Balancing Privacy And Community In Children’s Inpatient Units
Private patient rooms have become the norm in newly constructed hospitals, largely due to the recommendation of the Facility Guidelines Institute (FGI), which is motivated by concerns about the spread of infections and patient privacy.
The FGI’s 2014 guidelines propose new standards for children’s hospitals that further support the need for private patient rooms in new construction, “unless functional program demonstrates necessity for two-bed arrangements,” such as when siblings are treated at the same time. Even in countries outside of the U.S. where it’s rare to find a children’s hospital with all private rooms, some new hospitals are proposing this approach.
With concerns surrounding infection control and patient privacy, the argument for private rooms is valid, and for the most part, I celebrate this recommendation. But spending long periods of time in a room with potentially limited contact with staff, friends, and family can leave young patients feeling lonely, isolated, and disconnected.
I’ve spoken with parents of children who have weathered long hospital stays and a variety of caregivers, from Child Life Specialists to hospice volunteers, and I’ve found several common themes: Families want a space to sit with and hold their child, storage for personal belongings, privacy to nurture and care for their child without the distractions a shared room can perpetuate, and a place to sleep overnight in the room. As most of you know, all of these things are commonplace in new construction and are recommended by the FGI.
While this bare-minimum scenario takes into account the need for families to be with and support their children, it overlooks the fundamental need we all have for community. I have fond memories of taking my son to the park when he was younger, hoping he might make a new friend. But I also hoped that I might make a connection, as well, by bonding with others through a shared interest—parenting and our children. If we can look at the patient unit in the same light and allow strangers the chance to engage, as organically as possible under the stressful situation of being in a hospital, perhaps we can encourage a sense of healing, comfort, and community beyond the patient room.
One solution might be to organize a patient unit that provides multiple neighborhoods or pods, by cohort when possible, where groups of 6-8 patient rooms sit adjacent to spaces where children can eat, play, and gather—essentially creating a “park” for all to engage as a community. Ideally, these neighborhoods would connect to the outdoors in some capacity, literally or at least visually, and allow patients and families to choose to participate in activities when and if they feel a need for interaction and socialization.
While the design for such “neighborhoods” could potentially cause a shift in nursing strategies and supply deliveries, increase staff travel distances (and require some creativity in storage solutions), and increase “traditional” construction costs, such an idea is not unrealistic.
As a design community, let’s rethink the holistic patient unit in children’s hospital environments and find creative ways to include opportunities for engagement. If we address the need for privacy while still providing a sense of community, we can have the best of both worlds and create an environment that encourages holistic healing.