Literature shows that using evidence to inform decision making when designing healthcare settings can result in improved care outcomes. This research focuses on the purpose-built evidence-based design (EBD) of three forensic psychiatric hospitals. The findings highlight four themes instrumental to supporting patients’ daily well-being: privacy; upholding one’s sense of self; comfort and harmony; and connection to one’s life.
The purpose of the research was to investigate the extent to which forensic psychiatric facilities designed using EBD, along with person-centered care, support patients’ everyday experiences.
This study utilized a qualitative approach to evaluate patients’ everyday experiences of the environment of three newly built forensic psychiatric hospitals in Sweden. These facilities were designed utilizing the EBD process to support a patient-centered approach, with physical features such as single-patient rooms with access to private bathrooms, access to views of nature through windows, access to gardens, and implementation of noise reduction strategies in design.
The three facilities had similar configurations but were located in different geographic areas. Hospital A was a high-security facility located on the outskirts of a large city; hospitals B and C were low- and medium-security facilities located in rural areas.
Purposeful sampling was used to select 19 participants and data was collected through the photovoice method. All the participants were admitted to the hospitals at the time of the study. The research questions that guided the study were: “Can purpose-built environments and a person-centered philosophy be mirrored in patients’ experiences of the environment and care after relocation? How do patients experience the new buildings in their everyday living?”
After receiving ethical approval of the study and gathering formal consents from the hospitals, patients were informed about the study. After accepting the invitation and signing consent forms, participants were given cameras accompanied by a note that mentioned "Please take photographs of 3-4 objects in your room that are important to you in a positive or negative sense.” Photographs were printed and used during the open-ended interviews with the patients.
Researchers utilized thematic analysis for analyzing thematic meanings and patterns in the data. First, the interview texts were read critically by the researchers; second, the content of the photographs was analyzed, and third ‘meaning units’ were identified in the text, coded for understanding underlying meaning, and finally, the overall themes were identified.
The researchers analyzed the interviews with patients and photographs that they submitted as part of the photovoice methodology and investigated the ways that forensic psychiatric facilities designed using EBD support the daily lives of patients. Four major themes emerged through the analysis: 1) privacy; 2) upholding one’s sense of self; 3) comfort and harmony; and 4) connection to one’s life. Each theme is summarized here:
1) Having a private place: Possibilities in the built environment to safely withdraw and reflect were identified as important for supporting daily life. In addition, flexibility of space in offering opportunities for furnishing the rooms with patients’ personal objects and individual choices was highlighted as central to creating a sense of homeliness.
2) Upholding one’s sense of self: Private patient rooms with private bathrooms were identified as instrumental in establishing feelings of self-respect, securing personal boundaries, and not feeling powerless in a hospital setting. In addition, spaces such as the prayer room or activity center that allowed patients to exercise their religion and interests were critical to maintaining one’s personality and identity.
3) Feelings of harmony and comfort: Spaces and features such as private bathrooms, comfortable beds, and homely features that allowed patients to live a normal life as possible were identified as vital for feelings of comfort and sense of harmony.
4) Remaining connected to one’s life: Features that allowed patients to continue being part of a larger community and their lives out of the institution (e.g., photographs of loved ones, gifts, and personal belongings, as well as participation in group social activities) were critical for maintaining a sense of hope for the future. In addition, windows with views to the outside also provided opportunities to connect with the outside world, and peacefully withdraw and reflect.
The findings of the study were instrumental in understanding how a facility can support daily life and a sense of normalcy for patients.
The researchers identified participant selection as a possible limitation of the study mainly because staff members in the unit, not the research team, were the ones who selected them. Additionally, it is worth noting that the setting of the research (Sweden) and the cultural backgrounds and values of both the researchers and the participants are central to the analysis and themes that were identified in the research. Future research could explore the EBD process in various cultural settings.