The value of materiality for an aesthetic and restorative healthcare environment : a design proposal

Material och materialitet i landskapet är något vi ofta upplever med alla våra sinnen och är en viktig komponent i hur vi tolkar och tillskriver vår omgivning estetiska värden. I detta arbete undersöks främst de sinnliga och estetiska upplevelserna av materialitet och hur det genom landskapsarkitekturen kan kopplas till utemiljöer i vårdsammanhang. Arbetet är en fallstudie och ett gestaltningsförlag som genom en kombination av olika metoder undersöker och ger exempel på hur materialitet kan utgöra ett betydelsefullt inslag i restorativa vårdmiljöer. Syftet med arbetet har varit att skaffa mig generell kunskap och studera goda exempel på materialitet vid utemiljöer för vårdboenden inför min designprocess. Gestaltningsförslaget i arbetet är således främst baserat på den kunskap jag införskaffat mig inom områdena: materialitet och utformning utifrån behoven från en identifierad användargrupp. Några av de slutsatser som kunnat urskiljas från ovanstående metoder i arbetet är att att material och materialitet är viktigt för en trivsam samt estetiskt tilltalande miljö och upplevs ofta genom sinnlig perception utan att vi är direkt medvetna om det. Även platsspecifika aspekter så som sambandet mellan utformning, komposition, detaljnivå tillsammans med materialen och dess uttryck har visat sig vara avgörande för hur vi upplever platsen och dess helhet som estetiskt tilltalande. Vidare verkar vad som upplevs som estetiskt tilltalande vara högst personligt betingat och huvudsakligen genomsyrat av individuella mentala processer.Different kinds of material and materiality in the landscape is something we experience with all our senses and is an important component of how we interpret and attributes our environment values. This master thesis aims to investigate the sensual and aesthetic experiences of materiality and how the landscape architecture can be linked to outdoor environments in the context of healthcare. This thesis is a case study and a design proposal that through a number of methods, examines how materiality can be an important element in restorative care environments. The main purpose of the this thesis has been to acquire general knowledge and study good examples of materiality in outdoor environments for nursing homes as apart of my design process. The design proposal is thus mainly based on the knowledge I acquired in the areas: materiality and design based on user needs of the site. The key conclusions that have been identified from the above methods can be summarized as follows, material and materiality is important for a pleasant and aesthetically pleasing environment and is often experienced by sensible perception without being aware of it. Even site-specific aspects such as the relationship between design, composition, detail level together with the materials and their expressions are also decisive for how we perceive the place and its entirety as aesthetically appealing. Furthermore, what is considered aesthetically appealing seems to be highly personalized and essentially imbued with individual mental processes

Inverkan av urbana grönområden på människors hälsa

Both mental and physical ill health, population and urbanization is increasing both in the world and in Sweden. These are challenges that politicians and city planners in today's society should take into account when it is expected to cause problems in the future regarding the economy and human health. To highlight efforts to improve public health, the main objectives of this study is to examine the evidence regarding the relationship between the available green space in urban environments and people's physical and mental health. The method is a systematic literature review based on 19 scientific articles. The result shows four main areas: Physical activity linked to green areas accessibility, physical activity in green areas linked to mental health, mental health linked to green spaces and restorative effects. The result shows that the availability of green areas is important for the frequency of visits. The studies found that mental health improvements were made both in natural habitats and in green areas in urban environments and also that rehabilitation through stay in nature can reduce depression and concentration difficulties, and promote prevention. The study concludes that there are clear links and impacts between natural / green areas, physical activity and mental health. By planning and making natural and green spaces available to people, it can provide and increasing the chances to use and thereby increase people's quality of life and reduce stress-related illness and sick leave. The results also suggest that external factors are necessary to take account of existing green areas. It requires more comprehensive and clinical research in the field. These findings could generate more reliable and concrete evidence regarding green spaces in urban environment's health benefits in the planning of cities.Både psykisk och fysisk ohälsa, befolkning och urbanisering ökar både i världen och i Sverige. Detta är utmaningar som politiker och stadsplanerare i dagens samhälle bör ta hänsyn till då det väntas innebära problem i framtiden gällande ekonomi och människors hälsa. För att lyfta fram insatser till förbättrad folkhälsa är studiens huvudmål och syfte att undersöka evidens gällande sambandet mellan tillgängliga grönytor i urbana miljöer och människors fysiska och psykiska hälsa. Metoden är en systematisk litteraturstudie som baserar sig på 19 vetenskapliga artiklar. Resultatet visar fyra olika huvudområden: Fysisk aktivitet kopplat till grönområdens tillgänglighet, Fysisk aktivitet i grönområden kopplat till psykisk hälsa, Psykisk hälsa kopplat till grönområden och Restorativa effekter. Det visade sig att det finns samband för att tillgängligheten till grönområden har betydelse för besöksfrekvensen. I undersökningarna såg man även att psykiska hälsoförbättringar skedde både i naturliga miljöer samt i grönområden i urbana miljöer och att rehabilitering genom vistelse i natur kan minska depression och koncentrationssvårigheter samt verka förebyggande. Studiens slutsats är att det finns tydliga samband och effekter mellan natur/ grönområden, fysisk aktivitet och psykisk hälsa. Genom att planera och göra natur och grönområden tillgängliga för människor kan man erbjuda och öka chanserna till användningen och på så sätt öka människors livskvalité och minska stressrelaterade sjukdomar och sjukskrivningar. Resultatet tyder även på att yttre faktorer är nödvändiga att ta hänsyn till gällande grönområden. Det krävs mer omfattande och klinisk forskning inom området. Dessa forskningsresultat skulle kunna generera till fler tillförlitliga och konkreta bevis gällande grönområden i stadsmiljös positiva hälsoeffekter vid planering av städer

The Impact of an In-service Educational Program on Nurses' Knowledge and Attitudes Regarding Pain Management in an Ethiopian University Hospital

Background: Although pain control for hospitalized patients is a central issue for all health care providers, nurses' knowledge, and attitudes are the major barriers. Educational program is a strategy to improve nurses' knowledge and attitudes on pain management. However, there is paucity of information on how in-service education program influences nurses' knowledge and attitudes score for pain management in Ethiopia. The objective of this study was therefore, to investigate the influence of an in-service educational program on nurses' knowledge and attitudes regarding pain management in an Ethiopian university hospital.Methods: A quasi-experimental study was conducted between 1 October and 15 November 2016. Totally 111 nurses working at Jimma University Medical Center participated in the study. We provided 2 consecutive days of intensive pain management education with a follow-up training session after 1 month. Knowledge and Attitudes Survey Regarding Pain (KASRP) was used as a tool for measuring the impact of educational program. Data were analyzed using the Wilcoxon signed-rank test, and results were considered significant at p < 0.05.Result: Of the 111 nurses, who participated in the study, 39.5% were female, 46.8% had a baccalaureate degree, and 67.6% had worked in nursing for 6–10 years. The mean age of respondents was 26.9 (SD ± 5.6) years. On average, participants answered 41.4% of the survey items correctly before the intervention and 63.0% after the intervention. The mean rank score of nurses' knowledge and attitudes regarding pain significantly improved following participation in the educational program (Z = −9.08, p < 0.001).Conclusion: The educational program improved nurses' scores for pain management knowledge and attitudes. This may lead to more effective pain management by nurses

Classifying nursing organization in wards in Norwegian hospitals: self-identification versus observation

<p>Abstract</p> <p>Background</p> <p>The organization of nursing services could be important to the quality of patient care and staff satisfaction. However, there is no universally accepted nomenclature for this organization. The objective of the current study was to classify general hospital wards based on data describing organizational practice reported by the ward nurse managers, and then to compare this classification with the name used in the wards to identify the organizational model (self-identification).</p> <p>Methods</p> <p>In a cross-sectional postal survey, 93 ward nurse managers in Norwegian hospitals responded to questions about nursing organization in their wards, and what they called their organizational models. K-means cluster analysis was used to classify the wards according to the pattern of activities attributed to the different nursing roles and discriminant analysis was used to interpret the solutions. Cross-tabulation was used to validate the solutions and to compare the classification obtained from the cluster analysis with that obtained by self-identification. The bootstrapping technique was used to assess the generalizability of the cluster solution.</p> <p>Results</p> <p>The cluster analyses produced two alternative solutions using two and three clusters, respectively. The three-cluster solution was considered to be the best representation of the organizational models: 32 team leader-dominated wards, 23 primary nurse-dominated wards and 38 wards with a hybrid or mixed organization. There was moderate correspondence between the three-cluster solution and the models obtained by self-identification. Cross-tabulation supported the empirical classification as being representative for variations in nursing service organization. Ninety-four per cent of the bootstrap replications showed the same pattern as the cluster solution in the study sample.</p> <p>Conclusions</p> <p>A meaningful classification of wards was achieved through an empirical cluster solution; this was, however, only moderately consistent with the self-identification. This empirical classification is an objective approach to variable construction and can be generally applied across Norwegian hospitals. The classification procedure used in the study could be developed into a standardized method for classifying hospital wards across health systems and over time.</p

Incorporating health care quality into health antitrust law

<p>Abstract</p> <p>Background</p> <p>Antitrust authorities treat price as a proxy for hospital quality since health care quality is difficult to observe. As the ability to measure quality improved, more research became necessary to investigate the relationship between hospital market power and patient outcomes. This paper examines the impact of hospital competition on the quality of care as measured by the risk-adjusted mortality rates with the hospital as the unit of analysis. The study separately examines the effect of competition on non-profit hospitals.</p> <p>Methods</p> <p>We use California Office of Statewide Health Planning and Development (OSHPD) data from 1997 through 2002. Empirical model is a cross-sectional study of 373 hospitals. Regression analysis is used to estimate the relationship between Coronary Artery Bypass Graft (CABG) risk-adjusted mortality rates and hospital competition.</p> <p>Results</p> <p>Regression results show lower risk-adjusted mortality rates in the presence of a more competitive environment. This result holds for all alternative hospital market definitions. Non-profit hospitals do not have better patient outcomes than investor-owned hospitals. However, they tend to provide better quality in less competitive environments. CABG volume did not have a significant effect on patient outcomes.</p> <p>Conclusion</p> <p>Quality should be incorporated into the antitrust analysis. When mergers lead to higher prices and lower quality, thus lower social welfare, the antitrust challenge of hospital mergers is warranted. The impact of lower hospital competition on quality of care delivered by non-profit hospitals is ambiguous.</p

Challenging the holy grail of hospital accreditation: A cross sectional study of inpatient satisfaction in the field of cardiology

Extent: 7p.Background: Subjective parameters such as quality of life or patient satisfaction gain importance as outcome parameters and benchmarks in health care. In many countries hospitals are now undergoing accreditation as mandatory or voluntary measures. It is believed but unproven that accreditations positively influence quality of care and patient satisfaction. The present study aims to assess in a defined specialty (cardiology) the relationship between patient satisfaction (as measured by the recommendation rate) and accreditation status. Methods: Consecutive patients discharged from 25 cardiology units received a validated patient satisfaction questionnaire. Data from 3,037 patients (response rate > 55%) became available for analysis. Recommendation rate was used as primary endpoint. Different control variables such as staffing level were considered. Results: The 15 accredited units did not differ significantly from the 10 non-accredited units regarding main hospital (i.e. staffing levels, no. of beds) and patient (age, gender) characteristics. The primary endpoint "recommendation rate of a given hospital" for accredited hospitals (65.6%, 95% Confidence Interval (CI) 63.4 - 67.8%) and hospitals without accreditation (65.8%, 95% CI 63.1 - 68.5%) was not significantly different. Conclusion: Our results support the notion that - at least in the field of cardiology - successful accreditation is not linked with measurable better quality of care as perceived by the patient and reflected by the recommendation rate of a given institution. Hospital accreditation may represent a step towards quality management, but does not seem to improve overall patient satisfaction.Cornelia Sack, Peter Lütkes, Wolfram Günther, Raimund Erbel, Karl-Heinz Jöckel and Gerald J Holtman

Laying the foundations for implementing Magnet principles in hospitals in Europe: A qualitative analysis

Background: Magnet hospitals, a concept developed in the U.S., have been associated with improved nurse recruitment and retention, and better patient outcomes. Magnet principles may be useful to address workforce challenges in European hospitals, but they have not been implemented or evaluated on a large scale in the European hospital context. Objective: This study aims to explore the initial phase of implementing Magnet principles in 11 acute care hospitals in six European countries. The specific objectives of the study were to investigate the type of work that characterises the early phase of implementation and how implementation leaders engage with their context. Methods: A multinational qualitative study was conducted, with data from 23 semi-structured, one-to-one interviews with implementation leaders in 11 acute care hospitals in six European countries. Thematic analyses guided the analysis of data. Findings: Three themes of core work processes during the early phase of implementing Magnet principles in European hospitals were identified. The first theme, ‘Creating space for Magnet’, describes how work was directed towards creating both political and organisational space for the project. The second theme, ‘Framing to fit: understanding and interpreting Magnet principles’, describes the translational work to understand what the Magnet model entails and how it relates to the local hospital context. Finally, the third theme, ‘Calibrating speed and dose’, describes the strategic work of considering internal and external factors to adjust the process of implementation. Conclusions: The first phase of implementation was characterised by conceptual and relational work; translating the Magnet concepts, considering the fit into existing structures and practices and making space for Magnet in the local context. Understanding the local context played an important role in shaping and guiding the navigation of professional and organisational tensions. Hospitals employed diverse strategies to either emphasise or downplay the role of nurses and nursing to facilitate progress in the implementation