Reimagine the ICU: Healthcare Professionals' Perspectives on How Environments (Can) Promote Patient Well-Being.

OBJECTIVE: This study aims (1) to understand the needs and challenges of the current intensive care unit (ICU) environments in supporting patient well-being from the perspective of healthcare professionals (HCPs) and (2) to explore the new potential of ICU environments enabled by technology. BACKGROUND: Evidence-based design has yielded how the design of environments can advocate for patient well-being, and digital technology offers new possibilities for indoor environments. However, the role of technology in facilitating ICU patient well-being has been unexplored. METHOD: This study was conducted in two phases. First, a mixed-method study was conducted with ICU HCPs from four Dutch hospitals. The study investigated the current environmental support for care activities, as well as the factors that positively and negatively contribute to patient experience. Next, a co-creation session was held involving HCPs and health technology experts to explore opportunities for technology to support ICU patient well-being. RESULTS: The mixed-method study revealed nine negative and eight positive patient experience factors. HCPs perceived patient emotional care as most challenging due to the ICU workload and a lack of environmental support in fulfilling patient emotional needs. The co-creation session yielded nine technology-enabled solutions to address identified challenges. Finally, drawing from insights from both studies, four strategies were introduced that guide toward creating technology to provide holistic and personalized care for patients. CONCLUSION: Patient experience factors are intertwined, necessitating a multifactorial approach to support patient well-being. Viewing the ICU environment as a holistic unit, our findings provide guidance on creating healing environments using technology.

Environmental Enrichment in Postoperative Pain and Surgical Care: Potential Synergism With the Enhanced Recovery After Surgery Pathway.

BACKGROUND: Holistic biopsychosocial care has been underemphasized in perioperative pathway designs. The importance and a cost-effective way of implementing biopsychosocial care to improve postoperative pain and facilitate surgical convalescence are not well established, despite the recent popularization of Enhanced Recovery After Surgery (ERAS) programs. OBJECTIVE: We have explored the evidence and rationale of environmental enrichment (EE) as a complementary multimodal psychosocial care pathway to reduce postoperative pain, optimize patient recovery and improve existing weaknesses in surgical care. METHODS: We conducted a database search to identify and grade potential EE techniques for their evidence quality and consistency in the management of acute postoperative pain, perioperative anxiety and the etiologically comparable acute procedural or experimental pain. FINDINGS AND CONCLUSIONS: The introduction of music, virtual reality, educational information, mobile apps, or elements of nature into the healthcare environment can likely improve patients' experience of surgery. Compared with traditional psychological interventions, EE modalities are voluntary, therapist-sparing and more economically sustainable. We have also discussed practical strategies to integrate EE within the perioperative workflow. Through a combination of sensory, motor, social and cognitive modalities, EE is an easily implementable patient-centered approach to alleviate pain and anxiety in surgical patients, create a more homelike recovery environment and improve quality of life.

Landscape analysis of nutrition services at Primary Health Care Units (PHCUs) in four districts of Ethiopia.

BACKGROUND: Good nutrition and healthy growth during the first 1000days have lasting benefit throughout life. For this, equally important is the structural readiness of health facilities. However, structural readiness and nutrition services provision during the first 1000 days in Ethiopia is not well understood. The present study was part of a broader implementation research aimed at developing model nutrition districts by implementing evidence based, high impact and cost-effective package of nutrition interventions through the continuum of care. This study was aimed at assessing structural readiness of health facilities and the extent of nutrition service provision in the implementation districts. METHODS: This assessment was conducted in four districts of Ethiopia. We used mixed method; a quantitative study followed by qualitative exploration. The quantitative part of the study addressed two-dimensions, structural readiness and process of nutrition service delivery. The first dimension assessed attributes of context in which care is delivered by observing availability of essential logistics. The second dimension assessed the service provision through direct observation of care at different units of health facilities. For these dimensions, we conducted a total of 380 observations in 23 health centers and 33 health posts. The observations were conducted at the Integrated Management of Neonatal and Childhood Illnesses unit, immunization unit, Antenatal care unit and Postnatal care unit. The qualitative part included a total of 60 key informant interviews with key stakeholders and service providers. RESULT: We assessed structural readiness of 56 health facilities. Both quantitative and qualitative findings revealed poor structural readiness and gap in nutrition services provision. Health facilities lack essential logistics which was found to be more prominent at health posts compared to health centers. The process evaluation showed a critical missed opportunity for anthropometric assessment and preventive nutrition counselling at different contact points. This was particularly prominent at immunization unit (where only 16.4% of children had their weight measured and only 16.2% of mothers with children under six month of age were counselled about exclusive breastfeeding). Although 90.4% of pregnant women who came for antenatal care were prescribed iron and folic acid supplementation, only 57.7% were counselled about the benefit and 42.4% were counselled about the side effect. The qualitative findings showed major service provision bottlenecks including non-functionality of the existing district nutrition coordination body and technical committees, training gaps, staff shortage, high staff turnover resulting in work related burden, fatigue and poor motivation among service providers. CONCLUSION: We found a considerable poor structural readiness and gaps in delivering integrated nutrition services with a significant missed opportunity in nutrition screening and counselling. Ensuring availability of logistics and improving access to training might improve delivery of nutrition services. In addition, ensuring adequate human resource might reduce missed opportunity and enable providers to provide a thorough preventive counselling service.

Pathogenic characteristics of nosocomial infections in patients with cerebrovascular diseases and characteristics and treatment of pathogenic bacteria in different seasons.

OBJECTIVE: The objective of this study is to explore the bacterial distribution characteristics of air and bed environment in patients with cerebrovascular diseases and to analyze the relationship between bacterial distribution and nosocomial infection in patients with cerebrovascular diseases. METHODS: In this study, the inpatients with cerebrovascular diseases who suffer from nosocomial infection are taken as the research objects. The pathogenic characteristics of the air environment in the ward and the environment in the bed unit are monitored, and the samples of cerebrovascular patients are collected for identification and drug sensitivity detection. The changes of the number of pathogens in different seasons are statistically compared, and the drug sensitivity test results of various pathogens are analyzed. RESULTS: In large wards, the number of pathogens in the air environment in winter is significantly higher than that in spring. In summer, the number of pathogens in pillow environment is significantly more than that in small wards. Gram-negative bacilli are the main pathogens in the four seasons, followed by Gram-positive cocci and less fungal infections. Among them, Staphylococcus aureus is the main Gram-positive coccus, which is sensitive to vancomycin and other therapeutic drugs, and resistant to erythromycin and other therapeutic drugs. Gram-negative bacteria are mainly Klebsiella pneumoniae and Pseudomonas aeruginosa. K. pneumoniae is sensitive to imipenem, tekacillin, meropenem and ceftitam, and resistant to ampicillin. P. aeruginosa is sensitive to cefuroxime ester, cefazolin and cefuroxime sodium. It is resistant to ampicillin, ceftitam, compound sinomine and ampicillin plus sulbactam. Candida albicans is the main fungus, which is sensitive to ketoconazole, fluconazole, amphotericin and nystatin. CONCLUSION: The number of pathogenic bacteria in the ward environment of patients with cerebrovascular disease is affected by the size of the room and season. The main pathogenic bacteria are Gram-negative bacilli, followed by Gram-positive cocci and less fungal infections.

Provision and uptake of routine antenatal services: a qualitative evidence synthesis.

BACKGROUND: Antenatal care (ANC) is a core component of maternity care. However, both quality of care provision and rates of attendance vary widely between and within countries. Qualitative research can assess factors underlying variation, including acceptability, feasibility, and the values and beliefs that frame provision and uptake of ANC programmes.This synthesis links to the Cochrane Reviews of the effectiveness of different antenatal models of care. It was designed to inform the World Health Organization guidelines for a positive pregnancy experience and to provide insights for the design and implementation of improved antenatal care in the future. OBJECTIVES: To identify, appraise, and synthesise qualitative studies exploring:· Women's views and experiences of attending ANC; and factors influencing the uptake of ANC arising from women's accounts;· Healthcare providers' views and experiences of providing ANC; and factors influencing the provision of ANC arising from the accounts of healthcare providers. SEARCH METHODS: To find primary studies we searched MEDLINE, Ovid; Embase, Ovid; CINAHL, EbscoHost; PsycINFO, EbscoHost; AMED, EbscoHost; LILACS, VHL; and African Journals Online (AJOL) from January 2000 to February 2019. We handsearched reference lists of included papers and checked the contents pages of 50 relevant journals through Zetoc alerts received during the searching phase. SELECTION CRITERIA: We included studies that used qualitative methodology and that met our quality threshold; that explored the views and experiences of routine ANC among healthy, pregnant and postnatal women or among healthcare providers offering this care, including doctors, midwives, nurses, lay health workers and traditional birth attendants; and that took place in any setting where ANC was provided.We excluded studies of ANC programmes designed for women with specific complications. We also excluded studies of programmes that focused solely on antenatal education. DATA COLLECTION AND ANALYSIS: Two authors undertook data extraction, logged study characteristics, and assessed study quality. We used meta-ethnographic and Framework techniques to code and categorise study data. We developed findings from the data and presented these in a 'Summary of Qualitative Findings' (SoQF) table. We assessed confidence in each finding using GRADE-CERQual. We used these findings to generate higher-level explanatory thematic domains. We then developed two lines of argument syntheses, one from service user data, and one from healthcare provider data. In addition, we mapped the findings to relevant Cochrane effectiveness reviews to assess how far review authors had taken account of behavioural and organisational factors in the design and implementation of the interventions they tested. We also translated the findings into logic models to explain full, partial and no uptake of ANC, using the theory of planned behaviour. MAIN RESULTS: We include 85 studies in our synthesis. Forty-six studies explored the views and experiences of healthy pregnant or postnatal women, 17 studies explored the views and experiences of healthcare providers and 22 studies incorporated the views of both women and healthcare providers. The studies took place in 41 countries, including eight high-income countries, 18 middle-income countries and 15 low-income countries, in rural, urban and semi-urban locations. We developed 52 findings in total and organised these into three thematic domains: socio-cultural context (11 findings, five moderate- or high-confidence); service design and provision (24 findings, 15 moderate- or high-confidence); and what matters to women and staff (17 findings, 11 moderate- or high-confidence) The third domain was sub-divided into two conceptual areas; personalised supportive care, and information and safety. We also developed two lines of argument, using high- or moderate-confidence findings:For women, initial or continued use of ANC depends on a perception that doing so will be a positive experience. This is a result of the provision of good-quality local services that are not dependent on the payment of informal fees and that include continuity of care that is authentically personalised, kind, caring, supportive, culturally sensitive, flexible, and respectful of women's need for privacy, and that allow staff to take the time needed to provide relevant support, information and clinical safety for the woman and the baby, as and when they need it. Women's perceptions of the value of ANC depend on their general beliefs about pregnancy as a healthy or a risky state, and on their reaction to being pregnant, as well as on local socio-cultural norms relating to the advantages or otherwise of antenatal care for healthy pregnancies, and for those with complications. Whether they continue to use ANC or not depends on their experience of ANC design and provision when they access it for the first time.The capacity of healthcare providers to deliver the kind of high-quality, relationship-based, locally accessible ANC that is likely to facilitate access by women depends on the provision of sufficient resources and staffing as well as the time to provide flexible personalised, private appointments that are not overloaded with organisational tasks. Such provision also depends on organisational norms and values that overtly value kind, caring staff who make effective, culturally-appropriate links with local communities, who respect women's belief that pregnancy is usually a normal life event, but who can recognise and respond to complications when they arise. Healthcare providers also require sufficient training and education to do their job well, as well as an adequate salary, so that they do not need to demand extra informal funds from women and families, to supplement their income, or to fund essential supplies. AUTHORS' CONCLUSIONS: This review has identified key barriers and facilitators to the uptake (or not) of ANC services by pregnant women, and in the provision (or not) of good-quality ANC by healthcare providers. It complements existing effectiveness reviews of models of ANC provision and adds essential insights into why a particular type of ANC provided in specific local contexts may or may not be acceptable, accessible, or valued by some pregnant women and their families/communities. Those providing and funding services should consider the three thematic domains identified by the review as a basis for service development and improvement. Such developments should include pregnant and postnatal women, community members and other relevant stakeholders.

The Effect of Light on Sleep and Sleep-Related Physiological Factors Among Patients in Healthcare Facilities: A Systematic Review.

OBJECTIVES: Lighting is one of the environmental factors which can improve patient sleep in healthcare environments. Due to the high degree of variation in study designs and results on this topic, the implications have been difficult to interpret. This review consolidates studies on the impact of bright light exposure on sleep to identify lighting conditions that can be applied and researched in future healthcare environments. METHODS: We searched for peer-reviewed articles on the impact of light on sleep or sleep-related outcomes in healthcare settings. We provided detailed analysis of the direct links between light and sleep, and a more cursory analysis of links between light and sleep-related factors, from 34 articles which met our inclusion criteria. RESULTS: The current state of the literature includes evidence on how various durations and intensities of morning, midday, and evening bright light exposure, as well as whole-day light exposure interventions can improve specific aspects of sleep. Lighting interventions differed in all attributes (illuminance levels, exposure time, exposure duration, and spectral qualities) but showed promising results in improving patients' sleep. CONCLUSIONS: Short-term bright light exposure in the morning, up to 2 hr of moderate (3,000-10,000 lux) morning exposures, up to 4 hr of moderate evening exposure, and whole-day exposures to lower illuminance levels (<3,000 lux) can improve patient sleep outcomes. Based on new findings on the mechanism through which light impacts sleep, future studies should be more specific about the spectral qualities of light sources.

The clinical learning environment of a maternity ward: A qualitative study.

BACKGROUND: Clinical learning environments influence the learning and performance of learners by creating learning opportunities and experiences. The maternity ward offers a major educational opportunity for midwifery students, obstetrics and gynecology residents and medical interns to acquire and improve crucial skills. OBJECTIVES: This study seeks to determine the way in which the clinical learning environment of the maternity ward creates learning opportunities and enables the accumulation of experiences for the noted learners. METHODS: This qualitative study was conducted using inductive content analysis at the Maternity Ward of Shahid Beheshti Hospital, affiliated with University of Medical Sciences. Midwifery students, medical interns and obstetrics and gynecology residents spend a certain period of time in this ward as a mandatory part of their obstetrics and gynecology training. Data were collected through semi-structured individual interviews and observations and were then analyzed in MAXQDA concurrently with data collection. RESULTS: Three main categories emerged from the analysis of the data collected from the interviews and observations: disorganized learning opportunities, heavy emotional load and learners' abandonment in the care-provider and learner role. CONCLUSION: The maternity ward lacked the necessary organization to generate an environment conducive to learning and independent practice for the three groups of learners. The learners' training and acquired skills were thus affected by the clinical learning environment.

Resident-centred care and architecture of two different types of caring residences: a comparative study.

The relationship between architectural space and resident-centred care is poorly understood, even though architectural space is indicated as an important factor in the quality of care. This paper aims to address this gap in existing research by putting resident-centred care in the theoretical context of relationality and emergence in which space is a co-producing component. This qualitative case study includes two housing alternatives, which are compared: one assisted living and one extra-care housing residence, which differ in their legal status and architecturally. Similar fieldwork was carried out in the two residences. Individual interviews with staff and residents, as well as observations-direct and shadowing-were the main data collection methods. The concept of assemblage was used for the analysis of how resident-centred care and architectural space co-evolved. The findings show that resident-centred care appears in similar but also diverse and sometimes contradictory ways in different spaces in the two housing alternatives, suggesting that resident-centred care is situated, volatile and emergent. Although architecture has strong agency, space and care need to be considered together-a caring architecture-in order to understand the nuances and rich conceptual palette of resident-centred care.

Does the Transformation of Dietitians from Counseling to Therapy Also Apply to the Physical and Therapeutic Environment? A Case Study of Israeli Practice.

BACKGROUND: Lifestyle change can be influenced through effective interaction between care receiver and care provider. The physical environment where the interaction occurs can affect the dynamics of long-term therapeutic treatment. There have been no studies on the perception of the physical environment in nutritional treatment. OBJECTIVE: Our aim was to ascertain the impact of the physical environment on the dynamics and communication between dietitian and patient based on perceptions of dietitians. DESIGN: We conducted qualitative constructivist phenomenological research. PARTICIPANTS: In-depth interviews (n=10) and eight focus groups (n=62) were held with dietitians who offer treatment in a physical environment designed according to the medical model and/or in a physical dynamic environmental design according to the dynamic model. RESULTS: Most dietitians in Israel treat their patients in a physical environment arranged according to the medical model. The participants reported that the physical environment affects the interaction. However, the idea of transforming the physical environment according to the dynamic model raised reservations. Barriers include upsetting therapeutic boundaries, challenging professional authority, and lack of therapeutic tools suitable for the change. CONCLUSIONS: Changes in the spatial design in which the therapeutic interaction occurs might support the dietitians' transformation from counseling into therapy. The barriers toward such change suggest that professional training is needed to enable dietitians to overcome them. We recommend conducting further research to evaluate the current physical environment, as well as raising dietitians' awareness and training them to work in the new environment, reflecting a counseling/therapeutic mindset. These changes should be followed by additional research among practitioners to report on their effects.

Brief Mindfulness Meditation for Depression and Anxiety Symptoms in Patients Undergoing Hemodialysis: A Pilot Feasibility Study.

BACKGROUND AND OBJECTIVES: Up to 50% of patients undergoing hemodialysis suffer from symptoms of depression and/or anxiety. Access to traditional pharmacotherapies and psychotherapies for depression or anxiety in this patient population has been inadequate. The objective of this study was to investigate the feasibility and effectiveness of brief mindfulness meditation intervention for patients on hemodialysis with depression and anxiety symptoms. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study was a randomized, controlled, assessor-blinded trial conducted in an urban hemodialysis unit. Forty-one patients were randomly assigned to intervention (n=21) and treatment-as-usual (n=20) groups. The intervention group received an 8-week individual chairside meditation intervention lasting 10-15 minutes, three times a week during hemodialysis. Feasibility outcomes were primarily assessed: enrollment rates, intervention completion rates, and intervention tolerability. Symptoms of depression and anxiety were measured using the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). RESULTS: Of those deemed eligible for the study, 67% enrolled (41 of 61). Of the participants randomized to the intervention group, 71% completed the study, with meditation being well tolerated (median rating of 8 of 10 in a Likert scale; interquartile range=10-5 of 10). Barriers to intervention delivery included frequent hemodialysis shift changes, interruptions by staff or alarms, space constraints, fluctuating participant medical status, and participant fatigue. Meditation was associated with subjective benefits but no statistically significant effect on depression scores (change in PHQ-9, -3.0±3.9 in the intervention group versus -2.0±4.7 in controls; P=0.45) or anxiety scores (change in GAD-7, -0.9±4.6 versus -0.8±4.8; P=0.91). CONCLUSIONS: On the basis of the results of this study, mindfulness meditation appears to be feasible and well tolerated in patients on hemodialysis with anxiety and depression symptoms. The study did not reveal significant effects of the interventions on depression and anxiety scores. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_10_12_CJASNPodcast_17_12_.mp3.

Defining and describing birth centres in the Netherlands - a component study of the Dutch Birth Centre Study.

BACKGROUND: During the last decade, a rapid increase of birth locations for low-risk births, other than conventional obstetric units, has been seen in the Netherlands. Internationally some of such locations are called birth centres. The varying international definitions for birth centres are not directly applicable for use within the Dutch obstetric system. A standard definition for a birth centre in the Netherlands is lacking. This study aimed to develop a definition of birth centres for use in the Netherlands, to identify these centres and to describe their characteristics. METHODS: International definitions of birth centres were analysed to find common descriptions. In July 2013 the Dutch Birth Centre Questionnaire was sent to 46 selected Dutch birth locations that might qualify as birth centre. Questions included: location, reason for establishment, women served, philosophies, facilities that support physiological birth, hotel-facilities, management, environment and transfer procedures in case of referral. Birth centres were visited to confirm the findings from the Dutch Birth Centre Questionnaire and to measure distance and time in case of referral to obstetric care. RESULTS: From all 46 birth locations the questionnaires were received. Based on this information a Dutch definition of a birth centre was constructed. This definition reads: "Birth centres are midwifery-managed locations that offer care to low risk women during labour and birth. They have a homelike environment and provide facilities to support physiological birth. Community midwives take primary professional responsibility for care. In case of referral the obstetric caregiver takes over the professional responsibility of care." Of the 46 selected birth locations 23 fulfilled this definition. Three types of birth centres were distinguished based on their location in relation to the nearest obstetric unit: freestanding (n = 3), alongside (n = 14) and on-site (n = 6). Transfer in case of referral was necessary for all freestanding and alongside birth centres. Birth centres varied in their reason for establishment and their characteristics. CONCLUSIONS: Twenty-three Dutch birth centres were identified and divided into three different types based on location according to the situation in September 2013. Birth centres differed in their reason for establishment, facilities, philosophies, staffing and service delivery.

White coat effect in hypertensive patients: the role of hospital environment or physician presence.

This study was to evaluate the role of hospital environment or physician presence for white coat effect (WCE) in hypertensive patients. At first, 54 hypertensive outpatients diagnosed on office blood pressure (OBP) were included for 2-week placebo run in. During the second week of the run in period, home BP was measured using electronic BP monitors for 5-7 days. Finally, 26 sustained hypertensive patients with home systolic BP/diastolic BP over 135/85 (but <180/110) mm Hg were enrolled for 8-week treatment of nifedipine controlled-release tablet. In the visit day, BP was measured by patient-self (OBP-p) or by doctor (OBP-d) according to order determined with randomization method. The self-BP measurement was performed in a reception room of hospital. The differences between home BP and OBP-d or OBP-p were calculated as WCE calculated on doctor-measurement (WCE-d) or WCE calculated on patient-measurement (WCE-p), respectively. The home and OBP were measured with the same BP device for each patient during the study period. In the total 54 outpatients received placebo, the WCE-d was similar to the WCE-p (for systolic BP 6.6 ± 14.4 vs. 6.8 ± 15.8 mm Hg, NS; for diastolic BP 3.3 ± 8.8 vs. 2.9 ± 9.2 mm Hg, NS). Meanwhile, the 26 sustained hypertensive patients had similar systolic WCE-d and WCE-p (4.8 ± 10.3 vs. 5.0 ± 12.2 mm Hg, NS) at placebo stage. Similarly, these values were comparable (3.0 ± 14.0 vs. 2.2 ± 14.4 mm Hg, NS) in treatment stage. Hospital environment plays a main role for the WCE in hypertensive patients.

The Influence of Nature Stimulus in Enhancing the Birth Experience.

The physical environment is one of the factors that affect women's experience of labor. The basics of the childbirth process have not changed since the beginning of human existence; however, the environment in which women today give birth has changed significantly. Incorporating design elements and strategies that calm and reduce negative emotions may create positive experiences for women in labor. The purpose of this study was to examine the impact of one such strategy, namely, the presentation of images of nature, on the labor and delivery experience. The study findings showed that the experimental condition has a higher score on the Quality of Care From the Patient's Perspective (QPP) subscale. In addition, there was an increase in the QPP scores associated with the increase in Nature TV watching time, QPP mean of watching time (less than 1 hr) group, m = 4.5 and QPP mean of watching time (more than 3 hs), m = 4.8. The mean score for the heart rate was lower in the experimental condition, m = 84.60, than in the control one, m = 90.49. For Apgar, the mean score was higher for Group A, m = 8.65, and Group B, m = 8.92. These findings support the study hypothesis which states that the nature images would influence the labor experience positively. In addition, the findings emphasize the importance of incorporating nonpharmacological techniques in the labor and delivery room (LDR) units to sooth the pain. Adding nature imagery to the LDR environment can be one of these techniques.

The Multisensory Environment (MSE) in Dementia Care: Examining Its Role and Quality From a User Perspective.

BACKGROUND: Multisensory environments (MSEs) for people with dementia have been available over 20 years but are used in an ad hoc manner using an eclectic range of equipment. Care homes have endeavored to utilize this approach but have struggled to find a design and approach that works for this setting. AIMS: Study aims were to appraise the evolving concept of MSEs from a user perspective, to study the aesthetic and functional qualities, to identify barriers to staff engagement with a sensory environment approach, and to identify design criteria to improve the potential of MSE for people with dementia. METHODS: Data were collected from 16 care homes with experience of MSE using ethnographic methods, incorporating semi-structured interviews, and observations of MSE design. Analysis was undertaken using descriptive statistics and thematic analysis. RESULTS: Observations revealed equipment that predominantly stimulated vision and touch. Thematic analysis of the semi-structured interviews revealed six themes: not knowing what to do in the room, good for people in the later stages of the disease, reduces anxiety, it's a good activity, design and setting up of the space, and including relatives and care staff. CONCLUSION: Few MSEs in care homes are designed to meet needs of people with dementia, and staff receive little training in how to facilitate sessions. As such, MSEs are often underused despite perceived benefits. Results of this study have been used to identify the design principles that have been reviewed by relevant stakeholders.

Creating Healing Environments Through the Theory of Caring.

We describe the journey of personnel at one hospital to create a healing environment for patients and staff members at all levels through the implementation of Watson's Theory of Human Caring and her Caritas Processes (ie, loving kindness, authentic presence, spirituality, being the environment, believing in miracles). We used experiential teaching and learning to explore the nursing theory with staff members. Positive outcomes include using Caritas Processes care plans in our electronic medical record, greater ease in the understanding and application of Watson's theory, integrating a blessing for nurses during National Nurses Week, inclusion of ministry formation courses to extend the mission of the hospital's founding religious order to current and future employees, and positive patient feedback. As a result of theory application, our nurses are more open to discussing caring, authentic presence and, when appropriate, prayer in their clinical narratives and how it is affecting patients and themselves.

História espiritual e cuidado dispensado a pacientes no ambiente hospitalar / The spiritual history and care given to patients in the hospital

Conhecer a história e as preferências espirituais de pacientes internados. Método: Trata-se de um estudo descritivo quantitativo que avaliou 168 pessoas internadas em um Hospital Universitário utilizando o instrumento" História Espiritual: Abordagem Centrada na Pessoa". Resultados: Todos os pacientes disseram que a fé (religião, espiritualidade) é importante no curso da doença, assim como foi importante em momentos anteriores da vida. Informaram ausência de abordagem sobre crenças, espiritualidade, religiosidade no ambiente hospitalar (75%) e 81 % aceitaram explorar assuntos relacionados, como preces (44,9%) e leitura de texto bíblico (32,3%). Conclusão: A fé é um estado importante no momento em que as pessoas vivenciam o adoecimento e a internação. No ambiente hospitalar há ausência de abordagem sobre questões espirituais, sendo requerida pelas pessoas. Urge revisão dos padrões de cuidado espiritual para a incorporação de intervenção desejada, garantindo-se, assim, uma assistência holística...

To know the history and spiritual preferences of hospitalized patients. Method: This is a quantitative descriptive study that evaluated 168 people admitted to a University Hospital making use of the tool "Spiritual History: Person Centered Approach". Results: Ali patients said that faith (religion, spirituality) is important in the course of the disease, as it was important in previous moments of life. They reported absence of approaches to beliefs, spirituality, and religiosity in the hospital (75%) and 81 % of them agreed to explore related issues such as prayers (44.9%) and Bible text reading (32.3%). Conclusion: Faith is an important state when people experience diseases and hospitalization. It is urged a review of spiritual care standards in order to incorporate the desired intervention, ensuring thus a holistic assistance...

Conocer la historia y las preferencias espirituales de los pacientes hospitalizados. Método: Se trata de un estudio descriptivo cuantitativo que ha evaluado 168 personas ingresadas en un Hospital Universitario en lo cual se utiliza el instrumento "Histeria Espiritual: Abordaje Centrado en la persona". Resultados: Todos los pacientes han dicho que la fe (religión, espiritualidad) es importante en el curso de la enfermedad, ya que, ha sido importante en los momentos anteriores de la vida. Han informado la ausencia de un abordaje sobre las creencias, la espiritualidad y la religiosidad en el ambiente hospitalario ( 75 por ciento) y el 81 por ciento han aceptado explorar asuntos relacionados como: oraciones ( 44,9 por ciento) y lectura de texto bíblico ( 32,3 por ciento) . Conclusión: La fe es un estado permanente en el momento en lo cual las personas viven la enfermedad y la hospitalización. En el ambiente hospitalario no hay un abordaje sobre cuestiones espirituales requerido por las personas. Urge una revisión de los padrones de cuidado espiritual para incorporar la intervención deseada, garantizándose, así, una asistencia holística...

Evaluación del ambiente electromagnético en salas de rehabilitación / Evaluation of the electromagnetic environment in rehabilitation wards

Se realizó un estudio del ambiente electromagnético en 2 departamentos de electroterapia del municipio Palma Soriano de Santiago de Cuba, a fin de obtener el patrón de distribución para diferentes modos de operatividad y explotación del equipamiento médico-terapéutico. Para la caracterización electromagnética de los ambientes evaluados se elaboró un protocolo de medición a partir del análisis de normas internacionales y se empleó un medidor isotrópico que mostró los resultados a través de mapas de contorno. El equipo electromédico Magnetomed, modelo 7200 fue el que más aportó, aunque el valor máximo de la inducción magnética obtenido (19,7 µT) estuvo por debajo del límite de exposición establecido y por encima del límite de exposición sugerido por el Grupo de Trabajo Bioiniciativa. Se recomienda limitar la permanencia de personas en sus proximidades mientras está en funcionamiento.

A study of the electromagnetic environment was carried out in 2 electrotherapy departments of Palma Soriano in Santiago de Cuba, in order to obtain the distribution pattern for different operability ways and exploitation of the medical-therapeutic equipment. For the electromagnetic characterization of the evaluated environments a measurement protocol was elaborated starting from the analysis of international standards and an isotropic measure was used that showed the results through contour maps. The electro-medical device Magnetomed, model 7200 was the one that contributed the most, although the maximum value of the obtained magnetic induction (19.7 µT) was below the established exhibition limit and above the exhibition limit suggested by the Bioiniciativa Work Group. It is recommended to limit the permanency of people around, while it is in operation.

Interior effects on comfort in healthcare waiting areas.

BACKGROUND: This study compared the effects of pre-experience and expectations on participant comfort upon waking, arrival to, and after an appointment, as well as the assessment of properly placed Feng Shui elements in three healthcare waiting rooms. METHODS: Participants assessed comfort levels using self-report surveys. The researcher conducted 'intention interviews' with each doctor to assess the goals of each waiting area design, and conducted a Feng Shui assessment of each waiting area for properly placed Feng Shui elements. RESULTS: The waiting area designed by the Feng Shui expert rated 'most comfortable', followed by the waiting area design by a doctor, and the lowest comfort rating for the conventional waiting room design. Results show a sufficiently strong effect to warrant further research. CONCLUSIONS: Awareness of the external environment, paired with pre-experience and expectation, influences comfort for people over time. Fostering and encouraging a holistic approach to comfort utilizing eastern and western concepts and ergonomic principles creates a sense of "placeness" and balance in the design for comfort in built environments. This is new research information on the influences of the comfort experience over time, to include pre-experience, expectations and the placement of elements in the external environment.

Non-specific mechanisms in orthodox and CAM management of low back pain (MOCAM): theoretical framework and protocol for a prospective cohort study.

INTRODUCTION: Components other than the active ingredients of treatment can have substantial effects on pain and disability. Such 'non-specific' components include: the therapeutic relationship, the healthcare environment, incidental treatment characteristics, patients' beliefs and practitioners' beliefs. This study aims to: identify the most powerful non-specific treatment components for low back pain (LBP), compare their effects on patient outcomes across orthodox (physiotherapy) and complementary (osteopathy, acupuncture) therapies, test which theoretically derived mechanistic pathways explain the effects of non-specific components and identify similarities and differences between the therapies on patient-practitioner interactions. METHODS AND ANALYSIS: This research comprises a prospective questionnaire-based cohort study with a nested mixed-methods study. A minimum of 144 practitioners will be recruited from public and private sector settings (48 physiotherapists, 48 osteopaths and 48 acupuncturists). Practitioners are asked to recruit 10-30 patients each, by handing out invitation packs to adult patients presenting with a new episode of LBP. The planned multilevel analysis requires a final sample size of 690 patients to detect correlations between predictors, hypothesised mediators and the primary outcome (self-reported back-related disability on the Roland-Morris Disability Questionnaire). Practitioners and patients complete questionnaires measuring non-specific treatment components, mediators and outcomes at: baseline (time 1: after the first consultation for a new episode of LBP), during treatment (time 2: 2 weeks post-baseline) and short-term outcome (time 3: 3 months post-baseline). A randomly selected subsample of participants in the questionnaire study will be invited to take part in a nested mixed-methods study of patient-practitioner interactions. In the nested study, 63 consultations (21/therapy) will be audio-recorded and analysed quantitatively and qualitatively, to identify communication practices associated with patient outcomes. ETHICS AND DISSEMINATION: The protocol is approved by the host institution's ethics committee and the NHS Health Research Authority Research Ethics Committee. Results will be disseminated via peer-reviewed journal articles, conferences and a stakeholder workshop.