Single Room Design Research Articles

The Experiences of Hospital Admission in a Single Room for Older Persons With Dementia and Their Families: A Scoping Review.

When older persons with dementia are admitted to hospital, they often feel disoriented and confused and their cognitive impairment may worsen, purely due to the sudden change in their environment. As such hospital design is recognised as an important aspect in the care and well-being of older persons with dementia. As the number of persons with dementia is increasing, the experience of admission to a hospital with, for example, single rooms is more relevant than ever. This scoping review aimed to identify, explore and conceptually map the literature reporting on what older people with dementia and their families experienced during admission to a hospital with single room accommodation. We followed the Joanna Briggs Institute recommendations for undertaking a scoping review. In addition, we used the Preferred Reporting Items for Systematic reviews (PRISMA-ScR) Checklist, which assisted the development and reporting of this scoping review. We included 10 sources within a time frame of 23 years (1998-2021). The sources originate from Europe, Australia and Canada. We identified three conceptual maps: Safety and security, Privacy and dignity and Sensorial stimulation. Our review demonstrates that the themes of the three conceptual maps are experienced as mutually interdependent for the older persons with dementia and their families. We conclude that it is not merely the single room design that determines what the older persons with dementia and their families experience as important; the exposure to sensorial stimulation and the presence of well-trained staff taking a dignified patient-centred approach are also crucial for their experience of high-quality nursing care.

Comparison of neonatal morbidity and mortality between single-room and open-bay care: a retrospective cohort study

ObjectiveIn response to the increasing focus on family-centred care, neonatal intensive care unit (NICU) environments have gradually shifted towards the single-room design. However, the assumed benefits of this emerging design...

How staying in a single room affects the experiences of haematology inpatients in an Australian cancer hospital.

It has been suggested that single rooms for patients improve patient dignity and privacy and reduce infection transmission, but they can be socially isolating. It is not well understood how single rooms affect long-stay patients. To understand the experience of being an inpatient in a ward with single-room design. A qualitative, phenomenological study was conducted using semi-structured interviews with patients (n=10) in a newly built cancer hospital with a 100% single-room haematology ward. Interviews were analysed using Colaizzi's (1978) seven-step analysis. Patients described their experiences of their acute stay using the concepts of privacy, isolation and independence, as well as enabling sleep. Privacy enabled patients to have their own toilet, was perceived to aid infection control and provided silence. Privacy came at a cost of isolation, but patients re-framed this as expected and necessary for self-preservation. Furthermore, they were unsure as to whether other patients would reciprocate social contact and instead relied on the healthcare team. Patients sought independence during their acute stay as it enabled them to control the environment and create a space for healing. The ability to sleep and be rested was also a critical feature of patients' stay. The research highlighted that haematology patients prefer single rooms. However, because they experienced isolation, it also highlighted the importance of facilitating and enabling peer support within the haematology setting.

Impact of transition from open bay to single room design neonatal intensive care unit on multidrug-resistant organism colonization rates

The influence of the neonatal intensive care unit (NICU) design on the acquisition of multidrug-resistant organisms (MDROs) has not been well-documented. To examine the effect of single room unit (SRU) versus open bay unit (OBU) design on the incidence of colonization with MDROs and third-generation cephalosporin-resistant bacteria (3G-CRB) in infants admitted to the NICU. Retrospective cohort study, including all infants admitted to the NICU of a tertiary care academic hospital two years prior to and two years following the transition from OBU to SRU in May 2017. Weekly cultures of throat and rectum were collected to screen for MDRO carriership. Incidence of colonization (percentage of all infants and incidence density per 1000 patient-days) with MDROs and 3G-CRB were compared between OBU and SRU periods. Incidence analysis of 1293 NICU infants, identified 3.2% MDRO carriers (2.5% OBU, 4.0% SRU, not significant), including 2.3% extended-spectrum β-lactamase-producing Enterobacterales carriers, and 18.6% 3G-CRB carriers (17% OBU, 20% SRU, not significant). No differences were found in MDRO incidence density per 1000 patient-days between infants admitted to OBU (1.56) compared to SRU infants (2.63). Transition in NICU design from open bay to SRUs was not associated with a reduction in colonization rates with MDROs or 3G-CRB in our hospital. Further research on preventing the acquisition and spread of resistant bacteria at high-risk departments such as the NICU, as well as optimal ward design, are needed.

The physical environment and patients' activities and care: A comparative case study at three newly built stroke units.

To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units. Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce. This work is a comparative descriptive case study. Patients (N=55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioural mapping analysed with descriptive statistics and field note taking analysed with deductive content analysis. Data were collected from April 2013 - December 2015. The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single-room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care. Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment.

Impact of single room design on the spread of multi-drug resistant bacteria in an intensive care unit

BackgroundCross-transmission of nosocomial pathogens occurs frequently in intensive care units (ICU). The aim of this study was to investigate whether the introduction of a single room policy resulted in a decrease in transmission of multidrug-resistant (MDR) bacteria in an ICU.MethodsWe performed a retrospective study covering two periods: between January 2002 and April 2009 (old-ICU) and between May 2009 and March 2013 (new-ICU, single-room). These periods were compared with respect to the occurrence of representative MDR Gram-negative bacteria. Routine microbiological screening, was performed on all patients on admission to the ICU and then twice a week. Multi-drug resistance was defined according to a national guideline. The first isolates per patient that met the MDR-criteria, detected during the ICU admission were included in the analysis. To investigate the clonality, isolates were genotyped by DiversiLab (bioMérieux, France) or Amplified Fragment Length Polymorphism (AFLP). To guarantee the comparability of the two periods, the ‘before’ and ‘after’ periods were chosen such that they were approximately identical with respect to the following factors: number of admissions, number of beds, bed occupancy rate, per year and month.ResultsDespite infection prevention efforts, high prevalence of MRD bacteria continue to occur in the original facility. A marked and sustained decrease in the prevalence of MDR-GN bacteria was observed after the migration to the new ICU, while there appear to be no significant changes in the other variables including bed occupancy and numbers of patient admissions.ConclusionSingle room ICU design contributes significantly to the reduction of cross transmission of MRD-bacteria.

Single room versus open-bay design in neonatal intensive care units for improvement in infant outcomes: a systematic review protocol.

The objective of this review is to identify the impact of single room neonatal intensive care unit (NICU) design on infant outcomes compared to alternative design.The specific question is: what is the impact of single room design on outcomes of infants cared for in intensive care units compared to those in alternative designs?

An experimental investigation devoted to determine heat transfer characteristics in a radiant ceiling heating system

Investigations on heated ceiling method can be considered as a new research area in comparison to the common wall heating-cooling and cooled ceiling methods. In this work, heat transfer characteristics of a heated radiant ceiling system was investigated experimentally. There were different configurations for a single room design in order to determine the convective and radiative heat transfer rates. Almost all details on the arrangement of the test chamber, hydraulic circuit and radiant panels, the measurement equipment and experimental method including uncertainty analysis were revealed in detail indicating specific international standards. Total heat transfer amount from the panels were calculated as the sum of radiation to the unheated surfaces, convection to the air, and conduction heat loss from the backside of the panels. Integral expression of the view factors was calculated by means of the numerical evaluations using Matlab code. By means of this experimental chamber, the radiative, convective and total heat-transfer coefficient values along with the heat flux values provided from the ceiling to the unheated surrounding surfaces have been calculated. Moreover, the details of 28 different experimental case study measurements from the experimental chamber including the convective, radiative and total heat flux, and heat output results are given in a Table for other researchers to validate their theoretical models and empirical correlations.

Location! Location! Location! The Impact of Single-Room Design on Neurodevelopment of Preterm Infants

Abstract BACKGROUND: The impact of neonatal intensive care unit (NICU) design on neurodevelopmental outcomes of preterm infants is uncertain. Although single room design (SRD) reduces nosocomial infections and improves breastfeeding rates and parental satisfaction, recent data suggests that SRD may be associated with language delays and alterations in cortical development. OBJECTIVES: To compare neurodevelopmental outcomes of preterm infants who received care in a contemporary SRD environment compared with a similar cohort who received care during an earlier period with an open bay design (OBD). DESIGN/METHODS: Retrospective single-centre cohort study comparing the neurodevelopmental outcomes of all surviving extremely low birth weight (ELBW) i nfants admitted within 24 hours of birth in 2009 (OBD epoch) and 2011 (SRD epoch). The primary outcome was moderate or severe neurodevelopmental impairment using the Bayley Scales of Infant Development, third edition (BSID-III) at 18 months corrected age. Secondary outcomes included severe NDI and BSID-III scores. Multivariable logistic regression (MLR) analysis was used to evaluate the independent association between NICU design and outcomes. RESULTS: The study included 100 ELBW infants in 2009, and 98 in 2011. The 2 epochs were similar in follow-up rates (80% in 2009; 82% in 2011) and infant characteristics (including those lost to follow up). Mortality was 7.9% in 2009 and 6.1% in 2011. BSID-III language scores (median [interquartile range]) were similar for infants in the OBD and SRD epochs (86 [71,100] vs. 81 [71,94], p=NS). On MLR analysis, NICU design was not associated with significant differences in NDI or BSID-III language score less than 80 after adjustment for antenatal and perinatal confounders. (Table1) CONCLUSION: There was no significant difference in NDI between cohorts of ELBW infants cared for in an SRD compared with an OBD NICU design environment. The contrast in findings from earlier studies may be attributable to the local context of government-supported parental leave and strong promotion of parental presence in the NICU.

How can we help staff transition to a new NICU design?

BackgroundResearch has highlighted transitioning to the new design may be challenging for staff. To facilitate the transition to a new NICU we have searched literature to find strategies other units have implemented during their transition. MethodologyLiterature was retrieved via electronic and manual searches of MEDLINE, CINAHL, Science Direct and Cochrane databases. A list of keywords directed our search: Intensive Care Units, Neonatal, Hospital Design and Construction, Single Room Design (SRD), Change Management and Staff Attitude to Change. ResultsSeven articles provided detailed outlines of the strategies they implemented during transition to SRD. Our search has also highlighted the limited published work on solving staff issues post transition. ConclusionThis review provides an outline of strategies to facilitate the transition when changing NICU design. Future research that specifically targets the issues highlighted by staff may assist in finding long term solutions for those transitioning to a new NICU design.

Implementation of Cycled Lighting in a Single-Room Neonatal ICU

“In Our Unit” highlights unique practices, innovations, research, or resourceful solutions to commonly encountered problems in critical care areas and settings where critically ill patients are cared for. If you have an idea for an upcoming “In Our Unit,” send it to Critical Care Nurse, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2049; e-mail, ccn@aacn.org. The NICU’s mission is to bring the baby back within the family’s embrace by nurturing the family’s role as caregivers. The practice of nursery lighting has changed over the past several decades. In the 1970s, the most prevalent strategy was to continually dim the lights in the entire patient care area or cover the infants’ incubators, on the theory that dim lighting was appropriate for premature infants because it was similar to the environment in utero. Research has shown that constant dimness deprives infants of the light stimulation needed to reset their biological clock every 24 hours. Lack of light impedes growth because less cortisol is produced. Exposure of premature infants to low-intensity cycled lighting induces distinct patterns of rest/activity that are apparent within 1 week after discharge. Infants exposed to early cycled light (at birth and 32 weeks postmenstrual age [PMA]) gain weight faster than infants who do not receive cycled lighting until 36 weeks PMA.

Impact of the physical environment in paediatric hospitals on health outcomes: a systematic review

Background Nesmith1 identified two roles for the physical settings in which health care is provided. One is as a tool to support productivity and effectiveness and the second is as healer: "… they are an end in themselves - aiding in the healing and wellness process through psychological and physiological effect…" (p. 671). Research to confirm this statement has been slowly accumulating over the last two decades, but primarily in the area of adult care. Although there are a plethora of articles describing the various creative and innovative approaches to physical design in paediatric hospitals, very few of these innovations have been evaluated in terms of their impact on the health outcomes of children and their families. Objectives The objective of this review was to determine from the available evidence the impact of the physical paediatric hospital environment on health outcomes of children and adolescents. Search Strategy Using a defined search and retrieval method, a wide range of indexes of periodical articles were accessed for the period 1980 to 2008 including both health and architectural databases. Unpublished studies from 1991 were sought using a variety of sources including Dissertation Abstracts, Index to Theses, conference proceedings, research and clinical trials registers and web sites of relevant professional associations. Inclusion criteria The review considered studies using either quantitative or qualitative methodologies or mixed methods that assessed the impact of physical design elements of a paediatric hospital environment including architectural, interior design, ambient features and /or features that supported patient and family centred care. The primary outcomes of interest were clinical or psychological, with other outcomes of interest being patient - family perceptions, including safety and security. Methodological quality Each study was assessed independently by two reviewers prior to inclusion in the review using standardised critical appraisal instruments developed by the Joanna Briggs Institute. As both assessors were in agreement on all studies a third reviewer was not required. Data extraction and synthesis Data was extracted independently from each of the included studies by two reviewers using standardised critical appraisal instruments developed by the Joanna Briggs Institute. Again there were no disagreements between the reviewers in relation to the data extracted from the quantitative studies. Agreement was reached on the synthesis of the findings from the two qualitative studies through discussion. Given the differences in study design, interventions and outcome measures in the quantitative studies, statistical pooling of the results was not possible and the findings are presented in a narrative form. Results Eight studies were included in the review with five elements of physical design addressed. In the sub-topic of physical building structures, single room design for paediatric intensive care units significantly reduced nosocomial infections as did the addition of negative pressure ventilation to single rooms in an isolation unit. The one study on the effect of specially designed gardens found very low usage rates but children who did visit them were actively engaged with both natural and structural features. On the same theme of active engagement a play centre designed to encourage symbolic play generated statistically significantly more total play and less unoccupied time or wandering as well as the type of play it was designed to encourage. The one study on art did not demonstrate that nature art was effective in reducing stress in hospitalised children. In regard to adolescents, the two themes that emerged in regard to physical facilities from the two qualitative studies were ways of maximising normal life and ways of supporting coping with the illness through ward design. Conclusion Given the small number of studies addressing five sub-topics, no firm conclusions can be drawn from the review. However the results suggest positive elements of physical design that could be considered for implementation to support a healing environment within paediatric hospitals or paediatric wards in general hospitals. Implications for research The review clearly illustrates the need for more research in this area assessing the health outcomes of innovations in physical design in paediatric hospitals or units. There are numerous opportunities for multidisciplinary studies and in varying cultural contexts. Implications for practice This review suggests a number of aspects of physical design that can be implemented although cost and cultural appropriateness are a consideration in several cases. These include the use of single rooms with negative pressure ventilation to control cross infection; the provision of both private and 'public' space for adolescent inpatients with 'public' spaces including spaces for interaction just with other peers; the incorporation of interactive gardens, however small, designed for families and their use encouraged by staff; and specially designed play structures to encourage symbolic play.

Impact of the physical environment in paediatric hospitals on health outcomes: a systematic review.

Nesmith identified two roles for the physical settings in which health care is provided. One is as a tool to support productivity and effectiveness and the second is as healer: "… they are an end in themselves - aiding in the healing and wellness process through psychological and physiological effect…" (p. 671). Research to confirm this statement has been slowly accumulating over the last two decades, but primarily in the area of adult care. Although there are a plethora of articles describing the various creative and innovative approaches to physical design in paediatric hospitals, very few of these innovations have been evaluated in terms of their impact on the health outcomes of children and their families. The objective of this review was to determine from the available evidence the impact of the physical paediatric hospital environment on health outcomes of children and adolescents. Using a defined search and retrieval method, a wide range of indexes of periodical articles were accessed for the period 1980 to 2008 including both health and architectural databases. Unpublished studies from 1991 were sought using a variety of sources including Dissertation Abstracts, Index to Theses, conference proceedings, research and clinical trials registers and web sites of relevant professional associations. The review considered studies using either quantitative or qualitative methodologies or mixed methods that assessed the impact of physical design elements of a paediatric hospital environment including architectural, interior design, ambient features and /or features that supported patient and family centred care. The primary outcomes of interest were clinical or psychological, with other outcomes of interest being patient - family perceptions, including safety and security. Each study was assessed independently by two reviewers prior to inclusion in the review using standardised critical appraisal instruments developed by the Joanna Briggs Institute. As both assessors were in agreement on all studies a third reviewer was not required. Data was extracted independently from each of the included studies by two reviewers using standardised critical appraisal instruments developed by the Joanna Briggs Institute. Again there were no disagreements between the reviewers in relation to the data extracted from the quantitative studies. Agreement was reached on the synthesis of the findings from the two qualitative studies through discussion. Given the differences in study design, interventions and outcome measures in the quantitative studies, statistical pooling of the results was not possible and the findings are presented in a narrative form. Eight studies were included in the review with five elements of physical design addressed. In the sub-topic of physical building structures, single room design for paediatric intensive care units significantly reduced nosocomial infections as did the addition of negative pressure ventilation to single rooms in an isolation unit. The one study on the effect of specially designed gardens found very low usage rates but children who did visit them were actively engaged with both natural and structural features. On the same theme of active engagement a play centre designed to encourage symbolic play generated statistically significantly more total play and less unoccupied time or wandering as well as the type of play it was designed to encourage. The one study on art did not demonstrate that nature art was effective in reducing stress in hospitalised children. In regard to adolescents, the two themes that emerged in regard to physical facilities from the two qualitative studies were ways of maximising normal life and ways of supporting coping with the illness through ward design. Given the small number of studies addressing five sub-topics, no firm conclusions can be drawn from the review. However the results suggest positive elements of physical design that could be considered for implementation to support a healing environment within paediatric hospitals or paediatric wards in general hospitals. The review clearly illustrates the need for more research in this area assessing the health outcomes of innovations in physical design in paediatric hospitals or units. There are numerous opportunities for multidisciplinary studies and in varying cultural contexts. This review suggests a number of aspects of physical design that can be implemented although cost and cultural appropriateness are a consideration in several cases. These include the use of single rooms with negative pressure ventilation to control cross infection; the provision of both private and 'public' space for adolescent inpatients with 'public' spaces including spaces for interaction just with other peers; the incorporation of interactive gardens, however small, designed for families and their use encouraged by staff; and specially designed play structures to encourage symbolic play.