Fieldwork24 Hour Patient Room Registration11 October 2011 - 12 October 2011

The HospitalRoom.Of TheFuture

The Royal Danish Academy of Fine ArtsSchool of Architecture

Masters Students from Department 11Architecture, Design and Industrial Form

Signe Birkedal PedersenPaulo CunhaPaul FarrellHollie GibbonsAnna-Sophia HansenSimon HarkerPeter HornstrupNicholas LeeLea PaulsenRikke SrensenJacob WestergaardLouise WintherEva Zvodn

Contents

Introduction

Gastrology DepartmentD113 - Room 13.02

Paediatric DepartmentE110 - Room 10.05

Gynaecology and Obstetrics DepartmentG115 - Room 15.03

Cardiological DepartmentS105 - Room 5.19

Introduction to Registration

Commencing at 07:00 on 11th October 2011, 13 masters students from department 11 of the Royal Danish Academy of Fine Arts School of Archicture, began a 24 hour observation of the use of 4 hospital rooms in different departments of Herlev Hospital in Copenhagen.

This document is a registration of the recorded observations from each patient room over the 24 hour period. Photographs taken every 10 minutes record the use of the space within the rooms and are supplimented by sketches analysing the spatial use of occupants. These occupants are the many users of the space, many of whom contributed their experiences to the information gathered. The observational fieldwork measured physical and environmental characteristics of the room as well as surveying its contents and furniture.

The purpose of this fieldwork is to provide the observed research for the project Designing the Hospital Room of the Future/Fremtidens Sengestue.

Fremtidens sengestue et visionrt 1:1 projekt

Hospitalsudvikling som motor for innovation i industrienI hele det store hospitalsprojekt ligger et kmpe potentiale for udvikling af nye produkter til eksport, indenfor nsten alle kategorier, fra bygningskomponent til medico-teknik over bekldning og mbel. Dette forudstter imidlertid at man allerede tidligt i processen lukker op for nytnkning og innovation. Dette projekt har som sit helt centrale forml at invitere til debat om samspillet mellem offentlige investeringer og teknologisk og industriel udvikling. Et andet vsentligt ml er at introducere en integreret designmetode til processen. I dag udvikles de fleste enkeltdele i et hospital hver for sig, med fokus p primr-brugeren. I dette projekt foreslr vi en anden tilgang, hvor alle enkeltdelene udvikles som del af en kontekst: hospitalsstuens rumlige helhed indenfor hospitalet helhed, indenfor byens, landskabets og samfundets helhed. Med denne tilgang kommer patienten i centrum, bde meget konkret, som centrum for rummets organisation, og mere abstrakt i den forstand at mlet er, at sikre den praktiske funktionalitet for alle elementerne i hele deres anvendelse. Endelig nsker vi at udvikle en ny model for partnerskab mellem de forskellige sektorer i dette tilflde regioner, private rdgivningsvirksomheder og offentlige forsknings- og uddannelsesinstitutioner. Ved at arbejde p tvrs af sektorerne bliver det muligt at skabe et nyt rum for innovation.

Sengestuen er valgt som model i dette pilotprojekt, fordi den er relativt afgrnset og velbeskrevet. P Afdeling 11 p Kunstakademiets Arkitektskole har vi arbejdet med sengestue-problematikken i en lngere rrkke, og ude i regionerne findes flere studier af Fremtidens Sengestue. Vi ser det ogs som en fordel, at patientstuen er tt p borgerne det er et sted p hospitalet mange kender, og kan forholde sig til, og som sdan et sted, der er velegnet til at indbyde til dialog.

Endelig mener vi, at der trods mange rs studier, p KADK, p tegnestuerne og i Regionerne, mangler visioner for sengestuerne. Mange af de planlagte sengestuer vil frst blive bygget om 5-10 r, og dog peger de fleste nationale og internationale forestillinger om sengestuen snarere bagud. Vi er ndt til i hjere grad at kaste os ud i fremtidens teknologi, hvis vi vil ramme nutiden om bare fem r. Hvis vi kan tnke en sengestue, der i hjere grad indtnker den nyeste forskning og teknologi, indenfor alle vidensomrder, kan vi bruge den som spydspids for udviklingen p resten af hospitalet.

BaggrundI de kommende femten r skal der bygges op til 4000 nye sengestuer i Danmark. Mange af dem bliver en del af de nye supersygehuse, andre bliver bygget som udvidelser og moderniseringer af eksisterende hospitaler. De nye sengestuer skal rumme state-of-the-art teknologi, vre velfungerende i forhold til patientsikkerhed, lgehjlp, pleje og rengring, og samtidig befordre patientens velbefindende og helbredelse gennem positive rumligt-sanselige oplevelser.

Ved at opfre en sengestue i fuld strrelse p 33-35 m2, inklusive bad og efterprve dens muligheder i samarbejde med de forskellige brugergrupper, er det forventningen, at der kan skabes grundlag for en kritisk dialog om sengestuerne p de nye hospitaler. I projektforlbet vil det vre muligt at ndre rummets dimensioner og afprve alternative muligheder. En model, der tager udgangspunkt i, og udforsker, det flles grundlag vil alt andet lige give bedre grundlag for dialog.

Projektet har sit udgangspunkt i et konkret samarbejde med Henning Larsens Tegnestue og Herlev Hospital, men det er intentionen at arbejdet skal vre tilgngeligt for alle rdgivere og hospitalsansatte, der arbejder med udbygning eller nybygning af hospitaler.

Det sociale samspil med objekter i det arkitektoniske rumSom et vsentligt grundlag for projektet ligger den tese, at man kan forbedre arkitekturens kvalitet mlt p funktionalitet, holdbarhed, vedligehold og oplevelse, hvis man i forstudierne til designarbejdet kombinerer antropologisk metode med arkitektfaglig registrering og analyse. Her registrerer man denne adfrds fysiske aftryk i form af ting som bevgelsesmnstre, slidspor, uhensigtsmssige elementer (som ledninger, der er i vejen). I dialogen med brugerne om de arkitektfaglige iagttagelser opdages nye potentialer og erkendelser, der mske tidligere havde karakter af tavs viden. Det tvrfaglige forarbejde lgger grunden til den efterflgende integrerede designproces, ogs i den forstand, at det bidrager til en gensidig forstelse og anerkendelse. Denne metode, hvor antropologiske og arkitektfaglige metoder kombineres, er udviklet gennem flere r p KADK, og det er et centralt ml for projektet at f prciseret og beskrevet metoden, sledes at den kan blive alment tilgngelig.

Perception, kunst og atmosfreI de seneste r er patientens og hospitalsmedarbejdernes livskvalitet kommet i fokus. Antologien Sansernes Hospital er det vsentligste danske bud p en diskussion, der finder sted over hele verden. P tvrs af faglige grnser er der en stigende forstelse af perceptionens komplekse natur. Denne bevgelse eller retning har relevans for fremtidens sengestue p to mder: dels er der et nske om (gen-)integration af kunst i livsverdenen, som vi kender det fra Herlev Hospital, og dels er der meget inspiration at hente i det realistiske maleri og fotografis reprsentationer af virkeligheden.

MetoderProjektet rummer tre elementer: - feltarbejde med registrering og analyse- programmering- designudvikling

Denne publikation er frste del af feltarbejdet med registrering.Der er naturligvis taget hensyn til etiske problemstillinger i forlbet.

MlDet, vi ivrkstter nu, er et pilotprojekt, med udlb 1. 2. 2012. Mlet for denne periode er at afprve de ovenfor beskrevne metodiske elementer, og dermed det forsknings- og udviklingsmssige potentiale, der er i projektets hovedteser. Projektet afsluttes med et seminar eller en konference ben for rdgivere bygherrer og brugere i regionerne, med fokus p udvikling af fremtidens hospital.

Det er allerede nu hbet, at arbejdet fortstter, ogs med integration af andre faggrupper, som f.eks. designere og ingenirer, i processen. I det fremtidige forlb vil det vre oplagt ogs at arbejde med andre funktioner i hospitalet.

Merete Ahnfeldt-MollerupArkitekt MAA, PhD, Lektor,

Kuvse til Neonatal afdelinger, Afgangsprojekt Astrid Hall

LadcykelAfgangsprojekt Michael Hxbroe

CO2 neutral svineproduktion,Afgangsprojekt, Gry Holmskov

Spisebordsstol til brn og voksne,Afgangsprojekt, Michael Lysemose

Gastrologisk AfdelingGastrologi, eller gastroenterologi oversat fra grsk betyder lren om maveskken og p Gastrologisk afdeling plejer og behandler man patienter med mave-, tarm- eller leversygdomme. Nogle kalder afdlingen mave-, tarmafdelingen i daglig tale.

Der er 290 ansatte p afdelingen, der er underindelt i flere omrder: Sengeafsnit Kirurgisk Ambulatorium Medicinsk Ambulatorium Medicinsk Daghospital Operationsgang Laboratoriet

Afdelingen er meget uddannelses- og forskningsaktiv indenfor pleje og behandling.

Gastrologisk afdeling kerneomrde omfatter mavesyrerelaterede tilstande, en rkke kroniske tarmbetndelsessygdomme, tilstande med diar og mavesmerter samt sygdomme i lever-galdeveje. Under sidstnvnte hrer bl.a. leverbetndelse betinget af virus, skrumpelever, leversvigt samt tilstand efter levertransplantation.

Jacob WestergaardPeter HornstrupSigne Birkedal Pedersen

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7.00-8.00 8.00-9.00 Mdemedafdelingssygeplejerskeog

detvrigepersonalepD113

Omkldningtilsterilthospitalstj

Afventerafdetopatienterpstue13.02vkkesogjegkangigangmedregistreringen

Fotoregistreringstarter

P1forladerrummetforatgibad

P1harvretibadoggrmellemvrelsetogbad

P2vilhavekaffesommorgenmad.Sygeplejerskehenterkaffetilham.

P1vilnskeatdervarenspejlpsengestuen

P1tagervandfrahanenpstuen

P1grudafstuenforathentekoldtvandmedisklumper

P2frindsprjtningerafsygeplejer-sken,menshantalermedsygeplejer-sken

P2forsgeratfsinemorgenpillernedogdrikkerlidtvand

Dererheltstillepstuenogingenbevgelser

P2fretsengebordpdenandensidesengen,fordihankunhavdeetaltforlavtrullebord

P2frflerepillerafsygeplejerske

P1foreslrvideoovervgningafstuernedetvilskabetryghed,dadetnogengangekantageoptil20min.atfhjlpnrmanharrykketialarmsnoren

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Der kommer meget stj fra recep-tionen/modtagelsen p D113

P2 drikker din kaffe og saftevand

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P2 sover og snorker igen

Bde P1 og P2 lser papirer med dagens program for dem

P1 kigger p lampen og redder sin seng

P1 kalder det Herlev-gr-det-selv-Hospital

P1 henter to glas saftevand

P1 ligger i sin seng

Der er endnu en gang rigtig meget telefonstj fra receptionen

Bde P1 og P2 sover og snorker resten af timen

10.00-11.00 Begge patienter sover og snorker

stadig

Meget stj fra receptionen

P2 er vgnet og taler i mobiltelefon

Sygeplejersker kommer og afleverer et gangstativ til P2

P1 gr p toilettet

John skal op og g for frste gang i fire dag

Sengen kres til siden

P2 gr af sted med sygeplejersken til toilettet lngere ned af gangen

P1 gr afsted med avisen og stuen er tom for frste gang

Sygeplejersken kom ind p stuen og fortller mig om deres drlige arbejdsforhold, grundet de gamle og umekaniske senge

Sosu-hjlperen skifter sengetj p P2 seng

P1 kommer tilbage for drikke protein-drik

P1 viser mig sit madskema lavet af ditisten

P1 gr igen og stuen er tom

Sosu-hjlper tmmer skraldespanden

P1 kommer tilbage med endnu en proteindrik som han blander og drikker p stuen

P2 kommer tilbage fra toilettet med hjlp fra sygeplejerske

Sosu-hjlper giver P2 strmper p

P2 seng rykkes tilbage p plads

Sosu-hjlper mler blodsukker p P2

Sygeplejerske tjekker dagens tal p patienterne

Sosu-hjlper fylder flere hndserviet-ter i holderen

P1 gr for at hente kaffe

Sygeplejerske stter et glycose-drop til P2

Sygeplejerske meddeler P2 at han skal flyttes til aflastningsplads p Gentofte Hospital

P1 fortller mig om hvordan el-stik-kene p stuen ikke virker, da de laver hje brumme-lyde nr man stter noget til

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P1 sidder p sengekanten og drikker kaffe

P1 hjlper P2 med at vikle sig ud af hans dropledning

Kioskvognern kommer forbi stuen, men ingen nsker at kbe noget

P1 gr fra stuen mens P2 sidder og kigger ud af vinduet

Sygeplejerske sprger P2 om han havde affring da han var p toilettet, hvortil P2 svarer Det var s lidt, s lidt

P1 kommer tilbage tils tuen og stter sig p sengekanten

Sygeplejerske lukker for frste gang dren ind til stuen

P1 gr rastlrt rundt p stuen og for-styrrer dermed P2, der skiftevis sover og vgner

P1 rengr sit sengebord med vand og papir

P1 fortller mig om at vre patient p Herlev Hospital i en lngere periode

P1 gr ud til sygeplejerskerne og

12.00-13.00 Sygeplejerske kommer og meddeler

at der er frokost

Sygeplejerske forsger at overtale P2 til at spise noget mad, men han vil blot have en kop kaffe og et glas saftevand

P1 rejser sig for at hente frokost

Rengringsdamen kommer ind og tmmer skraldespand, vasker hnd-vasken, vindueskarmen og pan-elvggen. Hun trrer gulvet over. Det tager ca. 3 minutter i alt

P1 kommer tilbage med sin frokost

Sosu-hjlper kommer med P2 kaffe og saftevand

P1 sidder i sengen og spiser sin frokost ved sengebordet

Nu er der stuegang og en sosu-hjlper, en sygeplejerske og en lge kommer ind p stuen

Lgen giver P2 besked om at han skal overflyttes i dag, hun undersger ham i sengen (det er meget svrt for lgen at komme til pga. manglende plads p stuen. Lgen har ca. 30 cm at arbejde p ved siden af sengen. Sengen er s hj at lgen m st p ter for at undersge P2)

beder om sine kvalmepiller (som de hele tiden glemmer at give ham)

Sygeplejerkse kommer ind med P1 kvalmepiller

P1 ligger i sin seng og kigger hen over P2, der ligger i en hjere seng, og ud af vinduet

Begge patienter sover og der er helt stille p stuen

Dren er stadig lukket, men man kan tydeligt hre sygeplejerske og lger tale hjlydt lige p den anden side af dren

P1 vgner og fortller mig om sine operationer

Efter endt undersgelse glemmer per-sonalet at rulle P2 sengebord tilbage til sengen og P2 kan ikke lngere n sin kaffe og saftevand

Dren bliver lukket til stuen igen

P1 hjlper endnu en gang P2 med at vikle ham ud af sin dropledning

Ove stter sig og taler med mig om sit hospitalsforlb

P1 gr igen hvilelrt rundt p stuen

Fra den ene side af sengen til den anden side

P1 gr i seng for at sove til middag

P2 drikker mere kaffe og tager sin mo-biltelefon op i sengen

Ove taler i mobiltelefon i sengen

P2 sover p siden, trods smerter i netop denne side

Sygeplejerske kommer og meddeler at P2 skal overflyttes kl. 15 til Gentofte Hospital

Begge patienter sover

Jeg gr ud for at spise frokost kl. 12.40

P1 P1

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13.00-14.00 Begge patienter sover tungt

P2 vgner for at f styr p droplednin-gen med glucose

Falck kommer med en bre for at flytte P2 til Gentofte

P2 vgner forvirret ved de hrde bank p dren

Sygeplejersken kommer overrasket ind p stue og sprger hvorfor Falck er kommet s tidligt

Sygeplejersken fjerner P2 glucose-drop

P2 forlader stuen p Falcks bre

Sygeplejersken glemme at kigge i P2 sengebord efter hans ejendele

P1 vgner pga. alt den larm der plud-selig er p stuen

P1 gr p toilettet ude p gangen

Sygeplejerske kommer ind og henter P2 seng og papirer

Stuen er tom og dren lukkes

En besgende til P1 kan ikke finde ham p stuen

P1 kommer tilbage fra toilettet

14.00-15.00 Prsten er stadig p besg

P1 henter isvand til ham selv, prsten og mig og byder os p chokolade

Prsten og jeg taler sammen

P1s datter kommer p besg

Prsten takker for i dag og gr igen

P1 og hans datter taler sammen om dagen og sygsforlbet

Der er meget mere roligt p stuen p nuvrende tidspunkt

P1 fortller at han synes at besg fra familien godt kan blive for meget

P1 gr ud og henter en proteindrik

P1 og hans datter venter stadig p besg fra lgen, der muligvis vil udskrive P1 i dag

Jeg takker for denne gang og Jacob tager over

Tre sygeplejersker forsger at finde P1s gst nu hvor han er kommet tilbage fra toilettet

P1 fr besg af sin prst

P1 flytter en stol ud midt i rummet, hvor P2 seng tidligere stod, og stter sig p den

P1 taler med prsten om sit syg-domsforlb

Sygeplejerske kommer ind for at hre om hun skal bede lgen komme til stuegang, men P1 takker nej, fordi han har besg

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Flowdiagram

8.00-9.00

Patient 1

Patient 2

Sygeplejerske/sosu-hjlper/lge

Rengring

Falck-folk

P1s prst

P1s datter

Flowdiagram

9.00-10.00

Patient 1

Patient 2

Sygeplejerske/sosu-hjlper/lge

Rengring

Falck-folk

P1s prst

P1s datter

Flowdiagram

10.00-11.00

Patient 1

Patient 2

Sygeplejerske/sosu-hjlper/lge

Rengring

Falck-folk

P1s prst

P1s datter

Flowdiagram

11.00-12.00

Patient 1

Patient 2

Sygeplejerske/sosu-hjlper/lge

Rengring

Falck-folk

P1s prst

P1s datter

Flowdiagram

12.00-13.00

Patient 1

Patient 2

Sygeplejerske/sosu-hjlper/lge

Rengring

Falck-folk

P1s prst

P1s datter

Flowdiagram

13.00-14.00

Patient 1

Patient 2

Sygeplejerske/sosu-hjlper/lge

Rengring

Falck-folk

P1s prst

P1s datter

Flowdiagram

14.00-15.00

Patient 1

Patient 2

Sygeplejerske/sosu-hjlper/lge

Rengring

Falck-folk

P1s prst

P1s datter

RegistreringRummet

360 p sengestuen

Vg 1 Vg 2 - Vindue/udsigt Vg 3 - Senge- og panelvg Vg 4 - Skab og hndvask

SkitseRummet set fraoven

Gips

Linoleum

Gummiliste

Aluminium

AluminiumAluminium

Gummiliste

Glas

GummilisteVentilationskanal

Materialeregistrering af vindueskarmSnit 1:5

Sygeplejerskens 4 trin ved patienttransport med lift

Stole og evt. tj, yttes fra omrdet omkring sengene

Bordene kres vk Sngene kres ud til siden Liften placeres i midten og opereres der fra

RegistreringArbejdsgange p sengestuen

60 cm

Den prrendes fortrukne komfortzone under ophold p sengetsuen.

Opmling og undersgelse af sengebord

RegistreringSamtale

Samtale med sygeplejerske

Mangler generelt hjlpefaciliteter p stuerne. Der er f.eks. ingen lift.

Der er mangel p gulvplads p stuerne. Det er et problem hvis der nogen har fet et fjernsyn ind p stuen, det tager stort set den overskudende gulvplads. Det vil sige at hvis der er akut hjertes-top eller lignende, skal de kmpe sig forbi fjernsynet for at f plads til en hjertemaskine.

Skraldespanden ved hndvasken sidder p den forkerte side af hnd-vasken, hvilket gr det mere besvrligt for personalet at komme til den.

De gamle senge er helt hblse, da de er mekaniske og ikke elektroniske. Det betyder at bevgelse med og omkring sengene skal foreg ved hndkraft. F.eks. skal i sm sygeplejersker helt op og st p en fodpedal med deres fulde kropsvgt, for at ndre p sengens hjde. Ligeledes skal de selv lfte patienten op med armkraft hvis ryggen p sengen skal rejses.

Samtale med patient 1

Mener at man br og kan udvikle en ny type drop, sledes at patienterne un-dgr at skulle stikkes i hele tiden. Det bliver kun svrere og svrere at finde en re jo flere gange man er blevet stukket, da der dannes arvvv. Det er srligt relevant for patienter, som Ove, der har vret indlagt over en lngere periode.

Ove synes at der br vre et spejl p vrelserne, s man slipper for at g mellem toilet og vrelse s mange gange.

Han synes der helt klar br vre et fjernsyn p vrelserne, mske endda et til hver patient, da man ikke altid nsker at se det samme.

Han ser det som et problem at der ofte er mange besgende p stuen i lbet af dagen, bde ens egen familie/ven-ner og den anden patients familie/ven-ner. Man har ofte brug for mere ro i et sygdomsforlb/ved indlggelse.

Samtale med patient 1s datter

Synes at det giver en tryghed at vide at ens far ikke ligger alene p stuen. Det betyder at der en som kan hjlpe ham eller ringe efter personalet hvis han pludselig fr det drligt og ikke selv kan kalde p hjlp.

Faktisk synes hun at patienten burde have frit valg mellem enestue eller fleremandsstue.

Datteren synes som sin far at der mangler nogle dagligdagsfaciliteter p sengestuen, s som spejl, fjernsyn og bedre/nutidens strmstik til patients opladning af mobil eller computer.

Samtale med patient 1s prst

Mener at ideen om supersygehuse er helt forkert og det gr det svrere for patienterne at f den korrekte behan-dling og dermed et lngere sygdoms-forlb. Med supersygehusene vil blive sendt hjem efter kort tid og skal s pendle mellem hjem og sygehus hele tiden.

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SanseindtrykLugt

Kl. 8.31Hospitalslugt

Kl. 11.31Den lidt tunge og drlige lugt bliver

strkere nr dren holdes lukket

Kl. 10.14Lidt sdme

Kl. 12.33Lidt surt - pga.

der spises frokost p stuen

Kl. 13.09Lidt af tis

Kl. 14.44Friskere i luften nu hvor der kun er en patient p

stuen

SanseindtrykTemperatur

Der er en stor temperaturforskel for de to patienter p trods af at rummet ikke er srligt stort.Rummet er meget koldt ved vinudet og bliv gradvis varmere jo lngere mod dren man kommer.

SanseindtrykBlindtegning

Kl. 11.19Stol

Kl. 11.22Sengebord

Kl. 11.24Lampe

Kl. 11.44Hjul p seng

Kl. 11.27patient 1

Kl. 11.40patient 2

Kl. 14.36Patient 2s datter

SanseindtrykSkitser

Konklusion

De forstyrrelser der findes p sengestuen kan inddeles i to, den interne (hvor en patient eksempelvis snorker og kommer til at vkke den anden eller har gster) el-ler den eksterne, der er livet ude fra gangen (rengring pusler, personalet krer med vogne eller snak fra receptionen).

Patienterne er ofte meget rastlse og bruger meget energi p at finde ud af hvad det skal fordrive tiden med, en af patienterne i denne registrering, gik ekstremt mange gange frem og tilbage for at hente drikkelse af forskellig art, hvis han ikke gik hvilelst rundt i lokalet.

En meget vigtig iagttagelse er at hjlpen kan vre et stykke tid undervejs og derfor bliver patienterne utlmodige. I dette tilflde vaskede en patient sit bord og den mere raske patient hjalp den mindre raske flere gange med en dropslange. Ulempen er umiddelbart at det kan gres forkert, fordelen er den sociale interaktion mellem patienterne.

Gsterne kan ofte vre opslidende at have p besg, bde fordi de selv har stor autoritetstro overfor lokalerne og ikke tr bevge sig vk fra deres prrende, pa-tienten, og det dermed er patienten der skal vise dem hvad de m og ikke m, nr nu de befinder sig i et rum de ikke kender regelsttet for. Men for patienten er det ogs udmattende at vre p selvom det er dejligt med besg.

Patienten (grn) hjlper flere gange sin medpatient. Ulempen kan vre forkert behandling, fordelen

Patienten keder sig og henter drikkelse som aktivitet.

60 cm

Den prrendes fortrukne komfortzone under ophold p sengetsuen, nye omgivelser gr gsten utryg og bruger sengen som tryghed, for her kender han den indlagte.

Herlev Gr Det Selv Hospital

Patient om udfordringer der lses dagligt

Pdiatrisk AfdelingPdiatri oversat fra grsk betyder lren om brnesygdomme og p Pdiatrisk Afdeling beskftiger man sig med brn fra 0-15 r og kronisk syge er p afdelingen til de fylder 18 r. Hvert r indlgges omkring 6.000 brn og 11.000 kommer forbi i et af ambulatorierne

P afdelingen bhandler man brn med alvorlige infektioner, der ikke kan klares hjemmefra - svrere bronkitis, lungebetndelse, falsk strubehoste, maveinfektion, blindtarmsbetndelse, meningitis og andre akutvopstede sygdomme brn der skal opereres brn med diabetes brn med en sygdom i nervesystemet brn med en sygdom der har betydning for hvordan de vokser og udvikler sig for tidligt fdte brn og syge nyfdte brn med socialtbetingede sygdomme

Forldrene til de syge brn fylder meget for patienten, s personalet arbejder med et udvidet patientbegreb, der lgger stor vgt p at forklare og tydeliggre syg-dommene.

Hollie GibbonsAnna-Sofia BrunePaul Nicholas FarrellLouise Winther

10.05

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Morning meeting.What is going on at the department today, how are the patients feeling, what appointments do they have and who is taking care of who.

0740

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Patients are getting out of bed.The patient in bed no. 2 (P 2.) and P 3. are getting breakfast.P 4. is on her bed, watching tv.P 1. and her mum are getting ready for the day.

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P 3. eating in the room.Everybody else is out.

0720

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After the morning meeting, I set up the equipment and introduced the project to the patients and parents.

0840

P 3., P 1. and mum eating in the room.

0730

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Children are getting ready to go to school.Nurses checking in on the patients regularly.

0900

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Room empty, the TV is left on.

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The room is still empty, but 2 nurses have been by looking for other people.

0950

Elin came by to check if I had settled.Electrical sound from automatic door is often heard from the hallway.Turned off the TV, to be able to hear the sounds on the department.

1030

0920

1000

Earlier the hallway was very quiet, but now many footsteps, voices and trolleys are passing.The cleaning lady enters, wipes over sink, door handle, bed edges, window sills, lamps and tables. Sweeps the floor.

1040

P 3. enters and takes a blouse - they are going for a walk with the school, leaves.Returning to find a warmer jacket.P 2. gets a jacket, teacher arrives and rushes the girls out. They all leave the room.

0930

P 1.s mum came in and left again straight away.

1010

Cleaning lady finished after approx. 10 minutes, and leaves the room.Childrens voices and playing from hallway.

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P 3. and nurse in and out.P 1. and mum sitting by table. Speaking Icelandic.

1110

P 1. and P 4. enters the room.P 1. moves her bedside table.The girls are in the room for about 2 minutes before leaving - happy that they dont have to be outside, since it just started raining.Elin and Anette Madsen come by to say hi. P 2. enters and leaves.

1150

Nurse having brief talk with P 1.s mum. P 1. and mum sits on their beds. P 3. in and out. P 4. going in and out of the room for a while.

1120

P 1. and nurse enters - should be in school? Takes her outside, shouldnt sit in the room alone.Mum to P1. enters, moves the bedside table back and hangs her coat.P 3. and nurse enters and leaves.

1200

Anna arrives.P 1. and mum still on their beds.P 4. and nurse are sorting out clothes on bed. Attracts P 1.s attention and she joins them.

1130

Mum of P 1. walking around the bed, but has difficulties getting to the locker and has to move sideways.

1240

P 1. is sitting up in her bed with her bedside table over her legs, she has both something to drink, draw on, and books on the table. She is watching TV, at the same time she is drinking from a plastic cup with a straw. She is talking with P 4. who is laying on her own bed across from her in the room.

1250

P 4. is helping P 1. with which TV- program they should watch on TV while they lay each in their own beds. They are talking and laughing together while watching the same program.

1220

P 1.s mother is afraid that she is served a meat dish for lunch, she asks the canteen lady about it. The mother mentions that she has a computer with her at the Hospital but she has never found internet access so she cant go online and look if the dish is fine for her to eat.

1230

P 1. didnt want to eat more after 3-4 minutes, she leaves her plate with corn and a piece of rye bread on. She runs and hops up in her bed and turns her TV on.Her mother stays at the table for 10-12 minutes more after her daughter leaves and finishes eating.

1210

Lunch is served says the canteen lady who is standing out in the hall with the food on a trolley.P 1., her mother and P 4. get their lunch served on trays and bring it back the room to eat at the table there.

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Empty room, Anna walks around taking pictures.In general very quiet at the department - nobody passing in the hallway.

13.45 trolley with clinking glasses passes the door.

1420

P 4. enters, sits on the bed and turns on the TV - seems to be bored, and in lack of anything better to do, she just turns on the TV whenever shes in the room. Changes her mind and goes out to find colour pencils.P 1. arrives, talks briefly to nurse. Demands P 4. to turn on her TV as well.

1350

Mum enters, gets some stuff and leaves - they are playing in the playing area.

1400

P 3. in and out. Hereafter P 2. and P 4. - all having balloon animals made by the departments clown.P 1. and P 4. running in to the room, leaves again straight away.Mum of P 2. enters, takes her jacket and turns the bathroom light off, on her way out.Sirens can be heard for a long time.

1410

Mum to P 2. and nurse put their heads in to the room, but leave to find another place to talk since Im there.

Elin enters to talk.Nurse saying goodbye.

1300

P 1.s mother is lying in her bed and knitting clothes, P 1. has left the room and left the TV on.P 4. has also left the room, her TV is off. The room is now empty and there is noise from a childrens TV program in the background. At the same time there is noise of the trolleys driving down the hall.

1310

P 3.s mother comes into the room, she asks me where her daughter is and what the camera situated on the tripod is for, I let her know that we are not taking any pictures of her daughter without permission. She starts speaking loudly on the phone with a headset, she takes her shoes off and gets up in her daughters bed while talking.

1320

P 3.s mother is still talking loudly on the phone while laying in P 3.s bed. She gets a bag of food out of her bag and eats it, spilling crumbs in the bed and on the floor. P 1.s mother leaves the room quickly after P 3.s mother came in.

1330

The room is now empty again, P 1.s mother comes back in to turn off the TV and then leaves again.

1430

Lousie leaves . P 1. P 3. and P 4. are all laying in their beds with the TV on. (3 x same channel) P 3.s mother is speaking on the phone again. P 4. says to P 3, that she is lucky to have her mother there with her.

1440

P 4. gets a visitor, (her school teacher) she is happy and excited. The visitor brings flowers. P 1. and P 3. are also just as excited, they get out of their beds to come and look curiously. The nurse finds a vase for the flowers. There is now a lot of noise in the room from the patients, visitor, and 3 x TV that are running constantly.

1450

3 adults and 3 children in the room. P 3.s mother is still speaking on the phone while she is laying in the daughters bed together with her. P 3. starts taking the bedding off the bed, something has been spilled on the sheets. She gets a new set from the nurse.

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P 4. gets 2 more visitors (grandmother + 1 other lady, no relation mentioned). The nurse is speaking openly about the girls bladder problems - That she needs to go use the toilet before talking with the visitors.P 4. now has 3 visitors, all are talking at the same time.

1540

Room empty and 2 TVs running. Minimal noise coming from hallway.

1620

P 3. gets some asthma medicine from the nurse by the dining table. P 1. is there as well, standing and watching, she thinks it is exciting.

1510

P 1. is in bed, drawing and watching TV simultaneously together with her mother who is lying next to her in her own bed knitting. P 1. reacts loudly to everything new happening in the room and hall, with what are you doing? and names/mother.

1550

P 1. comes back with her mother after having taken a bath. The mother turns off the 2 TVs, saying she gets crazy from them running all the time without anybody watching.

1630

P 1. has found a piece of rye bread, she comes over to the dining table and starts buttering the bread standing up. She then runs out of the room while eating the piece of bread.

1520

P 2.s mother comes in the room, she walks sideways past the dinning table to get to her area. She collects her bag from the lounge chair. She speaks quickly with P 1.s mother before leaving the room again.

1600

P 1. is sitting up in her mothers bed across from her mother playing a board game and laughing loudly.

1640

P 1. and P 3. are playing together, running in and out of the room, hiding under the table, behind the door etc.

1530

P 4. leaves the room with her visitors to show them the school and area. P 1 leaves the room right after, following the action.

1610

Only noise is from P 1. playing with her mother. Room otherwise peaceful.

1650

P 4. comes back to the room with her 2 visitors. P 1. wants to play and talk but P 4. says not now, she has guests. P 3. comes with girl patient (from another room).

1700

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P 1. plays along with P 3. while P 4. talks with her visitors. P 2.s mother comes in, sits in lounge chair by her bed, changes her shoes and leaves again. P 2. comes in, puts her jacket over chairs back and leaves.

1740

P 2. and P 3. are playing in the hall with another girl patient. They come and are curious to tell that there is not enough activities for older children, their age. P 3. mentions that she likes all the colours in the hallway - but would like more colours in the room where they sleep.

1710

P 3. comes in and says that it is very bright in the room from the sun rays and it hurts her eyes. She closes the curtains to avoid the direct light. She looks through her bedside table storage and complains that she doesnthave enough space for her stuff. The closets over by P 4.s zone is used by P 4.

1750

Dinner time. P 1. is complaining about the food while eating at the dining table with her mother. P 4. is also having her dinner at the table, she eats quickly and leaves the room.

1720

P 2. is by P 4.s bed end, talking. First time I noticed her being social with the other kids in the room since Ive come. 2 x TVs are running.

1730

P 1. is drawing, watching TV and getting her hair brushed by her mother while in bed.

1820

The sun has now set. I sit with P1 and her mother whilst they finish eating. Now the dominant light source is from fluorescent up lights located on the side walls. The colours of the ward becomes more noticed and highly saturated.

1830

Patients P1 and her mother retire to bed for a post dinner lie down. P4 does the same. P3 seems to be the patient actively personalising her space. A blue balloon animal hangs from her bedside lamp.

1800

Its dinner time. 2 adults are eating with a child patient. The other children are eating in the hall. The sun is setting. The rooms windows face west.

1840

Almost totally dark outside. The colours seem a little overpowering now, maybe to my older eyes and not the childrens. Could such an abundance of colour result in individual colours losing their clarity, metaphor or presence?

1810

Not much has changed. The internet isnt working. Storage for all patients is located against the rear wall in numbered lockers, however P3 complains that P4 uses all them. Leaving P3 with only a smaller bedside unit to keep all her possessions. The only sink is in P1s corner, leading to crowding in that area.

1850

Still a glimmer of day light remains outside. Inside, the internal lights reflect strongly off the windows, mirroring the room and obscuring views out. This leads to feeling of being sealed off from the outside world.

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A helicopter comes in to land. Its very noisy. P1 and P4 run to look out of the window. Helicopters were the only times anyone looked out of the window. They return to the central table to attempt a magic trick, then run into the hall to join the others. P4 returns and closes her curtain completely, creating a flowery glowing box.

1940

P1 plus mother get into their beds for a bedtime story. The curtains are drawn on 2 sides, not completely closing themselves off.

2020

P4 returns with a friend and gently closes the door. It seems to be sleep time now. P1s mother comes back to the main table to knit and read. Her daughter is singing for attention but she ignores it. Again P1s TV is turned on by mistake. P4 gets up and turns it off.

1910

It is completely dark now and the room is empty which makes the lack of storage become more apparent. There are bags and coats on all the beds, chairs, flat surfaces etc. A game of hide and seek is happening and children (even from other rooms) all hide in each others spaces. Showing a good level of comfort and informality.

1950

P4 reads alone in bed. The room is too bright for people to sleep. All the televisions are off. The TVs sit outside of the individual spaces and past the curtains. Slightly impractical and impersonal.

2030

Nurse returns, walks straight to P3s bed to scan her wristband and give her some pills to swallow. They talk briefly. P1 realises Denmark are playing football tonight and the game is on TV. The mood in the room suddenly gets more lively.

1920

Nurse Bridget enters, approaches P4s bed from the left side and puts something on the patients right wrist. P1 is now sat on P4 whilst they talk casually to the nurse.

2000

P4 turns on her television. It is very quiet, as if not to disturb the others. P3 is back from her shower and has to stand on 2 chairs and stretch up to turn on her television. The 2 televisions compete for sound. P1s Tv is accidently turned on somehow.

2040

P1s mother gets up and closes the door left open by the nurse. P1 is snoring quietly. P4 returns with a friend and some drinks to watch the football.

1930

A group of young girls ask me some questions. The leader is P3 and called Kinza. She points to the sign on her bed. It becomes noticeable this is the only permitted personalisation of space in the room. She goes for a shower. P1s mother attempts to adjust her bed with the foot pedal, but gives up.

2010

P3 and P4 watch TV together now. P1s mother completely encloses her space and switches off the main lights. The main light sources are now P3s lamp and television and the hallway light through the glass door panel.

2050

P1s mother changes her daughters nappy in the bed. P3s mobile phone rings, she answers it, gets out of bed and parades around the room. Almost like a performance to show the others she is getting some attention.

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P4s friend gives me some popcorn which makes me thirsty, so I go out to hall to get some water. It is very bright, both light and colour wise. The glass panel in the door helps mediate the transition between the 2 areas.

2140

Another helicopter is landing and Denmark score in the football so the room feels significantly louder.

2220

I have taken off my shoes as they make a loud noise against the linoleum floor. Maybe not the best flooring solution? I can see a faint silhouette of P4, demonstrating a good level of translucency provided by the curtain, balancing privacy and monitoring.

2110

The friend of P1 is fooling around on the floor. I notice the furniture in the room is all adult sized, giving a signal that this is an adult area, not for playing, which the boy is ignoring.

2150

I have a small talk with P4s friend. He hits his face on the glass when trying to look at the helicopter, then shows me the glass actually shakes from the vibrations. He goes back to the match. P1s mother is on her laptop in bed.

2230

All is still in the room.

2120

Curtains are becoming increasingly closed, but not totally. P1s mother has returned from the shower and is struggling to find places to put her things. Views out of the window look into another ward where people are moving around which is distracting and comforting at the same time.

2200

P4 and friend are running around the room playing. But purposely not making a lot of noise.

2240

P4 reclines her bed (which makes a very loud noise) and turns off her light. P2s mum arrives in the room and closes the curtains around her space, and leaves again. It is very spatially tight between the curtains and the side chairs around the table.

2130

There is one bed lamp on which casts a strong and long shadow across the floor. P1s mother returns from the shower and gets back into bed.

2210

The football is over and all the televisions are off. P4s friend leaves and she closes all her curtains around herself. She is a teenager.

2250

P1s mother tells me there are no standard plug sockets near the beds, no one is sure why this is. Modern electronic appliances are very dear to people nowadays and should not be excluded from the patients room.

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2340Paul enters the room. All patients are in their beds. Patient 1 stirs. P 2. then stirs. P 1.s mother adjusts the rail on the side of the bed, this makes a loud noise.

0020P 3. fidgets and begins to snore quietly. Noise can be heard as someone walks down the corridor.

2310Two patients using their lamps, all other patients have their lights off.

2350

0030

2320Patient enters the room from the bathroom. All lights in the room are now off. P 2. puts her belongings away- the sound causes the patient opposite to stir. P 2. has to climb over her belongings- stored around the foot of her bed and onto her bed.

0000Paul leaves the room. The nurse can be heard cleaning the drinks area in the corridor.

0040All patients are still asleep. Ticking noise from the clock is very noticeable. The wind outside is causing the curtains to move very slightly.

2330

0010Try to make a recording of the sound of the clock ticking. All the patients are sleeping.

0050P 3. stirs in her bed but remains asleep.

2300

Hollie arrives and it feels like the final bed time. All the curtains are drawn creating a corridor in the middle of the room. The curtains are competing with the poorly stored bags.

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0220Talk with the nurse in the corridor, she asks what we are looking for in our studies of the room. I talk with her about the knock on affect that sound seems to happen in the room, if one patient stirs then so does another. Nurse explains they can provide earplugs for patients to help them sleep. Nurse offers to make coffee.

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0130Nurse enters leaving the door open, she checks on P 3., then P 4., then P 2. and finally P 1. Nurse leaves closing the door silently behind her. P 2. and 4 stir loudly, P 4. mutters something in her sleep.

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0340P 1. wakes up and calls for her mother. P 4. is woken by this. The nurse enters the room leaving the door open. She checks on all patients and closes the door quietly as she leaves.

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0540P 2. and P 1.s mother both wake in response to patient 1 moving around and talking in bed. P 2.s mother gets up and out of bed, she immediately returns back to bed. P 3. begins to move around in her bed.

0620P 2.s mothers checks her mobile phone, the light can be seen through the curtains.

0510

0550Nurse enters leaving the door open. Nurse checks on patient 4, then P 3., P 2. and then P 1. before closing the door as she leaves.

0630Lights in the corridor become brighter.

0520P 1. is stirring around, she eventually begins to lie across her mothers bed as well as her own.

0600

0640The cleaner outside in the corridor removes trolley creating a noise. Staff greeting each other outside in the corridor can be heard in the room, the sound of high heels echoes in the corridor.

0530P 1. gets into her mothers bed leaving her own bed completely vacant.

0610

0650The cleaner can be heard closing the cupboard doors located on the wall directly outside the room. P 2.s mother gets out of bed, collects some things and heads to the bathroom outisde in the corridor. The noise from the shower in the bathroom can be heard in the room.

0820

0950 1050patient views

0830Nurse getting down to patients level

1200 patient and nurse sorting out clothes 1210 lunch

1420 1400

1507 1530-1630mapping users

1640 light zones 1715

1755 1940

2010 turning on TV 2120

2140 2345 wall panel & door

0025 0130 nurses path

0215 0240

0305 0520

Patient 1:The bed closest to the door, the sink and the lockers.She's a 5-year old Icelandic girl, with long brown hair. She is in the school along with the other children from 9am to 12pm. Her mum has a bed in the room next to her daughter, and is at the hospital most of the time. For the registration period she was only gone around an hour while the girl was at school. The girl doesn't really seem to be affected by being in the hospital, she is very de-manding, and if the mother doesn't answer straight away when she's yelling - be-cause she's talking to a nurse - the girl keeps calling louder and louder. She can't reach the television by herself, so when she wants it turned on, she demands Patient 4 to do it for her. Patient 4 is trying to teach the girl to ask politely, and will not turn on the TV before she has asked her politely. The 2 girls seems to be fond of each other, despite a great age difference. Patient 4s correction of the behaviour, seems to be the only time the girl hears No, since her mother does not step up to the daughter. The mother seems very sad, and more affected by being here than her daughter. She's very quiet, and it seems more like the mother is around for her own sake, that she can't take the separation from the daughter, not because her daughter needs her. Mother and daughter speaks Icelandic to together.Patient 2:In the bed closest to window, at the same side as bed 1.She's a 9-10 year-old girl from Asia/Philippines? She has long straight black hair and also has her mother sleeping next to her. Both of them are extremely quiet, and do not wish to have their photos taken by us. The mother seems distrustful as to wheth-er we keep that agreement.None of them are in the room much, they only come in to get some things, and leaves straight away. They are not eating in the room either.

The Patients

P 1.

P 4.

P 2.

P 3.

The girl seems to accept the fact that shes at the hospital, but when the nurse tells her that she has to stay longer, she seems lost and start crying. Patient 3:The bed towards the window, in the opposite corner of the door.She's 10-years old and from Pakistan. She seems at home in the room and the hos-pital, and is the one girl that is interested in what we are doing here, asking questions and telling us about herself - she seems to miss the attention. She's also the one that has to stay in the room for the longest time.She's a bit overweight, and the nurses are trying to get her to eat more healthy food, but she's picky.Patient 3 has no parents staying with her, but her mum comes to visit early after-noon. The mother enters the room, lies down on the daughters bed and begins an extremely loud phone conversation in Pakistani, which disturbs the privacy and invades the entire room.

Patient 4:The bed is placed away from the window, next to the door.She is 13-years old, dark blond hair and is overweight. She doesn't have any fam-ily with her, and seems to be bored being in the hospital - The department does not have any 'toys' or activities directed to her age group - so every time she enters the room, she turns on the TV in lack of anything better to do. She seems insecure, she's arching her back when walking, looking down.She and P 1. seem fond of each other, and she's helping and taking care of her, but also educating and telling her off when she is being demanding. Seems lonely, and tells P 3., that she's lucky to have her mother visiting her. Gets very excited when visitors are coming, and shows them around the department.

1:50

The Room

Description of room 05 - E110 department of paediatricsBefore entering the room one passes a significant threshold, a 9-10 sqm. entrance zone, where there is 2 toilets with shower on the right hand and door to cleaning/storage room on the left. The walls and closets are painted orange, doors are yellow/white, and the floor is peach linoleum guiding the visitor towards the room which has the same surface only separated by a single orange door frame panel. The ceiling is covered with white panels in which 2 neon lights are situated over to the right side in between the 2 toilets and has its direction towards the room. This entrance zone advices a change in tempo and energy from the movement and acoustics in the hallway outside of the threshold. Once in the entrance zone, there is a notable change in sound level, and as a visitor one approaches the room door with a slower speed and lower voice automatically. Stepping inside the room, one faces a large wall to wall, floor to ceiling window. The glare from the sun can be quite powerful and almost blinding, in the day hours, if the white flower printed curtains arent pulled to shade the space. There is a small balcony with door access which is not in use. Every window, door, and ledges in the room have round corners, which fade smoothly over to the a siding wall/surface.

The room is most likely designed for 6 patients when the hospital was built in 1976, but now it is used by 4 patients under the age of 14. The one side of the room has 4 beds (2 patients/2 family) so the manoeuvring space around ones personal space is minimal. There is a washing area with sink, garbage bin etc. to the right from the door, under a meter from the first patients bed and in her zone. This becomes a traffic zone used by all including nurses and visitors coming in and leaving the room. There is 2 white dining tables directly across the doorway with 8 light blue chairs. The tables are not positioned in the center of the room, which causes access difficulty for patient 2 and her visitors. The walls and ceiling panels are white, the floor is a soft peach coloured linoleum. The one wall towards hall is beige/salmon with a pink painted frame around edges. The large yellow door is placed in the centre of the wall, its frame is multicoloured in blue/orange/blue/dark green/orange. Looking again out towards the hallway, and passing the 3 meter wide threshold, one has a narrow overview over the hall traffic and pink storage space. The floor covering is still linoleum in the hall, but dark blue, showing another flow zone.

P1P2

P3 P4

P1P2

P3 P4

P1P2

P3 P4

Patient 3

Patient 2 (full line)Mum to patient 2 (dotted line)

Patient 1 (full line)Mum to patient 1 (dotted line)

Patients trace 1530-1630

Patient trace overlay

P1P2

P3 P4

Patients views from bed

Patient 3

Patient 3

Patient 2

Patient 4

Patient 1

View from bed 2

View from bed 3View from rooms, overlay

P1P2

P3 P4

P1P2

P3 P4

P1P2

P3 P4

P1P2

P3 P4

Nurse path 0555Nurse path 0345

Nurse path 0130Nurse path 2315

P1P2

P3 P4

Nurse paths overlay

Nurse path, checking on sleeping patients

Architectural / Spatial Drawing / Diagram etc.

Colour palette in the room.

Limited space between the closet and the curtain

Bright colours and lighting reflecting in glass prevents view into room. Personal belongings stored openly in the room.

The only nature present in the room.

Only adult sized furniture in a childrens room broken aesthetic on ceiling

Only permitted personalisation of space. Hanging cables, easily caught by patients- untidy.

Contact with floor- design conflict. Threshold between patients and doctors/ visitor threshold

no designated area for serving food or dining play area seems too temporary

Summary of Interview With Contact Nurses 13/10/2011The overall opinion of the nursing staff at Herlev within paediatrics is against moving towards a single room only system.

Staff find that children within the ward behave better and heal faster through interac-tion with others. It also benefits the parents as they can look to other parents and adult staff for support and companionship.

This particular room is designated for monitoring newly diagnosed patients, typically over the course of a week but sometimes longer. Eating disorders, diabetes, kidney/urine problems and social issues are the types of illnesses dealt with.

Spatially, the ethos for the room is that it primarily belongs to the children. The adults are sometimes asked to leave to allow staff to make observations, parents just have to adjust and make do. The amount of parents staying reduces the amount of patients the ward can accommodate.

This make do way of thinking seemed to apply to other aspects of the rooms organi-sation, including long term and short term storage. Long term patients and short term have an equal amount of storage, even though the bigger lockers are located in only one area of the room.

Plants are allowed in the room only in the form of cut flowers. Potted plants are forbid-den due to the germs that can be carried in the soil.

When asked about the lack of headphones for the televisions the nurse said there werent any despite the headphone sockets. The crossover of television noise was not highlighted as a problem although it was said negatively that the TVs were left on all day even when the patients were out of the room.

Personalisation of space (posters, photographs etc) are not allowed in the space for cleaning and hygiene reasons. However, at Christmas decorations are permitted.

Both nurses interviewed had recently worked at Glostrup Hospital and highlighted the room doors being preferable there; split 50/50 with a glass top half and an opaque bottom. This allowed them to check patients with more ease, whilst passing by and not needing to fully approach the door. At night, hallway light bothering parents is prioritised below the practicality of observ-ing patients.

The windows stay sealed shut due to a combination of a closed ventilation system and prevention of suicides. The balcony is not considered useless now as it helps to filter sun during the hot summer months when the room overheats.

Outside of the rooms boundaries, the nurse said they would like to see a social area specifically for the teenage patients. They would like smaller pockets of space for people to socialise and relax, especially the adults as this would make it easier for the nurses to do their job.

They would like an external playground for parents to take the children to as currently the children can only go outside when the school takes them.

An average day for a child patients starts at around 0800 with breakfast, starting school at 0900. Lunch is at 12, when the younger kids finish for the day. The older children go back from 1300-1500. Dinner is around 1800, and there are no fixed ac-tivities there after. From 2000 patients are expected to be more relaxed. There are no fixed bedtimes.

To summarise, it appears that there are too many people for the room size however; the social interaction amongst this particular group demonstrated a good social dy-namic. Both patients and parents were observed assisting, aiding and keeping each other entertained. The implementation of singular rooms may create a rise in leth-argy, boredom and alienation amongst patients, visitors and staff.The lack of storage for personal belongings was the most obvious problem, upon ar-riving into the room patients belongings and coats were stored openly over chairs, on chairs and tables and along the length of the window sill. The lack of spatial ownership stems from poorly defined zones and bad placement of storage facilities. Patients are required to leave their personal zone in order to store their belongings in the closets located along the length of the wall closest to the door. These closets however, seem to merge into the personal zones of the two patients closest to the wall and hence they occupy all the storage, limiting the other patients. A lack of personalisation creates an un-homely and clinical atmosphere, devoid of patients personalities. The strength of the original 1960s design scheme for Herlev Hospital seems to limit the adaptability and modernisation of the patient rooms, the design scheme seems to take precedents over the requirements for todays staff and patients needs.

Conclusion

Placement of beds.

Storage.

Private zones.

Originally Now

Adapted design-conflicts

Gynkologisk/Obstetrisk AfdelingGynkologi oversat fra grsk betyder sygdomme i de kvindelige knsorganer og obstetrik betyder videnskaben om fdsler og fdselshjlp.Fdsel og graviditetnakkefoldskanningMisdannelsesskanningFrldreaftenerKontaktjordemoderAkupunkturSpeciel konsultation, herunder for srbare gravide.Overvgning af fostret ved komplicerede forlb. Behandling af alle typer af kvindesygdomme ambulant og indlggelse.Behandling af gynkologiske krftsygdomme. Abortklinik.Klinik til kvinder med problemer tidlig i svangerskabet, herunder Klinik for truende for tidlig fdsel.FertilitetsklinikFertilitetsklinik barnlse par.Behandling af kvindesygdomme er opdelt i tre omrder med hver sit behandlingsom-rde: Almen gynkologisk omrde: godartede sygdomme, Gynkologisk onkologisk omrde: krft eller forstadium til krft, Urogynkologisk omrde: vandladnings- el-ler bkkenbundslidelser

Nicholas LeeSimon HarkerEva Zvodn

15.03

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No record.

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No record.

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No record.

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No record.

0800

2 Person Bedroom with 2 Patients. They are currently both sitting up in their beds and talking to each other in a friendly manner.

0810

2 Patients. 2nd Patient leaves room in dressing gown to collect a plate of breakfast.

0820

2 Patients and 1 Nurse. Nurse briefly enters room to collect forms. Both patients are sitting in bed reading books. 2nd patient is eating breakfast while looking out of the window.

0830

2 Patients. 1st Patient is sitting in bed reading a book while the 2nd patient is eating her breakfast and looking out of the window. Nurse enters the room to talk to the 2nd patient regarding her operation. 2nd patient bangs her head on the angle pose lamp.

0840

2 Patients. Both patients are lying down reading in bed. Nurse enters the room and administers a plaster and some pain killer tablets.

0850

2 Patients. Both patients are sitting in bed. One patient is reading a book and the second is using her mobile phone. One patient adjusts her bed with moderate difficulty.

0900

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1000

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2 Patients. 1st patient is sitting in bed reading a book while the 2nd patient answers her phone and leaves the room in her dressing gown and slippers which she removes from her personal locker.

0910

2 Patients. Both patients are sitting in bed reading books. A doctor speaks to the second patient and performs an inspection and discusses the operation using a folder of notes. The doctor touches the patient on the forehead to feel temperature.

0920

2 Patients. Both patients are sitting in bed, the first is reading a book and the second is looking out into the corridor. The first patient uses her phone several times to make calls. It is noted that the window upstand is used to store personal bags ontop.

0930

2 Patients. Both patients are sitting in bed reading. Nurse visits to talk to both patients and then uses hand sanitizer as she leaves.

0940

2 Patients. First patient is in bed reading a book. second patient leaves the room.

0950

1 patient sitting in bed reading. Nurse visits the patient to cheack how she is.

1000

1 patient sitting in bed reading a book and using her mobile phone. The nurse visits the room with a hand held electronic device and a small plastic cup containing tablets.

1010

0 Patients. 1 patient returns to the room after using the bathroom. and checks her mobile phone.

1020

1 Patient. 1 patient sitting in bed reading a book.

1030

1 Patient. 1 patient sitting in bed reading a book. A visitor enters the room to see the second patient who is still out of the room.

1040

1 Patient. 1 patient sitting in bed reading a book.

1050

1 Patient. First patient is sitting in bed reading a book. A nurse enters the room with a gas bottle and then wheels the patient out of the room for surgery. The second patient returns to the room with her visitor.

1100

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1100

0 Patients, 1 Visitor. The patients visitor is waiting for the patient to return and is checking his phone while sitting on the end of the bed. A nurse enters the room briefly.

1110

1 Patient & 1 Visitor. The patient has changed into her personal clothes. A nurse enters the rooms and carries out an inspection with the door closed. The visitor sits on the window upstand while the inspection takes place.

1240

No record.

1120

No record.

1250

No record.

1130

1 Patient & 1 Visitor. The patient and visitor are talking alot and laughing. The nurse returns and gives the patient a card.

1140

1 Patient & 1 Visitor. The patient leaves the hospital room and then the bed is covered in a plastic sheet and is removed by a nurse. The room is now empty.

1150

0 Patients. The room is empty until the first patient returns from her surgery.

1200

0 Patients.

1210

0 Patients. I note that the room has curved junctions between the floor and walls which I assume makes cleaning easier.

1220

0 Patients, 1 Cleaner. A cleaner enters the room and cleans the sink and the patients chariot which has just left. She arranges the moveable furniture arranges personal belongings so she can sweep the floor with a broom.

1230

0 Patients. Room is empty.

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No record.

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No record.

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0 Patients. When the room is empty it is surprisingly large and clutter free. I assume this is so that it is easy to clean and keep sterile.

1340

0 Patients. Room is empty.

1350

0 Patients. Room is empty.

1400

0 Patients. Room is empty.

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0 Patients. Room is empty.

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0 Patients. Room is empty.

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0 Patients. Room is empty.

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0 Patients. Room is empty.

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No record.

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No record.

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0 Patients. Patient returns to room after surgery at 15.18 with visitor.

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1 Patient, 1 Visitor. Nurse visits the patient to take temperature and blood pressure.

1530

1 Patient, 1 Visitor. I leave the room whilst the patient changes. Guard is lifted up on one side of the bed.

1540

1 Patient, 1 Visitor. Senior nurse enters the room to chat to the patient. The visitor goes to the locker to get some items out of the patients personal bag. The visitor makes a phone call and then leaves the room.

1550

1 Patient, 1 Visitor. Visitor leaves the room to make a phone call. Nurse enters the room with food for the patient.

1600

1 Patient, 1 Visitor. Visitor uses his phone while looking out of the window.

1610

1 Patient, 1 Visitor. The visitor leaves the room to fetch a chair. Patient is very quiet while the visitor reads a book.

1620

1 Patient, 1 Visitor. Patient has consumed her yogurt but has left the rest of her food.

1630

1 Patient, 1 Visitor. Visitor answers his mobile phone two times using several areas of the room to speak.

1640

1 Patient, 1 Visitor. Visitor acts as a career for the patient by helping to prepare her food.

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1 Patient, 1 Visitor. Nurse enters the room with a trolley containing medical equipment and checks the mobility of the patients legs.

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1 Patient. Patient has been left on her own briefly.

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1 Patient, 1 Visitor. Visitor continues to prepare food for the patient.

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1 Patient, 1 Visitor. Nurse enters the room briefly to check up on the patient.

1730

1 Patient. The patient has been left on her own briefly.

1740

1 Patient, 1 Visitor and 1 Nurse. The visitor brings a tray of food for the patient. Nurse inspects the patient and turns on the uplighter on the wall console behind the patient.

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1 Patient, 1 Visitor. Nurse enters the room again with her trolley and a hand held electronic device to monitor the patient.

1800

1 Patient, 1 Visitor. Patient adjusts bed position so that it is more upright to make it easier to eat food from a tray.

1820

1 Patient, 1 Visitor. Visitor stretches their legs out while sitting on a side chair.

1830

1 Patient, 1 Visitor. Visitor leaves the room.

1840

1 Patient. Nurse enters the room and removes the catheter from the patient.

1850

1 Patient. Patient leaves to go to the bathroom.

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1 Patient, 1 Visitor. Nurse enters the room with a bunch of flowers for the patient which she places on the second wheelie chariot which is then moved next to the patient from the other side of the room.

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1 Patient, 1 Visitor. Nurse enters the room to examine the patient.

1910

2 Patients, 2 Visitors. First patient is taken for a walk along the corridor with her partner. A second patient and her partner arrive in the room after having surgery. Room suddenly feels very busy.

1920

2 Patients, 2 Visitors. Nurse enters the room to check up on the second patient.

1930

2 Patients, 2 Visitors. A screen has been placed between the two patients. The screen has been unevenly spaced between the two patients.

1940

No record.

1950

2 Patients, 2 Visitors. The screen seems to work better than a curtain but is still makes the room feel cramped.

2000

2 Patients, 2 Visitors. Nurse enters the room and takes a blood sample from the second patient.

2010

2 Patients, 2 Visitors. Both visitors sit on the right hand side of their patients. This leaves very little space for the nurse to provide care to the patients.

2020

2 Patients, 2 Visitors. Second patient is sick and her visitor goes to fetch a nurse who comes and assists the clean up.

2030

2 Patients, 2 Visitors.

2040

2 Patients, 2 Visitors. They chat in pairs seperated by the privacy screen.

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2 Patients, 2 Visitors. One of visitors leaves and introduces himself and his partner to the other two.

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No record.

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No record.

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2 Patients, 1 Visitor. Second visitor leaves room.

2110

2 Patients. First patient turns off her light but the second patient keeps her uplighter on.

2120

2 Patients. Both patients seem to be sleeping.

2130

2 Patients. Second patient recieves a phone call which wakes her up. The door to the corridor remains open providing some light.

2140

2 Patients. Both patients seem to be asleep.

2150

2 Patients. Second patient seems to be asleep while the first patient wakes and then briefly sits up in bed.

2200

2 Patients. Both patients seem to be asleep.

2210

2 Patients. One of the nurses enters the room to take the blood pressure of the second patient. I then get asked to leave the room.

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No record.

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No record.

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No record.

0020

One of the patients leaves the room to go to the bathroom and a nurse enters the room to check on both patients.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

0230

One of the patients leaves the room to go to the bathroom.

0240

No record.

0250

No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

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No record.

0530

The nurse was called to the room by one of the patients and then the second patient wakes up. Nurse leaves the room to get some medication from the closet outside of the room. The lights in the room were not turned on.

0540

No record.

0550

No record.

0600

No record.

0610

Nurse enters the room to check up on the patients and to take blood pressure. PAtients talk to each other. The nurse then leaves the room to fetch a doctor to come back and check up on the patients.

0650

No record.

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No record.

0630

No record.

0620

No record.

0820 0920

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Patient no. 2 vomits

2050 0420

Room (4.8 x 3.85 m)During our observations the room was used as a single patient room as well as room for two occupants. The design of the walls, ceiling and windows, and chosen materials have an impact on the look and atmosphere of the room. Several types of appliances are built into the room - sanitary console, wall panel, headboard, lighting, ventilation, lockers for patients, other pieces of furniture (patients chariot, chairs) can be fully removed from the room along with the most important pieces, like the bed and nurses trolley, which are moved a lot during the use.

The room serves for patients, the primary occupants. Nurses and doctors perform many quick activities in the room and use various equipment during short visits. Visitors want to be in close contact with the patient and are active or passive according to the situation. A cleaner visits the room everyday to sanitize the most used surfaces and to rearrange the moveable furniture.

ColourCount

Ceiling and WallsThe ceiling is the surface which patients see the most if they are laying down. Since it is complicated to clean there are minimum elements attached to it.

Walls, their colour and art displayed in the room are important decorative elements. There are 4 dominant surface colours, very bright with decorative purpose only, not informative. Paintings on the wall are often removed or changed upon patients request.

WindowThe window is the main source of light during the day and offers contact with the outside world. Patients often like to have a view to the outside. The current window does not serve for ventilation or as an access to the exterior balcony. The ventilation duct is located above the door.

The curtains are rarely used. Sick patients can hardly move these. They are regarded as non hygienic and are hard to clean.

VentilationCompletely artificial verntilation with no patient control. Ventilation duct and vents are above the doorway and in the window sill respectively.

Wall ConsolesWall panel contains light switches, phone, emergency alarm and night lights. It it used mostly by the nurses, the design of the buttons seems to be suitable for cleaning.

Sanitary console contains many elements in a compact space. It is used regularly, users move between the bed and the console (back and forth), creating a direct connection.

Headboard PanelThe headboard contains functions operated by the patients, all artificial lighting and media connections. It contains ambient uplighting to the ceiling and also operable angle poise task lamps and a remote panic button alarm for calling a nurse in case of emergency.

The BedThe bed is the most used piece of furniture, it has to be suitable for all the users.

Bed has removable side bars.

Adjustable positioning of the bed. It was observed that it is difficult for patient to adjust her own bed, control buttons were behind patient

Mobility of bed - beds need to be easy to move and control, beds are wheeled in after cleaning or with the patient, after departure of the patient the bed is covered with plastic and removed from the ward for complete sanitation.

Patient bed is quite high so patients use a small stool for getting in and out if bed. It is also used for resting their feel while sitting on the side of the bed.

Nurses trolley Used for storing and transporting nurses equipment, water and cups, as well as writing. It is moved around a lot.

Single metal frame, plastic rails holding containers, metal baskets hanging on the sides. The top container can be replaced by a wooden board.

Mobile stoolStool used in a room to sit next to the patient, can be easily removed (carried out). Metal structure, wooden seat (shaped). Possibility to alter the leg height and lift the seat.

ChariotMovable chariot positioned next to the bed contains personal belongings of the patient - used from the bed. It has a projecting tray that can be used as a table surface. It is constructed from two materials, the main structure is a metal frame and the planar surfaces are made from laminated wood.

Patients lockerThey are difficult to use for sick patients who posses the key. They seem to be quite small and often not adequate to contain all belongings.

Patients belongingsPatients have several personal belongings - small artefacts, important documents, baggage; but lack of space to store them so they often get placed in unintentional places.

BathroomLight in the bathroom is very bad. By the mirror - very bright and white, makes the users face look pale, almost green, the ceiling lamps give yellow light, which is very dull.

Bathroom Furniture

HallwayMulti-coloured, nurses use the colours to differentiate different parts of the floor. Strong graphics on the doors

Nurses lockers in the hallway for equipment storage. Different types - no shelves, with shelves, with baskets as drawers. It was observed that the top drawer is hard to reach for the nurse so she has to drag the whole drawer out and down.

NightThe colours of the corridor are clear from artificial illuminance

DayContrast to bright daylit patient rooms makes dark space with glare from floor and poorly defined colours.

ScreensThey are used to divide the space between two patients. Observed being used in the evening and at night for privacy. Their mobilitity means that they are often not placed exactly in the middle of the room which means that one patient often gets less space. The screen results in even more wheels touching the ground which creates a forest of legs.

How should the patients be made to feel when in the hospital?The patient should feel more at home, safe and secure. When patients are in the hospital they feel that they are not in control of their immediate situation. This results in the patient wanting as much control over their environment as possible. They like to choose what they hear, see, experience, ect. The room should be as flexible as possibile so that they can be individually adjusted for each patients needs.

Positive influence of the media and art.TVs, radio and other kinds of media are usually popular as long as the patient can choose the program. Patients will often choose to listen to music before their operations. They have personal radios inbuilt in the chariots. It is recommended to listen to white noise or birdsong rather than their favourite song prior to surgery because they can associate uncomfortable feelings with the music afterwards.Art work can have positive as well as negative effect on the patient. The nurses currently try and remove or changed it according to the patients preferences.

Use of the windows.Patients enjoy looking out of the window which is their contact with the outside world. It would be nice for the patients to be able to open the window for ventilation and to access fresh air. Currently they cant. There is no access to the balconies, however the hospital sometimes has suicidal patients which should not be able to get out over the balcony. The window is the only source of daylight but the users lack an efficient way to control the amount of daylight which enters the room. The curtains are regarded as non-hygienic and are also hard to operate by some patients.

Where do people store their own things?Each patient has a locker in their room and a night table next to the bed. There is lack of space for personal belongings of the patients. The lockers are small and hard to access for weak patients. If personal belongings are placed elsewhere they can get in the nurses way.

Closed or open doors?Nurses prefer to keep the hospital room doors open so that they are able to check up on the patient. However although the doors to the hospital rooms are often left open it is always the choice of the patient. Patients often feel more secure when the door is open because they get a sense of activity and community from outside the room. If the patient is very sick then they understandably prefer privacy with a closed door. It was observed that opening and closing the door makes a big difference to the feel of the room.Summary of discussion with Nurses

What is the role of patient visitors?Visiting relatives try to help the patient, it also takes some burden away from the nurses. It would be nice to have the opportunity for the guests to stay overnight by having an extra bed in the room. They dont have the chance to do so now. Some patients have larger families where all of the members want to participate and help. The room then has to accommodate larger numbers of people (up to 5) during the daytime.

Mobility of furniture.We move the pieces of furniture all the time, everyone wants it at a different place. It is good when the patient can adjust her bed or the chair she uses. The furniture is movable to give flexibility and practical access to cleaning surfaces and incase of the bed, easy removal in case of emergency. High level of flexibility and ease of operation by both the patient and staff is required for all furniture in the patient room.

How does the nurse approach the patient in bed?Nurses approach to the bed/patient depends if she is left or right handed. They need to have the chance to place their equipment on either side of the bed. Nurses would prefer for every room to be the same with the identical placement of the items.A closet for nurses equipment is lacking in the rooms, it should be accessed only by the nurses to ensure security.

Is the lighting sufficient?Light is an issue. It should be adjustable, controlled by the patients as well as the nurses. Possibility to dim the light would be useful, low level lighting would be good. Night light and guiding lights are lacking at the moment. At night nurses currently perform actions in the dark using light from the hallway or their flashlights which can be very limiting. Colour of the light is important as well. Different colours suit different activities and situations for example check up requires clear white light, eating can be triggered by warm colours, green light is calming, ect. Each faade of the hospital has a different colour. Blue is on the north faade and does not work very well it is too cold.

Requirements for the bathrooms.The rooms currently dont have en suite bathroom which is a very big disadvantage. The current external bathroom is also very small now. Patients often need assistance in the bathroom which can be very difficult with the current arrangement.

How are the rooms cleaned?Cleaning should be performed everyday with surfaces being sanitized. All the furniture should be moved and cleaned. It is hard to get it done. Applied materials (on surfaces, furniture, ect.) should be easy to clean. Direct contact with things should be limited minimize touching of items. It is good to avoid buttons, keys, remote controls. Voice or wireless control could be the solution. Single patient room positive or negative?For many patients the company of a second patient in their room is beneficial. They like to talk to and link with other patients which provides distraction from the typically stressful environment of the hospital. It also helps the nurses to have two patients which can check up on each other.Currently single rooms are given to seriously ill and dying patients. With a single patient room you obviously have a larger space. It is also easier to have a high level of personalization for the patient. With a single patient room it is alot more practical for visitors to stay overnight. Overall the nurses all agreed that the benefits of a single patient bedroom far outweighed the negative points.

NURSE

DOCTOR

VISITOR 2

START

VISITOR 1

PORTER

PATIENT 2

PATIENT 1

CLEANER

FOOD

09

10

11

17

16

15

14

1312

01

02

03

04

050618

19

20

21

22

2324

08

Room Occupancy RegisterRecord of various users occupying the patient room over the 24 hour period.

Research SummaryThe RoomSeveral types of appliances are built into the room which includes a sanitary console, a wall panel, a headboard panel, lighting, ventilation, lockers for patients. Other pieces of furniture (patients chariot, chairs) can be fully removed from the room along with the most important pieces, like the bed and nurses trolley, which are moved a lot during the use.

The headboard contains functions operated by the patients, all artificial lighting and media connections. It contains ambient up lighting to the ceiling and also an operable angle poise task lamps and a remote panic button alarm for calling the nurse in case of emergency.

The integrated sanitary console contains many elements in a compact space. Users move between the bed and the console regularly creating a direct connection.

The furniture is movable to give flexibility and practical access to cleaning surfaces and in the case of the bed, easy removal in case of emergency. A high level of flexibility and ease of operation by both the patient and staff is required for all furniture in the patient room. The lockers are generally considered to be to small and hard to access for