OBJECTIVE: The aim of this research study is to collaboratively generate insights in the current institutional long-term care environment for activity and mobility of older adults, and of solutions that could be used to increase the activity and improve the mobility of the older adults.
METHODS: This research constitutes a qualitative study with a critical approach.
METHODS: Data were collected using photo-elicitation in four long-term care units in Finland during the spring of 2022. Older adults participated in individual data collection sessions which combined photographing and discussion. Staff members individually took photographs and later participated in a group discussion based on the photographs. Reflexive thematic analysis was used to analyse all data together.
RESULTS: Ten older adults and 12 staff members participated in the research study. Four themes were identified: (1) facilities should be designed and equipped for their users, (2) moving in the institutional environment, (3) passivity as a norm, and (4) nurses should act differently and have the resources to do so.
CONCLUSIONS: To increase the activity and improve the mobility of older adults, improvements are needed in terms of the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses\' role in activating older adults and resources.
UNASSIGNED: Increased attention to the support of activity and mobility could benefit older adults in institutional long-term care. Physical activity promotion should be incorporated as an integral part of nursing practice.
UNASSIGNED: Directors of units were consulted when planning the study. Older adults and nurses contributed to the data collection and interpretation of data.
CONCLUSIONS: (ADDRESSING): What problem did the study address? ○Older adults have recurrently been reported as living inactive lives in institutional long-term care. ○There is evidence of the relationship between the environment and the activity and mobility of older adults, but there seems to be a research-practice gap in terms of implementing activity- and mobility-promoting environments. ○Older adults and staff members are important in developing practice and change-oriented knowledge that can be used to increase the activity and improve the mobility of older adults in institutional long-term care. What were the main findings? ○Various environmental improvements are recommended to increase the activity and improve the mobility of older adults in institutional long-term care settings. ○Improvements for the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses\' role in activating older adults and resources for activity support would benefit older adults\' activity and mobility. Where and on whom will the research have an impact? ○Increasing the activity of older adults requires better activity promotion and mobility support by nurses in institutional care. Sufficient education and resources should be organized for activity promotion, in addition to a care and organizational culture that values activity. ○Environmental aspects to promote activity and mobility need to be considered already at the planning, building and renovating phases of facilities. ○Policymakers and care organizers should consider evidence of the harms and benefits of different institutional living environments when making decisions on organizing care.
UNASSIGNED: The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ).

OBJECTIVE: To evaluate evidence that examined nurses\' work experiences in hospital wards with single rooms. The research question was \'What does the research tell us about nurses\' work experiences in hospital wards with single rooms?\'
BACKGROUND: In the last decades, new hospital builds have moved towards including a high proportion of single rooms. Yet, single rooms create \'complex environments\' that impact the nurses.
METHODS: A structured integrative review was undertaken of empirical evidence.
METHODS: Original, peer-reviewed articles, written in English, were sourced from four databases: CINAHL, PubMed, Embase and Web of Science. The initial searches were performed in April 2021 and repeated in December 2022. Quality appraisal was undertaken using the Mixed Methods Appraisal Tool. A narrative synthesis approach was used to analyse the data. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
RESULTS: Twelve studies, published between 2006 and 2022, with an international origin, and representing n = 826 nurses, were included in this review. The synthesis revealed mixed perspectives about nurses\' work experiences in wards with single rooms. Whilst single rooms are \'all good in theory (and) a good idea\', the reality was quite different. Synthesised findings are presented in four categories: (i) aesthetics and the physical space, (ii) privacy vs. isolation, (iii) safety, which includes situational awareness and (iv) communication and collaboration.
CONCLUSIONS: This review describes how single rooms affects nurses\' work experience. Whilst nurses shared multiple concerns about single rooms and the challenges they also acknowledged patient preference for the privacy and space afforded by single rooms.
CONCLUSIONS: Findings from this review highlight the need for careful planning to maintain and strengthen teamwork, prevent nurses\' sense of working in isolation, as well as creating opportunities for mentorship, and collaboration among nurses when working in single-room settings.

Restrictive interventions (seclusion, restraint and special observations) are used on psychiatric wards when there are no other means available to keep a patient or others safe. These measures can be traumatic, and the Mental Health Commission and the Health Service Executive are focused on minimising their use. We set out to determine whether, following a COVID related reduction in bed numbers on a high dependency psychiatric ward in St John of God Hospital in Dublin, there was a change in their incidence.
Data on restrictive interventions and challenging behaviours were gathered for 9-month periods before and after March 2020 when COVID related ward changes took place. Figures were also collected on seclusion and restraint for the previous 18 months for a longer-term view. Ward and hospital occupancy levels were also recorded.
Between the two time periods, episodes of seclusion fell by 53% and episodes of restraint by 56%. The hours devoted to special observation declined by 30% and incidents of challenging behaviours fell by 26%. Ward occupancy levels fell by only 5%. The longer-term comparison of figures for seclusion and restraint point towards a downward trend from mid-2019 that was accentuated in the post-COVID period.
The changes found may relate to reduced crowding on the ward or other COVID related factors such as the emphasis on social distancing and a shared sense of purpose on the ward. The longer-term trend points towards an emerging cultural shift. The challenge now is to sustain and build upon these changes.

UNASSIGNED: It has been suggested that single rooms for patients improve patient dignity and privacy and reduce infection transmission, but they can be socially isolating. It is not well understood how single rooms affect long-stay patients.
UNASSIGNED: To understand the experience of being an inpatient in a ward with single-room design.
UNASSIGNED: A qualitative, phenomenological study was conducted using semi-structured interviews with patients (n=10) in a newly built cancer hospital with a 100% single-room haematology ward. Interviews were analysed using Colaizzi\'s (1978) seven-step analysis.
UNASSIGNED: Patients described their experiences of their acute stay using the concepts of privacy, isolation and independence, as well as enabling sleep. Privacy enabled patients to have their own toilet, was perceived to aid infection control and provided silence. Privacy came at a cost of isolation, but patients re-framed this as expected and necessary for self-preservation. Furthermore, they were unsure as to whether other patients would reciprocate social contact and instead relied on the healthcare team. Patients sought independence during their acute stay as it enabled them to control the environment and create a space for healing. The ability to sleep and be rested was also a critical feature of patients\' stay.
UNASSIGNED: The research highlighted that haematology patients prefer single rooms. However, because they experienced isolation, it also highlighted the importance of facilitating and enabling peer support within the haematology setting.

OBJECTIVE: Exploring the influence of the 100% single-room environment on staff and patient experience of person-centred practice in an acute-care setting.
BACKGROUND: Current building guidance for the NHS advocates increasing the single-room inpatient environment. There is little evidence of the impact of this design in adult acute-care settings on the experience and delivery of person-centred care.
METHODS: Ethnography, underpinned by McCormack and McCance\'s Person-centred Practice Framework.
METHODS: Data collection took place between March and June 2018. Staff and patients in a National Health Service hospital in the United Kingdom took part in observations of practice (n = 108 hours); face to face inpatient interviews (n = 9); and participatory reflective staff groups (n = 3). A reflexive journal was kept by the researcher throughout the study. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
RESULTS: Themes relating to care delivery and interactions were identified. Staff and patients\' views converged around visibility and isolation. Patients appreciated the privacy afforded by the single rooms, while staff experienced a psychological shift, being viewed (and viewing themselves) as \'visitors\'. There was space for more sympathetic presencing, encouraging patients to speak more openly, to facilitate knowing and authentic engagement. However, time remained an issue resulting in more task-focused care.
CONCLUSIONS: Changes to the physical environment have an impact on the delivery and experience of person-centred practice. While the facilities enhance patient experience, the interweaving of engagement, emotional support and the development of therapeutic relationships remain challenging.

UNASSIGNED: The aim of this research was to obtain user perspectives of adolescent patients to inform the redesign of an adolescent mental health inpatient facility ward unit in regional Australia.
UNASSIGNED: It is well established that the consumer will use and understand unit space differently than the health professional, because of their unique positioning and depth of experience. The participation of young people in the design of ward environments and programs is essential.
UNASSIGNED: A combination of focus groups and interviews was undertaken with eight participants.
UNASSIGNED: This study found that, in its current form, the unit revolves around routines, tasks, and patient safety, which in turn are driven by secure spaces and surveillance of the patients. Due to these routines and tasks, the aspects of individualized patient care and personal impetus and comfort are lost. Adolescent patients are able to identify solutions to enhance their hospital stay in the mental health context without being excessive and unrealistic in their suggestions.
UNASSIGNED: When designing an adolescent unit, there needs to be some consideration as to how the group using the unit understands space. Through their role and depth of hospital experience, the adolescent patient will use and understand unit space differently from that of the health professional whose role is a worker. Therefore, it is necessary to gain the perspectives of adolescent patients for efficient and effective functioning of such an environment and to suit the needs of those it is \"built for,\" the adolescent patient.

OBJECTIVE: To explore how the physical and social environment of acute mental health units influences consumers\' perception and experience of safety.
BACKGROUND: Acute mental health units are places in which consumers should feel safe. Not all consumers, however, feel safe in this environment. Little is known about what contributes to consumers\' feelings of safety in this setting.
METHODS: The study used a qualitative descriptive design, influenced by naturalistic enquiry. Data were analysed using thematic analysis and are reported according to the COREQ checklist.
METHODS: Fifteen people who had experienced admission to an acute mental health unit were individually interviewed.
RESULTS: Having a supportive environment enhanced consumers\' perception and experience of safety. A supportive environment was experienced when consumers had privacy, felt safe from other consumers and had meaningful activities to participate in within the acute mental health unit. In contrast, having their privacy breached by other consumers made participants feel unsafe. Many participants were fearful of other consumers, and felt unsafe and unable to protect themselves. Lack of meaningful activities led to boredom and contributed to consumers feeling unsafe.
CONCLUSIONS: Personal spaces should address consumers\' privacy needs without compromising staff access. Staff presence enhances consumers\' feelings of safety, but this need can be heightened when consumers are unable to alert staff when they feel unsafe. Meaningful activities link consumers to their lives outside of the hospital and can enhance recovery.
CONCLUSIONS: Understanding how the acute unit environment is perceived by consumers can assist nurses and managers to promote feelings of safety among consumers. Feeling safe can, in turn, optimise recovery.

UNASSIGNED: The study was conducted according to the principles of Declaration of Helsinki, and was approved by the Norwegian Social Science Data Services.
OBJECTIVE: To describe patients\' experiences of staying in multiple- and single-bed rooms.
METHODS: This qualitative study employed a descriptive and exploratory approach, and systematic text condensation was used to analyze the material. Data were collected in a hospital trust in Norway. A total of 39 in-depth interviews were performed with patients discharged from the medical, surgical, and maternity departments.
RESULTS: Patients had ambiguous views on whether multiple-bed rooms or single-bed rooms were to be preferred. Main results include how patients cherished \"the importance of others\" but at the same time valued \"the importance of privacy.\" Being hospitalized in multiple-bed rooms was for many patients a very positive experience in terms of social interaction. Patients in single-bed rooms reported being more dependent on nurses to maintain social contact and obtain safety.
CONCLUSIONS: This research provides new knowledge on how the need for privacy can be in contradiction with the need for socializing with other patients. When hospitalized, the physical structure of a hospital impacts with whom patients interact and to what extent they depend on the nursing staff to have their social needs met.

BACKGROUND: The influence of the hospital\'s infrastructure on healthcare-associated colonization and infection rates has thus far infrequently been examined. In this review we examine whether healthcare facility design is a contributing factor to multifaceted infection control strategies.
METHODS: We searched PubMed/MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) from 1990 to December 31st, 2015, with language restriction to English, Spanish, German and French.
RESULTS: We identified three studies investigating accessibility of the location of the antiseptic hand rub dispenser. Each of them showed a significant improvement of hand hygiene compliance or agent consumption with the implementation of accessible dispensers near the patient bed. Nine eligible studies evaluated the impact of single-patient rooms on the acquisition of healthcare-associated colonization and infections in comparison to multi-bedrooms or an open ward design. Six of these studies showed a significant benefit of single-patient bedrooms in reducing the healthcare-associated colonization and infection rate, whereas three studies found that single-patient rooms are neither a protective nor risk factor. In meta-analyses, the overall risk ratio for acquisition of healthcare-associated colonization and infection was 0.55 (95% CI: 0.41 to 0.74), for healthcare-associated colonization 0.52 (95% CI: 0.32 to 0.85) and for bacteremia 0.64 (95% CI: 0.53 to 0.76), all in favor of patient care in single-patient bedrooms.
CONCLUSIONS: Implementation of single-patient rooms and easily accessible hand rub dispensers located near the patient\'s bed are beneficial for infection control and are useful parts of a multifaceted strategy for reducing healthcare-associated colonization and infections.

BACKGROUND: There is increasing interest in the effects of hospital and ward design on multi-faceted infection control. Definitive evidence is rare and the state of knowledge about current ward design is lacking.
OBJECTIVE: To collect data on the current status of ward design for intensive care units (ICUs) and to analyse associations between particular design factors and nosocomial infection rates.
METHODS: In 2015, operational infrastructure data were collected via an online questionnaire from ICUs participating voluntarily in the German nosocomial infection surveillance system (KISS). A multi-variate analysis was subsequently undertaken with nosocomial infection rates from the KISS database from 2014 to 2015.
RESULTS: In total, 534 ICUs submitted data about their operational infrastructure. Of these, 27.1% of beds were hosted in single-bed rooms with a median size of 18m2 (interquartile range 15-21m2), and 73.5% of all ICU beds had a hand rub dispenser nearby. The authors were able to match 266 ICUs in the multi-variate analysis. ICUs with openable windows in patient rooms were associated with lower device-associated lower respiratory tract infections [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.90]. ICUs with >40% two-bed rooms were associated with lower primary bloodstream infection rates (OR 0.66, 95% CI 0.51-0.86).
CONCLUSIONS: Only minor associations were found between design factors and ICU infection rates. Most were surrogates for other risk factors.