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

Anåker, Anna; Koch, Lena von; Sjöstrand, Christina; Heylighen, Ann; Elf, Marie

doi:10.1111/jan.13690

Cited by 20 publications

(49 citation statements)

References 46 publications

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“…The fact that patients in the current study were observed in their room 73% of their day certainly reveals flaws in the environment, especially as they were observed to be in bed for more than 60% of the time spent in their room. A study comparing different stroke units found that patients treated at a unit with shared bedrooms were more active than patients at a unit with exclusively single bedrooms (25). Another study found that stroke units serving food in communal areas had more physically active patients compared with units in which food was served in patients' rooms (26).…”

Section: Discussionmentioning

confidence: 99%

Levels of physical activity in acute stroke patients treated at a stroke unit: A prospective, observational study

Chen¹,

Viktorisson²,

Danielsson³

et al. 2020

J Rehabil Med

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This study aimed to map physical activity in patients treated at a stroke unit in Sweden between day 2 and day 5 or 6 after admission to hospital. The patients were observed for 1 min every 10 min between 08:00 h and 17.00 h on these days. A total of 46 patients were observed on day 2, of whom 29 were observed again on day 5 or 6. These results show that patients are inactive, alone and in their rooms for a majority of the time at the stroke unit. This study also shows that there is some increase in physical activity over time during the first days of the hospital stay. Objective: A prospective, observational study to describe levels of physical activity in patients with stroke on day 2 and day 5 or 6 after admission to a comprehensive stroke unit in Sweden. Methods: The study was performed at the stroke unit at Sahlgrenska University Hospital during a period of 4 months between 2017 and 2018. Consecutive patients with stroke were observed for 1 min every 10 min while the multidisciplinary team was at work. The level of physical activity, location and the people present were noted at each time-point. Results: A total of 46 patients were observed on day 2, of whom 29 were observed a second time on day 5 or 6. Patients were in bed half of the time and engaged in upright activity for less than 10% of day 2. Patients spent 73% of day 2 in the bedroom and 56% of this day alone. Over time, there was a significant shift of 10% from "in bed" activity to "sitting" (p <0.001). Conclusion: Patients are physically inactive, alone and in their rooms for a majority of the time during the first days at a comprehensive stroke unit. There is some increase in physical activity during the first week after admission.

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Section: Discussionmentioning

confidence: 99%

Levels of physical activity in acute stroke patients treated at a stroke unit: A prospective, observational study

Chen¹,

Viktorisson²,

Danielsson³

et al. 2020

J Rehabil Med

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“…Earlier studies showed an association between the well-being of patients and staff at healthcare facilities and the design of the physical environment [12][13][14][15]. In stroke units, the physical environment has been described as essential for patient activities and care [16][17][18]. Changes in the physical environment have been found to influence patient activity and social interactions [16].…”

Section: Introductionmentioning

confidence: 99%

“…Changes in the physical environment have been found to influence patient activity and social interactions [16]. In a recent study, patients were found to have higher levels of activity in a stroke unit that had a combination of single and multibed room designs compared to a stroke unit with only a singleroom design [18]. However, the interplay between the physical environment of stroke units and multi-professional teamwork has rarely been investigated.…”

Section: Introductionmentioning

confidence: 99%

The physical environment and multi-professional teamwork in three newly built stroke units

Anåker

Koch

Eriksson

et al. 2020

Disability and Rehabilitation

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Purpose: To explore multi-professional teamwork in relation to the physical environment in three newly built or renovated stroke units. Materials and methods: An observational study was undertaken. The participants were all staff members of a multi-professional team working in the reviewed stroke units. The data were collected using behavioural mapping and semi-structured observations, and they were analysed by content analysis and descriptive statistics. Results: Out of all the observations in the behavioural mapping, very few were of two or more members from the team together with a patient. None of the included stroke units had a co-location for all the members of the multi-professional team. Three main categories emerged from the analysis of the interviews: (i) the hub of the unit; (ii) the division of places; and (iii) power imbalance. All the categories reflected the teamwork in relation to parts of the physical environment. Conclusion: The design of the physical environment is important for multi-professional teamwork. Emphasis must be placed on better understanding the impact of the physical environment and on incorporating the evidence related to multi-professional teamwork during the design of stroke units. ä IMPLICATIONS FOR REHABILITATION Understanding the link between the physical environment and effective teamwork can lead to more tailored and supportive design solutions. The design of the physical environment should be considered as a vital part of effective teamwork in stroke units. The physical environment should include shared workstations, allowing team members to meet and communicate face to face.

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“…It is well-documented that one of the factors influencing patient rehabilitation is the physical environment of recovering stroke patients. [45] As a result, various components of the NICU and SW ranging from the composition of care teams to the architectural features of the building have been considered for their potential to facilitate or hamper recovery from stroke. [67]…”

Section: Introductionmentioning

confidence: 99%

Developments in hybrid operating room, neurointensive care unit, and ward composition and organization for stroke management

et al. 2019

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Stroke is the leading cause of adult disability in the US. Rapid diagnosis and treatment of stroke, in addition to efficacious rehabilitation, is invaluable. The present review aims to report the recent improvements in hybrid operating rooms (hybrid ORs), and in the organization of Neurological intensive care unit (NICUs) and dedicated stroke wards (SWs), which contribute to enhanced stroke treatment. A PubMed literature review was conducted in addition to the collection of other online media releases regarding recent organizational advances in stroke care. PubMed keywords included but were not limited to “neurological intensive care unit,” “hybrid operating room,” and “stroke ward,” while all other online information regarding recent advances in the physical organization was selected and synthesized in accord with its relevance. The current research indicates that hybrid ORs facilitate surgical innovation and improved patient care through the colocation of advanced imaging modalities and surgical capabilities. Moreover, the recent reorganization of NICUs and SWs may lead to better-quality initial treatment and rehabilitation. The present review also considers the current ER triage protocol for stroke patients, and it concludes with relevant considerations relating to the role of the physical hospital structure and organization in stroke care.

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

Abstract: Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment.

Cited by 20 publications

References 46 publications

Levels of physical activity in acute stroke patients treated at a stroke unit: A prospective, observational study

Levels of physical activity in acute stroke patients treated at a stroke unit: A prospective, observational study

The physical environment and multi-professional teamwork in three newly built stroke units

Developments in hybrid operating room, neurointensive care unit, and ward composition and organization for stroke management

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