Through Different Eyes: Patients' and Nurses' Perceptions of the Environment in an Australian Hospital

Wednesday, 24 July 2013: 3:30 PM

Ann Katherine Williams, RN, BA (Hons), MEd, PhD
Division of Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
Deborah Mary Armitage, RN, MN
Division of Medicine, John Hunter Hospital, Newcastle, Australia

Learning Objective 1: The learner will identify that patients and nurses have different perceptions of the hospital environment which may affect nurses' ability to provide person-centred care

Learning Objective 2: The learner will understand that education can facilitate a cognitive pereptual shift thus promoting person-centredness


Evidence suggests that hospital environments impact on patient outcomes with environments  perceived by patients as patient friendly having a therapeutic effect. This study explored patients’ and nurses’ perceptions of the physical environment in order to inform person-centred education.


A three stage modified photovoice methodology using opportunistic, non-purposive sampling of an in-patient population. Stage one: Patients were recruited and invited to nominate aspects of the physical environment which had particular meaning to them. Photographs of the nominated aspects were taken and participants were later interviewed and asked to describe the meaning the image/s had for them. Stage two: Nurses were recruited and not informed of the origin of the images. They were invited to select any number of photographs and describe what the image/s meant to them. Stage three: Nurses were recruited and informed that the images were chosen by patients. They were then invited to describe what the image/s meant to them.


Data analysis included: A thematic analysis of perceptions of: every image chosen by a patient or nurse and images chosen by both patients and nurses to conduct a cross-comparative thematic analysis of perceptions. Results showed that patients’ and nurses’ perceptions of the hospital environment differed. While patients ascribed personal meaning to the images, nurses predominantly ascribed clinical meaning. 


The ability to identify personal meaning embedded in a clinical context did not occur naturally for nurses in this study. It would appear that being ‘person-centred’ as well as ‘clinically focussed’ is learnt rather than intuitive. Informing nurses that the images were chosen by patients however, forced them to make a clinical-person-centred perceptual shift. The challenge for nursing education is to instil in undergraduate nurses a natural ability to see both the personal and clinical dimension of the care environment.