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Medical Design project of Design & Engineering course. Autumn semester 2013/2014

Medical Design project of Design & Engineering course. Autumn semester 2013/2014

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    • swivel Redefining personal space in a multi-bed room Development Project Report for North Estonia Medical Centre Foundation 2014 1
    • 2
    • Table of Contents 06 07 23 24 Introduction Research Brief 6 Course outline 7 Understanding Patient Dignity 23 Brief About Us Where we started Defining Dignity 8 Overview Observational Research 12 Interviews Concepts 24 Concepts 25 Inspiration 28 Macro 30 Local 34 Micro 13 Theoretical Research Privacy 16 Control 17 Personalisation 18 Healthcare Environment 20 Existing Hospital Enivronments 22 Summary 3
    • 35 46 56 57 Development Final Evaluation Resources 36 Storage Concecpts 47 Swivel Cabinet 56 Evaluation 58 References 59 Appendix 43 Scale Prototyping & Testing Materials & Construction 48 Functions 49 Testing 50 Simulations 53 Technical Drawings 4
    • Introduction Objective Students are to gain an understanding of hospital life, systems and services. The aim of this research will be to improve medical care at hospital with emphasis on safety and dignity. Research will be undertaken at both Tallinn University of Technology and the North Estonian Medical Centre (PERH). - Prof. Martin Parn 5
    • About Us Team: Dyre Magnus Vaa, Kristel Laur, Matthew Mccallum & Mike Negrello Supervisors: Martin Pärn, Janno Nõu TTU Design & Engineering We are a multidisciplinary team with backgrounds in industrial design, architecture, carpentry, building science, interior decoration and psychology. Where we started Before our initial research visit to the hospital we shared our personal experiences and perspectives of hospital care. Based on these discussions and our skill sets we chose to focus on patient dignity. Defining dignity Patient dignity is feeling valued and comfortable psychologically with one's physical presentation and behaviour, level of control over the situation, and the behaviour of other people in the environment. 6
    • Title Reasearch Understanding Patient Dignity In this chapter we will explain the different aspects and terminology that define patient dignity such as privacy, control, empowerment and the environment . We will also discuss problem areas at PERH and other hospitals and the developments being made to overcome them. 7
    • Overview To understand the concept and importance of dignity for our project we undertook research using a variety of methods including: • Visits to PERH to observe patient care, equipment, environments and services • Discussions with staff and patients both past and present. • Simulating a ward interior in 3D CAD software based on PERH floor plans. • Theoretical research from the perspectives of psychology, product design, interior architecture and hospital policy. • Analysing innovative approaches and solutions in areas such as public and private transport • Through the following chapters we explain our findings, process and analysis. Observational Research Our first visit to the hospital focused on documenting efforts towards maintaining or reducing patient dignity. We split into two groups to cover the multiple patient and staff areas. after the three hours spent at the hospital we combined our photographs and notes with each other and fellow classmates to form a broad understanding of different aspects to improve and develop. One issue that raised questions and our interest was differentiation in private, single-bed and multi-bed wards. This was supported by the increase in private single bed rooms from one to three on the newly renovated wards. We also noticed that in the shared four patient rooms that there was a dramatic lack of curtains (fig.1), control over environment and the shared bathroom facilities. Another interesting point was the lack of improvement between the old and renovated rooms in terms of privacy and patient dignity. However, the difference between furnishings of the private and shared is further exaggerated. These observations inspired further research into room layout and creating personal space and privacy between patients. 8 On our second visit we focused mostly on what patients bring to the hospital and where and how they store their things. Some examples of things that people take with them to the hospital or have/keep close to them are: mobile, laptop, book and magazines, drinks and glass, toiletries, some food/snacks, a hair brush and a few clothes (fig.2). We noticed that many people have multiple electronic devices such as computers, smartphones and tablets in addition to what items hospitals recommend. These use of these devices also raises questions over their benefits for personal privacy and the impact on others dignity. Patients could potentially be using technology to escape to a virtual world or to participate in work or socialise with others. However, the presence of these devices highlights the lack of suitable and secure storage available to patients. These devices also require regular access to a power source which further complicates the security and working environment for the nurses. The other problem the current storage cabinets create is their low height cupboards and non-ergonomic limits access for patients whom are disabled or bedridden. The combination of these discoveries inspired further research into patient storage facilities and usage scenarios.
    • (fig.1) (fig.2) 9
    • Table: The main differences in single-bed and multi-bed ward. Size Paitent’s personal space/territory Patient Shares Control over enviromental factors and social interaction Single Bedroom 6m squared per person Multi Bedroom ROOM Bed Bedside cabinet Work table- chair Personal fridge TV Chair for visitors Wardrobe for your clothes and belongings, Room light Bedside light on wall ROOM Bed Bedside cabinet Plastic chairs for visitors that are shared with other patients Room light (often regulated outside the room) Bedside light on wall (which is not directional) BATHROOM - Private Toilet Shower Basin Storage cabinet Nothing BATHROOM - shared with others. Toilet Shower Basin Storage cabinet Toilet, shower, sink, shared fridge in the corridor with other patients on the floor, dividers (2 pieces per floor) - usually only in intensive care, general lighting, windows (fresh air + natural light), door, TV (that is not yet present) Patient controls all aspects in Patient can’t control all aspects physical environment in his/ in physical environment in his/ her room (including windows - her room ( windows - fresh air + fresh air + natural light, door) natural light, door, general light, - patient is not seen, heard by noise from others etc) the others. - Patient can control bed and - Patient can choose when bedside cabinet. to see, hear, smell etc. the others(patients, visitors) - Patient and his/her personal except doctors, nurses, some space is like a “stage” for other other hospital staff. patients/their visitors at room - Patient can use his/her personal space/territory for personal activities, without permission of others or he/she does not have to worry about bothering the others. 10 2m squared per person - Doctors, nurses and other hospital staff are free to visit anytime. - You can’t always use your personal space for your personal activities without permission or thinking of others. They can also interrupt.
    • (fig.3) (fig.4) (fig.5) (fig.7) (fig.6) (fig.8) 11
    • Interviews Single vs double rooms The nurses mentioned that private rooms are becoming more and more popular and the prefered option. In the renovated ward the cost for this room is currently fifty euro per night. Patient privacy The nurses also felt that the patients did not mind not having curtains but they wished they had more of the portable dividers (fig.9) to divide male and female patients. (fig.9) We also discussed the nurses thoughts on arranging the beds in different ways and in non-perpendicular to the wall scenarios. They felt that this would be ok as long as access to the services panel behind the patient was maintained. New and old wards The nurses had mixed reactions to the changes between the old and renovated wards. We received comments about the ventilation being worse such as “the walls don’t breathe the same”. as well as comments about the ceiling height and lighting conditions. (fig.10,11) (fig.10 This inspired us to want to have a positive impact on the renovation of the remaining old wards. (fig.11) 12
    • Theoretical Research Privacy There is no universal description of the term ‘‘privacy.’’ However, a commonly accepted aspect of privacy is that it is a fundamental human need and right. The term is generally described as the ‘‘state of control,’’‘‘freedom of choice,’’ ‘‘withdrawal of interaction,’’ and ‘‘a zone of inaccessibility.’’ Types of privacy, based on Akyüz and Erdemir research (2013). or social status. Furthermore, it has been used to describe states characterized by possessiveness and control over an area of physical space. An individual wants to arrange an appropriate environment for himself or herself, form a social circle and maintain this order, and to control his or her interaction with other people. Psychological privacy concerns the ability of human beings to control cognitive and Physical privacy is the control of the affective inputs and outputs, to form values, individual over their surrounding physical place; it also refers to physical contact with and the right to determine with whom and under what circumstances they will share other people and the intimacy level of this contact. Physical privacy includes the terms thoughts or reveal intimate information. Burgoon(1982) links up the concept of ‘‘personal space’’ and ‘‘territoriality.’’ privacy with the functions it performs. Sommer (1969) described personal space These have to do with the development of as an invisible place surrounding the personal autonomy, growth, self-evaluation, human body, an individual area separating self identity, and self-protection. people from one another. The concept of territoriality refers to a Social privacy means managing social physical place such as the home and relationships and controlling the parties, room, or a place in an official building (e.g. frequency, duration, and scope of these a hospital); sometimes, it has also been relationships. Altman and Winsel suggested used to refer to a certain knowledge area 13
    • that social privacy combines the control of both personal social skills and social partnership. Social privacy necessitates evaluating people as individuals and groups according to cultural factors. The level of this privacy depends on the individuals’ limits of managing and controlling other people’s activities, whether directly or not. 14 and Erdemir research (2013), additional authors have pointed out. Physical privacy in healthcare settings. The patient’s room at a hospital differs from his or her room at home in terms of its order, plan, illumination, color, heat, and the people in it and is not an environment arranged according to the patient’s own Informational privacy means that an will and control. Restricting the personal individual controls other people’s access to places of the patients at hospitals (setting his or her personal data and can protect physical restrictions) and interfering himself or herself against revealing such with those places (the patient’s room data. Informational privacy has been or body) mean interfering directly with defined as the right to decide how, when, their privacy. Lesley Baillie’s thesis (2007) and to what extent one reveals personal is an important material about results data. Developments in and increased from different researches about dignity access to communication technologies and privacy matters. Here are some of present potential risks to data security: how the highlighted results. Patients have data are recorded, which data are to be been found to dislike wards that allow used, and by whom. inadequate privacy and personal space (Douglas and Douglas, 2004) and small bed Privacy in Hospital Context spaces leading to close proximity of beds threaten dignity (Seedhouse and Gallagher, Aküz and Erdemir (2013) research 2002; Woogara,2004). Woogara (2004) describes, how within health-care highlighted the open nature of wards which environments, people experience are designed for observation not privacy complicated and private events, and nurses and Johnson (2005) suggested such designs are central to these experiences. Such provide unacceptable levels of privacy by environments include inequalities between today’s standards while acknowledging the the service provider and receiver, and new tension between promoting privacy and roles and expectations, thus threatening observing patients. the autonomy and privacy of individuals. Hospitals have limited resources to control In healthcare settings, patients are the physical environments of patients, generally expected to share their and patients are mostly deprived of their bedroom with complete strangers and is privacy and experience stress in hospitals, perceived by some patients as a loss of and that intruding into personal spaces privacy(Jacelon, 2003; Kirk, 2002; Woogara, results in personal trauma and causes the 2004). Two studies in terminal care found a person to withdraw from social interaction. preference for single room accommodation They suggest that privacy in the field of (Kirk, 2002; Street and Love, 2005) and health care should be considered within participants in some acute care studies its physical, social, psychological, and also expressed that single rooms offered informational aspects. greater privacy (Matiti, 2002; Woogara, 2004). In our project we focused more in physical and a bit in social privacy. During our Social privacy in healthcare settings. research and project development we also Social privacy means the control of the see how these different privacy aspects individual in an interaction, and this are related as research material refers. control passes to health-care personnel The following definitions, descriptions, in healthcare settings. Enabling and and examples are based mainly on Aküz maintaining privacy in professional
    • relationships is a right, and every right puts others (professionals) under an obligation to perform (positive right) or not perform (negative right) a specific task. In multi-bed ward social privacy is affected also by other patients and their visitors. space and entering somebody else’s personal space are indicators of perception of the relationship between the people. A person’s personal space (and the corresponding physical comfort zone) is highly variable and difficult to measure. Estimates for an average Westerner, for Psychological privacy in health-care example, place it at about 60 centimeters practices. Violating the privacy of a patient on either side, 70 centimeters in front and may result in deep trauma, whether 40 centimeters behind. Personal space is apparent or not. The fact that health-care highly variable, and can be due to cultural personnel violate or fail to consider this differences and personal experiences. right of the patient may result in the person Personal space refers to the space an feeling undervalued, social withdrawal, or individual maintains around him or herself, loss of self-confidence. As a result, patients while territory is a larger area an individual may constantly feel uncomfortable and controls that can provide privacy (for restless while at hospital, which may lead to example, an office or a specific chair in permanent problems, depending on their the conference room). Invading another’s personality. territory may cause that person discomfort and the desire to defend his or her space Informational privacy in healthcare (by turning away or creating a barrier, for practices. Health-care practices are based example) (Argyle, 1988). on information, and the management of collecting and distributing data by Hall (1966) describes the subjective the rapid developments in information dimensions that surround each person and technologies and by electronic records is the physical distances they try to keep from precarious. Another aspect of informational other people, according to subtle cultural privacy relates to informing the patient. rules.There are different zones: intimate Information is very valuable for the space (for lovers, children, close family patient. Patients’ expectations regarding members), personal space (for friends, informational family, to chat with associates, and in group privacy include not only confidentiality of discussions), social space (reserved for their medical records but also facilitating strangers, newly formed groups, and new and supporting their physical, interactive, acquaintances), public space (used for and psychological privacy by informing speeches, lectures, and theater; essentially, them of related procedures and decisions. public distance is that range reserved for larger audiences). Territory and Personal Space (Proxemics) Related to physical and psychological privacy there is an important concept about personal space. Personal space is the region surrounding a person which they regard as psychologically theirs (Hall, 1966). Edward T. Hall, calls this area of research, that examines how people use space, proxemics, which he defines as the study of people’s use of space as a function of culture. Most people value their personal space and feel discomfort, anger, or anxiety when their personal space is encroached. Permitting a person to enter personal Credit: Google image search 15
    • Control In privacy context there is need to define perceived control and privacy regulation theory. Perceived control is the belief that one can determine one’s own internal states and behavior, influence one’s environment, and/or bring about desired outcomes. Already in 1987 Wallston et. al. mentioned that theoretically, and to some extent empirically the perception that one has control over what occurs in a given health care setting results in a better adjustment to the setting (e.g., less anxiety or other forms of distress; greater satisfaction and well-being; less reactance behavior such as noncompliance or other forms of “acting out” or expressing anger or frustration) than not perceiving control. Future trends in social and health care are moving more to patient empowerment approach (for example European Network on Patient Empowerment). Our topic and challenge in this context has a small part, but is still “Patients who have a sense of control recover more quickly. “One of the worst things about being a patient is that you don’t have control over what is happening to you or around you,” - Doug Bazuin, Senior Researcher at Herman Miller. 16 important in the main approach. We believe that giving more and accessible control over your personal space and territory empowers patients and supports their recovery process and wellbeing. As some research material in general empowerment field have shown (Wang et al, 2007, Wallston et al. 1987). Here it is also important to mention the social privacy aspect because in multi-bed wards patients are “forced” to be together with strangers and often their privacy and personal space is threatened or violated by other patients and their visitors. At the same time the these people can play important role in positive socializing, helping to avoid loneliness feeling. Photo collage indicating methods of privacy regulation Social psychologist Irwin Altman (1975) developed Privacy regulation theory, that shows how the physical environment and control over it can support privacy including hospital context. This theory explains why people sometimes prefer to stay alone but at other times like get involved in social interactions. Traditionally, privacy is regarded as a state of social withdrawal (i.e., avoiding people), but Altman says that privacy is not static but “a selective control
    • of access to the self or to one’s group”. Therefore, people might want to avoid other people at a particular time but desire contact at another time. Altman believes that the goal of privacy regulation is to achieve the optimum level of privacy (i.e., the ideal level of social interaction). At the optimum level of privacy, people can experience the desired solitude when they want to be alone or enjoy the desired social contact when they want to be with others. If actual level of privacy is greater than the desired one, “Patient empowerment is an approach that aims to establish the patient’s autonomy and self-control.” Patients that feel a sense of control over their care and can become more independant recover faster and will have a psychological feeling of accomplishment. - Peritoneal Dialysis International, Vol. 27 (2007), Supplement 2 people will feel lonely or isolated; on the other hand, if actual level of privacy is smaller than the desired one, people will feel annoyed or crowded. In order to regulate privacy successfully, people use a variety of behavioral mechanisms such as verbal, paraverbal and non-verbal behavior, environmental mechanisms of territoriality and personal space, etc. By combining these behavioral mechanisms (i.e., techniques), they can effectively express and control their desired privacy level to others. Personalisation If we talk about privacy and personal space/ territory there is often present the need to “sign” one’s territory. People seem to have a human need of personalization. There are not much specific studies in hospital context. Brunia S. & Hartjes-Gosselnik A. (2009) tried to explain this concept in their research in workplace context. They found several research materials that a regularly mentioned motivation for personalization is the feeling of control and creating a territory. Following references supported their research. People can feel a psychological ownership over a certain space or workplace (Spicer and Taylor, 2006). Also Wells (2000) mention that a feeling of personal control is an important motivation for personalization. Wells (2000) adds that personalization can be used to feel like an individual rather than a “cog in a machine,” to cope with stress by relaxing and inspiring, to reminding of lives outside the office and to enhance a person’s attachment to the environment. Personalization is used to make sense of space. We can argue whether this is also valid in hospital context, but we can consider this aspect during our project development, but we can’t overlook this. There is also study of how personhood is maintained in a hospice, Kabel and Roberts (2003) found that patients personalized their space with photos and items from home, which could be a way of patients exerting some control over their surroundings, as well as reducing unfamiliarity. We also believe that through the personalisation of patients space there could be an improvement in visitor orientation and reduce cases of mistaken identity. 17
    • Healthcare Environment The built environment significantly affects the healthcare experience of patients and staff. Below we will present some research results. There is a big opportunity and challenge of improving healthcare experience and satisfaction through better environment design. Quan et al (2012) mentioned in their article several studies and evidence that indicates that healthcare physical environment plays an important role in improving the experiences and satisfaction of patients and staff. Research has also identified patient satisfaction with the physical environment as a significant factor in determining a patient’s overall satisfaction with healthcare services— ranked only behind nursing quality and clinical quality (Harris, McBride, Ross, & Curtis, 2002). Lawson and Phiri (2003) concluded that patients who are happier in their environment transfer these feelings to their assessment of other aspects of their experience. In addition, staff may feel more positive in a better environment and portray this to patients in their behaviour. According to Baillie (2007) environmental factors such as a lack of privacy, inadequate resources both physical and human and a dehumanizing ward culture and organisation have all been found to threaten dignity. Based on Reiling et al (2008) theoretical research findings, patients and families tend to be more satisfied with single-bed rooms, that enhance patient safety and create environments that are healthier for patients, families, and staff by preventing injury from falls, infections, and medical errors; minimizing environmental stressors associated with noise and inefficient room and unit layout; and using nature, color, light, and sound to control potential stressors. 18 Douglas & Douglas (2003) described in their research results that patients identified having a need for personal space, a homely welcoming atmosphere, a supportive environment, good physical design, access to external areas and provision of facilities for recreation and leisure. Responses suggested that patient attitudes and perceptions to the built environment of hospital facilities relates to whether the hospital provides a welcoming homely space for themselves and their visitors that promotes health and wellbeing. In hospital context cleanliness is something, that is important and mentioned also through research, for example Douglas and Douglas, (2004) & Lawson and Phiri (2003). ““Patient accommodation is not flexible enough” Individual spaces need to be redesigned to allow for a really wide range of different patient needs. In the ward this is often about better use of small spaces..”” - Priestmangoode Health Manifesto 2010 Virtual Environments as part of hospital experience This was a topic of interest based on our personal hospital experiences and our observations at PERH. As computers have become part of our everyday lives it is becoming easier for patients’ to continue work and socialising from within the hospital context. We thought this trend to would be interesting to explore in the context of dignity and potential for virtual space to influence perceptions of physical space.
    • Future trends in the healthcare system are moving toward tablets, which are available free or through rented service in the hospital. For patients that can mean different outcomes, for example available reach to medical records and information, health education, preventive medicine and recovery instructions/trainings, entertainment and also possibility to create your own “bubble” through the use of digital media devices allowing to connect with the outside world from the hospital, create your own virtual territory bigger, to be connected to the wider world and communities. Judi Moline, stated already in 1997, in her report how virtual environments and related technologies are allowing medical practitioners to help their patients in a number of innovative ways (Surgical procedures; medical therapy; preventive medicine and patient education; medical education and training; visualization of massive medical databases; skill enhancement and rehabilitation; architectural design for health-care facilities). Virtual environments present a unified workspace allowing more or less complete functionality without requiring that all the functions be located in the same physical space. Digital territory is a vision. It introduces the notion of space and borders and other concepts to better understand and manage future. Digitisation is growing and becoming increasingly ubiquitous; in addition, the younger generations are more familiar with the digital world than previous ones. Jefferey, P. (1998) explored in his study, whether the societal norm of personal space influence behavior during interaction and communication in a virtual environment. The results showed that personal space exists in virtual environment and it influences behaviour. Different technological devices work as nonverbal communication and as “signs” “Patients who have a sense of control recover more quickly. “One of the worst things about being a patient is that you don’t have control over what is happening to you or around you,” - Doug Bazuin, Senior Researcher at Herman Miller. and “dividers” in a psychological and physical sense (as we also mentioned before). This ideology can be related back to machine behaviours for example sitting behind computer, using headphones, watching your mobile, sitting behind the wall/cupboard can create a sense of security and personal space and security feeling. Reviews and Blog posts In order to gain a deeper understanding of patients feelings towards the hospital environment we read reviews and blog posts by past patients of hospitals around the globe. This research painted an interesting picture of the types of problems patients face in relation to the environment factors and a obscure usage scenarios especially in foreign contexts. However, the same themes emerged regarding single and shared rooms and the negative effects of sharing a personal space and the security of ones belongings. 19
    • Existing Hospital Environments This selection of images was found through Google image search. 20
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    • Summary In the hospital context, during the crisis period of an illness, it is often necessary to divide the territorial space with strangers and thus, invasion of the personal and territorial space of the hospitalized patient often occurs. suitable for storing common electronic devices that today’s patients bring with them such as laptop, tablets, smartphones, e-book readers etc. There is also limited potential for personalising the space around them. The rights of the patients to privacy, respect, dignity and individuality are mentioned in the Universal Declaration of Human Rights. A current and somewhat effective method hospitals are employing is the restructuring or redevelopment of their wards to include mostly or complete single bed hotel type rooms. This solution provides many improvements in for patient dignity such as the ability to hold private conversations. The negative effects from this solution and trend is that it creates the potential for patient isolation and increases the workload for a variety of hospital staff. Throughout our research we have documented the important link between dignity, privacy and control. We found that privacy and personal space/territory have been identified as an important aspects in patient dignity, healing process, well-being and satisfaction. Privacy can be violated in a variety of ways. For example: the right to enjoy their property; the right to protect their medical and personal information as confidential; the right to expect treatment with dignity during intimate care; and the right to control their personal space and territory. The research materials also highlighted the importance of the patients having control over their environment and interactions with others whenever possible, reducing stress and conflict, and disturbance by others on sleep or relaxation. Through different research materials patients have been consistently commented on the positive impact of a pleasant environment on their health and their well-being. 22 Lack of personal space is a common issue within shared hospital rooms. Here we found that patients have little control over noise, vision, smell and lighting of their environment creating a feeling of no personal or private space. This is further exaggerated by the dysfunctional storage that restricts patients access to their belongings. The storage is not secure or The main problem for most hospitals including PERH is the they cannot provide single bed rooms for all their patients without major redevelopment and construstruction. Our research also has helped define and explain two key areas we believe most concern patient dignity. These are patient privacy & control or patient privacy and physical surrounding/environemnt. We also broken those two into main contributing factors as listed below or the next stage of our project we will use these factors as a criteria to develop concepts and analyse their effectiveness. Patient privacy: Vision Smell Noise Control Personalisation Environment: Access Aesthetics Innovation
    • Brief Develop a new solution to improve patients feeling of control and personal space within a shared hospital room. Potential Outcomes: Improved patient feelings in shared rooms, functional & flexible environments, tools that empower patients and promote independence. 23
    • Concepts In the following chapters we will explore alternative methods for creating personal space within a shared hospital room environment. Our process will begin at a macro level where we will look at the design of the whole ward and space. Next we will focus on the design of the room both single and shared. lastly we will explore the micro level or space within arms reach of a patient. Our solutions will aim to be more human centered than user centered by also considering benefits and effects for hospital staff and visitors. We also want to reflect the values of PERH such as being innovative and creating a supportive and healing environment. 24
    • Inspiration We started our concept generation process with inspirational moodboards reflecting the criteria defined by our research. The images used to compose the mood boards are from Google image search. Inspiration 25
    • Noise Vision 26
    • Light Accessibility 27
    • Macro - Ward Design These concepts involved developing a 3D CAD model of the current hospital ward to explore new layouts and potential space saving. The aim was to create a separate physical space for each patient. All the other services: toilets, shower rooms were collected together ( like in gyms, spas etc). In the middle of the ward situates the medical areas and staff . The patient bubbles are moveable and you can organize them according to the medical condition of the patient or social needs. The ideas are to improve visual privacy based on an open floor plan that will give natural light to more areas. 28
    • Conclusion: This concept was the most innovative and challenging one for the hospital as well as for us. We saw huge potential with this concept and what it offered in terms of changing the hospital experience for patients, particular for when new hospitals are built as apposed to renovations as It would have had a long time frame for implementation and would be economically costly. These were the main reasons we decided not to develop this concept any further. 29
    • Local - Ward Design These concepts explored a variety of methods to improve privacy and personal space . We particularly were interested in solutions that also give natural light to everybody and keep the area accessible and supportive to hospital staff. Some ideas were also based on changing to way we use existing curtains and dividers and if they can offer more to patients than what they currently have. These ideas were also explored in more detail than the prior theme so we have used a key for each concept. Physical Concepts: A) Inflatable dividers Description: Dividers that are easy to inflate (because hospital has oxygen-lines/tubes next to each bed. This condition helps to protect privacy in different ways: visual, smell, noise/sound (from outside and also supports private discussions inside). Also we tried to keep the accessibility, natural light to everybody and hygiene aspect. 30 Conclusion: The main problems appeared with inflatable-function - it can be noisy,it costs more because you need a engine that continues to pump air in it, some controllable and accessibility complications, quite difficult to keep it clean.
    • B) Self Standing Dividers Description: Self-standing constructions that offer improved visual privacy and give patients better control over their space. We also thought it may be possible to integrate with cupboards to create multi purpose solutions. We explored using a variety of materials such as textiles and construction techniques that could offer noise absorption or direction. Below are dividers that are connected to the wall and that patient can open them to create more private space. Also more conventional dividers that are based on self-standing-construction idea. Material: metal, wood, textiles, fabrics, plastic, paper. Conclusion: Whilst these solutions offer improved patient dignity they were often clumsy and are limited by the limited floor plan and design of the room. 31
    • C) Telescopic Curtain Telescopic curtain solution from the ceiling or from the wall. Conclusion: Construction and cleanliness are a big issue.us. D) Horizontal Curtain Description: Unusual concept, dividing room in horizontal way, using textile material, that is easy to clean, change and that is comfortable. It also relies on the shape and textile qualities to control noise and visual privacy. By placing the curtain closer to the patient this concept offers an improved sense of control. The solution could also be changed between patients increasing the sense of hygiene. 32
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    • Conclusion: Psychologically too clinical and strange, also makes potential territory smaller and can disturb hospital personnel work and efficiency. Can be difficult to manage by the patient, if there are extra equipment and difficulties to move. Material Exploration: • Textile - noise/sound absorbing, dirt repellent, easy to clean (washing), “cosy”feeling, not so expensive (that can reuse or replace easily), light reflecting (with metal colour), textile can have a light and wavy feeling. • Plastic - reasonable cost, easy to clean, you can use as transparent material, light, inflatable, soft/hard, easy to create different atmospheres (prints etc) • Combining textile & plastic Micro - Patients Reach These concepts explore ways can hospital furniture be designed and arranged to create personal space. We feel that if patients can access and use their belongings easier then they may be able to create a more comforting and personal space within the shared room. In multi-bed ward the main things that belong only to one patient are a bed, chair, storage cupboard. Due to the renovations of the currently happening at PERH the room size will remain unchanged, that means also that the space for one patient will remain almost the same as previously (approximately 50 cm in both sides). The other consistent factor is that patients will always require access to their belongings in some form. We decided to looking for new possibilities how to improve personal space/territory and privacy through cupboard design. 34
    • Title Development 35
    • Storage Concept This concept was the result of removing material from around the patient and what remained was the storage cabinet for their belongings. The opportunity was clear, if we lifted the cabinet up it has an added function of being able to block visual privacy from other patients. There was also added feelings of hygiene as the belongings were raised from the floor and allowed for better cleaning of the room. The challenge now was to design a solution that kept or improved the functionality of the existing cabinets but in this new location. As we developed the concepts we noticed that building storage on or into the walls made access for patients more difficult. Another issue was making something that did not look bulky and clumsy on the wall next to the patient. Adding Functionality Security During our research we found that patients are more likely to bring expensive electronic devices with them to hospital. Because of this we wanted to make our solution more suitable for safely and securely storing these items. We analyzed security aspect and tried to find solution to lock the cupboard when the patient leaves the room and has to leave the computer, phone wallet etc. Shape The concept started from the traditional squared shape of the current storage cabinet. To develop and improve this design we chose to add smooth and circular lines. This not only made the cabinet look lighter on the eye but added functionality for cleaning and reducing areas where dirt can become trapped. This process was prototyped in cardboard, clay and foam board models at a variety of scales but mostly one to one. We decided to find a shape that could be also pleasant in appearance. Dimensions We also analyzed and tested what kind of dimensions are optimal for the solution. we questioned whether to give patients the same amount of space as in the old cabinet or less space but more ‘useable’. This was to reduce the overall physical dimensions on the wall and weight to make the cabinet light and easy to move. But at the same time the volume had to be big enough to support privacy and personal space functionality. Mobility Through analysing our concepts we thought it would be good if the cabinet was not fixed to a single location on the wall but could be moved depending on patient disabilities or function of the room. The following concepts included rolling or slid out compartments as well as a free turning design that could pivot from an arm. The last idea could greatly improve patients access to their belongings and offer other more ergonomic solutions for eating and lighting control. To further develop this idea we analysed what patients used or needed near them the most. This was based on our observations at the hospital and research into what patients were asked to bring with them. The most common and important item was a water bottle or cup. 36
    • Common patient items: Often Used Not often used • Magazines and books • electronic devices - phone, laptop, tablet, chargers • Water bottle or drink • cup for drink • snacks • pens • Toiletries - shampoo, soap, Hairbrush etc • Towel • Robe • Change of clothing • wallet Concepts Textile Cabinet Description:Textile covered solution is based on the idea of having a skeleton structure that can be covered in a textile skin or membrane. This solution offers much potential for personalisation and because it mostly textile it can be washed and cleaned easily 37
    • Conclusion: The pros of this solution are different material feeling in the hospital environment especially with the effect of light lighting.. The textile cover could help to absorb noise and every patient will get their own clean cover upon admission to the hospital. This gives a more - more personalised feel and could even be decorated by the patient or their visitors. The problems are that the hospital will have increased cost and workload in order to maintain the cabinets cleanliness. Because the patients will move the cabinet with their hands it can become dirty easily in everyday use. The textile design also can look more fragile or not so stable and may be difficult to manage with different scenarios such as spilling a glass of water. Mobile Cabinets 38
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    • These concepts propose modular attachments for drink bottles, cups magazines etc. These elements add both functionality and personality to the designs. They can also be removed for cleaning in a dishwasher. 40
    • These concepts explore different methods of using the arm as both a support and handle for patients. The designs add more strength and rigidity but have a significant impact in terms of weight, complexity and aesthetics. 41
    • EGG-SHAPE to the woll you can connect in two sides (which are flat or almost flat) front and side B ABOUT SHAPE: we can make it also more rounder in different sides at the moment B side is not used - no function it can be magnetwall, but then it is more to other people direction /mirror?/ or just clean surface :) VERSION A VERSION B door can also work as a litlle table-holder front view - more flat side view A VERSION C door opens - 2 ways I dont know yest which one is better 780 closed area a. 350 x 500 310 side B more flat side A 480 310 310 open 480 open hole 350 open about 540 x 430 about 350 x 430 about 620-640 mm Door/table solutions - can we find the way how to open it from the bottom or from computer shelf 42
    • LEAF-SHAPE open from B side side B I didn’t manage to think more through - but this is the shape-idea what are the deepness dimensions? I also understand that we need to modify this bottom part better, for table use and construction :) Scale Prototypes & Testing 43
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    • Final We now present our innovative storage and privacy concept called Swivel. This design offers patients a new level of privacy control and access to their belongings. The shelves have been designed to accommodate all the essential items a patient needs at their bed including lighting and retractable power cord. We have included a large lockable compartment via an rfid mechanism inside the folding tray table. This will allow patients to safely store their most important belongings whilst they away. The folding tray table has also been modified to be easily removed for cleaning and can be adjusted to suit the patients activities. The construction reduces the amount of parts and joints greatly reducing hygiene issues and makes cleaning easier. 46
    • Swivel Cabinet Material & Construction Material Choice In order to choose the material we had to check which material on the market was the most suitable for our cabinet. We opted for a polymer material because it can be very smooth and produced able to be produced in a single piece. This is important to avoid crevices where can harbor bacteria and also because it is not so heavy as wood or metal materials. The material that we decided to use for the cabinet is from the group of thermoplastic. We decided to use it because this material is easy to work compared to the thermosetting plastics and also can be produced in a single piece without different joints. The most common materials in the furniture field for its quality are polycarbonate or other polyamid that can be reinforced with fibre-glass. Manufacturing We did some research about how similar furniture designs are produced and found it was by rotational-moulding. This method allows the cabinet to be produced without joints reducing critical points for stress and hygiene. This rotational moulding process is heavily used because it has low production cost and and can give us almost unlimited design possibilities. This process gives us the opportunity to manufacture stress-free parts with uniform wall thickness and complex shapes.Furthermore It produces little waste, compared to other process as thermoforming and plastic injection moulding, since the exact weight of plastic required to produce the part is placed inside the mould. Injection moulding would be our second choice for construction as it still retains many of the positive aspects as roto moulding but with increased cost. Also this process is much more complex and requires bigger initial investment to test. 47
    • Functions Ball-bearing Internal RFID lock mechanism Rotating reading light Retractable power cable 180 deg of movement 360 deg of movement Easy access zones 48 Easy to clean hinge for adjustable tray table
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    • Stress & Deformation Testing In order to calculate the final materials and details for our design we performed a stress and deformation simulation using ANSYS software package. The cabinet will be hung from a wall so we wanted to know how much weight the tubular arm can handle without significant deformation or breaking. The straight part which will be a part of the wall hanging is set as fixed support, as this will not move in any directions, other than rotating around its own axis. The force put on the construction is the weight of the cabinet, which is approximately 25kg + 10 kg worth of contents inside. 50 The results of the simulations shows that the maximum stress on the construction will be 214,8 MPa, and the highest stresses will be the tensile stress. The maximum deformation will be on the end where the cabinet is hung from. With the load payload of 10 kg, the deformation is 16,5 mm. The deformation, and thereby vertically relocation of the cabinet of 16,5 mm is acceptable.
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    • Evaluation This project has led to some interesting discoveries both in research and in prototyping solutions for the hospital. Whilst we believe our design is very innovative and supports our research on dignity we believe this is simply beginning of a new system. Our other concepts show where the hospital has potential to radically change the way patients can control their personal space but firstly we must develop our prototype further and look towards the future of hospital care. 56
    • Resources 57
    • References Akyüz, E. & Erdemir, F. (2013). Surgical patients’ and nurses’ opinions and expectations about privacy in care. Nursing Ethics, 20(6), pp. 660–671. Altman, I. & Winsel, A. (1997) Personal space: an analysis of ET Hall’s proxemics framework. In: Altman I and Wohlwill J (eds) Human behavior and environment: advances in theory and research, vol. 2. New York: Plenum Press, pp. 181–259. Altman, I (1975). The environment and social behavior. Monterey, CA: Brooks/Cole. Argyle, M. (1988). Bodily Communication, 2nd ed. New York, NY: Methuen. Baillie, L. (2007). A case study of patient dignity in an acute Hospital setting. A thesis submitted in partial fulfilment of the requirements of London South Bank University for the degree of Doctor of Philosophy. Brunia, S. & Hartjes-Gosselink, A. (2009). Personalization in non-territorial Offices: a study of a human need. Journal of Corporate Real Estate Vol. 11 No. 3, pp. 169-182. Burgoon J. (1982). Privacy and communication. Communication year book, vol. 6. Beverly Hills, CA: Sage Publications, pp. 206–249. Douglas, C.H. & Douglas, M.R. (2004). Patient-friendly hospital environments: exploring the patients’ perspective. Health Expectations. 7(1), pp.61-73. Hall, Edward T. (1966). The Hidden Dimension. Anchor Books Harris, P. B., Mcbride, G., Ross, C., & Curtis, L. (2002). A place to heal: Environmental sources of satisfaction among hospital patients. Journal of Applied Social Psychology, 32(6), 1276–1299. Herman Miller Healthcare Research (2010). Patient Rooms: A Changing Scene of Healing. Jacelon, C.S. (2003). The dignity of elders in an acute care hospital. Qualitative Health Research. 13(4), pp.543-556. Jeffrey, P. & Mark, G. (1998). Constructing Social Spaces in Virtual Environments: A Study of Navigation and Interaction. Workshop on Personalised and Social Navigation in Information Space, March 16-17, Stockholm: Swedish Institute of Computer Science (SICS), 24-38. Johnson, M. (2005). Notes on the tension between privacy and surveillance in nursing. Online Journal of Issues in Nursing. 10(2), 11p. Kabel, A & Roberts, D. (2003). Professionals’ perceptions of maintaining personhood in hospice care. International Journal of Palliative Nursing. 9 (7), pp.283-289. Kirk, S. (2002). Patient preferences for a single or shared room in a hospice. Nursing Times. 98(50), pp.39-41. Lawson, B. and Phiri, M. (2003) The architectural healthcare environment and its effects on patient health outcomes: a report on an NHS Estates funded research project. Norwich: HMSO. Matiti, M. R. (2002). Patient dignity in nursing: a phenomenological study. Unpublished thesis. University of Huddersfield School of Education and Professional Development. Moline, J. (1997). Virtual reality for Health Care: a survey. IOS Press. Reiling, J. Hughes, R.G. & Murphy, M. R. (2008). The Impact of Facility Design on Patient Safety Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 28. Seedhouse, D. & Gallagher, A. (2002). Undignifying situations. Journal of Medical Ethics. 28(6), pp.368-372. Sommer R. (1969). Personal space: the behavioral basis of design. Englewood Cliffs, NJ: Prentice-Hall. Spicer, A. & Taylor, S. (2006). “The struggle for organizational space”, Journal of Management Inquiry, pp. 2-27. Street, A.F. and Love, A. (2005). Dimensions of privacy in palliative care: views of health professionals. Social Science and Medicine. 60(8), pp.1795-1804. Universal Declaration of Human Rights. (1948). http://www.un.org/en/documents/udhr/. UN General Assembly, 10 December Wang, L., Dong, J. , Gan, H-B., and Wang T. (2007). Empowerment of patients in the process of rehabilitation, Peritoneal Dialysis International, Vol. 27, Supplement 2. Wells, M.M. (2000). Office clutter or meaningful personal displays: the role of office personalization in employee and organizational well-being. Journal of Environmental Psychology, Vol. 20, pp. 239-55. Woogara, J. (2004). Patient privacy: an ethnographic study of privacy in NHS patient settings. Unpublished phd thesis. University of Surrey. Wallston,K.A., Wallston, B.S., Smith, S. & Dobbins, C.J. (1987). Perceived Control and Health. Current Psychological Research & Reviews, Spring vol. 6, no.1, 5-25. Quan, X., Joseph, A. & Ensign, J. C. (2012). Impact of Imaging Room Environment: Staff Job Stress and Satisfaction, Patient Satisfaction, and Willingness To Recommend. Health Environments Research & Design Journal (HERD), February 1. 58
    • Appendix What kind of disturbing and uncomfortable aspects you have experienced during your stay in multi-bed ward? SUMMARY OF RESPONSES: PRIVACY & CONTROL PROBLEMS IN MULTI-BED PATIENT ROOMS knowing that you are not alone in a room you hear (snoring, other conversations, body sounds, music, other doings etc), smell (body smells, food, flowers, lack of fresh air etc) , see (everything, everybody) hospital staff, nurses, doctors are moving in-out other patients in your room move in-out other unknown people move around (visitors of other patients) you have to be ready “sudden” visits you have your own side - cupboard - but it isn’t locked, your things are seen - so other patients can see your staff or “take” them, it is not safe to leave them there. your body and problems are exposed to the others - your condition, examinations, doctor visits, medical procedures, your personal conversations etc. everybody can see/hear/smell what you are doing & you also experience the same backwards - (at the same time you have to control yourself and body, because of the others) you are dependent of other bathroom habits - you can’t use it always when you want the room conditions are not under your control - cleanliness, fresh air, lighting, sounds you hear noise outside your room you have to eat in front of the others - and when you have your personal food, then it can be uncomfortable. you can’t enjoy always the things that you would like to do (tv programs, music, my own visitor’s visits, conversations, working, reading etc) everybody in room can hear your health problems if you like to be close to the window, you can’t bathroom is not locked different sexes in the same room, using the same facilities (toilet/shower) you are exposed in your private condition in very weak moment - special condition in general staff sex and your privacy - man-man, woman-woman you have to use other patient’s stuff (laundry, clothes, medical things….) you can’t hide, go away (always) you have to be social when you don’t want (you have to be polite, nice etc) - because it affects your staying there you don’t know these people with whom you are there you have lost control over your body, everyday habits, life you can’t control many aspects in your physical environment (choose room, bed, etc) you can’t control many aspects in your psychological environment (roommates, peace, socializing) you can change the environment as you would like to (colours, smells, lighting, aesthetic part, cosiness, etc - that helps you to feel like home, or the environment where is nice to be, when you are sick / recovering) you are always waiting, spending time you don’t know what is going on? what is the new information? You don’t remember all - you would like to “see” your situation, need to have some accessible medical record together with explanations. 59