Marie Elf

To identify instruments measuring the quality of the physical healthcare environment, describe their psychometric properties. The physical healthcare environment is regarded as a quality factor for health care. To facilitate evidence-based design there is a need for valid and usable instruments that can evaluate the design of the healthcare environment. Systematic psychometric review. A systematic literature search in Medline, CINAHL, Psychinfo, Avery index and reference lists of eligible papers (1990-2016). Consensus based standards for selection of health measurement instruments guidelines were used to evaluate psychometric data reported. Twenty-three instruments were included. Most of the instruments are intended for healthcare environments related to the care of older people. Many of the instruments were old, lacked strong, contemporary theoretical foundations, varied in the extent to which they had been used in empirical studies and in the degree to which their validity and rel...

Several studies have found that fatigue is one of the most commonly reported symptoms after stroke and the most difficult to cope with. The present study aimed to investigate the presence and severity of self-reported fatigue six years after stroke onset and associated factors. The cohort "Life After Stroke Phase I" (n = 349 persons) was invited at six years to report fatigue (Fatigue Severity Scale 7-item version), perceived impact of stroke and global recovery after stroke (Stroke Impact Scale), anxiety and depression (Hospital Anxiety and Depression Scale), life satisfaction (Life Satisfaction Checklist) and participation in everyday social activities (Frenchay Activities Index). At six years 37% of the 102 participants in this cross-sectional study reported fatigue. The results showed that in nearly all SIS domains the odds for post-stroke fatigue were higher in persons with a higher perceived impact. Furthermore, the odds for post-stroke fatigue were higher in those who had experienced a moderate/severe stroke and had signs of depression and anxiety. Fatigue is still present in one-third of persons as long as six years after stroke onset and is perceived to hinder many aspects of functioning in everyday life. There is an urgent need to develop and evaluate interventions to reduce fatigue.

Earlier studies have shown that patients are dissatisfied with the information they receive from doctors and nurses. The purpose of this study was to analyze satisfaction with information and quality of life in patients with cancer undergoing chemotherapy, considering the patient's information preference. Data were collected during interviews with 30 consecutive patients undergoing chemotherapy for cancer. The subject of the interviews was the satisfaction of patients with the information they received, and additional measures used were the Miller Behavioral Styles Scale and EORTC-QLQ-30. The results showed that 21 of 30 patients were satisfied with the information they received from health care. Married patients or cohabitants were satisfied more often than single patients. No significant differences in quality of life could be found between satisfied and dissatisfied patients. Regarding information preferences, the dissatisfied patients reported more information-avoiding behavior than those who were satisfied. The results must be interpreted cautiously because of the study's limitations, but one clinical implication can be stated: There is value in being aware of patients' information-seeking/avoiding behavior before starting to inform them.

Earlier studies have shown that patients are dissatisfied with the information they receive from doctors and nurses. The purpose of this study was to analyze satisfaction with information and quality of life in patients with cancer undergoing chemotherapy, considering the patient's information preference. Data were collected during interviews with 30 consecutive patients undergoing chemotherapy for cancer. The subject of the interviews was the satisfaction of patients with the information they received, and additional measures used were the Miller Behavioral Styles Scale and EORTC-QLQ-30. The results showed that 21 of 30 patients were satisfied with the information they received from health care. Married patients or cohabitants were satisfied more often than single patients. No significant differences in quality of life could be found between satisfied and dissatisfied patients. Regarding information preferences, the dissatisfied patients reported more information-avoiding behavior than those who were satisfied. The results must be interpreted cautiously because of the study's limitations, but one clinical implication can be stated: There is value in being aware of patients' information-seeking/avoiding behavior before starting to inform them.

The Content and Quality in Briefs Instrument (CQB-I) was designed to develop a valid and reliable audit instrument to examine the content and quality of information in documents (briefs) created in the early stages of designing healthcare environments. The importance of effective briefing has been emphasized in many research studies during the past two decades. However, there is no developed instrument for auditing the content and quality of these documents. The study had a methodological and developmental design based on an established methodology for instrument development and validation. The development process consisted of three main phases: (1) item generation and scale construction; (2) assessment of face and content validity, and (3) testing of the reliability. To obtain face and content validity, expert panels reviewed the COB-I. Content validity was assessed using the Content Validity Index (I - CVI = item level, S - CVI = scale level). Reliability was tested by test-retest and inter-rater reliability. CQB-I was found to have good content validity (I - CVI = 0.78 - 1.0 and S - CVI = 0.98). Inter-rater reliability was acceptable (Spearman's correlation = 0.62) and stability was considered high for both raters (83% and 88%, respectively).

This study describes the development of a system dynamics model in a design process devoted to planning a new stroke unit. The model was created with a group modeling approach in which several professionals were involved. The advantage of using system dynamics is the simplicity and the ability to reveal the underlying structure of complex problem. Moreover, the method is transparent, showing the model boundaries and explicitly defined the variables and the relationships between them.

Current research shows a relationship between healthcare architecture and patient-related outcomes. The planning and designing of new healthcare environments is a complex process. The needs of the various end users of the environment must be considered, including the patients, the patients' significant others, and the staff. The aim of this study was to explore the experiences of healthcare professionals participating in group modeling utilizing system dynamics in the predesign phase of new healthcare environments. We engaged healthcare professionals in a series of workshops using system dynamics to discuss the planning of healthcare environments in the beginning of a construction and then interviewed them about their experience. An explorative and qualitative design was used to describe participants' experiences of participating in the group-modeling projects. Participants (N = 20) were recruited from a larger intervention study using group modeling and system dynamics in planning and designing projects. The interviews were analyzed by qualitative content analysis. Two themes were formed, representing the experiences in the group-modeling process: "Participation in the group modeling generated knowledge and was empowering" and "Participation in the group modeling differed from what was expected and required the dedication of time and skills." The method can support participants in design teams to focus more on their healthcare organization, their care activities, and their aims rather than focusing on detailed layout solutions. This clarification is important when decisions about the design are discussed and prepared and will most likely lead to greater readiness for future building process.

Health care is a complex dynamic setting suitable for system dynamics analyses. The method has the potential to be an important quality improvement tool in the near future. However, it will be necessary to develop the models beyond the pure production model focus on the clinical care process from a patent perspective and in doing so it is inevitable that variables such as health, communication and care planning are involved. Consequently, useful and valid models for modern health care must involve variables that are unfairly designated as intangible. The present paper describes an exploratory system dynamics model of the care planning process. It draws on a range of studies and theories about the process. The paper discusses how it could be possible to incorporate and validate variables alongside the more traditional way.

The necessity to improve the building design process is stressed in many studies. Communication in the early stages of the process is particularly important and it is suggested that this influences the quality of the whole process. In recent times, the construction sector has become more customer-oriented and is making use of the organisation and its main process as a basis for design decisions and as an important complement to construction issues. Participants in the building design process need tolls to indentify the requirements of the organisation for a building project. The overall aim of this thesis was to explore modelling and simulations (system dynamics) as at tool in facilitating collaboration between participants in the early stages in the design process for new health care environments. Two models were developed: a conceptual model for care planning and a simulation model of a stroke care process with a patient-centred focus. The thesis also investigated whether system d...

In this study system dynamics has been used to explore staff retention and job satisfaction at a maternity department, which was in an unfavourable spiral of attrition after an expansion period. This raised the issue about how to stop this downward spiral. To understand and ex- plore this a causal loop diagram and a system dynamics model were developed, integrating factors of attrition and hiring rates, workload and qualitative contents of the work. The causal loop diagram shows an unbalanced system, which may spiral favourably or unfavourably after a relatively small disturbance. The system dynamics model shows that an unfavourable spiral may be reversed by qualitative interventions. The conclusions are that system dynamics is an interesting method, which may increase the understanding of the factors determining staff retention, job satisfaction and work pressure in a hospital setting. There is need for fur- ther examination of the qualitative factors incorporated in the model.

Over the past two decades System Dynamics (SD) modeling has been used in strategic thinking, policy testing, and quality improvement work. Many modelers have used SD in participatory group-modeling situations both as a method for fact elicitation and for group learning of the system. Several authors have stated that the modelling process is problematic and especially modelling with multi-professional groups. We conducted a scoping review of the literature on methods for group process work to identify methods that can be useful for the SD field. The article includes a description of several well-accepted methods from other fields for the briefing process at the early stages of a participatory modeling process.

Aim. The paper presents the development and structure of a generic stroke care simulation model, used in designing of a stroke unit in Sweden. Background and rationale. Designing new health care spaces is a multifaceted process; requiring multi-professional (nurses, other healthcare professionals, building planners and architects) involvement. To secure that the patients’ interest are in focus the different stakeholders need to analyze and develop a common understanding of the care processes that are to take place in the new space. Modeling and simulation is one significant method, making it possible to depict the dynamic structure of the system and experiment with the model, asking “what – ifs” questions. Methods. System dynamics, a modeling method was used to develop the model. The iterative and group-modeling process included development of a quantified model (with a multi-professional design team, based on evidence from the literature, and a survey from stroke care experts), and...

Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments. This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific a...

The main purpose of the study was to investigate the usability of a newly developed instrument designed to assess the content and quality briefs (CQB-I) in programs for new healthcare environments. We studied the perception of using the instrument on a group of space planners. The study is part of a larger project designed to ensure the quality of the planning of new healthcare environments with a focus on documents (programs or briefs) created in the early phases of the planning process. In this study, we used an instrument that measures the clarity of the mission statement for the project based on user needs and care activities that will take place in the new healthcare environment. The instrument further evaluates whether there are clear patient-related outcome measures specified and whether the information in the documents is person-oriented and evidence-based. The study used a mixed-method design where the relevance and usability of the instrument was estimated and a focus grou...

The aim of this study was to explore nurses' perceptions of climate and environmental issues and examine how nurses perceive their role in contributing to the process of sustainable development. Climate change and its implications for human health represent an increasingly important issue for the healthcare sector. According to the International Council of Nurses Code of Ethics, nurses have a responsibility to be involved and support climate change mitigation and adaptation to protect human health. This is a descriptive, explorative qualitative study. Nurses (n = 18) were recruited from hospitals, primary care and emergency medical services; eight participated in semi-structured, in-depth individual interviews and 10 participated in two focus groups. Data were collected from April-October 2013 in Sweden; interviews were transcribed verbatim and analysed using content analysis. Two main themes were identified from the interviews: (i) an incongruence between climate and environmen...

There is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability. SCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics. Translation...

The Content and Quality in Briefs Instrument (CQB-I) was designed to develop a valid and reliable audit instrument to examine the content and quality of information in documents (briefs) created in the early stages of designing healthcare environments. The importance of effective briefing has been emphasized in many research studies during the past two decades. However, there is no developed instrument for auditing the content and quality of these documents. The study had a methodological and developmental design based on an established methodology for instrument development and validation. The development process consisted of three main phases: (1) item generation and scale construction; (2) assessment of face and content validity, and (3) testing of the reliability. To obtain face and content validity, expert panels reviewed the COB-I. Content validity was assessed using the Content Validity Index (I - CVI = item level, S - CVI = scale level). Reliability was tested by test-retest...

This study describes the development of a system dynamics model in a design process devoted to planning a new stroke unit. The model was created with a group modeling approach in which several professionals were involved. The advantage of using system dynamics is the simplicity and the ability to reveal the underlying structure of complex problem. Moreover, the method is transparent, showing the model boundaries and explicitly defined the variables and the relationships between them.

The aim of the present study was to monitor the health-related quality of life (HRQOL) of patients with head and neck cancer or haematological malignancies during a period from before to after medical treatment, and to investigate the relationships between patient experiences of oral symptoms and HRQOL. The sample consisted of 41 consecutive patients. At the start, during and end of radiotherapy or the second/third cycle of chemotherapy, patients rated their experiences of oral symptoms on a 100-mm visual analogue scale and completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30 and the EORTC QLQ H&N35 (head and neck patients). At the end of treatment, an interview was done regarding the perceived influence of oral status on HRQOL. Among patients receiving radiotherapy, HRQOL tended to decrease over time, and oral symptoms increased. Patients who reported that their oral symptoms had influenced their everyday life (56%) reported more severe oral symptoms and lower HRQOL scores at the end of treatment when the oral symptoms were most intense. The findings from correlational analyses support the patients' reports from the interviews. For patients receiving chemotherapy for haematological malignancies, the quality of life did not change during the chemotherapy cycle. They reported very few oral symptoms, and very few reported that oral symptoms had any influence on their HRQOL. However, the correlational data indicate a relation between oral symptoms and HRQOL. Patients who reported more severe oral symptoms also reported lower HRQOL scores. The results demonstrate that oral status is related to HRQOL in these patient groups.

The brief is a central document in decision-making during the early stages of the planning and construction (briefing/programming) of healthcare environments. Thus, the demand on the content and quality of these documents is high. The content and quality of initial briefs developed in Sweden were assessed to obtain an up-to-date picture of current practices of writing project statements in the