Physical environment of stroke units : importance to health care

• Background: The physical environment is essential for health and well-being. Early rehabilitation is crucial for the person who has had a stroke to be able to regain knowledge and abilities lost as a result of the illness. There are few studies on how the design of the physical environment of a stroke unit can support patient ́ activities and care. Furthermore, the knowledge is limited as to how the physical environment impacts multi-professional teamwork in stroke units. Aim: The overall aim of this thesis was to generate knowledge about the physical environment of stroke units and the complex relationship between the design of the environment, the care and the user's experience of the physical environment. Method: The thesis was based on four studies. These studies had a descriptive and exploratory design. The case study as method was used throughout. In studies I, II and IV, structured observations were used to quantify the amount and nature of patients ́ activity, their location in a setting and the other people present. In studies I, II and IV, non-structured observations were also used. These aimed to explore support and obstacles in the physical environment for patients and the multidisciplinary team. For study III, a qualitative method was used which, with the help of interviews, aimed to study the patients’ experiences in terms of the physical environment. Results: Study I showed that in the new stroke unit, the patients spent more time alone in their rooms, were less active, and had fewer interactions than the patients in the original unit. Changes in the physical environment may have affected patient activity and interaction. Study II showed that the stroke units differed in terms of patient activity level and the proportion of the day that they were alone in their rooms. Patients had higher levels of activity in a stroke unit that had a combination of single and multiple bedrooms compared to a stroke unit with only single rooms. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients ́ activities and care. In study III, 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 the single rooms, the patients experienced loneliness and an absence of social community. The patients were positively distracted when they looked at nature or watched activities happening outside their windows. Study IV showed that the multidisciplinary team did not work together in their meetings with patients. Furthermore, the results demonstrated various supports and obstacles in terms of the physical environment that affected the team’s activities: for example, barriers in the form of a physically divided environment for the team. Conclusions: This thesis serves to contribute to an increased understanding and improved knowledge in terms of the physical environment of stroke units. In the case of evidence-based design of stroke units, it is central that this understanding and knowledge be used and that the physical environment is looked at in terms of how it can be a support for both the person who has had a stroke and the multidisciplinary team. The physical environment should be designed to reduce both inactivity and the experience of loneliness, and to contribute to the multidisciplinary team having suitable locations where members can work together.

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