Residential Long-Term Care and the Built Environment: Balancing Quality of Life and Infection Control.

OBJECTIVES: This article explores expert insights into residential long-term care (RLTC), specifically regarding the built environment, its impact on infection control (IC) measures and on resident, staff, and family member quality of life. DESIGN: The interviews discussed in this report form part of a larger mixed methods research design, examining the planning, design, and operation of RLTC. Specifically, this report discusses findings from one aspect of this research, a series of semistructured interviews. SETTING AND PARTICIPANTS: Interviews were conducted online through video conferencing platform Zoom. The project's steering committee were asked to suggest key organizations involved in IC and RLTC provision and policy, with 23 representatives (17 organizations) being invited to interview. Where representatives were unable to participate, they suggested alternate representatives. METHODS: The research team conducted 20 interviews with key representatives or "experts" from different aspects of RLTC provision, policy, and IC. A thematic analysis was employed to analyze and generate key themes. RESULTS: For brevity, the codes that had been mentioned by >5 interviewees, specific to the built environment, IC and quality of life were prioritized, resulting in 16 prioritized themes grouped according to spatial scale. CONCLUSIONS AND IMPLICATIONS: This research demonstrates the growing awareness of the built environment as a critical partner in the RLTC health and social care model, as well as illustrating the need for a holistic design approach across all key spatial scales to support the health and well-being of older people in RLTC. Further research is needed on various aspects of RLTC, including the impact of care models and setting size on IC, quality of life, and cost implications. RLTC policy needs a more integrated approach to planning and design, specifically around RLTC location. This research suggests that RLTC providers look to evidence-based, inclusive design guidelines to inform the design and retrofit of RLTC. Additionally, the operation and management of space should be considered by providers.

Dementia Friendly Hospital Design: Key Issues for Patients and Accompanying Persons in an Irish Acute Care Public Hospital.

OBJECTIVES: Research was conducted to investigate the impact of the hospital environment on older people including patients with dementia and their accompanying persons (APs). The article presents key research findings in the case study hospital. BACKGROUND: For many patients, the hospital is challenging due to the busy, unfamiliar, and stressful nature of the environment. For a person with dementia, the hospital experience can be exacerbated by cognitive impairment and behavioral or psychological symptoms and can therefore prove to be a frightening, distressing, and disorientating place. METHOD: The findings are based on a stakeholder engagement process where the research team spent approximately 150 hr observing within the hospital, administered 95 questionnaires to patients and/or APs, and conducted 12 structured interviews with patients and APs. A thematic analysis was employed to analyze and generate key themes emerging from the process. RESULTS: Themes were grouped into overarching issues and design issues across spatial scales. CONCLUSION: This research confirms the negative impact of the acute hospital setting on older people with cognitive impairments including dementia and delirium. The multiple perspectives captured in this study, including most importantly people with dementia, ensure that stakeholder needs can be used to inform the design of the hospital environment. The research points to the value of understanding the lived experience of the person with dementia and APs. The voices of patients, particularly persons with dementia and their APs, are a crucial element in helping hospitals to fulfill their role as caregiving and healing facilities.

The impact of clinician education on IUD uptake, knowledge and attitudes: results of a randomized trial.

BACKGROUND: Many ministries of health worldwide would like to increase use of the intrauterine device (IUD) since it is very safe, effective and inexpensive to provide. Efforts to stimulate interest in the method have not been rigorously tested. METHODS: A randomized trial was conducted among 40 clinics in Nicaragua to test the impact of medical education on both IUD uptake and on provider knowledge/attitude toward the method. Two types of interventions were used: face-to-face medical training/education of providers and/or provision of an IUD checklist to help clinicians assess the medical eligibility of clients. RESULTS: The interventions had no impact on uptake of the IUD or on provider knowledge/attitude. CONCLUSION: While medical education and job tools (such as a checklist) for providers are indispensable for ensuring quality care, they may not be adequate to stimulate interest in the IUD on the part of clients.