Do the hospital rooms make a difference for patients’ stress? A multilevel analysis of the role of perceived control, positive distraction, and social support

Cláudia Campos Andrade,Ann Sloan Devlin,Cícero Roberto Pereira,Maria Luísa Lima

doi:10.1016/j.jenvp.2017.06.008

Abstract

The physical environment of healthcare settings can contribute to preventing or reducing patients' stress. Using Ulrich's theory of supportive design (1991), this study tested whether this relationship occurs because the physical environment promotes perceptions of control, positive distractions, and social support. The research disentangles the contribution of the objective qualities of physical environment to stress, over and above patients' perceptions about the environment. In a multi-site field study (five hospital units from two countries), 57 hospital rooms were assessed in terms of the number of favorable design features, and 187 patients responded to a questionnaire after surgery. Multilevel regression analysis showed that the greater the number of favorable design features, the less the patients' stress, that positive perceptions about the room qualities in terms of how much social support and distraction they provide explain this effect, and that the relative importance of these dimensions may differ between cultures.

Highlights

The qualities of the healthcare physical environment have been demonstrated to prevent or to reduce patients’ stress and to promote patients’ satisfaction and recovery (e.g., Ulrich et al, 2008)
One exception is the Theory of Supportive Design (Ulrich, 1991, 2001). This theory emphasizes three properties of healthcare settings that contribute to stress reduction: providing opportunities for environmental control, social support, and positive distraction
Distraction (b = -.12, SE = .05, t = -2.37, p = .019) predict a reduction in stress, but not Perceived Control (b = .03, SE = .04, t = 0.74, p = .459) (Figure 1). These results indicate that the effect of the number of favorable elements in the rooms is mediated by how much Social Support

Summary

Introduction

The qualities of the healthcare physical environment have been demonstrated to prevent or to reduce patients’ stress and to promote patients’ satisfaction and recovery (e.g., Ulrich et al, 2008). The application of this evidence to practice is still limited, which means that healthcare providers are missing an opportunity to improve the quality of care (e.g., Stall, 2012). Perhaps one barrier to more widespread consideration of the design of the physical environment in healthcare settings is the paucity of theory about the role of the physical environment on patients’ outcomes. One exception is the Theory of Supportive Design (Ulrich, 1991, 2001) This theory emphasizes three properties of healthcare settings that contribute to stress reduction: providing opportunities for environmental control, social support, and positive distraction

Objectives

Methods

Results

Discussion

Conclusion