NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Healthcare environment
Evidence review M
NICE Guideline, No. 204
National Guideline Alliance (UK).
Healthcare environment
Review question
What features of the environment in which healthcare is provided are important to babies, children and young people to improve their experience of care?
Introduction
The healthcare environment encountered by babies, children and young people when accessing healthcare services can be central to their overall experience of healthcare.
Healthcare environments need to provide a balance between the need for practical and clinical activities or procedures to take place within them, while creating an environment that can contribute to a good experience. This may be particularly difficult to achieve if babies, children and young people receive healthcare treatment or consultation in environments not specifically designed for them.
The aim of this review is to determine what features of the healthcare environment are important to babies, children and young people, and should therefore be included in designs or provided to improve the experience of care.
Summary of the protocol
See Table 1 for a summary of the population, phenomenon of interest and primary outcomes characteristics of this review.
Table 1
Summary of the protocol.
For further details see the review protocol in appendix A.
Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. Methods for this review question are described in the review protocol in appendix A and the methods supplement.
Declarations of interest were recorded according to NICE’s conflicts of interest policy.
Clinical evidence
Included studies
This was a qualitative review with the aim of:
- Understanding which features of the healthcare environment are important to babies, children and young people.
A systematic review of the literature was conducted using a combined search. Eight studies were included for this review (Boyden 2012, Brown 2009, Dean 2015, Flacking 2013, Heath 2015, Hunt 2015, McKenzie 2010, and Wood 2018). All studies utilised a qualitative design, with 5 of them conducting semi-structured interviews, and all were conducted in the UK.
The included studies are summarised in Table 2.
The data from the included studies were synthesised and explored in a number of central themes and sub-themes (as shown in Figure 1). Main themes are shown in dark blue and sub-themes in pale blue.
Figure 1
Theme map.
See the literature search strategy in appendix B and study selection flow chart in appendix C.
Excluded studies
Studies not included in this review are listed, and reasons for their exclusion are provided in appendix K.
Summary of studies included in the evidence review
Summaries of the studies that were included in this review are presented in Table 2.
Table 2
Summary of included studies.
See the full evidence tables in appendix D. No meta-analysis was conducted (and so there are no forest plots in appendix E).
Quality assessment of studies included in the evidence review
A summary of the strength of evidence (overall confidence), assessed using GRADE-CERQual is presented according to the main themes. For each of the sub-themes the overall confidence was judged to be:
Main theme 1: Location of care
- Sub-theme 1.1: Community-based care. The overall confidence in this sub-theme was judged to be moderate.
Main theme 2: Physical healthcare environment
- Sub-theme 2.1: Age-appropriateness. The overall confidence in this sub-theme was judged to be moderate.
- Sub-theme 2.2: Privacy and an area for friends and family. The overall confidence in this sub-theme was judged to be moderate.
Findings from the studies are summarised in GRADE-CERQual tables. See the evidence profiles in appendix F for details.
Evidence from reference groups and focus groups
The children and young people’s reference groups and focus groups provided additional evidence for this review. A summary of findings is presented in Table 3.
Table 3
Summary of the evidence from reference groups and focus groups.
See the full evidence summary in appendix M.
Evidence from national surveys
The grey literature review of national surveys provided additional evidence for this review. A summary of findings is presented in Table 4.
Table 4
Summary of the evidence from national surveys.
See the full evidence summary in appendix N.
Economic evidence
Included studies
A systematic review of the economic literature was conducted but no studies were identified which were applicable to this review question. A single economic search was undertaken for all topics included in the scope of this guideline. See supplementary material 6 for details.
Excluded studies
Economic studies not included in this review are listed, and reasons for their exclusion are provided in appendix K.
Summary of studies included in the economic evidence review
No studies were identified which were applicable to this review question.
Economic model
No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.
The committee’s discussion of the evidence
Interpreting the evidence
The outcomes that matter most
This review focused on features of the environment which can improve children and young people’s experience of healthcare, and the experience of parents and carers of babies and young children. To address this issue, the review was designed to include qualitative data, and as a result, the committee could not specify in advance the data that would be located. Instead, they identified the following main themes to guide the review:
- Architectural, physical or design features of the environment such as:
- Age- and gender- appropriate healthcare environment (e.g. different wards for children and young people, single-sex accommodation)
- Ambience of healthcare environment (e.g. lighting, peace and quiet, privacy, windows)
- Availability of recreational materials (e.g. computer games, reading materials, toys)
- Freedom to move around healthcare environment (e.g. hospital)
- Provision of amenities or equipment (e.g. access to toilets, age-specific playrooms and facilities, multi-faith prayer rooms, outdoor spaces, single or multiple occupancy rooms, private rooms, storage space, use of wheelchair)
The themes that were identified related to the location of care and the physical healthcare environment, age-appropriateness, privacy and the presence of family and friends. The committee did not prioritise any of these themes above other ones, and considered all the evidence when making their recommendations.
The quality of the evidence
The quality of the evidence for this review was assessed using GRADE-CERQual. The quality of the methodology of the individual studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist.
The overall confidence in the review findings was moderate. All sub-themes were downgraded for methodological limitations. The sub-theme ‘Community-based care’, which comprises the ‘Location of Care’ theme was rated as moderate overall, as only one study contributed to the review finding.
The two sub-themes from the theme ‘Physical healthcare environment’ were both rated as moderate. The sub-theme ‘Age appropriateness’ was rated as moderate because there were some concerns about the methodology of the included studies and the relevance of the evidence. The setting and population of the studies varied widely and included a critical care unit (Wood 2018), a general paediatric outpatient clinic (Heath 2015), general hospital (McKenzie 2010), and an evaluation of services for life-limiting conditions (Hunt 2015).
The sub-theme ‘Privacy and an area for friends and family’ was rated as moderate because there were some concerns about the methodology of the included studies and the coherence of the evidence for the review finding.
Finally, there were concerns over the applicability of some of the evidence. For example, one study examined parents’ experiences of the neonatal intensive care unit (NICU) environment in a multi-national study, which may not be applicable to the population of all babies, children and young people in the UK (Flacking 2013).
Overall, due to the small amount and poor quality of the evidence, the committee also used their knowledge and experience when drafting the recommendations.
Benefits and harms
Although the committee were aware that the environment for each baby, child or young person would often be primarily determined by clinical need or the healthcare setting (for example, hospital inpatient wards would provide different facilities compared to a GP waiting room), they discussed that the features of the healthcare environment would still need to meet the needs of babies, children and young people. The committee discussed that some of their recommendations would, however, only be applicable to an inpatient environment, and so they included this detail in some of the recommendations. Evidence from a wide-range of settings (including ICU, hospital wards and community outpatient clinics) showed that children and young people preferred to be cared for in an age-appropriate healthcare environment. In particular, young people thought it was important to have designated areas that are designed for adolescents. Some of the committee members were aware that young people often feel overlooked as paediatric areas of hospitals are mainly designed to appeal to very young children. The committee discussed the evidence and noted that providing an age and developmentally appropriate environment was important. They acknowledged that the preferences of children or young people may differ, for example older children may prefer to be cared for on adult wards, but agreed that that children’s and young people’s preferences as well as those of parents and carers (acting as proxies for babies and young children) should be taken into consideration wherever possible.
From their own experience, the committee highlighted that accessibility and adaptability were important, and this included accessibility for parents or carers, and therefore they included this in their recommendation too.
The evidence from the sub-theme of privacy and family and friends had shown that children and young people valued privacy, and the committee agreed that this was important to allow dignity. The evidence suggested that the presence of friends and family was important to most babies, children and young people feeling comfortable in their healthcare environment, and that, in an inpatient setting, convenient visiting hours and a pleasant environment for visitors was important. Drawing from the evidence and discussing their experience as healthcare providers and users, the committee agreed that it was important that there is provision for parents or carers to be present and support babies, children and young people while they receive healthcare. However, the committee also noted that, in some cases, the presence of the family could be detrimental, and that some children and young people may not want their families present all the time. The committee noted that, while there is often provision for parents or carers to be present in paediatric areas, it is not always the case in other areas where healthcare is provided, and that young people may receive care outside paediatric settings from 16 years of age, or when specialist care is required, such as maternity care. The committee therefore recommended that a healthcare environment should support all these factors that were important to improve healthcare experience. Based on stakeholder feedback, the committee also agreed that it was important to provide inpatients with information on the ward facilities and routine which could make them feel more at home.
There was evidence from the theme on physical environment that young children preferred an environment in which they could play, and that young people reported being bored, so the committee added to their recommendation that easily accessible and age-appropriate play and recreation opportunities should be available. This would both reduce boredom, but also may help reduce anxiety.
The evidence from a study exploring the experiences of young people admitted to adult wards (Dean 2015) suggested that a feeling of safety was an important factor and that young people did not always feel safe in this environment, particularly where adults were able to enter their personal space. The committee therefore also included a recommendation that babies, children and young people should feel safe in their environment. The evidence also showed that young people felt safer in a healthcare environment they could trust, therefore the committee agreed that it would be beneficial to convey confidence by supporting a smooth healthcare process, and they included this in a recommendation.
The evidence showed that many young people did not like noise – this included coughing, staff whispering, equipment beeps and alarms and people crying. The committee discussed that although the evidence came from only one study which explored the experience of young people admitted to adult wards (Dean 2015), this finding was in alignment with their personal experience that noise is an important factor that can impair the healthcare experience of babies, children and young people. The committee discussed the importance of sleep for the wellbeing of babies, children and young people, and noted the impact noise can have on sleep, and so recommended that noise levels should be kept low, particularly at night.
The evidence from parents of babies on a neonatal unit showed that they preferred comfortable furniture and furnishings and a ‘homely’ environment. The committee discussed other factors that had been identified by the evidence as important – this included having enough room so the environment didn’t feel cramped, having adequate signposting and the availability and accessibility of recreation facilities and spaces-, and therefore the committee included these features in their recommendations.
In addition to the evidence from the systematic review, there was also evidence from the reference and focus groups and from the national surveys of children and young people’s experience. The feedback from the younger children (aged 7 to 11) was mainly about the availability of separate spaces for play and activities, which the committee agree had already been included in the recommendations. Additional areas identified by the 7-11 year olds were concerns about curtains around beds not being soundproof, their dislike of bad smells, the important of cleanliness and being able to access windows to see outside. The feedback from the 11-14 year olds was more focused on comfort, a calm environment and adequate space, but there was also a strong message that the environment should be clean and hygienic, and the committee included cleanliness and calmness in their recommendations. Both age groups had mentioned the use of call bells – to summon help, or to indicate if they needed a treatment or procedure to stop. The committee therefore included call-bells as an example in their recommendation on feeling safe.
The national surveys highlighted that the environment should be age-appropriate, with greater satisfaction from young people aged 12 to 15 years accommodated on a teenage ward, compared to a children’s or adult ward. The committee agreed that this reflected their experience. The committee noted that only 40% of children and young people in one survey reported that it was quiet enough to sleep on a ward and this reinforced the evidence from the systematic review. Children and young people also reported issues with comfort, smells and broken toys. A specific issue relating to appropriate equipment or adaptations was reported by the parents of children with developmental disability, mental health conditions, neurological conditions or other long term conditions. Feedback from parents of babies focussed on the suitability of the environment for them to visit and stay close to their babies. The committee agreed that their recommendations already included the need for an age-appropriate, comfy and quiet environment, with adaptations made to meet individual needs, and also the need for family-centred care for babies.
The committee discussed any potential harms identified by the evidence and from their recommendations, and identified the risk that, if ‘rooming-in’ facilities are provided, parents or carers may feel pressurised to stay with babies, children and young people all the time, even when it may not be beneficial for their wellbeing (for example, parents with other children at home). A concern was also raised that open visiting times, separate play areas and access for multiple visitors may lead to a safeguarding risk. The committee discussed that safeguarding was an over-arching consideration which surmounted all other recommendations and therefore made an over-arching recommendation at the beginning of the guideline concerning the need to consider safeguarding issues in all settings.
Cost effectiveness and resource use
There was no existing economic evidence for this review. The committee explained that the recommendations in this area should bring consistency in practice across the health service. The committee noted that changing or redesigning healthcare environments could be an expensive process, and although some changes may be easy to facilitate, others may require considerable resources to implement. The committee explained that the majority of services are designed within the standards implied by the recommendations in this area. It was also noted that any additional expense would be outweighed by the potential long-term benefits and would represent a cost-effective use of resources. The committee agreed that the healthcare environment can contribute to positive health outcomes in addition to improvements in the experience of care and quality of life improvements. Also, it was noted that once redesigned, healthcare environments would benefit thousands of babies, children and young people.
The committee noted that some healthcare organisations may have resources or access to charity or grant funding to implement these changes while others do not, and so this may increase the disparity in healthcare experience between different providers.
Recommendations supported by this evidence review
This evidence review supports recommendations 1.1.1, 1.1.2 and 1.8.1 to 1.8.4 in the NICE guideline.
References
Boyden 2013
Boyden, P., Muniz, M., Laxton-Kane, M., Listening to the views of children with learning disabilities: An evaluation of a learning disability CAMHS service, Journal of Intellectual Disabilities, 17, 51–63, 2013 [PubMed: 23257112]Brown 2009
Brown, Freddy Jackson, Guvenir, Jane, The experiences of children with learning disablilities, their carers and staff during a hospital admission, British Journal of Learning Disabilities, 37, 110–115, 2009Dean 2015
Dean, L., Black, S., Exploring the experiences of young people nursed on adult wards, British journal of nursing (Mark Allen Publishing), 24, 229–236, 2015 [PubMed: 25723268]Flacking 2013
Flacking, R., & Dykes, F., ‘Being in a womb’ or ‘playing musical chairs’: the impact of place and space on infant feeding in NICUs, BMC pregnancy and childbirth, 13(1), 179, 2013 [PMC free article: PMC4015611] [PubMed: 24053167]Heath 2015
Heath, G., Greenfield, S., Redwood, S., The meaning of ‘place’ in families’ lived experiences of paediatric outpatient care in different settings: A descriptive phenomenological study, Health and Place, 31, 46–53, 2015 [PubMed: 25463917]Hunt 2015
Hunt, A., Brown, E., Coad, J., Staniszewska, S., Hacking, S., Chesworth, B., Chambers, L., ‘Why does it happen like this?’ Consulting with users and providers prior to an evaluation of services for children with life limiting conditions and their families, Journal of child health care : for professionals working with children in the hospital and community, 19, 320–333, 2015 [PMC free article: PMC4561454] [PubMed: 24270996]McKenzie 2010
McKenzie, S., Norrish, S., Parker, L., & Frampton, I., Young people and healthcare. Part I: Experience of the hospital environment, Pediatric health, 4(2), 157–166, 2010Wood 2018
Wood, D., Geoghegan, S., Ramnarayan, P., Davis, P. J., Pappachan, J. V., Goodwin, S., Wray, J., Eliciting the experiences of the adolescent-parent dyad following critical care admission: a pilot study, European Journal of Pediatrics, 177, 747–752, 2018 [PMC free article: PMC5899104] [PubMed: 29468417]
Appendices
Appendix A. Review protocol
Appendix B. Literature search strategies
Appendix C. Clinical evidence study selection
Appendix D. Clinical evidence tables
Appendix E. Forest plots
Forest plots for review question: What features of the environment in which healthcare is provided are important to babies, children and young people to improve their experience of care?
No meta-analysis was conducted for this review question and so there are no forest plots.
Appendix F. GRADE-CERQual tables
Appendix G. Economic evidence study selection
Economic evidence study selection for review question: What features of the environment in which healthcare is provided are important to babies, children and young people to improve their experience of care?
No economic evidence was identified which was applicable to this review question
Appendix H. Economic evidence tables
Economic evidence tables for review question: What features of the environment in which healthcare is provided are important to babies, children and young people to improve their experience of care?
No evidence was identified which was applicable to this review question.
Appendix I. Economic evidence profiles
Economic evidence profiles for review question: What features of the environment in which healthcare is provided are important to babies, children and young people to improve their experience of care?
No economic evidence was identified which was applicable to this review question.
Appendix J. Economic analysis
Economic evidence analysis for review question: What features of the environment in which healthcare is provided are important to babies, children and young people to improve their experience of care?
No economic analysis was conducted for this review question.
Appendix K. Excluded studies
Excluded studies for review question: What features of the environment in which healthcare is provided are important to babies, children and young people to improve their experience of care?
Clinical studies
Table 9Excluded studies and reasons for their exclusion
| Study | Reason for Exclusion |
|---|---|
| Palatability of hypoallergenic formulas for cow’s milk allergy and healthcare professional recommendation, Pediatric allergy and immunology, 29, 857–862, 2018 [PubMed: 30192414] | Not related to features of physical environment in healthcare settings |
| Home interventions and light therapy for the treatment of vitiligo (HI-Light Vitiligo Trial): study protocol for a randomised controlled trial, BMJ open, 8, 2018 [PMC free article: PMC5893933] [PubMed: 29615444] | Not a qualitative study |
| Abdelrahim, Z., Dooley, A., Khan, A., Development of a paediatric specialist multidisciplinary down syndrome clinic, Archives of disease in childhood, 103 (Supplement 1), A162–A163, 2018 | Conference Abstract |
| Abid, S., Greenshields, N., Lowe, J., Survey of stakeholders of a paediatric anaesthetic room, Archives of disease in childhood, 103 (Supplement 1), A163–A164, 2018 | Conference abstract |
| Aceijas, C., Waldhausl, S., Lambert, N., Cassar, S., Bello-Corassa, R., Determinants of health-related lifestyles among university students, Perspectives in Public Health, 137, 227–236, 2017 [PubMed: 27597797] | Not related to features of physical environment in healthcare settings |
| Ahmed, M., Boyd, C., Vavilikolanu, R., Rafique, B., Visual symptoms and childhood migraine: Qualitative analysis of duration, location, spread, mobility, colour and pattern, Cephalalgia, 38, 2017–2025, 2018 [PubMed: 29629600] | Not related to features of physical environment in healthcare settings |
| Ahmed, S. A., Arasu, A., Ethical dilemma in neonatology, Archives of Disease in Childhood, 97, A300, 2012 | Conference abstract |
| Ahmed, S. A., Arasu, A., Another ethical dilemma in neonatology, Archives of Disease in Childhood, 96, A72, 2011 | Conference abstract |
| Ahrens, W., Bammann, K., Siani, A., Buchecker, K., De Henauw, S., Iacoviello, L., Hebestreit, A., Krogh, V., Lissner, L., Marild, S., Molnar, D., Moreno, L., Pitsiladis, Y., Reisch, L., Tornaritis, M., Veidebaum, T., Pigeot, I., The IDEFICS cohort: Design, characteristics and participation in the baseline survey, International journal of obesity, 35, 53–515, 2011 [PubMed: 21483420] | Not a qualitative study |
| Alexander, S., Bath, L., McDonald, M., Adolescent diabetic outpatient clinics-more than just an HbA1c, Archives of disease in childhood, 101 (Supplement 1), A275–A277, 2016 | Conference abstract |
| Allen, Kate, Marlow, Ruth, Edwards, Vanessa, Parker, Claire, Rodgers, Lauren, Ukoumunne, Obioha C., Seem, Edward Chan, Hayes, Rachel, Price, Anna, Ford, Tamsin, ‘How I Feel About My School’: The construction and validation of a measure of wellbeing at school for primary school children, Clinical child psychology and psychiatry, 23, 25–41, 2018 [PubMed: 28135832] | Not related to features of physical environment in healthcare settings |
| Al-Taee, M., Abood, S., Garrett, C., Choudhary, P., Kapoor, R. R., Feasibility and acceptability of robot assistant in self-management of type 1 diabetes in children, Hormone Research in Paediatrics, 1), 104–105, 2014 | Conference abstract |
| Armstrong, V. G., Howatson, R., Parent-infant art psychotherapy: A creative dyadic approach to early intervention, Infant mental health journal, 36, 213–222, 2015 [PubMed: 25728765] | Not related to features of physical environment in healthcare settings |
| Ashbullby, K. J., Pahl, S., Webley, P., White, M. P., The beach as a setting for families’ health promotion: A qualitative study with parents and children living in coastal regions in Southwest England, Health and Place, 23, 138–147, 2013 [PubMed: 23906586] | Not related to features of physical environment in healthcare settings |
| Babbage, C., Jackson, G. M., Nixon, E., Desired Features of a Digital Technology Tool for Self-Management of Well-Being in a Nonclinical Sample of Young People: Qualitative Study, JMIR Mental Health, 5, e10067, 2018 [PMC free article: PMC6315233] [PubMed: 30563820] | Not related to features of physical environment in healthcare settings |
| Baczynska, K. A., Price, L. L., Higlett, M. P., O’Hagan, J. B., Estimating Sun Exposure of Children in Day Care Nurseries in South Oxfordshire, UK, Photochemistry and photobiology, 92, 193–200, 2016 [PubMed: 26452244] | Not related to features of physical environment in healthcare settings |
| Bailey,S., Taylor,A., Kent,A., More space, Better quality care?Parents’ perception of quality of care prior to and after neonatal unit relocation, Intensive Care Medicine, 37, S428–S429, 2011 | Conference abstract |
| Biddiss, E., Knibbe, T. J., McPherson, A., The effectiveness of interventions aimed at reducing anxiety in health care waiting spaces: A systematic review of randomized and nonrandomized trials, Anesthesia and Analgesia, 119, 433–448, 2014 [PubMed: 24942321] | Not a qualitative study |
| Datt, C., Travers, M., Odell, C., Improving the hospital experience for young people (YP) with autism, Archives of disease in childhood, 102 (Supplement 1), A20, 2017 | Conference abstract |
| Dean, L. A., An exploration of the experiences of young people who have been nursed on adult wards, Archives of disease in childhood, 1), A76, 2012 | Conference abstract |
| Dovey-Pearce, Gail, Price, Christine, Wood, Helen, Scott, Tracy, Cookson, Jennifer, Corbett, Sally, Young people (13 to 21) with disabilities in transition from childhood to adulthood: An exploratory, qualitative study of their developmental experiences and health care needs, Educational and Child Psychology, 29, 86–100, 2012 | Population not in protocol - 13-21 with not identification of years in text. |
| Dula, G., Seth, A., Jononis, M., Mohamedally, D., Conner, S., Priestman, W., Sebire, N. J., ‘reward rush’ for gosh: Development of a mobile augmented reality application (APP) to improve patient experience at gosh, Archives of disease in childhood, 103 (Supplement 2), A50–A51, 2018 | Conference abstract |
| Duncombe, R., Evans Fry, R., An innovative app designed to reduce healthcare-related anxiety in young children, Archives of Disease in Childhood, 103 (Supplement 1), A160, 2018 | Conference abstract |
| Duran, C., Curtis-Tyler, K., Exploring children’s healthcare experiences of haematopoietic stem cell transplantation (HSCT)-a small scale study for service improvement, Bone Marrow Transplantation, 1), S257, 2016 | Conference abstract |
| Edwards, M., Lawson, C., Rahman, S., Conley, K., Phillips, H., Uings, R., What does quality healthcare look like to adolescents and young adults? Ask the experts!, Clinical Medicine, Journal of the Royal College of Physicians of London, 16, 146–151, 2016 [PMC free article: PMC4952968] [PubMed: 27037384] | Age group >17 years |
| Farrugia, E., Edwards, K., Art therapy in hospital waiting rooms, Rheumatology (United Kingdom), 57 (Supplement 8), viii8, 2018 | Conference abstract |
| Fawcett, R., Porritt, K., Stern, C., Carson-Chahhoud, K., Experiences of parents and carers in managing asthma in children: A qualitative systematic review, JBI Database of Systematic Reviews and Implementation Reports, 17, 793–984, 2019 [PubMed: 31090652] | Systematic review. References checked for possible included studies - none were identified. |
| Fenton, K., Larkin, M., Boden, Z. V. R., Thompson, J., Hickman, G., Newton, E., The experiential impact of hospitalisation in early psychosis: Service-user accounts of inpatient environments, Health and Place, 30, 234–241, 2014 [PubMed: 25460906] | Study participants >17 years age |
| Fernandez Medina, I. M., Granero-Molina, J., Fernandez-Sola, C., Hernandez-Padilla, J. M., Camacho Avila, M., Lopez Rodriguez, M. D. M., Bonding in neonatal intensive care units: Experiences of extremely preterm infants’ mothers, Women & Birth: Journal of the Australian College of MidwivesWomen Birth, 31, 325–330, 2018 [PubMed: 29191725] | Relates to experiences as a parent rather than as a proxy for baby |
| Finlay, Fiona, Baverstock, Anna, Lenton, Simon, Therapeutic clowning in paediatric practice, Clinical child psychology and psychiatry, 19, 596–605, 2014 [PubMed: 23855014] | Not a systematic review (narrative literature review) |
| Flacking, R., Dykes, F., Creating a positive place and space in NICUs, The practising midwife, 17, 18–20, 2014 [PubMed: 25109070] | Not a qualitative study |
| Fletcher, T., Glasper, A., Prudhoe, G., Battrick, C., Coles, L., Weaver, K., Ireland, L., Building the future: Children’s views on nurses and hospital care, British Journal of Nursing, 20, 39–45, 2011 [PubMed: 21240138] | Included in 5.1. Not related to features of physical environment in healthcare settings |
| Foster, M. J., Whitehead, L., Maybee, P., Cullens, V., The parents’, hospitalized child’s, and health care providers’ perceptions and experiences of family centered care within a pediatric critical care setting: a metasynthesis of qualitative research, Journal of Family Nursing, 19, 431–468, 2013 [PubMed: 23884697] | Not a UK study |
| Hassall, L., Lynch, J., Swan-Merrison, J., Manchanda, R., Norman, R., Make it fun and they will come: Creating a youth friendly culture in a first episode psychosis clinic, Early intervention in psychiatry, 1), 63, 2010 | Conference abstract |
| Hodkinson, S., Bunt, L., Daykin, N., Music therapy in children’s hospices: An evaluative survey of provision, Arts in Psychotherapy, 41, 570–576, 2014 | Survey of music therapists and staff experiences |
| Hope, G., Haake, A., Hilliard, C., The bare necessities of life: An evaluation of a live-music programme in a children’s hospital, Psycho-Oncology, 25 (Supplement 3), 72, 2016 | Conference abstract |
| James, J., Children as service users of a children’s centre, Community practitioner : the journal of the Community Practitioners’ & Health Visitors’ Association, 89, 42–45, 2016 [PubMed: 27111978] | Study about experiences of children as users of preschool/nursery at children’s centre. Not related to healthcare settings. |
| Kean, S., Children and young people visiting an adult intensive care unit, Journal of advanced nursing, 66, 868–877, 2010 [PubMed: 20423374] | Related to CYP’s experience as visitors rather than users of healthcare |
| Kerri, O., Byron, P., Improving strategies to better support adolescents with cancer: The creation of an “adolescent-friendly oncology ward”, Pediatric Blood and Cancer, 53 (5), 751–752, 2009 | Conference abstract |
| Kim, J., Stegemann, T., Music listening for children and adolescents in health care contexts: A systematic review, Arts in Psychotherapy, 51, 72–85, 2016 | Not a qualitative study |
| Kingsnorth, S., Treurnicht Naylor, K., Lamont, A., McKeever, P., MacArthur, C., The effectiveness of music in pediatric healthcare: A systematic review of randomized controlled trials, Evidence-based Complementary and Alternative Medicine, 2011, 2011 [PMC free article: PMC2957635] [PubMed: 20976017] | Not a qualitative study |
| Lambert, V., Coad, J., Hicks, P., Glacken, M., Social spaces for young children in hospital, Child: care, health and development, 40, 195–204, 2014 [PubMed: 23294129] | Study conducted in Ireland |
| Lambert, Veronica, Coad, Jane, Hicks, Paula, Glacken, Michele, Young children’s perspectives of ideal physical design features for hospital-built environments, Journal of child health care, 18, 57–71, 2014 [PubMed: 23423998] | Study conducted in Ireland |
| Larkin, M., Boden, Z. V., Newton, E., On the Brink of Genuinely Collaborative Care: Experience-Based Co-Design in Mental Health, Qualitative health research, 25, 1463–1476, 2015 [PubMed: 25829467] | Age group unclear; only describes as young adults with psychosis |
| Lee, Soeun, Narendran, Gaya, Tomfohr-Madsen, Lianne, Schulte, Fiona, A systematic review of sleep in hospitalized pediatric cancer patients, Psycho-Oncology, 26, 1059–1069, 2017 [PubMed: 27147507] | Not a qualitative study |
| Livesley, J., Long, T., Children’s experiences as hospital in-patients: Voice, competence and work. Messages for nursing from a critical ethnographic study, International journal of nursing studies, 50, 1292–1303, 2013 [PubMed: 23332686] | Study reports children’s experiences as hospital in-patients. Does not report on features of physical environment. |
| Longhi, Elena, Pickett, Nick, Hargreaves, David J., Wellbeing and hospitalized children: Can music help?, Psychology of Music, 43, 188–196, 2015 | Not a qualitative study |
| Loyland, B., Angelhoff, C., Kristjansdottir, G., Sjolie, H., A systematic integrative review of parents’ experience and perception of sleep when they stay overnight in the hospital together with their sick children, Journal of Clinical Nursing, 29, 706–719, 2020 [PubMed: 31821674] | Systematic review. References checked for possible included studies - none were identified. |
| McMaster, C., Gow, M., Cohen, J., Neal, R., Alexander, S., Baur, L., Patient and parent satisfaction with hospital-based paediatric weight management services and reasons for attrition: a mixed methods systematic review, Obesity Research and Clinical Practice, 13 (3), 311, 2019 | Conference abstract |
| Nichols, Andy, The impact of the clinical environment on family centred care in the neonatal unit: A qualitative investigation, Journal of Neonatal Nursing, 20, 230–235, 2014 | Participants are healthcare staff members |
| Nightingale, R., Hall, A., Gelder, C., Friedl, S., Brennan, E., Swallow, V., Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration, Journal of medical Internet research, 19, e235, 2017 [PMC free article: PMC5516103] [PubMed: 28676470] | Not related to features of physical environment in healthcare settings |
| Northcott, A., Curtis, P., Reid, J., Family-centred cubicles? issues associated with delivering and receiving care in cubicles, Archives of disease in childhood, 3), A99–A100, 2015 | Conference abstract |
| Norton-Westwood, D., Pearson, A., Robertson-Malt, S., The ability of environmental healthcare design strategies To impact event related anxiety in paediatric patients: A comprehensive systematic review, JBI Library of Systematic Reviews, 9, 1828–1882, 2011 [PubMed: 27820538] | Phenomenon of interest of included studies not in protocol. Included studies checked for inclusion. |
| O’Reilly, M., Dogra, N., Hughes, J., Reilly, P., George, R., Whiteman, N., Potential of social media in promoting mental health in adolescents, Health promotion international, 30, 30, 2018 | Not related to features of physical environment in healthcare settings |
| Panda, A., Garg, I., Bhobe, A. P., Children’s perspective on the dentist’s attire, International journal of paediatric dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children, 24, 98–103, 2014 [PubMed: 23600841] | Study conducted in India |
| Peng, M., Lovett, S., Damda, F., The treatment room on children’s ward-a quality improvement project, Archives of Disease in Childhood, 1), A93, 2014 | Conference abstract |
| Petrie, K., McArdle, A., Cookson, J., Powell, E., Poblete, X., ‘Let us speak’-children’s opinions of doctors, Archives of Disease in Childhood, 102 (Supplement 1), A200–A201, 2017 | Conference abstract |
| Pineda, R., Raney, M., Smith, J., Supporting and enhancing NICU sensory experiences (SENSE): Defining developmentally-appropriate sensory exposures for high-risk infants, Early Human Development, 133, 29–35, 2019 [PubMed: 31054467] | Country not in protocol: USA |
| Preti, Costanza, Welch, Graham F., Music in a hospital: The impact of a live music program on pediatric patients and their caregivers, Music and Medicine, 3, 213–223, 2011 | Study conducted in Italy |
| Schuller, L., Thaker, K., Instant messaging: The way to improve access for young people to their school nurse, Community practitioner : the journal of the Community Practitioners’ & Health Visitors’ Association, 88, 34, 36–8, 2015 [PubMed: 26837151] | Phenomenon of interest not in protocol - Access to healthcare services |
| Sexton, K., Heinz, P., Lothian, K., Young people get active! focus group involvement to improve the experience of adolescent paediatric patients in emergency departments, Archives of Disease in Childhood: Education and Practice Edition, 1), A109, 2013 | Conference abstract |
| Shahheidari, Marzieh, Homer, Caroline, Impact of the design of neonatal intensive care units on neonates, staff, and families: A systematic literature review, The Journal of Perinatal & Neonatal Nursing, 26, 260–266, 2012 [PubMed: 22843008] | Only one included study from this systematic review is relevant(Beck 2009)which was conducted in Denmark |
| Sisson, Helen, Jones, Catriona, Williams, Rhona, Lachanudis, Lisa, Metaethnographic synthesis of fathers’ experiences of the neonatal intensive care unit environment during hospitalization of their premature infants, Journal of Obstetric, Gynecologic, & Neonatal Nursing: Clinical Scholarship for the Care of Women, Childbearing Families, & Newborns, 44, 471–480, 2015 [PubMed: 26017337] | Related to fathers’ experiences in the NICU, rather than fathers’ acting as proxies for babies’ experiences |
| Smith, L., Medves, J., Harrison, M. B., Tranmer, J., Waytuck, B., The Impact of Hospital Visiting Hour Policies on Pediatric and Adult Patients and their Visitors, JBI Library of Systematic ReviewisJBI Libr Syst Rev, 7, 38–79, 2009 [PubMed: 27820226] | Not a qualitative study |
| Stickland, A. E. J., Clayton, E. K., Hill, C. M., Children’s sleep quality in hospital, Archives of disease in childhood, 1), A65, 2012 | Conference abstract |
| Stickland, A., Clayton, E., Sankey, R., Hill, C. M., A qualitative study of sleep quality in children and their resident parents when in hospital, Archives of disease in childhood, 101, 546–551, 2016 [PubMed: 27013526] | Population not in protocol - parental views only. Mean age = 7, only 2 children under 5. |
| Stuart, M., Melling, S., Understanding nurses’ and parents’ perceptions of family-centred care, Nursing children and young people, 26, 16–21, 2014 [PubMed: 25200238] | Not related to features of physical environment in healthcare settings |
| van Veenendaal, N. R., van Kempen, A. A. M. W., Franck, L. S., O’Brien, K., Limpens, J., van der Lee, J. H., van Goudoever, J. B., van der Schoor, S. R. D., Hospitalising preterm infants in single family rooms versus open bay units: A systematic review and meta-analysis of impact on parents, EClinicalMedicine, 23, 100388, 2020 [PMC free article: PMC7284081] [PubMed: 32548575] | Systematic review. Included studies checked for relevance. |
| Vorster, N., Evans, K., Murphy, N., Kava, M., Cairns, A., Clarke, D., Ryan, M. M., Siafarikas, A., Rowe, P. W., Parkinson, S., Gaynor, O., Chiu, L., Anderson, J., Bayley, K., Jacoby, P., Cross, D., Downs, J., Powered standing wheelchairs promote independence, health and community involvement in adolescents with Duchenne muscular dystrophy, Neuromuscular Disorders, 29, 221–230, 2019 [PubMed: 30826157] | Specific to DMD; Not related to features of physical environment in healthcare settings |
| Walsh, L., Play in the children’s hospital; discreet activity or way of life?, Archives of disease in childhood, 103 (Supplement 2), A46, 2018 | Conference abstract |
| Watts, R., Wilson, S., Impact of the physical environment in paediatric hospitals on health outcomes: a systematic review, JBI Library of Systematic ReviewisJBI Libr Syst Rev, 7, 908–941, 2009 [PubMed: 27819847] | Systematic review - references checked for possible included studies. None were identified. |
| Wensley, C., Botti, M., McKillop, A., Merry, A. F., A framework of comfort for practice: An integrative review identifying the multiple influences on patients’ experience of comfort in healthcare settings, International journal for quality in health care, 29, 151–162, 2017 [PubMed: 28096279] | Systematic review looking at patient experience in general, with no segregated data for BCYP |
| Whale, K., Cramer, H., Joinson, C., Left behind and left out: The impact of the school environment on young people with continence problems, British journal of health psychology, 23, 253–277, 2018 [PMC free article: PMC5900927] [PubMed: 29228510] | Not related to features of physical environment in healthcare settings |
| Winner-Stoltz, R., Lengerich, A., Hench, A. J., O’Malley, J., Kjelland, K., Teal, M., Staff Nurse Perceptions of Open-Pod and Single Family Room NICU Designs on Work Environment and Patient Care, Advances in Neonatal CareAdv Neonat Care, 18, 189–198, 2018 [PubMed: 29794838] | Cohort study including perceptions of healthcare staff |
Economic studies
No economic evidence was identified for this review. See supplementary material 6 for details.
Appendix L. Research recommendations
Research recommendations for review question: What features of the environment in which healthcare is provided are important to babies, children and young people to improve their experience of care?
No research recommendations were made for this review question.
Appendix M. Evidence from reference groups and focus groups
Appendix N. Evidence from national surveys
Final
Evidence reviews underpinning recommendations 1.1.1, 1.1.2 and 1.8.1 to 1.8.4 in the NICE guideline
These evidence reviews were developed by the National Guideline Alliance which is a part of the Royal College of Obstetricians and Gynaecologists
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.
- Supplement 1: Glossary and abbreviations (PDF)
- Supplement 2: Methods (PDF)
- Supplement 4: Evidence from reference and focus groups (PDF)
- Supplement 4a: Reference and focus groups evidence (PDF)
- Supplement 4b: Children and young people's opinions and experiences of healthcare (PDF)
- Supplement 5: Grey literature review of national surveys (PDF)
- Supplement 5a: Grey literature mapping to questions (PDF)
- Supplement 6: Economic study selection (PDF)
- The future of Cochrane Neonatal.[Early Hum Dev. 2020]The future of Cochrane Neonatal.Soll RF, Ovelman C, McGuire W. Early Hum Dev. 2020 Nov; 150:105191. Epub 2020 Sep 12.
- Review Measuring experience: Babies, children and young people’s experience of healthcare: Evidence review L[ 2021]Review Measuring experience: Babies, children and young people’s experience of healthcare: Evidence review LNational Guideline Alliance (UK). 2021 Aug
- Review Providing information: Babies, children and young people’s experience of healthcare: Evidence review D[ 2021]Review Providing information: Babies, children and young people’s experience of healthcare: Evidence review DNational Guideline Alliance (UK). 2021 Aug
- Review Design of healthcare services: Babies, children and young people’s experience of healthcare: Evidence review K[ 2021]Review Design of healthcare services: Babies, children and young people’s experience of healthcare: Evidence review KNational Guideline Alliance (UK). 2021 Aug
- Critical Care Network in the State of Qatar.[Qatar Med J. 2019]Critical Care Network in the State of Qatar.Hijjeh M, Al Shaikh L, Alinier G, Selwood D, Malmstrom F, Hassan IF. Qatar Med J. 2019; 2019(2):2. Epub 2019 Nov 7.
- Healthcare environmentHealthcare environment
Your browsing activity is empty.
Activity recording is turned off.
See more...