Being a hospital patient is never easy. A hospital stay is a scary experience. Patients fear for their physical wellbeing. Will the treatments be successful? How much will it hurt? How long will the stay be? A hospital stay also takes people out of their comfort zone. Separated from close family and friends for most of the day, the patient’s most intimate experiences – from using the toilet to bathing – are shared with complete strangers. Although hospital staffs strive to maintain the patient’s dignity, this unfamiliar intimacy can cause additional anxiety.
Although I have worked as a healthcare architect for a number of years, I experienced these fears and anxieties when I was a patient undergoing surgery at a community hospital in California. My 1980’s era semi-private room was not up to contemporary design standards, but in interacting with this environment I gained new insights about patient rooms that I will incorporate into my designs.
Patients spend a lot of time with the head of the bed raised. Even with today’s sophisticated beds, this moves the patient’s upper body away from the headwall and makes the area near the wall on either side of the bed inaccessible. The bedside cabinet is often placed there. I found the cabinet is not accessible unless it is pulled away from the wall and located closer to the middle of the bed. In my situation, the telephone was on the bedside cabinet, making it totally inaccessible unless the bedside cabinet was pulled forward (or they put the phone on my bed). Trying to talk with friends or family on the telephone became stressful rather than providing comfort. The solution of pulling the bedside cabinet forward reduced the nursing staff’s efficiency by restricting accessibility to that side of the bed. Today’s communications technology will develop a wireless device for the patient that will incorporate a telephone as well as other connectivity. This wireless device will be easily patient accessible by being attached to the side rails of the patient bed.
Room Flexibility and Circulation
Patient rooms are not static. The beds move, furniture is rearranged, and medical equipment is moved in and out. These changes modify the useable traffic patterns and room clearances at any given moment. My movements around the room required a walker and I was always assisted by a staff member. The clearance between the parked bed position and the footwall of the room – a highly trafficked area – averaged three to four feet during most of the day. Although the walker would physically fit at the end of the bed, I was frustrated because the clearance was inadequate for two people to negotiate when actually using the walker. The bed always had to be moved. The bed also had to be moved to accommodate computers on wheels, portable imaging equipment and other medical devices. Patient rooms must have sufficient space to maintain clear circulation zones as they evolve during the course of the patient’s stay. The lack of circulation zones creates clutter in the room and adds frustration to an already stressful experience. Contemporary single occupancy patient rooms have circulation zones that are better defined. Incorporating flexible, moveable casework instead of fixed cabinetry enhances the ability to arrange these rooms appropriately as large pieces of medical equipment are brought in to the room.
In my room, space for patient and visitor seating was limited. Two side chairs – usually occupied by visitors – were provided for each bed, but there was not a dedicated “patient” chair. This reduced the opportunities to sit and have a conversation with visitors. The ability to practice getting in and out of a chair, a necessary skill that will be required upon discharge, was also severely limited. Every room should have a chair designated for the patient and of a small enough scale to be easily moved.
The Family Zone
Family and friends of the patient are often involved in their care. In addition to providing emotional support, family can extend the effectiveness of the nursing staff by assisting the patient. Family members may help with meals or serve as translators. Opening the drapes or window blinds, pulling the cubicle curtain closed or closing the door when the corridor is noisy provide elements of comfort and control. Families need to be accommodated in every patient room design. The family also needs to be within an incapacitated patient’s zone of accessibility. My experience was that I felt the most supported and most comforted when my family pulled up a chair and sat at the bedside where I could easily see and hear them. As the patient’s condition improves their zone of activity extends. Instead of just being at the bedside, they are able to engage family and friends in a more conversational way.
In many contemporary patient rooms the area between the patient bed and the exterior wall is the family zone. Often a sleeper sofa is provided near the exterior wall. This approach places the family zone, anchored by the sofa, too far from the patient bedside. Ideally, family and friends would be able to create a conversation circle with the patient whether they are in the bed or sitting in a patient chair. The location of the family zone on the exterior wall side of the room works well. Designers should carefully consider how the furniture will be used and provide pieces that are easily moveable. A sofa may not be the best solution to family zone seating.
The hospital experience can be improved by understanding how patients interact with their physical environment. The practical and emotional implications of space planning and furnishings selection cannot be ignored. Considering small things such as the placement of the bedside cabinet or providing the proper chair contributes to healing by enhancing the patient experience.
This post was originally authored by Larry Metcalf.