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Fenkart L, von Nitzsch R, Höggemann E, Spreckelsen C. Using value-focused thinking to elicit oncologic inpatients' life and treatment objectives: a qualitative interview study. J Int Med Res 2024; 52:3000605241266224. [PMID: 39082318 PMCID: PMC11295223 DOI: 10.1177/03000605241266224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/10/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE Value-focused thinking (VFT) is a decision-making method that places the qualitative elicitation of decisionmakers' objectives at the beginning of the decision-making process. A potential healthcare application of VFT is to elicit patients' objectives to better understand what matters to them. Only then can treatments be tailored accordingly. This is particularly important for patients with life-threatening diseases such as cancer. Thus, this interview study used VFT to elicit the life and treatment objectives of non-terminal oncologic inpatients. METHODS Fifteen cancer inpatients (median age 66 years) were sampled in a German university hospital in September 2019. The participants completed questionnaires, the data of which were used to semi-structure the subsequent interviews. Data were analysed using inductive category formation to identify objectives in the transcribed interviews. RESULTS Sixteen objectives in five life domains (optimising physical wellbeing, optimising mental wellbeing, optimising personal life, optimising family life and optimising financial life) were identified. CONCLUSION Comparison of the findings with previous research indicated that VFT is a reliable approach to elicit patients' objectives. The identified objectives could increase understanding of the outcomes that cancer inpatients care about.
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Affiliation(s)
- Lukas Fenkart
- Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Rüdiger von Nitzsch
- Department of Decision Theory and Financial Services, RWTH Aachen University, Aachen, Germany
| | - Esther Höggemann
- Department of Decision Theory and Financial Services, RWTH Aachen University, Aachen, Germany
| | - Cord Spreckelsen
- Institute for Medical Statistics, Computer Science and Data Science (IMSID), Friedrich Schiller University Jena, Jena, Germany
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Pasha S, Shepley MM. A Structured Literature Review on the Research and Design of Rehabilitation Environments. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241248604. [PMID: 38742748 DOI: 10.1177/19375867241248604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
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.
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Seale B, Davis A, Lawson J, Smith L, Watson J, Henderson-Wilson C. Nature-Based Design in Stroke Rehabilitation Environments: A Scoping Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241251832. [PMID: 38742749 DOI: 10.1177/19375867241251832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
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.
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Affiliation(s)
- Belinda Seale
- Health Nature & Sustainability Research Group, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Aaron Davis
- UniSA Creative, University of South Australia, Adelaide, Australia
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Justin Lawson
- Health Nature & Sustainability Research Group, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Louisa Smith
- Disability and Inclusion, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Joanne Watson
- Disability and Inclusion, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Claire Henderson-Wilson
- Health Nature & Sustainability Research Group, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
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Houssaini MS, Aboutajeddine A, Toughrai I. Development of a Data-Centric Design Thinking Process for Innovative Care Delivery. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:146-165. [PMID: 38062743 DOI: 10.1177/19375867231215071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
OBJECTIVES This work aims to improve the quality of care provided to patients by equipping caregivers with comprehensive set of problem-solving tools and competencies. This is achieved through the development of a customized health design process that incorporates both human-centric and data-centric tools. BACKGROUND To meet the growing complexity of today's clinical practice, caregivers need to be empowered with the tools and competencies necessary to address the multifaceted challenges they encounter. This has emphasized the need to broaden the traditional role of caregivers as evidence-based practitioners to include being healthcare problem-solvers and innovators who utilize their creative and critical thinking skills. METHOD While design thinking (DT) is a popular methodology that fosters caregivers' empathy and creativity, it does not provide tools for evaluating the quality of obtained solutions. To address this gap, a problem-solving process that combines DT and data-centric tools of the Lean Six Sigma method was developed in this work. RESULTS The evaluation of this customized design process was based on targeted competencies derived from the six aims of healthcare. The potential benefits are then highlighted through mapping the possible outputs of every phase with the targeted set of caregivers' skills. Additionally, an implementation plan was outlined for a local hospital, showcasing the potential impact this process can have in empowering caregivers with the necessary competencies to create effective and innovative solutions for care delivery. CONCLUSION Overall, This unique approach has the potential to contribute to the ongoing effort to transform healthcare into an efficient system that meets the needs of both patients and caregivers.
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Affiliation(s)
- M Squalli Houssaini
- Laboratory of Mechanical Engineering, Faculty of Science and Technology of Fez, Sidi Mohamed Ben Abdellah University, Morocco
| | - A Aboutajeddine
- Laboratory of Mechanical Engineering, Faculty of Science and Technology of Fez, Sidi Mohamed Ben Abdellah University, Morocco
| | - I Toughrai
- Laboratory of Epidemiology and Research in Healthcare Sciences 'ERESS', Hassan II University Hospital, Fez, Morocco
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Ribbe Kelso L, Stockton K, Mahendran N, Brauer SG, Rosbergen I. The influence of communal spaces on patient activity in rehabilitation: a mixed methods study. Disabil Rehabil 2024; 46:309-321. [PMID: 36587814 DOI: 10.1080/09638288.2022.2160834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE This study aimed to determine whether patients are more active in communal spaces compared to their bedrooms and explore patient perspectives on communal spaces for activity, rest, and wellbeing. MATERIALS AND METHODS A prospective study observed participants via behavioural mapping in a mixed inpatient rehabilitation unit for up to three days. Physical, social, and cognitive activity levels in communal spaces were compared with activity in bedrooms using independent t-tests. Three focus groups explored participants' perspectives on communal spaces for activity, rest and wellbeing using thematic analysis. RESULTS Thirty-three participants (age 71.6 ± 13years, 39%male) were observed, and a subset (n = 12) (age 67.3 ± 16.9, 50%male) participated in focus groups. Participants spent a greater proportion of time being physically active (mean difference 22.7%, 95%CI 8.7-36.6, p = 0.002) and socially active (mean difference 23.6%, 95%CI 9.1-38.1, p = 0.002) in communal spaces than bedrooms. No difference in cognitive activity was found. Participants perceived communal spaces to positively influence mood and activity. Reduced independence was a barrier, while visitors, activities, and an inviting design attracted people to communal areas. CONCLUSION Communal spaces may positively influence patient activity and mood during inpatient rehabilitation. Future studies should seek strategies to optimise engagement in communal environments.IMPLICATIONS FOR REHABILITATIONOptimising patient activity throughout the day in inpatient rehabilitation is important to support recovery.Communal spaces in inpatient rehabilitation hospitals can positively influence patient activity and mood.Strategies to promote use of communal spaces in the inpatient rehabilitation hospital are needed.
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Affiliation(s)
- Lucy Ribbe Kelso
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kellie Stockton
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Niruthikha Mahendran
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sandra G Brauer
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Ingrid Rosbergen
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Department of Physiotherapy, Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
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Saa JP, Lipson-Smith R, White M, Davis A, Yang T, Wilde J, Blackburn M, Churilov L, Bernhardt J. Stroke Inpatient Rehabilitation Environments: Aligning Building Construction and Clinical Practice Guidelines Through Care Process Mapping. Stroke 2023; 54:2946-2957. [PMID: 37846565 DOI: 10.1161/strokeaha.123.044216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/01/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Stroke inpatient rehabilitation is a complex process involving stroke survivors, staff, and family utilizing a common space for a shared purpose: to optimize recovery. This complex pathway is rarely fully described. Stroke care is ideally guided by Clinical Practice Guidelines, and the rehabilitation built environment should serve to optimize care delivery, patient and staff experience. We aimed to articulate the inpatient stroke rehabilitation process of care in a series of process maps, and to understand the degree to which current stroke clinical and building construction (ie, design) guidelines align to support inpatient stroke rehabilitation. METHODS We used the Value-Focused Process Engineering methodology to create maps describing the events and activities that typically occur in the current stroke inpatient rehabilitation service model. These maps were completed through individual and group session consultations with stroke survivors, architects, policy makers, and clinical experts. We then determined which sections of the Australian Stroke Rehabilitation Guidelines and the Australasian Health Facility Design Guidelines could be aligned and applied to the process maps. RESULTS We present a summary process map for stroke inpatient rehabilitation, alongside detailed process maps for 4 different phases of rehabilitation (admission, a normal weekday, a weekend day, and discharge) using Value-Focused Process Engineering notation. The integration of design and clinical guidelines with care pathway maps revealed where guidelines lack detail to be readily linked to current stroke inpatient care practice, providing an opportunity to design stroke inpatient rehabilitation spaces based on the activities occurring within them. CONCLUSIONS Our findings highlight gaps where clinical and design experts should work together to use guidelines to their full potential; and to improve the process of planning for future stroke rehabilitation units.
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Affiliation(s)
- Juan Pablo Saa
- The Florey Institute (Austin Site), University of Melbourne, VIC, Australia (J.P.S., R.L.-S., J.B.)
- La Trobe University, Bundoora Campus, Melbourne, VIC, Australia (J.P.S.)
| | - Ruby Lipson-Smith
- The Florey Institute (Austin Site), University of Melbourne, VIC, Australia (J.P.S., R.L.-S., J.B.)
- The MARCS Institute for Brain, Behaviour, and Development, Western Sydney University, Penrith, NSW, Australia (R.L.-S.)
| | - Marcus White
- Swinburne University of Technology, School of Design and Architecture, Melbourne, VIC, Australia (M.W., T.Y.)
| | - Aaron Davis
- University of South Australia, Adelaide, SA, Australia (A.D., J.W.)
| | - Tianyi Yang
- Swinburne University of Technology, School of Design and Architecture, Melbourne, VIC, Australia (M.W., T.Y.)
| | - Jack Wilde
- University of South Australia, Adelaide, SA, Australia (A.D., J.W.)
| | - Marnie Blackburn
- Australasian Health Facility Guidelines, Health Infrastructure/Australasian Health Infrastructure Alliance, New South Wales Health Infrastructure, NSW, Australia (M.B.)
| | - Leonid Churilov
- The University of Melbourne, Melbourne Medical School, VIC, Australia (L.C.)
| | - Julie Bernhardt
- La Trobe University, Bundoora Campus, Melbourne, VIC, Australia (J.P.S.)
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Janssen H, Bird ML, Luker J, Sellar B, Berndt A, Ashby S, McCluskey A, Ada L, Blennerhassett J, Bernhardt J, Spratt NJ. Impairments, and physical design and culture of a rehabilitation unit influence stroke survivor activity: qualitative analysis of rehabilitation staff perceptions. Disabil Rehabil 2022; 44:8436-8441. [PMID: 35113761 DOI: 10.1080/09638288.2021.2019840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to investigate rehabilitation staff perceptions of factors influencing stroke survivor activity outside of dedicated therapy time for the purpose of supporting successful translation of activity promoting interventions in a rehabilitation unit. MATERIALS AND METHODS Purposive sampling of multi-disciplinary teams from four rehabilitation units was performed, and semi-structured interviews were conducted by telephone, digitally audio-recorded and then transcribed verbatim. A stepped iterative process of thematic analysis was employed until data saturation was reached. RESULTS All but one of the 22 participants were female, the majority were either physiotherapists or occupational therapists, with a median of 4 years (interquartile range, 2-10) working at their respective rehabilitation units. Analysis of the data revealed three themes: (i) stroke survivor characteristics influence their activity outside therapy, (ii) the rehabilitation environment influences physical, cognitive, and social activity, and (iii) institutional priorities, staff culture, and attitude can be barriers to activity. Rehabilitation units were perceived to be unstimulating, and visitors considered enablers of activity when resources were perceived to be scarce. CONCLUSIONS Our results suggest careful consideration of the involvement of visitors, an individual's needs and preferences, and the institution's priorities and staff attitude may result in greater stroke survivor activity during rehabilitation.Implications for rehabilitationStaff should consider stroke survivor impairments and a rehabilitation unit's institutional priorities and staff attitudes when aiming to enhance stroke survivor engagement in activity.The physical and social environment of a rehabilitation unit can be optimised by rehabilitation staff to promote activity.Utilisation of visitors of stroke survivors on a rehabilitation unit may be one way to enhance engagement in activity.Discussion within the rehabilitation team concerning "ownership" of the role of supporting stroke survivor activity outside of structured therapy time may support better engagement in same.
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Affiliation(s)
- Heidi Janssen
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute and Hunter New England Local Health District, New Lambton Heights, Australia
| | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Julie Luker
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Ben Sellar
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Angela Berndt
- International Centre for Allied Health Evidence (iCAHE), Adelaide, Australia.,Occupational Therapy Australia (OTA), Fitzroy, Australia
| | - Samantha Ashby
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Annie McCluskey
- School of Health Sciences, The University of Sydney, Sydney, Australia.,The StrokeEd Collaboration, Sydney, Australia
| | - Louise Ada
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | | | - Julie Bernhardt
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Recovery, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne Australia
| | - Neil J Spratt
- School of Biomedical Sciences and Pharmacy, University of Newcastle and Hunter New England Local Health District, New Lambton Heights, Australia
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Shirozhan S, Arsalani N, Seyed Bagher Maddah S, Mohammadi-Shahboulaghi F. Barriers and facilitators of rehabilitation nursing care for patients with disability in the rehabilitation hospital: A qualitative study. Front Public Health 2022; 10:931287. [PMID: 36033757 PMCID: PMC9402936 DOI: 10.3389/fpubh.2022.931287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Nurses play a key role in providing rehabilitation care. In this regard, identifying the factors that affect their practice can be useful in planning to improve the quality of rehabilitation nursing care. This study aims to explore the experience of nurses and members of the rehabilitation team about barriers and facilitators of rehabilitation nursing care of patients with disability in the rehabilitation hospital. This qualitative study was conducted in the main public rehabilitation hospital in Tehran, Iran. Eighteen persons including 12 nurses in clinical and managerial positions, an occupational therapist, a physical medicine specialist, a patient, and an informal caregiver participated in this study. Participants were selected based on purposeful sampling. Data were collected through 18 in-depth semi-structured interviews and analyzed based on qualitative content analysis principles. Three themes were derived from the data analysis, which represented Barriers and facilitators related to nurses (specialized knowledge and skills, psychological status, mentoring, professional communication), barriers and facilitators related to the work environment (nurses' performance evaluation, nursing workforce, comprehensive care facilities, workplace design, specialized unit), barriers and facilitators related to patients and caregivers (patient's participation in nursing care, patient adaptation, efficiency of formal caregivers). The experiences of the rehabilitation team shows that not only nurses, but also the environment, patients, and caregivers can affect the provision of care and change the quality of care. Identifying these factors can help managers, researchers, and clinical nurses to facilitate and improve rehabilitation nursing care by modifying the influencing factors.
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Affiliation(s)
- Shima Shirozhan
- Nursing Department, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Narges Arsalani
- Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,*Correspondence: Narges Arsalani ;
| | | | - Farahnaz Mohammadi-Shahboulaghi
- Iranian Research Center on Aging, Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Parks RF, Wigand RT, Benjamin Lowry P. Balancing information privacy and operational utility in healthcare: proposing a privacy impact assessment (PIA) framework. EUR J INFORM SYST 2022. [DOI: 10.1080/0960085x.2022.2103044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rachida F Parks
- Computer Information Systems, Quinnipiac University, Hamden, Quinnipiac, USA
| | - Rolf T Wigand
- Emeritus College at Arizona State University, Scottsdale, Arizona, USA
| | - Paul Benjamin Lowry
- Pamplin College of Business Department of Business Information Technology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
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10
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Lakhani A, Waters D, Dema S. Evaluating an Inpatient Created Art Installation on Perceptions of the Physical Environment, Health Status, and Rehabilitation Motivation. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:96-111. [PMID: 35038888 DOI: 10.1177/19375867211069297] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES A methodology to assess the impact of involving end users in therapeutic activities to address the hospital physical environment is provided. The impact of participating in a recreational art creation program with the aim of developing an art installation on the immediate feelings of participants and their perception of the physical rehabilitation environment (PPRE) and motivation to participate in rehabilitation (MPR) is investigated. BACKGROUND Rehabilitation unit design has largely excluded the perspectives of end users with disability. Including their aesthetic design contributions moves beyond contemporary approaches where their perspectives are considered. METHODS A two-period, mixed-methods pre-post intervention design involving within and between group comparisons is proposed. During Period 1, program participants and nonparticipants completed admission (T1) and discharge (T2) surveys including PPRE and MPR measures developed by the authors. Surveys pre and post each art session were completed. The art installation will be implemented within unit corridors. Period 2 participants will complete a T1 survey and their physical environment perceptions compared to Period 1 participants. RESULTS Participating in the recreational art program significantly improved immediate levels of calmness, happiness, pain, and physical health. There is a positive relationship between environment perception and rehabilitation motivation. CONCLUSIONS People with disability should be actively involved in healthcare environment design. Arts-based programs have relevance to people with neurological injury as it promotes essential sensory stimulation. The methodology and findings can encourage further work which involves end users in the design of healthcare environments and evaluates the impact of their involvement.
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Affiliation(s)
- Ali Lakhani
- The School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Dan Waters
- Austin Health-Royal Talbot Rehabilitation Centre, Kew, Victoria, Australia
| | - Salvatore Dema
- Austin Health-Royal Talbot Rehabilitation Centre, Kew, Victoria, Australia
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Kenah K, Bernhardt J, Spratt NJ, Oldmeadow C, Janssen H. Depression and a lack of socialization are associated with high levels of boredom during stroke rehabilitation: An exploratory study using a new conceptual framework. Neuropsychol Rehabil 2022; 33:497-527. [PMID: 35142257 DOI: 10.1080/09602011.2022.2030761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This exploratory sub-study aimed to develop a framework to conceptualize boredom in stroke survivors during inpatient rehabilitation, establish the effect of an activity promotion intervention on boredom, and to investigate factors that are associated with boredom. A framework was developed and explored within a cluster non-randomised controlled trial. Self-reported boredom was measured in 160 stroke survivors 13 (±5) days after rehabilitation admission; 91 participants received usual-care (control) and 69 had access to a patient-driven model of activity promotion (intervention). Individuals with pre-existing dementia or unable to participate in standard rehabilitation were excluded. Hierarchical logistic regression analysis was used to identify demographic, health and activity measures associated with boredom. Results indicated 39% of participants were highly bored. There was no statistically significant difference in boredom levels between treatment groups (difference -11%, 95% CI -26% to 4%). The presence of depression (OR 6.17, 95% CI 2.57-14.79) and lower levels of socialization (OR 0.96, 95% CI 0.92-0.99) predicted high boredom levels. This comprehensive framework provides a foundation for understanding the many interacting factors associated with boredom. Results suggest managing depression and improving opportunities for socialization may support meaningful engagement in rehabilitation to optimize recovery following stroke.
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Affiliation(s)
- Katrina Kenah
- School of Health Sciences, The University of Newcastle, Newcastle, Australia.,Monash Health, Cheltenham, Australia
| | - Julie Bernhardt
- The Florey Institute of Neuroscience and Mental Health, NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Heidelberg, Australia
| | - Neil J Spratt
- Hunter Medical Research Institute, NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The University of Newcastle, Newcastle, Australia.,Department Neurology, John Hunter Hospital, Newcastle, Australia
| | | | - Heidi Janssen
- Hunter Medical Research Institute, NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The University of Newcastle, Newcastle, Australia.,Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia
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12
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Lipson-Smith R, Pflaumer L, Elf M, Blaschke SM, Davis A, White M, Zeeman H, Bernhardt J. Built environments for inpatient stroke rehabilitation services and care: a systematic literature review. BMJ Open 2021; 11:e050247. [PMID: 34353805 PMCID: PMC8344318 DOI: 10.1136/bmjopen-2021-050247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke, their family/caregivers and staff. DESIGN A convergent segregated review design was used to conduct a systematic review. DATA SOURCES Ovid MEDLINE, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched for articles published between January 2000 and November 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative, quantitative and mixed-methods studies investigating the impact of the built environment of inpatient rehabilitation facilities on stroke survivors, their family/caregivers and/or staff. DATA EXTRACTION AND SYNTHESIS Two authors separately completed the title, abstract, full-text screening, data extraction and quality assessment. Extracted data were categorised according to the aspect of the built environment explored and the outcomes reported. These categories were used to structure a narrative synthesis of the results from all included studies. RESULTS Twenty-four articles were included, most qualitative and exploratory. Half of the included articles investigated a particular aspect of the built environment, including environmental enrichment and communal areas (n=8), bedroom design (n=3) and therapy spaces (n=1), while the other half considered the environment in general. Findings related to one or more of the following outcome categories: (1) clinical outcomes, (2) patient activity, (3) patient well-being, (4) patient and/or staff safety and (5) clinical practice. Heterogeneous designs and variables of interest meant results could not be compared, but some repeated findings suggest that attractive and accessible communal areas are important for patient activity and well-being. CONCLUSIONS Stroke rehabilitation is a unique healthcare context where patient activity, practice and motivation are paramount. We found many evidence gaps that with more targeted research could better inform the design of rehabilitation spaces to optimise care. PROSPERO REGISTRATION NUMBER CRD42020158006.
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Affiliation(s)
- Ruby Lipson-Smith
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Luis Pflaumer
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Marie Elf
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Sarah-May Blaschke
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Aaron Davis
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Marcus White
- Centre for Design Innovation, The Swinburne University of Technology, Hawthorne, Melbourne, Australia
| | - Heidi Zeeman
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Julie Bernhardt
- Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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Smits M, Eddahchouri Y, Meurs P, Nijenhuis SM, van Goor H. Do Simulated Hospital Admissions Reflect Reality? A Qualitative Study of Volunteer Well-Being During a 24-Hr Simulated Hospitalization. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:130-146. [PMID: 34105390 PMCID: PMC8597193 DOI: 10.1177/19375867211020682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aims to delineate if and how healthy volunteers admitted to simulated care can aid in understanding real well-being experiences of in-hospital surgical patients. BACKGROUND Scientific research is necessary to understand the mediating effect of healthcare design on patient outcomes. Studies with patients are, however, difficult to conduct as they require substantial funding, time, and research capacity, and recovering patients are often not willing or able to participate. If studies conducted with volunteers provide similar findings, such studies might serve as fruitful alternatives for future research. METHOD A multimethod study was conducted between July 2017 and December 2017 with 17 volunteers who underwent a 24-hr simulated inpatient postsurgical care protocol. Data on value experiences, norms, and design requirements for an optimal healing environment were collected via diaries and semi-structured value-oriented interviews, focused on the values of spatial comfort, privacy, autonomy, sensory comfort, safety and security, and social comfort. Volunteers' outcomes were compared to prior literature on similar patients' outcomes. RESULTS Volunteers seem to experience their healing environment similarly to patients with regard to the values of spatial comfort, privacy, autonomy, sensory comfort, and social comfort related to contact with personnel and relatives. Less valuable insights were gained on the values of safety and security, and social comfort related to interaction with other patients, most probably due to the study design and because the participants did not truly experience a diseased bodily state. CONCLUSION Simulated hospital admissions with volunteers provide a satisfactory alternative for studying real patient outcomes.
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Affiliation(s)
- Merlijn Smits
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Yassin Eddahchouri
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Pleun Meurs
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sharon M Nijenhuis
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Rosbergen ICM, Tonello I, Clark RA, Grimley RS. Does hospital design impact on patient activity levels and time spent alone? Disabil Rehabil 2020; 44:3173-3180. [PMID: 33336598 DOI: 10.1080/09638288.2020.1861117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to quantify changes in patients' activity levels, location and people present, within one acute stroke unit (ASU) and one inpatient rehabilitation unit (IRU) with respect to change in hospital design. METHODS A prospective observational study using behavioural mapping. We observed participants from 8 am till 5 pm every 10 minutes across two days and compared participant activity (physical, social and cognitive), location and people present pre and post-transition to new units. Built design, staffing levels and models of care were contrasted. RESULTS We recruited 73 participants (63% stroke): old-ASU (n = 19); new-ASU (n = 15); old-IRU (n = 19); new-IRU (n = 20). Compared to old, new units had more single rooms, larger floor spaces and higher staffing levels. We found no significant change in participants' activity levels between the old and new ASU. Participants in the new IRU showed increased physical activity (43.4% vs. 54.4%, p = 0.02) but social and cognitive activity remained similar. Participants were more alone (ASU 47.4% vs. 66.7%, p = 0.01; IRU 41.7% vs. 58.3%, p < 0.001), and less often with nursing staff (ASU 17.7% vs. 6.7%, p = 0.04; IRU 18.8% vs. 5.7%, p < 0.001) in new units. CONCLUSION Hospital design appears to impact on patients' physical activity. Single rooms may increase isolation and reduce interaction with nursing staff.Implications for rehabilitationDesign of new rehabilitation units needs to consider patients' social engagement with family, friends, other patients and staff in addition to privacy and infection control.A change in built design of rehabilitation units should prompt observation of patients' activity levels and engagement with people and available space to ensure optimal use of new environments.Promotion of communal spaces and activities away from the bedroom to encourage social engagement is recommended for patients recovering in rehabilitation facilities.Less time in contact with nursing staff in rehabilitation environments with predominantly single rooms suggests a review of clinical practice and patient safety is warranted.
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Affiliation(s)
- I C M Rosbergen
- Allied Health Services, Sunshine Coast Hospital and Health Services, Birtinya, Australia.,Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - I Tonello
- Allied Health Services, Sunshine Coast Hospital and Health Services, Birtinya, Australia
| | - R A Clark
- School of Health and Sports Science, University of the Sunshine Coast, Sippy Downs, Australia
| | - R S Grimley
- Medical Service Division, Sunshine Coast Hospital and Health Services, Birtinya, Australia.,Sunshine Coast Clinical School, School of Medicine, Griffith University, Birtinya, Australia
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Lipson-Smith R, Zeeman H, Bernhardt J. What's in a Building? A Descriptive Survey of Adult Inpatient Rehabilitation Facility Buildings in Victoria, Australia. Arch Rehabil Res Clin Transl 2020; 2:100040. [PMID: 33543069 PMCID: PMC7853350 DOI: 10.1016/j.arrct.2020.100040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To identify all the services that offer inpatient rehabilitation in Victoria, Australia, and to describe the buildings in which these services are housed, including their size, age, whether or not they were purpose-built, whether or not they are colocated with a tertiary hospital, the proportion of single-bed rooms, and ward layout. DESIGN Cross-sectional survey of inpatient rehabilitation buildings. Data were collected via telephone questionnaire and websites. PARTICIPANTS Sixty-four rehabilitation facilities were identified and all participated in the survey (37 public, 27 private). RESULTS Results revealed heterogeneity on most variables measured, including size (number of beds ranged from 2-104), age (oldest building built in 1860, and 26% built since 2010), purpose-built status (48% purpose-built), freestanding status (34% freestanding), percentage of single-bed rooms (ranged from 0%-100%), and layout. All facilities had a therapy gym, and most had a communal area (96%). CONCLUSION Since 2010, the proportion of buildings being purpose-built and colocated with a tertiary hospital has increased. The proportion of single-bed rooms has also increased and is especially high in privately funded facilities. Results suggest that rehabilitation design is influenced by norms and evidence from acute medical health care despite the purpose of care being different: acute care (short-term, medical illness) and rehabilitation (longer-term, recovery, relearning).
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Affiliation(s)
- Ruby Lipson-Smith
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria
| | - Heidi Zeeman
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland
- The Hopkins Centre Research for Rehabilitation and Resilience, Brisbane, Queensland
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Victoria
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