Outdoor exposure and perceived outdoor environments correlated to fear of outdoor falling among assisted living residents.

BACKGROUND: Fear of falling is a major health concern among older adults. Although several studies have addressed general fear of falling in relation to personal factors, little is known about the specific relationship between fear of outdoor falling and perceptions of the outdoor environments. PURPOSE: This study is to identify perceived environmental factors and outdoor exposure associated with fear of outdoor falling among assisted living residents aged 65 or older stratified by the amount of time spent outdoors. METHODS: This study used survey data collected from a multiregional study conducted in 2007 that surveyed residents in 68 assisted living facilities in Houston, Texas; Chicago, Illinois; and Seattle, Washington. Out of 1,043 total participants, this study used a subset of 907 residents who used outdoor areas at least five minutes a day. Multivariate logistic regression was used after controlling for covariates. RESULTS: Approximately 31% of the participants reported having worried about falling while using the outdoor areas in their assisted living community. Multivariate analyses showed that adequately designed walkways (OR = 0.614, 95% CI = 0.405-0.931), comfort levels in using outdoor areas (OR = 0.657, 95% CI = 0.437-0.989), and frequency of outdoor usage (OR = 0.538, 95% CI = 0.368-0.787) were associated with decreased fear of outdoor falling after adjusting for individual factors (i.e. age, sex, health condition, fall history, vision problems, mobility aids). CONCLUSION: Improved walkways and comfort levels when using outdoor areas, as well as the amount of time spent outdoors, would be helpful in reducing fear of outdoor falling, which can help promote healthy lifestyle among assisted living residents.

The implications of high-quality staff break areas for nurses' health, performance, job satisfaction and retention.

AIM: The main study objective was to explore policy and design factors contributing to nurses' perception of how well-designed staff break areas can play an important beneficial role in relation to their overall job satisfaction, retention, performance and job-related health concerns. BACKGROUND: Nurses are extremely valuable to the healthcare industry; however, today's nursing profession is challenged by nurses' fatigue and its negative consequences on nurses' health and the quality of patient care they provide. METHODS: Preliminary interviews were conducted with 10 nurses who worked as consultants in the healthcare design and construction industry. Based on findings, an online survey was developed and distributed to over 10 000 members of the Academy of Medical-Surgical Nurses in the United States. RESULTS: The majority of nurses viewed high-quality break spaces as 'fairly' or 'very' important in terms of their potential to positively influence staff, patient and facility outcomes. Stress, rest breaks and the quality of break areas were some of the significant factors contributing to their perception. CONCLUSION/IMPLICATIONS FOR NURSING MANAGEMENT: The results of this empirical study support the conclusion that improvements in healthcare facility policies regarding staff breaks, as well as the creation of better-designed break areas, can be of significant benefit for nurses and the patients that they serve.

How Visibility May Reduce Security Issues in Community Hospitals' Emergency Departments.

This research explored the relationship between visibility and the level of security risks as perceived by nurses and physicians in emergency departments (EDs). Security in EDs has been reported as a major global concern, and visibility has been identified as a design factor impacting behavior. However, few previous studies have rigorously investigated the role of visibility in reduction of ED security risks with evidence-based design approach. There is a lot of significant questions about how visibility impacts the reduction of security issues in EDs. METHODS: How visibility may influence ED security was explored via qualitative methods in five EDs using semi-structured one-on-one interviews with 17 clinical staff and 48 hr of field observations. The coding process for both interviews and observational notes followed the principles of naturalistic inquiry. RESULTS: The findings suggest security risks can be decreased by improving visibility. Medical staff (registered nurses and physicians) felt more secure in the EDs with higher visibility. DISCUSSION: This study provides a framework to identify preferable levels of visibility in EDs and proposes design strategies to minimize security issues. Registered nurses and physicians can improve their team's sense of security by considering visibility throughout their daily practices.

The Correlation Between Visibility and Medical Staff Collaborative Communication in Emergency Departments.

OBJECTIVES: This study empirically investigates the correlation between visibility and nurses and physicians' collaborative communication in emergency departments (EDs). The researchers hypothesized that higher visibility levels in EDs are associated with higher collaborative communication among nurses and physicians. BACKGROUND: The review of related literature addresses the role of communication in EDs, and more specifically, how visibility has been found to affect nurse and physician behavior in healthcare facilities. METHOD: The visibility levels in four EDs within the same hospital system were quantitatively measured in this study. Also, the communication levels among medical staff were explored by two methods. Data collection included computerized floor plan analyses, observations, and surveys. RESULTS: The researchers found statistically significant relationships between several underlying dimensions of ED visibility and collaborative communication among the medical staff members. CONCLUSION: Understanding the role of visibility provides a critical design principle for future EDs. The enhancement of ED design helps nurses and physicians to benefit from supportive environments.

The Influence of Visibility on Medical Teamwork in Emergency Departments: A Mixed-Methods Study.

AIM: This mixed-methods study delivers empirical evidence on the influence of visibility on healthcare teamwork in Emergency Departments (EDs). This study researchers hypothesized that with changes of visibility in EDs, teamwork among medical staff members will be impacted. BACKGROUND: Prior research results suggest that visibility can influence health-setting efficacy. Teamwork is one of the components of each healthcare system that can be supported by environmental design. METHOD: Visibility in four subject sites from the same healthcare system was objectively measured by morphology plan analyses. Teamwork among medical staff members was the behavioral variable of interest and explored through field observations, interviews, and surveys. RESULTS: The qualitative outcomes demonstrated that teamwork can be enhanced by improved visibility, while the quantitative findings supported the idea that some specific measures of visibility were correlated with teamwork. CONCLUSION: This study provides a model for future research on the association between healthcare staff behavior and ED plan configuration. The enhancement of ED design, considering the significance of visibility, enhances the perceptions of nurses and physicians in terms of teamwork.

Older Adults' Preference for Landscape Features Along Urban Park Walkways in Nanjing, China.

Evidence shows that walking in urban parks has multiple health benefits for older adults, but little research is available on their preference for specific walkway features. This study explored a range of common landscape and hardscape features to learn which were preferred by park users over age 60. This photo comparison study hypothesized that older adults would prefer certain features of urban park walkways, with each feature represented by four different paired images (28 pairs in all). Within each pair of photos, both were identical except for the specific feature being tested in that comparison, where the image was digitally modified to depict the hypothesized feature. A total of 283 older adults (mean age 71 years) completed the survey by selecting the images they preferred. In this Chinese sample, older park users significantly favored all seven hypothesized walkway features, providing empirical support for the existing research and design-based literature on green space for older adults. This study found minor gender differences in visual preferences for walkway features and increasing preference for access to seating with advancing age. By helping to confirm which walkway features are preferred by older adults, these findings can be used to improve the future design and management of urban parks in China, which are an important source of exercise and recreation for nearby elderly residents.

Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers.

Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS). Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 2011 to 2014 involving adults aged 65 and older in the city of San Antonio (TX, USA) were analyzed at the census tract level (n = 264). Negative binomial regression was used to identify significant census tract-based neighborhood environmental variables associated with the count of fall injuries in each census tract. Adjusting for exposure variable and the size of the census tract, neighborhoods with higher residential stability, captured as the percent of those who lived in the same house as the previous year were associated with decreased count of fall injuries. Neighborhoods with higher residential density and having a higher vacancy rate were associated with increased count of fall injuries. The study highlights the importance of stable and safe neighborhoods in reducing fall risks among older adults, which should be considered a prerequisite for promoting age-friendly environments.

A Review of Design and Policy Interventions to Promote Nurses' Restorative Breaks in Health Care Workplaces.

The nursing profession in the United States is on the precipice of a crisis. Nurses are essential to the health care industry, and maintaining quality nursing care is a primary concern of today's health care managers. Health care facilities report high rates of staff burnout and turnover, and interest in the nursing profession among younger students is declining. Health care leaders must improve nurses' job satisfaction, performance, and retention. However, they often overlook the need for nurses' respite and underestimate the value of well-designed staff break areas. An exhaustive and systematic literature search was conducted in the summer of 2014, and all studies found on the topic were reviewed for their relevance and quality of evidence. The existing literature about the main causes of nurses' fatigue, barriers that prevent nurses from taking restorative breaks, and consequences of nurses' fatigue for staff, patient, and facility outcomes demonstrates the pressing need for interventions that improve nurses' working conditions. Additional literature on the restorative effects of breaks and the value of well-designed break areas indicates that efforts to improve breakroom design can play an important role in improving nurses' job satisfaction and performance.

Restorative Design Features for Hospital Staff Break Areas: A Multi-Method Study.

OBJECTIVES: The study investigated the main restorative components of staff break areas in healthcare facilities, by assessing usage patterns, verbal/visual preferences, and perceived restorative qualities of specific design features found in break areas for hospital staff. BACKGROUND: Nurses are extremely important to the healthcare industry, and maintaining the quality of nursing care is a central concern for healthcare administrators. While healthcare leaders are concerned about improving nurses' satisfaction, performance, and job retention, they may overlook the importance of respite for nurses and underestimate the value of designing staff break areas to maximize their restorative potential. METHODS: A multi-method approach combined qualitative explorations (focused interviews and narrative survey questions) with quantitative measurements (discrete survey questions and a visual ranking of break-room spaces), and the results were compared and triangulated. RESULTS: It was found that staff break areas are more likely to be used if they are in close proximity to nurses' work areas, if they have complete privacy from patients and families, and if they provide opportunities for individual privacy as well as socialization with coworkers. Having physical access to private outdoor spaces (e.g., balconies or porches) was shown to have significantly greater perceived restorative potential, in comparison with window views, artwork, or indoor plants. CONCLUSIONS: The results of this empirical study support the conclusion that improvements in the restorative quality of break areas may significantly improve nurses' satisfaction and stress reduction, potentially leading to improved care for the patients they serve.

The Seniors' Outdoor Survey: An Observational Tool for Assessing Outdoor Environments at Long-Term Care Settings.

PURPOSE OF THE STUDY: To describe the development and psychometric testing of the Seniors' Outdoor Survey (SOS), an instrument for evaluating how well the outdoor space in a long-term care setting supports the preferences and outdoor usage of residents. DESIGN AND METHODS: Content validity of the main SOS items initially was based on relevant literature and preliminary studies in diverse long-term care settings. After conducting a multiregional pilot study with 152 outdoor spaces at 68 assisted living facilities, the instrument was substantially revised and tested for interrater and test-retest reliability with 22 outdoor spaces at 12 long-term care settings, using 2 raters. Validity was examined using content analysis of resident survey responses (N = 1,128) from the multiregional study and specific item validation by subject matter experts (N = 53). RESULTS: The final instrument contains 60 ratable items organized in 5 domains: access to nature (14 items), outdoor comfort and safety (15 items), walking and outdoor activities (14 items), indoor-outdoor connection (11 items), and connection to the world (6 items). Intraclass correlation coefficient (ICC) estimates of interrater reliability were .91 for the overall instrument, ranging from .83 to .98 for the 5 domains. Interrater reliability (ICC) was above .70 for more than 79% of individual items. Test-retest reliability (ICC) was .92, ranging from .81 to .98 for domains. IMPLICATIONS: The SOS tool fills a gap in the available environmental assessment instruments, providing a reliable way for researchers, providers, and designers to evaluate and compare the supportive potential of outdoor spaces for long-term care residents.

Can Better Outdoor Environments Lead to Cost Benefits in Assisted Living Facilities Through Increased Word-of-Mouth Referrals?

OBJECTIVE: This study explores how better outdoor environments may produce cost benefits for assisted living providers by raising occupancy levels through increased resident satisfaction and word-of-mouth referrals. BACKGROUND: Older adults who spend even minimal time outdoors may reap substantial health benefits. However, many existing outdoor areas in assisted living facilities are reportedly underutilized, in part because of design issues. Providers may be more willing to improve outdoor areas if they produce cost benefits for provider organizations. METHODS: This study used data from a recent assisted living survey to assess the relationship between satisfaction with outdoor spaces, time spent outdoors, and resulting improvements in mood. A financial analysis was developed to estimate potential benefits from improved outdoor areas attributable to increased occupancy and decreased marketing costs associated with increased word-of-mouth referrals. RESULTS: Increasing resident satisfaction with outdoor areas (from approximately 29% to 96%) results in residents spending more time outdoors (increase of 1½ hours per week per resident) and improved psychological well-being (12% increase in feeling better). This greater overall satisfaction leads to 8% more residents willing to refer potential residents to their community. Because word-of-mouth referrals by current residents are a major factor in resident recruitment, improving outdoors areas leads to an estimated 4% increase in new residents, resulting in over $170,000 of increased revenue per year for a community of 100 residents. CONCLUSIONS: Improved outdoor space can provide substantial cost benefits for assisted living providers. Increasing resident well-being and satisfaction, and thereby generating additional word-of-mouth referrals, can result in higher occupancy levels. KEYWORDS: Outdoor environments, assisted living, cost benefits, resident satisfaction, occupancy levels, seniors, rental income, word-of-mouth referralPreferred Citation: Rodiek, S., Boggess, M. M., Lee, C., Booth, G. J., & Morris, A. (2013). Can better outdoor environments lead to cost benefits in assisted living facilities through increased word-of-mouth referrals? Health Environments Research & Design Journal 6(2), pp. 12-26.