Does a new spatial design in psychiatric inpatient care influence patients' and staff's perception of their care/working environment? A study protocol of a pilot study using a single-system experimental design

Britt-Marie Lindgren, Jenny Molin, Mats Lundström, Maria Strömbäck, Ellinor Salander Renberg, Anders Ringnér, Britt-Marie Lindgren, Jenny Molin, Mats Lundström, Maria Strömbäck, Ellinor Salander Renberg, Anders Ringnér

Abstract

Background: Research shows that worn-out physical environments are obstacles to psychiatric inpatient care. Patients want better relationships with staff and things to do; staff want an environment that offers hope, a calm atmosphere, and joint activities. A county council in northern Sweden and Philips Healthcare partnered to create solutions to the environmental challenges of psychiatric inpatient care. One ward at a county psychiatric clinic was selected for a pilot project to test solutions that could improve the care environment for patients, staff, and relatives. The aim of the overall project is to evaluate the effects of a newly designed psychiatric inpatient ward on patients and staff in terms of quality of care and stress. In this study, we focus on the feasibility through testing questionnaires and exploring barriers to recruiting staff and patients.

Methods: This study had a single-system experimental design, comparing a psychiatric unit pre- and post-implementation of the novel spatial design, using repeated measures with the same questionnaires twice a week during baseline and intervention phases. Primary outcomes were quality interactions (patients) and perceived stress (staff). Secondary outcomes were levels of anxiety and depression (patients), and stress of conscience (staff). A process evaluation was aimed to describe contextual factors and participant experiences of the new design. Data was collected using questionnaires and semi-structured individual interviews with patients and focus group discussions with staff. Both visual and statistical methods were used to analyse the quantitative data and content analysis for the qualitative data.

Discussion: The findings will contribute insights into whether and how a new spatial design might contribute to quality interactions and reduced stress. This is relevant both nationally and internationally, as similar interventions are needed but sparse. The findings will be disseminated through peer-reviewed publications and conference presentations.

Trial registration: ClinicalTrials.gov, NCT03140618, registered 4 May 2017.

Keywords: Activity; Environment; Feasibility; Intervention; Nursing; Process evaluation; Protocol; Psychiatric inpatient care; Quality interactions; Single-system design.

Conflict of interest statement

The study is approved by the Head of the Clinical Department of Psychiatry involved and the Central Ethical Review Board in the region (Dnr 2017/72-31). The participants will be informed that participation is voluntary, that they have the right to withdraw whenever they want without specifying why, and that confidentiality will be assured. Informed consent will be assigned by all participants. The findings will be presented at research conferences and in peer-reviewed journals.Not applicable.The authors declare that they have no competing interests. As mentioned earlier, the rebuilding of the ward was completed in a collaboration between the county council and Philips Health Care. Neither the county council nor Philips Health Care has been part of this research.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. The National Board of Health and Welfare. Tillståndet och utvecklingen inom hälso- och sjukvård och socialtjänst, Lägesrapport 2015. [The state and development in the healthcare and social services, Situation report 2015]. . Accessed 19 Dec 2017.
    1. Eklund M, Hansson L. Ward atmosphere, client satisfaction, and client motivation in a psychiatric work rehabilitation unit. Community Ment Health J. 2001;37:169–177. doi: 10.1023/A:1002765800180.
    1. Johansson H. Therapeutic alliance in general psychiatric care. Doctoral dissertation. Lund: The Department of Psychology, Lund University, and the Division of Psychiatry, Lund University; 2006.
    1. Middleboe T, Schjødt T, Byrsting K, Gjerris A. Ward atmosphere in acute psychiatric in-patient care: patients' perceptions, ideals and satisfaction. Acta Psychiatr Scand. 2001;103:212–219. doi: 10.1034/j.1600-0447.2001.00102.x.
    1. Howard PB, Clark JJ, Rayens MK, Hines-Martin V, Weaver P, Littrell R. Consumer satisfaction with services in a regional psychiatric hospital: a collaborative research project in Kentucky. Arch Psychiatr Nurs. 2001;15:10–23. doi: 10.1053/apnu.2001.20577.
    1. Schröder A, Ahlström G, Larsson BW. Patients’ perceptions of the concept of the quality of care in the psychiatric setting: a phenomenographic study. J Clin Nurs. 2006;15:93–102. doi: 10.1111/j.1365-2702.2005.01241.x.
    1. Connellan K, Gaardboe M, Riggs D, Due C, Reinschmidt A, Mustillo L. Stressed spaces: mental health and architecture. HERD. 2013;6:127–168. doi: 10.1177/193758671300600408.
    1. Johansson I, Skärsäter I, Danielsson E. The meaning of care in a locked acute psychiatric ward: patients’ experiences. Nord J Psychiatry. 2009;63:501–507. doi: 10.3109/08039480903118208.
    1. Borge L, Fagermoen M. Patients’ core experiences of hospital treatment: wholeness and self-worth in time and space. J Ment Health. 2008;17:193–205. doi: 10.1080/09638230701505996.
    1. Rowlands J, Noble S. How does the environment impact on the quality of life of advanced cancer patients? A qualitative study with implications for ward design. Palliat Med. 2008;22:768–774. doi: 10.1177/0269216308093839.
    1. Lindgren BM, Aminoff C, Hällgren Graneheim U. Features of everyday life in psychiatric inpatient care for self-harming: an observational study of six women. Issues Ment Health Nurs. 2015;36:82–88. doi: 10.3109/01612840.2014.941077.
    1. Molin J, Graneheim UH, Lindgren BM. Quality of interactions influences everyday life in psychiatric inpatient care–patients’ perspectives. Int J Qual Stud Health Well-being. 2016;11:29897. doi: 10.3402/qhw.v11.29897.
    1. Molin J, Graneheim UH, Ringnér A, Lindgren BM. From ideals to resignation – interprofessional teams’ perspectives on everyday life processes in psychiatric inpatient care. J Psychiatr Ment Health Nurs. 2016;23:595–604. doi: 10.1111/jpm.12349.
    1. Delaney KR, Johnson ME. Meta-synthesis of research on the role of psychiatric inpatient nurses: what is important to staff? J Am Psychiatr Nurses Assoc. 2014;20:125–137. doi: 10.1177/1078390314527551.
    1. Graneheim UH, Slotte A, Säfsten HM, Lindgren BM. Contradictions between ideals and reality: Swedish registered nurses’ experiences of dialogues with inpatients in psychiatric care. Issues Ment Health Nurs. 2014;35:395–402. doi: 10.3109/01612840.2013.876133.
    1. Ejneborn Looi GM, Engström Å, Sävenstedt S. A self-destructive care: self-reports of people who experienced coercive measures and their suggestions for alternatives. Issues Ment Health Nurs. 2015;36:96–103. doi: 10.3109/01612840.2014.951134.
    1. Cleary M. The realities of mental health nursing in acute inpatient environments. Int J Ment Health Nurs. 2004;13:53–60. doi: 10.1111/j.1447-0349.2004.00308.x.
    1. Wood L, Alsawy S. Patient experiences of psychiatric inpatient care: a systematic review of qualitative evidence. J Psychiatr Intensive Care. 2016;12:35–43. doi: 10.20299/jpi.2016.001.
    1. Giménez M, Geerdinck L, Versteylen M, Leffers P, Meekes G, Herremans H, et al. Light and sleep within hospital settings. Sleep-Wake Research in the Netherlands, annual proceedings of the Dutch Society for Sleep-Wake Research. NSWO. 2011;22:56–59.
    1. Baillon S, Diepen Van E, Prettyman R. Multi-sensory therapy in psychiatric care. Adv Psychiatr Treatment. 2002;8:444–452. doi: 10.1192/apt.8.6.444.
    1. Björkdahl A, Perseius KI, Samuelsson M, Lindberg MH. Sensory rooms in psychiatric inpatient care: staff experiences. Int J Ment Health Nurs. 2016;25:472–479. doi: 10.1111/inm.12205.
    1. Novak T, Scanlan J, McCaul D, MacDonald N, Clarke T. Pilot study of sensory room in an acute inpatient psychiatric unit. Australas Psychiatry. 2012;20:401–406. doi: 10.1177/1039856212459585.
    1. Cummings KS, Grandfield SA, Coldwell CM. Caring with comfort rooms. Reducing seclusion and restraint use in psychiatric facilities. J Psychosoc Nurs Ment Health Serv. 2010;48:26–30. doi: 10.3928/02793695-20100303-02.
    1. Chalmers A, Harrison S, Mollison K, Molloy N, Gray K. Establishing sensory-based approaches in mental health inpatient care: a multidisciplinary approach. Australas Psychiatry. 2012;20:35–39. doi: 10.1177/1039856211430146.
    1. Ellis N, Crone D, Davey R, Grogan S. Exercise interventions as an adjunct therapy for psychosis: a critical review. Br J Clin Psychol. 2007;46:95–111. doi: 10.1348/014466506X122995.
    1. Fox KR, Stathi A, McKenna J, Davis MG. Physical activity and mental well-being in older people participating in the Better Ageing Project. Eur J App Physiol. 2007;100:591–602. doi: 10.1007/s00421-007-0392-0.
    1. Ekeland E, Heian F, Hagen KB, Abbott J, Nordheim L. Exercise to improve self-esteem in children and young people. Cochrane Database Syst Rev. 2004;(1):CD003683. 10.1002/14651858.CD003683.pub2.
    1. Faulkner G. Exercise as an adjunct treatment for schizophrenia. In: Faulkner G, Taylor A, editors. Exercise, health and mental health: emerging relationships. London: Routledge; 2005. pp. 27–45.
    1. Stonerock GL, Hoffman BM, Smith PJ, Blumenthal JA. Exercise as treatment of anxiety: systematic review and analysis. Ann Behav Med. 2015;49:542–556. doi: 10.1007/s12160-014-9685-9.
    1. Carless D, Douglas K. The role of sport and exercise in recovery from mental illness: two case studies. Int J Mens Health. 2008;7:137–156. doi: 10.3149/jmh.0702.137.
    1. Carless D, Douglas K. Narrative, identity and mental health: how men with serious mental illness re-story their lives through sport and exercise. Psychol Sport Exerc. 2008;9:576–594. doi: 10.1016/j.psychsport.2007.08.002.
    1. Thyer B. The handbook of social work research methods. London: Sage; 2010.
    1. Morgan DL, Morgan RK. Single-case research methods for the behavioral and health sciences. London: Sage; 2009.
    1. Wyder M, Bland R, Blythe A, Matarasso B, Crompton D. Therapeutic relationships and involuntary treatment orders: service users’ interactions with health-care professionals on the ward. Int J Ment Health Nurs. 2015;24:181–189. doi: 10.1111/inm.12121.
    1. Gabrielsson S, Sävenstedt S, Olsson M. Taking personal responsibility: nurses’ and assistant nurses’ experiences of good nursing practice in psychiatric inpatient care. Int J Ment Health Nurs. 2016;25:434–443. doi: 10.1111/inm.12230.
    1. Tuvesson H, Eklund M, Wann-Hansson C. Perceived stress among nursing staff in psychiatric inpatient care: the influence of perceptions of the ward atmosphere and the psychosocial work environment. Issues Ment Health Nurs. 2011;32:441–448. doi: 10.3109/01612840.2011.564344.
    1. Swanson KM. Predicting depressive symptoms after miscarriage: a path analysis based on the Lazarus paradigm. J Womens Health Gend Based Med. 2000;9:191–206. doi: 10.1089/152460900318696.
    1. Miller SD, Duncan BL, Brown J, Sparks JA, Claud DA. The Outcome Rating Scale: a preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. J Brief Therapy. 2003;2:91–100.
    1. Kazdin AE. Single-case research designs: methods for clinical and applied settings. New York: Oxford University Press; 2011.
    1. Lambert MJ, Burlingame GM, Umphress V, Hansen NB, Vermeersch DA, Clouse GC, Yanchar SC. The reliability and validity of the Outcome Questionnaire. Clin Psychol Psychother. 1996;3:249–258. doi: 10.1002/(SICI)1099-0879(199612)3:4<249::AID-CPP106>;2-S.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Herrmann C. International experiences with the Hospital Anxiety and Depression Scale–a review of validation data and clinical results. J Psychosom Res. 1997;42:17–41. doi: 10.1016/S0022-3999(96)00216-4.
    1. Lisspers J, Nygren A, Söderman E. Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatr Scand. 1997;96:281–286. doi: 10.1111/j.1600-0447.1997.tb10164.x.
    1. Schröder A, Wilde Larsson B, Ahlström G. Quality in psychiatric care: an instrument evaluating patients’ expectations and experiences. In J Health Care Qual Assur. 2007;20:141–160. doi: 10.1108/09526860710731834.
    1. Schröder A, Wilde Larsson B, Ahlström G, Lundqvist LO. Psychometric properties of the instrument quality in psychiatric care and descriptions of quality of care among in-patients. In J Health Care Qual Assur. 2010;23:554–570. doi: 10.1108/09526861011060924.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–396. doi: 10.2307/2136404.
    1. Nordin M, Nordin S. Psychometric evaluation and normative data of the Swedish version of the 10-item perceived stress scale. Scand J Psychol. 2013;54:502–507. doi: 10.1111/sjop.12071.
    1. Glasberg AL, Eriksson S, Dahlqvist V, Lindahl E, Strandberg G, Söderberg A, et al. Development and initial validation of the stress of conscience questionnaire. Nurs Ethics. 2006;13:633–648. doi: 10.1177/0969733006069698.
    1. Glasberg AL, Eriksson S, Norberg A. Burnout and ‘stress of conscience’ among healthcare personnel. J Adv Nurs. 2007;57:392–403. doi: 10.1111/j.1365-2648.2007.04111.x.
    1. Kvale S, Brinkmann S. Interviews: learning the craft of qualitative research interviewing. Los Angeles: Sage; 2009.
    1. Richards DA, Rahm Hallberg I. Complex interventions in health: an overview of research methods. Abingdon: Routledge; 2015.
    1. Krippendorff K. Content analysis: an introduction to its methodology. Thousand Oaks: Sage; 2013.
    1. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24:105–112. doi: 10.1016/j.nedt.2003.10.001.
    1. Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350:h1258. doi: 10.1136/bmj.h1258.

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