Högskolan i Skövde

Aim: The overall aim of this doctoral thesis was to examine and evaluate if and how an intensive care unit (ICU) room, which had been designed using the principles of evidence-based design (EBD), impacted the safety, wellbeing and caring for patients, their family members and staff.

Methods: Paper I explored the nursing staff experiences of working in an EBD intensive care patient room through 13 interviews that were analysed by qualitative content analysis. Paper II focussed on the meaning of caring and nursing activities performed in two patient rooms—one EBD refurbished and one standard. Ten non-participant observations were conducted, which were followed by interviews. The data were analysed using a phenomenological hermeneutical approach. Paper III evaluated the relationship between a refurbished intensive care room and adverse events (AE) in critically ill patients. A total of 1,938 patients’ records were included in the analysis. Descriptive statistics and binary logistic regressions were conducted. Paper IV studied visitors’ (N = 99) experiences of different healthcare environmental designs of intensive care patient rooms through questionnaires. Descriptive statistics and linear regressions were conducted for the analysis.

Main results: The refurbished intervention room was reported as a positive experience for the working nursing staff and the visiting family members. The nursing staff additionally indicated the intervention room strengthened their own wellbeing as well as their caring activities. Although there were no observed, objective differences regarding the caring and nursing activities due to the different environments, the differences were instead interpreted as being due to different developed nursing competencies. The visitors reported the enriched healthcare environment to have a higher everydayness and a feeling that it was a safer place compared to the control rooms. The findings revealed a low incident of AEs in both the intervention room as well as in the control rooms, lower than previous described in literature. The likelihood for adverse events were not significantly lower in the intervention room compared to the control rooms.

Conclusion: This dissertation contributed to the existing knowledge on how a refurbished patient room in the ICU was experienced by nursing staff and visiting family members. The dissertation also showed the complexity of conducting interventional research in high-tech environments. The new knowledge on the importance of the healthcare environment on wellbeing, safety and caring must be considered by stakeholders and decision-makers and implemented to reduce suffering and increase health and wellbeing among patients, their families and staff.