Environment of Care

The design and overall environment of care in psychiatric inpatient units play a critical role in influencing both patient outcomes and staff well-being. A thoughtfully designed therapeutic environment can reduce patient agitation, enhance safety, promote recovery, and support the delivery of compassionate, person-centered care. For nursing staff, a well-structured and supportive physical setting can help manage stress, reduce burnout, and improve job satisfaction and retention. Elements such as access to natural light, noise control, clear visibility for monitoring, and spaces that promote autonomy and dignity are especially influential in shaping daily experiences within psychiatric settings.

In response to current regulatory standards requiring ligature-resistant environments, psychiatric units must be thoughtfully designed to minimize risk while maintaining a therapeutic and inviting atmosphere. Although these spaces aim to reflect the comfort and familiarity of residential settings, the heightened focus on safety has sometimes led to environments that feel institutional or even punitive. Striking a balance between safety and therapeutic design remains a complex challenge. Patients and staff alike are often caught in the tension between ensuring security and fostering recovery. Therefore, understanding the design features that enhance a sense of safety, autonomy, and emotional well-being is essential. This knowledge supports psychiatric-mental health nurses in creating interpersonal and physical environments that promote healing, dignity, and optimal care for individuals experiencing acute mental health crises.

This selection of literature examines the critical role that the physical environment of psychiatric inpatient units plays in both patient and staff experiences. Key areas of focus include:

• The impact of various design elements on patients’ experiences during hospitalization and their contribution to the healing process.
• Comparative research on the implications of open versus closed nursing station designs.
• The influence of unit design on the delivery of care by nurses and interdisciplinary staff.
• The relationship between environmental factors and quality outcomes such as the incidence of seclusion, restraint, violence, and patient falls.

References:

Improving the safety of psychiatric care through environmental design: Reducing falls and other preventable harms.
Barach, P., & Johnson, J. K. (2024). Improving the safety of psychiatric care through environmental design: Reducing falls and other preventable harms. Health Policy, 128(3), 317–325. https://doi.org/10.1016/j.healthpol.2024.01.005

The Role of the Built Environment as a Therapeutic Intervention in Mental Health Facilities: A Systematic Literature Review.
Rodríguez-Labajos, L., Kinloch, J., Grant, S., & O’Brien, G. (2024). The Role of the Built Environment as a Therapeutic Intervention in Mental Health Facilities: A Systematic Literature Review. HERD: Health Environments Research & Design Journal, 17(2), 281–308. https://doi.org/10.1177/19375867231219031

It’s not just in the walls: Patient and staff experiences of a new spatial design for psychiatric inpatient care.
Molin, J., Strömbäck, M., Lundström, M., & Lindgren, B.-M. (2021). It’s not just in the walls: Patient and staff experiences of a new spatial design for psychiatric inpatient care. Issues in Mental Health Nursing, 42(12), 1114–1122. https://doi.org/10.1080/01612840.2021.1931585

Design research and behavioral health facilities: A review of the literature. HERD: Health Environments Research & Design Journal
Shepley, M., Pasha, S., & White, R. (2021). Design research and behavioral health facilities: A review of the literature. HERD: Health Environments Research & Design Journal, 14(2), 96–108. https://doi.org/10.1177/1937586720903844

The built environment and its influence on psychiatric inpatients’ activities and well-being.
Sundberg, T., Eklund, M., & Argentzell, E. (2021). The built environment and its influence on psychiatric inpatients’ activities and well-being. Health & Place, 71, 102655. https://doi.org/10.1016/j.healthplace.2021.102655

Psychiatric ward design can reduce aggressive behavior.
Ulrich, R. S., Bogren, L., & Lundin, S. (2021). Psychiatric ward design can reduce aggressive behavior. Journal of Environmental Psychology, 75, 101594. https://doi.org/10.1016/j.jenvp.2021.101594

Healing spaces in mental health design.
Golembiewski, J. A. (2020). Healing spaces in mental health design. In M. P. Ruck (Ed.), Architecture and health: Guiding principles for practice (pp. 165–179). Routledge. https://www.routledge.com/Architecture-and-Health-Guiding-Principles-for-Practice/Ruck/p/book/9780367331644

Designing out ligature risks in mental health inpatient facilities: Balancing safety and therapeutic environments.
Peters, S., & Beavan, V. (2020). Designing out ligature risks in mental health inpatient facilities: Balancing safety and therapeutic environments. Journal of Psychiatric and Mental Health Nursing, 27(6), 646–653. https://doi.org/10.1111/jpm.12699

The impact of the built environment on nurses’ job satisfaction in psychiatric settings: A qualitative study.
Daly, S., & Muir-Cochrane, E. (2019). The impact of the built environment on nurses’ job satisfaction in psychiatric settings: A qualitative study. International Journal of Mental Health Nursing, 28(1), 177–185. https://doi.org/10.1111/inm.12521

How Patients and Nurses Experience an Open Versus an Enclosed Nursing Station on an Inpatient Psychiatric Unit.
Shattell, M., Bartlett, R., Beres, K., Southard, K., Bell, C., Judge, C. A., & Duke, P. (2015). How Patients and Nurses Experience an Open Versus an Enclosed Nursing Station on an Inpatient Psychiatric Unit. Journal of the American Psychiatric Nurses Association, 21(6), 398–405. https://doi.org/10.1177/1078390315617038