Abstract
BackgroundResearch shows that worn-out physical environments are obstacles to psychiatric inpatient care. Patients want better relationships with staff and things to do; staff want an environment that offers hope, a calm atmosphere, and joint activities. A county council in northern Sweden and Philips Healthcare partnered to create solutions to the environmental challenges of psychiatric inpatient care. One ward at a county psychiatric clinic was selected for a pilot project to test solutions that could improve the care environment for patients, staff, and relatives. The aim of the overall project is to evaluate the effects of a newly designed psychiatric inpatient ward on patients and staff in terms of quality of care and stress. In this study, we focus on the feasibility through testing questionnaires and exploring barriers to recruiting staff and patients.MethodsThis study had a single-system experimental design, comparing a psychiatric unit pre- and post-implementation of the novel spatial design, using repeated measures with the same questionnaires twice a week during baseline and intervention phases. Primary outcomes were quality interactions (patients) and perceived stress (staff). Secondary outcomes were levels of anxiety and depression (patients), and stress of conscience (staff). A process evaluation was aimed to describe contextual factors and participant experiences of the new design. Data was collected using questionnaires and semi-structured individual interviews with patients and focus group discussions with staff. Both visual and statistical methods were used to analyse the quantitative data and content analysis for the qualitative data.DiscussionThe findings will contribute insights into whether and how a new spatial design might contribute to quality interactions and reduced stress. This is relevant both nationally and internationally, as similar interventions are needed but sparse. The findings will be disseminated through peer-reviewed publications and conference presentations.Trial registrationClinicalTrials.gov, NCT03140618, registered 4 May 2017
Highlights
Research shows that worn-out physical environments are obstacles to psychiatric inpatient care
We focus on the feasibility of the project, and the objectives are to test the questionnaires and explore barriers to the recruitment of staff and patients
Combining the system experimental design (SSED) with a process evaluation is considered highly valuable [54]. Collecting both quantitative and qualitative data will offer opportunities to describe the introduction of the new spatial design from different viewpoints
Summary
This is an intervention project using a single-system experimental design (SSED) with baseline and intervention phases [32]. Data for the system will consist of aggregated measurements from patients and staff respectively on the ward [32, 33]. Participants During phase A, phase B, and the follow-up, all patients admitted to the ward will be informed about the project by a research assistant They will be invited to participate in the evaluation, which comprises completing questionnaires, using an activity monitor, and taking part in semi-structured interviews. Based on results from previous research [13, 35, 36] showing that staff in psychiatric inpatient care experience stress related to inadequate physical environments, the primary outcome measure for staff will be perceived stress. Measurement data for each of the questionnaires will consist of the mean ratings from all participants, patients, and staff respectively, answering at each point in time. Qualitative content analysis is an interpretive process, focusing on subject and context, considering differences and similarities between and within parts of the texts [53]
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