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Exploring staff perceptions on the role of physical environment in dementia care setting

Originally Published:
Key Point Summary
Key Point Summary Author(s):
Zborowsky, Terri
Key Concepts/Context

Person-centered care is spreading into environments for the elderly population, particularly those with dementia. It is a philosophy of care recognizing that each person has an equal right to dignity, respect, and to participate in their environment (Alzheimer Society of Canada, 2011; Brooker & Surr, 2005).  Recently, attention in the literature has been paid to studying the impact the built environment has on people with dementia. However, there is very little literature on the perceptions and experiences of the staff who work in these environments.


The purpose of this study was to examine staff perceptions on the effect of physical environmental features on residents’ behaviors and their care practices in two care facilities in Vancouver, Canada.


The method used for this study was focus groups of the staff. Participants were informed that the researchers were interested in the architecture or spatial layout (e.g., corridor length and bathroom size), interior design aspects (e.g., lighting, flooring, and furnishings), and sensory aspects (e.g., noise, smell, and tactile properties) along with questions about staff job satisfaction. The two facilities selected for the study had different environmental features; one facility was designed with 12-bed units, short corridors, and all private bedrooms. The other facility was based a more traditional design with 30-bed units, longer corridors, and mixed single/semiprivate bedrooms.

Design Implications
These findings suggest that the design of the physical environment housing people with dementia is significant in influencing the staff’s quality of work, as well as their job satisfaction, which are related to residents’ care experiences. When staff felt supported by the environment, they were happier and more effective in caring for residents.

Data analysis revealed two main themes and seven subthemes.  The main themes were a supportive physical environment contributes positively to both quality of staff care practice and residents’ quality of life, and an unsupportive physical environment contributes negatively to residents’ quality of life and thereby makes the work of staff more challenging. The subthemes are comfort, familiarity, an organized space, stimulation overload, safety risks, way-finding challenges, and rushed care. Authors noted that their findings support the theory of person-centered care.  Overall, staff were positive about the small-unit facility and found the traditional facility created feelings of exhaustion.


Data from focus groups has limited generalizability, particularly with small groups such as those found in this study. The authors also noted that having the director of nursing in the focus groups may have affected the participants’ responses.

Key Point Summary Author(s):
Zborowsky, Terri
Primary Author
Lee, S. Y.