THE PHYSICAL ENVIRONMENT Petra van der Schaaf– Researcher, Dutch Centre for Health Assets (part of TNO).
Aggression: the role of hospital design
This article describes some of the main findings of a recent report undertaken by Netherlands Organisation for Applied Scientific Research (TNO) which, for the first time, examined the relationship between design features and the frequency of use of seclusion rooms in psychiatric wards in the Netherlands.
Violence in healthcare is a significant international problem and an economic burden that adversely impacts the quality of care and safety of all involved.1
In mental
health, violence is considered endemic.2-3 Staff injury rates in psychiatric hospitals, for example, reportedly exceed those encountered by high-risk industry workers in other settings. Violence and severely disturbed behaviour
are also identified as the most frequent reason for the use of coercive measures such as restraint and seclusion. These are high-risk containment procedures which are used in many healthcare settings to control the maladaptive behaviour of patients. Their use is emotionally charged and controversial, because of the traumatising and iatrogenic effects. It adversely impacts organisations, their workforce and the people served. The Government and mental health organisations in the Netherlands have put into place many initiatives to prevent and reduce the use of coercive measures. The debate in the Netherlands is focused
on the need to drastically reduce the use of seclusion. The Dutch Health Care Inspectorate even stated that solitary seclusion of patients should be banned: “a sick patient must never be left alone”.4 near future, new developed and renovated
Many initiatives have been taken to create more humane alternatives to seclusion rooms – an IC-unit, or spaces that can prevent further escalation such as a comfort rooms.
facilities for mental health will no longer contain seclusion units. Existing units might even be closed. Dutch mental health is also faced with the challenge of reducing inpatient care. There is a strong need to fundamentally change views on inpatient care and to find new design concepts for intensive psychiatric care. Inpatient aggression can result from a
In the
complex interaction of individual characteristics of the patients, staff characteristics and contextual characteristics. While its potential impact is often acknowledged, little is
‘While its potential impact is often acknowledged, little is known about the role of the physical environment in preventing and reducing aggression and the use of coercive measurements.’
IFHE DIGEST 2013
known about the role of the physical environment in preventing and reducing aggression and the use of coercive measures. Only recently have architects and
psychiatrists started to pay attention to the rationale and effects of physical design, encouraged by research in the field of environmental psychology and evidence based design.5-7
These studies have demonstrated the impact of the physical Petra van der Schaaf
Petra van der Schaaf, MSc, studied health sciences at the University of Maastricht and is a researcher at the Dutch Centre for Health Assets (part of TNO). Her research is focused on the design of health environments and the design-related outcomes associated with safety, clinical results, organisational and staff performance and the human experience. She also translates research into practice by formulating design guidelines, by describing ‘state of the art’ hospital design and by developing tools to create a healing environment. Her areas of attention include the reduction of aggression and the use of restraint and seclusion in psychiatric hospitals.
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Intensive care unit
AAA Architecten, Propersona.
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