Literature Review - HSC Home - University of the West of England

wards and three female wards, including people with mental disabilities,psycho geriatric patients and those with various psychiatric disorders. Thestudy found a reduction in seclusion following the experimental condition,although the results are non-significant. Casualty incidents were also reducedfollowing the intervention, but very small numbers of incidents were reportedoverall. No change in medication rates were found in either intervention orcontrol ward. The self-report data showed that staff and patients perceivedminor improvements in relationships, although staff also reported minordeterioration on the personal development scales. Nursing reports generallyreflected favourable attitudes to the intervention. The authors conclude thatmodest results may be achieved by using low-cost methods in difficult settingswith difficult client populations, and that the provision of social seating mayreduce the hostility of the maximum-security hospital environment.Clinical indicators were also assessed in a control study comparing two floortypes and two types of physiotherapy in avoiding falls in elderly patients in acommunity hospital (Donald et al., 2000). The study included 54 patients whowere randomly allocated to vinyl flooring or carpet and falls were measuredduring the trial. The study found vinyl flooring and additional exercises to beassociated with fewer falls although the results are non-significant. The studyis knowingly underpowered, making it difficult to assess the impact of theintervention. The author notes that falls were reduced in both intervention andcontrol groups during the trial, a result possibly attributed to staff awarenessthat the research was being carried out.The impact of the environment on psychosocial items in patients withadvanced cancer in palliative care was investigated in a pilot study using RCTdesign and semi-structured interviews to investigate the use of the Snoezelenmulti-sensory environment (Schofield, 2003). The experimental group of 26patients were given access to the Snoezelen for one hour on two occasionsand members of the control group were given access to a quiet room for thesame amount of time. The study used the Hospital Anxiety and Depressionscale (HAD), reporting a significant reduction in anxiety in the experimentalgroup following the intervention. While the study is underpowered, the authorconcludes that Snoezelen is worthy of further investigation as an environmentthat can promote relaxation, reduced anxiety and reduced use of medication.This interpretation is reinforced in thematic content analysis of qualitativeinterview data, which identified key themes of calm, sleep, continued effectand environment from patients’ accounts.8.3 Behavioural responses to the environmentAnother control study focused on behavioural responses to the environment,investigating the impact of architectural design on wayfinding in patients withdementia in a large hospital (Passini et al., 1998). The study comparedfourteen patients with dementia of the Alzheimer’s type (DAT) and a controlgroup of 28 subjects, matched in terms of age, sex and education.Participants were asked to find their way to a named destination in a largehospital and observational measures of wayfinding based on participants’verbalisations of their actions were used. The study found that DAT patients42