HERD: Health Environments Research & Design Journal

To determine differences in the rate of falls, healthcare-acquired infections (HAIs), and the degree of social isolation in hospitalized older adults admitted to private versus semiprivate rooms.

The American Institute of Architects recommends that private rooms become the industry standard for all new construction of acute care hospitals. Healthcare design researchers contend that private rooms decrease infection, facilitate healthcare workers' efficiency, provide space for families, and afford greater access to privacy. Although links between room type and health outcomes have been described in the literature, the actual relationship between these two variables has not been determined, nor is it clear whether a one-size-fits-all approach to hospital design is appropriate for all patient populations, particularly older adults.

This retrospective case comparative design utilized a sample of patients admitted to the University Medical Center of Princeton in 2006 and received full internal review board approval. Patient records were randomly selected through the admission/discharge/transfer system of the hospital and then divided into two groups based on room type. Data collected included demographics, incidence of falls, HAIs, and risk of social isolation.

All patients were more than 65 years old and had been admitted to the hospital for a variety of diagnoses. Length of stay was between 3 and 10 days. There was no significant difference between the type of room and the likelihood of falling (p = .37), however the relative risk of falling in a private room was 4.01. There was no significant difference in the occurrence of HAIs based on room type (p = 1.0). The risk-of-social-isolation variable was unable to significantly affect which hospitalized older adults would suffer a negative outcome, fall, or HAI (p = .52).

Room type may play a role in the occurrence of falls in hospitalized older adults, but room type alone does not increase the chance of acquiring an infection in the hospital. Nor does the risk of social isolation affect the likelihood of an adverse outcome.

To pilot test the Birth Unit Design Spatial Evaluation Tool (BUDSET) in an Australian maternity care setting to determine whether such an instrument can measure the optimality of different birth settings.

Optimally designed spaces to give birth are likely to influence a woman's ability to experience physiologically normal labor and birth. This is important in the current industrialized environment, where increased caesarean section rates are causing concerns. The measurement of an optimal birth space is currently impossible, because there are limited tools available.

A quantitative study was undertaken to pilot test the discriminant ability of the BUDSET in eight maternity units in New South Wales, Australia. Five auditors trained in the use of the BUDSET assessed the birth units using the BUDSET, which is based on 18 design principles and is divided into four domains (Fear Cascade, Facility, Aesthetics, and Support) with three to eight assessable items in each. Data were independently collected in eight birth units. Values for each of the domains were aggregated to provide an overall Optimality Score for each birth unit.

A range of Optimality Scores was derived for each of the birth units (from 51 to 77 out of a possible 100 points). The BUDSET identified units with low-scoring domains. Essentially these were older units and conventional labor ward settings.

The BUDSET provides a way to assess the optimality of birth units and determine which domain areas may need improvement. There is potential for improvements to existing birth spaces, and considerable improvement can be made with simple low-cost modifications. Further research is needed to validate the tool.

Because studies of crowding in long-term care settings are lacking, the authors sought to: (1) generate initial estimates of crowding in nursing homes and assisted living facilities; and (2) evaluate two operational approaches to its measurement.

Reactions to density and proximity are complex. Greater density intensifies people's reaction to a situation in the direction (positive or negative) that they would react if the situation were to occur under less dense conditions. People with dementia are especially reactive to the environment.

Using a cross-sectional correlational design in nursing homes and assisted living facilities involving 185 participants, multiple observations (N = 6,455) of crowding and other environmental variables were made. Crowding, location, and sound were measured three times per observation; ambiance was measured once. Data analyses consisted of descriptive statistics, t-tests, and one-way analysis of variance.

Crowding estimates were higher for nursing homes and in dining and activity rooms. Crowding also varied across settings and locations by time of day. Overall, the interaction of location and time affected crowding significantly (N = 5,559, df [47, 511], F = 105.69, p < .0001); effects were greater within location-by-hour than between location-by-hour, but the effect explained slightly less variance in Long-Term Care Crowding Index (LTC-CI) estimates (47.41%) than location alone. Crowding had small, direct, and highly significant correlations with sound and with the engaging subscale for ambiance; a similar, though inverse, correlation was seen with the soothing subscale for ambiance.

Crowding fluctuates consistent with routine activities such as meals in long-term care settings. Furthermore, a relationship between crowding and other physical characteristics of the environment was found. The LTC-CI is likely to be more sensitive than simple people counts when seeking to evaluate the effects of crowding on the behavior of elders—particularly those with dementia—in long-term care settings. aging in place.

This paper provides an overview of the available literature on architectural wayfinding design for people with dementia in nursing homes. The results were to be summarized and substantiated through an interdisciplinary interpretation, taking into account changes in the orientation process of people with dementia.

Spatial disorientation and declining wayfinding abilities are among the early symptoms of dementia, limiting a person's ability to perform activities of daily living (ADLs) independently and ultimately, perhaps leading to institutionalization. A prerequisite to maintaining residents' quality of life in a nursing home is their ability to orient themselves within their new environment.

The available literature on wayfinding design for people with dementia in nursing homes was reviewed. Two aspects of interventions for residents' wayfinding abilities were identified: the design of the floor plan typology and environmental cues.

The design of the physical environment plays a major role in supporting the wayfinding abilities of people with dementia. The floor plan design of a nursing home in particular has a significant influence on residents' spatial orientation and wayfinding. Additional interventions such as signage, furnishing, lighting, and colors are additional supporting features but they cannot compensate for an adverse architectural design.

For the creation of a supportive, dementia-friendly environment, both aspects of architectural design must be considered. Design guidelines to support the wayfinding abilities of people with dementia were developed to synthesize both.

Two studies were conducted to obtain an understanding of the types of items seniors keep in their nightstands and to understand how users feel about the possibility of “smart” furniture.

To enable aging in place and universal design, it is vital to understand the needs of a broad range of aging individuals, especially since there is little research on nightstand usage and design.

Study 1 allowed for the development of a structured inventory of nightstand use today in assisted living and rehabilitation facilities. Study 1 led to Study 2, demonstrating the need to conceptualize new ideas for smart nightstands. Feedback was obtained from intergenerational participants who could discuss their needs and preferences for a smart nightstand.

In Study 1, more than 150 items were recorded and categorized into 25 different groups. The authors found that participants utilized the top portion of their nightstand as opposed to the lower sections; most items were found on top of the nightstand or in the top drawer. In Study 2, the authors found that the vast majority of participants are willing to consider the use of a smart nightstand. Participants discussed key functions and design preferences, which included carefully designed storage, the ability to move the nightstand up and down, contemporary design, and interaction through voice activation.

Existing nightstands do not meet the needs of current users. This research provides greater understanding of the existing limitations associated with nightstands. Study 2 confirmed that user-centered design and the use of technology can be used to enhance daily living. Smart furniture may play a role in promoting the health and independence of diverse user groups.

A medical-surgical unit in a southwestern United States hospital examined the results of adding wireless communication technology to assist nurses in identifying patient bed status changes and enhancing team communication. Following the addition of wireless communication, response time to patient calls and the number of nurse-initiated communications were compared to pre-wireless calls and response time sampling period.

In the baseline study, nurse-initiated communications and response time to patient calls were investigated for a team nursing model (Guarascio-Howard & Malloch, 2007). At this time, technology consisted of a nurse call system and telephones located at each decentralized nurse station and health unit coordinator (HUC) station. For this follow-up study, a wireless device was given to nurses and their team members following training on device use and privacy issues.

Four registered nurses (RNs) were shadowed for 8 hours (32 hours total) before and after the introduction of the wireless devices. Data were collected regarding patient room visits, number of patient calls, bed status calls, response time to calls, and the initiator of the communication episodes.

Follow-up study response time to calls significantly decreased (t-test p = .03). RNs and licensed practical nurses responded to bed status calls in less than 1 minute—62% of the 37 calls. Communication results indicated a significant shift (One Proportion Z Test) in RN-initiated communications, suggesting an enhanced ability to communicate with team members and to assist in monitoring patient status. Patient falls trended downward, although not significantly (p > .05), for a 6-month period of wireless technology use compared to the same period the previous year.

The addition of a wireless device has advantages in team nursing, namely increasing communication with staff members and decreasing response time to patient and bed status calls. Limitations of the study included a change in caregiver team members and issues regarding wireless device and locator badge compliance. Administrative issues that arose during this field study included bed and cable maintenance, device battery charging, and the training of new and floating team members.

Medical and technological advances dominate the design of infant incubators because of their essential role in the survival of critically ill neonates. Yet other important design considerations, such as caregiver interaction, discomfort at bedside, and harmful materials, often are overlooked. The purpose of this paper is to consider the effects of existing incubator designs and to suggest criteria for the next generation of infant incubators.

Incubators of the mid-1940s established an industry standard that exists to this day: portholes in an infant chamber positioned over a mechanical system, resting on top of storage cabinets or drawers. This design is unresponsive to many of the infants' needs and significantly influences parent/infant interaction. The physical effects and social barriers that the incubator presents to the health and well-being of infants are compounded by the use of unhealthful substances and materials such as formaldehyde. Collectively, these conditions call for an incubator that not only ameliorates physical and social obstacles, but also uses benign materials.

Simple alterations to existing incubator design, such as introducing color and pattern, providing arm rests, and freeing space beneath the infant chamber to accommodate seated caregivers, would encourage more prolonged periods of contact with the infant occupants, thereby improving their behavioral organization and recovery. Replacing harmful materials with alternatives such as formaldehyde-free substrates in the cabinetry also will improve the developmental outcomes of the infant occupants. These types of recommended changes embrace the intent of the incubator to provide a controlled, secure environment while acknowledging that incubators are not merely medical equipment, but the living spaces of their infant occupants.