How does the built environment affect patient safety in relation to physical activity? Experiences at a rehabilitation center.

Physical activity benefits patients in rehabilitation yet comes with various safety issues. The built environment impacts on both safety and physical activity. We aim to explore the role of the built environment in safety issues related to being physically active in rehabilitation. We conducted a case study at a free-standing rehabilitation center for patients with Multiple Sclerosis, neurologic, or locomotor issues. Patients participated in two interviews supported by activity tracking data. Care professionals participated in focus group interviews respectively with two therapists and four head nurses. Accessibility and physical barriers, visual connections and (in)dependence, and spatial familiarity are important themes when identifying aspects of the built environment in relation to reducing safety issues patients encounter during physical activity. Raising awareness about each of these among care and design professionals could help them to balance safety issues in relation to physical activity and to communicate about them in a nuanced way.

What affects physical activity in a rehabilitation centre? Voices of patients, nurses, therapists, and activity trackers.

PURPOSE: In the context of rehabilitation, research shows a close connection between patients' physical activity, care culture, and the built environment. As these three impact on patients' rehabilitation process, we aim to understand what affects physical activity in a particular rehabilitation centre. MATERIALS AND METHODS: We combine insights from literature with a qualitative study informed by quantitative data. Semi-structured and walking interviews with 16 patients were informed by output from activity trackers. Two focus-group interviews with respectively four nurses and two therapists provided extra perspectives. RESULTS: We found that patients interpret physical activity rather narrowly, equating it with therapy. Yet, the data of the activity trackers show that daily activities are often as active as therapy, as confirmed by nurses and therapists. Motivation to be physically active was found in setting clear goals, social interaction, allowing choice and control to achieve a sense of normality, and the built environment. How patients act in and interact with the built environment are closely related to how staff approaches and communicates care. CONCLUSIONS: The focus on what affects - defines, hampers, or supports - physical activity in a rehabilitation centre allowed developing a better understanding of how care culture and the built environment interrelate.Implications for rehabilitationHow physical activity is perceived by patients reflects the goals they like to achieve through rehabilitation.The built environment is a third factor in the relation between care culture and patients' physical activity.Fully supporting patients to be physically active with respect to their personality and capabilities requires differentiating between patients both in how they are approached (patient- or person-centred) and in how they are spatially facilitated.

Building scale and well-being in a hospice: a qualitative exploration.

OBJECTIVE: This study explored how built space plays out in palliative care, focusing on spatial aspects that could support or hamper patients', relatives' and caregivers' well-being. METHODS: This study was conducted in a freestanding small-scale hospice combining a residential part for eight guests with a day-care part for groups of about five persons. Observations were combined with semistructured, individual interviews with eight guests (sometimes accompanied by relatives) and three focus-group interviews with staff, volunteers and relatives. All interviews were audio-recorded and transcribed verbatim. Data were analysed based on the Qualitative Analysis Guide of Leuven. RESULTS: The most important spatial aspects that impact on physical and social well-being in palliative care turned out to be the building scale and physical proximity. The small-scale setting counters the (often negative) association of palliative care with hospital environments. When the medical condition of the guest allows, it makes communal or outdoor spaces reachable, which enhances emotional and social well-being. In worse conditions, it still makes that care and nature are always nearby. The compactness of communal spaces intensifies social contacts. CONCLUSIONS: The building scale and physical proximity play out in the relationship between the building and its surroundings, between the residential and the day-care parts and among people within the building. Future research could investigate to what extent these spatial aspects are relevant in more conventional palliative care units or even in general hospital wards.

Re-grounding the concept of liminality by foregrounding spatial aspects in experiences of cancer care.

Liminality captures the passing stages in transitioning from one sociocultural status to another. As its spatial dimension remains under-examined, we analyse this in experiences of people affected by cancer. We review liminality in cancer-related literature and juxtapose this with empirical material. Analysing interview data (with eight patients) and participant-made photos highlights why places may be experienced differently throughout a period of illness and how places of diagnosis and care 'stretch' across locations. We conclude that exploring liminality's spatial dimension has implications for people 'living beyond' cancer, advances sociological understandings of (cancer) illness, and may inform healthcare facility design.

Everyday comforting practices in psychiatric hospital environments: A design anthropology approach.

WHAT IS KNOWN ON THE SUBJECT: Comfort as a conceptual and lived experience is essential in psychiatric hospital contexts and for overall mental health wellbeing. Comfort is a valuable aspect when designing hospitals and built environments for psychiatric care. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: This article presents the results from a Design Anthropology study at four Psychiatric Units co-located in a newly built regional hospital based on 126 ethnographic interviews with staff, within which 63 participants mentioned the importance of comfort in generating environments conducive to wellbeing. An in-depth qualitative understanding of comforting practices, as emergent forms of everyday care. These may receive less attention within more established interventions from organisational models of care (e.g., Safewards) and might appear to be implicit gestures of courtesy. However, they contribute to meaningful encounters and contribute to individual and organisational wellbeing in psychiatric care. WHAT ARE THE IMPLICATIONS FOR PRACTICE: This paper builds on comfort theories and demonstrates implications for practice through ethnographic examples. Comfort, often unnoticed until it is absent, needs to be maintained through continuous "small" but intentional acts of care. These constitute a finely tuned repertoire of everyday comforting practices of care at psychiatric contexts. Corridors and doors are presented as spaces where people have brief interactions that can contribute to everyday comforting experiences. Comfort is discussed in dialogue with existing literatures from psychiatric nursing, healthcare building design and design anthropology. Implicit and improvised practices of care that foster comforting environments have vital potential to support institutionally endorsed models of care (e.g., Safewards). The article proposes that design has a dual role for comforting environments in psychiatric care; (a) through the practice of architectural design and (b) through the practices of staff when creating everyday comforting interactions for wellbeing. ABSTRACT: INTRODUCTION: Creating a comforting environment is essential for delivering psychiatric care. While healthcare organisations explicitly implement care models and adapt the physical environment, attention to staff's implicit everyday practice is limited. AIM: Developing a design anthropology approach tailored specifically to the research site, we examine the social and physical environment to unpack how staff integrate both-implicit comforting interventions, and the explicit measures taken by the organisation-into their everyday practices of psychiatric care. METHOD: Design and sensory ethnography, using extended observations and "walking tours" were undertaken with 126 staff members. A thematic analysis was conducted on all visual and audio material. RESULTS: Staff's everyday implicit care practices and situated design decisions provide a comforting environment for patients, visitors and staff. DISCUSSION: Implicit practices combine with an explicit organisational model of care to achieve a comforting environment. The value of design anthropology to uncover these dynamics is emphasized. Comforting practice involving implicit gestures of courtesy, which are infrequently addressed within organisational models of care (e.g., Safewards), are foregrounded. IMPLICATIONS FOR PRACTICE: Explicit models of care have clear value in generating comfort; however, psychiatric hospital care also benefits from less visible modes of delivering comfort through everyday practices. By acknowledging both explicit and implicit modes of comfort, we can better understand how care models and psychiatric cultures of care are nurtured. Continuous "small" but intentional acts of care (e.g., brief interactions in corridors and at doors) constitute a finely tuned repertoire of everyday comforting practices.

Foregrounding the built environment in the experience of cancer care: A qualitative study of autobiographical cancer narratives.

BACKGROUND: For cancer patients, exposure to cancer care facilities entails confrontation in multiple ways. The value ascribed to these places grows over time and can be expected to affect the experience of care. OBJECTIVE: The purpose of this study was to foreground the role of the built environment in this experience. METHODS: This qualitative study is based on seven autobiographical narratives written by cancer patients being treated in Belgium or in neighbouring countries. RESULTS: The thematic analysis of these accounts raises awareness of architecture's role in the experience of cancer patients. Their radius of action is typified by the contrasting adventurous undertakings and shrinking lifeworlds. The built environment furthermore provides leads to metaphors for patients to reformulate their experiences of illness and care. CONCLUSIONS: Deterritorialised landscapes of cancer care include multiple, geographically dispersed places of care, rather than a single prominent care facility. Simultaneously, exposure to buildings where formal cancer care takes place is intense and meaningful. Metaphors are linked to the built environment and can be seen, through their use in the narratives, to support coping. Further research could look into the potential of metaphors to enhance understanding between stakeholders collaborating around design for cancer care.

Researching and Designing Health Care Environments: A Systematized Review of Creative Research Methods.

In research and design, Creative Research Methods (CRMs) are useful to gain insight into user perspectives. Reviews suggest that CRMs offer potential to engage people, yet little detail is available regarding their use in relation to built health care environments. Consider environments for cancer care, where patients are confronted with particular physical and emotional challenges. This review aims to synthesize what is known from existing literature about CRMs exploring user experience when researching and designing (cancer) care environments. Based on 16 items, we evaluate the potential of CRMs, offering insight into why, how, where, and when they are employed. Generally little consideration is shown for participants' abilities and limitations. Our analysis further emphasizes the importance of reflecting on visual methods, and the need to report research approaches transparently including where CRMs are used. A sophisticated research approach can leverage CRMs' potential to study experience and carry artifacts forward to inform design(ers).

How Do Adolescents Affected by Cancer Experience a Hospital Environment?

PURPOSE: Adolescence is a transition period involving complex development processes. A life-threatening disease like cancer jeopardizes this development and often exposes adolescents to hospital environments that are unadjusted to them. Despite growing research on how the physical environment affects the well-being of the (child as) patient, adolescents are often overlooked. We investigated how adolescents experience a hospital stay and how the physical environment influences that experience. METHODS: We interviewed ten adolescents who are or have been affected by cancer between the age of 14 and 25, and discussed preliminary findings with professional experts. RESULTS: In young people's experience of a hospital environment three interrelated themes stand out: support, distraction, control, and autonomy. Adolescent patients primarily look for connections with life outside the hospital. The hospital confronts them with different obstacles, most of which appear to relate to difficulties concerning the loss of these connections. These obstacles include a lack of freedom, control, and autonomy; limited social interaction with friends; inability to participate in daily activities; boredom; and a lack of privacy. CONCLUSION: As a group, adolescent patients clearly have specific characteristics and needs. This specificity, which is largely hidden in the development and transition they are undergoing, explains the need for a hospital environment dedicated to them-be it a separate adolescent ward, or the grouping of adolescents on children's and/or adult wards. Rather than focusing on a superficial list of wishes and needs, the design of this environment should consider the specific reasons driving adolescents' wishes and needs.

The Role of Space in Patients' Experience of an Emergency Department: A Qualitative Study.

INTRODUCTION: Nurses are increasingly involved in the design of health care facilities. Although their experience differs from that of patients, they are often expected to represent patients in design processes. Especially in the context of an emergency department, patients' states of mind alter their experiences. Knowledge about the role of space in ED patients' experience is limited. Our study aims to gain insight into this role and thus provide ED nurses with information to better represent ED patients' perspectives in design. METHODS: We conducted qualitative interviews with 22 patients. The interviews were supported by visual material collected through ethnographic methods to facilitate participants' reflections on the role of space in their experience. Participants were selected during their stays at the emergency department by convenience sampling. Interviews were audio-recorded, transcribed, and analyzed in combination with the visual material through open and axial coding. RESULTS: We found that the role of space in ED patients' experiences is affected by their altered sensory awareness and shaped by material, social, and time-related aspects. These aspects are intertwined and influenced by the transient character of the emergency department. DISCUSSION: The study indicates that paying attention to the role of space yields a nuanced understanding of ED patients' experiences. The challenge for hospital designers and staff lies in taking into account patients' altered sensory awareness and in designing interventions that support staff in emphasizing a human approach without counteracting the medical-technical aspect of emergency care.

Being Wheeled or Walking: A Qualitative Study of Patients' Spatial Experience in Two Distinct Day Surgery Centers.

OBJECTIVE: In this article, we explore what a different way of moving-being wheeled versus walking-means for the spatial experience of day surgery patients. BACKGROUND: Day surgery centers can be conceived in very different manners. Some are organized similar to traditional hospital admittance; others are located in a specifically designed part of the hospital and receive patients as guests who walk through the entire procedure. METHODS: We conducted semistructured interviews with 37 patients at two distinct day surgery centers. RESULTS: Despite the different managerial concepts and corresponding spatial designs, in both centers, patients' spatial experience is shaped by the interrelation of material, social, and time-related aspects. However, the chosen concept results in a different experience throughout patients' journey. CONCLUSIONS: Based on an analysis of the different journeys, we conclude that patients' interpretation of a hospital's care vision is influenced not only by what the hospital communicates explicitly or how it educates its staff but also by what is implicitly told by the built environment.