Research| Volume 44, ISSUE 2, P139-145, March 2018

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The Role of Space in Patients’ Experience of an Emergency Department: A Qualitative Study

Published:December 07, 2017DOI:


      Nurses are increasingly involved in the design of health care facilities. Although their experience differs from that of patients, they are often expected to represent patients in design processes. Especially in the context of an emergency department, patients’ states of mind alter their experiences. Knowledge about the role of space in ED patients’ experience is limited. Our study aims to gain insight into this role and thus provide ED nurses with information to better represent ED patients’ perspectives in design.


      We conducted qualitative interviews with 22 patients. The interviews were supported by visual material collected through ethnographic methods to facilitate participants’ reflections on the role of space in their experience. Participants were selected during their stays at the emergency department by convenience sampling. Interviews were audio-recorded, transcribed, and analyzed in combination with the visual material through open and axial coding.


      We found that the role of space in ED patients’ experiences is affected by their altered sensory awareness and shaped by material, social, and time-related aspects. These aspects are intertwined and influenced by the transient character of the emergency department.


      The study indicates that paying attention to the role of space yields a nuanced understanding of ED patients’ experiences. The challenge for hospital designers and staff lies in taking into account patients’ altered sensory awareness and in designing interventions that support staff in emphasizing a human approach without counteracting the medical-technical aspect of emergency care.
      Contribution to Emergency Nursing Practice
      • Raising awareness regarding patients’ altered experience of the (built) environment when being admitted to the emergency department.
      • Providing an improved understanding of how adaptations to the built environment affect patients and can improve their experience, thus impacting on the functioning of the department.
      • Better preparing nurses for the role of design team members they are increasingly expected to play.

      Key words

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        • Cesario S
        • Stichler J
        Designing health care environments.
        J Contin Educ Nurs. 2009; 40: 324-328
        • Stichler J
        Staff nurse engagement in health facility design.
        JONA. 2008; 38: 315-318
        • Elmqvist C
        • Fridlund B
        • Ekebergh M
        On a hidden game board.
        J Clin Nurs. 2012; 21: 2609-2616
        • Gordon J
        • Sheppard L
        • Anaf S
        The patient experience in the ED.
        Int Emerg Nurs. 2010; 18: 80-88
        • Kihlgren AL
        • Nilsson M
        • Skovdahl K
        • et al.
        Older patients awaiting ED treatment.
        Scand J Caring Sci. 2004; 18: 169-176
        • Reed R
        How to build your role in healthcare construction projects.
        BI&T. 2005; 39: 347-352
        • Huisman ERCM
        • Morales E
        • van Hoof J
        • et al.
        Healing environment: a review of the impact of physical environmental factors on users.
        Build Environ. 2012; 58 ( 70-80
        • Hamilton DK
        The four levels of evidence-based design practice.
        Healthc Des. 2003; 11: 19-26
        • Hamilton DK
        Evidence-based design and the art of healing.
        in: Wagenaar C The Architecture of Hospitals. Rotterdam, Netherlands2006: 271-280
        • Malkin J
        Healing environments as the century mark.
        in: Wagenaar C o.c. The Architecture of Hospitals. Rotterdam, The Netherlands2006: 259-265
        • Nairn S
        • Whotton E
        • Marshal C
        • et al.
        The patient experience in emergency departments.
        Accid Emerg Nurs. 2004; 12: 159-165
        • Wellstood K
        • Wilson K
        • Eyles J
        Unless you went in with your head under your arm.
        Soc Sci Med. 2005; 61: 2363-2373
        • Löfgren O
        • Ehn B
        in: The Secret World of Doing Nothing. University of California Press, Berkeley, CA2010
        • Holden D
        • Smart D
        Adding value to the patient experience in emergency medicine.
        Emerg Med. 1999; 11: 3-8
        • Göransson K
        • von Rosen A
        Patient experience of the triage encounter.
        Int Emerg Nurs. 2010; 18: 36-40
        • Coughlan M
        • Corry M
        The experiences of patients and relatives/significant others of overcrowding in accident and emergency in Ireland.
        Accid Emerg Nurs. 2007; 15: 201-209
        • Olthuis G
        • Prins C
        • Smits MJ
        • et al.
        Matters of Concern.
        Ann Emerg Med. 2014; 63: 311-319
        • Thompson DA
        • Yarnold PR
        • Williams D
        • et al.
        Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality.
        Ann Emerg Med. 1996; 28: 657-665
        • Frank C
        • Asp M
        • Dahlberg K
        Patient participation in emergency care.
        Int Emerg Nurs. 2009; 17: 15-22
        • Ekwall A
        • Gerdtz M
        • Manias E
        The influence of patient acuity on satisfaction with emergency care.
        J Clin Nurs. 2008; 17: 800-809
        • Welch SJ
        Twenty years of patient satisfaction research applied to the ED.
        Am J Med Qual. 2010; 25: 64-72
        • Baraff L
        • Bernstein E
        • Bradley K
        • et al.
        Perceptions of emergency care.
        Ann Emerg Med. 1992; 21: 814-818
        • Annemans M
        • Van Audenhove C
        • Vermolen H
        • et al.
        Hospital Reality from a Lying Perspective: Exploring a Sensory Research Approach.
        in: Langdon P Clarkson P Robinson P Designing Inclusive Systems. Springer-Verlag, London2012: 3-12
        • Merchant S
        The body and the senses.
        Body Soc. 2011; 17: 53-72
        • Pink S
        Doing Visual Ethnography.
        2nd ed. Sage Publications, London2007
        • Collier J
        Visual Anthropology.
        Holt Rinehart and Winston, New York1967
        • Ross NJ
        • Renold E
        • et al.
        Moving stories.
        Qual Res. 2009; 9: 605-623
        • Annemans M
        • Van Audenhove C
        • Vermolen H
        • et al.
        Lying architecture: Experiencing space from a hospital bed.
        in: Proceedings of WELL-BEING 2011: The First International Conference Exploring the Multi-dimensions of Well-being. Birmingham, UK2011: 10
      1. NVivo qualitative data analysis software QSR International Pty Ltd. (Version 10.1.3) [Software].
        (Available from)
        • Mortelmans D
        Handbook of Qualitative Research Methods.
        Leuven, Belgium, Acco2013
        • Esterberg KG
        Qualitative Methods in Social Research.
        McGraw Hill, London2002
        • Richardson S
        • Casey M
        • Hider P
        Following the patient journey.
        Accid Emerg Nurs. 2007; 15: 134-140


      Margo Annemans is Faculty of Engineering Science, Department of Architecture, KU Leuven, Leuven, Belgium.


      Chantal Van Audenhove is Chair, Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium.


      Hilde Vermolen is Architect at Osar Architects NV, Antwerp, Belgium.


      Ann Heylighen is Faculty of Engineering Science, Department of Architecture, KU Leuven, Leuven, Belgium.