Understanding Experience of Patients With Highly Infectious Diseases During Extended Isolation: A Design Perspective.

OBJECTIVES: This study aimed to develop a better understanding of the unique needs of patients with highly infectious diseases and their perceptions of being placed in isolation. We explore the subjective experiences of patients treated for Ebola in a biocontainment unit (BCU) and the healthcare personnel who cared for them. BACKGROUND: The 2014 Ebola outbreak and the COVID-19 pandemic have brought to focus some major challenges of caring for patients with serious infectious diseases. Previous studies on BCU design have looked at ways to prevent self- and cross-contamination, but very few have examined how the built environment can support an improved patient experience. METHOD: A qualitative study was conducted with four patients treated for Ebola and two critical care nurses who provided direct care to them at a single BCU in the U.S. Data were collected through in-depth semi-structured interviews to capture the actual patients' perception and experience of isolation. The interviews were analyzed using the thematic analysis approach. RESULTS: The Ebola patients placed in source isolation perceived the BCU as an artificial environment where they lacked control, agency, autonomy, and independence. The physical separation from other patients, visitor restrictions, and staff wearing PPE contributed to feelings of social and emotional isolation, and loneliness. CONCLUSIONS: The isolation can take a toll on physiological and psychological well-being. A thoughtful design of isolation units may improve patients' experience by supporting human and social interactions, empowering patients through space flexibility and personalization of space, and supporting a more holistic approach to isolation care.

Lighting the Patient Room of the Future: Evaluating Different Lighting Conditions From the Patient Perspective.

OBJECTIVE: This study explores whether "future" lighting systems that provide greater control and opportunity for circadian synchronization are acceptable to participants in the role of patients. BACKGROUND: Tunable, dimmable light emitting diode systems provide multiple potential benefits for healthcare. They can provide significant energy savings, support circadian synchronization by varying the spectrum and intensity of light over the course of the day, address nighttime navigation needs, and provide user-friendly control. There is an emerging understanding of the important visual and nonvisual effects of light; however, important questions remain about the experience and acceptability of this "future" lighting if we are to adopt it broadly. METHODS: Volunteer participants (34) performed a series of tasks typical of patients, such as reading or watching a video, in a full-scale simulated inpatient room. Each participant conducted these tasks under 12 lighting conditions in a counterbalanced order that included varying illuminance levels, correlated color temperatures (CCTs), and in a few conditions, saturated colors. The participants rated each lighting condition on comfort, intensity, appropriateness, and naturalness. RESULTS AND CONCLUSIONS: The participants found that conditions with CCTs of 5,000 K and higher were significantly less comfortable and less natural than conditions with lower CCTs. Conditions with lighting distributed in multiple zones in the patient room were viewed more favorably than a traditional overbed configuration. The participants in this simulated patient study reacted negatively to colored lighting on the footwall of the room but found a mixture of warmer and cooler luminaire CCTs acceptable.

Lighting the Patient Room of the Future: Evaluating Different Lighting Conditions for Performing Typical Nursing Tasks.

PURPOSE: This study explores how aspects of lighting in patient rooms are experienced and evaluated by nurses while performing simulated work under various lighting conditions. The lighting conditions studied represent design standards consistent with different environments of care-traditional, contemporary, and future. BACKGROUND: Recent advances in lighting research and technology create opportunities to use lighting in hospital rooms to improve everyday experience and provide researchers with opportunities to explore a new set of research questions about the effects of lighting on patients, guests, and staff. This study focuses on the experience of nurses delivering simulated patient care. METHOD: Perceptions of each of the 13 lighting conditions were evaluated by nurses using rating scales for difficulty of task completion, comfort, intensity, appropriateness of the lighting color, and naturalness of the lighting during the task. The nurses' ratings were analyzed alongside qualitative reflections to provide insight into their responses. RESULTS: Significant differences were found for several a priori hypotheses. Interesting findings provide insight into lighting to support circadian synchronization, lighting at night, the distribution of light in the patient room and the use of multiple lighting zones, and the use of colored lighting. CONCLUSION: The results of this study provide insight into potential benefits and concerns of these new features for patient room lighting systems and reveal gaps in the existing evidence base that can inform future investigations.

Design Strategies for Biocontainment Units to Reduce Risk During Doffing of High-level Personal Protective Equipment.

BACKGROUND: Few data exist to guide the physical design of biocontainment units, particularly the doffing area. This can impact the contamination risk of healthcare workers (HCWs) during doffing of personal protective equipment (PPE). METHODS: In phase I of our study, we analyzed simulations of a standard patient care task with 56 trained HCWs focusing on doffing of high-level PPE. In phase II, using a rapid cycle improvement approach, we tested different balance aids and redesigned doffing area layouts with 38 students. In phase III, we tested 1 redesigned layout with an additional 10 trained HCWs. We assessed the effectiveness of design changes on improving the HCW performance (measured by occurrence and number of risky behaviors) and reducing the physical and cognitive load by comparing the results from phase I and phase III. RESULTS: The physical load was highest when participants were removing their shoe covers without any balance aid; the use of a chair required the lowest physical effort, followed by horizontal and vertical grab bars. In the revised design (phase III), the overall performance of participants improved. There was a significant decrease in the number of HCW risky behaviors (P = .004); 5 risky behaviors were eliminated and 2 others increased. There was a significant decrease in physical load when removing disposable shoe covers (P = .04), and participants reported a similar workload in the redesigned doffing layout (P = .43). CONCLUSIONS: Through optimizing the design and layout of the doffing space, we reduced risky behaviors of HCWs during doffing of high-level PPE.