Florey Department of Neuroscience and Mental Health - Theses
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ItemExploring how the indoor hospital physical environment may impact physical and social behaviour, and affective responses of people with brain injury( 2022)The physical environment of the interior hospital environment is an aspect of the environment of care of the person with brain injury that has received little attention in studies. Although several physical design attributes (e.g. daylight, patient room) have been studied in diverse healthcare settings (neonatal, cancer, ICU) few studies have involved people with brain injury. In addition, this field of research in the design of the physical environment is complex, requiring a multi-pronged approach to examine how and to what extent the physical environment might impact on people with brain injury in hospital. The overall objective of my thesis research was to explore how the physical environment of hospitals, specifically the indoor physical environment, might impact the physical and social behaviour, and affective responses of people with brain injury. Methods A series of sequentially-conducted studies were done over the course of this thesis. Firstly, I utilised a behavioural mapping approach and an adapted environmental checklist to compare the physical, and social activity of people in hospital for neurological conditions (including stroke) during a ‘before and after’ hospital re-location study. Then I conducted a systematic review where I aimed to differentiate the physical design attributes in a ‘single patient room’ from a ‘multi-patient room’, and to establish the strength of empirical evidence supporting one patient room type over the other. The systematic review motivated me to embark on a scoping review of the theories utilised by others in the field to attempt to explain or to test how the physical environment impacts on adults in health facilities. With the findings of studies 1-3, I was positioned to be able to design and conduct a factorial experimental design, using a virtual reality technology, to explore the impact of the physical design attributes on people with stroke, using numerical, categorical, and interviewing data collection. Results Firstly, the observational study showed that people with neurological conditions (>50% with stroke) spend most of the daytime in the patient room (social activity, physical activity), in both the old and new hospital ward environments. Further, these people spent time in close proximity to the window outlook and window seat (new ward), and not in communal areas. The systematic review revealed the paucity of diverse physical design attributes, beyond occupancy, used to examine the content of patient rooms, and highlighted the heterogeneity of outcomes (mostly hospital-acquired infection and falls rates) with which to compare the room types. Although a variety of theories were identified through the scoping review, few of them had been utilised consistently during a health research design study. One theory (the Theory of Supportive Design) was found to be consistently applied through a research study of the hospital ward environment. Finally, putative physical design characteristics (including ‘single’ versus ‘multi-patient’ room), led to the final thesis study (RiSE-VR). Identification of the magnitude and direction of stroke participant choice-preference and affective responses during exposures to a number of physical design characteristics were primarily sought. Quantitative findings were elaborated using interviews in the qualitative study. Feasibility of use of Virtual Reality in stroke was shown. Conclusions/ Implications New insights have been provided about how to study the impact of the interior hospital physical environment and people with brain injury. A novel study approach using virtual reality was developed and utilised to evaluate selected typical hospital physical design attributes in people after stroke. Feasibility and safety of this approach was shown. Regression analyses revealed the impact of different physical design attributes when co-existing with other physical attributes, in daytime and night-time. Thematic analysis provided triangulation and explanation of the quantitative data findings