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  • 1.
    Anåker, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Fysisk miljö på strokeenheter: betydelse för vården2019Doctoral 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.

  • 2.
    Anåker, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nurses' perceptions of climate and environmental issues2015Conference paper (Refereed)
  • 3.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Design quality in a healthcare context – time to operationalize the concept2016Conference paper (Refereed)
    Abstract [en]

    We present a review of the concept of design quality in healthcare. The aim of review was to define the concept of design quality in order to be able to operationalize the concept for future research. In recent years, several studies have shown that the design of the physical environment affects the patient's health and wellbeing and how different models of care can be implemented, for example, person-centered care. Design quality in architecture has long been the subject for theoretical discussion. From the Roman architect Vitruvius to contemporary design quality following tangible and intangible properties such as utility, durability and beauty. In dictionaries, the general design quality is described as a standard for something when it is compared to other things; how good or bad something is to be of good / bad / the highest quality. Design quality can be described as a measure of a high standard, a plan or an intention of design in the way that it will work and look like. However, until recently, the meaning of design quality in healthcare has been vague and merely described as a subjective experience of the environment. In order to be useful the concept need to be connected to quality indicators of healthcare. In this presentation, we discuss the concept of design quality and its relation to evidence-based design i.e. design decisions based on the best available results from credible research and evaluation of completed building projects.

  • 4.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sustainability – a question for the leadership?2014Conference paper (Refereed)
    Abstract [en]

    Background The overall issue for the health sector during the coming century will be the climate change and its implication for human health. We argue that awareness of nurse’s experience and knowledge in climate and environmental issues is a crucial question for the health sector and their leadership in the process with a sustainable development.

    Aim The aim of this study was to explore nurse’s experience and knowledge of climate and environmental issues in relation to a health perspective and how nurses can contribute to the process of sustainable development.

    Method/design The study was conducted as an interview study with qualitative approach. Eight individual and two focus groups with registered nurses who represented hospitals, primary care and emergency medical services participated in the study and were analyzed with content analysis.

    Result One of the results that appeared in the study showed that there is a sense of responsibility to work on climate and environmental issues, but this is overshadowed by care task in daily work at the clinic.

    Conclusion The leadership has an enormously important role to integrate climate and environmental change issues in their daily work. The leadership needs to avoid that the question of sustainability becomes an imposition to be made after all other work. This study has shown the importance of knowledge concerning climate and environmental issues in the health sector and the importance of knowledge about a sustainable development within leadership.

  • 5.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sustainability in nursing: a concept analysis2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 2, p. 381-389Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of this study was to describe, explore and explain the concept of sustainability in nursing.

    Background. Although researchers in nursing and medicine have emphasised the issue of sustainability and health, the concept of sustainability in nursing is undefined and poorly researched. A need exists for theoretical and empirical studies of sustainability in nursing.

    Design. Concept analysis as developed by Walker and Avant.

    Method. Data were derived from dictionaries, international healthcare organisations and literature searches in the CINAHL and MEDLINE databases. Inclusive years for the search ranged from 1990 to 2012. A total of fourteen articles were found that referred to sustainability in nursing.

    Results. Sustainability in nursing involves six defining attributes: ecology, environment, future, globalism, holism and maintenance. Antecedents of sustainability require climate change, environmental impact and awareness, confidence in the future, responsibility and a willingness to change. Consequences of sustainability in nursing include education in the areas of ecology, environment and sustainable development as well as sustainability as a part of nursing academic programs and in the description of the academic subject of nursing. Sustainability should also be part of national and international healthcare organisations. The concept was clarified herein by giving it a definition.

    Conclusion. Sustainability in nursing was explored and found to contribute to sustainable development, with the ultimate goal of maintaining an environment that does not harm current and future generations' opportunities for good health. This concept analysis provides recommendations for the healthcare sector to incorporate sustainability and provides recommendations for future research.

  • 6.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Heylighen, Ann
    KU Leuven, Belgium.
    Nordin, Susanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Design quality in the context of healthcare environments: a scoping review2017In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 10, no 4, p. 136-150Article in journal (Refereed)
    Abstract [en]

    Objective:

    We explored the concept of design quality in relation to healthcare environments. In addition, we present a taxonomy that illustrates the wide range of terms used in connection with design quality in healthcare.

    Background:

    High-quality physical environments can promote health and well-being. Developments in healthcare technology and methodology put high demands on the design quality of care environments, coupled with increasing expectations and demands from patients and staff that care environments be person centered, welcoming, and accessible while also supporting privacy and security. In addition, there are demands that decisions about the design of healthcare architecture be based on the best available information from credible research and the evaluation of existing building projects.

    Method:

    The basic principles of Arksey and O’Malley’s model of scoping review design were used. Data were derived from literature searches in scientific databases. A total of 18 articles and books were found that referred to design quality in a healthcare context.

    Results:

    Design quality of physical healthcare environments involves three different themes: (i) environmental sustainability and ecological values, (ii) social and cultural interactions and values, and (iii) resilience of the engineering and building construction. Design quality was clarified herein with a definition.

    Conclusions:

    Awareness of what is considered design quality in relation to healthcare architecture could help to design healthcare environments based on evidence. To operationalize the concept, its definition must be clear and explicit and able to meet the complex needs of the stakeholders in a healthcare context, including patients, staff, and significant others.

  • 7.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nilsson, Maria
    Umeå universitet.
    Holmner, Åsa
    Umeå universitet.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nurses’ perceptions of climate and environmental issues: a qualitative study2015In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 71, no 8, p. 1883-1891Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to explore nurses' perceptions of climate and environmental issues and examine how nurses perceive their role in contributing to the process of sustainable development. 

    Background: Climate change and its implications for human health represent an increasingly important issue for the healthcare sector. According to the International Council of Nurses Code of Ethics, nurses have a responsibility to be involved and support climate change mitigation and adaptation to protect human health. 

    Design: This is a descriptive, explorative qualitative study. 

    Methods: Nurses (n=18) were recruited from hospitals, primary care and emergency medical services; eight participated in semi-structured, in-depth individual interviews and 10 participated in two focus groups. Data were collected from April-October 2013 in Sweden; interviews were transcribed verbatim and analysed using content analysis. 

    Results: Two main themes were identified from the interviews: (i) an incongruence between climate and environmental issues and nurses' daily work; and (ii) public health work is regarded as a health co-benefit of climate change mitigation. While being green is not the primary task in a lifesaving, hectic and economically challenging context, nurses' perceived their profession as entailing responsibility, opportunities and a sense of individual commitment to influence the environment in a positive direction. 

    Conclusions: This study argues there is a need for increased awareness of issues and methods that are crucial for the healthcare sector to respond to climate change. Efforts to develop interventions should explore how nurses should be able to contribute to the healthcare sector's preparedness for and contributions to sustainable development.

  • 8.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Inst, Solna, Sweden..
    von Koch, L.
    Karolinska Inst, Solna, Sweden..
    Eriksson, G.
    Karolinska Inst, Solna, Sweden..
    Sjostrand, C.
    Karolinska Inst, Solna, Sweden..
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Multi-professional teamwork in stroke units - time to understand the impact of the built environment on the work of staff2018In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 13, p. 59-59Article in journal (Other academic)
  • 9.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    von Koch, Lena
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Designing Inclusive Architecture: Facilitators and Barriers of the Healthcare Environment for Rehabilitation at Stroke Units2016In: Designing Around People: CWUAAT 2016 / [ed] Pat Langdon, Jonathan Lazar, Ann Heylighen, Hua Dong, Springer London, 2016, p. 229-230Chapter in book (Refereed)
  • 10.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    von Koch, Lena
    Karolinska Institutet.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    “Det är ensamt”– patienternas upplevelse av den fysiska miljön på en nybyggd strokeenhet2018Conference paper (Refereed)
  • 11.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    von Koch, Lena
    Karolinska institutet.
    Heylighen, Ann
    Katholieke Universiteit Leuven, Leuven, Belgium.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet; Chalmers.
    "It's lonely": Patients' experiences of the physical environment at a newly built stroke unit2019In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, no 3, p. 141-152Article in journal (Refereed)
    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.

  • 12.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    von Koch, Lena
    Sjöstrand, Christina
    Bernhardt, Julie
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet; Chalmers University of Technology.
    A comparative study of patients’ activities and interactions in a stroke unit before and after reconstruction – the significance of the built environment2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 7, article id e0177477Article in journal (Refereed)
    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.

  • 13.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    von Koch, Lena
    Sjöstrand, Christina
    Heylighen, Ann
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet; Chalmers.
    The physical environment and patients' activities and care. A comparative case study at three newly built stroke units2018In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 74Article in journal (Refereed)
    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. 

  • 14.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Chalmers Univ Technol.
    Anåker, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Marcheschi, Elizabeth
    Sigurjonsson, Asgeir
    Ulrich, Roger S.
    The built environment and its impact on health outcomes and experiences of patients, significant others and staff-A protocol for a systematic review2020In: Nursing Open, E-ISSN 2054-1058Article in journal (Refereed)
    Abstract [en]

    Aim This review will identify, evaluate and synthesize the literature related to evidence-based design of healthcare environments and to identify impacts of the built environment on the outcomes and experiences of patients, significant others and staff. Design A mixed-method systematic review of literature 2010-2018. Methods Database searches for evidence in peer-reviewed journals will be conducted electronically using CINAHL, Medline, SCOPUS and Web of Science. , full-text screening and data extraction will be completed independently by the reviewers. Quality assessment will follow Swedish Agency for Health Technology Assessment and Social Services Assessment. Results This review will offer knowledge for informed decisions about the design of the healthcare environment. The review is comprehensive, includes a large volume of literature various research designs and will highlight the knowledge gap in evidence-based design and provide a breadth of knowledge about the built environments and its impact on health and well-being.

  • 15.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Chalmers Tekniska Högskola; Karolinska institutet.
    Lindahl, Göran
    Chalmers Tekniska Högskola.
    Anåker, Anna
    Karolinska institutet.
    A study of relationships between content in documents from the health service operational plan and documents from the planning of new healthcare environments2019In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 12, no 3, p. 107-118Article in journal (Refereed)
    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.

  • 16.
    Shannon, Michelle
    et al.
    Florey Institute, Melbourne .
    Nordin, Susanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Anåker, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Bernhardt, Julie
    Florey Institute, Melbourne .
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Theoretical frameworks used in built environment research – a scoping review2017Conference paper (Refereed)
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