A comparative study of patients’ activities and interactions in a stroke unit before and after reconstruction—The significance of the built environment

Abstract

Early mobilization and rehabilitation, multidisciplinary stroke expertise and comprehensive therapies are fundamental in a stroke unit. To achieve effective and safe stroke care, the physical environment in modern stroke units should facilitate the delivery of evidence-based care. Therefore, the purpose of this study was to explore patients’ activities and interactions in a stroke unit before the reconstruction of the physical environment, while in a temporary location and after reconstruction. This case study examined a stroke unit as an integrated whole. The data were collected using a behavioral mapping technique at three different time points: in the original unit, in the temporary unit and in the new unit. A total of 59 patients were included. The analysis included field notes from observations of the physical environment and examples from planning and design documents. The findings indicated that in the new unit, the patients spent more time in their rooms, were less active, and had fewer interactions with staff and family than the patients in the original unit. The reconstruction involved a change from a primarily multi-bed room design to single-room accommodations. In the new unit, the patients’ lounge was located in a far corner of the unit with a smaller entrance than the patients’ lounge in the old unit, which was located at the end of a corridor with a noticeable entrance. Changes in the design of the stroke unit may have influenced the patients’ activities and interactions. This study raises the question of how the physical environment should be designed in the future to facilitate the delivery of health care and improve outcomes for stroke patients. This research is based on a case study, and although the results should be interpreted with caution, we strongly recommend that environmental considerations be included in future stroke guidelines.

The physical environment and patients’ activities and care: A comparative case study at three newly built stroke units

“…High‐quality care that is safe, efficient and person‐centred requires a high standard for the physical environment (architecture or built environment) (Anåker, Heylighen, Nordin, & Elf, ; Clancy, ; Sadler et al., ). A recent study on a new stroke unit showed that the environment negatively affected patients’ activity levels (Anåker, von Koch, Sjostrand, Bernhardt, & Elf, ). However, studies on how the environment has an impact on health, rehabilitation and stroke care are still scarce; thus, the environment and its importance are not addressed in Swedish or European stroke guidelines (Ringelstein et al., ; Socialstyrelsen, ).…”

Feasibility of creating an enriched environment and subsequent impact on activity levels for stroke patients in an acute stroke unit

“…This framework supports that physical design features may need to be different for specific patient groups. A recent study observed stroke survivors in a Swedish acute stroke unit pre and post rebuilding of the unit, and highlighted how location of the communal area and bed lay out (single vs. multi-room) influenced activity levels of stroke survivors, and their ability to optimally engage with the environment (Anaker et al, 2017). Findings indicated that in the new acute stroke unit, stroke survivors spent more time alone, in their rooms, and were less active compared with stroke survivors who recovered in the original 'old' unit (Anaker et al, 2017).…”

“…A recent study observed stroke survivors in a Swedish acute stroke unit pre and post rebuilding of the unit, and highlighted how location of the communal area and bed lay out (single vs. multi-room) influenced activity levels of stroke survivors, and their ability to optimally engage with the environment (Anaker et al, 2017). Findings indicated that in the new acute stroke unit, stroke survivors spent more time alone, in their rooms, and were less active compared with stroke survivors who recovered in the original 'old' unit (Anaker et al, 2017). While there is a push towards single bed spaces for reasons such as infection control and privacy, the possible impact of single rooms on stroke recovery, activity levels and interaction with others needs to be seriously considered (Pennington & Isles, 2013).…”

“…Physical build design of the ward can impact on patient activity (Blennerhassett et al, 2018;Shannon et al, 2018). For example, a study that tracked stroke patients in a stroke unit pre and post reconstruction of the environment highlighted how location of the communal space and bed lay out (single vs. multi-bedrooms) influenced activity levels of stroke patients (Anaker et al, 2017). Thus, an enriched environment model may be enhanced when the physical design of the unit supports social activity and rehabilitation, and time spent away from the bedside.…”

“…For example, recent findings that tracked patients in a rehabilitation environment pre and post rebuilding the environment highlighted how location of the communal space (e.g., in a far corner of the unit with a small entrance vs. end of a corridor with a noticeable entrance), and bed lay out (single vs. multi-room) influenced activity levels of patients, and their ability to optimally engage with the environment. Findings indicated that in the new build environment patients spent more time in their rooms, were less active, and had fewer interactions with staff and family than patients in the original unit (Anaker et al, 2017). Until now, only a few studies have investigated how patient activities relate to lay out of the physical design of the unit and have highlighted that physical design may impact on patients' activity levels (Anaker et al, 2017;Blennerhassett et al, 2018;Shannon et al, 2018).…”