Can an ICU-patient roompromote wellbeing and improve healthcare quality? (original) (raw)
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Australian Critical Care, 2021
Background: While the impact of the intensive care environment on patients' experiences and outcomes has been extensively studied, relatively little research has examined the impact on clinicians and their provision of care in the intensive care unit (ICU). Understanding staff experience and views about the environment is needed to optimise the ICU environment, patient outcomes and staff wellbeing. Objective: The objective of this study was to inform design of an optimised intensive care bedspace by describing clinicians' views about the current environment, including experience, impact on performance of clinical duties, and experience and outcomes of patients and family members. Methods: A pragmatic, qualitative descriptive study was conducted, with data collected in focus groups and interviews with 30 intensive care clinicians at a large cardiothoracic specialist hospital and analysed using the framework approach. Results: Participants acknowledged that the busy and noisy ICU provided a suboptimal healing environment for patients, was confronting for visiting families and exposed clinicians to risk of psychological injury. The bedspace, described as small and cluttered, hindered provision of clinical care of various kinds and contributed to an increased risk of staff physical injuries. Participants noted that the bland, sterile environment, devoid of natural light and views of the outside world, negatively affected both staff and patients' mood and motivation. Aware of the potential benefits of natural light, cognitive stimulation and visually appealing environments for patients and families, clinicians were frustrated by their inability to personalise the bedspace. Some participants, while acknowledging the importance of family contact for patients, were concerned about the impact of visitors on care delivery, particularly within already crowded bedspaces, suggesting restrictions on visiting. Conclusions: Intensive care clinicians perceive that the current intensive care environment is suboptimal for patients, their families and staff and may contribute to suboptimal patient outcomes. The intensive care bedspaces need to be redesigned to ensure they are built around the needs of the people using them. Optimisation is dependent on engaging all stakeholders in future design processes.
Associations between healthcare environment design and adverse events in intensive care unit
Nursing in Critical Care, 2020
BackgroundHealthcare environment can affect health. Adverse events (AEs) are common because rapid changes in the patients' status can suddenly arise, and have serious consequences, especially in intensive care. The relationship between the design of intensive care units (ICUs) and AEs has not been fully explored. Hence, an intensive care room was refurbished with cyclic lightning, sound absorbents and unique interior, and exterior design to promote health.AimsThe aim of this study was to evaluate the differences between a regular and a refurbished intensive care room in risk for AEs among critically ill patients.DesignThis study retrospectively evaluated associations of AEs and compared the incidence of AEs in patients who were assigned to a multidisciplinary ICU in a refurbished two‐bed patient room with patients in the control rooms between 2011 and 2018.MethodsThere were 1938 patients included in this study (1382 in control rooms; 556 in the intervention room). Descriptive st...
Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005–2020)
HERD: Health Environments Research & Design Journal, 2021
Background:The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005–2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge.Purpose and Aim:This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities.Method and Result:Each source reviewed was classified as one of the five types—opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays—and into nine content categories: nature engagement and outdoor v...
Intensive & critical care nursing, 2017
It has been known for centuries that environment in healthcare has an impact, but despite this, environment has been overshadowed by technological and medical progress, especially in intensive care. Evidence-based design is a concept concerning integrating knowledge from various research disciplines and its application to healing environments. The aim was to explore the experiences of nursing staff of working in an evidence-based designed ICU patient room. Interviews were carried out with eight critical care nurses and five assistant nurses and then subjected to qualitative content analysis. The experience of working in an evidence-based designed intensive care unit patient room was that the room stimulates alertness and promotes wellbeing in the nursing staff, fostering their caring activities but also that the interior design of the medical and technical equipment challenges nursing actions. The room explored in this study had been rebuilt in order to create and evaluate a healing...
HERD, 2018
To identify family members' and visitors' needs with relation to the design of a hospital room. There is a trend toward incorporating family zones in hospital patient rooms in order to improve patient satisfaction and encourage family caregivers to stay longer and overnight. A mixed-method study was employed. Interviews of patients and family caregivers were conducted to understand opportunities to improve hospital room designs based on recent experiences. Features intended to support short-term and overnight visitors were embedded in five full-scale simulated room design concepts. Small groups of family caregivers and patients toured two room design concepts and reacted real time to room features. A grounded theory approach was employed to identify emerging themes. A theoretical design framework is developed for the needs of family members and visitors for a range of time periods. This framework is founded upon desires to help make the patient feel more comfortable. There a...
Concord, CA: The Center …, 2004
outcomes. The team found scientific studies that document the impact of a range of design characteristics, such as single-rooms versus multi-bed rooms, reduced noise, improved lighting, better ventilation, better ergonomic designs, supportive workplaces and improved layout that can help reduce errors, reduce stress, improve sleep, reduce pain and drugs, and improve other outcomes. The team discovered that, not only is there a very large body of evidence to guide hospital design, but a very strong one. A growing scientific literature is confirming that the conventional ways that hospitals are designed contributes to stress and danger, or more positively, that this level of risk and stress is unnecessary: improved physical settings can be an important tool in making hospitals safer, more healing, and better places to work.
The Environmental Services Perspective on Hospital Room Design: A Mixed-Methods Approach
Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare, 2017
Our aim is to enhance the safety and efficiency of all healthcare staff by designing patient rooms that meet the physical and cognitive needs of those providing direct and indirect patient care in hospital settings. A mixed-methods study was employed, where findings were compiled from twenty-six environmental services personnel across study activities. The insights were grouped into six categories of challenges with the design of hospital rooms in acute care settings: room cleaning, bathroom, room size, furniture, communication, and a miscellaneous 'other' category. There are design implications for storage, room design features, locations of room items, and fabrics and finishes.
Design indicators for better accommodation environments in hospitals: Inpatients’ perceptions
Intelligent Buildings International, 2012
Several studies have found an association between the physical environment and human health and wellbeing that resulted in the postulation of the idea of evidence-based and patient-centred design of healthcare facilities. The key challenge is that most of the underpinning research for the evidence base is context specific, the use of which in building design is complex, mainly because of the difficulties associated with the disaggregation of findings from the context. On the other hand, integrating patients' perspectives requires an understanding of the relative importance of design indicators, which the existing evidence base lacks to a large extent. This research was aimed at overcoming these limitations by investigating users' perception of the importance of key design indicators in enhancing their accommodation environments in hospitals. A 19-item structured questionnaire was used to gather inpatients' views on a 5-point scale, in two Chinese hospitals. A principal component analysis (PCA) resulted in five constructed dimensions with appropriate reliability and validity (Cronbach's alpha=0.888). The item, design for cleanliness, was ranked as most important, closely followed by environmental and safety design indicators. The item, entertainment facilities, was ranked lowest. The indicator, pleasant exterior view had the second lowest mean score, followed by the item, ability to customise the space. Age, accommodation type and previous experience of hospitalisation accounted for statistically significant differences in perceptions of importance of various constructed design dimensions.