Hospital stays scare people due to several causes. First is a fear about the individual’s well-being. Will the treatment work? How much will it hurt? How long will the stay be? Fear is also generated by the patient being well outside his or her personal comfort zone. Often, the patient’s most intimate experiences — from using the toilet to bathing to walking — are shared with complete strangers. Another source of fear is the loss of control over the patient’s activities — when to eat, when to sleep, when to exercise — are decisions controlled by the staff and not the patient.
All three of these fear factors were an issue for me during a recent post-surgical stay at a community hospital in California. As a designer specializing in health care facilities, I used the opportunity to observe how the staff, family and patient interact with each other and with the physical environment. Even though my 1980’s-era semi-private room was not up to contemporary design standards, I took away lessons about patient room functionality that are applicable to private room design today. Through observation, I reached conclusions about the useable space in the room, clearances required in circulation paths, patient and visitor seating, and the location of the family zone.
Functional space is lost in any patient room in which there is a flat wall behind the patient bed. Even with today’s sophisticated beds that retract in order to keep the patient’s head from moving, the patient is still effectively moved farther away from the headwall. Because the patient’s bedside cabinet is often placed next to the bed and against the headwall, it’s not accessible unless it’s pulled away and located close to the middle of the patient bed. This was the case in my situation.
When the bedside cabinet was pulled forward, the nursing staff’s accessibility to that side of the bed was severely diminished. In my observation, the typical patient room configuration has 18 to 20 square feet of minimally useable space at the side of the bed near the headwall. Use of this space is limited to IV poles and medical equipment, such as a ventilator, but even these items are pulled away from the wall to facilitate access by the nursing staff. Current designs lose five to 10 percent of expensive square footage by not recognizing the actual position of the patient’s head and shoulders when the bed is raised. Wrapping the headwall surface around the head of the bed is one option that could be explored to make this area a functional space.
Patient rooms move. The beds move, furniture is rearranged and medical equipment is wheeled in and out. These factors can change room clearance greatly at any given moment. The clearance between the normal parked bed position and the footwall of the room — a highly trafficked area — was approximately 4 feet. During my stay, I was confined to a walker for mobility and was always assisted by a physical therapist. While the walker would physically fit around the end of the bed, I found the clearance to be inadequate for maneuvering. The 4-foot clearance at the end of the bed was also insufficient for maneuvering the computers on wheels the hospital used for charting, medication distribution and dietary orders into the room. These factors are why patient rooms should be planned with the high-volume traffic areas of sufficient width.
Patient and Visitor Seating
In this particular room, space for patient and visitor seating was limited. Two side chairs — usually occupied by visitors — were provided for each bed, but the lack of a dedicated “patient” chair was a definite obstacle to patient care. It reduces the opportunity for the patient to sit and have a conversation with visitors and limits the ability for a patient to practice getting in and out of a chair, a necessary skill that will be required upon discharge. As with other elements in the room, these chairs were not static against the wall but were being constantly moved. Because of this, weight and bulk should be considered along with clean-ability and durability when selecting furnishings.
The Family Zone
Including family and friends in the design of the patient room is essential to creating a true “healing environment.” The design of the typical “family-centered” patient room follows a common template. The space between the corridor wall and the bed, on the entry side of the room, is deemed to be the caregiver zone. The space between the patient bed and the exterior wall is determined to be the family zone. Often a sofa or sleeper sofa is provided near the exterior wall. The sofa is the primary seating for the guests and also allows them to stay with the patient overnight.
Various versions of this basic concept have been developed using both inboard and outboard patient toilet and shower rooms. The flaw with this design is that the family zone, anchored by the sofa, is too far from the patient bedside. Patients who are heavily medicated have a limited zone of interactivity around them. My experience was that I felt the most supported and most comforted when my family pulled up a chair and sat at the bedside.
As the patient’s condition improves, their zone of activity extends. Instead of just being at the bedside, they begin to engage family and friends in a more conversational way. While the sofa provides for the overnight stay, a true conversation area is not created by this long horizontal surface. It’s difficult to make a conversation circle with a sofa.
From this perspective of the patient, I realized that the function of the patient room and the healing environment can be improved by analyzing the space. Taking seemingly small things like the placement of a bedside cabinet or a dedicated patient chair into account can make a great deal of difference in the quality of the patient experience.