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Fysisk miljö på strokeenheter: betydelse för vården
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.ORCID iD: 0000-0002-8694-3127
2019 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Bakgrund: Den fysiska miljön har betydelse för människors hälsa och välbefinnande. Rehabilitering som påbörjas på strokeenheter i ett tidigt skede, kan förbättra återhämtning och minska risken för funktionshinder. Hur den fysiska miljön på en strokeenhet ska vara utformad för att utgöra ett stöd för patientens aktiviteter och vård är i begränsad omfattning studerat. Vidare är kunskapen begränsad gällande hur utformningen av den fysiska miljön kan påverka det multidisciplinära teamets arbete på en strokeenhet.

Syfte: Det övergripande syftet var att generera kunskap om den fysiska miljön på strokeenheter och den komplexa relationen mellan utformningen av miljön, vården och användarens erfarenhet av den fysiska miljön.

Metod: Avhandlingen baserades på fyra delstudier. Delstudierna hade en beskrivande och explorativ design. Tre nybyggda strokeenheter studerades, varav en strokeenhet följdes från den ursprungliga, via den temporära till den nybyggda enheten. I delstudie I, II och IV användes strukturerade observationer för att dokumentera patientens aktivitetsnivå, det fysiska rummet för aktiviteten, samt vilken eller vilka personer som var med patienten i rummet. I delstudie I, II och IV användes även icke-strukturerade observationer. De icke-strukturerade observationerna syftade till att utforska stöd och hinder i den fysiska miljön för patienter och det multidisciplinära teamet. För delstudie III användes en kvalitativ metod som med hjälp av intervjuer syftade till att studera patienternas erfarenheter av den fysiska miljön.

Resultat: Delstudie I visade att på den nybyggda strokeenheten tillbringade patienterna mer tid på sina rum, hade lägre aktivitetsnivå och hade färre interaktioner med personal och anhöriga, än på den gamla strokeenheten. Förändringar av den fysiska miljön kan ha påverkat patienternas aktiviteter och interaktioner. Delstudie II visade att strokeenheterna skilde sig åt gällande patienternas aktivitetsnivå och proportion av dagen som patienterna var ensamma på sina rum. Patienterna hade högre aktivitetsnivå på en strokeenhet med en kombination av enkelrum och flerbäddsrum jämfört med en strokeenhet med uteslutande enkelrum. En flexibel, lättorienterad och omväxlande miljö utgjorde ett stöd för vård och aktiviteter. I delstudie III framkom två teman: (i) inkongruens mellan gemenskap och avskildhet och (ii) förbindelse med världen utanför ger distraktion och en känsla av normaltillstånd. I enkelrummen upplevde patienterna ensamhet och en frånvaro av social gemenskap. Patienterna blev positivt distraherade när de tittade på natur eller på aktiviteter som fortgick utanför deras fönster. Delstudie IV visade att det multidisciplinära teamet inte arbetade tillsammans i mötet med patienten. Vidare framkom i resultatet olika stöd och hinder i den fysisk miljö som påverkade teamets aktiviteter, exempelvis hinder i form av en fysiskt uppdelad miljö för teamet.

Konklusion: Denna avhandling har bidragit till att öka förståelsen och kunskapen om den fysiska miljön på strokeenheter. Att använda ett evidensbaserat kunskapsunderlag när det gäller planering och design av nya strokeenheter är centralt. Den fysiska miljön kan vara ett stöd både för den person som insjuknat i en stroke och för det multidisciplinära teamet. Den fysiska miljön bör utformas för att minska inaktiviteten och upplevelsen av ensamhet, samt bidra till att det multidisciplinära teamet har lämpliga lokaler där teamet kan arbeta tillsammans.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, Dept of Neurobiology, Care Sciences and Society , 2019.
National Category
Nursing
Research subject
Health and Welfare
Identifiers
URN: urn:nbn:se:du-29758ISBN: 978-91-7831-323-5 (print)OAI: oai:DiVA.org:du-29758DiVA, id: diva2:1298900
Public defence
2019-02-21, Hörsal H2, Alfred Nobels allé 23, Flemingsberg, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2019-03-25 Created: 2019-03-25 Last updated: 2019-03-25Bibliographically approved
List of papers
1. A comparative study of patients’ activities and interactions in a stroke unit before and after reconstruction – the significance of the built environment
Open this publication in new window or tab >>A comparative study of patients’ activities and interactions in a stroke unit before and after reconstruction – the significance of the built environment
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 7, article id e0177477Article in journal (Refereed) Published
Abstract [en]

Early mobilization and rehabilitation, multidisciplinary stroke expertise and comprehensive therapies are fundamental in a stroke unit. To achieve effective and safe stroke care, the physical environment in modern stroke units should facilitate the delivery of evidence-based care. Therefore, the purpose of this study was to explore patients’ activities and interactions in a stroke unit before the reconstruction of the physical environment, while in a temporary location and after reconstruction. This case study examined a stroke unit as an integrated whole. The data were collected using a behavioral mapping technique at three different time points: in the original unit, in the temporary unit and in the new unit. A total of 59 patients were included. The analysis included field notes from observations of the physical environment and examples from planning and design documents. The findings indicated that in the new unit, the patients spent more time in their rooms, were less active, and had fewer interactions with staff and family than the patients in the original unit. The reconstruction involved a change from a primarily multi-bed room design to single-room accommodations. In the new unit, the patients’ lounge was located in a far corner of the unit with a smaller entrance than the patients’ lounge in the old unit, which was located at the end of a corridor with a noticeable entrance. Changes in the design of the stroke unit may have influenced the patients’ activities and interactions. This study raises the question of how the physical environment should be designed in the future to facilitate the delivery of health care and improve outcomes for stroke patients. This research is based on a case study, and although the results should be interpreted with caution, we strongly recommend that environmental considerations be included in future stroke guidelines.

National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25237 (URN)10.1371/journal.pone.0177477 (DOI)000406634500001 ()28727727 (PubMedID)
Note

Open Access APC beslut 20/2017

Available from: 2017-06-20 Created: 2017-06-20 Last updated: 2019-03-25Bibliographically approved
2. The physical environment and patients' activities and care. A comparative case study at three newly built stroke units
Open this publication in new window or tab >>The physical environment and patients' activities and care. A comparative case study at three newly built stroke units
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2018 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 74Article in journal (Refereed) Published
Abstract [en]

AIM: To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units.

BACKGROUND: 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.

DESIGN: This work is a comparative descriptive case study.

METHOD: 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: behavioral mapping analyzed with descriptive statistics and field note taking analyzed with deductive content analysis. Data were collected from April 2013 - December 2015.

RESULTS: 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.

CONCLUSIONS: 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. 

Keywords
evidence-based design, nursing, physical environment, rehabilitation, stroke guidelines, stroke unit
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27520 (URN)10.1111/jan.13690 (DOI)29676493 (PubMedID)2-s2.0-85046626112 (Scopus ID)
Note

Open Access APC beslut 10/2018

Available from: 2018-04-24 Created: 2018-04-24 Last updated: 2019-03-25Bibliographically approved
3. "It's lonely": Patients' experiences of the physical environment at a newly built stroke unit
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

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