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Elf, M., Lindahl, G. & Anåker, A. (2019). A study of relationships between content in documents from the health service operational plan and documents from the planning of new healthcare environments. Health Environments Research & Design Journal, 12(3), 107-118
Open this publication in new window or tab >>A study of relationships between content in documents from the health service operational plan and documents from the planning of new healthcare environments
2019 (English)In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 12, no 3, p. 107-118Article in journal (Refereed) Published
Abstract [en]

Aim: The aim was to investigate the content and quality of the governing documents created in the planning and design phase of new healthcare environments and in the related healthcare strategic and operational plans.

Background: Quality deficits in buildings can often be traced back to the initial stages in the planning and design phase. Although, large investments have been made to improve the process of planning new healthcare environments and linking the requirements to health service strategies, healthcare organizations rarely relate their strategy goals to the built environment.

Methods: A retrospective review of documents created in the planning and design stages of new healthcare environments and the operational plans of the target organizations was conducted.

Results: The organizational operational plans did not contain any statements or information about the built environment or how a building could or should support the organization's goals. Important information was frequently absent from the documents governing the planning and design of buildings. The documents lacked information about what and how to follow-up and what to measure once a construction project had been completed. There were no references to evidence.

Conclusions: Poor documentation might undermine the quality of the planning and design phase and ultimately the opportunity to create environments that support health outcomes. Therefore, more emphasis must be placed on the importance of documentation but above all to strengthen and clarify the relationship between the healthcare organization strategy to achieve an effective and efficient care process and the intention made in the planning and design process.

Keywords
Conceptual planning, Construction, Space programming, Design development, Evidence-based design, Post-occupancy evaluation.
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28290 (URN)10.1177/1937586718796643 (DOI)30205707 (PubMedID)2-s2.0-85058944272 (Scopus ID)
Available from: 2018-08-10 Created: 2018-08-10 Last updated: 2019-11-20Bibliographically approved
Shannon, M. M., Elf, M., Churilov, L., Olver, J., Pert, A. & Bernhardt, J. (2019). Can the physical environment itself influence neurological patient activity?. Disability and Rehabilitation, 41(10), 1177-1189
Open this publication in new window or tab >>Can the physical environment itself influence neurological patient activity?
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2019 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 10, p. 1177-1189Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate if a changed physical environment following redesign of a hospital ward influenced neurological patient physical and social activity.

METHODS: A "before and after" observational design was used that included 17 acute neurological patients pre-move (median age 77 (IQR 69-85) years Ward A and 20 post-move (median age 70 (IQR 57-81) years Ward B. Observations occurred for 1 day from 08.00-17.00 using Behavioral Mapping of patient physical and social activity, and location of that activity. Staff and ward policies remained unchanged throughout. An Environmental Description Checklist of each ward was also completed.

RESULTS: Behavioral Mapping was conducted pre-/post-move with a total of 801 Ward A and 918 Ward B observations. Environmental Description Checklists showed similarities in design features in both neurological wards with similar numbers of de-centralized nursing stations, however there were more single rooms and varied locations to congregate in Ward B (30% more single-patient rooms and separate allied health therapy room). Patients were alone >60% of time in both wards, although there was more in bed social activity in Ward A and more out of bed social activity in Ward B. There were low amounts of physical activity outside of patient rooms in both wards. Significantly more physical activity occurred in Ward B patient rooms (median = 47%, IQR 14-74%) compared to Ward A (median = 2% IQR 0-14%), Wilcoxon Rank Sum test z = -3.28, p = 0.001.

CONCLUSIONS: Overall, patient social and physical activity was low, with little to no use of communal spaces. However we found more physical activity in patient rooms in the Ward B environment. Given the potential for patient activity to drive brain reorganization and repair, the physical environment should be considered an active factor in neurological rehabilitation and recovery. Implications for Rehabilitation Clinicians should include consideration of the impact of physical environment on physical and social activity of neurological patients when designing therapeutic rehabilitation environments. Despite architectural design intentions patient and social activity opportunities can be limited. Optimal neurological patient neuroplasticity and recovery requires sufficient environmental challenge, however current hospital environments for rehabilitation do not provide this.

Keywords
Behavioral Mapping, Physical environment, brain injury, healthcare design, neurological, neuroplasticity, physical activity, social activity
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26956 (URN)10.1080/09638288.2017.1423520 (DOI)000465208200006 ()29343110 (PubMedID)
Available from: 2018-01-23 Created: 2018-01-23 Last updated: 2019-06-10Bibliographically approved
Miedena, E., Lindahl, G. & Elf, M. (2019). Conceptualizing health promotion in relation to outpatient healthcare building design: a scoping review. Health Environments Research & Design Journal, 12(1), 69-86
Open this publication in new window or tab >>Conceptualizing health promotion in relation to outpatient healthcare building design: a scoping review
2019 (English)In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 12, no 1, p. 69-86Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: This review explored different conceptualizations of health promotion in the context of, and in relation to, outpatient building design.

BACKGROUND: Today's healthcare organizations are implementing holistic healthcare approaches such as health promotion, while simultaneously increasing their outpatient services. These health promotion approaches, focused on empowering people to take control of their health, are expected to have implications for the outpatient healthcare building design. Yet there is limited knowledge what these may be. A review of the literature on the current state of the art is thus needed to enable and support dialog on future healthcare building design.

METHOD: A scoping review of 4,506 papers, collected from four databases and three scientific journals in 2015, resulted in 14 papers relating health promotion to building design and outpatient healthcare. From the subsequent content analysis, multiple common themes and subthemes emerged.

RESULTS: The review reveals diverse range of health promotion interpretations, three health promotion perspectives (health behavior, health equity, and sense of coherence), associated design approaches, design objectives, health-related outcomes, building features, and solutions.

CONCLUSIONS: While diverse health promotion perspectives might merely represent variations in focus, these differences become problematic when relating to building design. To support further dialogs on development of health promotion in, and in relation to, the build environment, there is a need to strengthen the health promotion vocabulary. Further research is needed to compare different design approaches and how these can be combined to minimize contradicting implications for building design.

Keywords
Health promotion, built environment, scoping reveiw
National Category
Health Sciences Architecture
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28291 (URN)10.1177/1937586718796651 (DOI)000462081400005 ()30203663 (PubMedID)2-s2.0-85058928925 (Scopus ID)
Available from: 2018-08-10 Created: 2018-08-10 Last updated: 2019-04-11Bibliographically approved
McKee, K., Nordin, S. & Elf, M. (2019). Developmentand initial validation of the Staff Perception Of Residential care Environments(SPORE) instrument. In: : . Paper presented at The International Association of Gerontology and Geriatrics European Region Congress 2019 (IAGG-ER). 23-25 May 2019 in Gothenburg.
Open this publication in new window or tab >>Developmentand initial validation of the Staff Perception Of Residential care Environments(SPORE) instrument
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Staff perceptions of the health care environment influence the delivery of person-centred care.  Little research has examined staff perceptions of health care environments, in part because of a lack of validated instruments.  This study reports the development and initial validation of the Staff Perception Of Residential care Environments (SPORE) instrument for use in residential care facilities for older people (RCFs).

Items developed in a British project on the design of care environments were translated and adapted for the Swedish care context as SPORE (24 items, 5 sub-scales).  In a study of the physical environment and quality of care, 200 staff recruited from 20 RCFs sampled from across Sweden completed a questionnaire containing SPORE, the Person-centred Care Assessment Tool (PCAT), the Person-centred Climate Questionnaire – staff version (PCQ-S), and the Sheffield Care Environment Assessment Matrix –Sweden (SCEAM-S).

All SPORE sub-scales were normally distributed with good internal consistency reliability (Cronbach αs=.85-.88). Correlations between SPORE and PCAT sub-scales ranged from .301-.503, and between SPORE and PCQ-S sub-scales from .353-.557.  RCF-level analyses (N=20) indicated that scores on SCEAM overall environment quality correlated significantly with all SPORE sub-scales (range=.496-.700).  The SCEAM Comfort sub-scale was correlated with all SPORE sub-scales (range=.509-.721), while the SCEAM Privacy sub-scale was correlated (r=.428) with the SPORE Staff Facilities sub-scale.  The SPORE Working and Caring for Residents sub-scale was correlated with SCEAM cognitive support (r=.502) and physical support (r=.566) sub-scales.

The SPORE instrument demonstrated good psychometric properties and its sub-scales an excellent range of associations with staff perceptions of person-centred care and with objective assessments of the physical environment.  Further validation is required, but the SPORE instrument has potential for understanding how staff perceptions of the RCF environment relate to the delivery of person-centred care.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30275 (URN)
Conference
The International Association of Gerontology and Geriatrics European Region Congress 2019 (IAGG-ER). 23-25 May 2019 in Gothenburg
Available from: 2019-06-18 Created: 2019-06-18 Last updated: 2019-06-19Bibliographically approved
Anåker, A., von Koch, L., Heylighen, A. & Elf, M. (2019). "It's lonely": Patients' experiences of the physical environment at a newly built stroke unit. Health Environments Research & Design Journal (3), 141-152
Open this publication in new window or tab >>"It's lonely": Patients' experiences of the physical environment at a newly built stroke unit
2019 (English)In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, no 3, p. 141-152Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

The aim of this study was to explore patients' experiences of the physical environment at a newly built stroke unit.

BACKGROUND:

For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients' health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce.

METHOD:

This study used a qualitative design. Patients ( n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis.

RESULTS:

Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows.

CONCLUSIONS:

The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients' experiences could be a starting point when designing new healthcare environments and inform evidence-based design.

Keywords
evidence-based design; healthcare facilities; nursing; rehabilitation; single-room design
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28774 (URN)10.1177/1937586718806696 (DOI)30336696 (PubMedID)2-s2.0-85058959552 (Scopus ID)
Available from: 2018-10-19 Created: 2018-10-19 Last updated: 2019-11-20Bibliographically approved
Nordin, S., Dahlberg, L., McKee, K. & Elf, M. (2019). Technology to support decision-making for older people with dementia. In: : . Paper presented at IAGG 2019 The International Association of Gerontology and Geriatrics European Region Congress 2019, 23-25 May, Gothenburg.
Open this publication in new window or tab >>Technology to support decision-making for older people with dementia
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29866 (URN)
Conference
IAGG 2019 The International Association of Gerontology and Geriatrics European Region Congress 2019, 23-25 May, Gothenburg
Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-04-11Bibliographically approved
Kylén, M., Von Koch, L., Pessah-Rasmussen, H., Marcheschi, E., Ytterberg, C., Heylighen, A. & Elf, M. (2019). The importance of the built environment in person-centred rehabilitation at home: study protocol. International Journal of Environmental Research and Public Health, 16(13), Article ID E2409.
Open this publication in new window or tab >>The importance of the built environment in person-centred rehabilitation at home: study protocol
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2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 13, article id E2409Article in journal (Refereed) Published
Abstract [en]

Health services will change dramatically as the prevalence of home healthcare increases. Only technologically advanced acute care will be performed in hospitals. This-along with the increased healthcare needs of people with long-term conditions such as stroke and the rising demand for services to be more person-centred-will place pressure on healthcare to consider quality across the continuum of care. Research indicates that planned discharge tailored to individual needs can reduce adverse events and promote competence in self-management. However, the environmental factors that may play a role in a patient's recovery process remain unexplored. This paper presents a protocol with the purpose to explore factors in the built environment that can facilitate/hinder a person-centred rehabilitation process in the home. The project uses a convergent parallel mixed-methods design, with ICF (International Classification of Functioning, Disability and Health) and person-environment theories as conceptual frameworks. Data will be collected during home visits 3 months after stroke onset. Medical records, questionnaires, interviews and observations will be used. Workshops will be held to identify what experts and users (patients, significant others, staff) consider important in the built environment. Data will be used to synthesise the contexts, mechanisms and outcomes that are important to support the rehabilitation process at home.

Keywords
housing, mixed-methods design, person-centred care, person–environment fit, rehabilitation
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30578 (URN)10.3390/ijerph16132409 (DOI)000477037900153 ()31284620 (PubMedID)
Note

Open Access APC beslut 12/2019

Available from: 2019-07-24 Created: 2019-07-24 Last updated: 2019-08-15Bibliographically approved
Kylén, M., von Koch, L., Pessah-Rasmussen, H., Marcheschi, E., Ytterberg, C., Heylighen, A. & Elf, M. (2019). The Importance of the Built Environment in Person-Centred Rehabilitation at Home: Study Protocol. International Journal of Environmental Research and Public Health, 16(13), Article ID 2409.
Open this publication in new window or tab >>The Importance of the Built Environment in Person-Centred Rehabilitation at Home: Study Protocol
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2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 13, article id 2409Article in journal (Refereed) Published
Abstract [en]

Health services will change dramatically as the prevalence of home healthcare increases.Only technologically advanced acute care will be performed in hospitals. This—along with theincreased healthcare needs of people with long-term conditions such as stroke and the rising demandfor services to be more person-centred—will place pressure on healthcare to consider quality across thecontinuum of care. Research indicates that planned discharge tailored to individual needs can reduceadverse events and promote competence in self-management. However, the environmental factorsthat may play a role in a patient’s recovery process remain unexplored. This paper presents a protocolwith the purpose to explore factors in the built environment that can facilitate/hinder a person-centredrehabilitation process in the home. The project uses a convergent parallel mixed-methods design,with ICF (International Classification of Functioning, Disability and Health) and person–environmenttheories as conceptual frameworks. Data will be collected during home visits 3 months after strokeonset. Medical records, questionnaires, interviews and observations will be used. Workshops will beheld to identify what experts and users (patients, significant others, sta) consider important in thebuilt environment. Data will be used to synthesise the contexts, mechanisms and outcomes that areimportant to support the rehabilitation process at home.

Keywords
rehabilitation; person-centred care; person–environment fit; mixed-methods design; housing
National Category
Other Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31259 (URN)10.3390/ijerph16132409 (DOI)
Projects
REARCH
Funder
Swedish Research Council Formas, 2015/389
Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2019-12-11Bibliographically approved
Kylén, M., von Koch, L., Pessah-Rasmussen, H., Ytterberg, C., Heylighen, A. & Elf, M. (2019). The importance of the built environment in person-centred stroke rehabilitation at home. In: The importance of the built environment in person-centred stroke rehabilitation at home: . Paper presented at UK Stroke Forum, 3-5 December 2019 at The International Centre in Telford.
Open this publication in new window or tab >>The importance of the built environment in person-centred stroke rehabilitation at home
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2019 (English)In: The importance of the built environment in person-centred stroke rehabilitation at home, 2019Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Introduction: Health services will change dramatically as the prevalence of home healthcare increases. Only technologically advanced stroke acute care will be performed in hospitals. This, along with the rising demand for services to be more person-centred will place pressure on healthcare to consider quality across the continuum of care. Research indicates that planned discharge tailored to individual needs can reduce adverse events and promote competence in self-management. However, the environmental factors that may play a role in a patient’s recovery process remain unexplored. In this presentation, experiences and emerging findings from a research project targeting such issues will be presented. The purpose is to explore factors in the built environment that can facilitate/hinder a person-centred rehabilitation process in the home. Methods: The study uses a mixed methods design, with the ICF and person-environment theories as conceptual frameworks. Qualitative and quantitative data are currently collected from medical records and during home visits three months after stroke by use of questionnaires, interviews and observations. Workshops will be held to identify what experts and users (patients, significant others, staff) consider important in the built environment. Results: Emerging findings concerning the contexts and mechanisms that are important to support the rehabilitation process at home will be presented. Conclusions: Providing scientific knowledge that support patients’ recovery process in the home poses challenges for research that requires multidisciplinary knowledge. By bringing together international experts committed to improve care models and design, we will contribute to this under researched field and build capacity for the future.

National Category
Other Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-31260 (URN)
Conference
UK Stroke Forum, 3-5 December 2019 at The International Centre in Telford
Projects
REARCH
Funder
Swedish Research Council Formas, 2015/389
Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2019-12-11Bibliographically approved
Udo, C., Neljesjö, M., Strömkvist, I. & Elf, M. (2018). A qualitative study of assistant nurses’ experiences of palliative care in residential care. Nursing Open, 5(4), 527-535
Open this publication in new window or tab >>A qualitative study of assistant nurses’ experiences of palliative care in residential care
2018 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 4, p. 527-535Article in journal (Refereed) Published
Abstract [sv]

Aim

To explore assistant nurses' experiences and perceptions of both positive and negative aspects of providing palliative care for older people in residential care facilities.

Design

A qualitative explorative study.

Methods

Critical incidents were collected through semi‐structured face‐to‐face interviews and analysed by performing a qualitative content analysis.

Results

A total of 40 critical incidents from daily work was described by assistant nurses. The results showed that close cooperation between unlicensed and licensed professionals was crucial to provide good care but was sometimes negatively affected by the organizational structure. The availability of professionals was identified as a critical factor in providing good care at the end of life in a consultative organization. The most prominent findings were those that indicated that, especially in a consultative organization, there seems to be a need for clear roles, comprehensive and clear care plans and a solid support structure to ensure continuity of care.

Keywords
assistant nurses, critical incident technique, organization, palliative care, Sweden
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27736 (URN)10.1002/nop2.159 (DOI)30338098 (PubMedID)2-s2.0-85062114772 (Scopus ID)
Note

Open Access APC beslut 9/2018

Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2019-03-11Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7044-8896

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