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Objective: This study aims to analyze research methodologies from 157 research articles published in this journal in the last five years (2016–2020). Background: Health environments research is comprised of research covering many topics and from various disciplines worldwide. No systematic study exists to uncover themes in evidence-based design (EBD) research concerning the types of research published, people engaged in research, and the research methods employed. Understanding the nature of health environment research performed can help researchers, practitioners, and students situate their work within an EBD research structure. Methods: Case study research was used to analyze 157 articles published in the Health Environments Research & Design Journal devoted to EBD and research. Secondary data were extracted to capture research methods from health environments studies and then analyzed to identify themes. The design and outcome categories were structured around and the Center for Health Design’s (CHD) Knowledge Repository with origins to Ulrich et al.’s Evidence-Based Design Framework. Results: Findings are reported on categories commonly found in empirical research articles: (i) key words, (ii) disciplines from authors, (iii) settings studied, (iv) populations studied or sampled, (v) research approach and study design, (vi) research strategies, (vii) data collection methods, (viii) data analysis procedures, (ix) design categories and variables, and (x) outcome categories and variables. Conclusions: The analyses highlighted the research methods most frequently used in health environments research. Findings revealed several inconsistencies across articles on key words and the framing of research methodologies. Results suggest that there should be a consistent and overarching research taxonomy with a set of acceptable terms for effective literature searches.

Maintaining an older adult’s health is crucial to achieving a high quality of life. However, as older adults age, many face health issues making it impossible, or unsafe, to venture outdoors. Nevertheless, the natural environment has consistently shown, dating back to ancient times, to have therapeutic benefits with mounting supporting evidence. The premise of this chapter is that technology is an effective means to simulate natural landscapes as a substitute for actual immersion in nature. The health benefits related to simulated landscapes are widespread including encouraging physical activity, boosting cognitive functioning, and facilitating social relationships. This emerging field is demonstrating how technological supports are recreating nature through interactive display screens, fiber optics, virtual environments, and virtual reality googles. Technology is increasingly extending beyond isolated objects and becoming fully integrated into physical environments, yielding simulated experiences that more closely replicate real world settings.

The delivery and consumption of health care services and information is in rapid change due to the introduction of technology, socio-political considerations (in the United States), and the change in population demographics (i.e., the “baby boom generation”). This chapter discusses some of these trends and their implications for two specific stakeholders in the health care system: the nurse and the older patient. In two case studies the authors report on the application of human factors methods to better understand the role of the built-environment on nursing work and the role of technology acceptance issues in older adult usage of electronic personal health records. The authors hope to show that while the challenges are great, the application of human factors methods can help increase performance, safety, and satisfaction for both nurse and older patient.

Although a nurse's job is inundated with prospective memory (PM) demands, and studies show that PM failures are a key component of adverse medical events, only one study has examined prospective memory in nursing (Grundgeiger, Sanderson, MacDougall, & Venkatesh, 2009). The purpose of the current study was to complement existing research with self-reports from 25 nurses on the PM tasks they must remember and those they forget. Results revealed that nurses most frequently perform episodic tasks, and these tasks can be further classified to better explain when nursing PM demands arise and what the demands consist of. A more specific categorization of nursing PM tasks enables researchers to focus on specific design solutions. We provide examples of such re-design recommendations intended to alleviate PM demands.

To improve the healthcare environment where nurses work and patients receive care, it is necessary to understand the elements that define the healthcare environment. Primary elements include (a) the occupants of the room and what knowledge, skills, and abilities they bring to the situation; (b) what tasks the occupants will be doing in the room; and (c) the characteristics of the built environment. To better understand these components, a task analysis from human factor research was conducted to study nurses as they cared for hospitalized patients. Multiple methods, including a review of nursing textbooks, observations, and interviews, were used to describe nurses' capabilities, nursing activities, and the environmental problems with current patient room models. Findings from this initial study are being used to inform the design and evaluation of an inpatient room prototype and to generate future research in improving clinical environments to support nursing productivity.

In the United States, primary care has emerged as an increasingly effective alternative to costly inpatient emergency care and hospitalization. Thousands of outpatient community-based clinics have been built in the past decade, in rural, suburban and urban contexts. The majority focus on the provision of preventative and public health care for medically underserved and/or uninsured patient populations. As this facility type has flourished, there remains a paucity of empirical research on the architectural performance of these ambulatory care environments. In response, an empirical investigation was developed. A post-occupancy evaluation was conducted on five community health centers in Cincinnati, Ohio, all of which were located in urban settings. Among the findings, a set of planning and design provisions were articulated on issues centered on site planning, wayfinding, amenities, and the internal deployment of diagnostic and treatment functions, with the principal focus on the design of highly patent-centered care environments. The findings are discussed in relation to this healthcare building type and are likely of significant interest to primary care providers, architects, and allied design professionals, both in the US and internationally. An innovative feature and outcome of this project was the comparison of square footages of the 5 community health centers, divided by the number of annual patient encounters, number of staff, as well as energy consumption. This resulted in the establishment of objective efficiency ratings, thus permitting the development of corrective measures and interventions.

The idea of affordance, borrowed from perceptual psychology, is applied to the domain of architecture. As to architectural theory, affordances can be used as a conceptual framework to understand the relationship between environments and occupants, especially with respect to form and function. Regarding architectural design, the concept of affordance allows for a common theoretical basis to improve the design process. Concerning architectural practice, affordances can be used as a tool to explore the connection between the intentions of the design with how the artifact is actually used, leading to archived knowledge, and the potential for avoiding common design failures.

Concern for the deleterious effect of nursing homes on older adults' quality of life has resulted in a grassroots movement calling for a shift from the traditional medical model of care to that of a social model, thereby creating life enriching environments which foster meaningful relationships and activity engagement among residents, staff, and family members (Eaton, 1997; 2000; Kane, Kane, & Ladd, 1998; Pioneer Network, 2004). In this manuscript one approach to creating a life-enriching nursing home environment, the family model, is presented. The Family Model of Care provides guidance and direction to nursing homes seeking to create home-like environments that will foster family-like bonds among residents, staff, and family members. The components of the Family Model of Care include: (1) collaborative culture, (b) home-like setting, and (c) meaningful activities.

Background: Nature images are frequently used for therapeutic purposes in hospital settings. Nature images may distract people from pain and promote psychological and physiological well-being, yet limited research is available to guide the selection process of nature images. Objective: The hypothesis is that higher degrees of presence and/or influence in the still photograph make it more effective at holding the viewer's attention, which therefore may distract the viewer from pain, and therefore be considered therapeutic. Research questions include: (1) Is there a significant difference in the level of perceived presence among the selected images? (2) Is there a significant difference in the level of perceived influence among the selected images? (3) Is there a correlation between levels of presence and levels of influence? Methods: 109 college students were randomly assigned to one of four different image categories defined by Appleton's prospect refuge theory of landscape preference. Categories included prospect, refuge, hazard, and mixed prospect and refuge. A control group was also included. Each investigation was divided into five periods: prereporting, rest, a pain stressor (hand in ice water for up to 120 seconds), recovery, and postreporting. Physiological readings (vital signs) were measured repeatedly using a Dinamap automatic vital sign tracking machine. Psychological responses (mood) to the image were collected using a reliable instrument, the Profile of Mood States. Results: No significant statistical difference in levels of presence was found among the four image categories. However, levels of influence differed and the hazard nature image category had significantly higher influence ratings and lower diastolic blood pressure readings during the pain treatment. A correlation ( r = .62) between presence and influence was identified; as one rose, so did the other. Mood state was significantly low for the hazard nature image after the pain stressor experience. Conclusions: Though the hazard image caused distraction from pain, it is nontherapeutic because of the low mood ratings it received. These preliminary findings contribute methodology to the research field and stimulate interest for additional research into the visual effects of nature images on pain.

Background: Views of nature have been reported to relieve stress and pain, making nature an ideal medium for use in healthcare settings. In hospitals whose design does not allow for a view of nature, virtual and surrogate views of nature may be viable therapeutic options. Objective: This study tests the effects of specific nature images, as defined by Appleton's prospect refuge theory of landscape preference, on participants experiencing pain. The hypotheses were: (1) Nature views are variable in their impact on specific psychological and physiological health status indicators; and (2) Prospect and refuge nature scenes are more therapeutic than hazard nature scenes. The research question was (1) Which nature image categories are most therapeutic as evidenced by reduced pain and positive mood? Methods: An experiment using mixed methods assessed the effects of four different nature scenes on physiological (blood pressure, heart rate) and psychological (mood) responses when a person was subjected to a pain stressor. Four groups were subjected to a specific nature image category of prospect, refuge, hazard, or mixed prospect and refuge; the fifth group viewed no image. The Short-Form McGill Pain Questionnaire and the Profile of Mood States survey instruments were used to assess pain and mood, respectively. Continuous physiological readings of heart rate and blood pressure were collected. Pain was induced through a cold pressor task, which required participants to immerse their nondominant hand in ice water for up to 120 seconds. Results: The mixed prospect and refuge image treatment showed significantly lower sensory pain responses, and the no-image treatment indicated significantly higher affective pain perception responses. The hazard image treatment had significantly lower diastolic blood pressure readings during the pain treatment, but it also had significantly high total mood disturbance. Conclusions: Although there was no clear “most” therapeutic image, the mixed prospect and refuge image showed significant potential to reduce sensory pain. The hazard image was the most effective at distracting participants from pain, but it should not be considered a positive distraction because it also received the highest mood disturbance scores of all groups.

Objective: The goal of this project was to create an easy-to-administer and inexpensive tool that can help identify usability issues in a patient room bathroom during the design process so improvements can be made before the final product is constructed and put into operation. Background: The bathroom is an essential part of any hospital patient room, yet it is associated with nurse dissatisfaction and patient falls. Minimal literature has examined whether the physical structure of various elements within the bathroom are efficient, safe, and satisfactory for the majority of users. Furthermore, there is a paucity of human factor guidelines for architects and designers to follow to ensure the usability of bathroom space for a wide variety of users. Methods: The authors adapted a common technique used in software usability: the heuristic evaluation. A heuristic evaluation is a “discount” evaluation method used to quickly and efficiently evaluate the usability flaws of user interfaces. Three methods were used to provide input for the heuristic evaluation: (1) Review of existing heuristic evaluations, reported hospital bathroom problems, and safety checklists; (2) Interviews with nurses and nursing assistants; and (3) Focus groups with nurses. Analysis of the interview and focus group transcripts enabled the categorization of the types of problems nurses encounter in the patient room bathroom. These categories served as the basis for the heuristics in the heuristic evaluation tool. Results: Eleven major heuristics (or categories of problems in the bathroom) were identified initially. The authors then went through several iterations of designing and refining the heuristic evaluation to form parsimonious categories and subcategories. Each of the eventual six major heuristic categories contains a general description as well as specific exemplar questions. These detailed subcategories enable an evaluator to easily gauge whether a bathroom adheres to the guideline, to write any comments about a particular issue, and to rate the severity of any problems. Conclusions: The bathroom heuristic evaluation was designed to be a discount usability evaluation tool. It can be used to assess a hospital bathroom during the design process for major usability issues, enabling necessary alterations before a final product is developed.

A nurse's working environment may place high demands on both event-based and time-based prospective memory (PM), leading to forgetting. In the field of nursing, forgetting can have serious consequences and put a patient's life in danger. To better understand the role of prospective load (quantity of PM tasks in memory) in nursing, the current study will examine the effects of type of PM task being performed (event-based or time-based) and quantity of PM tasks (n = 1 or 4) on performance of an ongoing task and PM task(s). A novel paradigm will be used to capture naturalistic elements of the nursing environment. Forty registered nurses will complete a representative documentation task in a full-scale mock-up patient room, while also remembering to perform 1 or 4, event-based or time-based PM task(s). Results from this study can be used to further the literature on prospective load, explain possible causes of nursing error, and inform the design of memory technology aides.