Rethinking hospital design: Accommodating a growing diversity of patients

What affects physical activity in a rehabilitation centre? Voices of patients, nurses, therapists, and activity trackers

PURPOSE

In the context of rehabilitation, research shows a close connection between patients' physical activity, care culture, and the built environment. As these three impact on patients' rehabilitation process, we aim to understand what affects physical activity in a particular rehabilitation centre.

MATERIALS AND METHODS

We combine insights from literature with a qualitative study informed by quantitative data. Semi-structured and walking interviews with 16 patients were informed by output from activity trackers. Two focus-group interviews with respectively four nurses and two therapists provided extra perspectives.

RESULTS

We found that patients interpret physical activity rather narrowly, equating it with therapy. Yet, the data of the activity trackers show that daily activities are often as active as therapy, as confirmed by nurses and therapists. Motivation to be physically active was found in setting clear goals, social interaction, allowing choice and control to achieve a sense of normality, and the built environment. How patients act in and interact with the built environment are closely related to how staff approaches and communicates care.

CONCLUSIONS

The focus on what affects - defines, hampers, or supports - physical activity in a rehabilitation centre allowed developing a better understanding of how care culture and the built environment interrelate.Implications for rehabilitationHow physical activity is perceived by patients reflects the goals they like to achieve through rehabilitation.The built environment is a third factor in the relation between care culture and patients' physical activity.Fully supporting patients to be physically active with respect to their personality and capabilities requires differentiating between patients both in how they are approached (patient- or person-centred) and in how they are spatially facilitated.

The role of space in obstructing clinical sexual health education: A qualitative study on breast cancer patients' perspectives on barriers to expressing sexual concerns

OBJECTIVE

Breast cancer patients report hoping to receive professional medical advice on sexual health and sexuality, but only few of them actively seek help from medical professionals. This study aims to gain clear understanding about barriers to patients' sexual health education seeking from the patient perspective.

METHODS

A qualitative study using in-depth interviews was conducted in an urban hospital in Guangdong Province. China. 20 female breast cancer patients were selected and interviewed. The interview was recorded and transcribed verbatim. Content analysis was used for the data analysis.

RESULTS

Four main barriers participants experienced to expressing sexual health education need to medical personnel included: (1) Avoiding discussion of sexuality due to the inappropriate space. (2) Avoiding sexual activity due to the disease treatment. (3) Avoiding sexual activity due to the body related distress. (4) Sexuality as a metaphor.

CONCLUSIONS

It is found that breast cancer patients' expression about sexuality was constrained by the hospital, disease, body space and the cultural logic behind the three spaces. Clinical staff should provide an appropriate space for discussing sexual concerns, increase sexual health knowledge, comprehensively evaluate patients' condition and develop a culturally adaptable sexual health education.

Ways to harness the built environment of ambulatory cancer facilities for comprehensive patient support: A review of the literature

OBJECTIVE

To review patient experiences of the architectural elements conducive to a supportive or healing-promoting environment in the context of ambulatory oncology care.

DESIGN

A comprehensive review of original peer-reviewed qualitative studies conducted to reveal the meaning and significance of patient experience in this context was undertaken.

DATA SOURCES

Studies were identified through electronic databases including Ovid MEDLINE, CINAHL, PubMed and Embase. No time limit was applied and language was restricted to English.

REVIEW METHODS

The generated records were screened at the titles and abstracts level by the first reviewer, with full text assessment conducted by both authors. Main themes were extracted in an excel file and a narrative synthesis strategy was used to systematically gather evidence and explain the findings. The guidelines of the Centre for Reviews and Dissemination have been followed in the searching and reporting of the essential matters relevant to this review.

RESULTS

Eleven original studies were selected; in addition to these, fourteen other studies that did not fully meet the selection criteria, however held important information relevant to the scope of the review, were considered to expand the discussion with relevant information to ambulatory cancer facilities. The findings of these studies were synthesized into five major themes: stimulating and homely environments; flexibility and environmental enrichment; social support; complementary support and engagement; and physical and sensory support.

CONCLUSION

The paper identified key architectural design qualities that have the potential to support treatment and empower patients, with particular reflection on patients undergoing intravenous anti-cancer treatment within ambulatory settings. It provides examples in which designing the built environment with people in mind and providing tailored solutions to meet their actual needs and preferences may help cancer patients cope with the emotional and physical challenges of the disease and its treatment and support a general experience of patient-centred care. A conceptual framework that articulates the principal constituents of a supportive environment is tentatively proposed, extending existing theoretical propositions to facilitate further investigation of this context.