Does the physical environment matter? - A qualitative study of healthcare professionals’ experiences of newly built stroke units

Figures & data

Table I. Environmental characteristics of stroke units

Stroke unit ID/Type of hospital	Type of stroke care	Construction/ renovation	Patient room types/Number of beds	Patient room facilities	Access to activity/therapy area	Day areas	Staff workplaces
Unit 1/University hospital	Acute stroke care and strokerehabilitation	Newly built	A mix of single rooms and multi-bed rooms with an overbalance towards single rooms. In total 23 beds.	Windows to the outside. Bathrooms within all rooms.	Located at the same floor as the patient rooms	Patient lounge/dining room located at the unit entrance with windows facing the outside. A glazed balcony adjacent to the lounge.	Several workplaces for staff, and open workplaces/desks located in the corridors. Designated rooms for team conferences, one located inside the unit, and one located close to the unit.
Unit 2/Regional hospital	Acute stroke care and stroke rehabilitation	Completely redesigned and renovated	Mainly single rooms. Access to two rooms with three beds in each room reserved for patients in need of medical monitoring. In total 22 beds.	Windows to the outside. Bathrooms within all rooms.	Located at the same floor as the patient rooms	Patient lounge/dining room located in the middle of the unit with a large open area in direction to the corridor. No windows, only artificial light.	Several workplaces for staff, and open workplaces/desks located adjacent to staff workplaces. No designated rooms for team conferences.
Unit 3/University hospital	Acute stroke care and stroke rehabilitation	Completely redesigned and renovated	Mainly single rooms. Access to one room with three beds reserved for patients in need of medical monitoring. In total 22 beds.	Windows to the outside. Bathrooms within all rooms.	Located at the same floor as the patient rooms	Patient lounge/dining room located at the end of one of the corridors. Windows facing the outside.	Several workplaces for staff. Designated rooms for team conferences.

Table II. Examples of the analysis process

Meaning units	Condensed meaning units	Codes	Subcategories	Categories
I experience it as positive that the patients have their own rooms so that I am coming in to the patient and that both assessment and treatment are taking place in the patient’s room a bit on the patient’s terms	As the patients have their own room, assessment and treatment can be on the patient’s terms	More focus on the patient in single rooms	Caring for the patient on her or his own terms is facilitated in single rooms	Working towards patient engagement in single rooms
What I think can be difficult, is this rehab conference in this oblong room when everyone is sitting with their heads twisted, instead of everyone sitting around a table where we all can look each other in the eyes and so we are sitting and looking askew up at a projected computer, and that is not optimal in teamwork	Not optimal in teamwork when everyone is sitting with their heads twisted during the rehab conference instead of sitting around a table looking at each other	Difficult to see each other during conference	Varying prerequisites for team dialogues and documentation in work areas	Collaboration and task fulfilment – a challenge due to care unit design

Table III. Subcategories and categories

Subcategories	Categories
Caring for the patient on her or his own terms is facilitated in single rooms Family involvement in care is promoted in single rooms Privacy is facilitated in single rooms but restricted in multi-bed rooms	Working towards patient engagement in single rooms
Transfers and exercises require functional design and adequate space Transfers and exercises are restricted by non-purposeful furniture Environmental distractions as barrier and support	Hampered rehabilitation in an environment not always adapted to patients’ difficulties
Social interactions are restricted by inadequate communal spaces Rest and recovery are hindered by high sound levels Positive distraction is promoted by access to nature Opportunity to withdraw versus risk of loneliness in single rooms	Addressing patients’ psychosocial needs in the environment
The patient’s form of disability guides the use of aids and furniture Patients with a risk of falling are placed to enhance staff supervision Monitoring of patients is promoted by a central location and proximity to spaces	Ensuring patient safety by using the environment in accordance with individual needs
Availability at the expense of being interrupted in workplaces with open designs Limited privacy in workplaces Varying prerequisites for team dialogues and documentation in work areas	Collaboration and task fulfilment—a challenge due to care unit design