– Psychiatric Hospital: A Design for Aiding Healing in Inpatient Psychiatric Facilities –
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ABSTRACT
A systematic literature review was conducted to identify factors in the inpatient healthcare environment that support an optimal healing environment.
The PICO question for this review was what design factors in the inpatient healthcare environment support an optimal healing environment? A search of five databases and a hand search of reference lists were conducted.
The search included studies from 1980 to the present, original research conducted on inpatient units with adult patients that investigated an intervention with an outcome that promotes a healing environment.
Experimental, quasi-experimental, non-experimental, systematic literature reviews and expert opinions were sought and evaluated using a scale to analyze scientific rigor and research quality. A total of 6,874 articles were identified in the search and after screening, 27 articles were included in the final synthesis.
The search found research on eight hospital design features which may support optimal healing environments: artwork (n = 7), building configuration (n = 2), finish materials (n = 7), interior details (n = 6), lighting (n = 11), nature and view (n = 8), noise (n = 10) and room configuration (n = 6).
More than 50% of the research used quasi-experimental and non-experimental designs with rare use of experimental research designs.
Evidence suggests seven design features for healing inpatient psychiatric environments. Only one of the seven design feature recommended by the literature was found to be inconsistent with industry standards and was modified to meet compliance with guidelines.
Then an evidence-based design of a psychiatric inpatient room design was formulated and illustrated incorporating all seven recommendations including (a) provide calm, naturalistic and domestic artwork or photographs; (b) provide east facing windows in the patient rooms to provide bright light;
Provide plants in window box or low shrubs planted outdoors; (d) use acoustic ceiling tiles; (e) provide a window view of nature visible from the hospital bed;
TABLE OF CONTENTS
Title page – – i
Declaration – – ii
Certification – – iii
Dedication – – iv
Acknowledgement – – v
Abstract – vi
Table of content -vii
List of table – – x
List of figures – – xi
List of appendices -xii
CHAPTER ONE: INTRODUCTION
- Background of the Study 1
- Research Problem 3
- Research Questions 4
- Aim and Objectives 5
- Justification of the Study 5
- The Scope of the Study 6
- Limitations of the Study 6
- Structure of the Study 7
CHAPTER TWO: THE STUDY AREA
- Location Setting 8
- Demographic Setting 8
- Physical Setting 10
- Socio-economic/Cultural Setting 15
CHAPTER THREE: REVIEW OF RELATED LITERATURE
- Review of Related Literature 17
- Conceptual / Theoretical Framework – 52
CHAPTER FOUR: RESEARCH METHODS
4.1 Research Design 56
4.3 Sample and Sampling 58
4.4 Inclusion and Exclusion Criteria 59
4.5 Literature Appraisal 61
4.6 Evidence Review Criteria 61
4.7 Rating Scale 65
4.8 Techniques of Data Analysis 66
4.9 Literature Synthesis 68
4.10 Design Creation 71
4.11 Conclusion 72
CHAPTER FIVE: DATA PRESENTATION, ANALYSIS AND DISCUSSION OF RESULTS
5.0 Preamble 73
5.1 Initial Search 73
5.2 Search Strategy and Literature Selection 77
5.3 Study Characteristics 82
5.4 Synthesis of the Systematic Literature Review Findings 98
5.5 Translating the Evidence for use in Psychiatric Facilities 124
5.6 Conclusion 130
CHAPTER SIX: SUMMARY, CONCLUSION AND RECOMMENDATIONS
6.1 Summary 131
6.2 Conclusion 132
6.3 Environmental Implication of Findings 132
6.4 Contribution to Knowledge 134
6.5 Recommendations 135
6.6 Suggestions for Further Studies 137
REFERENCES 141
APPENDICES 153
INTRODUCTION
We shape our buildings; thereafter they shape us, noted statesman and Prime Minister Winston Churchill, 1945.This is certainly true for all kinds of buildings including hospital facilities. The “ambiance” of a space has an effect on people using the space.
In recent years, design for health care environments has begun to include esthetic enhancements in an attempt to reduce stress and anxiety, increase patient satisfaction, and promote health and healing.
Internal and external environments, as well as building design, are clearly associated with stress and the development of a range of stress-induced pathological responses affecting both psychological and physical health (Devlin and Arneill, 2003; Evans, 1987; Liberman and Yager, 1994; Rashid and Zimring, 2008).
Stressors like shape and size of room, work stress, financial difficulties and personal loss can lead to alterations in the immune response as well as greater risk for asthma, diabetes, gastrointestinal disorder, myocardial infarction, cancer and viral infections (Glaserand Kiecolt-Glaser, 2005; McEwen and Stellar, 1993).
Thus internal spaces, common stressors, and chronic stress can adversely affect health through a deleterious effect on endocrine and immune function (Glaser and Kiecolt-Glaser, 2005).
REFERENCES
Aaron, J. N., Carlisle, C. C., Carskadon, M. A., Meyer, T. J., Hill, N. S. and Millman, R. P. (1996). Environmental noise as a cause of sleep disruption in an intermediate respiratory care unit. Sleep, 19(9), 707–710.
ADA (2010). 2010 ADA Standards for accessible design. Retrieved from http://www.ada.gov/regs2010/2010ADAStandards/2010ADAStandards_prt.pdf
AHRQ (2009). Healthcare cost and utilization project. Retrieved from http://hcupnet.ahrq.gov/HCUPnet
Aitken, R. J. (1982). Quantitative noise analysis in a modern hospital. Archives of Environmental Health, 37(6), 361-364.
AHRQ (2009). 2009 National statistics – principal diagnosis only. Retrieved from http://hcupnet.ahrq.gov/HCUPnet
American Nurses Association (2011). Code of Ethics. Retrieved from: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNur ses/Code-of-Ethics.aspx
American Psychiatric Nurses Association (2007). Seclusion and Restraint standards of practice. Retrieved from http://www.apna.org/files/public/APNA_SR_Standards-Final.pdf
APA (2000). Diagnostic criteria from DSM-IV-TR. Washington, DC: American Psychiatric Association.
APA (2006). Stress and Mind/Body Health. Retrieved from http://gqrr.com/articles/1670/1889_APAStressReport.pdf
APA (2006). Americans engage in unhealthy behaviors to manage stress. Retrieved from http://gqrr.com/articles/1670/1891_APARelease.pdf
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