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Purpose: The aim of this study was to describe sleep patterns of adults with traumatic brain injury and examine effects of environmental stressors (patient care activities and light) on patterns of sleep., Design: A descriptive, correlational, explanatory design was used for this study., Methods: Sixty-three subjects with traumatic brain injury (>18 years) on an acute traumatic brain injury rehabilitation unit wore an Actiwatch for 48 hours to collect light and sleep data. Patient care activity data were collected between 11 p.m. and 7 a.m., Findings: Patient care activities and light occurred between 11 p.m. and 7 a.m. Nighttime sleep duration and sleep efficiency were explained by patient care activities, whereas light explained wake time after sleep onset., Conclusion: Patient care activities and light serve as environmental stressors that affect sleep., Clinical Relevance: Results necessitate examining the need and timing of nursing care activities and light during nighttime. Findings provide a basis for policy changes that optimize sleep., (Copyright © 2019 Association of Rehabilitation Nurses.)

Aim: To test the relationship between work practice environment and turnover intention, considering the mediation of work engagement and the moderation of work pressure among community health nurses., Design and Samples: A cross-sectional survey design., Methods: A total of 410 nurses were recruited from 32 community health centres between September 2016-January 2017 with survey on work practice environment, work engagement, work pressure and turnover intention. Structural equation modelling was used to test a mediated moderation model., Results: Work practice environment was positively associated with higher work engagement and lower turnover intention and work engagement partially mediated the relationship between work practice environment and turnover intention. In addition, work pressure moderated the relationship between work practice environment and work engagement., Conclusion: The improvement of work practice environment including the physical and humanitarian environment could enhance nurse engagement and reduce turnover intention in community, which was more pronounced among high-pressure nurses., Impact: In front of the nursing shortage, especially in communities, the strategies on how to retain and motivate nurses have become the focus of concern. Based on the job demands-resources model and the conservation of resources theory, this study examined the effect of work practice environment on turnover intention with the mediation role of work engagement and the moderation role of work pressure among community health nurses. The nurse managers of communities should pay attention to the role of work practice environment in stimulating nurses' engagement and decreasing turnover intention, especially when nurses are under high work pressure., (© 2019 John Wiley & Sons Ltd.)

Objectives: To provide a historical review on the evolution of contemporary Chinese nursing unit design and contextual factors that drive the design and changes., Background: China is undergoing a major healthcare construction boom. A systematic investigation of the characteristics and development of Chinese nursing unit design is warranted to help U.S. healthcare designers to provide design that fits the local context., Methods: The investigation is developed in two phases. The first phase is a large-scale spatial analysis of 176 Chinese acute care unit layouts from three periods: 1989-1999, 1999-2004, and 2005-2015. In addition to qualitative descriptions of the nursing unit typologies, the percentage of various typologies, patient room (PR) types, the number of beds, visibility from nurse station (NS) to PRs, and access to natural light during each period were evaluated quantitatively. The second phase defined key factors that shape Chinese nursing unit design through expert interviews., Results: Significant differences were found between design in these three periods. Chinese nursing unit size has continuously grown in the number of beds. Most PRs have shifted from three-bed to double-bed rooms. Most Chinese hospitals use single corridor, racetrack, and mutated racetrack layouts. Mutated racetrack has taken over single corridor as the dominant configuration. The access to southern sunlight remains important. The average visibility from NS to some PRs is restricted by the preferences of allocating most PRs on the south side of a unit., Conclusions: Chinese nursing unit design has undergone transformations to fit the local cultural, socioeconomic context and staffing model.

Study Objective: Methicillin-resistant Staphylococcus aureus (MRSA) transmission dynamics in the emergency department (ED) are not well defined; environmental surfaces may serve as reservoirs for transmission. This study investigates the effect of patients with a history of MRSA colonization or infection on subsequent MRSA contamination of the ED environment., Methods: Adult ED patients with evidence of an MRSA-positive surveillance result or clinical microbiologic culture in the year preceding their current ED visit were enrolled. Cultures from 5 anatomic sites were obtained to detect active MRSA colonization. After patients' discharge and before environmental disinfection, up to 16 prespecified surfaces in their ED rooms were cultured. Strain typing was performed by repetitive-sequence polymerase chain reaction on all recovered MRSA isolates to determine concordance with the corresponding patient strain., Results: Of 42 patients enrolled, 25 (60%) remained colonized with MRSA. Nineteen of the 25 ED rooms (76%) occupied by MRSA-colonized patients contained greater than or equal to 1 MRSA-contaminated environmental surface on patient discharge. Surfaces were more likely to be contaminated when rooms were occupied by patients colonized with MRSA at 1 body site (odds ratio 11.7; 95% confidence interval 1.5 to 91.5) and greater than or equal to 2 body sites (odds ratio 16.3; 95% confidence interval 3.1 to 86.8) compared with noncolonized patients. In 16 of the 19 ED rooms (84%) where MRSA was recovered, all environmental strains were concordant with the corresponding patient strain., Conclusion: Contamination of the ED environment with MRSA from actively colonized patients is common. Improved environmental surface disinfection may help reduce transmission of MRSA to ED health care professionals and patients during emergency care., (Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Background: The mechanism of how work environments affect nurse outcomes and quality of care has not been studied in intensive care unit (ICU) settings., Purpose: The purpose was to investigate the effects of work environment on nurse outcomes and quality of care in ICUs, through the mediating effects of nursing care left undone., Methods: This study used survey data from 459 nurses from 22 ICUs in 22 hospitals in China. Hierarchical logistic regression modeling was used to analyze the relationships and the mediating effects., Results: Positive work environments were associated with lower nurse job dissatisfaction, less burnout, higher quality of care, and safer care. Adding nursing care left undone could reduce the effects of work environments, showing partial mediating effects of nursing care left undone., Conclusions: Cultivating supportive work environments serves as a strategy to reduce nursing care left undone, and to improve nurse outcomes and quality of care in ICUs.

Introduction: Health professionals and institutions need to understand how to facilitate family involvement within settings designed prior to the adoption of patient- and family-centered philosophies. This study sought to explore how the physical environment of an inpatient rehabilitation setting influenced family involvement in health care delivery., Method: We conducted this study on the inpatient acquired brain injury ward of a Canadian adult rehabilitation center. This study used a basic interpretive qualitative approach. We conducted observations of how the physical environment influenced the conversations, interactions, and activities, which were central to family involvement, in this setting. We used a systematic qualitative analysis method. This study received research ethics board approval prior to commencing., Results: We conducted 26 2-hr observation sessions. Five sessions occurred in the morning, 17 in early and late afternoon, and 4 in the evening. Eighteen sessions occurred on a weekday and 8 on a weekend day. The following 6 categories emerged from the field data: (a) accessing health professionals, (b) awareness of family presence, (c) facilitating family presence, (d) facilitating patient-family activities, (e) providing information for families, and (f) facilitating family involvement in therapy., Discussion: This study provided information to inform future discussions and strategies for facilitating family involvement within the existing physical environments of health care institutions. Initial steps should consider ways to help families feel welcomed, such as including additional seating in spaces, posting signage inviting families into spaces, having resources tailored to families readily available, and creating a visible sign-in/sign-out board for families. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Background: Research in criminology and social-psychology supports the idea that visible signs of disorder, both physical and social, may perpetuate further disorder, leading to neighborhood incivilities, petty violations, and potentially criminal behavior. This theory of 'broken windows' has now also been applied to more enclosed environments, such as organizations., Main Text: This paper debates whether the premise of broken windows theory, and the concept of 'disorder', might also have utility in the context of health services. There is already a body of work on system migration, which suggests a role for violations and workarounds in normalizing unwarranted deviations from safe practices in healthcare organizations. Studies of visible disorder may be needed in healthcare, where the risks of norm violations and disorderly environments, and potential for harm to patients, are considerable. Everyday adjustments and flexibility is mostly beneficial, but in this paper, we ask: how might deviations from the norm escalate from necessary workarounds to risky violations in care settings? Does physical or social disorder in healthcare contexts perpetuate further disorder, leading to downstream effects, including increased risk of harm to patients?, Conclusions: We advance a model of broken windows in healthcare, and a proposal to study this phenomenon.

Background: Reality shock is a critical representation of the gap between nursing education and clinical practice and it is important to explore the level of reality shock among nurses. However, there is no relevant instrument to assess the level of reality shock in South Korea., Objectives: The purpose of this is to determine the validity and reliability of the Korean version of the Environmental Reality Shock-Related Issues and Concerns instrument., Design: A cross-sectional study design was used in this study., Settings: The data collection was conducted in selected 15 hospitals in South Korea., Participants: A convenience sample of 216 newly graduated nurses participated in the study., Methods: The Korean version of the Environmental Reality Shock-Related Issues and Concerns instrument was developed through the forward-backward translation technique, and revision based on feedback from expert groups. The internal consistency reliability was assessed using Cronbach's alpha, and the construct validity was determined via exploratory and confirmatory factor analysis., Results: The Korean version of the Environmental Reality Shock-Related Issues and Concerns has reliable internal consistency (Cronbach's alpha=0.91). Exploratory factor analysis revealed five factors including job, relationships, expectations, private life, and performance, which explained 61.92% of variance. The factor loadings ranged from 0.451 to 0.832. The five-factor structure was validated by confirmatory factor analysis (RMR<0.05, CFI>0.9)., Conclusion: It was concluded that the Korean version of the Environmental Reality Shock-Related Issues and Concerns instrument has satisfactory construct validity and reliability to measure the reality shock of newly graduated nurses in South Korea., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This project describes a multifaceted noise reduction program on 2 hospital units designed to ensure a quiet hospital environment, with the goal of improving the patient experience. The noise committee in an urban city hospital developed a plan to control noise including scripted leadership rounding, staff education, a nighttime sleep promotion cart, and visual aids to remind staff to be quiet. Postintervention improvement in patient satisfaction scores was noted.

Purpose: To examine the relationship between environmental ambience and psychological well-being of persons with dementia., Design: A secondary analysis was conducted using observational data with repeated measures. A total of 1,857 observations from 177 persons with dementia in 17 nursing homes and 6 assisted living facilities were included., Methods: Psychological well-being was measured by observed displays of positive and negative emotional expressions. The environmental ambience was assessed by two subscales of the Ambiance Scale: Engaging and Soothing. Multilevel modeling was used to account for hierarchical structures in the data., Findings: An engaging environment was associated with more positive emotional expressions after controlling for covariates. However, a soothing environment was associated with neither positive nor negative emotional expressions., Conclusions: Results suggest that the environment is an important consideration for administrators and clinicians as they respond to the mandate to actively plan and provide care to persons with dementia., Clinical Relevance: An environment that is relevant and interesting may promote a sense of well-being and support resident-centered care., (© 2016 Sigma Theta Tau International.)

The inpatient environment is a critical space for nurses and patients in psychiatric settings. In this article, we describe nurses' and patients' perceptions of the inpatient environment both before the removal of a Plexiglas enclosure around a nurses' station and after its removal. Nurses had mixed feelings about the enclosure, reporting that it provided for confidentiality and a concentrated work space but also acknowledged the challenge of the barrier for communication with their patients. Patients unanimously preferred the nurses' station without the barrier, reporting increased feelings of freedom, safety, and connection with the nurses after its removal. It is important to consider the implications of environmental decisions in inpatient settings in order to promote a healthy workplace and healing environment for all community members., (© The Author(s) 2015.)

Background: Falls in hospital account for almost two-fifths of the patient safety incidents reported to the National Reporting and Learning System in U.K. Studies have suggested an increased incidence of falls in single-bedded hospitals., Objective: To compare the outcome of in-patient falls occurring in units with 100% single rooms (SRs) and multi-bedded wards (M-BWs). SAMPLING DESIGN AND METHODS: An observational study. Retrospective standard incident reporting data (DATIX) on in-patient falls and associated injury were obtained from both sites over 18 months each. There was no change in demographics, size and characteristics of population except change in the geography of new hospitals., Results: The total number of in-patient fall incidents reported over the 3 years was 1,749. The mean age of patients on M-BW and SR sites was 81.0 ± 2.4 (51.3% females) and 80.3 ± 10.3 (50.7% females), respectively. The mean incidence of falls/1,000 patient-bed days on M-BW and SR sites was 5.44 ± 4.76 and 15.82 ± 19.56, respectively (P < 0.01). Overall fracture incidence/1,000 patient-bed days on M-BW and SR sites was 0.07 ± 0.48 and 0.36 ± 1.52 (P < 0.01), respectively. The hip fracture incidence/1,000 patient-bed days on M-BW and SR sites was 0.04 ± 0.38 and 0.15 ± 1.00 (P < 0.01), respectively. One-year mortality from the date of first incident fall was lower in M-BWs (41.1%) compared with SRs (47.1%), but this is not significant (P = 0.12)., Conclusion: This observational study shows a significantly increased incidence of falls and fracture in a hospital design with SRs compared with a multi-bedded facility. Consideration should be given to increased incidence of falls and falls-related injury in SRs when deciding on the percentage of single-room provision in new hospitals to admit frail older adults., (© The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: The benefits of quiet time, a therapeutic method of improving the health care environment, have been evaluated in patients, but only a few studies have examined the effects of quiet time on intensive care nurses., Objective: To evaluate the effects of implementing quiet time in a medical-surgical intensive care unit on levels of light, noise, and nurses' stress., Methods: Quiet time consisted of turning down the unit lights for a designated time. Levels of light, noise, and nurses' stress were measured. Nurses' stress levels were measured by using a 100-point visual analog scale; unit noise, by using a digital sound level meter (model 407736, Extech Instruments); and unit light, by using an illumination light meter (model 615, Huygen Corporation). Measurements were obtained 30 minutes before and 30 minutes, 1 hour, and 2 hours after implementation of quiet time., Results: Analysis of variance and comparisons of means indicated that both light levels and nurses' stress levels were significantly decreased after quiet time (both P < .001). Noise levels were also decreased after quiet time, but the decrease was not significant (P = .08)., Conclusions: Use of quiet time resulted in decreased light levels and decreased stress levels among nurses. Quiet time is an easily performed energy-saving intervention to promote a healthy work environment., (©2015 American Association of Critical-Care Nurses.)

Objective: This exploratory study describes space allocation among different generic categories of functions in adult intensive care units (ICUs) showing how the amount of space of any one functional category is related to that of another functional category, and how different strategic choices, such as size, construction type, specialty type, and layout type, affect space allocation in these ICUs., Background: Even though critical care practice has already undergone significant changes in the last few decades, it is still an evolving domain of medical practice. As a result, ICU design is also evolving as new regulatory standards, new technologies, and new clinical models are being introduced. A good understanding of the above issues regarding space allocation may help us better guide the evolution of ICU design., Methods: The study includes a set of 25 adult ICUs that were recognized between 1993 and 2012 by the Society of Critical Care Medicine (SCCM), the American Association of Critical Care Nurses (AACCN), and the American Institute of Architects Academy of Architecture for Health (AIA AAH) for their efforts to promote healing of the critically ill and injured patients through the design of the critical care unit environment., Results: The study finds notable differences in space allocation among different generic categories of functions between the ICUs of the first decade (1993-2002) and the second decade (2003-2012). The study also finds notable differences in space allocation among different generic categories of functions in relation to size, construction type, specialty type, and layout type., Conclusions: Despite several limitations, the study should help design better adult ICUs based on an evidence-based understanding of the relationships between space allocation and strategic choices., Keywords: Construction, critical care/intensive care, evidence-based design, planning, project management.

Objective: This study aimed to establish the potential for significant energy reduction in hospitals in the United States by providing evidence of Scandinavian operational precedents with high Interior Environmental Quality (IEQ) and substantially lower energy profiles than comparable U.S. facilities. These facilities set important precedents for design teams seeking operational examples for achieving aggressive energy and interior environmental quality goals. This examination of operational hospitals is intended to offer hospital owners, designers, and building managers a strong case and concrete framework for strategies to achieve exceptionally high performing buildings., Background: Energy efficient hospitals have the potential to significantly impact the U.S.'s overall energy profile, and key stakeholders in the hospital industry need specific, operationally grounded precedents in order to successfully implement informed energy reduction strategies. This study is an outgrowth of previous research evaluating high quality, low energy hospitals that serve as examples for new high performance hospital design, construction, and operation. Through extensive interviews, numerous site visits, the development of case studies, and data collection, this team has established thorough qualitative and quantitative analyses of several contemporary hospitals in Scandinavia and the Pacific Northwest. Many Scandinavian hospitals demonstrate a low energy profile, and when analyzed in comparison with U.S. hospitals, such Scandinavian precedents help define the framework required to make significant changes in the U.S. hospital building industry., Methods: Eight hospitals, four Scandinavian and four Pacific Northwest, were quantitatively compared using the Environmental Protection Agency's Portfolio Manager, allowing researchers to answer specific questions about the impact of energy source and architectural and mechanical strategies on energy efficiency in operational hospitals., Results: Specific architectural, mechanical, and plant systems make these Scandinavian hospitals more energy efficient than their Pacific Northwest counterparts. More importantly, synergistic systems integration allows for their significant reductions in energy consumption., Conclusions: This quantitative comparison of operational Scandinavian and Pacific Northwest hospitals resulted in compelling evidence of the potential for deep energy savings in the U.S., and allowed researchers to outline specific strategies for achieving such reductions., (© 2014 Vendome Group, LLC.)

Objective: To describe the current state of design characteristics of acute care units in China's public hospitals and compare these with characteristics with acute care units in the United States., Background: The healthcare construction industry in China is one of the fastest growing sectors in China and, arguably, in the world. Understanding the physical design of acute care units in China is of great importance because it will influence a large population., Methods: Descriptive study was performed of unit configuration, size, patient visibility, distance to nursing station and supplies, and lighting conditions in 25 units in 19 public hospitals built after 2003. Data and information were collected based on spatial and visibility analysis., Results: The study identified major design characteristics of the recently built (from 2003 onward) acute care units in China, comparing them, where appropriate, with those in U.S. It found there are three dominant types of unit layout: single-corridor (52%), triangular (36%), and double-corridor (12%). The number of private rooms is very low (11%), compared with two- or three-bed rooms. Centralized nursing stations are the only type of nurses' working area. China also has a large unit size in terms of number of patient beds. The average number of patient beds in a unit is 40.6 in China (versus 32.9 in U.S.). The care units in China have longer walking distance from nursing station to patient bedside. The percentage of beds visible from a nursing station is lower in China than in the U.S. The access to natural light and direct sunlight in patient rooms is greater in China compared with those in U.S.-100% of patient rooms in China have natural lighting. A majority of them face south or southeast and thus receiving direct sunlight (91.4%)., Conclusions: Because of the differences in economies and building codes, there are dramatic differences between the spatial characteristics of acute care units in China and the United States., (© 2014 Vendome Group, LLC.)

Introduction: Several policy and cultural factors still hinder the development of ambulatory surgery (AS) in France. Our surgery unit developed a day-surgery approach with extension of a non-medicalized post-operative stay in a hotel-like structure within the hospital, called an "ambulotel". The present study aims to evaluate the potential of this approach in increasing the possibilities of ambulatory surgery by comparing our stays to those of a nationwide database., Patients and Methods: We matched 66 patients according to seven criteria in our one-day ambulotel program to the 2011 DRG national database and then compared their characteristics., Results: Of the 10,428 patients in the database with one-night stays in a traditional surgery unit, more than half (52%) would probably have been eligible for ambulatory surgery with a potential theoretical savings estimated at €12,806,568., Conclusion: This estimated amount of savings represents a major medical and economic issue. The savings could contribute to increased ambulatory surgery activity in France by creating new dedicated Ambulatory Units, pooling conventional beds, or using night accommodation in non-hospital nursing homes, for example., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objectives: We conducted health literacy environmental scans in 26 Maryland community-based dental clinics to identify institutional characteristics and provider practices that affect dental services access and dental caries education., Methods: In 2011-2012 we assessed user friendliness of the clinics including accessibility, signage, facility navigation, educational materials, and patient forms. We interviewed patients and surveyed dental providers about their knowledge and use of communication techniques., Results: Of 32 clinics, 26 participated. Implementation of the health literacy environmental scan tools was acceptable to the dental directors and provided clinic directors with information to enhance care and outreach. We found considerable variation among clinic facilities, operations, and content of educational materials. There was less variation in types of insurance accepted, no-show rates, methods of communicating with patients, and electronic health records use. Providers who had taken a communication skills course were more likely than those who had not to use recommended communication techniques., Conclusions: Our findings provide insight into the use of health literacy environmental scan tools to identify clinic and provider characteristics and practices that can be used to make dental environments more user friendly and health literate.

Introduction: The aim of the dissertation was to com- pare the psychophysical state of people over 50 years of age from different societies., Material and Methods: The first group consisted of 30 care home residents, the second group consisted of 30 participants of Active Senior Fair. In the research, two scales were applied: Mini-Mental State Examination, measuring the mental state, and Instrumental Activity of Daily Living, measuring agility in the field of complex everyday tasks. CONCLUSIONA: The study indicates the difference in the psychophysical state of both researched groups. The results may be connected with both age difference between groups and different living environment.

Background: Critically ill patients are susceptible to health care-associated infections because of their illnesses and the need for intravenous access and invasive monitoring. The critical care work environment may influence the likelihood of infection in these patients., Objective: To determine whether or not the critical care nurse work environment is predictive of nurse-reported health care-associated infections., Methods: A retrospective, cross-sectional design was used with linked nurse and hospital survey data. Nurses assessed the critical care work environment and provided the frequencies of ventilator-associated pneumonias, urinary tract infections, and infections associated with central catheters. Logistic regression models were used to determine if critical care work environments were predictive of nurse-reported frequent health care-associated infections, with controls for nurse and hospital characteristics. Results The final sample consisted of 3217 critical care nurses in 320 hospitals. Compared with nurses working in poor work environments, nurses working in better work environments were 36% to 41% less likely to report that health care-associated infections occurred frequently., Conclusion: Health care-associated infections are less likely in favorable critical care work environments. These findings, based on the largest sample of critical care nurses to date, substantiate efforts to focus on the quality of the work environment as a way to minimize the frequency of health care-associated infections.

Study Objective: Few investigations have been performed that address why emergency department (ED) crowding is associated with an increase in hospital mortality for emergency patients. The purpose of this study was to evaluate whether ED crowding is associated with delayed resuscitation efforts (DREs) that resulted in hospital mortality., Methods: This is a retrospective observational study performed at a single urban tertiary ED. All adult patients who entered the resuscitation room and underwent resuscitative procedures from October 2008 to May 2010 were enrolled in the study. Demographic data were collected from a designed resuscitation room registry. The ED electronic log data were used for calculating the crowding status. A crowded day was defined as a daily number of patients greater than 93, which was a cut-off derived from a sensitivity analysis. The primary outcome was a DRE, which occurred when a patient was located in the hallway or waiting room, then entered the resuscitation room, and received resuscitative procedures after the patient had clinically deteriorated. A secondary outcome was hospital mortality. Matched samples were selected using propensity scores to consider the clinical parameters and emergency severity index when the patients received triage immediately after registration. A logistic regression analysis was modeled to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) on the DRE., Results: A total of 1296 patients underwent resuscitative procedures in the resuscitation room. Of these, 226 (17.4%) were classified as the DRE group. A final 396 cases (30.6%) were matched and analyzed between DRE and non-DRE using the propensity score. The incidence of DRE was significantly higher on crowded days (OR, 2.00; 95% CI, 1.28-3.15). Mortality during the ED stay or during the total hospital stay was significantly higher in the DRE group (OR, 3.39; 95% CI, 1.22-9.45 and OR, 3.96; 95% CI, 2.28-6.88, respectively) compared with the non-DRE group., Conclusion: Delays in resuscitation efforts occurred more frequently on crowded days and were associated with higher in-hospital mortality., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: The physical environment is presumed to have an effect on aggression and also on the use of seclusion on psychiatric wards. Multicentre studies that include a broad variety of design features found on psychiatric wards and that control for patient, staff and general ward characteristics are scarce., Aims: To explore the effect of design features on the risk of being secluded, the number of seclusion incidents and the time in seclusion, for patients admitted to locked wards for intensive psychiatric care., Method: Data on the building quality and safety of psychiatric as well as forensic wards (n = 199) were combined with data on the frequency and type of coercive measures per admission (n = 23 868 admissions of n = 14 834 patients) on these wards, over a 12-month period. We used non-linear principal components analysis (CATPCA) to reduce the observed design features into a smaller number of uncorrelated principal components. Two-level multilevel (logistic) regression analyses were used to explore the relationship with seclusion. Admission was the first level in the analyses and ward was the second level., Results: Overall, 14 design features had a significant effect on the risk of being secluded during admission. The 'presence of an outdoor space', 'special safety measures' and a large 'number of patients in the building' increased the risk of being secluded. Design features such as more 'total private space per patient', a higher 'level of comfort' and greater 'visibility on the ward', decreased the risk of being secluded., Conclusions: A number of design features had an effect on the use of seclusion and restraint. The study highlighted the need for a greater focus on the impact of the physical environment on patients, as, along with other interventions, this can reduce the need for seclusion and restraint.

Objective: Falls in inpatient psychiatric units are more frequent than in other age-matched unit types. We set out to explore factors associated with falls in inpatient units in a large metropolitan mental health service., Method: Contributory factors, location, activity and outcomes were identified for 559 falls. Overall falls rates were also calculated., Results: Falls rate was 1.25 per 1000 occupied bed days, with highest rates in psychogeriatric units. Almost 50% of falls were related to physiological factors, with balance or mobility difficulties accounting for 19% of all falls. Falls most frequently occurred in bedrooms, outdoor areas, corridors and bathrooms. The most common activity at the time of the fall was walking (41%) and transfers were associated with 17% of falls. Outcomes were evenly spread between no outcome and minor to moderate injury. No severe injuries were reported., Conclusions: Although falls may have been under-reported, this study establishes an analysis framework and baseline data for the monitoring of falls in inpatient psychiatric units in Australia.

Use of mammograms to detect presence of breast cancer is influenced by many factors, including ability to access mammography services. Access to services is often affected by the capacity of mammography facilities to serve women. We sought to describe the capacity of mammography facilities to conduct mammograms in a largely urban area of Texas. We used a 24-item survey to all mammography facilities in Texas Public Health Region 6/5 South. The survey contained questions across six domains: facility type, scheduling, staffing, mechanical capacity, cost/payment methods, and patient reminders. We received or completed 60 surveys (43%). Most of the facilities were open only Monday through Friday (61.7%) and were open only during typical business hours (51.7%). About 83% of the facilities had one or two machines. Most facilities had only one or two staff to conduct mammograms. The results of this survey indicate that the capacity of mammography facilities vary dramatically across many characteristics of capacity. As these indicators are tied to the ability of women to access necessary preventive services, it is important to determine how these characteristics are associated with mammography utilization.

Objective: To evaluate the compliance of hospital staff, inpatients and visitors with Sydney South West Area Health Service's Smoke-free Environment Policy., Methods: Six sites were observed at two Sydney hospitals 2 weeks before implementation of the policy and at 2 weeks, 6 months, 12 months, 18 months and 2 years after implementation., Results: There was an overall significant 36% (P≤0.05) reduction in observed smoking incidents on hospital grounds 2 years after implementation. Two years after implementation, observed smoking incidents reduced by 44% (P≤0.05) in staff, 37% (P≤0.05) in visitors and remained unchanged among inpatients., Conclusions and Implications: The Smoke-free Environment Policy was effective in reducing visitors and staff observed smoking on hospital grounds, but had little effect on inpatients' smoking. Identifying strategies to effectively manage nicotine addiction and promote cessation amongst hospital inpatients remains a key priority.

The objectives of the study were to assess sound pressure level (SPL) in two rooms of a Neonatal Intensive Care Unit (NICU) and to identify their sources. This quantitative-descriptive study was conducted in two rooms of a NICU of a University Hospital in São Paulo, Brazil. Three dosimeters were used to register SPL (total of 261 hours). A 48-hour register of noise sources was obtained. The results showed high SPL in both rooms. The greatest mean Leq were 71.0 dBA (room A) and 68.0 dBA (room B). Main noise sources in both units were: NICU hallway noise, traffic and conversation among professionals. The results indicate that SPLs in NICU rooms are higher than the levels recommended by regulatory agencies. A guideline was developed and an educational program was implemented as a means to reduce sound pressure levels.

Purpose: To create a thermal map of ambient air, radiant, and evaporative temperatures and humidity throughout the NICU nursery by season across a calendar year., Subjects: Each cubicle of the 32-bed NICU, distributed across 5 rooms, in a level III nursery was measured., Methods: Temperatures were recorded at a consistent time on one day during January, April, July, and October., Main Outcome Measures: : An electronic monitor (QUESTemp ° 34; Quest Technologies, Oconomowoc, Wisconsin) was used to measure dry bulb, wet bulb, and globe thermometer temperatures., Results: Analysis of variance revealed statistically significant (P ≤ .000) differences in season, room, and season by room interaction. Room ambient air temperatures differed by less than 2 ° F across season. Radiant temperature paralleled air temperature. Humidity, the predominant difference across season, produced evaporative temperatures considerably lower than room air temperature, and the gradient between mean nursery dry bulb temperature and wet bulb temperature was 9.3 ° F in summer and 16.8 ° F in winter., Conclusions: The thermal map revealed seasonal thermal differences, particularly in humidity level and evaporative temperature. Room temperature alone does not reflect the total thermal environment. Recommendations include periodic assessment of nurseries along with air, evaporative, and radiant temperatures as well as humidity to fully appreciate the impact of the thermal environment on infants.

Background/rationale: Guided by the need-driven dementia-compromised behavior (NDB) model, this study examined influences of the physical environment on wandering behavior., Methods: Using a descriptive, cross-sectional design, 122 wanderers from 28 long-term care (LTC) facilities were videotaped 10 to 12 times; data on wandering, light, sound, temperature and humidity levels, location, ambiance, and crowding were obtained. Associations between environmental variables and wandering were evaluated with chi-square and t tests; the model was evaluated using logistic regression., Results: In all, 80% of wandering occurred in the resident's own room, dayrooms, hallways, or dining rooms. When observed in other residents' rooms, hallways, shower/baths, or off-unit locations, wanderers were likely (60%-92% of observations) to wander. The data were a good fit to the model overall (LR [logistic regression] chi(2) (5) = 50.38, P < .0001) and by wandering type., Conclusions: Location, light, sound, proximity of others, and ambiance are associated with wandering and may serve to inform environmental designs and care practices.

Background: The potential for staff exposure to antineoplastic agents exists in the workplace despite current recommended safe handling procedures. Reliance on cytotoxic drug safety cabinets (CDSC) to provide total protection from exposure to hazardous drugs is insufficient. Preventing workplace contamination is the best strategy to minimise exposure. PhaSeal is a commercially available system for ensuring the leak-free transfer of hazardous drugs, fitting both the NIOSH and ISOPP definitions of a closed system. To date, there have been no published studies examining the use of a closed system drug transfer device (PhaSeal) under Australian conditions.The purpose of this study is to determine the impact of a closed system drug transfer device on cytotoxic surface contamination in the cytotoxic preparation areas of two Australian metropolitan public hospitals., Method: This was a pre- and post-intervention study in which chemical contamination was tested at baseline then at five and 12 months after the introduction of the a closed system drug transfer device. Cyclophosphamide was used as a surrogate marker for all cytotoxic drugs. Surface wipe sampling was performed at specified sites within the cytotoxic suite using a standardized technique. Commercial products of cyclophosphamide were also sampled., Results: After five months, contamination was reduced in 13 of the 22 sites sampled (59%), with four of these samples showing undetectable levels of contamination. Two other site samples (9%) remained unchanged. The total contamination of surfaces tested was reduced by 24%. After five months hospital 1 withdrew from the study. After 12 months, surface contamination was reduced in 75% of sample sites. The total contamination of surfaces tested was reduced by 68%. The wipes of the external surface of commercial products detected cyclophosphamide contamination., Conclusion: When used inside a CDSC, the closed system drug transfer device PhaSeal further reduces surface contamination, in some instances to undetectable levels.

Introduction: Elective colorectal resection is associated with a postoperative stay (LOS) of 7-10 days. Counties Manukau District Health Board (DHB) has two sites for elective colorectal surgery: Manukau Surgery Centre (MSC)-a stand-alone elective surgical site; and Middlemore Hospital (MMH)-a general hospital. MSC opened in 2001 and it was noted that patients recovered more quickly there than patients operated on at MMH. It was thus our aim to identify if LOS following major elective colorectal surgery is influenced by hospital environment., Methods: 294 consecutive patients undergoing elective colorectal resection between January 2002 and October 2005 at the two facilities were analysed. Confounding factors (age, gender, race, duration of surgery, ASA grade, colonic vs rectal surgery, stoma/no stoma) were identified and corrected for using a multivariate Poisson log-linear regression model., Results: Patients who underwent surgery (colonic=227, rectal=67) at MMH (n=210, median length of stay 11 days) had a LOS 1.52 times longer (95%CI 1.28-1.81) than those who had their surgery at MSC (n=84, median length of stay 7 days). This figure was corrected for all other variables (p<0.0001)., Conclusion: Because MSC and MMH are both part of the same DHB, share the same surgeons, and service an identical population, it can be concluded that environmental differences are likely to be influential in the recovery process. However, further research is required to elucidate the significance of individual factors.

Nurses are at considerable risk for work-related violence. This study compared the experiences of work-related violence among registered nurses (RNs) and licensed practical nurses (LPNs) to quantify differences in risks and exposures and to gain insight into possible interventions. A random sample (n = 6,300) of licensed Minnesota nurses was surveyed regarding the previous 12-month period. Nurses self-reported violent events and demographic information. After adjustment for potential confounders and nonresponse, LPNs had an increased risk for both physical assault (odds ratio = 1.4; 95% confidence interval = 1.1-1.9) and nonphysical violence (odds ratio = 1.2; 95% confidence interval = 1.0-1.5) compared to RNs. Some exposures resulted in increased risks for both types of violence for RNs and LPNs: working primarily in psychiatric departments and long-term care facilities. In contrast, working in clinics resulted in decreased risks for both license types. Some risks varied by license type. Risk of physical assault was increased for LPNs working with neonatal/pediatric patients, whereas RNs' risk was decreased. RNs' risk of physical violence increased while providing care, whereas LPNs' risk increased while supervising care. A better understanding of how this problem varies by license type and work setting will assist in designing efficacious interventions.

The National Childbirth Trust wants all women to be able to give birth with confidence and dignity, and believes it is important for women to begin motherhood feeling fit and well, good about themselves, and valued and supported by others. Good health and positive experiences can act as a buffer against the tiredness and demands of looking after a new baby. This paper draws on surveys conducted in 2003 and 2005 to describe what women want and need from birth environments, and how these factors can help or hinder them in having the kind of birth experience they desire.

Objective: To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors., Design: Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses., Setting: All licensed LTC facilities in Ontario with designated medical directors., Participants: Medical directors in the facilities., Main Outcome Measures: Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received., Results: Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff's capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%)., Conclusion: Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care.

Objective: To determine time and staffing requirements as they relate to laboratory personnel in the field of assisted reproductive technology (ART)., Design: Descriptive study., Setting: Assisted reproductive technology clinics in the United States., Personnel: All personnel working in ART laboratories, which included laboratory directors and technicians (those laboratory personnel trained in specific areas of embryology, andrology, and endocrinology)., Intervention(s): None., Main Outcome Measures(s): Frequencies were determined for time and staffing requirements as they pertained to individuals and procedures (e.g., oocyte retrieval, embryo transfer, semen analysis, hormone assay, etc.) performed in embryology, andrology, and endocrine laboratories., Result(s): Two different surveys of ART clinics in the United States were combined in this report. The average technician worked 40 hours a week, whereas the average laboratory director worked 49 hours per week. The average embryologist performed 181 procedures (not cases) per year. The average andrologist performed 648 procedures (not cases) per year, while the average endocrinologist completed 2,673 procedures (not cases) per year., Conclusion(s): This is the first report to describe time and staffing requirements as they relate to the laboratory personnel in an ART facility.

Objective: To identify the nature, severity, impact, frequency and risk factors for patient perceived privacy infringements in the ED of St Vincent's Health Melbourne with 32,000 emergency attendances per annum., Methods: Patients 18 years and older attending emergency over a 2-week period were offered a nine-item questionnaire using a Likert scale. A privacy incident was defined as: (i) overhearing medical or personal information; (ii) being overheard; (iii) having private body parts exposed or (iv) seeing others' body parts. Differences between demographic, emergency environment, length of stay and other factors suspected of affecting patient privacy were quantified., Results: From 1169 emergency presentations, 235 patients returned questionnaires, with 105 of these (45%) reporting a total of 159 privacy incidents. Seventy-eight patients (33%, 95% CI 28-36%) reported a definite privacy incident and 81 (35%, 95% CI 29-37%) reported a probable privacy incident. Ninety-six patients (41%, 95% CI 35-47%) reported overhearing other patient's conversations with the staff whereas 36 (15%, 95% CI 11-21%) felt their conversations with staff were overheard by others. Twenty-seven patients (11%, 95% CI 6-14%) experienced or observed inappropriate exposure of private body parts. Ten patients (4%, 95% CI 2-7%) changed or withheld information from staff because they felt others may overhear it and two refused part of their physical examination because they felt they may be seen by inappropriate people. Twenty-four patients (10%, 95% CI 6-14%) did not have their expectations of privacy met. The longer a patient was in emergency the greater the number of privacy incidents they experienced (Spearman correlation P < 0.01). Patients in walled cubicles experienced fewer privacy incidents than those in curtained cubicles (P < 0.05)., Conclusions: Patient privacy incidents occur frequently in an ED, risk factors being length of stay and absence of a walled cubicle. Patients who have their conversations overheard are more likely to withhold information from staff and less likely to have had their expectations of privacy met.

Background and Method: Suicide research has identified regional and local clusters of increased suicide prevalence. As part of a comprehensive prevention strategy to fight railway suicides, we sought to identify such particular clusters on the German Railway net (total length 37,080 km) during a 6-year observation period (1997-2002). Data stem from the central registry of all person accidents on the German Railway net., Results: During the observation period, a total of 5,731 suicides (in average 18 cases per week) were registered. Against expectation derived from distribution patterns in the general suicide research, we found a preponderance in the southern part compared to the northern part of Germany and a significant downward trend from west to east ( p=0.004). Most suicides occurred on open track (66%) compared to suicides at railway platforms (34%). We identified 16 places of high risk with 6 to 29 suicides per railway km. Of these high risk places, 75% were in the proximity of psychiatric hospitals., Conclusion: Increased awareness for regional and local suicide clusters, initiatives to reduce the accessibility and warning infra-red beams are among recommendations for suicide prevention derived from these data.

Purpose: We systematically measured the associations between environmental design features of nursing home special care units and the incidence of aggression, agitation, social withdrawal, depression, and psychotic problems among persons living there who have Alzheimer's disease or a related disorder., Design and Methods: We developed and tested a model of critical health-related environmental design features in settings for people with Alzheimer's disease. We used hierarchical linear modeling statistical techniques to assess associations between seven environmental design features and behavioral health measures for 427 residents in 15 special care units. Behavioral health measures included the Cohen-Mansfield physical agitation, verbal agitation, and aggressive behavior scales, the Multidimensional Observation Scale for Elderly Subjects depression and social withdrawal scales, and BEHAVE-AD (psychotic symptom list) misidentification and paranoid delusions scales. Statistical controls were included for the influence of, among others, cognitive status, need for assistance with activities of daily living, prescription drug use, amount of Alzheimer's staff training, and staff-to-resident ratio. Although hierarchical linear modeling minimizes the risk of Type II-false positive-error, this exploratory study also pays special attention to avoiding Type I error-the failure to recognize possible relationships between behavioral health characteristics and independent variables., Results: We found associations between each behavioral health measure and particular environmental design features, as well as between behavioral health measures and both resident and nonenvironmental facility variables., Implications: This research demonstrates the potential that environment has for contributing to the improvement of Alzheimer's symptoms. A balanced combination of pharmacologic, behavioral, and environmental approaches is likely to be most effective in improving the health, behavior, and quality of life of people with Alzheimer's disease.

Purpose: Assisted living is an increasingly important residential setting for the frail elderly person. How often and why residents leave such facilities are important issues for consumers, for clinicians advising frail patients on their options for living arrangements, and for policymakers. This research investigated the impact of facility and individual characteristics on residents' departures from assisted living., Design and Methods: This research is based on data on 1,483 residents in a nationally representative sample of 278 assisted living facilities (ALFs). Analyses of these data from 1998 and 1999 especially focused on those residents who left a study ALF between baseline and follow-up data collection. Multinomial logit models were estimated to investigate the impact of facility and individual factors on residents' status at follow-up., Results: Over three quarters of those leaving their baseline ALF did so because they needed more care. The multivariate analyses indicated that poorer functional status and being married affected residents' relative odds of death before follow-up. Moving to another setting, other than a nursing home, was more likely for residents in for-profit ALFs. Functional status, cognitive status, and the presence of a full-time RN affected residents' odds of moving from an ALF to a nursing home., Implications: Both facility-level and individual-level factors affected residents' relative odds of leaving an ALF. The findings with the most potentially interesting policy implications are those concerning the factors that affected residents' relative likelihoods of entering a nursing home.

The present study revealed perception of forty-five patients and fifty nine family members selected from the outpatinet deptt. of a Psychiatric hospital. A semi-structured questionnaire was used. The issues like efficiency, punctuality, behaviour of doctors and other staff, waiting time, supply of draugs and diet and cleanliness of the hospital etc were enquired. More than ninety % of the patients and their escorts appreciated the services provided. Most of them (75-80%) was satisfied with supply of drugs, quality of diet, clinical care and cleanliness of the hospital. Measures for improvement were also suggested.

Radiographers process X-ray films using developer and fixer solutions that contain chemicals known to cause or exacerbate asthma. In a study in British Columbia, Canada, radiographers' personal exposures to glutaraldehyde (a constituent of the developer chemistry), acetic acid (a constituent of the fixer chemistry), and sulfur dioxide (a byproduct of sulfites, present in both developer and fixer solutions) were measured. Average full-shift exposures to glutaraldehyde, acetic acid, and sulfur dioxide were 0.0009 mg/m3, 0.09 mg/m3, and 0.08 mg/m3, respectively, all more than one order of magnitude lower than current occupational exposure limits. Local exhaust ventilation of the processing machines and use of silver recovery units lowered exposures, whereas the number of films processed per machine and the time spent near the machines increased exposures. Personnel in clinic facilities had higher exposures than those in hospitals. Private clinics were less likely to have local exhaust ventilation and silver recovery units. Their radiographers spent more time in the processor areas and processed more films per machine. Although exposures were low compared with exposure standards, there are good reasons to continue practices to minimize or eliminate exposures: glutaraldehyde and hydroquinone (present in the developer) are sensitizers; the levels at which health effects occur are not yet clearly established, but appear to be lower than current standards; and health effects resulting from the mixture of chemicals are not understood. Developments in digital imaging technology are making available options that do not involve wet-processing of photographic film and therefore could eliminate the use of developer and fixer chemicals altogether.

Objective: The purpose of this study was to identify the incidence of ED personnel victimization in Central Florida and examine its relationship to victims' reports of 3 factors: characteristics of the patient/perpetrator, characteristics of the personnel victimized, and characteristics of the ED environment., Methods: Data were collected anonymously in a mail survey using 37 items from Mahoney's Emergency Department Victimization Questionnaire (EDVQ) and a demographic questionnaire. Chi square, Spearman's rank correlation coefficient, and Pearson's product moment correlation were used to describe frequencies, incidence, and their relationships to the variables studied. A sample of 226 of the 600 direct care personnel (37%) from 18 of the 19 hospital emergency departments in a tri-county area (95%) participated., Results: The incidence of physical assault was reported to be 42% during the past year and 72% during the respondents' careers. Alcohol use was associated with incidence (1-tailed Pearson; P =.001). Verbal abuse was significantly higher on day shift (P =.043). The most desired environmental variable was 24-hour security attendants, available to 51.8% of the respondents. More than a fourth of the subjects reported that they had completed no coursework or had no continuing education in violence prevention., Discussion: Respondents reported avoiding identification on duty, underreporting, postvictimization staff turnover, dissatisfaction with security, and the desire for every security provision listed. The goals of reducing the fears and victimization of ED personnel should become a priority within the health care system.

High environmental and psychosocial stress contribute to the onset and relapse of major psychiatric disorders. High sound levels in general hospitals are common and may be indirectly associated with negative physical effects because of increased physiological stress on the body. Excessive sound also interferes with cognitive functioning, especially affecting prefrontal cortical processes, but no information about sound levels in psychiatric hospitals was available. This study critically examines literature on sound stress and reports findings from an exploratory study of sound levels in a tertiary care psychiatric hospital. An overall mean sound level of 75.68 dB was found, with peak sound levels as high as 85 to 90 dB, in the range that causes hearing loss. These levels, higher than sound levels on medical, surgical, and intensive care units, suggest the need for more attention to the effect that environmental sound has on the behavior of patients hospitalized with acute psychiatric symptoms.

Noise sources and levels were evaluated in a six-bed intensive care unit (ICU) in Athens, Greece. Ten patients (six males, four females) completed specifically designed questionnaires, and at the same time nine 8-h sound measuring sessions took place. A Bruel and Kjaer 2231 sound-meter was used on the decibel-A scale combined with observation. Human activity, operating equipment and construction engineering of the hospital building were identified as sources of noise. Noise levels were elevated [LEQ = 60.3-67.4 dB(A)]. No reliable information was obtained from the questionnaires. ICU noise levels were higher by 27 dB(A) than recommended hospitals levels. To counteract noise pollution in ICUs, staff awareness and sensitivity are needed.

The study covers 17 hospitals on the territory of the Capital Community, including their clinics, departments and rooms for treating of social significant and other diseases. The analysis reveals a number of negative aspects: inappropriate situation, insufficiency or lack of green areas, unfavourable aspect of the rooms, overcrowding, insufficient area of the windows, irrational heating regime, lack of ventilation regime, etc. Undesirable parameters of the microclimate are observed in the patients' rooms and this leads to discomfort to the patients and prolonging of the convalescent period. A study on a large scale for the town of Sofia is presented which aims at revision of the current building norms and requirements in respect of their correction and the improving the future building of hospitals in our country.

The present study was conducted on a sample of 6 hospitals in Jeddah to investigate the status of noise pollution there, and as related to community background noise, operational activities, hospital size and operational concepts (public vs private). Generally, the levels of noise in the clinics, patient rooms, offices, waiting areas and corridors significantly exceed the recommended standard. The noise levels in the machinery rooms significantly exceed the levels in offices, waiting areas and corridors which, in turn, significantly exceed the levels in clinics and patient rooms. Background community noise has a little impact on indoor noise due to the construction characteristics of the hospitals' buildings. However, "operational noise" from machinery and from the move of public (patients, attendants and employees) significantly contribute to indoor noise. Proper site location, city planning, traffic engineering, building construction, equipment selection, construction and equipment maintenance, and system management have been recommended for the abatement of hospital noise pollution.