Preliminary Development of Items for a Nurses' Physical Environmental Stress Scale.

RESEARCH PURPOSE: This study aimed to develop a preliminary Nurses' Physical Environmental Stress Scale (NPESS) that explores the relationships between the physical environment in the intensive care unit (ICU) and work-related stress among ICU nurses. BACKGROUND: Working within the healthcare field is stressful and comes with a high level of responsibility for nurses, especially ICU nurses. The ICU work environment is associated with risk factors such as excessive workload, increased expectations, and long working hours that can lead to burnout among nurses. There is some evidence that environmental design has the potential to prevent or mitigate work-related stress; however, an adequate assessment tool to identify physical environmental stressors or supports for moderating stress is lacking. METHODS: To develop the preliminary environmental assessment tool, an exploratory sequential methodology was used. The approach consisted of three distinct phases, including (a) a qualitative content analysis of existing focus group data, (b) a qualitative content analysis of pertinent literature related to environmental assessment tools in a healthcare context, and (c) the development and refinement of the NPESS assessment tool. Tool refinement was based on interviews with ICU nurses. RESULTS: The resulting NPESS tool was comprised of seven sections (sounds, lighting, smells, staff respite spaces, staff workspaces, patient rooms, and aesthetic qualities) containing a total of and 81 items that address factors that were identified as potential moderators of environmental stress in ICU settings. CONCLUSIONS: The resulting NPESS assessment tool provides a feasible approach for evaluating ICU settings to identify possible improvements to reduce stress among nurses. Future research will be conducted to assess the validity and reliability of the final tool by distributing it to a larger sample of ICU nurses.

On the Restorative Break: Understanding the Role of Break Room Design on Nurse Engagement and Satisfaction.

BACKGROUND: Healthcare organizations need to attract and retain qualified nurses, and break areas may influence nurse engagement with breaks, but this has not been studied in situ. The goal of this study was to understand nurse perception of breaks and ways building design and culture impact the frequency, duration, and location of nurse breaks. METHODS: This was Part 1 of a two-part study. Mixed-method approaches included on-site behavior mapping, focus groups, online survey, and break room usage rates analysis. FINDINGS: In this study, nurses did not take restorative breaks but focused on quick "bio" breaks in rooms nearest the central nurse station. When nurses left care floors, they preferred the cafeteria and outdoor eating spaces. CONCLUSION: Nurses' proclivity to minimize restorative breaks remains a major organizational concern. Future studies should investigate leadership activities impacting nurses' perception of shifts and break-taking behavior. APPLICATION TO PRACTICE: By optimizing the break setting and changing the cultural perspective of breaks, occupational health services and healthcare management can support nurses' engagement in restorative activities.

Investigating the Feasibility of Multisensory Environments to Improve the Assisted Bathing Experience for Veterans With Dementia: A Clinical Trial.

OBJECTIVES: This evidence-based design clinical trial assessed the feasibility of a multisensory environment (MSE) using aromatherapy, color-changing lights, and music as a behavioral intervention to calm Veterans with dementia during assisted bathing to improve the patient experience. BACKGROUND: The number of Veterans with dementia is growing rapidly, along with the associated debilitating behavior challenges. The severity of these distressed behaviors that predominantly occur at bath time often necessitates costly, dangerous sedatives. Feasibility studies of nonpharmacological behavioral interventions during bathing for people with dementia are urgently needed, and research supports MSE as a viable solution. METHOD: Using an A-B, multiple baselines across participants design, this study tracked operational behaviors of four Veterans with dementia during bathing without and with an MSE intervention. Sessions were provided and recorded by a dedicated team of five nurses, so the study team could analyze the Veterans' operational behaviors to understand the impact of individualized MSE during both baseline and intervention phases. RESULTS: The results support the feasibility of MSE as a helpful, nonpharmacological behavioral intervention for Veterans with dementia during bathing. All participants experienced an overall increase in duration of positive operational behaviors and an overall decrease in duration of negative operational behaviors. CONCLUSIONS: Healthcare environments are integral components in dementia care and the use of MSE within the bathing setting appears to improve not only operational behaviors but the overall bathing experience.

Design Thinking for Healthcare: Transliterating the Creative Problem-Solving Method Into Architectural Practice.

PURPOSE: The purpose of this article is to define design thinking, provide insights into how it may be integrated into the healthcare design process, and provide a checklist for future implementation. BACKGROUND: Design thinking is a collaborative method of inquiry that fosters innovative, team-generated solutions to complex scenarios, known as "wicked problems," that are extraordinarily difficult to solve. It is a practical tool in the toolbox of the codesign team, which includes the client and design professionals as primary stakeholders. It is powered by team-based creativity that adaptively responds to a need for new approaches and products in an innovative and practically applicable way. The need for design thinking in healthcare is steadily increasing as the healthcare system and its care environments continue to grow in complexity. Although major medical breakthroughs have undeniably expanded the average human life span, the current healthcare system is inefficient. Now, more than ever, design thinking and the innovative, human-centered solutions it enables are needed within healthcare design. Although the use of design thinking as a method within the field of architecture is not new, many design teams struggle integrating it fully within the design process, particularly in healthcare. The knowledge, design method, checklists, and direction provided in this article can benefit healthcare design teams to successfully integrate the method into practice. CONCLUSION: If design thinking is integrated into the healthcare architectural design process with the creative problem-solving method, opportunities will arise for innovative solutions and deeper insights into problems to benefit healthcare delivery.

The Impact of the Built Environment on Patient Falls in Hospital Rooms: An Integrative Review.

OBJECTIVES: The aims of this study were to identify and evaluate scientific evidence examining the impact of the built environment on patient falls in hospital rooms. METHODS: An integrative review (IR) with a systematic literature search was performed using the patient, intervention, comparison, outcome framework. We searched CINAHL, PsychINFO, PubMED, and Web of Science databases. The search included peer-reviewed studies from 1990 to 2017 written in English. An additional hand search was also conducted. Selected articles were reviewed and rated based on a hierarchical categorization, comprising six evidence levels, developed by the American Association of Critical-Care Nurses and adapted for evidence-based design systematic literature reviews. RESULTS: After a multitiered process, 30 articles met the selection criteria. Thematic areas were created based on the examined elements of the physical environment including patient room configuration and available space, bathroom configuration, bathtub and shower, door, bed height and bed rail, flooring, floor mats, patient chair, lighting, toilet, handrail, grab bars, intravenous pole, sink, ceiling lift, and wheelchair and walking aids. Findings of studies on each element are discussed in detail. CONCLUSIONS: Some environmental elements have not been examined in past relational or causal studies, and the level of evidence for the examined attributes is not high enough to gain robust confidence in healthcare design decision-making. Because of the low level of evidence for several environmental elements, conclusions must be taken with caution. More studies using quantitative, relational, or causal designs are recommended to develop actionable interventions on patient falls in hospital rooms.

Sensory Environments for Behavioral Health in Dementia: Diffusion of an Environmental Innovation at the Veterans Health Administration.

OBJECTIVES: To evaluate the diffusion of multisensory environments (MSEs) as an innovation at the Veterans Health Administration (VHA) and gather feedback regarding staff perceptions of barriers to uptake and effectiveness of MSEs for Veterans with dementia. BACKGROUND: Responding to the need for nonpharmacological behavioral interventions, VHA funded the first MSE for Veterans with dementia in 2010. The room incorporated LED color-changing lights, bubble tubes, vibroacoustic furniture, music, and aromatherapy, and the success of this patient-centered sensory room fueled national rollouts in 2013 and 2015. METHOD: A qualitative interview approach was used. Thirty-two staff members participated from 12 of the 53 sites producing 21 individual interviews and 1 group interview with 11 participants. Results were analyzed by a team of eight researchers using the rapid qualitative inquiry method to identify common themes and major insights. RESULTS: Important insights emerged with regard to staff members' perceptions about the effectiveness of MSE therapy as well as barriers to uptake and suggested strategies for overcoming those barriers (e.g., empowering a champion, developing a clear maintenance plan). CONCLUSIONS: The findings from this research indicate MSEs are perceived as effective in improving behavior for Veterans with dementia and represent an innovation that has been well-diffused within the VHA, with great potential for future clinical applications.

Impact of Multisensory Environments on Behavior for People With Dementia: A Systematic Literature Review.

PURPOSE OF THE STUDY: Behavioral and psychological symptoms of dementia (BPSD) affect quality of life for people with dementia. Nonpharmacological interventions are the preferred first line of treatment, and it is theorized that BPSD are directly influenced by sensory imbalance and improved by sensory equilibrium. The purpose of this article is to investigate the evidence regarding the use of multisensory environments (MSEs) as treatment for BPSD. DESIGN AND METHODS: A systematic literature review was performed using the PICO framework within PsycINFO, Web of Science, ERIC, PubMED, and Cinahl databases, as well as additional hand-searched documents. Included articles were published during 1990 to 2015 and report empirical studies of MSE BPSD interventions that include furniture, fixtures, and equipment to provide visual, auditory, tactile, and olfactory stimulation. Desired elements include ergonomic vibroacoustic furniture, bubble tubes, color-changing lights, and fiber optics. RESULTS: Twelve articles met the inclusion criteria for review. Evidence supports the positive impact of sensory stimulation as a nonpharmacological behavioral treatment for dementia. Many studies investigated both behavior and mood, and several investigated biomedical parameters including heart rate and cognition. Significant differences were not found in the between-group studies when MSE was compared with other one-to-one interventions. Results on long-term effects were mixed. Variations can be seen in terms of research methods, types of environmental interventions, duration, and specific characteristics of participants, thus confounding the reliability of findings. IMPLICATIONS: Key findings and directions for future research are discussed including primary outcomes, study design, environmental intervention types, and relevant assessment tools.

How to Write a Systematic Review of the Literature.

This article provides a step-by-step approach to conducting and reporting systematic literature reviews (SLRs) in the domain of healthcare design and discusses some of the key quality issues associated with SLRs. SLR, as the name implies, is a systematic way of collecting, critically evaluating, integrating, and presenting findings from across multiple research studies on a research question or topic of interest. SLR provides a way to assess the quality level and magnitude of existing evidence on a question or topic of interest. It offers a broader and more accurate level of understanding than a traditional literature review. A systematic review adheres to standardized methodologies/guidelines in systematic searching, filtering, reviewing, critiquing, interpreting, synthesizing, and reporting of findings from multiple publications on a topic/domain of interest. The Cochrane Collaboration is the most well-known and widely respected global organization producing SLRs within the healthcare field and a standard to follow for any researcher seeking to write a transparent and methodologically sound SLR. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), like the Cochrane Collaboration, was created by an international network of health-based collaborators and provides the framework for SLR to ensure methodological rigor and quality. The PRISMA statement is an evidence-based guide consisting of a checklist and flowchart intended to be used as tools for authors seeking to write SLR and meta-analyses.