Well shit, you mean you didn't take into account research showing nature scenes even in a painting were helpful.
As an important part of the rehabilitation process at stroke units, the physical environment has recently been highlighted as an important factor in stimulating both cognitive and social activities among patients (Janssen et al., 2014; White, Bartley, Janssen, Jordan, & Spratt, 2015). According to Harris, McBride, Ross, and Curtis (2002), the physical environment can be described as the ambient environment (e.g., lighting, noise levels, and air quality); architectural features (e.g., layout of hospital); the size and shape of rooms and placement of windows; and interior design features (e.g., furnishing and artwork). All dimensions are important for supporting care and helping patients return to health and well-being. In nursing, the concept of the environment has traditionally been referred to as all that surrounds the patient; there is constant interaction between the patient and the environment (Meleis, 2017).
Ulrich (1991) argued that to promote well-being, the physical environment should be designed to support patient care by providing a sense of control, access to social support, and access to positive distraction. Researchers have examined several areas in which the physical environment can impact patients’ health outcomes; it has been found that sound and light (Huisman, Morales, van Hoof, & Kort, 2012) as well as the ability to experience nature (Ulrich et al., 2008) can affect health and well-being. Research has also shown that high levels of attractiveness, in the form of colorful contemporary furnishings and artwork, for example, may reduce patients’ anxiety (Becker & Douglass, 2008). The physical environment can also provide opportunities for activities and social interactions, for example, by providing access to communal areas with books, games, and computers; having access to these opportunities for interaction can be an important prerequisite for recovery after a stroke (Janssen et al., 2014; White et al., 2015).
Based on the knowledge that the physical environment can contribute to health and well-being, the concept of evidence-based design has been established and is increasingly attracting attention. Evidence-based design incorporates research to achieve the best possible health outcomes for patients, staff, and visitors (Hamilton & Watkins, 2009; Ulrich, Berry, Quan, & Parish, 2010). To gain a better understanding of the importance of the physical environment, individual experiences of the environment need to be studied further. This need for research applies especially when the trend is to go exclusively to single rooms.
The present study focuses on patients who have suffered a stroke. Stroke can affect any neurological function, for example, it can cause visual impairment and memory loss, and it can impact a person’s daily life (Elf, Eriksson, Johansson, von Koch, & Ytterberg, 2016; Langhorne, Bernhardt, & Kwakkel, 2011). Shortly after a stroke, increased engagement in physical activities targeting mobility may result in reduced impairment (Veerbeek et al., 2014).
To live independently and manage their daily lives at home, all stroke patients should be treated in stroke units. A stroke unit is an organized and highly specialized unit that provides complete care for stroke patients and constitutes a geographically defined unit in the hospital (SUTC, 2013). A person who receives care in a stroke unit is less likely to have complications caused by immobility, such as venous thromboembolism or chest infections, compared to a patient who receives care in a general ward (Govan, Langhorne, & Weir, 2007). The care at stroke units focuses on acute medical interventions and early rehabilitation, which are provided by a multiprofessional team (Riksstroke, 2015). Stroke guidelines recommend starting rehabilitation early to regain functions such as the abilities to walk, talk, and read (Ringelstein et al., 2013; SUTC, 2013).
Research on patients at stroke units has focused mainly on aspects such as where patients spend their days as well as the types of activities and interactions they engage in (Bernhardt, Dewey, Thrift, & Donnan, 2004; West & Bernhardt, 2012). Recently, we had the opportunity to compare patients’ behavior in a stroke unit before and after the unit underwent reconstruction. The comparison showed that patients’ activities and interactions varied between the old and the new units and that these variations could be related to the difference in design. In the new stroke unit, the patients spent more time alone in their rooms, were less active, and had fewer interactions compared with the patients in the old unit. One explanation could be the transformation from mainly multibed rooms to single rooms (Anåker et al., 2017). Nevertheless, we need a deeper understanding of how the physical environment affects patients and the quality of care at stroke units (Campbell, Roland, & Buetow, 2000). A well-designed physical environment can be defined as an environment that can contribute to social, psychological, spiritual, physical, and behavioral care (Jonas & Chez, 2004). However, the physical environment’s design and its impact on health and care are rarely the focus of the studies conducted at stroke units.
In summary, a well-designed, stimulating, and attractive healthcare environment is a key factor in patient care. Observations of patients’ activities and interactions during stroke care are important; however, such studies do not reveal how patients experience an environment and what meaning they give to that environment. How patients experience the physical environment in stroke units in general, and stroke units with single-room designs in particular, remains unknown. The aim of this study was to explore patients’ experiences of the physical environment at a newly built stroke unit, and the knowledge generated by this investigation can inform the design of new stroke units.