Does the physical environment matter? - A qualitative study of healthcare professionals' experiences of newly built stroke units

Is There Room for Improvement? Stroke Rehabilitation Environments May Not Reflect Home Environments in Terms of Chair, Toilet, and Bed Heights

The present study aims to describe the chair, bed, and toilet heights in rehabilitation hospitals and home environments to challenge rehabilitation clinicians to better prepare stroke survivors for discharge home. This study uses analysis of secondary outcomes from a multicentre, phase II randomized controlled trial (HOME Rehab trial) and additional observation of hospital environment. Data were collected from six rehabilitation hospitals and the homes of two hundred first-time stroke survivors who were aged >45 years. Chair, bed and toilet heights were measured; we measured 936 chairs and beds in hospital (17%) and home (83%) environments. Mean chair height at home was 47 cm (SD 6), which was 2 cm (95% CI, 0-4) lower than in the hospital ward and 5 cm (95% CI, 3-7) lower than in the hospital gym. Mean toilet height at home was 42 cm (SD 3), which was 3 cm (95% CI, 2-4) lower than in the hospital. Study findings suggest a disparity in heights between hospitals and home. Although clinicians may be aware of this disparity, they need to ensure that chair and bed heights within the hospital environment are progressively made lower to better prepare stroke survivors for discharge home.

A Structured Literature Review on the Research and Design of Rehabilitation Environments

AIM

This literature review is conducted to identify knowledge gaps and shape a framework for the development of guidelines and future research on programming and design of rehabilitation environments.

BACKGROUND

Patients suffering from trauma, stroke, neurological or cardiopulmonary conditions, or recovering from surgery or cancer treatment require rehabilitation services. A comprehensive rehabilitation program can support continuum of care for inpatient and outpatient groups. However, within most facilities, rehabilitation environments are found to be outdated and undersized compared to other programs or lack the correct adjacencies within the facility. Unfortunately, this deficiency is echoed by limited guidelines on programming, planning, and design of these environments. General guidelines derived from healthcare environments research is not adaptable to rehabilitation environments, because the paradigm used in most healthcare environment research does not address specific needs of rehabilitation patients in regaining confidence or relearning daily life skills.

METHOD

We conducted a structured literature review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a basis for reporting the available body of work on evidence-based research in rehabilitation environments.

RESULT AND CONCLUSION

Through analysis of the limited literature, specific mediators such as patient confidence and motivation were identified. An environment that creates a balance between privacy and social interaction can promote these mediators. Creating enriched environments through elements that engage the senses and encourage more social and physical interaction is essential for recovery. Finally, accessibility and wayfinding are of great importance in these environments due to potential limited mobility or cognitive impairments of patients.

Nature-Based Design in Stroke Rehabilitation Environments: A Scoping Review

OBJECTIVE

To identify, examine, and map the characteristics of knowledge of nature-based design in stroke rehabilitation facilities, examine how research in this field has been conducted and identify gaps in knowledge.

BACKGROUND

Many stroke survivors have wide ranging impacts, resulting in long hospital stays to undertake rehabilitation. The physical environment can influence brain recovery; however, there is limited evidence to support the design of effective rehabilitation environments. Conversely, the health benefits available from connection with nature are well established. A nature-based design approach may have benefits and implications for the physical environment of inpatient stroke rehabilitation facilities; however, it is unclear what evidence exists in this field.

METHOD

This scoping review followed the JBI methodological guidance for the conduct of scoping reviews, with systematic searches of six databases.

RESULTS

Twenty-eight studies were included in the review. Aims and research methods varied widely. Investigations in 19 studies related to gardens and other designed outdoor nature-based environments. Other studies explored natural analogues, nature inside, inside/outside connections, and the natural environment. Findings from the studies were spread across the fields of design, use, exposure to, and engagement in nature-based environments.

CONCLUSION

The characteristics of knowledge underpinning nature-based design in stroke rehabilitation environments are highly diverse, and significant gaps exist in the evidence base. A framework developed during this review for mapping knowledge on the intentions and impacts for spaces and services in this field assisted to identify these gaps and may be applied to other areas of healthcare design research.

Development and initial validation of the staff perception of residential care environments (SPORE) instrument

BACKGROUND

The impact of the physical environment on healthcare staff well-being and work performance is well recognised, yet there is a lack of instruments assessing environmental features from the perspective of staff working in residential care facilities (RCFs) for older people.

OBJECTIVES

To develop and provide initial validation of the instrument Staff Perceptions Of Residential care facility Environments (SPORE).

DESIGN

An instrument development and psychometric evaluation study.

METHODS

Based on material from a British project, items were translated and adapted for Swedish residential care facilities as SPORE. Care staff (N = 200), recruited from 20 Swedish RCFs, completed a questionnaire-based survey containing the SPORE instrument and two other instruments selected as suitable for use in the validation. In addition, an environmental assessment instrument was used for further validation. Analyses were performed at individual (staff) level and home (RCF) level.

RESULTS

The SPORE subscales demonstrated good internal consistency reliability and were moderately to strongly correlated at the individual level with the subscales of measures of person-centred care, and strongly correlated with the same measures at the home level. The SPORE subscales were also highly correlated with the total score of the instrument used to assess the quality of the physical environment.

CONCLUSION

The initial validation indicates that the SPORE instrument is promising for measuring care staff perceptions of environmental features in care facilities for older people. SPORE can be a valuable instrument for use in research and in practice to evaluate the environment as part of working towards high-quality care.

IMPLICATIONS FOR PRACTICE

The design of the physical environment within RCFs can affect the staff's health and work performance. The instrument is useful for evaluating the environment and informing decisions about design solutions that support staff in their important work.

Patient Satisfaction and Quality of Life After Mastectomy at King Abdulaziz Medical City, Jeddah

Background Overall well-being after surgical intervention is one of the most important aspects of assessing quality of life (QOL), yet it is not well explored in the literature. In this paper, it was necessary to involve the patient's perspective of the nature of their QOL. The burden of being diagnosed with breast cancer is an adaptation to a new lifestyle, having to deal with disease stigma, interpersonal relations problems, and being limited to specific clothing. This can be very challenging for patients. This study aims to identify which patient group, based on their treatment regimen, exhibits higher levels of satisfaction and dissatisfaction compared to other groups. Methods A retrospective, cross-sectional study analyzing the QOL among female breast cancer patients who underwent mastectomy, with or without breast reconstruction, in King Abdulaziz Medical City, Jeddah, between 2009 and 2022. Patients' demographics and phone numbers were obtained from each patient's medical record file in our hospital. Phone call-based interviews were conducted to contact patients to assess their QOL, satisfaction, and regrets after surgery. We excluded patients who do not speak Arabic, are illiterate, have memory disorders, patients who underwent lumpectomy or palliative mastectomy, patients with metastatic stage 4 cancer at the time of diagnosis, patients who are males, and patients who passed away. Results A total of 2,309 patients were screened during the period aforementioned; a total of 346 patients met our inclusion criteria. All of whom are female participants with a current mean age of 52.3 ± 11.5 years. There were 301 (86.99%) participants reported being satisfied, while only 45 (13.01%) participants reported being unsatisfied with surgery outcomes. Although the majority of participants were satisfied after mastectomy, many of them still struggled with psychological, social, and/or emotional challenges. These challenges can have a significant impact on a patient's overall well-being and QOL and must be addressed to provide patients with the highest quality of care possible. Conclusion The study findings highlight the significant impact of mastectomy on patients' lives. It is important to consider individual patient experiences and circumstances when evaluating treatment outcomes and patient satisfaction. We observed that patient satisfaction may vary depending on several factors, including patients' baseline satisfaction. Those factors may be psychological, such as body image issues, low self-esteem, the feeling of losing a body part, and fear of recurrence or metastasis. Other factors may be postoperative-related complications, including lymphedema, redundant skin, chronic pain, and operation scar. Additionally, factors may be socially related, such as loss of confidence, social withdrawal, embarrassment, inability to buy prostheses, being limited to specific clothes, and occupational impact.

Psychometric testing of the Persian version of the Nursing Care Quality Scale: A methodological study

AIM

To evaluate the psychometric properties of the Persian version of the Cambodian Nursing Care Quality Scale.

DESIGN

Methodological design.

METHODS

This study was carried out in several steps: a forward-backward translation was done, face and construct validity was measured using exploratory and confirmatory factor analysis and the reliability was evaluated. A convenience sampling method was employed to recruit 350 nurses from May 2021 to March 2022.

RESULTS

The exploratory factor analysis extracted six factors that explained 60.76% of the total variance. The six-factor model is supported by confirmatory factor analysis. The Cronbach's alpha and the intra-class correlation coefficient were 0.94 and 0.85, respectively.

PATIENT OR PUBLIC CONTRIBUTION

Evaluation of the quality of care can lead to the enhancement of the quality of nursing services and patient safety. This will subsequently increase the patients' and community satisfaction.

Healthcare Service Quality Evaluation in a Community-Oriented Primary Care Center, Italy

Community-oriented primary care (COPC) is an inclusive healthcare approach that combines individual care with a population-based outlook, striving to offer effective and equitable services. This study concentrates on assessing the perceived quality of a "Casa della Comunità" (CdC) implemented by the Romagna Local Health Authority, which embraces the COPC model. Through the examination of user experiences, the study aims to comprehend the influence of the CdC's care delivery model on the community's perception of service quality. From 13-18 March 2023, paper questionnaires were distributed by trained healthcare professionals and volunteers. The cross-sectional study enrolled participants aged 18 or older, capable of understanding written Italian, and willing to take part voluntarily. A total of 741 questionnaires were collected, resulting in an overall acceptance rate of 85.6%. Among the respondents, 37.9% were female, with an average age of 55.4 ± 16.2 years. While the respondents generally held a positive view of the quality, the results displayed varying levels of satisfaction across the different areas. Multivariate analysis revealed significant associations between factors such as gender, employment status, financial resources, education level, and distance from the healthcare center with the perceived quality of the facility in terms of accessibility, environment, staff, continuity of care, and overall satisfaction. The study yielded valuable insights, identifying strengths and areas for improvement and underscoring the importance of ongoing monitoring studies to enhance patient satisfaction continuously.

Assessing Client Satisfaction with Health Service Delivery under the National Health Insurance Scheme: The Case of Komfo Anokye Teaching Hospital

Background. Client satisfaction is the direct effect of service delivery and, in essence, the basis for quality improvement in any industry. In health financing, it is a significant determinant of clients’ enrolment in an insurance scheme. Objectives. This study sought to assess client satisfaction with healthcare delivery under the National Health Insurance Scheme (NHIS) at a tertiary facility in Ghana. Methods. A cross-sectional study was conducted among patients attending the outpatient department of the Komfo Anokye Teaching Hospital. Data were collected using structured questionnaires. Questionnaires were administered to 300 purposively selected patients, stratified based on their insurance status. Data obtained were then analysed using mean score ranking and an independent sample t-test. Results. The client satisfaction variable with a high level of satisfaction was observed for physical environment (πins = 3.80; πunins = 3.69). The least rated construct was responsiveness (πins = 2.59; πunins = 2.51). A statistically significant difference in the means between the insured and uninsured was observed for two of the five constructs, namely, communication (πdiff = 0.36; $p<0.05$ ) and service availability (πdiff = 0.33; $p<0.05$ ). Conclusions. This study advocates for prioritization of measures and policy initiatives aimed at improving responsiveness in healthcare delivery, as the least rated construct. It further draws health providers’ attention to modesty in communication regardless of socioeconomic or insurance status.

Evidence-Based Performance Indicators of Positive Inpatient Experiences

GOAL

Patient experiences affect the competitiveness and financial viability of a hospital. The purpose of this research was to ascertain the factors that contribute to positive inpatient experiences by using empirical evidence from national databases and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data.

METHODS

Data were assembled from four publicly available U.S. government datasets. The HCAHPS national survey responses (n = 2,472) were based on four consecutive quarters of patient surveys. Measures of clinical complications obtained from the Centers for Medicare & Medicaid Services were used to assess hospital quality. Social determinants of health were incorporated into the analysis by including data from the Social Vulnerability Index as well as zip code-level information from the Office of Policy Development and Research.

PRINCIPAL FINDINGS

The study results show that hospital quietness, nurse communication, and care transition positively affected patient experience ratings and the patient's likelihood to recommend the hospital. In addition, findings show that hospital cleanliness positively influenced patient experience ratings. However, hospital cleanliness had little impact on the likelihood of a patient's recommending the hospital, and staff responsiveness had a negligible impact on both patient experience ratings and the likelihood to recommend the hospital. The results also revealed that hospitals with better clinical outcomes received better patient experience ratings and recommendation scores, whereas hospitals that serve more vulnerable populations received worse patient experience ratings and recommendation scores.

PRACTICAL APPLICATIONS

Findings from this research demonstrate that managing the physical surroundings by providing a clean and quiet environment, providing relationship-centered care through interactions with medical personnel, and working to engage patients in their health as they transition out of care contributed to positive inpatient experiences.

Recognition of Delirium Superimposed on Dementia: Is There an Ideal Tool?

Delirium in persons with dementia (DSD) is a common occurrence. Over the past three decades, several tools have been developed and validated to diagnose delirium, yet there is still a shortage of tools recommended in persons with dementia and there is a lack of sufficient research on the accuracy of performance of such tools in this growing population. The purpose of this article is to (1) conduct a clinical review of the detection of DSD across settings of care by formal health care professionals and informal family members and care partners; (2) identify barriers and facilitators to detection and highlight delirium tools that have been tested in person with dementia; and (3) make recommendations for future research, practice, and policy. Given this review, an "ideal" tool for DSD would point to tools being brief, easy to integrate into the EMR, and accurate with at least 90% accuracy given the poor outcomes associated with delirium and DSD. Knowing the baseline and communication between family members and healthcare professionals should be a top priority for education, research, and health systems policy. More work is needed in better understanding DSD and optimizing and standardizing feature assessment, especially the acute change feature at the bedside for DSD.

The physical environment is essential, but what does the design and structure of stroke units look like? A descriptive survey of inpatient stroke units in Sweden

BACKGROUND

The design of the physical environment is a critical factor in patient care and is known to influence health, well-being, clinical efficiency, and health-related outcomes. To date, there has been no general review of the physical environment of modern Swedish stroke units.

AIM

To explore the physical environment of inpatient stroke units in Sweden and describe the design and structure of these units.

METHODS

This was a cross-sectional study. Data were collected in Sweden from April to July 2021 via a survey questionnaire.

RESULTS

The layout of the stroke units varied broadly, such as the number of single-bed and multi-bed rooms. More than half the stroke units comprised spaces for rehabilitation and had an enriched environment in the form of communal areas with access to computers, games, books, newspapers, and meeting places. However, they offered sparse access to plants and/or scenery.

CONCLUSIONS

Healthcare environments are an essential component of a sustainable community. From a sustainability perspective, healthcare facilities must be built with high architectural quality and from a long-term perspective. Research on the physical environment in healthcare should contribute to improved quality of care, which can be achieved through building healthcare facilities that support the performance of care and recovery. Therefore, mapping of areas of interest for further investigation is crucial.