Ward Design Research Articles

Outcome evaluation and exploration of the humanities oriented nursing aesthetics

Objective To study and explore the evaluation of the humanities oriented nursing aesthetics, in order to seek a standard of the curriculum .Methods Students enrolled from 2012 to 2013 were included as the study subjects .According to the students＇characteristics and the syllabus , group assignment , shape-up exercises and other tests were combined and applied .At the end of the curriculum , students were surveyed by the questionnaire .Results Scene simulation examination was the most popular way of evaluation , accounting for 44.3%.The etiquette test and ward design assignment were at the second place of popularity , accounting for 26.7% and 23.3%.Paper writing was the least favorite way of evaluation , accounting for 5.7%.Totals of 93.9%of the students thought the content of evaluation could fully reflect the teaching effects , 84.2%of the students thought the content of evaluation could generally reflect the teaching effects , 92.2% of the students thought the content of the evaluation were suitable .The degree of favor of the theoretical instruction and scene simulation in different genders had no significant difference （χ2 =0.027, 1.079, respectively;P>0.05 ） .The degree of favor of the etiquette and makeup class in different genders had significant differences （χ2=6.339-57.295;P 〈0.05）.Conclusions Diversified evaluation methods can reflect the effect of humanistic classes. Key words: Education,nursing; Educational measurement; Nursing aesthetics; Humanistic attainment

The psychiatric ward as a therapeutic space: systematic review.

Hospital care is still an integral part of mental healthcare services. But the impact of ward design on treatment outcomes is unclear. To review the effects of ward design on patient outcomes and patient and staff well-being. A systematic review of literature was carried out on Medline, Embase and PsycINFO. Papers on psychogeriatric and child and adolescent wards were excluded as these necessitate specific safety features. Twenty-three papers were identified. No strong causal links between design and clinical outcomes were found. Private spaces and a homely environment may contribute to patient well-being. Different stakeholders may experience ward design in conflicting ways; design has a symbolic and social dimension for patients. Data on the impact of design on treatment outcomes are inconclusive. Rigorous randomised controlled trials, qualitative studies and novel methods are called for. Different stakeholders' responses to the ward as a symbolic environment merit further investigation.

The Challenges of Nigerian Hospital Ward Setting in Providing for Family Participation

Healthcare facilities design is a complex and dynamic process that considers meeting the needs of each of its stakeholders. The design becomes more complex when it involves building for particular user groups with non-standard specification. The Nigerian healthcare delivery system like many other health care systems in developing countries requires active participation of the patient's family member. However, the hospital setting in Nigeria has not been configured to accommodate their stay. This qualitative study is carried out to explore the extent of family participation in caring for their hospitalised ones with a view to identify design indices that will guide Nigerian hospital ward design. Data was obtained through observation and unstructured interview in a typical adult male and female surgical wards in one of the tertiary hospitals in Nigeria. Data was analysed using classical content analysis method. The result shows the design indices generated from patient's families involvement required in the Nigerian hospital ward configuration.

Hospital ward design and prevention of hospital-acquired infections: A prospective clinical trial.

Renovation of a general medical ward provided an opportunity to study health care facility design as a factor for preventing hospital-acquired infections. To determine whether a hospital ward designed with predominantly single rooms was associated with lower event rates of hospital-acquired infection and colonization. A prospective controlled trial with patient allocation incorporating randomness was designed with outcomes on multiple 'historic design' wards (mainly four-bed rooms with shared bathrooms) compared with outcomes on a newly renovated 'new design' ward (predominantly single rooms with private bathrooms). Using Poisson regression analysis and adjusting for time at risk, there were no differences (P=0.18) in the primary outcome (2.96 versus 1.85 events/1000 patient-days, respectively). After adjustment for age, sex, Charlson score, admitted from care facility, previous hospitalization within six months, isolation requirement and the duration on antibiotics, the incidence rate ratio was 1.44 (95% CI 0.71 to 2.94) for the new design versus the historic design wards. A restricted analysis on the numbers of events occurring in single-bed versus multibed wings within the new design ward revealed an event incidence density of 1.89 versus 3.47 events/1000 patient-days, respectively (P=0.18), and an incidence rate ratio of 0.54 (95% CI 0.15 to 1.30). No difference in the incidence density of hospital-acquired infections or colonizations was observed for medical patients admitted to a new design ward versus historic design wards. A restricted analysis of events occurring in single-bed versus multibed wings suggests that ward design warrants further study.

Evaluating the Built Environment in Inpatient Psychiatric Wards

Research on inpatient psychiatric care has paid little attention to the built environment of psychiatric wards. This study described the built environment in a sample of inpatient psychiatric wards in England and investigated relationships between staff satisfaction with the built environment of the ward and objective design features of the environment. Trained researchers completed a checklist of built-environment characteristics of 98 inpatient wards in England in 2007-2009. Interrater reliability was assessed and confirmed. Staff on these wards completed a three-item measure assessing the ward for overall design, fitness for purpose, and role in ensuring safety. Multilevel modeling was used to test relationships between built-environment features and staff satisfaction. A total of 1,540 staff responded. The wards encompassed a wide variety of service types and built-environment features. Staff satisfaction with the built environment was associated with noncorridor design and with the provision of personal bathrooms for patients. No association with observability of patients, exterior views, or other facilities was found. There was no difference between nurses and other groups in satisfaction with overall design, but nurses rated ward environment lower on ensuring safety (p=.036) and on fitness for purpose (p=.012). Objective measurement of the built environment in inpatient psychiatric settings is feasible and can be used to identify features that increase user satisfaction.

Compassionate containment? Balancing technical safety and therapy in the design of psychiatric wards

This paper contributes to the international literature examining design of inpatient settings for mental health care. Theoretically, it elaborates the connections between conceptual frameworks from different strands of literature relating to therapeutic landscapes, social control and the social construction of risk. It does so through a discussion of the substantive example of research to evaluate the design of a purpose built inpatient psychiatric health care facility, opened in 2010 as part of the National Health Service (NHS) in England. Findings are reported from interviews or discussion groups with staff, patients and their family and friends. This paper demonstrates a strong, and often critical awareness among members of staff and other participants about how responsibilities for risk governance of ‘persons’ are exercised through ‘technical safety’ measures and the implications for therapeutic settings. Our participants often emphasised how responsibility for technical safety was being invested in the physical infrastructure of certain ‘places’ within the hospital where risks are seen to be ‘located’. This illuminates how the spatial dimensions of social constructions of risk are incorporated into understandings about therapeutic landscapes. There were also more subtle implications, partly relating to ‘Panopticist’ theories about how the institution uses technical safety to supervise its own mechanisms, through the observation of staff behaviour as well as patients and visitors. Furthermore, staff seemed to feel that in relying on technical safety measures they were, to a degree, divesting themselves of human responsibility for risks they are required to manage. However, their critical assessment showed their concerns about how this might conflict with a more therapeutic approach and they contemplated ways that they might be able to engage more effectively with patients without the imposition of technical safety measures. These findings advance our thinking about the construction of therapeutic landscapes in theory and in practice.

Patients’ experiences of care quality and satisfaction during hospital stay: a qualitative study

Rationale, aim and objectives: Patients experiencing high care quality and satisfied patients are more likely to follow treatments. Patient satisfaction is an important contributor to physical and mental health-related quality of life. Research emphasises the need to further study satisfaction from the patients’ perspective. The aim was to describe patients’ experiences of care quality and the relation to their satisfaction during hospital stay. Methods: A qualitative descriptive design was used. Interviews were conducted with 22 patients discharged from hospital. Data was analysed by conventional content analysis. Results: Four categories and seven subcategories describing patients’ experiences of care quality and the relation to their satisfaction emerged. Desire to regain health comprised waiting for treatment, being cured, having hopes of being cured and described the treatment and health outcome of hospitalisation. Need to be met in a professional way as a unique person comprised receiving personalized knowledge , receiving healthcare by competent healthcare personnel and described the way patients need to be met by healthcare personnel. Need to be involved comprised taking responsibility for own health, leaving responsibility for own health and concerned the patients’ way of handling hospitalisation. Nee d to have balance between privacy and companionship concerned the relationship to fellow patients. Conclusions: Health condition is of great importance to patients’ experiences of quality of care and their satisfaction in relation to hospital stay. The healthcare personnel need to be aware that seriously ill patients may never be completely satisfied. Furthermore, healthcare personnel must do their utmost to provide the patients with person-centered care. Hospital managers must consider the design of wards with respect to such matters as multiple-bed versus single-bed rooms and heads of nursing must carefully plan each patient’s accommodation.

The ‘dis-ease’ of dying: Challenges in nursing care of the dying in the acute hospital setting. A qualitative observational study

Background: Changes in health care and an ageing population have meant that more people are dying in the acute hospital setting. While palliative care principles have resulted in quality care for the dying, many patients die in an acute care, still receiving aggressive/resuscitative care. Aims: The aims were to explore nurses’ ‘recognition of’ and ‘responsiveness to’ dying patients and to understand the nurses’ influence on end-of-life care. Design: A qualitative approach was taken utilising non-participant observation to elicit rich data, followed by focus groups and individual semi-structured interviews for clarification. Setting/participants: This study was conducted in two acute medical wards in one health service, identified as having the highest rates of death, once palliative care and critical care areas were excluded. Twenty-five nurses consented to participate, and 20 episodes of observation were conducted. Results: Nurses took a passive role in recognising dying, providing active care until a medical officer’s declaration of dying. Ward design, nurse allocation and nurses’ attitude to death impacts patient care. End-of-life care in a single room can have negative consequences for the dying. Nurses demonstrated varying degrees of discomfort, indicating that they were underprepared for this role. Conclusion: When patients are terminally ill, acknowledgement of dying is essential in providing appropriate care. It should not be assumed that all nurses are adequately prepared to provide dying care. Further work is necessary to investigate how the attitudes of nurses towards caring for dying patients in the acute hospital setting may impact care of the dying patient.

Compassionate containment? Balancing technical safety and therapy in the design of psychiatric wards

Compassionate containment? Balancing technical safety and therapy in the design of psychiatric wards

Lessons from a large norovirus outbreak: impact of viral load, patient age and ward design on duration of symptoms and shedding and likelihood of transmission

Hospital norovirus outbreaks cause significant financial and operational disruption which should be minimised by optimal handling of affected areas and use of isolation facilities. To identify factors associated with increased duration of symptoms and viral excretion and increased probability of transmission. Retrospective observational study of a large norovirus outbreak at a UK teaching hospital in the winter of 2009-2010 where patients were diagnosed using a real-time polymerase chain reaction (PCR) assay. Symptom duration was significantly associated with patient age (Spearman rank correlation coefficient: 0.197; P=0.002) but not with PCR cycle threshold (C(T)) value. Duration of viral excretion was found to be longer in patients with higher viral loads. Transmission within a ward bay was not significantly associated either with age or with C(T) value but was more likely to occur in some ward blocks than others, which may relate to differences in ward design. Transfer of patients into isolation rooms or cohorted area within two days of symptom onset did not significantly influence probability of onward transmission (52% vs 47%; P=0.67). The presented data suggest that C(T) value may guide timing of repeat sample collection if ongoing gastrointestinal symptoms may relate to other pathologies, and that patients developing symptoms of norovirus may remain in their current bay rather than being moved into isolation facilities. The bay or ward should be closed to new admissions but it should be anticipated that duration of symptoms and therefore closure will be longer when the outbreak involves elderly patients.

Comparison of Private Room with Multiple-Bed Ward Neonatal Intensive Care Unit Environments

This study determined whether a private room or open ward design better met optimal environmental conditions for a neonatal intensive care unit with regard to sound level, light level, temperature and humidity. Multiple-bed designs for hospital neonatal intensive care units were the standard until recently. Now, private room designs promise to provide better conditions for neonate development and patient care quality. The study compared an eight-bed open ward design with a private room design of a 45-bed neonatal intensive care unit, measuring the environmental parameters of sound, light, temperature, and humidity before and after the construction and occupation of a new private room unit. Average light levels were higher in the private room design because of the increased number of windows, but both designs were within the recommended levels. Mean temperature readings were two degrees cooler in the private room environment, and readings were more stable. Mean humidity readings in the two environments were the same, but humidity levels in the private room design were more stable. Median sound level in the private room design was lower than the open ward design, but the range was similar. The private room design allows for a more controlled patient care environment that can be maintained within a smaller range of variation nearer optimal environmental conditions.

Under the Gaze of Staff: Special Observation as Surveillance

This study explores the relationship of special observation (SO) to a range of patient, staff, and ward variables. End-of-shift reports were completed by nurses on 136 acute mental health wards in England during 2004 and 2005. Intermittent SO (patient checked at specified intervals) was used five times more frequently than constant SO (patient kept within sight or reach). Significant relationships were found between SO and measures of ward surveillance, door locking, and the ease of observing patients on the wards. Both types of SO were more common when higher numbers of staff without a nursing qualification were on duty. Improved ward design, less reliance on unqualified staff, and greater use of surveillance measures may reduce the need for SO.

Multifactorial Influences on and Deviations from Medication Administration Safety and Quality in the Acute Medical/Surgical Context

Although numerous factors influence medication administration, our understanding of the interplay of these factors on medication quality and safety is limited. The aim of this study was to explore the multifactorial influences on medication quality and safety in the context of a single checking policy for medication administration in acute care. An exploratory/descriptive study using non-participant observation and follow-up interview was used to identify factors influencing medication quality and safety in medication administration episodes (n=30). Observations focused on nurses' interactions with patients during medication administration, and the characteristics of the environment in which these took place. Confirmation of observed data occurred on completion of the observation period during short semi-structured interviews with participant nurses. Findings showed nurses developed therapeutic relationships with patients in terms of assessing patients before administering medications and educating patients about drugs during medication administration. Nurses experienced more frequent distractions when medications were stored and prepared in a communal drug room according to ward design. Nurses deviated from best-practice guidelines during medication administration. Nurses' abilities and readiness to develop therapeutic relationships with patients increased medication quality and safety, thereby protecting patients from potential adverse events. Deviations from best-practice medication administration had the potential to decrease medication safety. System factors such as ward design determining medication storage areas can be readily addressed to minimise potential error. Nurses displayed behaviours that increased medication administration quality and safety; however, violations of practice standards were observed. These findings will inform future intervention studies to improve medication quality and safety.

Analyzing User Costs In a Hospital: Methodological Implication of Space Syntax to Support Whole-life Target Value Design

Research Hypothesis: H1: Space Syntax analysis can be used to simulate a user’s experience and movement for investigating design alternatives in the design of healthcare facilities. H2: Space Syntax can efficiently be used to support Whole-life Target Value Design (TVD). Purpose: This paper investigates a methodological implication of Space Syntax to Whole- life TVD in the design of healthcare facilities. Research Design/Method: Three hypothetical hospital ward design alternatives are selected – shallow-plan, deep-plan, and courtyard-plan type – to analyze user costs in hospital design to determine which alternative is the most cost-efficient. These three hypothetical design alternatives are evaluated using a Space Syntax program, and then the findings are interpreted to determine user costs. Findings: The study finds that the deep-plan type has four “low” scores, the shallow-plan type has three “high” and one “medium” score, and the courtyard type has two “high” scores and two “medium” scores. Thus, the deep-plan type is determined to be the lowest user cost type, and the shallow-plan type is expected to have the highest user costs. Limitations: User costs are discussed in qualitative basis such as high, medium, or low with proportion to the simulation due to the lack of empirical evidence in financial value. Implications: Space Syntax assures valid results of spatial analysis in relation to users’ movement within the built environment. Value for practitioners: Space Syntax allows designers to visually compare design alternatives relating to space planning during set-based design using spatial analysis applications.

Rethinking hospital general ward ventilation design using computational fluid dynamics

Indoor ventilation with good air quality control minimises the spread of airborne respiratory and other infections in hospitals. This article considers the role of ventilation in preventing and controlling infection in hospital general wards and identifies a simple and cost-effective ventilation design capable of reducing the chances of cross-infection. Computational fluid dynamic (CFD) analysis is used to simulate and compare the removal of microbes using a number of different ventilation systems. Instead of the conventional corridor air return arrangement used in most general wards, air return is rearranged so that ventilation is controlled from inside the ward cubicle. In addition to boosting the air ventilation rate, the CFD results reveal that ventilation performance and the removal of microbes can be significantly improved. These improvements are capable of matching the standards maintained in a properly constructed isolation room, though at much lower cost. It is recommended that the newly identified ventilation parameters be widely adopted in the design of new hospital general wards to minimise cross-infection. The proposed ventilation system can also be retrofitted in existing hospital general wards with far less disruption and cost than a full-scale refurbishment.

Emergency physicians accumulate more stress factors than other physicians–results from the French SESMAT study

IntroductionFrance is facing a shortage of available physicians due to a greying population and the lack of a proportional increase in the formation of doctors. Emergency physicians are the medical...

Psychogeriatric inpatient unit design: a literature review

In many parts of the world the provision of psychogeriatric inpatient units (PGUs) remains limited. More units will be required over coming decades given rapid population aging. Medline (1950-2010), psycINFO (1806-2009), EMBASE (1980-2009) and CINAHL (1982-2009) were searched for papers about PGU design. Selected non-peer reviewed literature such as government reports and unpublished academic dissertations were also reviewed. Data were also obtained from the literature related to general adult psychiatry inpatient units where there was limited information from studies of units designed for older people. Over 200 papers were reviewed and 130 were included. There are few good quality studies to guide the design of acute PGUs and much of the existing literature is based on opinion and anecdote or, at best, based on observational studies. Randomized controlled studies comparing different designs and assessing outcomes are virtually non-existent. Several studies have identified violence and trauma resulting from hospitalization as significant problems with current acute PGU care. Despite its limitations the available literature provides useful guidance on how PGU design can optimize patient and staff safety and improve clinical outcomes. There are significant problems with current acute PGUs, and patient mix on existing units is an important issue. Future research should examine patient and staff perceptions of different PGU ward environments, the relationship between ward design and clinical outcomes, the effects of segregating patients with challenging behaviors in dementia and the benefits or otherwise of gender segregation.

Role of two-way airflow owing to temperature difference in severe acute respiratory syndrome transmission: revisiting the largest nosocomial severe acute respiratory syndrome outbreak in Hong Kong

By revisiting the air distribution and bioaerosol dispersion in Ward 8A where the largest nosocomial severe acute respiratory syndrome (SARS) outbreak occurred in Hong Kong in 2003, we found an interesting phenomenon. Although all the cubicles were in 'positive pressure' towards the corridor, the virus-containing bioaerosols generated from the index patient's cubicle were still transmitted to other cubicles, which cannot be explained in a traditional manner. A multi-zone model combining the two-way airflow effect was used to analyse this phenomenon. The multi-zone airflow model was evaluated by our experimental data. Comparing with the previous computational fluid dynamic simulation results, we found that the air exchange owing to the small temperature differences between cubicles played a major role in SARS transmission. Additionally, the validated multi-zone model combining the two-way airflow effect could simulate the pollutant transport with reasonable accuracy but much less computational time. A probable improvement in general ward design was also proposed.

Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey

BackgroundSuicide prevention by mental health services requires an awareness of the antecedents of suicide amongst high risk groups such as psychiatric in-patients. The goal of this study was to describe the social and clinical characteristics of people who had absconded from an in-patient psychiatric ward prior to suicide, including aspects of the clinical care they received.MethodsWe carried out a national clinical survey based on a 10-year (1997-2006) sample of people in England and Wales who had died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death.ResultsThere were 1,851 cases of suicide by current psychiatric in-patients, 14% of all patient suicides. 1,292 (70%) occurred off the ward. Four hundred and sixty-nine of these patients died after absconding from the ward, representing 25% of all in-patient suicides and 38% of those that occurred off the ward. Absconding suicides were characterised by being young, unemployed and homeless compared to those who were off the ward with staff agreement. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were proportionally more likely than in-patients on agreed leave to have been legally detained for treatment, non-compliant with medication, and to have died in the first week of admission. Whilst absconding patients were significantly more likely to have been under a high level of observation, clinicians reported more problems in observation due to either the ward design or other patients on the ward.ConclusionMeasures that may prevent absconding and subsequent suicide amongst in-patients might include tighter control of ward exits, and more intensive observation of patients, particularly in the early days of admission. Improving the ward environment to provide a supportive and less intimidating experience may contribute to reduced risk.

Action stations

Ward layout and design provoke heated discussion among patients and staff. But as the move to single room accommodation gathers pace, the days of nurses' stations seem to be numbered.