Insights & Solutions

Shepley, M. M., Peditto, K., Sachs, N. A., Pham, Y., Barankevich, R., Crouppen, G., Dresser, K. (2021) Staff and resident perceptions of mental and behavioural health environments. Building Research & Information

The patient perspective is unique, cannot be replicated, and is crucial for designing effective healthcare environments. Every person is an expert when it comes to their own experience, and everyone’s experience is informed by their unique perspective.

Wang, Z., & Pukszta, M. (2018). Private Rooms, Semi-Open Areas, or Open Areas for Chemotherapy Care: Perspectives of Cancer Patients, Families, and Nursing Staff. HERD: Health Environments Research & Design Journal

Designers should consider spaces that provide options for privacy, social interaction, and access to nurses, and views of nature. The number of patients (or treatment pods) per treatment area depends on several constraints set in each project, but designers can refer to the suggestions made in this study (5 to 6.5 patients) as a jumping off point for discussion.

FGI (2014) recommends that the size of the treatment area and ratio of open patient care stations and private bays/cubicles/rooms should depend on the patient acuity mix and planned use of the unit, and that at least one private treatment room is recommended. This study supports the guideline, showing that a mix of treatment spaces can support the various needs and preferences patients, families, and staff may have. Patient and staff needs are likely to vary from day to day and project to project, and flexibility in treatment area types can support this.   While the minimum standards provided by FGI and current best practices are a great starting point, many organizations will want to go above and beyond in providing the best possible environment for their patients. This study attempts to find out what “the best” might include.

Hopkins, S., Morgan, P. L., Schlangen, L. J. M., Williams, P., Skene, D. J., & Middleton, B. (2017). Blue-enriched lighting for older people living in care homes: Effect on activity, actigraphic sleep, mood and alertness. Current Alzheimer Research

As we get older, sleep quality suffers, and poor sleep can lead to poor overall health. Our circadian function plays a major role in the quality of our sleep, and research suggests that the physical environment can support better circadian function. Some research shows that residents with dementia in care homes experienced better sleep when exposed to increased light levels. The authors believe this to be the first study to look at the effect on a general population of older people not diagnosed with dementia.

Altizer, Z., Canar, W. J., Redemske, D., Fullam, F., & Lamont, M. (2019). Utilization of a Standardized Post-Occupancy Evaluation to Assess the Guiding Principles of a Major Academic Medical Center. HERD: Health Environments Research & Design Journal

“Let’s do a POE.” Seems simple, right? Design professionals get the potential value of post-occupancy evaluation, but they often find that there is zero time after construction is complete to create a POE tool and go through the evaluation process. Can standardized tools that have customizable features provide a balanced solution to this evaluation conundrum?  

Dhala, A., Sasangohar, F., Kash, B., Ahmadi, N., & Masud, F. (2020). Rapid implementation and innovative applications of a virtual ICU during the COVID-19 pandemic: A case study. Journal of Medical Internet Research

The novelty of the coronavirus, combined with the complexity of treating COVID-19 patients, forced many organizations to redirect their critical care staff to the COVID-19 units for 24-hour bedside coverage. The hospital accelerated and expanded their tele-critical care program that connected ICU patient rooms to remote caregivers - virtual ICU (vICU). This technology ended up augmenting their critical care capacity during the COVID-19 surge. The program was expedited with COVID, and over the weeks, multiple ICUs implemented the vICU and became COVID-19 units.  While the program was not intended for virtual visits, the virtual setup became a welcomed communication tool during the pandemic. The Ops Center collaborated with bedside staff to coordinate virtual family visits, which improved emotional well-being for patients and families. Anxiety about PPE shortages were alleviated, and medical staff and specialists felt more protected with a reduced number of times they had to go into the room.

Lednicky, J. A., Lauzardo, M., Hugh Fan, Z., Jutla, A., Tilly, T. B., Gangwar, M., Usmani, M., Shankar, S. N., Mohamed, K., Eiguren-Fernandez, A., Stephenson, C. J., Alam, M. M., Elbadry, M. A., Loeb, J. C., Subramaniam, K., Waltzek, T. B., Cherabuddi, K., Glenn Morris, J., & Wu, C. Y. (2020). Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients. International Journal of Infectious Diseases

There has been ongoing debate about how SARS-CoV-2 is transmitted – is it just droplets? Or does it also transmit by air? Lednicky and colleagues developed a sampling method to test air in a shared patient room with COVID19-positive patients. The air samplers were located at a distance greater than 6’ from the patients. The results showed a complete sequence of SARS-CoV-2 collected from an air sample was an exact match with the virus isolated from patient 1. This study does clearly suggest there is an inhalation risk for acquiring COVID-19 beyond the 6’ practice of physical or social distancing. For designers, aerosolization raises questions about HVAC systems and air changes, but since HVAC design wasn’t the purpose of this study, we know we need to continue to work with engineering professional to establish how to best mitigate transmission by air.

Mills, P. D., C. Soncrant, J. Bender, and W. Gunnar. “Impact of Over-the-Door Alarms: Root Cause Analysis Review of Suicide Attempts and Deaths on Veterans Health Administration Mental Health Units.” General Hospital Psychiatry 64

In order to reduce inpatient suicide, ligature resistance has been a focus of CMS and accrediting organizations for the past several years, but questions remain as to how far we go and where the real risks lie. In this study based in the Veterans Administration, researchers conducted a retrospective review and analysis of system-wide data of suicide deaths and attempts. As with other studies, the majority of suicides or attempts involved hanging, most of which used doors as the anchor point. Of events where the patient was using a door, more than a third involved an over-the-door alarm (OTD), and none of those events included a death. While correlation does not prove causation, the results suggest that OTD alarms prevented death. Knowing the alarm might alert staff became part of the deterrent. Quite simply, in mental health units where the risk of patients committing suicide is high, OTD alarms may help save lives, as part of a comprehensive strategy that includes sight lines, rounding, ongoing maintenance, and even ligature resistant bedding.

Momeni, M., Jamshidimanesh, M., & Ranjbar, H. (2020). Effectiveness of a Snoezelen Room on fear, anxiety, and satisfaction of nulliparous women: A randomized controlled trial. Iranian Journal of Psychiatry and Behavioral Sciences

We have a number of studies looking at the influence of room design on birth and birthing outcomes, but understanding any implications of room design are important because it potentially influences the health of both the mom and baby. The researchers conducted a 13-month randomized control trial with first-time mothers who were either in a standard room or a multi-sensory room. The multi-sensory room included aspects of sight, sound and smell. Measures were taken before, during, and after birth. During the birthing, the fear score went down with every measurement phase in the sensory room while it went up in every phase in the standard room. Results also showed that the mean score of anxiety decreased across all phases in the multi-sensory room. In addition, the total mean score of birth satisfaction was 163 in the intervention room and only about 75 in the control room. This study addresses cultural context, but it also takes what we know about positive distractions and pain and what we know about multi-sensory environments and the regulation of behavior, and applies that evidence in a different setting – one for birth.

King, B., Bodden, J., Steege, L., & Brown, C. J. (2020). Older adults experiences with ambulation during a hospital stay: A qualitative study. Geriatric Nursing

The inability to independently ambulate during an admission frequently results in “hospital associated disability” for older adults. Understanding and addressing ambulatory barriers from their point of view is essential to facilitate better outcomes. Focus groups were conducted to solicit and categorize responses. Researchers uncovered a new place-based concept that they referred to as “Danger Zones.” Unwelcoming environments, inadequate care planning, and interpersonal biases all contribute to challenges with older patient’s lack of ambulation. This study provides a prototype for identifying barriers to ambulation in healthcare settings from the perspective of older adults as well as a broader range of inpatients.

Martins, B. A., Barrie, H., Visvanathan, R., Daniel, L., Martins, L. A., Ranasinghe, D., Wilson, A., & Soebarto, V. (2020). A multidisciplinary exploratory approach for investigating the experience of older adults attending hospital services. HERD: Health Environments Research & Design Journal, in press.

Giving older adults and others with functional limitations a place to temporarily land while ambulating is the least we an do to promote their functional health in hospitals.