abstract: Over the past century, the relationship between the built environment and people’s health and well-being has become central to the discussion and critique of healthcare design. The concept of such a relationship is not new; more than a century ago, Florence Nightingale promoted a particular vision for hospital design. Her concerns with naturalism, acoustics, ventilation, and aesthetics in the healthcare environment are as relevant today as they were in the mid-19th century. This dissertation examines Nightingale’s contributions to the development of the nascent field of healthcare interiors by: identifying major developments of healthcare interiors through the centuries; investigating Nightingale’s life, work, and principles on the healthcare environment; and examining whether certain contemporary hospital design approaches support, expand upon, or negate her principles. The research integrates material culture analysis of extant objects and content analysis of documents within the framework of a case study of two healthcare facilities in Tucson, Arizona. Findings show that the Nightingale era was seminal in the evolution of the healthcare environment, with key developments towards healthful interiors for the sick. Wide adoption of hospital design guidelines suggested by Nightingale—emphasizing physical elements such as ventilation, natural light, view, sanitization, and ambiance—occurred in various types of healthcare facilities, including military and tuberculosis sanatoria around the world. Additionally, analysis of the case study shows just how welcoming and supportive a 1920s healthcare facility, like the Desert Sanitarium, can be. The facility successfully adapts Florence Nightingale’s principles to the local climate and context, including indigenous pueblo architecture, traditional Southwestern materials, Native American artifacts, desert views, and even the traditional courtyard plan used by Spanish colonial settlers. This successful adaptation suggests that Nightingale’s principles may be valuable to and relevant within different places and times, even today. Thus, Nightingale contributed to the emerging field of healthcare interiors by: 1) functionally organizing the built environment affecting patients’ healing, 2) preventing healthcare-associated infection in the physical environment, and 3) supporting psychological health with aesthetic amenities. The findings advance interior design scholarship, education, and practice; and further the documentation and explication of Arizona’s history in the healthcare environment. / Dissertation/Thesis / Doctoral Dissertation Design 2015

In his classic book, Experiencing Architecture, Rasmussen (1959) noted that architects inspired by addressing problems in built environments created buildings with a special spirit: a distinctive stamp. Recent problems in healthcare facilities, specifically those related to reducing stress and anxiety, have inspired designers to create positive, uplifting distractions to redirect a patient's attention from a sterile environment and/or noxious event. In doing so, healthcare facilities have become special environments with a caring spirit. This study examined a specific aspect of creating a caring environment: determining whether or not a positive distraction, a child's art-light mosaic movie developed by the researcher, would lower pain and distress in children 4, 5, and 6 years old during an immunization procedure. The researcher conducted a randomized controlled study in two locations using a child's self-report pain scale, heart rate, parent/guardian report, and nurse report measures. After collecting and analyzing data from 76 well-participants receiving one to five immunizations, the researcher found no statistically significant difference between the conditions for any of the measures. Thus, the null hypothesis, the art-light mosaic image would not assist in lowering pain and distress in pediatric patients, 4 to 6 years old, during an immunization procedure, was not rejected. From these results, the researcher recommended future studies incorporate training the parent and child on how to use the distraction, combine the distraction with a topical analgesic, provide a clear understanding of pain and distress from the child's point of view, and develop more sensitive self-report measures of pain for children. / Ph. D. / In his classic book, Experiencing Architecture, Rasmussen (1959) noted that architects inspired by addressing problems in built environments created buildings with a special spirit. Recent problems in places that provide healthcare, specifically those related to reducing stress and anxiety, have inspired designers to create positive, uplifting distractions to redirect a patient’s attention from an unfriendly environment and/or unpleasant event. In doing so, healthcare facilities have become special places with a caring spirit. This study investigated one area in creating a caring environment: determining whether or not a positive distraction, a child’s art-light mosaic movie developed by the researcher, would lower pain and distress in children 4, 5, and 6 years old receiving a vaccination. The researcher conducted a study in two locations using proven measures to determine the child’s anxiey. After collecting and analyzing information from 76 well-children receiving one to five vaccinations, the researcher found no difference between the children’s anxiety watching or not watching the positive distraction during a vaccination. Therefore the researcher stated the positive distraction, an art-light mosaic image, would not help lower pain and distress in children, 4 to 6 years old, during a vaccination. From these results, the researcher recommended future studies include training the parent and child on how to use the distraction, combine the distraction with a cream designed to rub on the skin to relieve pain, provide a clear understanding of pain and distress from the child’s point of view, and develop better measures to determine pain in children.

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Bakgrund: Vårdmiljön har genom tiderna gått från att vara i fokus, till att bli åsidosatt till förmån för den medicintekniska utvecklingen och nu på senare år blir den igen allt mer uppmärksammad. Problem: Sjuksköterskan har en viktig roll i skapandet av en vårdmiljö men hur upplever patienten vårdmiljön? Syfte: Att belysa patientens upplevelser av vårdmiljön. Metod: En litteraturstudie med kvalitativ inriktning med en beskrivande syntes som metod. Resultat: Utifrån patientens upplevelser av vårdmiljön identifierades tre teman med tillhörande subteman. Den omgivande miljön innefattande välkomnande och trygg samt estetikens betydelse. De viktiga relationerna innefattande sjuksköterskors omsorg och samspel med andra. Den inre kraften innefattande en holistisk syn samt delaktighet i vården. Slutsats: Patienterna upplevde både den yttre och den inre miljön som viktig och de båda miljöerna var i ett ständigt utbyte med varandra. Patienterna önskade uppleva en välkomnade och trygg omgivning vid ankomst till en vårdmiljö, miljön skulle även vara estetiskt tilltalande. Patienterna önskade goda relationer med sjuksköterskorna och samspel med de andra patienterna, de ville bli sedda med en holistisk syn samt vara delaktiga i sin egen vård. / Background: The healthcare environment has gone from being in focus, to be disregarded in favor of the medical progress and in recent years again becoming more and more attentive. Problem: The nurse has an important role in creating a care environment but how does the patient experience the care environment? Aim: To elucidate the patient's experience of the care environment in hospital settings. Method: A literature review with a qualitative approach and a descriptive synthesis as method. Results: Based on the patient's perceptions of the care environment three themes with related subthemes were identified. The surrounding environment including welcoming and safe as well as the aesthetic importance. The important relationships including nursing care and interaction with others. The internal power including a holistic approach and involvement in care. Conclusion: Patients experienced both the external and internal environment as important, and the two environments are intertwined. Patients wanted to experience a welcoming and safe surrounding on arrival to a healthcare environment, they also wanted the environment to be aesthetically pleasing. Patients wanted good relations with nurses and interaction with the other patients, they wanted to be seen with a holistic view and participate in their own care.

Bakgrund Sömn är ett basalt behov för människan och har stor betydelse för tillfrisknandet hos patienter. Påslutenvårdsavdelningar kan patienters sömn påverkas av faktorer i vårdmiljön samt av patientenspatofysiologiska- och psykiska tillstånd. Brist på sömn har påvisat negativa effekter på hälsan,både fysiskt och psykiskt. Sömnbrist riskerar bland annat att ge ett högre blodtryck, försämradläkningsprocess, nedsatt ork, fördröjd mobilisering, risk för fall och ökad oro. Sjuksköterskan harett nyckelansvar att främja patientens sömn utifrån ett holistiskt perspektiv, vilket betonadesredan på 1800-talet av Florence Nightingale. Genom att identifiera faktorer i vårdmiljön somutgör ett hinder mot patientens sömn, ges sjuksköterskan möjlighet att utvecklaomvårdnadsåtgärder för att främja en god natts sömn utifrån patientens individuella behov. Syfte Syftet med uppsatsen var att utifrån ett patientperspektiv identifiera faktorer i vårdmiljön somskapar hinder för en god natts sömn i samband med övernattning på en slutenvårdsavdelning. Metod Studiens design är en litteraturöversikt. Litteraturöversikten lutar sig på manuella samt systematiska sökningar i olika databaser, i detta fall PubMed och CINAHL. Artiklarna som inkluderats är skrivna någon gång mellan åren 2010 - 2020. Efter noggrann granskning har totalt 16 vetenskapliga artiklar, publicerade inkluderats i studien. Artiklarna är både utav kvalitativ och kvantitativ sort. Resultat Resultaten från artiklarna visade på flera faktorer som skapade svårigheter för patienterna attsova. Faktorerna delades in i externa faktorer vilka utgjordes av faktorer i vårdmiljön och övriga faktorer. Slutsats Slutsatsen som dras utifrån resultaten är att det krävs striktare rutiner på sjukhus runtom i världen gällande anpassning av vårdmiljön nattetid för att främja patienternas sömn utifrån patienternas individuella behov. / Background Sleep is a basic human need and has a significant impact on the recovery in patients. In inpatientwards, patients' sleep is characterized by disturbing factors in the health facility environment. The patient's pathophysiological and mental state can also affect. Lack of sleep has shown negative effects on health, both physically and mentally. Sleep loss increases risk for high blood pressure,immobility, falls, anxiety and decreased healing process. The nurse plays a key role to promote patient sleep from a holistic perspective, which was stated already in the 1800th century by Florence Nightingale. By identifying disturbing factors in the healthcare environment, the nurseis given the opportunity to develop nursing measures to promote a good night's sleep from the patient's individual needs. Aim The aim of the study was to identify factors in the healthcare environment from a patient perspective that create obstacles to a good night's sleep in connection with an overnight stay in aninpatient ward. Method The design of the study is a literature review. The literature review is based on manual andsystematic searches in various databases, in this case PubMed and CINAHL. The included articles are written sometime between the years of 2010 - 2020. After careful review, a total of 16 scientific articles were included in the study. The articles are both qualitative and quantitative. Results The results showed that there are numbers of factors in the hospital environment that aredisruptive for patient sleep. The factors have been divided into external environmental factorsand internal causes.

Yes / The current healthcare systems have numerous gaps that need to be filled to reach the best practice. This paper presents a novel approach to design and validate a hybrid knowledge-based system (KBS) to evaluate QM of healthcare environment (QMHE) using a hybrid system that has not been used before. It will be combined with gauge absence perquisite (GAP) method to sustain a successful operation of the large number of key performance indicators (KPIs) that involved in QMHE and to detect the gap between each KPI and the anticipated point. Out of 354 KB rules answered, the system has categorised 225 as GPs and the remaining 128 as BPs. The 128 bad points are categorised into different problem categories (20 PC-1, 34 PC-2, 34 PC-3, 40 PC-4, and 0 PC-5) where they represent the actions that need to be enhanced to reach the desired level of quality management.

Yes / The cost of medical care is snowballing at an alarming and unmaintainable rate universally. Consequently, the need for a trusted quality management (QM) system at healthcare organizations is a must. Such system will aid the healthcare governance to increase the effectiveness and decrease the cost. It will help in minimizing the risk and enhancing patient safety. Several challenges facing healthcare QM in Oman are creating computerizing monitoring tool and confirming commitment of decision makers at all levels. The Report of Quality and Patient Safety (RQPS) in Oman 2016 highlighted the low level of patient safety and quality culture among staff. It recommended to inaugurate a well-defined organizational chart based on each healthcare organization’s vision and mission. Therefore, it is important to design a national accreditation system that is accredited by an international accreditation body. Such step will help in prioritizing the needs and minimizing the cost of maintaining and upgrading systems. To overcome these challenges, this article is presenting a novel methodology of hybrid knowledge-based (KB) system to assess QM in healthcare environment (QMHE) using gauging absence of prerequisites tool for benchmarking and analytical hierarchy process for prioritizing. The KB-QMHE model can be used as a standard to assess QM at any healthcare organization around the globe. The results showed that 852 questions were answered by the quality managers in a tertiary hospital in Oman; the percentage of bad points in this hospital was 32%. The KB-QMHE model has clearly shown that the priority 1, in level 0, is to focus on the patient-centered dimension in the healthcare quality dimensions submodule. Output, also, suggested a prioritized action plan covering healthcare governance module, healthcare leadership module and healthcare organization’s resources module in level 1–3.

Yes / Governance perspective plays a vital role in the success of Quality Management in Healthcare Environment (QMHE). In fact QMHE has adopted and applied different quality tools and models in recent times, with some even developing their own quality‐based initiatives. This paper will present an original and novel approach (KB/ES coupled with GAP analysis) to evaluate the effectiveness of governance body in QMHE. The KB system inserts GAP for benchmarking and evaluating the current practices with the desired ones. The KB system will benchmark the current position of governance perspective as part of QMHE with the ideal benchmark one. The results will help healthcare practitioners to improve the governance boy’s gaps and take the correct decisions. / Sultan Qaboos University, Oman

Yes / This paper presents the development of a Knowledge-Based System (KBS) to support the implementation of Lean Six Sigma (L6σ) principles applied to enhance Quality Management (QM) performance within a Healthcare Environment. The process of KBS building has been started by acquiring knowledge from experts in field of L6σ and QM in healthcare. The acquired knowledge has been represented in a rule-based approach for capturing L6σ practices. These rules are produced in IF….THEN way where IF is the premise and THEN is the action. The produced rules have been integrated with Gauging Absence of Pre-requisites (GAP) technique to facilitate benchmarking of best practice in a healthcare environment. A comprehensive review of the structure of the system is given, detailing a typical output of the KBS. Implementation of L6σ principles to enhance QM performance in a Healthcare Environment requires a pre-assessment of the organisation’s competences. The KBS provides an enhanced strategic and operational decision making hierarchy for achieving a performance benchmark. This research presents a novel application of a hybrid KBS with GAP methodology to support the implementation of L6σ principles to enhance QM performance in a healthcare environment.

Bakgrund: Den svenska befolkningen ökar vilket resulterar i en ökad press på vården. Som patient ska man vara centrum för allt vårdande. Sjuksköterskan har ett ansvar för att lindra lidande och hjälpa patienten att uppleva hälsa och välbefinnande. Vårdmiljön har ett stort inflytande på patientens tillfrisknande. Därför är det viktigt att veta hur patienterna upplever vårdmiljön i de olika salarna för att på bästa sätt kunna gynna deras hälsa. Syfte: Att beskriva patienters upplevelser av vårdmiljön i fler- respektive enkelbäddssalar. Metod: Detta examensarbete är en litteraturöversikt grundad på tolv vårdvetenskapliga originalartiklar. Artiklarna hämtades från databaserna CINAHLComplete samt PubMed. Efter inhämtning av artiklar analyserades dessa efter Fribergs metod om litteraturöversikter. Resultat: Resultatet i denna översikt sammanställdes i sex kategorier, och dessa var: Upplevelsen av en gemenskap, Aktiviteter och tidsfördriv, Stöd av andra patienter, Integritet i förhållande till andra patienter, Sömnen påverkas och Upplevelsen av trygghet. Upplevelserna hos patienterna av att vårdas i flerbädds- och enkelbäddssalar varierade. En del patienter föredrog flerbäddssalar där möjligheten till gemenskap fanns, medan andra föredrog enkelbäddssalar då integriteten kunde tillgodoses. Diskussion: Resultatet diskuterades i relation till SAUK-modellen och andra studier. / Background: The Swedish population is increasing. This results in an increasing demand on the healthcare. The patient is the center of caring and the concept of being a patient implies suffering or being perseverant in suffering. The nurses have several areas of main responsibilities to attend to the patients in the best possible ways. The healthcare environment have a great impact on the patient's ability to recover from their illness. It is therefore important to know how the patients experience the healthcare environment in the hospital rooms. Aim: To describe patients experiences of the healthcare environment in single and multiple hospital rooms. Method: This essay is a literature review based on twelve original articles. The articles were collected by the use of the databases CINAHL Complete and Pubmed. The articles were analysed using Fribergs method of literature reviews. Results: The results were divided into six categories: The experience of a companionship, Activities and sparetime, Support from other patients, Integrity in relation to other patients, The effect on sleep and The experience of safety. The patients’ experiences of being cared for in a single or multiple hospital room varied. Some patients preferred multiple hospital rooms where they could socialize with other patients while others preferred single hospital rooms because of the need for privacy. Discussion: The results were discussed in the light of the model SAUK and other studies.