The purpose of both precision medicine and precision nursing is to improve patient outcomes. This theoretical article is designed as a conceptual and position paper situated within caring science, with a specific focus on understanding precision nursing across diverse clinical contexts. Rather than presenting empirical findings, the paper synthesizes theoretical perspectives, caring science foundations, and selected scholarly literature. In this position paper, we seek to expand the concept of precision nursing from a caring science perspective with clinical examples, vignettes, from an emergency care context. Precision medicine can be viewed as an effort to truly individualize a treatment and make it as accurate and effective as possible. While the focus on measurable outcomes saves lives, it also carries the risk of narrowing attention to what can be observed and quantified. These visible clinical markers represent only part of what matters in care. To get the full picture of a patient and their treatment, caring must serve as the foundation for precision nursing, as it is caring that ensures that technological advancements remain aligned with individual patient needs. Precision medicine and precision nursing may offer direction, but to provide meaning to the concepts, a grounding in caring science is provided in this study.

Aim: This dissertation called the COPE (Caring Optimized Physical Environment) project, aimed to evaluate the perceptions of patients, family members, and staff regarding support from the physical environment, with a focus on light, color, and person-centered climate, before and after there furbishment and remodeling of an emergency department (ED).

Methods: A quasi-experimental design was employed, implementing evidence-based design principles for light and color in the ED. The study evaluated the perceived support and person-centered climate among participants using a newly developed and validated questionnaire, the Light and Color Questionnaire (LCQ). It also validated a Swedish version of the Person-centered Climate Questionnaire for family members (PCQ-F). A total of 600 participants, including patients, family members, and staff, were included in the study.

Results: The scores for the perceptions of light and color and person centered climate were higher after the redesign than before for patients, family members, and staff. Thus, redesign of a healthcare environment based on knowledge and experience in light and color design corresponded with a positive change in self rated perceived support of that environment to all three groups: patients, family members, and staff. The redesign involved enhancing access to natural daylight by incorporating additional windows and diverse artificial lighting options. The redesign also included the use of color coding to facilitate way finding and uniform colors for shared floor surfaces and contrasting colors for non-patient areas to enhance safety.

Conclusion: The intervention, which focused on optimizing lighting and color in the ED, coincided with an increased perceived support from light and color for patients, family members, and staff. Further, the changes in light and color, along with the overall redesign, concurred with a higher score for perceived person-centered climate. These findings emphasize the importance of evidence-based design interventions and highlight the potential benefits they can bring to staff and patients in other health care settings.

Aim: To evaluate patients’ and family members’ perceived support from light and color before, compared with after an evidence-based design (EBD) intervention at an emergency department (ED) using a validated instrument—the Light and Color Questionnaire (LCQ). Background: EDs offer acute care day and night. Thus, a supportive physical environment where light and color is crucial for how the milieu is experienced is vital. Research is limited on how care settings are perceived as supportive by users. Methods: Quasi-experimental evaluation of the refurbishing and remodeling of an ED by an expert group of nurse managers, nursing staff, nursing researchers and architects in south Sweden. LCQ includes dimensions “maximizing awareness and orientation,” “maximizing safety and security,” “supporting functional abilities,” “providing privacy,” “opportunities for personal control” (not for LCQ-Color), and “regulation and quality of stimulation.” LCQ was analyzed and compared in 400 surveys from 100 patients and 100 family members before the intervention and 100 patients and 100 family members after the intervention. Results: The LCQ total score significantly improved after the intervention for both patients and family members. Four of the six dimensions of LCQ Light subscale scores were significantly higher for family members, and three of the six dimensions were significantly higher for patients after the intervention. The LCQ Color subscale score showed significant improvements for all five dimensions for both patients and family members after the intervention. Conclusion: This study showed improved perceived support from light and color in the physical environment for patients and family members after an EBD intervention at an emergency department using a validated instrument—the Light and Color Questionnaire. 

Aim: The aim of this study was to develop and evaluate a self-report instrument measuring patients', family members', and staff's perceived support from light and color in the physical environment of an emergency department (ED)-the Light and Color Questionnaire (LCQ). Background: The physical care environment is an important part of a comprehensive caring approach in all levels of care not only for patients but also for family members and staff. However, no existing self-report questionnaire assessing the extent to which light and color are perceived as being supportive in the physical care environment from the users' perspective was found. Method: The LCQ was developed as part of a pre-post study in which an ED serving 125,000 people was refurbished and remodeled using evidence-based design. The LCQ consists of six items for light and five items for color and assesses awareness/orientation, safety/security, functional abilities, privacy, personal control, and stimulation. The study was carried out in four steps: constructions of items, assessment of face validity, data collection, and data analysis. Result/Conclusion: Psychometric evaluation of the two versions, LCQ-Patient/Family member and LCQ-Staff, showed satisfactory content and internal validity (>90%) and high internal consistency (Cronbach's coefficient alpha = .9) to support the use of the questionnaire for research and development purposes. Explorative factor analysis of a total of 600 questionnaire responses confirmed light and color as distinctive and independent dimensions creating perceptions of more or less supportiveness for respondents. The LCQ instrument may be useful for architects, administrators, and researchers of healthcare environments.

Background: It is well recognized that long waiting times at Emergency Departments (ED) influence patient satisfaction rates. Evidence suggests that changes in the design of healthcare environments can improve patient care when these changes include the provision of nature and music elements in different ways.

Aim: To explore how patients, relatives and staff perceive a slideshow with nature pictures and music in the emergency department waiting room.

Method: A descriptive survey design including a slideshow with nature pictures and music shown in the waiting room. Questionnaires were distributed to patients and relatives (n=94) as well as to the staff (n=76), analysed with descriptive statistics and content analysis.

Results: A majority (67%) of the participants thought that the slideshow contributed to a positive environment in the waiting room. Content analysis of 254 comments demonstrated it to be experienced as relaxing and calming. There is, however, room for improvement regarding quality, length and variation of the slideshow.

Conclusion: An organized wait time with different alternative activities including nature elements and music in the waiting environment may have positive impacts. The challenge lies in creating a supportive design, which supports the three separate groups and their needs for control in terms of freedom of choice and variation.

Background

In a holistic view of care, the family is important for the patient as well as for the staff and integration of family members in health care is a growing trend. Yet, family participation in the care is sparsely investigated and valid assessment instruments are needed.

Setting

Data were collected from 200 family members participating in an intervention study at an emergency department (ED) in Sweden.

Method

The Person-centred Climate Questionnaire – Family (PCQ-F) is a measure for how family members perceive the psychosocial climate. PCQ-F is a self-report instrument that contains 17 items assessing safety, everydayness and hospitality – three subscale dimensions that mirror the Swedish patient version of the questionnaire, the PCQ-P.

Aim

The aim of this study was to evaluate the psychometric properties of the Swedish version of the PCQ-F in an ED context.

Results

The psychometric properties of the PCQ-F were evaluated using statistical estimates of validity and reliability and showed high content validity and internal consistency. Cronbach's Alpha was >0.7 and item–total correlations were >0.3 and <0.7.

Conclusion

In terms of psychometrics, the findings in this study indicate that the PCQ-F can be used with satisfactory validity and reliability to explore to what degree family members perceive ED settings as being person-centred, safe, welcoming and hospitable within an everyday and decorated physical environment. As the PCQ already exists in a valid and reliable patient (PCQ-P) and staff (PCQ-S) version, this new family member version is a significant addition to the literature as it enables further comparative studies of how diverse care settings are perceived by different stakeholders.