Healing Spaces: Elements of Environmental Design That Make an Impact on Health

Supporting Aging-in-Place: Drivers and Desired Outcomes of a Healing Environment for Older Adults in Block Spaces of High-Density Cities

Aim: The objective of this study was to develop a comprehensive multidimensional framework by identifying the key drivers and components associated with the health of older people in healing environments, and to apply this framework in high-density city block spaces, creating opportunities for aging in place. Background: Effective theoretical and practical research frameworks are necessary to determine how to best support older adults in high-density city areas as they face aging-related challenges. Methods: The methodological approach involved bibliometric analysis (SciMAT) and systematic literature review of approximately 4446 articles related to rehabilitation settings and older adults. The review focused on literature that developed concepts and research frameworks and provided an empirical foundation. Results: The review identified four types of drivers for a healing environment for older individuals in high-density city blocks (HEOI-HCBs): self-environment, interpersonal, physical, and informational environments. These drivers were linked to eight desirable outcomes: initiative acquisition, shared vision, trust, empathy, integrity, systematicity, networking, and perceived usefulness. Conclusion: The drivers and outcomes formed the HEOI-HCBs framework, each representing a distinct dimension of the HEOI-HCBs concept. This study and the resulting framework facilitate the application and understanding of healing environments.

Streets and Stress: A Pilot Study on How Quality and Design of Streets Impacts on Urban Stress

OBJECTIVES

To identify how quality and design of streets impacts urban stress.

BACKGROUND

Few studies have comprehensively addressed environmental factors affecting stress in urban public spaces. However, a remarkable portion of our everyday life is spent in public spaces, particularly streets.

METHOD

This study seeks to evaluate the effect of three types of streets as major public spaces on stress. These include a street with the dominance of green spaces (A), a motorist-oriented street (B), and a pedestrian street (C). For this purpose, we selected a group of participants (n = 16) aged 20-30, with an equal number of men and women who were generally healthy and had normal stress levels. Participants were asked to wear an electroencephalogram (EEG) headset, walk different streets, and answer the Perceived Restorativeness Scale (PRS) and urban design qualities questionnaires.

RESULTS

According to the results, participants experienced the highest stress in street type B and the lowest in type A.

CONCLUSIONS

Green space and vegetation, a sense of security, privacy and coziness, climatic comfort, and safety of space had the most positive effect on stress reduction. Whereas noise pollution, vehicle traffic, and crowdedness were the most critical factors of stress. Finally, our findings suggest that the component of green space has a more significant effect on stress reduction compared with the elimination of vehicle traffic.

COVID-19 hospital indoor environments and how it helped patients' recovery and staff's work: a case study in South Korea

The indoor environment has been recognized as a crucial factor that can influence health and wellbeing of occupants. This is particularly true in hospital settings, where various environmental attributes can significantly affect patients' recovery and staff members' productivity. The present study aimed to investigate how occupants in hospitals perceived indoor environment, focusing specifically on COVID-19 hospitals across Republic of Korea. The study recruited two groups of participants: patients (n = 100) who had been hospitalized in COVID-19 hospitals and staff members (n = 103) who worked in COVID-19 hospitals. The data collected from the participants were analyzed using multiple regression models to determine which environmental attributes significantly affected their perception of the indoor environment. The study revealed that satisfaction with indoor acoustic environment and odor were significant predictors for how patients perceived the indoor environment as helpful for their recovery from COVID-19. On the other hand, odor was also the significant factor affecting staff members' perceived helpfulness for work. The results suggested that different environmental attributes can have a significant impact on the perception of the indoor environment, depending on the characteristics of occupancy. The study's findings provided insights into the certain environmental factors that COVID-19 hospitals can prioritize. These insights can help policymakers and hospital administrators to develop strategies to create hospital environments that meet the needs of both groups. The study also suggested that further research is needed to investigate additional factors affecting occupants' perception of the indoor environment in hospital settings.

Designing a Child-, Family-, and Healthcare Provider-Centered Procedure Room in a Tertiary Care Children's Hospital

AIM

The study aim was to co-design new pediatric procedure room prototypes with children, caregivers, and healthcare providers (HCPs).

BACKGROUND

Medical procedures can cause pain and anxiety for children and their families. If spaces are not designed for patients' needs, procedures may take longer, require sedation, and result in an inferior care experience. Involving HCPs in co-designing optimal spaces can result in more efficient and safer environments. co-designing spaces with patients and their families can inform psychologically safer and less traumatic environments.

METHODS

We followed human-centered design methodology. Data were collected via semi-structured interviews, field observations, and two multidisciplinary design workshops with patients, caregivers, and HCPs. Themes from the data were extracted using a content analysis and used to make evidence-informed recommendations for design features.

RESULTS

The study took place from October 2021 to February 2022. Patients, families, and HCPs reported similar needs: (1) control over the environment, including the ability to adjust lighting, temperature, and sound; (2) space that supports patient privacy; (3) the use of evidence-based pain reduction and distraction methods; (4) attention to the sensory environment, including visual (light, color), tactile (textures of furniture and equipment), auditory, and olfactory stimuli; (5) human factors organization of the space and equipment; (6) accessible and equitable spatial design; and (7) the significance of the journey leading up to and after the procedure.

CONCLUSIONS

It is feasible to co-design procedure rooms that support evidence-based psychological, physical, and pharmacological interventions that are known to minimize pain for children.

Complexity theory in the management of patients with musculoskeletal pain

Nonlinear systems are not susceptible to research with a reductionist approach. In this sense, the complexity theory provides an alternative approach to quantify the importance of contextual factors in patients with musculoskeletal pain. The use of positive (placebo) or negative (nocebo) contextual factors in the therapeutic setting could largely account for the non-specific component of treatment efficacy, directly affecting the quality of patients’ health-related outcomes (e.g., pain, disability, or satisfaction). In recent years, there has been a better understanding of the effects of contextual factors. However, the knowledge and awareness of them is limited and heterogeneous among physical therapists, reducing their translational value in the field of physiotherapy. The purpose of this essay is to describe the management of patients with musculoskeletal pain from the complexity theory perspective.

The Effect of Correlated Colour Temperature on Physiological, Emotional and Subjective Satisfaction in the Hygiene Area of a Space Station

The hygiene area is one of the most important facilities in a space station. If its environmental lighting is appropriately designed, it can significantly reduce the psychological pressure on astronauts. This study investigates the effect of correlated colour temperature (CCT) on heart rate, galvanic skin response, emotion and satisfaction in the hygiene area of a space station. Forty subjects participated in experiments in a hygiene area simulator with a controlled lighting environment. The lighting conditions included 2700 K, 3300 K, 3600 K, 5000 K and 6300 K; physiological responses (heart rate, galvanic skin response), as well as emotion and satisfaction, were recorded. The results showed that CCT significantly influenced the participants’ physiological and subjective responses in the space station hygiene area. 6300 K led to the best emotion and satisfaction levels, the highest galvanic skin response and the lowest heart rate. The opposite was true for 2700 K.

A Conceptual Framework for Blockchain Enhanced Information Modeling for Healing and Therapeutic Design

In the face of the health challenges caused by the COVID-19 pandemic, healing and therapeutic design (HTD) as interventions can help with improving people's health. It is considered to have great potential to promote health in the forms of art, architecture, landscape, space, and environment. However, there are insufficient design approaches to address the challenges during the HTD process. An increased number of studies have shown that emerging information modeling (IM) such as building information modeling (BIM), landscape information modeling (LIM), and city information modeling (CIM) coupled with blockchain (BC) functionalities have the potential to enhance designers' HTD by considering important design elements, namely design variables, design knowledge, and design decision. It can also address challenges during the design process, such as design changes, conflicts in design requirements, the lack of design evaluation tools and frameworks, and incomplete design information. Therefore, this paper aims to develop a conceptual BC enhanced IM for HTD (BC-HTD) framework that addresses the challenges in the HTD and promotes health and well-being. The structure of BC-HTD framework is twofold: (1) a conceptual high-level framework comprising three levels: user; system; and information, (2) a conceptual low-level framework of detailed content at the system level, which has been constructed using a mixed quantitative and qualitative method of literature analysis, and validated via a pre-interview questionnaire survey and follow-up interviews with industry experts and academics. This paper analyzes the process of BC enhanced HTD and the knowledge management of HTD to aid design decisions in managing design information. This paper is the first attempt to apply the advantages of BC enabled IM to enhance the HTD process. The results of this study can foster and propel new research pathways and knowledge on the value of design in the form of non-fungible token (NFT) based on the extended advantages of BC in the field of design, which can fully mobilize the healing and therapeutic behaviors of designers and the advantage potential of HTD to promote health, and realize the vision of Health Metaverse in the context of sustainable development.

Unlimited Surrounding: A Scoping Review on the Impact of the Built Environment on Health, Behavior, and Quality of Life of Individuals With Intellectual Disabilities in Long-Term Care

OBJECTIVES

To identify available literature on the impact of built environments on health, behavior, and quality of life of individuals with intellectual disabilities in long-term care. Additionally, we aimed to map the available literature, (re)frame the overall research situation in this area, and formulate recommendations.

BACKGROUND

Long-term care facilities in the Netherlands are planned without using knowledge from research regarding evidence-based design because it is unclear what evidence is available about the impact of long-term care built environments on individuals with intellectual disabilities receiving 24/7 care.

METHODS

Twelve scientific databases were searched for keyword combinations. After systematically screening 3,095 documents, 276 were included in the analysis.

RESULTS

There is an underrepresentation of research and publications in intellectual disabilities, compared to other user groups living in long-term care facilities. A total of 26 design components were found in all groups; as for intellectual disabilities, research was available on only seven of them. Community care, home-likeness, and variety seem to have a positive effect on health, behavior, and quality of life. There are conflicting results regarding the effects of house size.

CONCLUSIONS

Although individuals with intellectual disabilities live in long-term care facilities, sometimes for life, little research has been conducted on the impact of the built environment on them. In the future, more empirical research should be conducted, addressing all aspects of quality of life and specific design components, with hypotheses based on needs assessments and the use of good research designs. This requires an investment of time and funding.

It's Not Just in the Walls: Patient and Staff Experiences of a New Spatial Design for Psychiatric Inpatient Care

The environment in psychiatric inpatient care is key to patient recovery and staff job satisfaction. In this qualitative study of patient and staff experiences of a new spatial design in psychiatric inpatient care, we analysed data from 11 semi-structured interviews with patients and five focus group discussions with staff using qualitative content analysis. The new design contributed to feelings of safety and recovery, but patients and staff also reported some frustration and added stress. The results lead us to conclude that while the new spatial design improves some conditions for recovery and job satisfaction, the design itself is simply not enough. Changes in care environments require that both patients and staff be informed and involved in the renovation to ensure that patients feel respected and staff feel confident in using the new environment before and during treatment and follow-ups.

Permanent Supportive Housing Design Characteristics Associated with the Mental Health of Formerly Homeless Adults in the U.S. and Canada: An Integrative Review

The built environment directly and indirectly affects mental health, especially for people transitioning from long-term homelessness to permanent supportive housing (PSH) who often experience co-occurring behavioral health challenges. Despite a rapid increase in PSH availability, little research examines influences of architecture and design within this context. This integrative review synthesized limited research on PSH design in the U.S. and Canada to identify built environment characteristics associated with PSH residents’ mental health, highlight gaps in the literature, and prioritize future research directions. A systematic search for peer-reviewed articles was conducted using nine databases drawing from multiple disciplines including architecture, environmental psychology, interior design, psychology, psychiatry, medicine, and nursing. Seventeen articles met inclusion criteria. Study design, methodology, built environment properties, place attributes, and relevant findings were extracted and iteratively analyzed. Three domains relevant to architecture and design were identified related to home, ontological security, and trauma sensitivity; dwelling unit type, privacy, control, safety, housing quality and location, and access to amenities; and shared common space. Integrative review results emphasize the potential of architecture and design to contribute to improved built environment quality and mental health outcomes among PSH residents. Methodological limitations and directions for future research are also discussed.

A Study of Older Adults' Perception of High-Density Housing Neighbourhoods in Singapore: Multi-Sensory Perspective

Associated sensory and cognitive declines progress with ageing and profoundly impact the daily living and quality of life of older adults. In the context of an increased ageing population globally, this paper outlines an exploratory study of socio-sensory properties of two high-density housing neighbourhoods in Singapore and the ways senior local residents perceive their familiar built environments. This study employed exploratory on-site exercises with 44 student researchers (including sensory photo-journeys, documentation of sensory properties and daily activity patterns), and 301 socio-perceptual surveys with local residents, the majority of whom were older adults. The findings reveal important aspects related to sensory assessment and appreciation (e.g., crowdedness, noise, smell, cleanliness), walking experience (e.g., safety, wayfinding) and overall satisfaction with the neighbourhood (e.g., available public amenities, opportunities for inter-generational bonding), some of which correlated with age and reported health condition. Multi-sensory assessment shows the capacity to inform more integrated, empathetic, ability-building and context-specific ageing-friendly neighbourhood design.

Putting patients first: development of a patient advocate and general practitioner-informed model of patient-centred care

Background

Patients, providers and health care organisations benefit from an increased understanding and implementation of patient-centred care (PCC) by general practitioners (GPs). This study aimed to evaluate and advance a theoretical model of PCC developed in consultation with practising GPs and patient advocates.

Methods

Qualitative description in a social constructivist/interpretivist paradigm. Participants were purposively sampled from six primary care organisations in south east Queensland/northern New South Wales, Australia. Participants engaged in focus group discussions where they expressed their perceptions, views and feelings of an existing PCC model. Data was analysed thematically using a constant-comparison approach.

Results

Three focus groups with 15 patient advocates and three focus groups with 12 GPs were conducted before thematic saturation was obtained. Three themes emerged: i) the model represents the ideal, ii) considering the system and collaborating in care and iii) optimising the general practice environment. The themes related to participants’ impression of the model and new components of PCC perceived to be experienced in the ‘real world’. The data was synthesised to produce an advanced model of PCC named, “Putting Patients First: A Map for PCC”.

Conclusions

Our revised PCC model represents an enhanced understanding of PCC in the ‘real world’ and can be used to inform patients, providers and health organisations striving for PCC. Qualitative testing advanced and supported the credibility of the model and expanded its application beyond the doctor-patient encounter. Future work could incorporate our map for PCC in tool/tool kits designed to support GPs and general practice with PCC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06273-y.

Effect of Spatial Ambiances on the Patient Satisfaction and Well-Being in Hospitals: The Case of UHC Ibn Sina Annaba and UHC Benbadis Constantine-Algeria

OBJECTIVES

In this work, we aim to have a better understanding of the impact of the architectural ambiance on patient well-being, by exploring patient's perception of physical ambiantal factors in their rooms.

BACKGROUND

Perception of ambiantal factors is beginning to be relatively documented in space psychology, including health. There is no research in this field in Algeria; therefore, we would like to fill this gap and draw attention to the importance of the ambiantal physical factors in our hospitals.

METHODS

We conducted a practical study via a 19-item questionnaire at the neurology hospitalization department of two hospitals. This is complemented by in situ observations and reactivated observations. Descriptive, principal component analysis and statistical tests were applied on the responses.

RESULTS

Thirteen ambiantal physical items studied were all classified relatively medium with mean scores ranging between -0.55 < mean < 1.34, with SD 0.765, on a scale of -2 to 2. Patients therefore consider the room ambiance medium. Patients' satisfaction and well-being results meet with findings about ambiantal physical factors. Neurological diseases affect patient cognition, which increase the importance of space-sensitive perception. The bad general condition of the building is negatively pointed in all testimonies of the questioned, especially spatial organization with multiple occupation room.

CONCLUSION

The results indicate that reflection should be oriented on the design of single or double rooms, taking into account the emotional (sensitive) state of the patient, by integrating ambiantal physical factors (natural lighting variable, sound variable, thermal variable, olfactory variable), to contribute significantly to their well-being.

Diet and companionship modulate pain via a serotonergic mechanism

Treatment of severe chronic and acute pain in sickle cell disease (SCD) remains challenging due to the interdependence of pain and psychosocial modulation. We examined whether modulation of the descending pain pathway through an enriched diet and companionship could alleviate pain in transgenic sickle mice. Mechanical and thermal hyperalgesia were reduced significantly with enriched diet and/or companionship. Upon withdrawal of both conditions, analgesic effects observed prior to withdrawal were diminished. Serotonin (5-hydroxytryptamine, 5-HT) was found to be increased in the spinal cords of mice provided both treatments. Additionally, 5-HT production improved at the rostral ventromedial medulla and 5-HT accumulated at the dorsal horn of the spinal cord of sickle mice, suggesting the involvement of the descending pain pathway in the analgesic response. Modulation of 5-HT and its effect on hyperalgesia was also investigated through pharmaceutical approaches. Duloxetine, a serotonin-norepinephrine reuptake inhibitor, showed a similar anti-nociceptive effect as the combination of diet and companionship. Depletion of 5-HT through p-chlorophenylalanine attenuated the anti-hyperalgesic effect of enriched diet and companionship. More significantly, improved diet and companionship enhanced the efficacy of a sub-optimal dose of morphine for analgesia in sickle mice. These findings offer the potential to reduce opioid use without pharmacological interventions to develop effective pain management strategies.

What Physiotherapists Specialized in Orthopedic Manual Therapy Know About Nocebo-Related Effects and Contextual Factors: Findings From a National Survey

Objective

The aim of this study was to investigate the knowledge of orthopedic manual therapists (OMTs) regarding context factors (CFs) capable of triggering nocebo effects during the treatment and how this knowledge is related to their socio-demographic features.

Design

A cross-sectional online survey.

Setting

National.

Main Outcome Measures

A 20 items questionnaire composed by open-ended and closed single-choice questions was administered to explore: (a) socio-demographic variables (10 questions); (b) the relation between different CFs and nocebo-related effects (2 questions); and (c) the knowledge of participants about nocebo-related effects and how they managed them in the clinical practice (8 questions).

Participants

1288 OMTs were recruited from the database of the Master in Rehabilitation of Musculoskeletal Disorders (MRDM) of the University of Genova from March to May 2019. Inclusion criteria were: (a) to possess a valid email account; (b) to understand and use as a native language the Italian; (c) to be graduated as OMTs; and (d) to be employed as physiotherapists specialized-OMTs during the survey.

Results

791 responses were received (61.4%); 473 of them were male (59.8%), with an average age of 31.0 ± 7.1 years. OMTs defined nocebo-related effects as the psychosocial context effects around therapy and patient with specific biological bases (72.2%). OMTs know that their clinical practice is pervaded by nocebo-related effects (42.5%), triggered by CFs. Participants communicated nocebo-related effects balancing the positive features of the therapy with the negative ones (50.9%), during the decision of the therapeutic plan (42.7%). They reported associative learning as the main mechanism involved in nocebo-related effects (28.8%). OMTs taught and trained patient’s strategies to manage nocebo-related effects (39.6%) through an evaluation and correction of patient’s anxieties, doubts and expectations (37.7%). OMTs most frequently considered themselves to have a “medium” education about nocebo-related effects (48.2%) and that their management should be taught during bachelor (78.6%).

Conclusion

OMTs believed that nocebo-related effects were present in their clinical practice and that they can be triggered by CFs.

Health Professionals' Perception of Psychological Safety in Patients with Coronavirus (COVID-19)

BACKGROUND

Medical personnel act as the protectors of people's health by preventing, controlling, and treating emerging diseases, including the coronavirus infection. COVID-19 is a highly infectious and contagious disease which has presented the Iranian healthcare system with a variety of clinical challenges. There is a lack of research on clinical challenges in health crises especially those caused by emerging diseases, hence a need for more exploration of these clinical challenges and dilemmas. The present study aims to determine the different aspects of health professionals' perception of the psychological safety of patients infected with the coronavirus (COVID-19).

METHODS

The present study is a qualitative work which uses conventional content analysis. The participants were 17 health professionals who were responsible for COVID-19 patients and met the inclusion criteria. They were selected via purposeful sampling. The study lasted from February to March 2020. Data were collected through semi-structured, individual interviews which were conducted via video call. The collection of data was kept up to the point of saturation. The collected data were analyzed using the conventional content analysis method.

RESULTS

Three themes such as "respect for dignity", "comprehensive support" and "peaceful environment" with 11 categories were extracted from the findings of the study.

CONCLUSION

According to the results of the present study, patients infected with the coronavirus should be given care in a peaceful environment where they receive comprehensive support and have their dignity respected. Such conditions can guarantee the psychological safety of these patients and produce positive behavioral results on their part. Thus, it is essential that the cultural, professional, and organizational prerequisites of protecting all the dimensions of the psychological safety of these patients be provided.

Respect for Autonomy: Seeking the Roles of Healthcare Design From the Principle of Biomedical Ethics

OBJECTIVE

This article aims to discuss the role of the healthcare environment on patient's autonomy. Referring to biomedical ethics will provide a research logic and form a theoretical framework for healthcare designers to define patient autonomy, to master the conditions for promoting it, and to discover the potential of the environment.

BACKGROUND

In modern society, it becomes the responsibility of healthcare architects to realize the design of "benefit for patients." The goal of healthcare environment design and research is also gradually from a basic level of ensuring the physiological safety of patients to achieving a higher level of respecting patients and helping realize their self-realization. However, how to express respect to patients in the healthcare environment is ambiguous. In order to break through the limitation of architectural specialty, we propose to introduce biomedical ethics. Under this major premise, this article will discuss from the perspective of respect for autonomy (RA).

METHOD

This article combines the definition of autonomy and the discussion of the medical and nursing practice to summarize and propose the themes about RA. It draws on the top-down deductive logic of biomedical ethics from theory to application and applies the three-condition theory of Beauchamp and Childress to deduce the role of the healthcare environment on patient autonomy in each theme.

CONCLUSION

Introducing biomedical ethics into the study of environmental design provides a more theoretical and systematic way of thinking about the role of the healthcare environment. Some autonomy-supportive design strategies are collected and proposed.

The Therapeutic Waiting Room: Therapist and Service User Perspectives on the Psychologically Supportive Dimensions of Architectural Space

BACKGROUND

Waiting areas in healthcare settings play an important role in reassuring or potentially further distressing service users. The effects of the designed environment on mental health service users specifically are regarded by health professionals as having a considerable influence on treatment outcomes, experiences, and perceptions of care.

PURPOSE

The purpose of this article is to explore service user and practicing therapist perspectives of waiting areas in mental health service settings and how the design of these spaces affects anxiety levels, comfort, therapeutic relationships, outcomes, and perceptions of care.

METHODS

The methodology for this exploratory phenomenological study was developed in order to preserve the integrity of participant voices in the essences of experiences, during explorations of their encounters with therapeutic waiting areas. Fieldwork undertaken by the author involved a series of focused in-depth interviews with service users of mental health services and practicing therapists, counselors, and psychologists.

RESULTS

Key themes identified through data analysis include (1) space acting as symbolism, (2) interpersonal relations which are threatening, and (3) sensory modulation. Design implications in relation to each theme are presented.

CONCLUSIONS

This study uncovered a set of findings in relation to symbolic content inferred by spatial design aspects and the ways in which design can afford, or mitigate, development of interpersonal agencies, psychological safety, and negative stigmas. Future transdisciplinary research directions are suggested, including (1) examination of other relationships, beyond the service user-therapist dyad, which may influence waiting area experiences and (2) examination of the applicability of design suggestions to different contexts.

Hospital flooring safety and health: knowledge gaps and suggestions

Fall incidents are a leading safety concern in the hospital industry. Whereas roughening the floor surface can reduce fall risks, there remains unanswered controversies between achieving and maintaining hygienic cleaning efficiencies and adequately addressing conditions of flooring safety. Thus, the current study critically overviews the status of research and accepted practices on hospital flooring safety and healthy controls. Salient literature was identified by searching keywords and phrases within the databases of PubMed, Web of Science, MEDLINE, Scopus and ScienceDirect to find answers for the major questions on hospital floorings. A comprehensive review analysis identified that underlying causes of hospital fall incidents and flooring-attributable infectious illnesses mainly comprised floor types and materials, cleaning chemicals, materials and methods, maintenance and slip-resistance properties. Findings from this study suggest several major actions to advance hospital flooring safety and health research and practice.

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.

Organisational change in hospitals: a qualitative case-study of staff perspectives

Background

Organisational change in health systems is common. Success is often tied to the actors involved, including their awareness of the change, personal engagement and ownership of it. In many health systems, one of the most common changes we are witnessing is the redevelopment of long-standing hospitals. However, we know little about how hospital staff understand and experience such potentially far-reaching organisational change. The purpose of this study is to explore the understanding and experiences of hospital staff in the early stages of organisational change, using a hospital redevelopment in Sydney, Australia as a case study.

Methods

Semi-structured interviews were conducted with 46 clinical and non-clinical staff working at a large metropolitan hospital. Hospital staff were moving into a new building, not moving, or had moved into a different building two years prior. Questions asked staff about their level of awareness of the upcoming redevelopment and their experiences in the early stage of this change. Qualitative data were analysed using thematic analysis.

Results

Some staff expressed apprehension and held negative expectations regarding the organisational change. Concerns included inadequate staffing and potential for collaboration breakdown due to new layout of workspaces. These fears were compounded by current experiences of feeling uninformed about the change, as well as feelings of being fatigued and under-staffed in the constantly changing hospital environment. Nevertheless, balancing this, many staff reported positive expectations regarding the benefits to patients of the change and the potential for staff to adapt in the face of this change.

Conclusions

The results of this study suggest that it is important to understand prospectively how actors involved make sense of organisational change, in order to potentially assuage concerns and alleviate negative expectations. Throughout the processes of organisational change, such as a hospital redevelopment, staff need to be engaged, adequately informed, trained, and to feel supported by management. The use of champions of varying professions and lead departments, may be useful to address concerns, adequately inform, and promote a sense of engagement among staff.

Is cancer prevention influenced by the built environment? A multidisciplinary scoping review

The built environment is a significant determinant of human health. Globally, the growing prevalence of preventable cancers suggests a need to understand how features of the built environment shape exposure to cancer development and distribution within a population. This scoping review examines how researchers across disparate fields understand and discuss the built environment in primary and secondary cancer prevention. It is focused exclusively on peer-reviewed sources published from research conducted in Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States from 1990 to 2017. The review captured 9958 potential results in the academic literature, and this body of results was scoped to 268 relevant peer-reviewed journal articles indexed across 13 subject databases. Spatial proximity, transportation, land use, and housing are well-understood features of the built environment that shape cancer risk. Built-environment features predominantly influence air quality, substance use, diet, physical activity, and screening adherence, with impacts on breast cancer, lung cancer, colorectal cancer, and overall cancer risk. The majority of the evidence fails to provide direct recommendations for advancing cancer prevention policy and program objectives for municipalities. The expansion of interdisciplinary work in this area would serve to create a significant population health impact.

Residential Satisfaction, Psychological Well-Being and Perceived Environmental Qualities in High- vs. Low-Humanized Residential Facilities for the Elderly

Using the “user-centered” design perspective and the construct of design “humanization” as theoretical underpinnings, this field study verified the role of “objective” design quality of residential facilities for the elderly in the prediction of “subjective” users’ psychological responses. A sample of over-65-year-old adults (N = 114) was recruited in eleven residential facilities, which differed for the degree of “objective” design humanization (rated on the basis of a design expert assessment). Participants had to fill in a questionnaire including measures of both specific perceived environmental qualities (spatial-physical and social-relational) and more general psychological responses (such as residential satisfaction and psychological well-being). Outcomes revealed that older residents living in high-humanization structures show higher scores of residential satisfaction, psychological well-being and perceived environmental qualities than those living in low-humanization structures. Moreover, significant correlations emerged between specific perceived environmental qualities of the facility and general psychological outcomes. These results confirm the importance of design features for supporting elders’ needs and fostering their quality of life.

Exploring the ripple effects of an Australian hospital redevelopment: a protocol for a longitudinal, mixed-methods study

INTRODUCTION

Hospital redevelopment projects typically intend to improve hospital functioning and modernise the delivery of care. There is research support for the proposition that redevelopment along evidence-based design principles can lead to improved quality and safety. However, it is not clear how redevelopment influences the wider context of the hospital and its functioning. That is, beyond a limited examination of intended outcomes (eg, improved patient satisfaction), are there additional consequences (positive, negative or unintended) occurring within the hospital after the physical environment is changed? Is new always better? The primary purpose of this study is to explore the ripple effects of how hospital redevelopment may influence the organisation, staff and patients in both intended and unintended ways.

METHODS AND ANALYSIS

We propose to conduct a longitudinal, mixed-methods, case study of a large metropolitan hospital in Australia. The study design consists of a series of measurements over time that are interrupted by the natural intervention of a hospital redevelopment. How hospital redevelopment influences the wider context of the hospital will be assessed in six domains: expectations and reflections of hospital redevelopment, organisational culture, staff interactions, staff well-being, efficiency of care delivery and patient experience. Methods of data collection include a hospital-wide staff survey, semistructured interviews, a network survey, a patient experience survey, analysis of routinely collected hospital data and observations. In addition to a hospital-level analysis, a total of four wards will be examined in-depth, with two acting as controls. Data will be analysed using thematic, statistical and network analyses, respectively, for the qualitative, quantitative and relational data.

ETHICS AND DISSEMINATION

The study has been reviewed and approved by the relevant Ethics Committee in New South Wales, Australia. The results will be actively disseminated through peer-reviewed journals, conference presentations and in report format to the stakeholders.

Developing a Measurement Scale of Gender-Friendly Hospital Environments: An Exploratory Study of Customer Perceptions in Taiwan

According to the United Nations, males and females should be given equal treatment in physical and psychological services, and healthcare institutions should exert greater efforts to reduce the gap in gender equality. However, this issue has been largely ignored in previous literature on healthcare environments. Designing a hospital environment that focuses on gender differences is critical to academic researchers and practical managers in all healthcare institutions. Thus, as an exploratory effort, this study aims to develop a measurement to assess customer perceptions of gender-friendly hospital environments. To identify and refine the structure of the instrument, two studies are conducted at different hospitals in Taiwan. The exploratory evidence shows there are five factors (i.e., physical design, functional design, marking design, gender perception, and gender-friendly services) and 28 items in the measurement scale of gender-friendly hospital environments. Results also show that gender-friendly hospital environments affect customers' loyalty and willingness to pay. Based on our findings, hospital practitioners and researchers can adopt the measurement instrument used in this study to deal with the gap of gender equality in healthcare environments.

Grip on health: A complex systems approach to transform health care

This article addresses the urgent need for a transition in health care to deal with the increasing prevalence of chronic diseases and associated rapid rise of health care costs. Chronic diseases evolve and are predominantly related to lifestyle and environment. A shift is needed from a reductionist repair mode of thinking, toward a more integrated biopsychosocial way of thinking about health. The aim of this article is to discuss the opportunities that complexity science offer for transforming health care toward optimal treatment and prevention of chronic lifestyle diseases. Health and health care is discussed from a complexity science perspective. The benefits of concepts developed in the field of complexity science for stimulating transitions in health care are explored. Complexity science supports the elucidation of the essence of health processes. It provides a unique perspective on health with a focus on the relationships within networks of dynamically interacting factors and the emergence of health out of the organization of those relationships. Novel types of complexity science-based intervention strategies are being developed. The first application in practice is the integrated obesity treatment program currently piloted in the Netherlands, focusing on health awareness and healing relationships. Complexity science offers various theories and methods to capture the path toward unhealthy and healthy states, facilitating the development of a dynamic integrated biopsychosocial perspective on health. This perspective offers unique insights into health processes for patients and citizens. In addition, dynamic models driven by personal data provide simulations of health processes and the ability to detect transitions between health states. Such models are essential for aligning and reconnecting the many institutions and disciplines involved in the health care sector and evolve toward an integrated health care ecosystem.

Optimizing the patient-centered environment: results of guided tours with health care providers and employees

OBJECTIVE

To examine providers' perspectives on the care environment and patient-centered care (PCC) through the eyes of the veteran patient, using guided tours qualitative methodology.

BACKGROUND

Environmental factors, such as attractiveness and function, have the potential to improve patients' experiences. Participatory qualitative methods allow researchers to explore the environment and facilitate discussion.

METHODS

Guided tours were conducted with 25 health care providers/employees at two Veterans Affairs (VA) health care facilities. In guided tours, participants lead the researcher through an environment, commenting on their surroundings, thoughts, and feelings. The researcher walks along with the participant, asking open-ended questions as needed to foster discussion and gain an understanding of the participant's view. Participants were asked to walk through the facility as though they were a veteran. Tours were audio recorded, with participant permission, and transcribed verbatim by research assistants. Three qualitative researchers were responsible for codebook development and coding transcripts and used data-driven coding approaches.

RESULTS

Participants discussed physical appearance of the environment and how that influences perceptions about care. Overall, participants highlighted the need to shed the "institutional" appearance. Differences between VA and non-VA health care facilities were discussed, including availability of private rooms and staff to assist with navigating the facility. They reviewed resources in the facility, such as the information desk to assist patients and families. Finally, they offered suggestions for future improvements, including improvements to waiting areas and quiet areas for patients to relax and "get away" from their rooms.

CONCLUSIONS

Participants highlighted many small changes to the care environment that could enhance the patient experience. Additionally, they examined the environment from the patient's perspective, to identify elements that enhance, or detract from, the patient's care experience.

Assessing the physical service setting: a look at emergency departments

OBJECTIVE

To determine the attributes of the physical setting that are important for developing a positive service climate within emergency departments and to validate a measure for assessing physical service design.

BACKGROUND

The design of the physical setting is an important and contributing factor for creating a service climate in organizations. Service climate is defined as employee perceptions of the practices, procedures, and behaviors that get rewarded, supported, and expected with regard to customer service and customer service quality. There has been research conducted which identifies antecedents within organization that promotes a positive service climate which in turn creates service-oriented behaviors by employees toward clients. The antecedent of the physical setting and its impact on perceptions of service climate has been less commonly explored.

METHODS

Using the concept of the physical service setting (which may be defined as aspects of the physical, built environment that facilitate the delivery of quality service), attributes of the physical setting and their relationship with service climate were explored by means of a quantitative paper survey distributed to emergency nurses (n = 180) throughout a province in Canada.

RESULTS

The results highlight the validity and reliability of six scales measuring the physical setting and its relation to service. Respondents gave low ratings to the physical setting of their departments, in addition to low ratings of service climate.

CONCLUSIONS

Respondents feel that the design of the physical setting in the emergency departments where they work is not conducive to providing quality service to clients. Certain attributes of the physical setting were found to be significant in influencing perceptions of service climate, hence service quality, within the emergency department setting.

Architectural style and green spaces predict older adults' evaluations of residential facilities

The purpose of this study was to analyse the effects of residential facilities' design features on older adults' psychosocial responses. Participants (N = 192) were over 65-year-old residents who were randomly exposed to different experimental scenarios concerning a hypothetical residential facility for older adults, using a 3 × 2 between-subjects design (i.e. home-like vs. hotel-like vs. usual-standard architectural style; presence vs. absence of green spaces). After the experimental session, participants were asked to fill in a questionnaire that measured their attitudes towards short- and long-term relocation, anticipated residential satisfaction with the facility, and feelings of broken home attachment. The results showed (1) more positive responses to "home-like" and "hotel-like" architectural styles than the usual-standard type and (2) the positive impact of green spaces on the assessment of the facilities. These design features should thus play a role in both reducing the stressful impact of leaving home and promoting beneficial patterns, hence fostering "successful ageing".

Private Rooms in Low Acuity Settings: A Systematic Review of the Literature

OBJECTIVES

Determine if the peer-reviewed evidence supports single-patient ward bedrooms in low-acuity care settings within a hospital.

BACKGROUND

New evidence exists since the 2006 Facility Guideline Institute guideline recommended single-bedded rooms (SBRs) in low-acuity care settings. Additionally, prior studies evaluated high-acuity care settings (e.g., critical care) in their recommendations on SBRs. There is a need to reevaluate the evidence.

METHODS

A systematic review of the literature was completed including electronic and hand searches of references. A data extraction form was utilized. Two reviewers evaluated the studies independently. Studies that were included examined the effect of single-patient rooms on medical surgical ward beds only. Each study was graded using accepted clinical evidence grading instruments.

RESULTS

Over 1,400 records were identified. After excluding studies, a total of 49 records were graded. The highest quality evidence identified (Center for Evidence-Based Medicine [CEBM]: 2a, 2b, and Grading of Recommendations, Assessment, Development, and Evaluation [GRADE] C) did not support the use of single-patient rooms for reducing infections, for minimizing patient falls, for reducing medication errors, or for patient satisfaction. Operational efficiencies were improved with SBRs but only addressed the maternity ward. The lowest quality evidence (CEBM: 4/5 and GRADE D) supported the use of single-patient rooms.

CONCLUSIONS

Based on CEBM and GRADE assessments, there is a lack of high-quality data supporting the use of low-acuity SBRs throughout the entire hospital. Furthermore, it is recommended that more research be conducted on the effect of SBRs, so higher quality evidence is developed.

Exploring Inpatients' Experiences of Healing and Healing Spaces: A Mixed Methods Study

In order to understand a patient’s healing experience it is essential to understand the elements that they, the patient, believes contributed to their healing. Previous research has focused on symptom reducers or contributors through environment such as stress. A person’s experience of healing happens over time not instantaneous. Therefore, in this study, the interviews with patients happened after forty-eight hours of hospitalization. This mixed methods study describes the experiences of seventeen inpatients from two healthcare systems using a phenomenological approach combined with evidence based design evaluation methods to document the setting. The qualitative data was analyzed first for reoccurring themes then further explored and defined through quantitative environmental observations. The seventeen patients defined healing as “getting better/well.” Seventy three statements were recorded about contributors and detractors to healing in the physical environment. Three primary themes emerged from the data as positive influencers of a healing experience: being cared for, being comfortable and experiencing something familiar or like home. These results demonstrate that patients perceive their inpatient healing experience through a supported environment.

Systems Health: A Transition from Disease Management Toward Health Promotion

To date, most of the chronic diseases such as cancer, cardiovascular disease, and diabetes, are the leading cause of death. Current strategies toward disease treatment, e.g., risk prediction and target therapy, still have limitations for precision medicine due to the dynamic and complex nature of health. Interactions among genetics, lifestyle, and surrounding environments have nonnegligible effects on disease evolution. Thus a transition in health-care area is urgently needed to address the hysteresis of diagnosis and stabilize the increasing health-care costs. In this chapter, we explored new insights in the field of health promotion and introduced the integration of systems theories with health science and clinical practice. On the basis of systems biology and systems medicine, a novel concept called "systems health" was comprehensively advocated. Two types of bioinformatics models, i.e., causal loop diagram and quantitative model, were selected as examples for further illumination. Translational applications of these models in systems health were sequentially discussed. Moreover, we highlighted the bridging of ancient and modern views toward health and put forward a proposition for citizen science and citizen empowerment in health promotion.

Exploring the Concept of Healing Spaces

Evidence-based design (EBD) research has demonstrated the power of environmental design to support improved patient, family, and staff outcomes and to minimize or avoid harm in healthcare settings. While healthcare has primarily focused on fixing the body, there is a growing recognition that our healthcare system could do more by promoting overall wellness, and this requires expanding the focus to healing. This article explores how we can extend what we know from EBD about health impacts of spatial design to the more elusive goal of healing. By breaking the concept of healing into antecedent components (emotional, psychological, social, behavioral, and functional), this review of the literature presents the existing evidence to identify how healthcare spaces can foster healing. The environmental variables found to directly affect or facilitate one or more dimension of healing were organized into six groups of variables—homelike environment, access to views and nature, light, noise control, barrier-free environment, and room layout. While there is limited scientific research confirming design solutions for creating healing spaces, the literature search revealed relationships that provide a basis for a draft definition. Healing spaces evoke a sense of cohesion of the mind, body, and spirit. They support healing intention and foster healing relationships.

Informing Healthcare Waiting Area Design Using Transparency Attributes: A Comparative Preference Study

Objective:

This study aimed to explore people’s visual preference for waiting areas in general hospital environments designed with transparency attributes that fully integrate nature.

Background:

Waiting can be a tedious and frustrating experience among people seeking healthcare treatments and negatively affect their perception of the quality of care. Positive distractions and supportive designs have gained increasing attraction to improve people’s waiting experience. Nature, which has shown therapeutic effects according to a growing amount of evidence, could be a distinguished positive distraction in waiting areas. Additionally, the theory of transparency was operationalized to indicate a spatial continuity between the external nature and the built interiors in general healthcare waiting area design.

Method:

A survey method was adopted in the study. Twenty-one images of general healthcare waiting areas depicting three design typologies were preselected following a strict procedure, including designs with (a) no window views, (b) limited window views to nature, and (c) transparent spaces with maximum natural views. Ninety-five student participants rated the images based on their visual preference using a Likert-type scale.

Results and Conclusions:

The results showed that transparent waiting areas were significantly preferred. A significant positive relationship existed between the level of transparency and people’s preference scores. The factor analysis indicated additional supportive features that may affect people’s preferences, including daylight, perceived warmth, noninstitutional furniture arrangement, visual orientation, and the use of natural materials for interior design. However, these tentative results need to be furthered tested with the real patient population as the next step of this study.

Elements of yogic practice: Perceptions of students in healthcare programs

BACKGROUND

The practice of yoga has a long history as an integrated lifestyle science. Those who have practiced yoga in its full form (including all eight traditional aspects) find that it touches almost every aspect of their inter- and intra-personal lives. Despite this rich history, the West has adopted limited aspects of yoga practice. When understood narrowly as a physical fitness practice, healthful benefits of yoga may be lost, possibly promoting body-consciousness and injury instead.

AIM

To understand whether students in healthcare programs view yoga from a physical fitness versus holistic perspective, we explored perceptions of what constitute yoga's essential practices.

METHODS

We assessed endorsement of the eight limbs of yoga via the acceptability of yoga survey. The sample (n = 498) was recruited from programs in 10 healthcare professions at a Northwestern university. Participants were categorized as nonyogis, contemplators, yogis, and superyogis.

RESULTS

Across all groups, findings confirmed a narrow definition of yoga as portrayed in popular media and gym-based yoga classes. Breathing and posture practices were the most commonly endorsed practices, even among the sample's most seasoned yoga practitioners. Ethical practices and daily commitments of introspection, disciplined practice, or living with purity were least commonly associated with yoga despite their foundational nature in yoga philosophy. Concentration and meditation practices were only moderately endorsed as essential practices. Super-yogis endorsed a wider variety of limbs than nonyogis, contemplators, and yogis.

CONCLUSIONS

We offer a rationale for these findings along with recommendations that may help augment the definition of yoga and hence maximize its benefits.

The design and testing of interactive hospital spaces to meet the needs of waiting children

OBJECTIVE

To design an innovative interactive media display in a pediatric hospital clinic waiting space that addresses the growing demand for accessible, contact-surface-free options for play.

BACKGROUND

In healthcare settings, waiting can be anxiety provoking for children and their accompanying family members. Opportunities for positive distraction have been shown to reduce waiting anxiety, leading to positive health outcomes.

METHODS

An interactive media display, ScreenPlay, was created and evaluated using a participatory design approach and a combination of techniques including quality function deployment and mixed data elicitation methods (questionnaires, focus groups, and observations). The user and organizational design requirements were established and used to review contemporary strategies for positive distraction in healthcare waiting spaces and to conceptualize and test ScreenPlay. Ten staff members, 11 children/youths, and 6 parents participated in the design and evaluation of ScreenPlay.

RESULTS

ScreenPlay provided a positive, engaging experience without the use of contact surfaces through which infections can be spread. It was accessible to children, youth, and adults of all motor abilities. All participants strongly agreed that the interactive media display would improve the healthcare waiting experience.

CONCLUSIONS

ScreenPlay is an interactive display that is the result of a successful model for the design of healthcare waiting spaces that is collaborative, interdisciplinary, and responsive to the needs of its community.

KEYWORDS

Design process, healing environments, hospital, interdisciplinary, pediatric.

Stressed spaces: mental health and architecture

OBJECTIVE

To present a comprehensive review of the research literature on the effects of the architectural designs of mental health facilities on the users.

BACKGROUND

Using a team of cross-disciplinary researchers, this review builds upon previous reviews on general and geriatric healthcare design in order to focus on research undertaken for mental health care facility design.

METHODS

Sources were gathered in 2010 and 2011. In 2010 a broad search was undertaken across health and architecture; in 2011, using keywords and 13 databases, researchers conducted a systematic search of peer reviewed literature addressing mental health care and architectural design published between 2005 to 2012, as well as a systematic search for academic theses for the period 2000 to 2012. Recurrent themes and subthemes were identified and numerical data that emerged from quantitative studies was tabulated.

RESULTS

Key themes that emerged were nursing stations, light, therapeutic milieu, security, privacy, designing for the adolescent, forensic facilities, interior detail, patients' rooms, art, dementia, model of care, gardens, post-occupancy evaluation, and user engagement in design process. Of the 165 articles (including conference proceedings, books, and theses), 25 contained numerical data from empirical studies and 7 were review articles.

CONCLUSIONS

Based on the review results, especially the growing evidence of the benefits of therapeutic design on patient and staff well-being and client length of stay, additional research questions are suggested concerning optimal design considerations, designs to be avoided, and the involvement of major stakeholders in the design process.

KEYWORDS

Evidence-based design, hospital, interdisciplinary, literature review, post-occupancy.

Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes

INTRODUCTION

Placebo and nocebo represent complex and distinct psychoneurobiological phenomena in which behavioural and neurophysiological modifications occur together with the application of a treatment. Despite a better understanding of this topic in the medical field, little is known about their role in physiotherapy.

PURPOSE

The aim of this review is: a) to elucidate the neurobiology behind placebo and nocebo effects, b) to describe the role of the contextual factors as modulators of the clinical outcomes in rehabilitation and c) to provide clinical and research guidelines on their uses.

IMPLICATIONS

The physiotherapist's features, the patient's features, the patient-physiotherapist relationship, the characteristics of the treatment and the overall healthcare setting are all contextual factors influencing clinical outcomes. Since every physiotherapy treatment determines a specific and a contextual effect, physiotherapists should manage the contextual factors as a boosting element of any manual therapy to improve placebo effects and avoid detrimental nocebo effects.

Study protocol: developing a decision system for inclusive housing: applying a systematic, mixed-method quasi-experimental design

BACKGROUND

Identifying the housing preferences of people with complex disabilities is a much needed, but under-developed area of practice and scholarship. Despite the recognition that housing is a social determinant of health and quality of life, there is an absence of empirical methodologies that can practically and systematically involve consumers in this complex service delivery and housing design market. A rigorous process for making effective and consistent development decisions is needed to ensure resources are used effectively and the needs of consumers with complex disability are properly met.

METHODS/DESIGN

This 3-year project aims to identify how the public and private housing market in Australia can better respond to the needs of people with complex disabilities whilst simultaneously achieving key corporate objectives. First, using the Customer Relationship Management framework, qualitative (Nominal Group Technique) and quantitative (Discrete Choice Experiment) methods will be used to quantify the housing preferences of consumers and their carers. A systematic mixed-method, quasi-experimental design will then be used to quantify the development priorities of other key stakeholders (e.g., architects, developers, Government housing services etc.) in relation to inclusive housing for people with complex disabilities. Stakeholders randomly assigned to Group 1 (experimental group) will participate in a series of focus groups employing Analytical Hierarchical Process (AHP) methodology. Stakeholders randomly assigned to Group 2 (control group) will participate in focus groups employing existing decision making processes to inclusive housing development (e.g., Risk, Opportunity, Cost, Benefit considerations). Using comparative stakeholder analysis, this research design will enable the AHP methodology (a proposed tool to guide inclusive housing development decisions) to be tested.

DISCUSSION

It is anticipated that the findings of this study will enable stakeholders to incorporate consumer housing preferences into commercial decisions. Housing designers and developers will benefit from the creation of a parsimonious set of consumer-led housing preferences by which to make informed investments in future housing and contribute to future housing policy. The research design has not been applied in the Australian research context or elsewhere, and will provide a much needed blueprint for market investment to develop viable, consumer directed inclusive housing options for people with complex disability.

Creating Welcoming Spaces for Lesbian, Gay, Bisexual, and Transgender (LGBT) Patients: An Evaluation of the Health Care Environment

Health outcomes are affected by patient, provider, and environmental factors. Previous studies have evaluated patient-level factors; few focusing on environment. Safe clinical spaces are important for lesbian, gay, bisexual, and transgender (LGBT) communities. This study evaluates current models of LGBT health care delivery, identifies strengths and weaknesses, and makes recommendations for LGBT spaces. Models are divided into LGBT-specific and LGBT-embedded care delivery. Advantages to both models exist, and they provide LGBT patients different options of healthcare. Yet certain commonalities must be met: a clean and confidential system. Once met, LGBT-competent environments and providers can advocate for appropriate care for LGBT communities, creating environments where they would want to seek care.

How Patients and Nurses Experience an Open Versus an Enclosed Nursing Station on an Inpatient Psychiatric Unit

The inpatient environment is a critical space for nurses and patients in psychiatric settings. In this article, we describe nurses' and patients' perceptions of the inpatient environment both before the removal of a Plexiglas enclosure around a nurses' station and after its removal. Nurses had mixed feelings about the enclosure, reporting that it provided for confidentiality and a concentrated work space but also acknowledged the challenge of the barrier for communication with their patients. Patients unanimously preferred the nurses' station without the barrier, reporting increased feelings of freedom, safety, and connection with the nurses after its removal. It is important to consider the implications of environmental decisions in inpatient settings in order to promote a healthy workplace and healing environment for all community members.