home setting after stroke, facilitators and barriers: a systematic literature review
- 2018
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In: Health and Social Care in the Community. - : Hindawi Limited. - 1365-2524 .- 0966-0410. ; 26:4, s. e451-e459
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Research review (peer-reviewed)abstract
- This paper seeks to improve the understanding of the interaction between patients with stroke and the physical environment in their home settings. Stroke care is increasingly performed in the patient’s home. Therefore, a systematic review was conducted to identify the existing knowledge about facilitators and barriers in the physical environment of home settings for the stroke rehabilitation process. Based upon Arksey and O’Malley’s framework, a Boolean search strategy was performed in the databases; CINAHL, Medline, Web of Science and Scopus. Fifteen articles were retained from the literature search conducted between August and November 2016, and two researchers independently assessed their quality based on the Swedish Council on Health Technology Assessment guidelines. The results suggest that despite the healthcare system’s ongoing shift towards home-based rehabilitation, the role played by the physical environment of home settings is still considered a side finding. Moreover, the research appears to focus mainly on how this environment supports mobility and activities of daily living, whereas information regarding the psychosocial and emotional processes that mediate the interaction between stroke survivors and their home setting are missing. A lack of information was also found with regard to the influence of different geographic locations on the stroke rehabilitation process. Future investigations are therefore needed to advance the understanding of the role played by the physical environment of home settings in supporting stroke recovery.
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| 19. |
- Marcheschi, Elizabeth, 1980, et al.
(author)
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The physical environment and its effect on health outcomes: a systematic review.
- 2019
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In: ARCH19 Proceedings.
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Conference paper (peer-reviewed)abstract
- Objective : The study aims to identify and review the latest existing knowledge about evidence- based design (EBD) for healthcare architecture and determine the extent to which such findings pertain to the overarching goals proposed by the Institute of Medicine (IOM). Background : There is increasing knowledge regarding influences of healthcare physical environments on health and well-being outcomes. The demand for more evidence has steadily grown, and systematic literature reviews have gained increased importance in the healthcare design field. Research question : A systematic literature review was performed according to the guidelines proposed by The Swedish Agency for Health Technology Assessment and Social Services Assessment. Specific aims included evaluating the current status of research relating to evidence-based healthcare architecture and determining the extent to which such evidence corresponds to the key goals established by the IOM. Methods : A systematic literature review with a Boolean search strategy was performed using the following databases: CINAHL, Medline, SCOPUS, Cochrane library, and Web of Science. The time period covered was 2010-2018. The reference lists of articles obtained from keyword searches were then examined to identify additional relevant studies. The articles retrieved have been screened for eligibility for inclusion, and the final retained articles have been evaluated with descriptive statistics to identify which IOM quality categories are addressed, what type of healthcare settings, physical environment intervention and target groups are investigated, and what types of research design and methodology have been implemented. Furthermore, two researchers are independently assessing the quality of the material retained. This data is part of an ongoing project therefore, preliminary results are reported. Results : A total of 4546 articles were retrieved and screened for eligibility for inclusion, resulting in 688 retained articles published since 2010. Of these 92 has been analyzed until now with descriptive statistics and results suggest that the most frequently cited IOM goals are related to health (84%) and safety (46%), person-centred approach (29%) and effectiveness of care (28%). Moreover, research has been performed across acute care and overall hospital settings (22 and 21%). Conclusion : The systematic literature review indicates that the body of knowledge relating to EBD is clearly growing, and the main focus is on design interventions to improve the health and safety of patients across acute care units. Lack of evidence are instead found in regard to other IOM aspects such as, equality of care and patients’ participation.
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| 20. |
- Marcheschi, Elizabeth, 1980, et al.
(author)
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To come home after a stroke: patients' early experiences of health and recovery in their home settings
- 2018
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Conference paper (other academic/artistic)abstract
- Healthcare systems and services for stroke patients are increasingly performed within home settings where both, people with moderate and severe disability can receive care. However, at present little knowledge is available in regard to early stroke phases and how the interaction with the physical environment of home settings might affect rehabilitation outcomes. The aim of this work was thus, to increase our understanding in regard to the interplay between home settings and people’s rehabilitation process, a month after stroke onset. A cross-sectional interdisciplinary investigation was conducted using validated measures in face-to-face interviews and by observing the participants’ interactions with their home settings. People with stroke (N = 16) that had a mild disability, and cognitive and communicative abilities to participate in an interview of approximately 2 hours, were recruited in the study and their data was collected within 4 to 7 weeks after stroke onset. Information was collected in regard to their experience of the physical and social home environment, their attachment to place, self-efficacy and the quality of continuity of care from the hospital to the home. Moreover, data about their recovery and overall health were collected with, Stroke Impact Scale and the EQ-5D. Preliminary results suggests the existence of a relation between recovery levels, self-efficacy and the perceived quality of the physical environment of home settings. More detailed results and their implication for early rehabilitation phases of stroke patients within home settings will be discussed.
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| 21. |
- McKee, Kevin, 1961-, et al.
(author)
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Developmentand initial validation of the Staff Perception Of Residential care Environments (SPORE) instrument
- 2019
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Conference paper (peer-reviewed)abstract
- Staff perceptions of the health care environment influence the delivery of person-centred care. Little research has examined staff perceptions of health care environments, in part because of a lack of validated instruments. This study reports the development and initial validation of the Staff Perception Of Residential care Environments (SPORE) instrument for use in residential care facilities for older people (RCFs).Items developed in a British project on the design of care environments were translated and adapted for the Swedish care context as SPORE (24 items, 5 sub-scales). In a study of the physical environment and quality of care, 200 staff recruited from 20 RCFs sampled from across Sweden completed a questionnaire containing SPORE, the Person-centred Care Assessment Tool (PCAT), the Person-centred Climate Questionnaire – staff version (PCQ-S), and the Sheffield Care Environment Assessment Matrix –Sweden (SCEAM-S).All SPORE sub-scales were normally distributed with good internal consistency reliability (Cronbach αs=.85-.88). Correlations between SPORE and PCAT sub-scales ranged from .301-.503, and between SPORE and PCQ-S sub-scales from .353-.557. RCF-level analyses (N=20) indicated that scores on SCEAM overall environment quality correlated significantly with all SPORE sub-scales (range=.496-.700). The SCEAM Comfort sub-scale was correlated with all SPORE sub-scales (range=.509-.721), while the SCEAM Privacy sub-scale was correlated (r=.428) with the SPORE Staff Facilities sub-scale. The SPORE Working and Caring for Residents sub-scale was correlated with SCEAM cognitive support (r=.502) and physical support (r=.566) sub-scales.The SPORE instrument demonstrated good psychometric properties and its sub-scales an excellent range of associations with staff perceptions of person-centred care and with objective assessments of the physical environment. Further validation is required, but the SPORE instrument has potential for understanding how staff perceptions of the RCF environment relate to the delivery of person-centred care.
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| 22. |
- Miedema, Elke, 1985, et al.
(author)
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Conceptualizing health promotion in relation to outpatient healthcare building design: a Scoping review
- 2019
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In: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 12:1, s. 69-86
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Research review (peer-reviewed)abstract
- Objective: This review explored different conceptualizations of health promotion in the context of, and in relation to, outpatient building design. Background: Today’s healthcare organizations are implementing holistic healthcare approaches such as health promotion, while simultaneously increasing their outpatient services. These health promotion approaches, focused on empowering people to take control of their health, are expected to have implications for the outpatient healthcare building design. Yet, there is limited knowledge on what these may be. A review of the literature on the current state of the art is thus needed to enable and support dialog on future healthcare building design. Method: A scoping review of 4506 papers, collected from 4 databases and 3 scientific journals in 2015, resulted in 15 papers relating health promotion to building design and outpatient healthcare. From the subsequent content analysis multiple common themes and subthemes emerged. Results: The review reveals diverse range of health promotion interpretations, three health promotion perspectives (health behavior, health equity and sense of coherence), associated design approaches, design objectives, health-related outcomes, building features and solutions. Conclusions: While diverse health promotion perspectives might merely represent variations in focus, these differences become problematic when relating to building design. To support further dialogs on development of health promotion in, and in relation to, the built environment, there is a need to strengthen the health promotion vocabulary. Further research is needed to compare different design approaches, and how these can be combined to minimize contradicting implications for building design.
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| 23. |
- Miedema, Elke, 1985, et al.
(author)
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Health promotion and the built environment - views from Swedish healthcare organisations
- 2019
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In: ARCH19 - BUILDING for BETTER HEALTH Book of abstracts.
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Conference paper (peer-reviewed)abstract
- Objective– The study examined the role and integration of the built environment in health promotion as perceived and described by representatives of Swedish health promotive healthcare organisations (HPHs). Background– A majority of Swedish healthcare organisations haveimplemented health promotion strategies in their plans and actions [1]. These HPHs engage in an ongoing reorientation from a disease focus to a health focus,which includes a person-centred approachthatconsiders people as active participants controlling their own health and care [2]. Swedish HPHs are supported by the Swedish HPHnetwork in introducing health promotion. The HPH network aims are guided by health promotion standards [3-6], which indicate the importance of creating health-promoting environments [4, 7]. These aims are confirmed in a letter of intent and membership contract. The aims are also expected to have implications for the planning of healthcare buildings [8]. However, knowledge of the relationship between HPH strategies and the built environment is limited [9, 10]. Additionally, health promotion, when used by building designers, often seems to be reduced to a focus on the enhancement of health [11]. To continue developing health promotion and fulfilling the intentions of the letter of intent as a driver for HPHs, it is important to understand and actively include the built environment in analysis, planning and design [12, 13]. Research question– How do Swedish HPH representatives perceive and describe the relationship between HPHs and the built environment? Methods– An explorative study including both qualitative and quantitative data was carried out. First, data were collected through a survey with county representatives of Swedish HPHs (n=17). Then,qualitative datawere obtained from interviews with the Swedish HPH network committee members. The combined data wereanalysed through descriptive statistics and content analysis. Results– The resultsshowed varied and limited perspectives on the relationship between the built environment and health promotion and diverse HPH intentions related to health equity, health, empowerment, population health, and preventive measures. The results indicated that the documentation meant to support HPHs was not used or well known. Surprisingly, representatives who worked on healthcare building projects did not necessarily consider the built environment to be related to design strategies or characteristics or to their health promotion work within the framework of their HPHs. Conclusion– The results indicate the need to recognise the diverse dimensions and interpretations of health promotion to be able to integrate the built environment in HPHs.
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| 24. |
- Miedema, Elke, 1985, et al.
(author)
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Health promotive ambitions related to building design – the case of Angered Nearby Hospital
- 2017
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In: ARCH 17 - 3rd international conference on architecture, research, care and health. ; 1 edition, s. 331-344
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Conference paper (peer-reviewed)abstract
- The healthcare system in Sweden is re-orienting and transforming to embrace a holistic perspective on health, which includes a focus on Health Promotion. This development has led to new ambitions and processes in healthcare and has thus changed the requirements for related building design. This explorative study, based on a content analysis of 9 semi-structured interviews with stakeholders involved in the planning and design process of Angered Nearby Hospital (Närsjukhus), investigates how the building design was influenced by Health Promotion ambitions. Questions focused on expectations and challenges for the new building. The results illustrate how Health Promotion was interpreted in the design process and how expectations were described, e.g., as a “welcoming environment” or “active environment”. It is found that the understanding of how to interpret Health Promotion in design is vague and performed without any guidelines other than at the policy level. This lack of clarity is also related to the difficulty of finding studies on the topic. The results also point to a need for clarification of how Health Promotion can be interpreted in design, the need for Health Promotion-related design guidelines, and the need for definitions of requirements at the project level to measure health-promotive effects.
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| 25. |
- Miedema, Elke, 1985, et al.
(author)
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Healthcare architecture for health and well-being From hospital to neighbourhood care (PROARCH)
- 2015
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Other publication (other academic/artistic)abstract
- Background: PROARCH will study how, and in what way, healthcare architecture can influence health-promotion. An understudied but highlighted e.g. by the International Network of Health Promoting Hospitals (HPH), initiated by the World Health Organization's (WHO). Health-promotion has been defined as the process of enabling people to increase control over their health and its determinants (WHO, 2005). Although resources have been allocated to prevent illness, such as health information and support for behavioural risk factors (Wilson, 2015), healthcare tends to primarily focus on treating diseases when they occur (Wilson, 2011). More up-stream and proactive solutions are wanted i.e. Identifying people at risk of illness and built in health-promotion in all policy interventions (Wilson, 2015). Aim: The overall aim is to explore how healthcare architecture can contribute to health and well-being in an outpatient healthcare context. The research-questions are: How can health-promoting architecture be defined and measured? How can new healthcare environments support health and well-being in the neighbourhood? A further aim is to identify the key factors of the architecture and how they interact with contextual factors in order to increase the understanding of how and what supports health promoting.Methods: PROARCH has started with a systematic review on how health-promotion architecture can be defined and measured. Further on, a full-scale study of Angered Nearby hospital in Sweden (finished 2015) is planned. Angered, outside of Gothenburg, is a part of the Swedish Million Programs with a weak socio-economic status. Data collection corresponds to mixed methods, with clinical outcomes and interviews, in addition to process and outcome data from non-participant observations and semi-structured interviews. The findings will be compared to the design intentions, developed in the planning process of the Angered Nearby hospital. The results will be used in a design project in which we will conduct experience based co-design in Angered.
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| 26. |
- Nordin, Susanna, et al.
(author)
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Exploring Environmental Variation in Residential Care Facilities for Older People
- 2017
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In: Health Environments Research and Design Journal. - : SAGE Publications. - 1937-5867 .- 2167-5112. ; 10:2, s. 49-65
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Journal article (peer-reviewed)abstract
- Objective: The aim of this study was to explore variation in environmental quality in Swedish residential care facilities (RCFs) using the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM). Background: Well-designed physical environments can positively impact on health and well-being among older persons with frail health living in RCFs and are essential for supporting person-centered care. However, the evidence base for informing the design of RCFs is weak, partly due to a lack of valid and reliable instruments that could provide important information on the environmental quality. Methods: Twenty RCFs were purposively sampled from several regions, varying in their building design, year of construction, size, and geographic location. The RCFs were assessed using S-SCEAM and the data were analyzed to examine variation in environmental quality between and within facilities. Results: There was substantial variation in the quality of the physical environment between and within RCFs, reflected in S-SCEAM scores related to specific facility locations and with regard to domains reflecting residents’ needs. In general, private apartments and dining areas had high S-SCEAM scores, while gardens had lower scores. Scores on the safety domain were high in the majority of RCFs, whereas scores for cognitive support and privacy were relatively low. Conclusions: Despite high building standard requirements, the substantial variations regarding environmental quality between and within RCFs indicate the potential for improvements to support the needs of older persons. We conclude that S-SCEAM is a sensitive and unique instrument representing a valuable contribution to evidence-based design that can support person-centered care.
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| 27. |
- Nordin, Susanna, et al.
(author)
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Staff perceptions of the design of care environments for older people – a qualitative study
- 2018
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Conference paper (peer-reviewed)abstract
- Staff perceptions of the design of care environments for older people – a qualitative studyBackground: Although research has shown the important role played by the physical care environment for residents and staff of residential care facilities (RCFs) for older people, few studies have taken the care staff perspective regarding how the environment influences their ability to provide high quality care. This paper considers care staff perceptions of older people’s RCFs.Methods: Twenty RCFs in Sweden were purposively sampled to obtain facilities with varying building design, type of ownership, year of construction, building size and geographic location. From each RCF, ten staff were randomly selected and recruited by the care home managers. Staff completed the Staff Perception of Older People’s Residential Care Environments (SPORE) questionnaire. Written responses to open-ended questions on the care environment were analysed using qualitative content analysis.Results: Several needs and deficiencies in the care environment were identified. The participants described problems with limited spaces and non-functional building design, and restricted access to outside areas. They also expressed the need for physical and cognitive support in the care environment such as handrails, hoists, adequate lighting and colour coding.Conclusions: There is potential for improving the design of RCFs for older people to provide safe and supportive care environments for residents and to facilitate care delivery, by taking the needs of the building users into account in future planning and design processes.
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| 28. |
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| 29. |
- Nordin, Susanna, et al.
(author)
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The association between the physical environment and the well-being of older people in residential care facilities: A multilevel analysis
- 2017
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 73:12, s. 2942-2952
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Journal article (peer-reviewed)abstract
- Aims: To investigate the associations between the quality of the physical environment and the psychological and social well-being of older people living in residential care facilities. Background: Many older people in care facilities have cognitive and physical frailties and are at risk of experiencing low levels of well-being. High-quality physical environments can support older people as frailty increases and promote their well-being. Although the importance of the physical environment for residents' well-being is recognized, more research is needed. Design: A cross-sectional survey of 20 care facilities from each of which 10 residents were sampled. As the individual resident data were nested in the facilities, a multilevel analysis was conducted. Methods: Data were collected during 2013 and 2014. The care facilities were purposely sampled to ensure a high level of variation in their physical characteristics. Residents' demographic and health data were collected via medical records and interviews. Residents' well-being and perceived quality of care were assessed via questionnaires and interviews. Environmental quality was assessed with a structured observational instrument. Results: Multilevel analysis indicated that cognitive support in the physical environment was associated with residents' social well-being, after controlling for independence and perceived care quality. However, no significant association was found between the physical environment and residents' psychological well-being. Conclusion: Our study demonstrates the role of the physical environment for enhancing the social well-being of frail older people. Professionals and practitioners involved in the design of care facilities have a responsibility to ensure that such facilities meet high-quality specifications.
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| 30. |
- Nordin, Susanna, et al.
(author)
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The importance of the physical environment to support individualised care
- 2018
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In: Individualized Care: Theory, Measurement, Research and Practice. - Cham : Springer International Publishing. - 9783319898995 - 9783319898988 ; , s. 207-215
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Book chapter (other academic/artistic)abstract
- The physical environment is an important part of individualised care. Creating care environments tailored towards the individual person’s needs is essential for high-quality care and is increasingly recognised as being associated with improved health and well-being among older people. Today, care should be holistic and view the person behind the disease, taking that person’s perspective and treating the patient as a unique individual. Despite the emerging focus on individualised care approaches, the physical environment is still not considered as an integral part of care, and relatively little attention has been paid to environmental aspects. However, the physical environment has a great potential to facilitate or restrict care processes in a broad range of care settings, not least in residential care facilities for older people. The present chapter focuses on ways to support the individual in terms of the physical environment.
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| 31. |
- Shannon, Michelle M., et al.
(author)
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Can the physical environment itself influence neurological patient activity?
- 2019
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In: Disability and Rehabilitation. - : Informa UK Limited. - 1464-5165 .- 0963-8288. ; 41:10, s. 1177-1189
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Journal article (peer-reviewed)abstract
- Purpose: To evaluate if a changed physical environment following redesign of a hospital ward influenced neurological patient physical and social activity. Methods: A “before and after” observational design was used that included 17 acute neurological patients pre-move (median age 77 (IQR 69–85) years Ward A and 20 post-move (median age 70 (IQR 57–81) years Ward B. Observations occurred for 1 day from 08.00–17.00 using Behavioral Mapping of patient physical and social activity, and location of that activity. Staff and ward policies remained unchanged throughout. An Environmental Description Checklist of each ward was also completed. Results: Behavioral Mapping was conducted pre-/post-move with a total of 801 Ward A and 918 Ward B observations. Environmental Description Checklists showed similarities in design features in both neurological wards with similar numbers of de-centralized nursing stations, however there were more single rooms and varied locations to congregate in Ward B (30% more single-patient rooms and separate allied health therapy room). Patients were alone >60% of time in both wards, although there was more in bed social activity in Ward A and more out of bed social activity in Ward B. There were low amounts of physical activity outside of patient rooms in both wards. Significantly more physical activity occurred in Ward B patient rooms (median = 47%, IQR 14–74%) compared to Ward A (median = 2% IQR 0–14%), Wilcoxon Rank Sum test z = −3.28, p = 0.001. Conclusions: Overall, patient social and physical activity was low, with little to no use of communal spaces. However we found more physical activity in patient rooms in the Ward B environment. Given the potential for patient activity to drive brain reorganization and repair, the physical environment should be considered an active factor in neurological rehabilitation and recovery.Implications for Rehabilitation Clinicians should include consideration of the impact of physical environment on physical and social activity of neurological patients when designing therapeutic rehabilitation environments. Despite architectural design intentions patient and social activity opportunities can be limited. Optimal neurological patient neuroplasticity and recovery requires sufficient environmental challenge, however current hospital environments for rehabilitation do not provide this.
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| 32. |
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| 33. |
- Udo, Camilla, et al.
(author)
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A qualitative study of assistant nurses’ experiences of palliative care in residential care
- 2018
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In: Nursing Open. - : Wiley. - 2054-1058. ; 5:4, s. 527-535
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Journal article (peer-reviewed)abstract
- AimTo explore assistant nurses' experiences and perceptions of both positive and negative aspects of providing palliative care for older people in residential care facilities.DesignA qualitative explorative study.MethodsCritical incidents were collected through semi‐structured face‐to‐face interviews and analysed by performing a qualitative content analysis.ResultsA total of 40 critical incidents from daily work was described by assistant nurses. The results showed that close cooperation between unlicensed and licensed professionals was crucial to provide good care but was sometimes negatively affected by the organizational structure. The availability of professionals was identified as a critical factor in providing good care at the end of life in a consultative organization. The most prominent findings were those that indicated that, especially in a consultative organization, there seems to be a need for clear roles, comprehensive and clear care plans and a solid support structure to ensure continuity of care.
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| 34. |
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| 35. |
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