Anåker Anna, von Koch Lena, Sjöstrand Christina, Heylighen Ann, Elf Marie
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
J Adv Nurs. 2018 Apr 20. doi: 10.1111/jan.13690.
To explore and compare the impact of the physical environment on patients' activities and care at three newly built stroke units.
Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients' activities in relation to the design of the physical environment of stroke units are scarce.
This work is a comparative descriptive case study.
Patients (N = 55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioural mapping analysed with descriptive statistics and field note taking analysed with deductive content analysis. Data were collected from April 2013 - December 2015.
The units differed in the patients' levels of physical activity, the proportion of the day that patients spent with health professionals and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single-room design. Stroke units that were easy to navigate and offered variations in the physical environment had an impact on patients' activities and care.
Patients' activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment.
探讨并比较物理环境对三个新建卒中单元中患者活动及护理的影响。
在卒中单元而非普通病房接受护理可降低死亡、依赖和机构化护理的几率。在卒中单元中，物理环境的设计应支持循证护理。关于卒中单元物理环境设计与患者活动关系的研究较少。
本研究为比较性描述性案例研究。
从瑞典三个新建卒中单元招募确诊为卒中的患者（N = 55）。通过非参与观察对这些单元进行检查，采用两种数据收集方式：用描述性统计分析行为映射，用演绎性内容分析分析实地记录。数据收集时间为2013年4月至2015年12月。
各单元在患者身体活动水平、患者与医护人员相处的时间比例以及家属陪伴情况方面存在差异。与全单间设计的单元相比，单人间和多人间混合设计的单元中患者身体活动更频繁。易于通行且物理环境多样的卒中单元对患者的活动及护理有影响。
患者的活动水平和互动似乎因卒中单元物理环境的设计而异。侧重于健康状况评估、避免卧床休息和早期康复的卒中指南需要一个支持性的物理环境。
