THE PHYSICAL ENVIRONMENT


Table 2: General ward characteristics. General ward characteristics


Admission (n=82)


Non-rural catchment area: n (%)


Year of construction: n (%) Up to 1983


1984-1993 1994-2003 From 2004


Staffing Equivalent full-time staffing per bed: mean (s.d.)


Admissions Number of admissions in 2009-2010: mean (s.d.)


Length of stay (days): mean (s.d.)


Coercive measures Seclusion incidents per 1,000 admissions: mean (s.d)


Seclusion hours: mean (s.d.) Seclusion hours (proportion): mean (s.d.) Coercive measures per 1,000 admissions: mean (s.d.)


Even when the impact of patient, staff and general ward characteristics are taken into account. Design features related to ‘safety’, as well as ‘privacy’ and ‘comfort and control’ appeared to be the most important issues. They are all significantly related to the risk of


being secluded. Safety – In this study safety refers to the


presence of special safety measures (such as special communication and warning systems), the level of supervision (referring to the overview on the ward) and the presence of violence-proof finishing (of walls, ceilings, doors and frames, locking devices and type of glass). The presence of special safety measures and the presence of violence-proof finishing both increase the risk of being secluded. These negative effects could be explained by the impersonal, restrictive and institutionalised atmosphere that often occurs when special safety measures are being taken. A strong emphasis on safety may lead to opposite patient responses such as anxiety, crowding, conflict and aggression, which can even culminate to seclusion and restraint. Other studies indicate that unwanted and


even threatening behaviours are associated with institutional settings.11-13


On the other


hand, the level of supervision in the study had a positive effect; a lower risk of being secluded. It is often suggested that wards with a high level of supervision (i.e. camera’s, wider corridors, good overview and sight lines) tend to have a more institutionalised, less pleasant atmosphere. However, supervision can also have beneficial effects for patients and staff and their (sense of) security. It appears that, compared to other safety measures, supervision is less intimidating or obtrusive for patients. Unobtrusive safety measures, that do not hinder a pleasant more homelike atmosphere, seem to be preferable.


52 IFHE DIGEST 2013 39.0


16.0 23.0 25.0 18.0


1.4 (47.6)


(19.5) (28.0) (30.5) (22.0)


(0.7)


187.8 (163.6) 78.3


(62.9)


187.4 (216.8) 116.6 (270.6) 0.9


(5.5) 545.1 (1470.4) Type of ward


Non-admission (n=92)


37.0


20.0 15.0 33.0 24.0


1.5 90.0 120.8


162.7 140.7 0.7


544.4 Privacy, autonomy and comfort – Three


design features, related to the privacy and autonomy of patients, were found to result in a lower risk of seclusion: The total private space available per patient, a small number of patients in the building and a high level of comfort. Private space, like having a private room with a bathroom en-suite, offers patients territorial control, feelings of ownership, identity, a sense of dignity and the ability to regulate social interaction, which all enhances the well-being of patients. Privacy and autonomy is also related to better adjusted behaviour and better functioning. Lack of comfort and personal control over the physical environment can lead to distress and helplessness.14


On the other hand, no Intensive care unit. (40.2)


(21.7) (16.3) (35.9) (26.1)


(0.9)


(91.5) (73.9)


(401.5) (350.7) (3.8)


(962.9)


Forensic (n=25)


15.0 2.0


14.0 0.0 9.0


1.4 41.1 124.6 (60.0) (8.0)


(56.0) (0.0)


(36.0) (0.5)


(33.8) (69.8)


243.7 (297.6) 239.7 (534.6) 1.2


(3.4) 686.1 (613.2)


significant effects were found for the total size of the ward, the facility level (type and number of common rooms, total common space) and the number of patients on the ward itself. This suggests that private space is more important than common space, in relation to the risk of seclusion.


Conclusion The study supports the idea that the physical environment of the ward has an effect on the use of restraint and seclusion. Adjusted effects were found for several design features, related to the privacy and autonomy of patients, the level of safety and the atmosphere of the ward. The findings emphasise the importance of reassurance,


D/Dock, Arken


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