Built environments for inpatient stroke rehabilitation services and care: a systematic literature review

Abstract

ObjectivesTo identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke, their family/caregivers and staff.DesignA convergent segregated review design was used to conduct a systematic review.Data sourcesOvid MEDLINE, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched for articles published between January 2000 and November 2020.Eligibility criteria for selecting studiesQualitative, quantitative and mixed-methods studies investigating the impact of the built environment of inpatient rehabilitation facilities on stroke survivors, their family/caregivers and/or staff.Data extraction and synthesisTwo authors separately completed the title, abstract, full-text screening, data extraction and quality assessment. Extracted data were categorised according to the aspect of the built environment explored and the outcomes reported. These categories were used to structure a narrative synthesis of the results from all included studies.ResultsTwenty-four articles were included, most qualitative and exploratory. Half of the included articles investigated a particular aspect of the built environment, including environmental enrichment and communal areas (n=8), bedroom design (n=3) and therapy spaces (n=1), while the other half considered the environment in general. Findings related to one or more of the following outcome categories: (1) clinical outcomes, (2) patient activity, (3) patient well-being, (4) patient and/or staff safety and (5) clinical practice. Heterogeneous designs and variables of interest meant results could not be compared, but some repeated findings suggest that attractive and accessible communal areas are important for patient activity and well-being.ConclusionsStroke rehabilitation is a unique healthcare context where patient activity, practice and motivation are paramount. We found many evidence gaps that with more targeted research could better inform the design of rehabilitation spaces to optimise care.PROSPERO registration numberCRD42020158006.

Barriers and facilitators of rehabilitation nursing care for patients with disability in the rehabilitation hospital: A qualitative study

“…Problems such as lack of space prevent nurses from providing education in a calm environment, protecting the privacy and private dialogue with patients, observing hygiene principles and infection control, and acute care. In confirming these results, evidence suggests that the environment affects nurses' performance and can improve the efficiency, effectiveness, and safety of care ( 12 ). Other studies also show that environmental barriers affect the relationship between nurse and patient.…”

“…Other studies also show that environmental barriers affect the relationship between nurse and patient. Single bedrooms can somewhat resolve privacy and infection control, and the patient's distraction in providing education ( 12 , 40 ). Participants in this study also stated that the design of units has given them less access to patients' rooms.…”

“…Providing comprehensive rehabilitation nursing care in all dimensions requires some prerequisites. In addition to the nurse's competence in providing care, contextual factors such as environmental characteristics, care equipment, and leadership affect the nurse's ability to provide comprehensive care ( 12 – 15 ). In 2014, Clarke identified some of the factors affecting nursing care by reviewing the literature on stroke rehabilitation.…”

Why hospital design matters: A narrative review of built environments research relevant to stroke care

“…The evidence-base specific to stroke care is small. 41 In Figure 2, we summarize the design features and how they may influence a range of outcomes including patient and staff behavior. This should be considered illustrative rather than exhaustive.…”

“…Dotted lines ¼ a hypothesis, garnered from research in other populations; thin lines ¼ limited evidence, < 3 studies; thick lines ¼ moderate evidence, � 3 studies, based on systematic literature review. 41 generally underrecognized as providing spaces for incidental activity and interaction. 53 There is limited stroke-specific research about the value or harm of single-versus multiple-bed rooms.…”