The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.
Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
PLoS One. 2023 Jun 9;18(6):e0280690. doi: 10.1371/journal.pone.0280690. eCollection 2023.
Hospital design can impact patient outcomes, but there is very little healthcare design evidence specific to stroke rehabilitation facilities. Our aim was to explore, from the patient perspective, the role of the physical environment in factors crucial to stroke recovery, namely, stroke survivor activity (physical, cognitive, social), sleep, emotional well-being, and safety. We conducted a mixed-methods multiple-case study at two inpatient rehabilitation facilities in Victoria, Australia, (n = 20 at Case 1, n = 16 at Case 2) using "walk-through" semi-structured interviews, behavioural mapping, questionnaires, and retrospective audit. Four interrelated themes emerged: 1) entrapment and escape; 2) power, dependency, and identity in an institutional environment; 3) the rehabilitation facility is a shared space; and 4) the environment should be legible and patient-centred. Quantitative data revealed patterns in patient activity; stroke survivors spent over 75% of their time in bedrooms and were often inactive. Convergent mixed methods analysis was used to generate a new conceptual model of the role of the physical environment in stroke survivors' behaviour and well-being, highlighting the importance of variety and interest, privacy without isolation, and patient-centred design. This model can be used by designers, healthcare providers, and policy makers to inform the design of rehabilitation environments.
医院设计可以影响患者的治疗效果，但针对卒中康复设施的医疗保健设计证据却非常有限。我们的目的是从患者的角度探讨物理环境在与卒中康复相关的重要因素中的作用，这些因素包括卒中幸存者的活动（身体、认知、社交）、睡眠、情绪健康和安全。我们在澳大利亚维多利亚州的两家住院康复机构（案例 1 20 名患者，案例 2 16 名患者）进行了一项混合方法多案例研究，使用了“走查”半结构化访谈、行为映射、问卷调查和回顾性审计。结果得出了四个相互关联的主题：1）困在和逃脱；2）在机构环境中的权力、依赖和身份；3）康复设施是一个共享的空间；4）环境应该是清晰和以患者为中心的。定量数据揭示了患者活动的模式；卒中幸存者超过 75%的时间都在卧室里，且经常不活动。通过混合方法的收敛分析，生成了一个新的物理环境在卒中幸存者行为和幸福感中作用的概念模型，强调了多样性和趣味性、隐私而不孤立以及以患者为中心的设计的重要性。该模型可以为设计师、医疗保健提供者和政策制定者提供参考，以指导康复环境的设计。
