Research Methods Used in Evidence-Based Design: An Analysis of Five Years of Research Articles From the HERD Journal.

OBJECTIVE: This study aims to analyze research methodologies from 157 research articles published in this journal in the last five years (2016-2020). BACKGROUND: Health environments research is comprised of research covering many topics and from various disciplines worldwide. No systematic study exists to uncover themes in evidence-based design (EBD) research concerning the types of research published, people engaged in research, and the research methods employed. Understanding the nature of health environment research performed can help researchers, practitioners, and students situate their work within an EBD research structure. METHODS: Case study research was used to analyze 157 articles published in the Health Environments Research & Design Journal devoted to EBD and research. Secondary data were extracted to capture research methods from health environments studies and then analyzed to identify themes. The design and outcome categories were structured around and the Center for Health Design's (CHD) Knowledge Repository with origins to Ulrich et al.'s Evidence-Based Design Framework. RESULTS: Findings are reported on categories commonly found in empirical research articles: (i) key words, (ii) disciplines from authors, (iii) settings studied, (iv) populations studied or sampled, (v) research approach and study design, (vi) research strategies, (vii) data collection methods, (viii) data analysis procedures, (ix) design categories and variables, and (x) outcome categories and variables. CONCLUSIONS: The analyses highlighted the research methods most frequently used in health environments research. Findings revealed several inconsistencies across articles on key words and the framing of research methodologies. Results suggest that there should be a consistent and overarching research taxonomy with a set of acceptable terms for effective literature searches.

Using a task analysis to describe nursing work in acute care patient environments.

To improve the healthcare environment where nurses work and patients receive care, it is necessary to understand the elements that define the healthcare environment. Primary elements include (a) the occupants of the room and what knowledge, skills, and abilities they bring to the situation; (b) what tasks the occupants will be doing in the room; and (c) the characteristics of the built environment. To better understand these components, a task analysis from human factor research was conducted to study nurses as they cared for hospitalized patients. Multiple methods, including a review of nursing textbooks, observations, and interviews, were used to describe nurses' capabilities, nursing activities, and the environmental problems with current patient room models. Findings from this initial study are being used to inform the design and evaluation of an inpatient room prototype and to generate future research in improving clinical environments to support nursing productivity.

Developing a usability evaluation tool to assess the patient room bathroom.

OBJECTIVE: The goal of this project was to create an easy-to-administer and inexpensive tool that can help identify usability issues in a patient room bathroom during the design process so improvements can be made before the final product is constructed and put into operation. BACKGROUND: The bathroom is an essential part of any hospital patient room, yet it is associated with nurse dissatisfaction and patient falls. Minimal literature has examined whether the physical structure of various elements within the bathroom are efficient, safe, and satisfactory for the majority of users. Furthermore, there is a paucity of human factor guidelines for architects and designers to follow to ensure the usability of bathroom space for a wide variety of users. METHODS: The authors adapted a common technique used in software usability: the heuristic evaluation. A heuristic evaluation is a "discount" evaluation method used to quickly and efficiently evaluate the usability flaws of user interfaces. Three methods were used to provide input for the heuristic evaluation: (1) Review of existing heuristic evaluations, reported hospital bathroom problems, and safety checklists; (2) Interviews with nurses and nursing assistants; and (3) Focus groups with nurses. Analysis of the interview and focus group transcripts enabled the categorization of the types of problems nurses encounter in the patient room bathroom. These categories served as the basis for the heuristics in the heuristic evaluation tool. RESULTS: Eleven major heuristics (or categories of problems in the bathroom) were identified initially. The authors then went through several iterations of designing and refining the heuristic evaluation to form parsimonious categories and subcategories. Each of the eventual six major heuristic categories contains a general description as well as specific exemplar questions. These detailed subcategories enable an evaluator to easily gauge whether a bathroom adheres to the guideline, to write any comments about a particular issue, and to rate the severity of any problems. CONCLUSIONS: The bathroom heuristic evaluation was designed to be a discount usability evaluation tool. It can be used to assess a hospital bathroom during the design process for major usability issues, enabling necessary alterations before a final product is developed.

The effects of presence and influence in nature images in a simulated hospital patient room.

BACKGROUND: Nature images are frequently used for therapeutic purposes in hospital settings. Nature images may distract people from pain and promote psychological and physiological well-being, yet limited research is available to guide the selection process of nature images. OBJECTIVE: The hypothesis is that higher degrees of presence and/or influence in the still photograph make it more effective at holding the viewer's attention, which therefore may distract the viewer from pain, and therefore be considered therapeutic. Research questions include: (1) Is there a significant difference in the level of perceived presence among the selected images? (2) Is there a significant difference in the level of perceived influence among the selected images? (3) Is there a correlation between levels of presence and levels of influence? METHODS: 109 college students were randomly assigned to one of four different image categories defined by Appleton's prospect refuge theory of landscape preference. Categories included prospect, refuge, hazard, and mixed prospect and refuge. A control group was also included. Each investigation was divided into five periods: prereporting, rest, a pain stressor (hand in ice water for up to 120 seconds), recovery, and postreporting. Physiological readings (vital signs) were measured repeatedly using a Dinamap automatic vital sign tracking machine. Psychological responses (mood) to the image were collected using a reliable instrument, the Profile of Mood States. RESULTS: No significant statistical difference in levels of presence was found among the four image categories. However, levels of influence differed and the hazard nature image category had significantly higher influence ratings and lower diastolic blood pressure readings during the pain treatment. A correlation (r = .62) between presence and influence was identified; as one rose, so did the other. Mood state was significantly low for the hazard nature image after the pain stressor experience. CONCLUSIONS: Though the hazard image caused distraction from pain, it is nontherapeutic because of the low mood ratings it received. These preliminary findings contribute methodology to the research field and stimulate interest for additional research into the visual effects of nature images on pain.

The effects of nature images on pain in a simulated hospital patient room.

BACKGROUND: Views of nature have been reported to relieve stress and pain, making nature an ideal medium for use in healthcare settings. In hospitals whose design does not allow for a view of nature, virtual and surrogate views of nature may be viable therapeutic options. OBJECTIVE: This study tests the effects of specific nature images, as defined by Appleton's prospect refuge theory of landscape preference, on participants experiencing pain. The hypotheses were: (1) Nature views are variable in their impact on specific psychological and physiological health status indicators; and (2) Prospect and refuge nature scenes are more therapeutic than hazard nature scenes. The research question was (1) Which nature image categories are most therapeutic as evidenced by reduced pain and positive mood? METHODS: An experiment using mixed methods assessed the effects of four different nature scenes on physiological (blood pressure, heart rate) and psychological (mood) responses when a person was subjected to a pain stressor. Four groups were subjected to a specific nature image category of prospect, refuge, hazard, or mixed prospect and refuge; the fifth group viewed no image. The Short-Form McGill Pain Questionnaire and the Profile of Mood States survey instruments were used to assess pain and mood, respectively. Continuous physiological readings of heart rate and blood pressure were collected. Pain was induced through a cold pressor task, which required participants to immerse their nondominant hand in ice water for up to 120 seconds. RESULTS: The mixed prospect and refuge image treatment showed significantly lower sensory pain responses, and the no-image treatment indicated significantly higher affective pain perception responses. The hazard image treatment had significantly lower diastolic blood pressure readings during the pain treatment, but it also had significantly high total mood disturbance. CONCLUSIONS: Although there was no clear "most" therapeutic image, the mixed prospect and refuge image showed significant potential to reduce sensory pain. The hazard image was the most effective at distracting participants from pain, but it should not be considered a positive distraction because it also received the highest mood disturbance scores of all groups.

Hospital clinical laboratories are in a constant state of change.

In response to the accelerating changes in the health-care field, there has been a great deal of attention devoted to creating flexible designs and furnishings in hospital-based clinical laboratories. Even so, the hypothesis that hospital laboratories require a high degree of flexibility has been essentially untested. The aim of this study is to confirm or negate this need for flexible designs and furnishings as well as provide guidance for addressing flexibility in future hospital laboratory constructions and renovations. To explore the nature and rate of change in clinical laboratories, a multi-methodological approach employing both survey research and case study research was used to triangulate conclusions. Findings are organized into three areas: specific activities, technological processes, and the physical environment. The physical environment is further divided into three physical layers: infrastructure systems, space plan, and contents in the laboratory. This research supports the premise of planning and designing clinical laboratory environments that are flexible and versatile to support multiple laboratory applications. The goal of this study is to contribute to a body of knowledge that will help reduce the recurring problem of obsolescence in health-care buildings by understanding the relationship between activities, the technological processes, and the physical environment.