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The physical environment and patients' activities and care: A comparative case study at three newly built stroke
Anna Anåker1,2, Lena von Koch1,3, Christina Sjöstrand3,4
1Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Aim:
To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units.
Background:
Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce.
Design:
This work is a comparative descriptive case study.
Method:
Patients (N = 55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioural mapping analysed with descriptive statistics and field note taking analysed with deductive content analysis. Data were collected from April 2013 - December 2015.
Results:
The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single-room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care.
Conclusions:
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.