Patientsʼ experiences of wellbeing in the physical hospital environment: a systematic review of qualitative evidence protocol

Abstract

Review question/objective The objective of this systematic review is to identify, appraise and synthesize the best available evidence regarding patients' experiences of wellbeing in the physical hospital environment. More specifically, the review question is: How do hospitalized patients experience and assign meaning to the physical hospital environment in relation to their experience of wellbeing? Background The role of the physical hospital environment on patients' health outcomes represents a growing field of research with an underlying rationale pointing at the environment as an important source of recovery, health and wellbeing for the patients.1-4 The majority of research on the hospital environment has tested different environmental variables in relation to patient outcomes; for example the influence of noise on stress and sleep disruptions,5-7 the effect of daylight in the patient rooms on depression8,9 or the significance of nature sights on length of hospital stay,10 pain11 and stress.12 However, this field of research has gradually shifted the perspective from focusing exclusively on the relationship between the physical hospital environment and the patients' health outcomes in relation to, for example length of hospital stay, pain and stress, to including considerations on how the physical hospital environment is able to support the patients' experiences of wellbeing, relief and positive emotions.13-15 Moreover, for several decades, it has been argued, in a nursing context, that the hospital environment plays a significant role in relation to the patients' wellbeing and in caring for the patients.16-20 In this review, wellbeing is to be understood as an experiential phenomenon articulated in a multiplicity of different kinds of wellbeing.21 Galvin and Todres21 describe six different experiential domains within which wellbeing can be emphasized. This means that wellbeing can be experienced spatially, temporally, inter-personally, bodily, in mood, and in terms of the experience of personal identity. Further, these kinds of wellbeing encompass an experience of wellbeing where mobility is emphasized and an experience of wellbeing where dwelling is emphasized as well as a wellbeing possibility where experiences of dwelling and mobility are integrated into an experience of “dwelling-mobility”. This experience of “dwelling-mobility” is to be understood as an experience of both “peace” and “movement”, an intertwining of an experience of inner peace and dwelling encompassing a path of movement and an energizing potential. Galvin and Todres21 describe this unity of “dwelling-mobility” as the deepest form of wellbeing. Additionally, Chick and Meleis22 point to environmental factors as imperative for a positive transition process where the patients are able to experience connectedness and stability. A need for hospitalization during illness is described by Schumacher and Meleis23 as including experiences of transitions from one place to another; or from a familiar, predictable and safe environment to an unfamiliar hospital environment. A meta-synthesis informs of how stressful, unpredictable and scary patients experience their hospitalization transitions.24 The findings of existing empirical research on how the environmental factors influence the patients during hospitalization show a tension between clinical and technical sensory impressions, and more aesthetic and homelike ones. Existing empirical research has shown that traditional healthcare environments, where many clinical sensory impressions are dominant, may be experienced by patients as unfamiliar and alienating, fostering feelings of stress, vulnerability and a negative mood.14, 25-27 Contrarily, studies have demonstrated that a hospital environment with a more familiar and home-like physical environment can reduce stress and increase patient satisfaction during hospitalization.28-31 For instance, studies have shown that aesthetic and more homelike sensory impressions in the hospital environment have a significant impact on the patients' general wellbeing as these impressions generate positive thoughts and feelings.13-15,26 The patients found that aesthetic decorations as well as being surrounded by some of their personal items or undertaking familiar tasks created a sense of homeliness that reinforced their positive mood and sense of self.14 A view of nature helped them to forget their negative thoughts for a while and connected them with good memories that enabled them to recall some of their feelings of identity and personal strength.13,15 On the other hand, clinical sensory impressions in the hospital environment such as medical and technical equipment as well as an environment sparsely decorated, randomly furnished or walls painted white with no colors or pictures were generally associated with unfamiliarity and experienced as creating a feeling of insecurity and a negative mood.14 Further, patients have identified personal space, good physical design, access to external areas and provision of facilities for recreation and leisure as necessary for maintaining their wellbeing.32 Equally important, a study has shown how interior design was perceived by the patients as important for their fundamental mood, sense of security, vulnerability and trust as well as their experiences of the room as a life-affirming place.33 In contrast, the findings of Edvardsson and colleagues18 point to the physical hospital environment as being able to express messages of existential matters such as death, danger, shame and stigma; but also messages related to their experiences of being cared for or not. For example a sparsely decorated and run-down environment could convey negative values important for the patients' experience of wellbeing.18 As shown, existing research on the patients' experiences of sensory impressions in the hospital environment, though sparse, points to the importance of expanding our perceptions of wellbeing among patients to include the physical hospital environment. Therefore, to promote wellbeing in hospitalized patients, we are in need of research based knowledge to optimize a healing and caring hospital environment. We need to contribute with the synthesis of knowledge to promote an understanding of the potential impact of the physical environment on patients' experiences of wellbeing. An initial search of PubMed, CINAHL, The JBI Database of Systematic Reviews and Implementation Reports, Google Scholar and the Trip Database indicated that no systematic review of this topic exists or is currently underway.

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