Instrument Development to Measure the Natural Environment in Nursing Homes

Peggy Chi (University of Toronto)
Whitney Berta (University of Toronto)
Stephen Verderber (University of Toronto)

Natural environments in healthcare are significantly and positively associated with health and work-related outcomes. This research area is not new, but it is still innovative to the biomedical system.

There is a rising demand for “home-like” nursing homes to improve the health and quality of life for senior residents. However, validated instruments by which to measure the natural environment's design featuresand the way residents and care staff use the natural environment are limited. Rigorous research to develop these instruments will help future investigations that examine topics such as the natural environments' influence on nursing home residents' mental health and well-being and their care staff's job stress.

Therefore, this presentation will report the methods and findings from the development of two new surveys: 1) The Natural Environment Design (NED) Survey and 2) The Natural Environment Usage (NEU) Survey. A modified Delphi technique was conducted to gather expert opinions via three rounds of online surveys on the appropriate survey contents and questions. Purposive sampling was used to recruit experts (n=24) from fields of architecture, health services research, health policy, environmental psychology, gerontology, nursing, geography, and ecology, practitioners in psychogeriatrics, recreation, and horticulture therapy, and nursing home administrators. The developed surveys are undergoing cognitive debriefing with nursing home workers (n=25) and a pilot study to test, refine, and validate the surveys.

There is consensus on survey contents regarding design characteristics such as window views to the outdoors, control of daylight, seats and supportive features, planting design, physical access and things to do and see. A consensus was also established for usages such as residents’ directed and spontaneous activities and care staff’s perception about nature’s influence on health, facilitation of residents’ exposures to daylight, and incentives to go outdoors. My rigorous approach will advance science and provide evidence for ongoing senior strategy developments.