Bringing the single versus multi-patient room debate to vulnerable patient populations: a systematic review of the impact of room types on hospitalized older people and people with neurological disorders

Shannon, Michelle; Lipson-Smith, Ruby; Elf, Marie; Olver, John; Kramer, Sharon; Bernhardt, Julie

doi:10.1080/17508975.2018.1548339

Cited by 22 publications

(26 citation statements)

References 68 publications

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“…11 Single-bed patient rooms, for example, have been found to improve patient-clinician communication, infection control and noise reduction in other healthcare settings, 50 but evidence regarding the impact of single-bed rooms is lacking in patients with neurological injury. [51][52][53] Noise reduction and privacy are important considerations in stroke rehabilitation, especially considering the disabling experience of fatigue 15 ; however, exploratory studies in this review suggest that patients in single-bed rooms may be less active and spend more time alone than patients in shared bedrooms, 35 36 which may impact their recovery and well-being. 29 More recently, Rosbergen et al 54 found that patients spent more time alone but were also more physically active in a rehabilitation facility with more single-bed rooms, but there was no change in cognitive or social activity.…”

Section: Discussionmentioning

confidence: 95%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 95%

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

et al. 2021

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“…This also highlights the potential impact of the perceived power imbalance between staff and patients and the significance of interactions that are task-directed. Hersh et al 20 reported patients with aphasia felt disempowered in communicative interactions with nurses. Nurses often talked to the task and controlled interactions with patients.…”

Section: Discussionmentioning

confidence: 99%

Hospital staff, volunteers’ and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study

et al. 2021

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ObjectivesTo explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke.DesignA qualitative descriptive study as part of a larger study which aimed to develop and test a Communication Enhanced Environment model in an acute and a rehabilitation ward.SettingA metropolitan Australian private hospital.ParticipantsFocus groups with acute and rehabilitation doctors, nurses, allied health staff and volunteers (n=51), and interviews with patients following stroke (n=7), including three with aphasia, were conducted.ResultsThe key themes related to barriers and facilitators to communication, contained subcategories related to hospital, staff and patient factors. Hospital-related barriers to communication were private rooms, mixed wards, the physical hospital environment, hospital policies, the power imbalance between staff and patients, and task-specific communication. Staff-related barriers to communication were staff perception of time pressures, underutilisation of available resources, staff individual factors such as personality, role perception and lack of knowledge and skills regarding communication strategies. The patient-related barrier to communication involved patients’ functional and medical status. Hospital-related facilitators to communication were shared rooms/co-location of patients, visitors and volunteers. Staff-related facilitators to communication were utilisation of resources, speech pathology support, staff knowledge and utilisation of communication strategies, and individual staff factors such as personality. No patient-related facilitators to communication were reported by staff, volunteers or patients.ConclusionsBarriers and facilitators to communication appeared to interconnect with potential to influence one another. This suggests communication access may vary between patients within the same setting. Practical changes may promote communication opportunities for patients in hospital early after stroke such as access to areas for patient co-location as well as areas for privacy, encouraging visitors, enhancing patient autonomy, and providing communication-trained health staff and volunteers.

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“…At every patient meeting, patients must be regarded as partners in the team and be involved in the decision-making process about their care [30][31][32]. A recent systematic review of the benefit of single versus multi-bedroom design for persons with neurological disorders such as stroke did not find strong evidence to support or to refute single room design [33]. Based on the findings of our study it may be the case that when the multi-professional team works together with the patients, the single bedroom could be the best physical environment to enhance patient participation since it allows for a high level of confidentiality.…”

Section: Discussionmentioning

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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Bringing the single versus multi-patient room debate to vulnerable patient populations: a systematic review of the impact of room types on hospitalized older people and people with neurological disorders

Cited by 22 publications

References 68 publications

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

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

Hospital staff, volunteers’ and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study

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

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