Even if one is confident that the staff provide the bestpossible treatment, being admitted into hospital is still astressful situation. In recent decades, architecturalresearchers have elaborated on aspects of the patient'sperspective where the design of the physical environment maypositively enhance the healing experience. The emergingunderstanding reveals that this is not an issue to be solvedsimply by decorative design, for it entails the spatialinterpretation and integration of broader and deeper facets ofhuman response, within which suffering, empathy andprofessional care are embraced. This thesis elucidates the patients' use of space accordingto their cultural perceptions in two inpatient wards in aregional hospital in northwestern Namibia. The study appliescase study methodology with the focus on the interactionbetween patients, visitors and nursing staff in relation to thephysical environment. The theoretical basis within medical anthropologyconceptualises sickness as a cultural event in the dual notionillness and disease, signifying two ways of understandingsickness, the individual and the professional interpretations.The Foucauldian theory on discipline and space suggests thatthe biomedical discipline is spatially represented by themodern hospital, from which aspects of illness areexcluded. The results show that circumstances in the physicalenvironment highly influence the patients' illness experienceby possessing certain qualities or by the activities renderedpossible by spatial conditions. The two wards possess manymodern qualities adding to an enclosed and restrictingenvironment. Patients come from a culturally dynamic andchanging context where new approaches to healthcare andhospital physical space are generated. Whereas patients haveintegrated hospital-based biomedicine as a medical alternative,modern hospital space cannot accommodate certain patient needs.Patients, visitors and nursing staff negotiate space in orderto overcome spatial weaknesses. Family members' overnightaccommodation in the hospital, as well as their voluntarycontribution to patient care, are two important aspects whichare not spatially incorporated. An alternative ward design is suggested in which patients'and family members' active participation in the healing processis encouraged, with support from the nursing staff. The higherflexibility the design offers caters for the spatialintegration of future hybrid processes.

<p>Even if one is confident that the staff provide the bestpossible treatment, being admitted into hospital is still astressful situation. In recent decades, architecturalresearchers have elaborated on aspects of the patient'sperspective where the design of the physical environment maypositively enhance the healing experience. The emergingunderstanding reveals that this is not an issue to be solvedsimply by decorative design, for it entails the spatialinterpretation and integration of broader and deeper facets ofhuman response, within which suffering, empathy andprofessional care are embraced.</p><p>This thesis elucidates the patients' use of space accordingto their cultural perceptions in two inpatient wards in aregional hospital in northwestern Namibia. The study appliescase study methodology with the focus on the interactionbetween patients, visitors and nursing staff in relation to thephysical environment.</p><p>The theoretical basis within medical anthropologyconceptualises sickness as a cultural event in the dual notionillness and disease, signifying two ways of understandingsickness, the individual and the professional interpretations.The Foucauldian theory on discipline and space suggests thatthe biomedical discipline is spatially represented by themodern hospital, from which aspects of illness areexcluded.</p><p>The results show that circumstances in the physicalenvironment highly influence the patients' illness experienceby possessing certain qualities or by the activities renderedpossible by spatial conditions. The two wards possess manymodern qualities adding to an enclosed and restrictingenvironment. Patients come from a culturally dynamic andchanging context where new approaches to healthcare andhospital physical space are generated. Whereas patients haveintegrated hospital-based biomedicine as a medical alternative,modern hospital space cannot accommodate certain patient needs.Patients, visitors and nursing staff negotiate space in orderto overcome spatial weaknesses. Family members' overnightaccommodation in the hospital, as well as their voluntarycontribution to patient care, are two important aspects whichare not spatially incorporated.</p><p>An alternative ward design is suggested in which patients'and family members' active participation in the healing processis encouraged, with support from the nursing staff. The higherflexibility the design offers caters for the spatialintegration of future hybrid processes.</p>

L’utilisation des mesures de contrôle pour la gestion des comportements violents constitue une préoccupation majeure pour les infirmières qui pratiquent dans les unités de soins de santé mentale adulte. Le recours à ces mesures engendre des conséquences physiques et des traumatismes psychologiques chez les patients et tout le personnel soignant. Par conséquent, la prévention et la réduction de leur utilisation deviennent une priorité. De par l’aspect multifactoriel de cette problématique, la connaissance des facteurs qui influencent l’utilisation de ces mesures est primordiale pour cibler les interventions qui permettent de les prévenir ou les réduire. Les facteurs reliés aux caractéristiques cliniques des patients et au personnel soignant sont bien décrits dans la littérature. Toutefois, les facteurs reliés à l’environnement du patient ne sont pas attribués à l’ensemble des dimensions qui le constituent. Ceci est dû à la rareté des modèles conceptuels qui donnent une représentation structurée et globale de cet environnement. L’absence de cette représentation laisse les facteurs associés à l’environnement circonscrits seulement dans sa dimension physique, alors que d’autres facteurs reliés à ses autres dimensions sont rapportés dans la littérature sans être définis comme des facteurs environnementaux. Le but de cette revue de la portée a donc été d’explorer l’étendue des connaissances et d’identifier les facteurs de l’environnement qui sont associés à l’utilisation des mesures de contrôle chez les patients atteints de troubles mentaux. Afin d'intégrer une représentation globale de l’environnement, le cadre de référence du modèle de l’environnement thérapeutique optimal a été retenu (Optimal healing environment, ETO) (Jonas et al. , 2014). Les étapes de la revue de la portée selon Peters et al. (2020) ont été suivis, ce qui a donné lieu à l'inclusion de 35 écrits. L’analyse thématique des données extraites a permis d'identifier deux dimensions, à savoir l’environnement interpersonnel et l’environnement externe du patient. L’environnement interpersonnel décrit le développement et le maintien d’une relation thérapeutique à travers l’amélioration des compétences de communication du personnel soignant, l’utilisation des stratégies de prévention de crise d’agressivité, l’implication du patient, le retour post-évènement d’isolement et/ou contention et le sentiment d’appartenance à la communauté de l’unité de soins. Il décrit également la création d’organisations thérapeutiques via l’exercice du leadership organisationnel, les initiatives d’améliorations de l’organisation des soins, et la gestion des ressources humaines et technologiques. Pour sa part, l’environnement externe décrit la conception architecturale et le design intérieur des unités de soins où le patient est hospitalisé. Finalement, on pourrait conclure que des trois dimensions de l’ETO qui ont été incluses dans ce travail, les dimensions de l’environnement interpersonnel et l’environnement externe sont les plus représentées dans la littérature des cinq dernières années. De plus, les interventions de prévention de crise d’agressivité et le leadership organisationnel se sont montrés des facteurs clés d'un environnement thérapeutique favorisant la réduction de l’utilisation des mesures de contrôle. / The use of coercive measures (seclusion and restraints) to manage violent behaviors is a major preoccupation for adult mental health nurses. The use of these measures results in physical consequences and psychological trauma for patients and all caregivers. Therefore, prevention and reduction of their use becomes a priority. Due to the multifactorial aspect of this problem, understanding of the factors influencing this measures use is essential in order to target interventions to reduce them. Factors related to the clinical characteristics of patients and caregivers are well described in the literature. However, factors related to the patient's environment are not attributed to all of its dimensions. This is due to the scarcity of conceptual models that provide a structured, global representation of this environment. The absence of such a representation leaves the factors associated with the environment circumscribed only within its physical dimension, while other factors related to its other dimensions are reported in the literature without being defined as environmental factors. The aim of this scope review was therefore to explore the extent of knowledge and identify the environmental factors associated with reduced use of coercive measures in patients with mental disorders. In order to incorporate a holistic representation of the environment, the framework of the Optimal healing environment (ETO) model was selected (Jonas et al., 2014). The scope review steps according to Peters et al. (2020) were followed, resulting in the inclusion of 35 literatures. Thematic analysis of the extracted data identified two dimensions, namely the patient's interpersonal environment and external environment. The interpersonal environment describes the development and maintenance of a therapeutic relationship through the improvement of caregivers' communication skills, the use of aggressive crisis prevention strategies, patient involvement, the post-event return from isolation and/or restraint, and the sense of belonging to the care community. It also describes the creation of therapeutic organizations through the exercise of organizational leadership, initiatives to improve the organization of care, and the management of human and technological resources. For its part, the external environment describes the architectural and interior design of the care units where the patient is hospitalized. Finally, we may conclude that of the ETO three dimensions included in this work, interpersonal environment and external environment are the most represented in the literature of the last five years. In addition, aggression crisis prevention interventions and organizational leadership have been shown to be key factors in a therapeutic environment conducive to reducing the use of coercive measures.