abstract: The physical environment influences the physiology, psychology, and the societal interactions of those who experience it. The environment can also influence human behavior. Critical care nurses are in constant interaction with the physical environment surrounding their patients. High acuity ICU patients are vulnerable and at risk for harm, infection, and poor outcomes while the physical and cognitive workload of nurses presents a demanding and continuous challenge. The goal of this qualitative study was to explore and understand the way critical care nurses navigate within the patient room and interact with its features. The study of critical care nurses interacting with the patient room environment was conducted in five critical care units at three tertiary care institutions in the Eastern United States, along with another unit in the pilot study at a community hospital in the Southwest United States. Nurses were observed in their typical work environment as they performed normal tasks and patient care activities for entire day and night shifts. The study involved ethnographic field observations, individual semi-structured participant interviews, and examination of photographs and floor plans. The exploratory study resulted in a comprehensive model for nurse navigation that includes both cognitive and action components, along with a conceptual framework for nurse behavioral activity. Repetitive patterns of nurse movement were identified and named. The findings produced recommendations for nurses’ effective use of space and architectural design of ICU patient rooms to improve patient outcomes. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2017

Many airborne diseases such as Coronavirus variants are spread from person to person by indoor air movement. This is of particular concern in healthcare environments such as hospitals. There is a significant body of research that suggests that indoor ventilation strategies such as personalized ventilation systems my help reduce the spread of these viruses. While there are studies related to the efficacy of air movement from personalized ventilation, there are very few studies that explore how best to integrate these systems into the design process for hospital patient rooms. This study focuses on how to integrate personalized ventilation (PV) and displacement ventilation (DPV) systems into patient room design. The aims of this study are to first, develop a procedure using the Choosing By Advantages approach to make design decisions related to the implementation for personalized ventilation and displacement ventilation in private and semi-private patient rooms to prevent cross-infection. Secondly, using this approach, design solutions are proposed for patient room layouts with PV and DPV in different locations. The study proposes the best locations and components of the PV and DPV ventilation air supply and exhaust. Further practical models/simulation rooms are required to test the impact of PV systems on patients' and nurses' daily activities. / Master of Science / Many airborne diseases such as Coronavirus variants are spread from person to person by indoor air movement. This is of particular concern in healthcare environments such as hospitals. New personalized ventilation systems place ventilation air directly at the patient bed and consequently can reduce the spread of these viruses by effectively managing in-room air movement. This study explores how best to make design decisions for the implementation of personalized ventilation systems into hospital patient rooms. Applying this decision-making approach, design solutions are proposed that integrate personalized ventilation with commonly used displacement ventilation in patient rooms.

The biological need for lighting by an individual differs from the merely visual purpose, such as viewing objects and doing work or movement. Lack of adequate daylight for biological stimulation can lead to health problems, for e.g. imbalanced circadian rhythm. The importance of daylight is vital for hospital patients who are mostly physically and/or psychologically stressed. As, many patients stay indoors for 24 hours, they might be vulnerable to the lack of daylight which is necessary for health reasons. Hence, for hospital patients, daylight can be a strong therapeutic environmental design element to ensure good health and accelerate clinical recovery. The complex relationship between daylight environment and individuals responses are not fully understood. Controversy results that are debated by the previous researchers, has made the implementation of daylighting strategies in the architectural design of hospital in-patient rooms critical, mainly for therapeutic purpose. Strong evidence needs to be established that can build confidence to both architects and policy makers to use daylight for therapeutic purpose and integration of therapeutic effect of daylight to in-patient room architecture is necessary as well. This thesis provides information to architects (with examples) for incorporation of therapeutic effect of daylight in the design of in-patient rooms to reduce patient length of stay (LoS) in hospitals. A triangulation research method was applied in this work, where theories were developed qualitatively and tested quantitatively. Literature review was carried out to establish the potential effect of daylight on patient health. Retrospective field investigations were conducted to establish the quantitative relationship between daylight intensity and patient LoS inside in-patient rooms by developing Multiple Linear Regression (MLR) models under a general hospital environment. Using the daylighting goal to enhance therapeutic benefit for hospital patients, referred from literature and verified from field investigation data, a daylight design concept (sky window configurations) was developed and evaluated by prospective simulation study, and found better compared to traditional standard hospital window configurations, in order to enhance therapeutic benefit for hospital patients. A dynamic annual Climate-Based Daylight Modelling (CBDM) method that uses RADIANCE (backward) raytracer combined with a daylight coefficient approach considering Perez all weather sky luminance model (i.e. DAYSIM), was used for simulation analysis. This thesis develops strategies for architects to incorporate therapeutic effect of daylight in the architectural design of hospital in-patient rooms, including guidelines to support architectural decisions in case of conflicting situations, and to identify the range of daylight intensities within which patient LoS is expected to be reduced. The strategies also consider the ultraviolet radiation (UVR) protections and discuss the challenges of climate change for daylight researchers for the incorporation of therapeutic effect of daylight in the design of hospital in-patient rooms. The thesis provides a contribution to knowledge by establishing strong evidence of quantitative relationship between daylight and LoS, and by presenting new architectural forms for hospital in-patient room design as one of the possible ways to incorporate therapeutic effect of daylight in the design of hospital in-patient rooms effectively. It is expected that the research will encourage and help architects and policy makers to incorporate therapeutic effect of daylight in the design of hospital in-patient rooms, efficiently.

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Introduktion: Informationsöverföring inom sjukvården är ett kritiskt moment där viktig information kan försvinna eller missuppfattas. Ett sådant moment är sjuksköterskornas skiftöverlämning som kan genomföras på olika sätt. Att skiftöverlämningen sker på patientsal beskrivs av sjuksköterskor som både mer effektiv, korrekt och inbjudande för patienten. Syfte: Syftet var att beskriva patienters upplevelser av sjuksköterskans överrapportering på patientsal inom slutenvården.  Metod: Beskrivande design med allmän litteraturstudie som datainsamlingsmetod. Fem kvalitativa artiklar och sex mixed-method artiklar användes som grund för arbetet. Resultat: Resultatet visade att patienter genom överrapportering på patientsal kände sig mer involverade och delaktiga i sin vård. De upplevde även att överrapportering på patientsal bidrog till en tryggare sjukhusvistelse då sjuksköterskan introducerades tidigt under sitt skift men också möjligheten att verifiera den information som förs vidare. En stor del av patienterna ansåg inte att det var något problem att information delades så att andra kunde höra, det innebar inte att alla ämnen passade att pratas om på patientsalen då patienter såg vissa ämnen som mer inskränkande på deras integritet. Patienterna beskrev även sjuksköterskans förhållningssätt som en viktig del i hur patienters deltagande påverkas. Slutsats: Slutsatsen dras att överrapportering på patientsal bidrar till ökad delaktighet för patienten men att strukturen av överrapportering på patientsal bör utformas vidare för att säkerställa att sekretessen inte bryts samt att patienten blir involverad på ett lämpligt sätt. / Introduction: Information transfer in healthcare is a critical moment where important information can be lost or misunderstood. One such element is the nurses' shift handover, which can be carried out in different ways. That the shift handover takes place at the patient's bedside is described by nurses as both more efficient, correct and inviting. Aim: The aim of this study was to describe patients experiences with nursing bedside handover. Method: Descriptive design with general literature study as data collection method. Five qualitative articles and six mixed-method articles were used as a basis for the work.  Results: The results showed that through nursing bedside handoff, patients felt more involved in their care. Patients also felt that bedside handoff contributed to a safer hospital stay as the nurse was introduced early during the shift and with the opportunity to verify the information being passed on. Many patients did not consider it a problem that information was shared in a way that other patients could hear, but it did not mean that all topics were suitable to discuss at the bedside as patients saw certain topics as more intrusive of their privacy. The patients also described the nurse's approach as an important part of how patients' participation was affected. Conclusion: The conclusion is drawn that nursing bedside handoff contributes to increased participation for the patient, but that the structure of bedside handoff should be developed further to ensure that confidentiality is not breached and that the patient becomes involved in an appropriate way.

The process of patient care relies on clinical data spread across specialized hospital departments. Powerful software is being designed to assimilate this disconnected patient data before treatment can be decided. However, these data are often presented to clinicians on interfaces that do not fit clinical workflows, leading to poor operational efficiency and increased patient safety risks. This project relies on ethnographic design methods to create evidence of clinician preferences pertaining to the presentation and collection of information on user interfaces in patient rooms. Using data gathered in clinical observation, a prototype interface was designed to enable doctors to conduct clinical tasks through a usable patient room interface. The prototype evaluation with doctors identified clinical tasks that are relevant in the patient room and provided insight into the perceived usability of such an interface. The evaluation sessions also elucidated on issues of patient-centeredness in technology design, effortless authentication and interface customizability.

The process of patient care relies on clinical data spread across specialized hospital departments. Powerful software is being designed to assimilate this disconnected patient data before treatment can be decided. However, these data are often presented to clinicians on interfaces that do not fit clinical workflows, leading to poor operational efficiency and increased patient safety risks. This project relies on ethnographic design methods to create evidence of clinician preferences pertaining to the presentation and collection of information on user interfaces in patient rooms. Using data gathered in clinical observation, a prototype interface was designed to enable doctors to conduct clinical tasks through a usable patient room interface. The prototype evaluation with doctors identified clinical tasks that are relevant in the patient room and provided insight into the perceived usability of such an interface. The evaluation sessions also elucidated on issues of patient-centeredness in technology design, effortless authentication and interface customizability.

Syftet med litteraturstudien är att utforska hur sjukhusmiljön påverkar patienter inom sluten somatisk vård. Med sjukhusmiljö avsågs utformningen och designen av sjukhusmiljön och miljömässiga faktorer/komponenter i denna. Metoden för utförandet av litteraturstudien har inspirerats av Goodmans modell. Urvalet bestod av 13 empiriska vetenskapliga artiklar som granskats och analyserats. Resultaten som funnits berör musik, ljus, ljud, akustik, patientrum, enkelrum/delade patientrum, patientsäng, sängplats, privat utrymme, avdelningens utformning, fönster och bekvämligheter/hjälpmedel. Det har visat sig att de patienter som tyckte att musiken som spelades för dem var behaglig, även i hög grad upplevde sig som avslappnade. Musik har även funnits dölja olika typer av ljud under bypassoperation. Bra akustik har bidragit till en lägre incidens av återinläggning för patienter som varit inlagda för intensivvård på en hjärtavdelning. Patientens upplevelse av patientrummet har funnits påverka värderingen av sjuksköterskor, läkare och sjukhuset. Det har visat sig att privat utrymme är viktigt för patienter i sjukhusmiljön. Avsaknad av bekvämligheter och hjälpmedel leder till att patienter upplever känsla av förlorad självs-tändighet och kontroll. Slutsatsen är att sjukhusmiljön borde utformas mer genomtänkt med hjälp av forskningsresultat. För att förbättra sjukhusmiljön krävs inte alltid kostsamma renoveringar, sjuksköterskor kan i sitt omvårdnadsarbete förbättra miljön omkring patienten. Musik visade sig ha en positiv effekt på patienter som vistas i sjukhusmiljö. / The aim of this literature study is to investigate how the hospital environment influences patients that are within the somatic care. With hospital environment the authors intended hospital design and environmental factors. The method used for this study is inspired by the Goodman model. The sample was 13 scientific articles that was examined and analysed. The result that was to be found concern music, light, acoustics, patient room, single room/multioccupancy room, patient bed, place of bed, privacy, ward design, windows and facilities. Patients that enjoyed the music played for them also felt a higher level of relaxation. It has been found that music can camouflage different types of noise during bypass procedure. Good acoustics contributed to a lower incident of rehospitalization for patients whom had been hospitalized at an intensive coronary heart unit. The patients perception of their room was found to influence there perception and valuation of nurses, medicines and the hospital. The feeling of privacy is important for patients staying in a hospital environment. The lack of facilities might cause the patient a feeling of lost independence and personal control. The conclusion is that the hospital environment should be designed with more thought and by using scientific results. To improve the hospital environment it is not always necessary with expensive renovations, nurses could complement their care of the patient by improving the hospital environment.

Die Wohnlichkeit von Patientenzimmern in forensischen Kliniken wird von den architektonischen Anforderungen an Sicherheit, Hygiene und Suizidprävention in den Hintergrund gedrängt. Dabei haben die Architektur und die Gestaltung des Patientenzimmers einen hohen Einfluss auf das Wohlbefinden und den Behandlungserfolg der Patient:innen. In medizinischen Einrichtungen müssen die Grundbedürfnisse der Menschen berücksichtigt werden. Dazu gehört neben dem Wunsch nach einer wohnlichen Atmosphäre auch der Wunsch, etwas zu besitzen, territoriale Ansprüche auszuleben und sich selbst zu verwirklichen. Dieser wissenschaftliche Forschungsartikel beschäftigt sich mit der Frage, wie den Patient:innen in forensischen Kliniken eine Aneignung und Personalisierung ermöglicht und mit welchen architektonischen Mitteln diese umgesetzt werden kann. Ziel ist es, verschiedene Gestaltungsvorschläge zu ermitteln, durch die das Wohlbefinden der Patient:innen verbessert werden kann. Bei den geführten Interviews stehen die Bedürfnisse der Patient:innen im Fokus, aber auch die Erfahrungen der Mitarbeitenden fließen in die Vorschläge ein. Aus den Ergebnissen der Interviews und der Literaturrecherche wurden Gestaltungsmaßnahmen für eine Architektur entwickelt, die sich am Wohlbefinden der Patient:innen orientiert. [...aus dem Text]