Research

An Exploration of the Nightstand and Over-the-Bed Table in an Inpatient Rehabilitation Hospital

Health Environments Research & Design Journal 2015, Vol. 8(2) 43-55 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1937586714565612 herd.sagepub.com

Stan Healy, DHA, NHA, FACHE1, Joe Manganelli, BArch2, Patrick J. Rosopa, PhD2, and Johnell O. Brooks, PhD3,4

Abstract Objective: This study seeks to determine where patients in a rehabilitation hospital keep the greatest percentage of their belongings, that is, in/on the nightstand or on the over-the-bed table. Background: This study provides an inventory of patient items located on the over-the-bed table and in/on the nightstand. Understanding the functions of furnishings within the patient room is key for future preparation for designing a next-generation over-the-bed table or for redesigning a more useful nightstand. Methods: The contents on the top of the nightstand; the contents in the top, middle, and bottom drawers of the nightstand; items next to the nightstand; and the contents on the over-the-bed table within patient rooms were inventoried and placed into categories using similar, patient item categories as the Brooks et al. (2011) study, which examined the contents of the nightstand and the over-the-bed table in assisted living and skilled nursing facilities. Results: Overall, patients in a rehabilitation hospital had a greater percentage of their belongings on the top of the nightstand as compared to their belongings located in all three combined drawers of the nightstand. Overall, patients had a greater percentage of their belongings located on the over-the-bed table as compared to their belongings located on the nightstand. Conclusions: Tabletop surface area was used extensively in patient rooms at a rehabilitation hospital, but nightstand drawers were underutilized. Keywords rehabilitation, over-the-bed table, nightstand, hospital furniture

This exploratory study inventoried the contents and locations of patient belongings stored both in/on the nightstand and on the over-the-bed table located within patient rooms within a rehabilitation hospital. Thirty-six participants undergoing inpatient treatments at a regional rehabilitation hospital participated in this study. Each participant’s patient room had an entry level, institutional-grade HillRom nightstand and over-the-bed table as part of the furniture provided to him or her. This study focused on the utilization of the patient room

1

Greenville Health System, Greenville, SC, USA Department of Psychology, Clemson University, Clemson, SC, USA 3 Clemson University International Center for Automotive Research, Clemson University, Clemson, SC, USA 4 Clinical Research Faculty, Department of Medicine, Greenville Health System, Greenville, SC, USA 2

Corresponding Author: Johnell O. Brooks, PhD, Clemson University, 4 Research Drive, Greenville, SC 29607, USA. Email: [email protected]

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nightstand and over-the-bed table in order to understand aspects of both the functionality and the inpatient experience of a patient room in a rehabilitation setting. Focusing on understanding the functionality was motivated by demographic shifts that are placing increasing pressure on health care resources across the continuum of care, including rehabilitative care for patients with chronic illnesses. Focusing on improving the inpatient experience of patient rooms was motivated by structural changes in patient and caregiver expectations for amenities and clinical trends that place more equipment in the patient room. Pressure is being placed on health care resources because populations are increasingly older, suffering common illnesses and injuries associated with old age and because the incidence of chronic illnesses is growing rapidly for people of all ages and in many countries. With respect to the ‘‘graying’’ of the population, this is a global trend without parallel in the history of humanity. According to a report prepared by the Population Division of the United Nations (2002), by 2050 the number of older persons in the world will exceed the number of younger persons for the first time in history, with the population of adults older than 60 years projected to increase from 10% to 20%. Currently, nearly one of every four persons in Japan is 65 years and older, and there are similar trends in Italy and Germany (Jacobsen, Kent, Lee, & Mather, 2011). In addition, the population aged 80 years and older is increasing at a much faster rate than any other age-group (United Nations, 2009; Waite, 2004). As their numbers increase at the rate of 3.8% per year, they represent more than one tenth of the total number of older persons worldwide (United Nations, 2002). In the coming decades, it is likely that these unprecedented demographic changes will have widespread repercussions for health care systems worldwide as they adapt to and support aging adults who will likely face chronic illness, disability, and/or frailty. The graying of the population is a phenomenon also affecting the United States. According to the U.S. Census Bureau (2006), the U.S. population aged 85 years and older will increase to about 7.3 million in 2020 and then double to 15 million by 2040. This dramatic population

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transformation will occur as members of the very large baby boom cohort (the 78 million people born between 1946 and 1964) reach these ages (U.S. Census Bureau, 2006). By 2030, more than 37 million baby boomers will be managing more than one chronic condition, and this cohort will account for more than twice as many projected hospital admissions when compared to current hospitalization trends (First Consulting Group, 2007). Furthermore, an estimated 157 million Americans, nearly 50% of the general population, are projected to have at least one chronic condition by the year 2020 (Wolff, Starfield, & Anderson, 2002). These trends are significant for those planning how to address the U.S.’s health care needs. The challenge of addressing these trends is compounded because among the U.S. Medicare patients, 20% who are hospitalized are readmitted within 30 days, and most of these individuals have more than one chronic illness, which contributes to annual health care costs approaching US$2.5 trillion (Barnes, 2011). Unfortunately, health care delivery systems have been slow in adopting and developing appropriate services that will address the chronic illnesses and disabilities that both aging and current elderly Americans will likely face (Leveille, Wee, & Iezzoni, 2005; Lynn & Adamson, 2003). Furthermore, each year, more than 10 million Medicare beneficiaries are discharged from acute care hospitals (Buntin, 2007) into postacute care settings, which include inpatient and outpatient rehabilitation facilities. In general, during the past 20 years, the necessity for and the cost of medical rehabilitation care have been increasing due to the growing population of older adults who experience strokes, hip fractures, joint replacements, and other conditions (Heinemann, 2007) such as arthritis, diabetes, and obesity. At the same time that health care resources across America are increasingly under pressure to reduce costs, alleviate demands on caregivers, and positively affect patient outcomes (Fani & Artemis, 2010), the needs, preferences, values, and demands of older U.S. citizens lead them to have higher expectations for quality and convenience of care than those of past generations. The near-term senior population represents a patient clientele who will require the health industry to

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cater to their needs with innovative, safe, personalized care, and will expect less invasive surgical options, more diagnostic testing, consistent monitoring of health conditions, and assistive technologies that meet their needs (First Consulting Group, 2007). The above-mentioned trends, when considered jointly and with respect to inpatient rehabilitation care, are pressuring rehabilitation care providers to redefine appropriate models for meeting the demands of rehabilitation care settings with respect to both functionality and the user experience. Two key parts to improving functionality and the user experience of rehabilitation care are the services provided by clinicians and staff and the rehabilitation environment, furnishings, fixtures, and equipment. With respect to the former, the services provided by clinicians and staff help people with chronic illness and disability learn to live as independently as possible (Neatherlin & Prater, 2003). Medical rehabilitation care requires high touch and physical application and involves patient diagnoses that are extremely labor intensive (Heinemann, 2007). With respect to the latter, studies addressing the contribution of the inpatient rehabilitation care setting to a patient’s rehabilitation have been sparse, despite the fact that the patient room and its furnishings figure prominently in providing care. Furthermore, while inpatient rehabilitation care is a key component of the health care delivery system, little is known about the active components of rehabilitation practices that produce the best outcomes (Heinemann, 2007). Therefore, there is a need for examination of the unique role of the rehabilitation care setting in inpatient rehabilitation. In addition to redressing the dearth of information on the role of the patient room and furnishings during rehabilitative care, there are other reasons why understanding the functionality and user experience of the patient room and furnishings is important for hospital administrators and designers. Since the delivery of care within the patient room is currently undergoing structural changes and the gravity of these changes are coming into sharp focus (Herman Miller Healthcare Research Summary, 2010), hospital administrators are faced with new and complex business realities that exert pressure to improve quality

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in order to serve and satisfy current and future patient clientele. Part of the solution is discovering what is most utilized and needed within the patient room. Focusing on core assets is essential for medical rehabilitation settings to provide timely care that effectively addresses the needs of patients who are learning to accommodate their impairments, enhance their independence with respect to activities of daily living (ADL), and improve their quality of life. Given all of these considerations, research and design endeavors within the rehabilitation setting should be focused on creating flexibility where it impacts the patient the most—within the context of the patient room. The patient room presents a complex organizational utilization and design challenge due to the different people who will occupy the space (e.g., patients, clinicians, support staff, visitors, etc.); the complex integration of furniture, equipment, and building systems; and the wide range of activities that take place within it. By current standards, hospital rooms must be of sufficient size to accommodate a gurney bed or wheelchair to be moved in and out of the room as well as accommodating two caregivers simultaneously, a visitor/patient chair, a nightstand, an over-the-bed table, and a washing facility. In addition, to accommodate new advances in technology, patient demands, an aging population, and innovative models of care, rooms are now being designed to grant patients more control over their surroundings (Eagle, 2007). For instance, simply giving patients access to their own personal things may go a long way toward improving patients’ experiences, maximizing patient safety, and increasing customer satisfaction (Focus: Patient Room Furniture, 2008). New design strategies derived from evidence-based design research are beginning to closely examine all elements within the patient room that will increase safety, improve outcomes, meet patients’ personal needs, and make rooms more efficient not only for patients and families but also for staff who need easy access to their patients. All of this equates to more stuff in the patient room. As floor space becomes a scarcer commodity in today’s health care facilities, the footprints of items typically found in patient rooms are shrinking (Eagle, 2007).

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Even though in most patient rooms, patients and caregivers seem to rely heavily and consistently on the furniture, attention to individual furnishings (other than the patient bed), particularly the nightstand and the over-the-bed table, has been minimal for much of health care’s history. Therefore, there is a great need to understand the usage and effectiveness of these furnishings. Despite a few previous studies conducted within other care settings (Brooks et al., 2011), there is no evidence to suggest how patients in an inpatient rehabilitation hospital utilize the nightstand and the overthe-bed table within patient rooms. Establishing an empirical foundation for the usage and the needs of the nightstand and the over-the-bed table leads to a better understanding of furniture utilization in the patient room as well as a better understanding of patient needs for clinicians, administrators, and designers. This study, conducted at an acute care rehabilitation hospital, seeks to fill the void in the research by answering the question of how rehabilitation inpatients utilize the nightstand and the over-the-bed table within their rooms, which are their primary environments and points of care. Evaluating the usage of the nightstand as compared to the usage of the over-the-bed table and knowing what items patients keep on their nightstands as compared to their over-the-bed tables will lead to better understanding of patient behaviors and a reassessment of what furniture and equipment is essential within the patient room. This study is modeled after a recent descriptive study by Brooks et al. (2011) that investigated the contents of nightstands and over-thebed tables located in an assisted living facility and a skilled nursing facility to understand how patients used the furniture. Twenty-eight volunteers, ranging in age from 38 to 90 years, participated. All participants had similar three-drawer nightstands and over-the-bed tables. The contents on the top of the nightstand, the top drawer, the middle drawer, the bottom drawer, items next to the nightstand, and items on the over-the-bed table were cataloged. In order to understand how patients organize their belongings, investigators also documented the locations where patients keep items, that is, bag, open containers, and closed containers. After recording the locations and

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quantities of items in order to get an understanding of the items, individual participants were asked to identify the five ‘‘most used’’ items. Finally, the participants were asked to provide suggestions for future designs so that researchers may design better nightstands and furniture to be used by aging individuals in the future. Over 150 different items were recorded and then combined into 25 categories, with a minimum of 6 patients having items in each category (see Table 1). After identifying the number of patients with items in each category, Brooks et al. (2011) documented the number of items per patient (in each category) in order to calculate the minimum number of items, maximum number of items, average number of items, and standard deviation. Results showed that a minimum of 20 patients had items in 10 of the categories including personal hygiene (n ¼ 28), trash can (n ¼ 28), clothing item (n ¼ 24), food accessory (n ¼ 24), telephone (n ¼ 24), book/magazine (n ¼ 23), water jug (n ¼ 22), lotion (n ¼ 21), tissue box (n ¼ 21), and free-standing medical device (n ¼ 20). Based on the results of this study, Brooks et al. (2011) observed that it was apparent that even though the nightstand is clearly an important piece of furniture for older adults, some of their needs are not being fulfilled by the nightstand, such as, specific areas designated for personal hygiene items as well as additional storage and a power outlet.

Method Study Design Conducting this exploratory, descriptive study at an inpatient rehabilitation hospital was a natural progression following the Brooks et al. (2011) study, which was conducted in a skilled nursing facility and an assisted living facility. Approval from the appropriate institutional review boards was obtained prior to data collection.

Furniture Patients in this study used the Hill-Rom Patient Mate Jr. #220 over-the-bed table and the Hill-Rom Vista Bedside Cabinet P2303. These furnishings are entry level, institutional-grade items, with basic institutional-grade materials and

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Table 1. Comparative List of New Items Found in a Rehabilitation Hospital That Were Not Found in an Assisted Living Facility Brooks et al. (2011).

Brooks et al. (2011) Items Bedpan Beverage Book/magazine

Clothing item

Decoration

Dental hygiene

Entertainment

Equipment other Eyeglasses Food accessory

Freestanding medical device Linen Lotion Medical item

Emesis basin, urinal Ensure, juice, soda can, and water bottle Address book, phonebook, phone number list, and newspaper Belt, gloves, handkerchief, hat, jewelry, nightgown, pajamas, shirt, shoes, sock pair, sweater, underwear, and watch Calendar, craft, flowers, photo album, picture, picture frame, plant, plush toy, and stuffed animal Denture cream, dentures, mouthwash, teeth cup, toothbrush, and toothpaste Ball, deck of cards, DVD player, DVD’s, electronic handheld game, magic kit, paint in jar, puzzle, radio, and TV remote Flashlight, fan, ice bucket, lamp, and nightlight Sunglasses Clear plastic wrap, cup, food tray, fork, glass, lunch tray, napkins, plate, spoon, straw, toothpick, and TV tray Cane, commode chair, walker, and wheelchair Blanket, pillow, sheet, towels, and wash cloth Hand cream, lotion, and medicated cream Ace bandage, alcohol swabs, arm brace, bandage tape, call button, cold pack, cough drops, ear plugs, exercise handball, first aid kit, hand brace, magnifying glass, medication, pick up device, shoe horn, tubing, wheelchair charger, and plastic gloves

Items From Brooks et al. (2011) Not Found in Rehab Setting

New Items Found in Rehab Setting Cup of tea and milk carton

Address book and phone number list Belt, gloves, handkerchief, jewelry, nightgown, pajamas, underwear, and watch

Hospital gown, jacket, pants, and slippers

a

Dentures

Dental floss

Ball, DVD player, DVD’s, magic kit, paint in jar, and radio a

Sunglasses Clear plastic wrap, food tray, glass, lunch tray, plate, toothpick, and TV tray

Eyeglass case Bowl and knife

Cane Sheet

Bandage tape, cold pack, ear plugs, first aid kit, hand brace, magnifying glass, medication, and shoe horn

ADL devices, back scratcher, blood pressure cuff, clamps, cotton, foam tubing, gauze, hospital bracelet, hydrogen peroxide, ice bucket, lancet, leg lifter, medicine cup, ointment, oxygen cannula, sock aid, sterile water, syringe, thickener, trachea accessories, wheelchair accessories, and wound cleanser (continued)

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Table 1. (continued)

Brooks et al. (2011) Items Miscellaneous

Oxygen machine Paper

Telephone Tissue box Trash can Water jug Writing utensil Wallet/handbag

Items From Brooks et al. (2011) Not Found in Rehab Setting

New Items Found in Rehab Setting

Bank book, computer bag, Batteries, cell phone charger, aCoins, light bulb, glue, mail, flashlight, flowers, coins, light bulb, glue, medal, money, novelty item purse, rubber band, greeting card, mail, medal, (bingo prizes), pocket knife, stickers, trash items, money, novelty item (bingo scissors, tape measure, and and wallet prizes), pocket knife, wd40 scissors, tape, tape measure, and wd40 Nebulizer and breather Drawing pad Business cards and folders Blank paper, drawing pad, (with hospital materials) index cards, notepad, papers, and writing paper Cell phone

Pen and pencil Money pouch

a

Note. ADL ¼ activity of daily living. a Categories with less than six patients include decoration, equipment other, and wallet/handbag. Items within those categories were included in the miscellaneous category.

mechanisms. For the over-the-bed table, this includes an adjustable height table and pull out extendable tray with storage compartment. For the nightstand, this includes three drawers and casters on the bottom. Hill-Rom is considered a marketleading medical company, which has approximately 70% installed-base market share of patient room furniture in the United States (Hill-Rom Holdings’ CEO Presents at Morgan Stanley Global Healthcare Conference [Transcript], 2012).

inability to consent as a cognitively intact adult. The volunteers ranged in age from 14 to 92 years (M ¼ 63.7, SD ¼ 16.7). Eighteen were male, 21 had a private room, and the interview day ranged between the patient’s 1st to 23rd day in the hospital (M ¼ 7.8, SD ¼ 5.5). Participants were asked by the study team to participate, and all agreed to participate.

Procedures Participants Participants for this study consisted of 36 patients in an inpatient rehabilitation hospital who represented a cross section of the conditions seen at a rehabilitation hospital. Specifically, inclusion criteria were inpatients at the rehabilitation hospital with spinal cord injuries, lower or upper extremity amputations, strokes, orthopedic/comprehensive rehab (hips, knees, and multiple bone fracture), overall trauma, or chronic debility. Exclusion criteria were pediatric patients and patients with traumatic brain injury due to their

This study was modeled after a recent research study by Brooks et al. (2011), which investigated the contents of nightstands and over-the-bed tables located in postacute settings. The intent of this study was to improve the understanding of how patients in a rehabilitation hospital facility use the furniture in their patient rooms. Prior to data collection, one researcher was trained by Brooks et al. (2011) to ensure consistency with the data collection process from the previous study. Clinicians provided the researcher a list of participants who met the inclusion criteria on each

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data collection day. Participants were interviewed on an individual basis during nontherapy times, typically in the evening so as not to interfere with patient care. Data were collected through scripted, structured interviews that were recorded on paper and then later transferred to a tablet computer. Participants were told the purpose of the study was to investigate the contents of nightstands and over-the-bed tables so that researchers could design better nightstands and furniture for aging individuals in the future. After providing verbal consent, background information was recorded. Subsequently, the interviewer documented the contents on the top of the nightstand; the contents in the top drawer, the middle drawer, and the bottom drawer of the nightstand; items next to the nightstand; and the contents on the over-the-bed table. Each interview took less than 15 min.

Results A list of individual items was compiled to compare the individual items in the Brooks et al. (2011) study. Table 1 shows the individual items from the Brooks et al. (2011) study, which were not found in the rehabilitation setting, and new items found in the rehabilitation setting that were not recorded in the Brooks et al. (2011) study. Table 1 also compares the care settings, and the different items reflect the length of stay for the patient. Items that family members brought in or items that the patients themselves requested differed based on the needs of the patients, care settings, and lengths of stay. Next, all individual items were placed into categories using the same categories as the Brooks et al. (2011) study. The new items found in the rehabilitation setting all clearly fit into existing categories. Three categories were not included in this study because there were less than six patients with items in each (decoration, equipment other, and wallet/handbag), and items that would be categorized into those three categories were included in the miscellaneous category. Typically, patients did not have these types of items because their lengths of stay were shorter in the rehabilitation setting than the lengths of stay for participants in the long-term

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care or skilled nursing facility studied by Brooks et al. (2011). The number of patients with items in a given category, the locations of items, the number of locations each patient kept items, and other descriptive statistics are presented in Table 2. Table 3 shows the locations of the items averaged across the categories for the different locations. The number of patients with items in a given category is followed by the overall range, average number of items per person, and the respective standard deviations. The ranges and averages do not include zeros (i.e., people who did not have an item in a given category were excluded). The location of items is also presented. The number of locations patients kept the items is described using the minimum, maximum, mean, and standard deviation. For each patient, the overall quantity of items was determined as well as the quantity of items that each patient had at each of the six locations (i.e., over-the-bed tabletop, top of nightstand, nightstand drawer 1, nightstand drawer 2, nightstand drawer 3, and next to nightstand). The correlation matrix among seven variables can be found in Table 4. As expected, as the overall quantity of items increased, this was positively associated with the quantity of items (a) on the over-the-bed table (r ¼ .71), (b) on top of the nightstand (r ¼ .60), (c) in the nightstand drawer 1 (r ¼ .48), (d) in nightstand drawer 2 (r ¼ .44), (e) in nightstand drawer 3 (r ¼ .42), and (f) next to the nightstand (r ¼ .43). In addition, as the quantity of items in drawer 2 increased, the quantity of items in drawer 3 tended to increase (r ¼ .86). It deserves noting that the magnitude of the correlation coefficients generally decreased as the distance of the location from the patient’s bed increased. Stated differently, the proportion of variance explained in the quantity of items on the over-the-bed table due to the overall quantity of items was 51%, while the proportion of variance explained in the quantity of items on top of the nightstand due to the overall quantity of items was 36%. The proportion of variance explained in the quantity of items in nightstand drawer 1 due to the overall quantity of items was 23% and so forth. A correlation coefficient was calculated between the overall quantity of items and the

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1 1 1 1 1 1 1 1 1 1

1 1 1 1 1 1 1 1 1 1 1 1

6 19 27 10 11 24 8 32 26 26

13 19 23 17 7 27 32 32 16 6 32 10

4 3 32 5 2 4 13 2 2 1 1 3

1 3 7 4 5 2 1 18 17 3 33 30 123 33 9 43 120 42 19 6 32 13

6 39 83 21 22 27 8 229 94 37

Number of Min Max Total Items Patients Number Number Across With Item of Items of Items Patients

2.5 1.6 5.3 1.9 1.3 1.6 3.9 1.3 1.2 1.0 1.0 1.3

1.0 2.0 3.1 2.1 2.0 1.1 1.0 7.2 3.6 1.4 1.3 0.7 6.8 1.2 0.5 0.8 2.9 0.5 0.4 0.0 0.0 0.7

0.0 1.1 2.1 1.4 1.3 0.3 0.0 4.4 3.7 0.7 9 8 13 7 2 16 17 22 2 2 1

30 9

14 7

3 5 9 7 4 4

3 10 17 13 5 14 24 17 15

3 17 13 2 6 19 6 29 19

7 5

1 4 8 2

2 4 4

3

10

2 1 4

2 1

1 9 1

6

3 1 2

5

1

1

26

1

1 3

1

1

1

1 4 1

1 1 1 1 1 1 1 1 1 1 1 1

1 1 1 1 1 1 1 1 1 1

2 2 5 2 2 3 3 2 2 1 1 1

1 2 4 3 2 2 1 3 2 1

1.3 1.2 2.2 1.3 1.3 1.4 1.5 1.2 1.1 1.0 1.0 1

1.0 1.3 1.7 1.4 1.2 1.0 1.0 1.5 1.2 1.0

0.5 0.4 1.2 0.5 0.5 0.6 0.6 0.4 0.3 0.0 0.0 0

0.0 0.5 1.0 0.7 0.4 0.2 0.0 0.7 0.4 0.0

Number of Locations a Patient Keeps the Item Standard Deviation Min Max Standard of the Overbed Top of Nightstand Nightstand Nightstand Next to Number of Number of Deviation of Mean Table Nightstand Drawer 1 Drawer 2 Drawer 3 Nightstand Locations Locations Mean the Mean

Number of Patients With Item (Person Can Be Counted for More Than One Location)

Note. Categories not included (less than six patients): decoration, equipment other, wallet/handbag then all items combined in the miscellaneous category.

Bedpan Beverage Book/magazine Clothing item Dental hygiene Entertainment Eyeglasses Food accessory Food/snack Freestanding medical device Linen Lotion Medical item Miscellaneous Oxygen machine Paper Personal hygiene Telephone Tissue box Trash can Water jug Writing utensil

Items Across Patients

Mean Number of Items per Patient

Table 2. Description of the Number of Patient Items.

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Table 3. Locations of the Items Averaged Across the Categories for the Different Locations.

Items per Overbed Top of Nightstand Patient Total Tabletop Nightstand Drawer 1 Min Max Mean SD

7 56 30 14

4 36 15 7

2 30 9 7

Nightstand Drawer 2

0 14 3 3

0 11 1 2

Table 4. Intercorrelations Among Overall Quantity and Quantity of Items at Each of Six Locations. Quantity 1. Overall 2. Overbed table 3. Top of nightstand 4. Nightstand drawer 1 5. Nightstand drawer 2 6. Nightstand drawer 3 7. Next to nightstand

1

2

3

4

5

2 5 3 1

0 1 1 0

Location

M

SD

14.75 8.67 2.47 1.08 1.06 1.67

6.77 6.85 3.20 2.17 3.29 1.55

.21

.10 .07 .14 .86**

.43** .26 .30

0 6 2 2

Table 5. Average Quantity of Items by Location.

Overbed table Top nightstand Nightstand drawer 1 Nightstand drawer 2 Nightstand drawer 3 Next to nightstand

.48** .30 .00

.42*

0 19 1 3

6

.71** .60** .16

.44** .04 .01

Number of Number of Patients Locations (Excludes With Items Next to Next to Nightstand Next to Drawer 3 Nightstand Nightstand) Nightstand

.21 .07 .03

Note. N ¼ 36. *p < .05 (two-tailed). **p < .001 (two-tailed).

number of locations used by patients. There was a positive relationship (r ¼ .55), indicating that as the number of items increased, the number of locations used by patients tended to increase. Next, we tested the hypothesis that the average quantity of items differed by location. To determine whether the average quantity of items differed by location, a one-way repeated measures analysis of variance (ANOVA) was conducted on the six locations (King, Rosopa, & Minium, 2010). Because the overall ANOVA was statistically significant, F(5, 175) ¼ 62.37 (p < .001), Z2 ¼ .64, there was evidence to suggest that the average quantity of items differed by location. To understand the nature of the differences, pairwise comparisons between locations were conducted. To

control family wise Type I error rate, a Bonferroni correction procedure was used (King et al., 2010). Table 5 presents the means and standard deviations of the quantity of items by location. Although many of the locations differed significantly from one another, the three drawers and next to the nightstand did not differ significantly from one another. In other words, the average quantity of items placed on the overthe-bed table was greatest, followed by the top of the nightstand and the nightstand drawer 1. It deserves noting that seven patients did not place an item next to the nightstand. To examine whether there were any significant differences between patients who did and did not place an item next to the nightstand, twosample t tests were conducted on each of the quantities by location. Note that although the sample sizes were unequal, the variances between the two conditions were similar. That is, the homogeneity of variance assumption was not violated (Rencher, 2000). There were no statistically significant differences on any of the quantities between patients who did and did not place an item next to the nightstand.

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Analysis of the Number of Categories for Each Location Across Patients

Table 6. Average Number of Patients With an Item by Location. Location

M

For each of the 22 categories of items, the total number of items across patients as well as the average number of items per patient was calculated. The average number of locations that patients kept their items was also determined. Based on correlation analyses, a number of relationships were found. As the average number of items per patient increased, the average number of locations tended to increase (r ¼ .72). Similarly, as the total number of items across patients increased, the average number of locations used by patients increased (r ¼ .62). These results are consistent with the results in the previous section. For each of the 22 categories of items, the number of patients with an item by a given location was also determined. Thus, to determine whether the number of patients differed by location, another one-way repeated measures ANOVA was conducted on the six locations. Because the overall ANOVA was statistically significant, F(5, 105) ¼ 18.29 (p < .001), Z2 ¼ .47, there was evidence to suggest that the number of patients with an item did differ by location. Table 6 presents the means and standard deviations by location. Although the over-thebed tabletop did not differ from the top of the nightstand, the over-the-bed tabletop did differ from all of the other locations in terms of the average number of patients.

Overbed table Top nightstand Nightstand drawer 1 Nightstand drawer 2 Nightstand drawer 3 Next to nightstand

12.32 6.91 2.27 .95 .68 2.00

Discussion Due to the rapid growth in the population of older adults in the United States and their greater reliance on health care services, the health care infrastructure of the United States is under pressure to alleviate demands on caregivers and meet the needs of a rapidly increasing pool of patients (Fani & Artemis, 2010). Critical obstacles for health care environments lie ahead if services are to be provided to patients who are more savvy and who have higher expectations for care as compared to previous generations (First Consulting Group, 2007). In addition, to improve patient satisfaction and staff efficiency, it is important for

SD 8.80 6.16 3.01 2.06 1.32 5.56

all types of care settings to have an understanding of patient needs, and specific populations of patients must be studied to determine the appropriate mix for ideal patient care (Brown & Gallant, 2006). Since patient rooms are the primary environments and points of care where patients spend most of their time, undergo treatments and procedures, and receive nursing care, it is logical that the furnishings within the patient rooms likely affect the healing and well-being of the patients (Lorenz & Dreher, 2011). This study brings clarity to the needs of patients undergoing inpatient rehabilitation by analyzing their utilization of patient room furniture. This study shows how patient room nightstand utilization differs significantly between postacute care and rehabilitation settings and confirms the high utilization of the over-the-bed tabletop. In summary, patients expecting to be discharged home consider a rehabilitation facility a transitional setting and are therefore more self-reliant than patients staying in a long-term care facility—and the items they keep in and around them reflect this reality. In addition, where they keep these items is indicative of how useful the nightstand and over-the-bed table are. This study shows that the tabletops of each piece of furniture are heavily utilized, that the top drawer of the nightstand is somewhat utilized but that lower drawers are underutilized. Such insight questions the value of storage provided close to the ground in a patient room and opens the possibility that perhaps space may be better utilized. This study builds upon the Brooks et al. (2011) study, which examined the contents of the nightstand and the over-the-bed table in assisted living and skilled nursing facilities. The Brooks et al. (2011)

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study found that the greatest number of items was kept on the top of the nightstand. The next greatest number of items was stored in the top drawer of the nightstand. The third greatest number of items was kept on the over-the-bed table, while the fewest number of items was stored in the bottom drawers of the nightstand. In the rehabilitation hospital, a different pattern was observed where the greatest number of items was found on the over-the-bed table, followed by the top of the nightstand. This study used similar patient item categories as Brooks et al. (2011) and placed all patient items into those categories. In summary, patients in an inpatient rehabilitation hospital had a greater percentage (67% more) of their belongings located on top of the over-the-bed table as compared to the percentage of their belongings located on top of the nightstand. The patients had a greater percentage (200% more) of their belongings on top of the over-the-bed table compared to within all three of the nightstand drawers combined. When examining only the nightstand, overall, patients in an inpatient rehabilitation hospital had a greater percentage (80% more) of their belongings on the top of the nightstand as compared to the percentage of their belongings located in all three combined drawers of the nightstand. Notably, when examining the average number of items in each of the drawers, the top drawer had a mean of 3 items, while the bottom two drawers each had a mean of 1 item. Results of this study showed that, in general, patients chose to place the majority of items in the most accessible locations, the tops of the over-the-bed table and nightstand, rather than in the nightstand. Some differences between the earlier study Brooks et al. (2011) and this study, regarding the types of items, include the fact that in the rehabilitation hospital the book/magazine category primarily consisted of materials provided by the hospital, including a Bible, telephone book, or patient care materials; whereas, in the earlier study, the category consisted of items that the patient chose to read, including novels, magazines, and so on. A second difference is that in this study the entertainment category consisted primarily of remote controls, while in the earlier

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study the same category had more variety including a ball, deck of cards, DVD player, DVDs, electronic handheld game, magic kit, paint in jar, puzzle, radio, and remote controls for the TV. It deserves noting that items that family members brought in or that the patients themselves requested differed based on the needs of the patients, care settings, and lengths of stay. In addition, one should note that the staff did not keep their supplies either in the nightstand or on the over-the-bed table because of strict infection/cross-contamination protocols that exist. The patients have a greater percentage of their belongings located on the over-the-bed table and the top of the nightstand compared to their belongings located in the nightstand, suggesting that drawers may be unnecessary. If this proves true, the nightstand may be a piece of furniture that hospitals could eliminate as long as the equivalent tabletop surface area is provided, thus yielding more floor space within the patient room. Benefits of increased floor space may include increasing nurses’ and/or therapists’ efficiency and reducing the frustration of caregivers, since they would have additional floor space while interacting with patients. Conversely, if a nightstand must be available to patients, then perhaps it might be feasible to develop a hybrid combination of both an over-thebed table and a nightstand that better serves the needs of patients and caregivers. Other implications affecting nonclinical staff, specifically housekeeping and maintenance, may be the amount of time saved in cleaning and clearing the nightstand after discharge. Repairs, preventive maintenance, and replacement are all factors when considering any piece of health care furniture. Capital assets and inventories of rooms take place in most facilities annually and reduction and consolidation brings efficiencies. With respect to this study, the over-the-bed tabletop and the nightstand tabletop represent essential components of the patient room environment and the daily activities of the patient. Future studies might examine not only patient preferences and needs but also staff preferences and needs with general usage, mobility issues, and surface usage. Improving patient room furniture utilization may be a substantial component of realizing future design criteria for the patient room.

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Based on the outcomes of this study, current and future research should focus on the context and use cases of patient room furnishings. Specifically, understanding the functions of furnishings within the patient room is essential preparation for developing more useful and usable nightstands and over-the-bed tables. In addition, a focused study of the interrelationships between first costs, life cycle costs, how they are cleaned and maintained, and their usefulness would be valuable future research. This knowledge would also be valuable for contextualizing staff and patient preferences for features and functions of patient room nightstands and over-the-bed tables.

Implications for Practice  In the rehabilitation hospital, the greatest number of items was found on the overthe-bed tabletop, followed by the top of the nightstand.  The nightstand drawers are underutilized and may not meet the needs of patients, though the tabletop surface area is needed.  The nightstand drawers may be unnecessary components of furniture that hospitals can remove from the patient room, thus providing more floor space for staff, patients, and families.  Tabletop surface area is an essential component of the patient room environment and the daily activities of a patient. Acknowledgment This project was partially supported by the Roger C. Peace Rehabilitation Hospital of the Greenville Health System, Clemson University, and the Medical University of South Carolina. In particular, we would like to thank Mandy Argoe, Gladys Center, Carmen Cribb, Dr. Deborah Krotish, Jeremy McKee, Kylie Sprogis, Constance Truesdail, and Dr. James Zoller. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. References Barnes, J. (2011, May). Are we all accountable? Shared saving is shared responsibilities. Retrieved from the Health Management Technology website: http://www.healthmgttech.com/articles/201105/arewe-all-accountable-shared-savings-shared-responsibilities.php Brooks, J. O., Smolentzov, L., DeArment, A., Logan, W., Green, K., & Walker, I., . . . Yanik, P. (2011). Towards a ‘‘smart’’ nightstand prototype: an examination of nightstand table contents and preferences. Health Environments Research & Design Journal, 4(2), 91–108. Brown, K., & Gallant, D. (2006). Impacting patient outcomes through design: Acuity adaptable care/ universal room design. Critical Care Nursing Quarterly, 29, 326–341. Buntin, M. B. (2007, November). Access to postacute rehabilitation. Archives of Physical Medicine and Rehabilitation, 88, 1488–1493. doi:10.1016/j. apmr.2007.07.023 Eagle, A. (2007). Creating the [patient-centered] room. Health Facilities Management, 20(6), 40–44. Fani, V., & Artemis, K. (2010). An overview of the healing environment. Retrieved April 2, 2012, from International Hospital Federation: www.ihf-fih.org First Consulting Group. (2007, May). When I’m 64: How the Baby Boomer Will Change Health Care. Chicago, IL: American Hospital Association. Focus: Patient Room Furniture. (2008, October 2). Contract. Academic One File. Retrieved April 24, 2012, from http://go.galegroup.comlibrproxy.clem son.edu/ps/i.do?id¼GALE%7CA186777656&v ¼2.1 &u¼clemson_itweb&it¼r&p¼AONE7sw¼w Heinemann, A. W. (2007, November). State of the science on postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy: An introduction. Journal of NeuroEngineering and Rehabilitation, 4, 43. doi: 10.1186/1743-0003-4-43 Herman Miller Healthcare Research Summary. (2010). Patient rooms: A changing scene of healing. Zeeland, MI: Herman Miller.

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Copyright of Health Environments Research & Design Journal (HERD) (Sage Publications, Ltd.) is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

An Exploration of the Nightstand and Over-the-Bed Table in an Inpatient Rehabilitation Hospital.

This study seeks to determine where patients in a rehabilitation hospital keep the greatest percentage of their belongings, that is, in/on the nightst...
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