Environmental Needs, Barriers, and Facilitators for Optimal Healing in the Postoperative Process: A Qualitative Study of Patients’ Lived Experiences and Perceptions

Abstract

Objectives: Gaining an understanding of postoperative patients’ environmental needs, barriers, and facilitators for optimal healing. Background: An optimal hospital environment (the “healing environment”) can enhance patients’ postoperative recovery and shorten length of stay. However, insights lack into patients’ lived environmental needs for optimal healing after surgery and how these needs are being met. Method: A qualitative study was conducted between August 2016 and August 2017 with 21 patients who underwent elective major abdominal surgery in a Dutch university hospital. Data were collected through context-mapping exercises and interviews to capture patients’ lived experiences and explore the meaning of these experiences. Data were systematically analyzed according to the principles of thematic content analysis. Results: Three themes were identified. First, participants want a sense of control over their treatment, ambient features, privacy, nutrition, and help requests. Participants described the need for positive distractions: personalizing the room, connecting with the external environment, and the ability to undertake activities. Finally, participants expressed the importance of functional, practical, and emotional support from professionals, peers, and relatives. According to participants, the hospital environment often does not meet their healing needs while being hospitalized. Conclusion: The hospital environment often does not meet patients’ needs. Needs fulfillment can be improved by practical adjustments to the physical and interpersonal environment and considering patient’s individual preferences and changing needs during recovery. Patient narratives, pictures, and drawings are valuable sources for hospital managers in their efforts to design evidence-based environments that anticipate to patient-specific needs for achieving early recovery.

Do Simulated Hospital Admissions Reflect Reality? A Qualitative Study of Volunteer Well-Being During a 24-Hr Simulated Hospitalization

“…To facilitate future studies of the healing environment, we aimed to understand if healthy volunteers admitted to simulated care can provide “real” patient experiences. When comparing the results of this current study with existing literature, it appears that healthy participants do indeed provide valuable design insights that are comparable to real patients’ values of spatial comfort, privacy, autonomy, sensory comfort, and social comfort related to contact with personnel and relatives ( Devlin & Arneill, 2003 ; Herweijer-van Gelder, 2016 ; Hesselink et al, 2020 ; Ulrich, 1991 ). For spatial comfort, autonomy, and sensory comfort, the participants suggested design improvements such as better electronic equipment, control over the ambient environment, information about day planning, improved mobility, and improved lighting conditions.…”

“…Experiencing visual and auditory privacy is intrinsically an important factor for well-being in the healing environment ( Yildirim & Yalcin, 2016 ). Some norms and design requirements for optimal privacy referenced by our volunteers are also found in the literature; among these are a private room with curtain and door, hospital personnel knocking before entering, and avoidance of overhearing personal conversations from the hallway ( Bäck & Wikblad, 1998 ; Hesselink et al, 2020 ; Huisman et al, 2012 ).…”

“…More detailed explorations of patient experiences have been obtained from semi-structured interviews or context mapping exercises conducted with admitted patients. Our group used these methods to identify environmental factors related to postoperative recovery ( Hesselink et al, 2020 ). Anåker et al (2019) used these methods to investigate the experiences of stroke-unit patients.…”

Are the Physical Environments of Treatment Centres Meeting Recommendations for Patient-Centred Care? Perceptions of Haematological Cancer Patients

“…A recent qualitative study of patient perceptions of facilitators and barriers to optimal healing post-operatively identified three key needs of patients while in hospital [ 16 ]. Firstly, to have a sense of control over aspects of their treatment, such as the ambient features and privacy.…”

“…Secondly, to have positive distractions and the ability to undertake activities. Thirdly, to be able to access practical and emotional support from family and professionals [ 16 ]. The established theory of supportive design similarly recognises that the treatment centre environment can be effective in enhancing patient well-being and reducing patient-reported stress if it enables: (1) perceived control over the physical surroundings; (2) access to social support; and (3) access to positive distractions [ 17 , 18 , 19 ].…”