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Insights & Solutions

Slidecast
November 2021 Slidecast

Degl' Innocenti, A., Wijk, H., Kullgren, A., Alexiou, E. (2020) The influence of evidence-based design on staff perceptions of a supportive environment for person-centered care in forensic psychiatry. Journal of Forensic Nursing

In recent years, there has been a philosophical shift to prioritize a therapeutic social model for long-term forensic psychiatric care over a curative or correctional model which dramatically changes expectations for and demands placed upon the design of the built environment. Research is needed to understand the relationship between the physical environment, provision of care, and workforce outcomes. This study used repeated questionnaires to solicit staff perceptions of and experience with the delivery of person-centered care before and after the relocation of three forensic psychiatric hospitals into new purpose-built facilities. The responses to the questionnaires did not produce any statistically significant outcomes but did reveal upward trends in staff perceptions about safety and everyday aesthetic. This study helps to illustrate how the provision of person-centered care is intended to honor those providing as well as receiving rehabilitation and reintegration care and services.

Slidecast
November 2021 Slidecast

Olausson, S., Wijk, H., Berglund, I. J., Pihlgren, A., Danielson, E. (2021) Patients’ experiences of place and space after a relocation to evidence-based designed forensic psychiatric hospitals. International Journal of Mental Health Nursing

The major aim of forensic psychiatric care is to provide rehabilitation and reintegration to prevent new crimes and violence by mentally ill patients. An environment that mirrors ‘normal life’ is seen as more congruent than traditional short-stay hospital settings. This study offers insight from the perspective of the patient in three secure inpatient care settings in Sweden. Photovoice data collection was used to empower patients to photograph and then explain the meaning attributed to environmental features. Four themes emerged from the analysis: 1) Having a private place; 2) Upholding one’s sense of self; 3) Feelings of comfort and harmony; and 4) Remaining connected to one’s life.  This study provides a method for engaging protected patient populations as equal contributors of insight for design.

Slidecast
November 2021 Slidecast

Shepley, M. M., Peditto, K., Sachs, N. A., Pham, Y., Barankevich, R., Crouppen, G., Dresser, K. (2021) Staff and resident perceptions of mental and behavioural health environments. Building Research & Information

There is broad support for using the built environment as a therapeutic tool for advancing health outcomes. Understanding how features within the environment contribute to outcomes, however, is less clear. This study evaluated staff and patient perspectives related to the importance and the effectiveness of various environmental attributes within four mental and behavioral health care settings. In general, staff and patients achieved consensus for the rated importance of environmental attributes, but effectiveness ratings resulted in significant differences. This study exemplifies a commitment to engaging staff and patients in mental and behavioral health settings as equal contributors for insight related to the designed environment.

Slidecast
April 2021 Slidecast

Wang, Z., & Pukszta, M. (2018). Private Rooms, Semi-Open Areas, or Open Areas for Chemotherapy Care: Perspectives of Cancer Patients, Families, and Nursing Staff. HERD: Health Environments Research & Design Journal

In recent years, the design of spaces for chemotherapy treatment has shifted from private rooms and open-units in inpatient settings, to semi-open areas in outpatient care centers. Despite the shift towards ambulatory care, the majority of evidence-based design research in this area is still focused on the inpatient setting. This appears to be one of the first studies to look at what patients need and want during their treatment in ambulatory chemo treatment centers.  

Slidecast
February 2021 Slidecast

Hopkins, S., Morgan, P. L., Schlangen, L. J. M., Williams, P., Skene, D. J., & Middleton, B. (2017). Blue-enriched lighting for older people living in care homes: Effect on activity, actigraphic sleep, mood and alertness. Current Alzheimer Research

As we get older, sleep quality suffers, and poor sleep can lead to poor overall health. Our circadian function plays a major role in the quality of our sleep, and research suggests that the physical environment can support better circadian function. Some research shows that residents with dementia in care homes experienced better sleep when exposed to increased light levels. The authors believe this to be the first study to look at the effect on a general population of older people not diagnosed with dementia.

Slidecast
February 2021 Slidecast

Altizer, Z., Canar, W. J., Redemske, D., Fullam, F., & Lamont, M. (2019). Utilization of a Standardized Post-Occupancy Evaluation to Assess the Guiding Principles of a Major Academic Medical Center. HERD: Health Environments Research & Design Journal

“Let’s do a POE.” Seems simple, right? Design professionals get the potential value of post-occupancy evaluation, but they often find that there is zero time after construction is complete to create a POE tool and go through the evaluation process. Can standardized tools that have customizable features provide a balanced solution to this evaluation conundrum?  

Slidecast
January 2021 Slidecast

Dhala, A., Sasangohar, F., Kash, B., Ahmadi, N., & Masud, F. (2020). Rapid implementation and innovative applications of a virtual ICU during the COVID-19 pandemic: A case study. Journal of Medical Internet Research

The novelty of the coronavirus, combined with the complexity of treating COVID-19 patients, forced many organizations to redirect their critical care staff to the COVID-19 units for 24-hour bedside coverage. The hospital accelerated and expanded their tele-critical care program that connected ICU patient rooms to remote caregivers - virtual ICU (vICU). This technology ended up augmenting their critical care capacity during the COVID-19 surge. The program was expedited with COVID, and over the weeks, multiple ICUs implemented the vICU and became COVID-19 units.  While the program was not intended for virtual visits, the virtual setup became a welcomed communication tool during the pandemic. The Ops Center collaborated with bedside staff to coordinate virtual family visits, which improved emotional well-being for patients and families. Anxiety about PPE shortages were alleviated, and medical staff and specialists felt more protected with a reduced number of times they had to go into the room.

Slidecast
January 2021 Slidecast

Lednicky, J. A., Lauzardo, M., Hugh Fan, Z., Jutla, A., Tilly, T. B., Gangwar, M., Usmani, M., Shankar, S. N., Mohamed, K., Eiguren-Fernandez, A., Stephenson, C. J., Alam, M. M., Elbadry, M. A., Loeb, J. C., Subramaniam, K., Waltzek, T. B., Cherabuddi, K., Glenn Morris, J., & Wu, C. Y. (2020). Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients. International Journal of Infectious Diseases

There has been ongoing debate about how SARS-CoV-2 is transmitted – is it just droplets? Or does it also transmit by air? Lednicky and colleagues developed a sampling method to test air in a shared patient room with COVID19-positive patients. The air samplers were located at a distance greater than 6’ from the patients. The results showed a complete sequence of SARS-CoV-2 collected from an air sample was an exact match with the virus isolated from patient 1. This study does clearly suggest there is an inhalation risk for acquiring COVID-19 beyond the 6’ practice of physical or social distancing. For designers, aerosolization raises questions about HVAC systems and air changes, but since HVAC design wasn’t the purpose of this study, we know we need to continue to work with engineering professional to establish how to best mitigate transmission by air.

Slidecast
January 2021 Slidecast

Mills, P. D., C. Soncrant, J. Bender, and W. Gunnar. “Impact of Over-the-Door Alarms: Root Cause Analysis Review of Suicide Attempts and Deaths on Veterans Health Administration Mental Health Units.” General Hospital Psychiatry 64

In order to reduce inpatient suicide, ligature resistance has been a focus of CMS and accrediting organizations for the past several years, but questions remain as to how far we go and where the real risks lie. In this study based in the Veterans Administration, researchers conducted a retrospective review and analysis of system-wide data of suicide deaths and attempts. As with other studies, the majority of suicides or attempts involved hanging, most of which used doors as the anchor point. Of events where the patient was using a door, more than a third involved an over-the-door alarm (OTD), and none of those events included a death. While correlation does not prove causation, the results suggest that OTD alarms prevented death. Knowing the alarm might alert staff became part of the deterrent. Quite simply, in mental health units where the risk of patients committing suicide is high, OTD alarms may help save lives, as part of a comprehensive strategy that includes sight lines, rounding, ongoing maintenance, and even ligature resistant bedding.

Slidecast
January 2021 Slidecast

Momeni, M., Jamshidimanesh, M., & Ranjbar, H. (2020). Effectiveness of a Snoezelen Room on fear, anxiety, and satisfaction of nulliparous women: A randomized controlled trial. Iranian Journal of Psychiatry and Behavioral Sciences

We have a number of studies looking at the influence of room design on birth and birthing outcomes, but understanding any implications of room design are important because it potentially influences the health of both the mom and baby. The researchers conducted a 13-month randomized control trial with first-time mothers who were either in a standard room or a multi-sensory room. The multi-sensory room included aspects of sight, sound and smell. Measures were taken before, during, and after birth. During the birthing, the fear score went down with every measurement phase in the sensory room while it went up in every phase in the standard room. Results also showed that the mean score of anxiety decreased across all phases in the multi-sensory room. In addition, the total mean score of birth satisfaction was 163 in the intervention room and only about 75 in the control room. This study addresses cultural context, but it also takes what we know about positive distractions and pain and what we know about multi-sensory environments and the regulation of behavior, and applies that evidence in a different setting – one for birth.