A survey of more than 2,000 nurses, conducted by the Royal College of Nursing in 2008, revealed that more than eight out of 10 nurses reported feeling “upset or distressed” because they were unable to provide the dignified care that they knew they should. There has been a concerted effort to address the issue of dignity in healthcare since these findings were first published – most notably with the drive for single-sex accommodation. However, despite the announcement from the Department of Health that 95% Trusts in England have “virtually eliminated” mixed sex accommodation, many challenges remain.
Patient-focused design
A recent initiative has sought to address some of these remaining barriers by inviting UK designers to develop innovative solutions to problems identified by patients and staff. Showcased at the Design Council, earlier this year, these included the following:
• Universal patient gown – designed to preserve patients’ “modesty”.
• BedPod – which creates a private, patient-controlled bed environment.
• Capsule washroom – to rapidly refit wards to create single sex toilet and washing facilities.
• Reclining day chair – a unique hybrid between a wheelchair and a bed which provides greater comfort and security for patients being moved around the hospital.
• Novel screening systems – to separate male and female areas on wards.
• Flexible signage system – to allow staff to designate same-sex areas.
The groundbreaking designs are the culmination of “Design for Patient Dignity” – a programme from the Department of Health and Design Council which has brought together seven teams of leading UK designers and manufacturers, with frontline healthcare staff, to help solve privacy and dignity issues for patients. Commenting at the unveiling of the concepts, Design Council CEO, David Kester, explained that the Design Council and Department of Health secured significant patient and staff involvement, receiving numerous suggestions on how some of the existing deficiencies in privacy and dignity could be addressed. As with the previous “Design Bugs Out” project, this input was critical in guiding the various teams to develop their products and systems in prototype to extremely tight deadlines. Based on the research undertaken with patients and staff a number of focus areas were identified to address the issues of:
• Separating male and female patients.
• Transfer and mobility.
• Toilets and washrooms.
• Retrofitting wards and new layouts.
• Patient wear.
• Humanity (an open brief).
Speaking to an audience of clinicians, politicians, patients and press, former Health Minister, Ann Keen, said: “As a nurse, I know that patients expect and deserve not only high quality, safe and effective care, but a dignified experience when they go into hospital. It is essential that the high standard of work carried out by our skilled NHS staff is not undermined by patients feeling vulnerable and undignified when they receive treatment. “I have spent years being embarrassed by asking people to wear revealing patient gowns and I know that patients will feel far more confident with the new design. We want to ensure that patients’ experience of the NHS goes from good to great and the exciting designs unveiled today show patients what they can expect from the NHS of the future.” Janice Stevens CBE, a nurse with over 30 years’ experience, who is now national director of the Department of Health’s HCAI and Cleanliness Division, said all experienced nursing personnel recognised the importance of a comfortable, relaxing, and, wherever possible, “private ” hospital environment on patient recovery. She said: “Many patients find things like wandering around in a gown which barely covers them, or having to move around a mixed ward to go to the toilet, disconcerting and embarrassing, and the wide range of practical solutions to some of the more common privacy and dignity issues developed as part of this project, are a credit to the skills of the teams – demonstrating both their creativity and their understanding of what hospital patients find most disconcerting. “It is easy to come up with ideas; what is pleasing, here, is that these have been turned extremely rapidly from drawing to prototype, and it is vital that these innovative designs now move forward to full production.” Janice Stevens said she felt the Design for Patient Dignity programme was important not only for generating exciting new product designs, but equally because, via the interaction between the development teams, staff and patients, many NHS nursing staff now had a better idea of key patient concerns, while patients understood better some of the challenges such personnel face in looking after them in surroundings which did not always “naturally engender privacy and dignity”.
Solutions
With gown design having changed little in decades, the creator of the new “Universal Gown, Ben De Lisi, showcased his “onesize- fits-all gown”. The high-end fashion designer explained that, before developing the gown, he consulted around 30 hospital staff and patients. The resulting gown is designed to be easy to put on and take off, and to “cover the patient’s front and back”, while its press-stud fastenings allow equipment such as IV lines to be attached without exposing the skin. As the gown is “completely reversible”, staff can ensure that the sleeve with the press stud openings is on the side nearest to bedside medical equipment. The gown is poly-cotton, with “softer jersey” at the back and shoulders for comfort and ease of movement, while optional additional side panels allow use by bariatric patients. Ben De Lisi added: “Because it opens out completely, the gown is easy to put on and take off. Nursing staff can dress patients without removing oxygen masks or other equipment attached to their head, and the gown can be laid out flat so that even completely immobile patients can be rolled onto it, in the same way that nurses change bed linen around patients who cannot be moved.” The Helen Hamlyn Centre at the Royal College of Art also showcased the “Inclusive Gown” alongside an “Intensive Care Unit Cover”. The latter is designed for use with patients at Critical Care Level 3, (who would generally be unconscious and connected to equipment that cannot be removed). The team said they realised that any new garment design must not only meet patient and staff needs, but also those of a hospital laundry service; the average hospital gown’s lifetime is reportedly 40 cycles of wash and wear, necessitating careful consideration of “lifetime costs”. Designed to “fit all sizes”, the Inclusive Gown has a belt tie around the waist “to help patients stay covered up”. Wearable with the opening at front or back, it incorporates butterfly sleeves (overlapping fabric with an opening down the arm) to facilitate access to patients’ arms. The waist tie is easily replaceable if damaged – “an improvement on traditional gowns”, and has an outside pocket for personal belongings, and one inside “large enough to support a catheter bag”. The ICU Cover is made from SMS fabric – alternate layers of spun-bonded and melt-bonded, non-woven disposable fabric that, as such, should aid infection control. The garment “draws around the patient”, attaching around arms and neck using peel-off adhesive tabs, while perforated lines simplify removal of those parts not needed. Instructions on putting on the gown would be printed on the front for staff. Designers from the Helen Hamlyn Centre at the Royal College of Art also showcased a disposable paper table mat that could incorporate ward information and be personalised with patient-specific data, for instance providing the names of the key nursing staff, or perhaps details of mealtimes and visiting hours. The table mat was designed under the category “Improving patient information”.
Another design company, Pearson Lloyd, discovered four “primary reasons” for loss of dignity during its research – lack of privacy, comfort, communication, and control – and decided to address all four. Design concepts included a “herringbone-shaped” bay screen, which harnesses “kite technology” and is manufactured from tough fabric stretched over lightweight carbon fibre rods. The screens can be “angled” from the side walls to create more private spaces, so that patients are unable to see the patient opposite when sitting or lying, but can still see and talk to passing nurses and clinicians. Pearson Lloyd also demonstrated a range of new “Poncho” garment designs, pointing out that the lack of sleeves would enable staff to easily access patients for treatment, “making the poncho ideal for wearing over a hospital gown instead of a dressing gown”. Luke Pearson said: “The poncho is a low-tech, potentially inexpensive solution, basically comprising just a piece of simply cut fabric, and might typically be made of materials such as polyester for higher wear applications, cotton, or DuPont’s Tyvek. With no sleeves, staff would be able to easily administer drugs intravenously, or perform a blood transfusion, while the large collar opening should simplify putting it on and taking it off.” Developed by designers at the Royal College of Art’s Helen Hamlyn Centre, and described as “a middle ground between a curtain and a wall” is a new retractable screen made from polymer fabric sheet across a plastic rib frame which “folds back concertina-style” against the walls. “We wanted something patients perceived to be like a wall, but that offered the flexibility of a curtain and was cheap and easy to store on the wards,” explained research associate, Yusuf Muhammad. The retractable screen is designed for fixing either side of the ward, suspended from the ceiling, and is secured to the floor using a foot-operated push clamp. For added rigidity it is made of two layers of fabric, one either side of the frame, and, being taut when pulled across, “feels more like a partition or a wall”. The screen can be pulled out to different lengths, and it is reportedly light enough for nursing staff to easily pull it out; the fabric is then cleanable either in situ or via “deep cleaning”. Another screen shown at the Design Council was the “Lightweight Screen” – a free-standing divider for separating areas of a ward or bay, comprising rotationmoulded plastic panels that are “simple to interlock securely”, but light enough to be installed or moved easily by nursing staff. The same team, which included expertise from the Together Creative Collaboration, Suck UK, Anthony Dickens Studio and ESRO, also developed the “Curtain Lock”. This is a one-piece moulded plastic hook that clips onto the curtain rail to prevent the curtain being drawn back past a certain point. It also “acts as a signal” to show staff and patients that a curtained area is in use. Patients can decide how far they want their curtains drawn back, while staff can use the lock to screen off larger areas by clipping a long run of curtains together. The designers said: “The psychological downside of curtains is that you never know if someone’s going to pull them open and burst in on you. We thought if the patient could be reassured this is not going to happen, they will feel a lot more secure.” Another system designed to give patients more control of their own “space”, is the Modular Bed Pod from architects Nightingale Associates, industrial design company Billings Jackson, and manufacturer SAS International. Richard Mazuch, project leader at Nightingale Associates, said: “Our Modular Bed Pod is all about patient empowerment. Hospital patients often say they do not feel in control, whether it’s because they cannot turn the lights off when they wish to, or because the ward acoustics mean everyone can hear their conversations.
For hospital staff space constraints can mean bed bays are cluttered and difficult to work in.” “We realised that if the necessary components that make up a complete bed environment, from medical gases and drip rails, to lighting and bedside lockers, could be integrated into one ‘product’; then the procurement and installation could be substantially simplified,” added Caroline Paradise, design research coordinator at Nightingale Associates. In addition to the outer shell, the Bed Pod features an individual modesty screen, for increased privacy. The curved perforated metal bedhead and ceiling canopy “re-directs sound down onto the bed rather than across the room”, which the team say could reduce the volume of conversations between clinicians and patients by up to 20 db. Also incorporated are ambient lighting behind the bedhead and low-level dimmable lighting at the unit’s base, providing sufficient light for the patient to safely negotiate the ward at night, when the main lights are off, but at a low enough level not to inconvenience others. The Bed Pod can also incorporate medical gases, power supplies, bedside grab rails, and mountings for entertainment systems, while high-level storage utilises previously unused space, and a fold-down chair can be incorporated for visitors. All materials were chosen to simplify cleaning. Commenting on the final designs, Ann Keen said: “Nursing is hard both physically and mentally, but made even harder if you feel privacy and dignity is being compromised. These products demonstrate how well the teams have assimilated and addressed key patient concerns; it is vital now that all those involved to date show the same commitment and passion to get the items into hospital use.” Design for Patient Dignity is part of a wider programme of work to improve privacy and dignity for patients and patient experience. This includes:
• The Dignity in Care Campaign Sir Michael Parkinson was appointed in May 2008 to promote dignity in care, as part of the Department of Health’s Dignity Campaign. (www.dignityincare.org.uk).
• BIG – Bright Ideas Grant The BIG ideas website helped generate and fund ideas to promote dignity in care. People posted their ideas online and bid for up to £10,000 of the total £50,000 fund. The online competition for the fund closed on 18 March 2010. Visitors to the BIG website will be able to rate ideas, with the top rated ideas appearing on the home page. (www.big.dh.gov.uk)
For further information on Design for Patient Dignity, visit: www.designcouncil.org.uk/dignity