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Associations between healthcare environment design and adverse events in intensive care unit
University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
University of Borås, Faculty of Caring Science, Work Life and Social Welfare.ORCID iD: 0000-0002-9828-961X
University of Borås, Faculty of Caring Science, Work Life and Social Welfare.ORCID iD: 0000-0002-0047-9723
Jönköping University.
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.

Place, publisher, year, edition, pages
2020.
Keywords [en]
complex interventions, critical care nursing, intensive care, quantitative research, research
National Category
Nursing
Research subject
Människan i vården
Identifiers
URN: urn:nbn:se:hb:diva-23220DOI: 10.1111/nicc.12513PubMedID: 32395862OAI: oai:DiVA.org:hb-23220DiVA, id: diva2:1431333
Funder
Swedish Research Council, 521‐2013‐969Available from: 2020-05-20 Created: 2020-05-20 Last updated: 2020-05-20
In thesis
1. A room designed for caring: Experiences from an evidence-based designed intensive care environment
Open this publication in new window or tab >>A room designed for caring: Experiences from an evidence-based designed intensive care environment
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
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:nbn:se:hb:diva-23183 (URN)978-91-88838-74-2 (ISBN)978-91-88838-75-9 (ISBN)
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

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Sundberg, FredrikaFridh, IsabellLindahl, Berit

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