1. 10 Design Solutions proposed
Creating a Dementia-Friendly Hospital Environment
Working with PATIENTS AND FAMILIES
Background
People with dementia that have acute medical needs deserve high quality of care in hospitals. Good hospital environment can support function and maintain ability. Poor design can cause confusion, leading to
Delirium
Declined functions
Delayed discharge
Walk-along Interviews involved having conversations about the hospital environment while the patient took the researcher for a walk in the unit corridors. The process was video-recorded by a hand-held camcorder.
A Participatory approach
Engage all stakeholders, including patients and families, staff and leaders to co-create a dementia friendly environment for a unit at the Vancouver General Hospital
Methods
Walk-along interviews with patients in corridors
Environmental audits using HEAP (Hospital Environment Audit Protocol)
Observation
Focus groups with staff & leaders
HEAP evaluates environmental attributes in 4 domains
Functional ability
Safety & Security
Familiarity & Orientation
Social Interaction
Family advisors and staff conducted the audits.
Participants & Advisors
4 patients with dementia staying in a medical unit
2 family advisors
1 patient advisor
14 staff and 4 leaders
Colors
“In a hospital you wouldn't feel quite so much in it if you had color around…Oh, I think it could be fun colors, not too bold, (e.g., warm pastel color), all different colors…” (Ann, patient)
Lighting
“I wouldn't go there unless there’s someone with me” (Terry, a patient described a dark area in the corridor)
“Glare coming from strong sunlight can be overwhelming and frightening” (Jim, patient advisor)
10 Design Solutions proposed
based on patients and families opinion and suggestions, current dementia design principles
Cognitive
Overload
“Clutter makes the brain feel getting overloaded by too much stimuli, overly charged with electricity, if you know what I mean” (Susan, patient)
Comfortable Seating Arrangement
Multiple Small Sitting Areas
Warm Colors
Adaptable Lighting
Turn Dead Ends to a Sitting Area
Decentralized Nursing Stations
De-clutter
Dining room as a Social space
Improve wayfinding
Focal points of interest
Wayfinding
“Hospital design should encourage mobility and wellness. Patients could get lost in all of the signs directed to staff” (Annette, family advisor)
Next Steps
Seek funding for physical environmental interventions
Staff education on dementia care
Collaborative inquiry and development of what person-centred care could be like in acute hospital
Space for Activities
“Little wee things are really important, it would be nice to have freedom, I miss doing things like cutting out interesting things in paper. The days here in the hospital is extremely boring ” (Rob, patient)
“Social connection is very important, if you’re just lying in bed all day, staring at the walls…” (Susan, patient )
Acknowledgements Funding support CIHR, Robert H. N. Ho Scholar Award, Canadian Nurses Foundation
Lillian Hung PhDc CNS1, 2, Jenifer Tabamo MSN CNS2, Doris Bohl BN CNE2, Leighanne
MacKenzie MEd Director2, Alison Phinney PhD1, Habib Chaudhury PhD3, Paddy Rodney PhD1
1 University of British Columbia , 2 Vancouver Coastal Health, 3 Simon Fraser University