Users' views of hospital environmental quality: Validation of the Perceived Hospital Environment Quality Indicators (PHEQIs)

Environmental Quality Perception (EQP) is an important construct used to help to understand the relationship between people and the hospital environment. From a patient-centered care perspective, it is important that hospital design take into account the patients' (and other users') point of view. This paper presents the adaptation and validation of a measure of hospital EQP, the Perceived Hospital Environment Quality Indicators (PHEQIs; Fornara, Bonaiuto, & Bonnes, 2006), and seeks to confirm the factor structure of this construct in a different cultural context. Three scales, two focusing on physical environments and one evaluating the social environment, were completed by 562 users of four orthopedic units in Portuguese hospitals, two older and two recently built or renovated. To assess criterion validity, hospital physical environments were also objectively evaluated by two architects. Using a confirmatory factor analysis the three validation procedures produced acceptable fit indices in the final measurement models. Overall reliability values were satisfactory, as was the evidence for criterion validity. PHEQIs scales and factors correlated with global evaluation of the environment, supporting concurrent criterion validity; and predictive criterion validity was demonstrated given that users of older and newer hospitals differed significantly on the perception of quality of hospital EQP, and that high congruence between users' and experts' evaluations was found. Discriminant construct validity was supported, and some difficulties in showing convergent validity are discussed in terms of item formulation adequacy. Implications for research and practice are described.     

Exogenous melatonin reduces water deficit-induced oxidative stress and improves growth performance of Althaea rosea grown on coal mine spoils

Environmental Science and Pollution Research - Coal mining activities are responsible for significant land degradation and often long-term irreversible effects on ecosystem functioning. To better...     

Browsing lawns? Responses of Acacia nigrescens to ungulate browsing in an African savanna

We measured browsing-induced responses of Acacia trees to investigate "browsing lawns" as an analogy to grazing lawns in a semiarid eutrophic African savanna. During the two-year field study, we measured plant tolerance, resistance, and phenological traits, while comparing variation in leaf nitrogen and specific leaf area (SLA) across stands of Acacia nigrescens, Miller, that had experienced markedly different histories of attack from large herbivores. Trees in heavily browsed stands developed (1) tolerance traits such as high regrowth abilities in shoots and leaves, high annual branch growth rates, extensive tree branching and evidence of internal N translocation, and (2) resistance traits such as close thorn spacing. However, phenological "escape" responses were weak even in heavily browsed stands. Overall, browsing strongly affected plant morpho-functional traits and decreased both the number of trees carrying pods and the number of pods per tree in heavily browsed stands. Hence, there is experimental evidence that tolerance and resistance traits may occur simultaneously at heavily browsed sites, but this comes at the expense of reproductive success. Such tolerance and resistance traits may coexist if browsers trigger and maintain a positive feedback loop in which trees are continually investing in regrowth (tolerance), and if the plant's physical defenses (resistance) are not nutritionally costly and are long-lived. Our results confirm that chronic browsing by ungulates can maintain A. nigrescens trees in a hedged state that is analogous to a grazing lawn. Further research is needed to fully understand the long-term effects of chronic browsing on reproduction within such tree populations, as well as the overall effects on nutrient cycling at the ecosystem level.     

Perceived hospital environment quality indicators: A study of orthopaedic units

The purposes of this study are to develop perceived hospital environment quality indicators for rating hospital settings, and to use those scales to compare hospitals selected to differ in their spatial–physical humanization (design features that support users’ needs and well-being). Orthopaedic units in three different hospitals in a major Italian city were selected to represent low, moderate and high levels of environmental humanization. Two architects rated the settings on 120 qualities and provided modest corroboration for the three levels. In each orthopaedic unit, patients, visitors and staff completed questionnaires including four scales about the physical and social environments (N=202). A total of 12 Perceived Hospital Environment Quality Indicators (PHEQIs) scales emerged from factor and reliability analyses of these responses. The PHEQIs had face validity, reflecting the main features articulated by the scientific literature on humanization, and overall had good inter-item reliability. ANOVAs supported hypotheses that patients and visitors would rate humanized environments more positively, although staff members seemed to be less sensitive than service users to differences in design quality.