Placing Care: The Impact of the Physical Environment on Experiences of Providing and Utilizing Palliative Care

10.1097/jnr.0000000000000508

David A. AGOM；Judith SIXSMITH；Jude OMINYI；Tonia C. ONYEKA；Joy C. AGOM

environment ； end-of-life care ； healthcare practice ； Nigeria ； palliative care

The Journal of Nursing Research

30卷5期（2022 / 10 / 01）

1 - 11

英文

Background: Environmental design in palliative and end-of-life care is known to improve care outcomes, service-user satisfaction, and the continuation of service uptake. No study in the literature has investigated the influence of the environment on palliative and end-of-life care in Nigeria or other African contexts. Purpose: This study was designed to explore the impact of the physical environment (i.e., place and people) on staff and service users and how these influence the experiences of providing and using palliative and end-of-life care in a Nigerian hospital context. Methods: Ethnographic methodology was employed because this approach facilitates understanding of environmental realities. This study is part of a larger ethnographic research project developed to uncover aspects of organizational complexities related to the provision and use of palliative and end-of-life care in the Nigerian context. Three hundred fifty hours of participant observation was achieved, and semistructured interviews were used to gather data from 26 participants, including 10 patients, 11 members of a palliative care team, and five hospital managers. Informal chats and photographic capture were additional methods used in data collection. Thematic analysis was conducted to identify and analyze patterns within the collected data. Results: Physical space, equipment, and placing staff were the three primary themes identified. The physical environment was untidy, and the ward layout prevented privacy, dignity, or comfort for patients and families. The equipment was old and inadequate, and the context of care was worsened by insufficient staffing and neglect of the environmental needs of the staff. Conclusions: Hospital design for palliative and end-of-life care in Nigeria is ＂autoinhibitory＂ (a negative feedback mechanism whereby hospital design detracts rather than promote quality of care), and a physical environment that supports the provision and utilization of care must be implemented to promote palliative and end-of-life care success. Urgent policy action is needed to improve environmental and staffing conditions to advance palliative and end-of-life care in Nigeria.

1. Agbawodikeizu, P. O.,Agwu, P. C.,Okoye, U. O.,Oyeoku, E. K.(2019).Perception and attitudes to end of life planning and implications for social work practice in Enugu State, Nigeria.International Social Work,62(2),892-904.
2. Agom, D. A.,Allen, S.,Neill, S.,Sixsmith, J.,Poole, H.,Onyeka, T. C.,Ominyi, J.(2020).Social and health system complexities impacting on decision-making for utilization of oncology and palliative care in an African context: A qualitative study.Journal of Palliative Care,35(3),185-191.
3. Agom, D. A.,Ominyi, J.,Onyeka, T. C.,Anyigor, C. N.(2020).Exploring organizational culture regarding provision and utilization of palliative care in a Nigerian context: An interpretive descriptive study.Indian Journal of Palliative Care,26(3),358-364.
4. Agom, D. A.,Onyeka, T. C.,Ominyi, J.,Sixsmith, J.,Neill, S.,Allen, S.,Poole, H.(2020).An ethnographic study of palliative and end-of-life care in a Nigerian hospital: Impact of education on care provision and utilization.SAGE Open,10(3),Article 2158244020938700.
5. Agom, D. A.,Poole, H.,Allen, S.,Onyeka, T. C.,Ominyi, J.(2019).Understanding the organization of hospital-based palliative care in a Nigerian hospital: An ethnographic study.Indian Journal of Palliative Care,25(2),218-223.
6. Boccagni, P.(2020).Multi-sited ethnography.SAGE Publications Limited.
7. Brambilla, A.,Rebecchi, A.,Capolongo, S.(2019).Evidence based hospital design. A literature review of the recent publications about the EBD impact of built environment on hospital occupants' and organizational outcomes.Annali di Igiene: Medicina Preventiva e di Comunita,31(2),165-180.
8. Braun, V.,Clarke, V.(2006).Using thematic analysis in psychology.Qualitative Research in Psychology,3(2),77-101.
9. Chandler, D.(2017).Semiotics: The basics.Routledge.
10. Copeland, D.,Chambers, M.(2017).Effects of unit design on acute care nurses' walking distances, energy expenditure, and job satisfaction: A pre-post-relocation study.HERD: Health Environments Research & Design Journal,10(4),22-36.
11. Edmondson, A. J.,Pini, S.(2019).The pros and cons of using photographs in nursing research.Nurse Researcher,27(2),8-13.
12. Elf, M.,Anåker, A.,Marcheschi, E.,Sigurjónsson, A.,Ulrich, R. S.(2020).The built environment and its impact on health outcomes and experiences of patients, significant others and staff-A protocol for a systematic review.Nursing Open,7,895-899.
13. Feld, S.,Basso, K.(1996).Senses of place.School of American Research Press.
14. Fetterman, D.(2019).Ethnography: Step by step.Sage.
15. Gardiner, C.,Brereton, L.,Gott, M.,Ingleton, C.,Barnes, S.(2011).Exploring health professionals' views regarding the optimum physical environment for palliative and end of life care in the acute hospital setting: A qualitative study.BMJ Supportive & Palliative Care,1,162-166.
16. Gold, R. L.(1958).Roles in sociological field observations.Social Forces,36(3),217-223.
17. Lefebvre, H.(1991).The production of space.Blackwell.
18. Lincoln, Y. S.,Guba, E. G.(1985).Naturalistic inquiry.Sage.
19. Loupa, G.(2020).Influence of noise on patient recovery.Current Pollution Reports,6,1-7.
20. Lynch, T.,Connor, S.,Clark, D.(2013).Mapping levels of palliative care development: A global update.Journal of Pain and Symptom Management,45(6),1094-1106.
21. Mackieson, P.,Shlonsky, A.,Connolly, M.(2019).Increasing rigor and reducing bias in qualitative research: A document analysis of parliamentary debates using applied thematic analysis.Qualitative Social Work,18(6),965-980.
22. Melo, S.(2018).The role of place on healthcare quality improvement: A qualitative case study of a teaching hospital.Social Science & Medicine,202,136-142.
23. Nantsupawat, A.,Kunavitktikul, W.,Nantsupawat, R.,Wichaikhun, O. A.,Thienthong, H.,Pogghosyan, L.(2016).Effects of nurse work environment on job dissatisfaction, burnout, and intention to leave.International Nursing Review,61(1),91-98.
24. Ndiok, A.,Ncama, B. A.(2019).Qualitative study of home visiting as a palliative care strategy to follow-up cancer patients by nurses in a clinical setting in a developing country.Scandinavian Journal of Caring Sciences,33(1),185-196.
25. Nightingale, F. (1946). Notes on nursing what it is and what it is not. Edward Stern.
26. Nyland, D.(2008).Organizational ethnography.Sage Publications.
27. Oleribe, O. O.,Momoh, J.,Uzochukwu, B. S.,Mbofana, F.,Adebiyi, A.,Barbera, T.,Williams, R.,Taylor-Robinson, S. D.(2019).Identifying key challenges facing healthcare systems in Africa and potential solutions.International Journal of General Medicine,12,395-403.
28. Oyebola, F. O.(2017).Palliative care trends and challenges in Nigeria-The journey so far.Journal of Emergency and Internal Medicine,1(2),Article 17.
29. Schreuder, E.,Lebesque, L.,Bottenheft, C.(2016).Healing environments: What design factors really matter according to patients? An exploratory analysis.HERD: Health Environments Research & Design Journal,10(1),87-105.
30. Slatyer, S.,Pienaar, C.,Williams, A. M.,Proctor, K.,Hewitt, L.(2015).Finding privacy from a public death: A qualitative exploration of how a dedicated space for end-of-life care in an acute hospital impacts on dying patients and their families.Journal of Clinical Nursing,24(15-16),2164-2174.
31. Spradley, J. P.(2016).Participant observation.Waveland Press.
32. Williams, C.,Gardiner, C.(2015).Preference for a single or shared room in a UK inpatient hospice: Patient, family and staff perspectives.British Medical Journal Supportive and Palliative Care,5(2),169-174.
33. Wright, M.,Clark, D.,Hunt, J.,Lynch, T.(2006).Hospice, and palliative care in Africa: A review of developments and challenges.Oxford University Press.
34. Ybema, S.,Yanow, D.,Wels, H.,Kamsteeg, F.(2009).Organizational ethnography: Studying the complexities of everyday life.Sage Publication.
35. Zadeh, R. S.,Eshelman, P.,Setla, J.,Kennedy, L.,Hon, E.,Basara, A.(2018).Environmental design for end-of-life care: An integrative review on improving the quality of life and managing symptoms for patients in institutional settings.Journal of Pain and Symptom Management,55(3),1018-1034.