Does hospital design make a difference? - British Lung Foun...

British Lung Foundation
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Does hospital design make a difference?

Just musing aloud. Some of us will recall the Nightingale wards in hospitals. Nowadays the in-patient experience is ergonomically driven, as much for our comfort as for nurses and doctors and domestic staff, Or should that be "convenience", and for whom? Is the patient encounter with illness of a safer and healthier experience than it used to be? More cosy and with hotel standards of care?

You may see where I am going with this train of thought. So many differences from then and now, but in what ways and for what ends? Is modernity working in health care or not? I think about human error and instructions somehow going adrift. I can give a number of examples of how the brave new world has not materialised in the bigger and labyrinthine hospitals of today. Bur perhaps that is my personal dystopia of a jaded and antagonistic encounter of the NHS.

I do not mean to be someone who hankers back to an idealised world which never existed in reality, Hospitals are worrying places for many of us and can't be wished away, like nightmares quickly forgotten. So maybe design is not the answer. Perhaps the human beings who are part of that hospital experience are flawed, like many of us patients.

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Mmm, just remembering when my maternity ward had to be fumigated for cockroaches in the 1970s .....they did take the babies out though, but left us in.

It was a former Workhouse.....my claim to fame as I was born there too, after it was a hospital, thank goodness.

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My maternity ward was also in a former workhouse and there was poison down for mice in all the corners! That was in the days when you stayed in for 10 days, had a nap without the baby in the afternoon and had them taken away to the night nursery after Dad's visiting time. How times have changed! xx Moy

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Having worked in the NHS and received much care, the Staff are the same as the rest of us, good, bad, indifferent, infuriating and sometimes brilliant.

As to design, I once had the joy of working with an office in a Unit which won a design award. It was an 8 sided building with a courtyard in the middle, 3 wards looking on to this, none of the rooms had all right angled corners, so space was lost in each as beds, desks etc could not be pushed into a corner. Money had been saved by using some form of plywood type construction on inside walls, so if a TV put on a TV shelf, the shelf fell off wall so all walls needed strengthening (where rails needed by toilets etc).

Best of all the Unit was for Older People and an Hospice Unit, in the central courtyard there was a fountain on day and night. The sound played havoc with the patients (and some staff) needing to go to the loo. The fountain was permanently turned off !!

I would be happy with a bad building and wonderful staff, rather than the other way round. Being as "what goes around comes around" we will go back to the Nightingale idea sooner or later.

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Good question and quite thought provoking!

As with everything there are pros and cons! Pro of nightingale style in my opinion is that if you need help maybe someone would be within earshot, whereas with the 3 or 4 bedded bays, chances of catching someone (even with call bell) can be remote. It should also, in theory, lessen likelihood of cross contamination/infection as only 4 of us could be impacted rather than 20 odd! I would think it is easier for clinicians to keep an eye on patients too as you can scan across all the beds from a distance?! For sleep - probably a better chance in a small bay than huge as the large wards were very echoey and noisy.

On the downside, if you have a noisy room mate/snorer or a wanderer/persistent escapee, you are kinda stuck with them with no one there to step in!

Have had a number of occasions where I am there on max length of oxygen cable trying to stop an elderly confused co-inhabitant from hurtling to the ground head first! Another downside is if someone goes down with something catching, you are so close to each other in a confined space that the chips are pretty much down for you picking it up too!

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I was going to reply to this post but you have the same observations as me.If I had to choose it would be the nightingale wards,felt safer and more airy and less claustrophobic.If you are in the corner of a bay if curtains are not fully pulled back on the side you are on you are completely cut off with no hope of being noticed.I spent 10 days like that,it was not nice xx :-(

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Ironically when I was in hospital only very recently there was a patient who really suffered panic attacks for exactly that reason. There were no windows in the corner she was in and with the curtains as they were she felt so pinned in that she was distraught when they tried to shut the curtains to even examine her. She also panicked when they shut the bay door saying it was like being in a prison. Was awful to see. When I was being discharged I asked the nurse whether it would cause huge problems if they were to move her to where I was since I was by a large window. They agreed it would be possible and did so whilst I was waiting for meds (that was quite a few hours of course!) and she visibly calmed and was so much happier.

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I don't normally suffer from claustrophobia but I was struggling to breathe with pneumonia so it was very scarey.It's an avoidable situation if the curtains between the beds are pulled back fully.That was kind of you to suggest moving the distraught lady and she may not have been helped be it not for your intervention.Sometimes us patients have to help each other when nursing staff miss the obvious,well done you xx

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I worked on the old nightingale wards and quite liked them, you could see all the patients all of the time, and the wards look tidy.

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Oops pressed wrong button!

Moving forward there are now bays of 4-6 at times the only time you see a nurse is at drug rounds and sometimes they have little idea of what’s going on. Yes, you can use the buzzer usually answered by a NA and then a long wait for the RN.

Also the wards generally look untidy but that’s prob me being old fashioned.

I’m really undecided about which is best there’s pros and cons for both.

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I remember the old days when the female nurses wore dresses rather than trousers like they do today at most places.

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I’m not sure what is a Nightingale Ward (I must google it) but I’m guessing one of those big long wards. I haven’t had to go to the hospital since I moved here (knock on wood, spit on the ground and spin 3 times anti-clockwise) but my dad did. His ward was like a H shape, with 6 people in each ward which were the upright bit of the H, and two toilets and one shower shared between both wards ie 12 people. Where I used to live and had the dubious pleasure of frequenting several hospitals, I was in a private room with toilet and shower, or a twin room but fortunate enough to be the only one in the room, also with toilet and shower. My insurance didn’t cover board and lodging, and tv and phone hire were extra too. Meals came with a bottle of wine. My aunt also moved to the U.K. a few years ago. When she had to go into a hospital my parents visited and took a bottle of wine for her. The nurse on duty went mad at them, my poor mum was almost in tears. Who knew that having wine with ones meal is not the done thing in British hospitals! 👩‍⚕️

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I worked in the NHS for many years and worked in both the environments you mention. Sadly both the new and the old had flaws. Both for Doctor, nurse and patient. Or should I say client. I worked in an area that the machines used to treat patients used many gallons of water. A new unit was designed. The nurses who actually operated these machines had the cheek to actually ask to help in the design. After all we knew all the problems. Management said no! So 18 months later the grand opening, 16 new beds, 16 new machines each using 200 gallons of purified filtered water. New shock protected electrics, a television at the side of every bed.... Wonderful you may think? Unfortunately those magical managers had forgotten to but in drains. Not one! Obviously they thought it unreasonable to think that all that water needed somewhere to go.

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I have sensed a bit of hankering back to the older times of bigger wards and more care for the individual patient (if not overlooked when bringing so many together in one place), when posting this thread and reading your answers and opinions. Is it fair therefore to suggest that there is an amount of nostalgia for times when hospital architecture and design was for more group cohesion and conformity of patients and nurses to a uniform code (trousers versus skirts?) of behaviour and subservience to fixed ways of doing things (bring back Matrons etc), patients who did as they were told. Did the consumer have less choice than now as a patient in the NHS? Or is that deceptive? Do administrators of large general hospitals wield more power than in earlier days and focus on saving money rather than curing the patient? These questions perhaps suggest another thread rather different than I started with, so apologies if i am widening the scope of the current issue of ergonomic design to one of a bigger scope of NHS governance and policies.

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Agree with everyone the design is full of pros and cons, which not only effects the patients but also the care given and cross contamination.

One of my earliest recollections is being in a Florence Nightingale ward as a child where there was still a tiled stove chimney in the centre as the only form of heating.

I have no wish to go backwards, although I also do think that for some things we have thrown the baby out with the bathwater.

Cx

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