Reviewing the Literature and Theory Essay
The final capstone project is a culmination of the written research-based assignments completed throughout the course. Each written assignment contributes to the final Evidenced-Based Proposal paper. This is the second written assignment.Reviewing the Literature and Theory Essay
Locate a minimum of 15 peer-reviewed articles that describe the problem or issue and that support the proposed solution. Eight of the 15 articles must be research-based (i.e., a study which is qualitative, quantitative, descriptive, or longitudinal).Reviewing the Literature and Theory Essay
The “Table of Evidence” document is a tool you can use to organize information from the study articles you have chosen for your literature review. Use this tool as a guide to ensure you have captured the key information that should be incorporated into your literature review narrative.
Begin your search for literature by utilizing the databases located in the GCU Library. Contact your instructor, the librarian, or library staff for additional researching tips and keyword suggestions.
Preview each of the 15 articles chosen by reading the article abstracts and summaries. Article abstracts and summaries provide a concise description of the topic, research outcomes, and significance of findings.
Analysis and Appraisal
Write an analysis and appraisal (1,500-2,000 words): This section should build and support your case, in the reader’s mind, of why your problem, purpose, and proposed solution are valid.
Remember, you are building an argument to prove your case to do this project; this is not simply an article review.
Analyze and appraise the selected articles to support your problem, purpose, and solution. Appraise each article by answering the following questions (one to two sentences is sufficient to answer each question):Reviewing the Literature and Theory Essay
How does the article describe the nature of the problem, issue, or deficit you have identified?
Does the article provide statistical information to demonstrate the gravity of the issue, problem, or deficit?
What are some examples of morbidity, mortality, and rate of incidence or rate of occurrence in the general population?
Does the article support your proposed change?
Group the analyses based on the content of the articles and the support each article provides for your project.Reviewing the Literature and Theory Essay
Incorporating a Theory
In addition to the review of the literature and theory paper, write a paper of 250-500 words in which you:
Find a theory that will assist you in your implementation or support your solution to your problem.
Describe this theory in simple terms.
Describe why this theory supports your project.
Describe how you will incorporate this theory.
General Requirements:
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.Reviewing the Literature and Theory Essay
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.Reviewing the Literature and Theory Essay
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
A visit to a U.S. hospital is dangerous and stressful for patients, families, and staff. Hospital-acquired infections and medical errors are among the leading causes of death in the United States, each killing more people than automobile accidents, breast cancer, or acquired immune deficiency syn- drome (AIDS) (Institute of Medicine [IOM], 2001; Klevens, et al., 2007a). The resulting yearly cost for U.S. hospitals is estimated to be $5 billion for hospital-acquired infections (Centers for Disease Control and Prevention [CDC], 2000) and $17 to $29 billion for medical errors (Kohn, Corrigan, & Donaldson, 1999). According to the IOM (2001) in its landmark Crossing the Quality Chasm report: “The frustration levels of both patients and clini- cians have probably never been higher. Yet the problems remain. Health care today harms too frequently and routinely fails to deliver its potential benefits” (p. 1). Problems with U.S. healthcare not only negatively influence patients; they affect staff. Registered nurses have a turnover rate av- eraging 20% (Joint Commission, 2002).
At the same time, a major boom in hospital construction is occurring in the United States and several other countries. The U.S. healthcare system is facing the confluence of the need to replace aging 1970s hospitals, population shifts, the graying of the Baby Boom generation, and the introduc- tion of new medical technologies. As a result, the United States will spend more than $180 billion for new hospitals in the next 5 years alone, and healthcare construction is projected to exceed $70 billion per year by 2011 (Jones, 2007). These new hospitals will remain in place for decades. Reviewing the Literature and Theory Essay
This once-in-a-lifetime construction program provides an opportunity to rethink hospital design and especially to consider how better design can improve patient and staff outcomes. Just as medicine has increasingly moved toward evidence-based medicine where clinical choices are informed by research, healthcare design is increasingly guided by rigorous research linking hospitals’ physical environments to healthcare outcomes, and it is moving toward evidence-based design (EBD) (Hamilton, 2003). For example, The Center for Health Design Pebble Project includes approximately 50 healthcare providers and manufacturers committed to using EBD for their construction projects. The Military Health System has adopted EBD for a $6 billion capital construction pro- gram for its 70 hospitals, which serve more than 9.2 million people worldwide. Kaiser Permanente and its partners in the Global Health and Safety Initiative are using EBD as a strategy to increase triple safety for pa- tients, staff, and the environment. The Global Health and Safety Initiative comprises partners that provide over 100,000 hospital beds.
This report is an updated and expanded version of a 2004 report, “The Role of the Physical Environment in the Hospital of the 21st Century” (Ulrich, Zimring, Quan, Joseph, & Choudhary, 2004). Research teams from Texas A&M University and the Georgia Institute of Technology conducted a new and more extensive search for empirical studies linking the design of the physical environments of hospitals with healthcare outcomes. The following questions are explored in this study: (1) What can rigorous research tell us about “good” and “bad” hospital design? (2) Can improved design make hospitals less risky and stressful and promote more healing for patients, their families, and staff? (3) Is there scientifically credible evidence that design affects clinical outcomes and staff effectiveness in delivering care? Reviewing the Literature and Theory Essay
Methodology
This review followed a two-step process. First, we conducted key word searches to identify potentially relevant studies published in English. Thirty-two key words were used, referring to patient and staff outcomes (such as infection, medical error, pain, sleep, de- pression, stress, and privacy), physical environmental factors (hospital, hospital units, healthcare facility, etc.), and other healthcare-related issues (such as patient and family-centered care). We conducted an extensive series of cross-search- es using combinations of key words through the EBSCO research data- base, which enabled the simultaneous search of multiple databases, such as Academic Search Premier, Alt Healthwatch, MED-LINE, PsycArticles, Psychology and Behavioral Sciences Collection, PsycINFO, and CINAHL. In addition, a supplemental search was conducted through the ISI Web of Knowledge and Google Scholar. The search included any study that alluded or referred to the physical environment of healthcare buildings in the title or the abstract. We also obtained additional relevant studies from the reference lists of identified articles.
In the second stage, we screened all identified references using two criteria: First, the study should be empirically based and examine the influence of environmental characteristics on patient, family, or staff outcomes. Second, the quality of each study was evaluated in terms of its research design and methods and whether the journal was peer-revieweD.
Summary of Key Findings
We found a growing number of rigorous studies that help establish the relationship between the physical design of hospitals and key outcomes. This report was organized according to three general types of outcomes. The first section focuses on patient safety issues, such as infections, medical errors, and falls. The second section examines studies related to other patient outcomes, such as pain, sleep, stress, depression, length of stay, spatial orientation, privacy, communication, social support, and overall patient satisfaction. The third section surveys the scientific research relevant to staff outcomes, such as injuries, stress, work effectiveness, and satisfaction. Although these outcomes were also discussed in the 2004 report, this new study has substantially expanded the scale of most sections. In particular, the section on hospital-acquired infections has been substantially revised and expanded, reflecting the rising severity and importance of infections, the rapid growth of infection research, and the appearance of several new studies directly relevant to hospital design. The last section of the paper, Conclusions and Design Recommendations, summarizes the findings ac- cording to design characteristics or interventions and their implications for various outcomes. Reviewing the Literature and Theory Essay
Overall, this review confirms the importance of im- proving the healthcare outcomes associated with a range of design characteristics or interventions, such as single-bed rooms rather than multibed rooms, effective ventilation systems, a good acoustic environment, appropriate lighting, better ergonomic design, and improved floor layouts and work settings. Compared to 2004, the body of evidence has grown rapidly and substantially in recent years. This is encouraging given that the importance of EBD has in- creased markedly as the need for better healthcare facilities has grown and become more urgent. It is now widely recognized that well-designed physical settings play an important role in making hospitals less risky and stressful, promoting more healing for patients, and providing better places for staff to work.
However, it is also important to address the limitations of the quality of existing evidence. In medical fields, a randomized controlled trial or experiment is considered the strongest research design for generating sound and credible empirical evidence. Our literature review, however, found relatively few randomized controlled trials linking specific design features or inter- ventions directly to impacts on healthcare outcomes.Reviewing the Literature and Theory EssayThis is not very surprising, because most changes of the physical environment in healthcare settings alter several environmental factors simultaneously. This creates confounding variables and makes it difficult to disentangle the independent effect of the environ- mental change of primary interest. As an example, renovating an intensive care unit (ICU) with two-bed patient rooms to create single-bed rooms would likely alter not only the number of patients per room, but also the ratio of hand-washing sinks per bed and possibly the room ventilation or air quality. However, there are certain design interventions that may alter only one environmental factor, and the intervention can be assigned randomly to some patients but not others. Examples include exposing patients to interventions such as nature distraction, art, and reduced noise. In the case of these types of interventions, particularly nature distraction, our literature search identified a number of prospective randomized clinical trials that provide strong evidence. Additionally, we identified many moderately strong quasi-experimental studies, and some well-conducted epidemiological investigations. The largest category of studies consisted of observational studies with or without control groups.
Although many studies are not well controlled, the strength of evidence is enhanced by the fact that in the case of certain environmental factors, reliable patterns of findings across several studies emerged with respect to outcome influences. Furthermore, these patterns were broadly consistent with predictions based on established knowledge and theory concerning environment and healthcare outcomes. For example, many studies have consistently found that high noise levels in hospitals worsen patient out- comes such as sleep quality, physiological stress, and satisfaction. It is important to note that validity is strengthened when findings tend to be reliable or consistent and are in accord with a priori hypotheses or predictions derived from previous knowledge. Thus, we believe the application of such findings in EBD should be encouraged despite the shortage of randomized experimental trials. On the other hand, future research should be carefully designed and controlled so that the independent role of specific environ- mental changes or interventions can be better understood.
Different Ways of Reading this Report
This report is written for readers from different disciplines and professions, including architects, healthcare professionals, administrators, and researchers in EBD or healthcare-related fields. It covers a wide range of topics and surveys hundreds of studies and therefore makes an exceptionally long article. It is organized in a systematic way to accommodate the needs of different readers and to facilitate reading at different levels of detail and scope, including: (1) reading the entire article; (2) reading through the article more quickly by looking at the Summary of Evidence and Recommendations that appears at the beginning of each section; (3) reviewing the subtitles and thoroughly reading one or more in- dividual sections on specific outcomes of interest; and (4) reading the last section of the paper, Conclusions and Design Recommendations, to extract major findings and recommendations organized according to specific design issues. Reviewing the Literature and Theory Essay
In addition, readers may notice instances of redundancy, where the same study has been cited in different sections. This is necessary because some characteristics of hospital physical environments (such as nature destruction and noise) influence multiple outcomes. Therefore, certain studies are cited in multiple sections, each focusing on a different outcome. Second, as mentioned previously, some readers may choose to read individual sections related to their specific interests. Cross-references would make reading difficult for such readers. To avoid this, some studies have been cited in more than one place in the article.
2. RESULT I: IMPROVING PATIENT SAFETY THROUGH ENVIRONMENTAL MEASURES
Reducing Hospital-Acquired Infections
Summary of Evidence and Recommendations
One critically important way that EBD improves safety is by reducing the risk of hospital-acquired infections (i.e., nosocomial infections), a leading cause of death in the United States. One general conclusion supported by the infection literature is that the design of the physical environment impacts nosocomial infection rates by affecting all three major transmission routes—air, contact, and water. This discussion addresses the three transmission routes separately and is followed by a discussion of several advantages of single-bed rooms, as compared to multibed rooms, in controlling infection. Reviewing the Literature and Theory Essay
There is a pattern across scores of studies indicating that infection rates are lower when there is very good air and water quality, and greater physical separation, isolation, or space per patient. Concerning hand washing, there is evidence that providing accessible, alcohol-based hand-rub dispensers at the bedside can increase hand-washing compliance and thereby reduce contamination spread by contact.
The large amount of research literature reviewed in this section strong- ly supports the following design measures for controlling and preventing infection:
- Use effective air quality control measures during construction and reno- vation to prevent the outbreak of airborne infections. Measures include, for example, using portable high-efficiency particulate air (HEPA) filters, installing barriers between patient-care areas and construction/renova- tion areas, generating negative air pressure for construction/renovation areas relative to patient-care areas, and sealing patient windows.
- Install alcohol-based hand-rub dispensers at the bedside and in other accessible locations to increase hand-washing compliance and reduce contact transmission of infection.
- Select easy-to-clean floor, wall, and furniture coverings, and employ proper cleaning and disinfection procedures.
- Design and maintain the water system at the proper temperature and adequate pressure; minimize stagnation and back flow; eliminate dead- end pipes; regularly clean point-of-use fixtures; and consider the location of decorative fountains and carefully maintain them to minimize the risk of waterborne infection.Reviewing the Literature and Theory Essay
- Provide single-bed rooms with private toilets to enable separation or isolation of patients on admission, so that those with unrecognized infections can be tested and identified without being mixed in with uninflected individuals in multibed rooms; to reduce airborne infection transmission by increasing isolation capacity and facilitating the maintenance of good air quality through measures such as effective ventilation, filtration, and appropriate air flow direction and pressure (positive or negative); and to facilitate thorough cleaning after a patient leaves, including the use of decontamination methods such as hydrogen peroxide vapor (HPV), which may be much more effective than conventional cleaning.Reviewing the Literature and Theory Essay