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A room designed for caring: Experiences from an evidence-based designed intensive care environment
University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this doctoral thesis was to examine and evaluate if and how an intensive care unit (ICU) room, which had been designed using the principles of evidence-based design (EBD), impacted the safety, wellbeing and caring for patients, their family members and staff.

Methods: Paper I explored the nursing staff experiences of working in an EBD intensive care patient room through 13 interviews that were analysed by qualitative content analysis. Paper II focussed on the meaning of caring and nursing activities performed in two patient rooms—one EBD refurbished and one standard. Ten non-participant observations were conducted, which were followed by interviews. The data were analysed using a phenomenological hermeneutical approach. Paper III evaluated the relationship between a refurbished intensive care room and adverse events (AE) in critically ill patients. A total of 1,938 patients’ records were included in the analysis. Descriptive statistics and binary logistic regressions were conducted. Paper IV studied visitors’ (N = 99) experiences of different healthcare environmental designs of intensive care patient rooms through questionnaires. Descriptive statistics and linear regressions were conducted for the analysis.

Main results: The refurbished intervention room was reported as a positive experience for the working nursing staff and the visiting family members. The nursing staff additionally indicated the intervention room strengthened their own wellbeing as well as their caring activities. Although there were no observed, objective differences regarding the caring and nursing activities due to the different environments, the differences were instead interpreted as being due to different developed nursing competencies. The visitors reported the enriched healthcare environment to have a higher everydayness and a feeling that it was a safer place compared to the control rooms. The findings revealed a low incident of AEs in both the intervention room as well as in the control rooms, lower than previous described in literature. The likelihood for adverse events were not significantly lower in the intervention room compared to the control rooms.

Conclusion: This dissertation contributed to the existing knowledge on how a refurbished patient room in the ICU was experienced by nursing staff and visiting family members. The dissertation also showed the complexity of conducting interventional research in high-tech environments. The new knowledge on the importance of the healthcare environment on wellbeing, safety and caring must be considered by stakeholders and decision-makers and implemented to reduce suffering and increase health and wellbeing among patients, their families and staff.

Place, publisher, year, edition, pages
Borås: Högskolan i Borås, 2020.
Series
Skrifter från Högskolan i Borås, ISSN 0280-381X ; 106
Keywords [en]
intensive care units, critical care, caring, hospital design and construction, evidence-based facility design, built environment, health facility environment, patient rooms, critical illness, patients, family, nurses
National Category
Nursing
Research subject
Människan i vården
Identifiers
URN: urn:nbn:se:hb:diva-23183ISBN: 978-91-88838-74-2 (print)ISBN: 978-91-88838-75-9 (electronic)OAI: oai:DiVA.org:hb-23183DiVA, id: diva2:1429068
Public defence
2020-06-11, M 404, Sandgärdet, Järnvägsgatan 5, Borås, 09:00 (Swedish)
Opponent
Note

Disputationen sänds via videolänk, för information se kalendariet på hb.se/forskning

Available from: 2020-05-20 Created: 2020-05-07 Last updated: 2020-05-20Bibliographically approved
List of papers
1. Nursing staff's experiences of working in an evidence-based designed ICU patient room-An interview study.
Open this publication in new window or tab >>Nursing staff's experiences of working in an evidence-based designed ICU patient room-An interview study.
2017 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, article id S0964-3397(17)30057-5Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: 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.

OBJECTIVE: The aim was to explore the experiences of nursing staff of working in an evidence-based designed ICU patient room.

METHOD: Interviews were carried out with eight critical care nurses and five assistant nurses and then subjected to qualitative content analysis.

FINDINGS: 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.

CONCLUSIONS: The room explored in this study had been rebuilt in order to create and evaluate a healing environment. This study showed that the new environment had a great impact on the caring staffs' wellbeing and their caring behaviour. At a time when turnover in nurses is high and sick leave is increasing, these findings show the importance of interior design of intensive care units.

Keywords
Hospital design and construction, Intensive care units, Interior design and furnishings, Nursing staff, Qualitative research
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-12871 (URN)10.1016/j.iccn.2017.05.004 (DOI)000417132800012 ()28595825 (PubMedID)2-s2.0-85020229055 (Scopus ID)
Available from: 2017-10-16 Created: 2017-10-16 Last updated: 2020-05-20Bibliographically approved
2. Room Design - A Phenomenological-Hermeneutical Study: A Factor in Creating a Caring Environment.
Open this publication in new window or tab >>Room Design - A Phenomenological-Hermeneutical Study: A Factor in Creating a Caring Environment.
2019 (English)In: Critical Care Nursing Quarterly, ISSN 0887-9303, E-ISSN 1550-5111, Vol. 42, no 3, p. 265-277, article id 31135477Article in journal (Refereed) Published
Abstract [en]

Medical technology has progressed tremendously over the last few decades, but the same development cannot be seen in the design of these intensive care unit environments. Authors report results of a study of evidence-based room design, emphasizing the impact on conveying a caring attitude to patients. Ten nonparticipant observations were conducted in patient rooms with 2 different designs, followed by interviews. The data were analyzed using a phenomenological-hermeneutical approach. The results did not reveal that it was obvious that redesigned spaces resulted in a more caring attitude. The meanings of caring displayed during nursing activities were interpreted by interpreting gazes. Some of the nursing staff had an instrumental gaze, interpreted as caring with a task-orientated approach, while others communicated their caring with an attentive and attuned gaze, where the needs of the patients regulated the working shift. The study findings indicated that caring may not be perceived when nurses use a task-oriented approach. However, when nurses practice a person-centered approach, using an attentive and attuned gaze, caring is conveyed. Caring in intensive care contexts needs to be assisted by a supportive environment design that cultivates the caring approach.

Place, publisher, year, edition, pages
USA: Wolters Kluwer, 2019
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-21134 (URN)10.1097/CNQ.0000000000000267 (DOI)2-s2.0-85066944981 (Scopus ID)
Funder
Swedish Research Council, 521-2013-969
Available from: 2019-05-31 Created: 2019-05-31 Last updated: 2020-05-20Bibliographically approved
3. Associations between healthcare environment design and adverse events in intensive care unit
Open this publication in new window or tab >>Associations between healthcare environment design and adverse events in intensive care unit
2020 (English)In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153Article in journal (Refereed) Published
Abstract [en]

Background: Healthcare 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.

Aims: The 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.

Design: This 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.

Methods: There were 1938 patients included in this study (1382 in control rooms; 556 in the intervention room). Descriptive statistics were used to present the experi-enced AEs. Binary logistic regressions were conducted to estimate the relationship between the intervention/control rooms and variables concerning AEs. Statistical significance was set at P < 0.05.

Results: For the frequency of AEs, there were no significant differences between the intervention room and the control rooms (10.6% vs 11%, respectively, P < 0.805). No findings indicated the intervention room (the refurbished room) had a significant influence on decreasing the number of experienced AEs in critically ill patients.

Conclusions: The findings revealed a low incident of AEs in both the intervention room as well as in the control rooms, lower than previously described. However, our study did not find any decreases in the AEs due to the design of the rooms.

Relevance to clinical practice: Further research is needed to determine the relation-ship between the physical environment and AEs in critically ill patients.

Keywords
complex interventions, critical care nursing, intensive care, quantitative research, research
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-23220 (URN)10.1111/nicc.12513 (DOI)32395862 (PubMedID)
Funder
Swedish Research Council, 521‐2013‐969
Available from: 2020-05-20 Created: 2020-05-20 Last updated: 2020-05-20
4. Visitor’s Experiences of an Evidence-Based Designed Healthcare Environment in an ICU
Open this publication in new window or tab >>Visitor’s Experiences of an Evidence-Based Designed Healthcare Environment in an ICU
(English)In: Article in journal (Refereed) Submitted
Abstract [en]

Objectives: The objective of the research was to study the visitors’ experiences of different healthcare environment designs of intensive care unit (ICU) patient rooms. 

Background: The healthcare environment may seem frightening and overwhelming in times when life-threatening conditions affect a family member or close friend and individuals visit the patient in an ICU. A two-bed patient room was refurbished to enhance the wellbeing of patients and their families according to the principles of evidence-based design (EBD). No prior research has used the Person-centred Climate Questionnaire—Family Version (PCQ-F) or the semantic environment description (SMB) in the ICU setting. 

Methods: A sample of 99 visitors to critically ill patients admitted to a multidisciplinary ICU completed a questionnaire; 69 visited one of the two control rooms, while 30 visited the intervention room. 

Results: For the dimension of everydayness in the PCQ-F, a significantly better experience was expressed for the intervention room (p < 0.021); the dimension of safety regarding the ward climate was also perceived as higher in the intervention room (p < 0.013). No significance was found in the SMB. 

Conclusion: Designing and implementing an enriched healthcare environment in the ICU setting increases person-centered care in relation to both the patient and his/her visitors. This may lead to better impressions and affect the outcomes for visitors in times of crisis.  

Keywords
Academic research, Family-centered care, intensive care units (ICU), Interior design, Access to nature, Design research, Evidence-based design (EBD), Nursing research, Patient/person-centered care, Patient room design
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-23222 (URN)
Available from: 2020-05-20 Created: 2020-05-20 Last updated: 2020-05-20

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2627282930313229 of 45
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