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Fieldwork 24 Hour Patient Room Registration 11 October 2011 - 12 October 2011

Of The Room . Future The Hospital


Contents Introduction Gastrology Department D113 - Room 13.02

The Royal Danish Academy of Fine Arts School of Architecture Masters Students from Department 11 Architecture, Design and Industrial Form Signe Birkedal Pedersen Paulo Cunha Paul Farrell Hollie Gibbons Anna-Sophia Hansen Simon Harker Peter Hornstrup Nicholas Lee Lea Paulsen Rikke Sørensen Jacob Westergaard Louise Winther Eva Závodná

Paediatric Department E110 - Room 10.05 Gynaecology and Obstetrics Department G115 - Room 15.03 Cardiological Department S105 - 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 visionært 1:1 projekt

Hospitalsudvikling som motor for innovation i industrien I hele det store hospitalsprojekt ligger et kæmpe potentiale for udvikling af nye produkter til eksport, indenfor næsten alle kategorier, fra bygningskomponent til medico-teknik over beklædning og møbel. Dette forudsætter imidlertid at man allerede tidligt i processen lukker op for nytænkning og innovation. Dette projekt har som sit helt centrale formål at invitere til debat om samspillet mellem offentlige investeringer og teknologisk og industriel udvikling. Et andet væsentligt mål er at introducere en integreret designmetode til processen. I dag udvikles de fleste enkeltdele i et hospital hver for sig, med fokus på primærbrugeren. I dette projekt foreslår 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, både meget konkret, som centrum for rummets organisation, og mere abstrakt i den forstand at målet er, at sikre den praktiske funktionalitet for alle elementerne i hele deres anvendelse. Endelig ønsker vi at udvikle en ny model for partnerskab mellem de forskellige sektorer – i dette tilfælde regioner, private rådgivningsvirksomheder og offentlige forsknings- og uddannelsesinstitutioner. Ved at arbejde på tværs af sektorerne bliver det muligt at skabe et nyt rum for innovation. Sengestuen er valgt som model i dette pilotprojekt, fordi den er relativt afgrænset og velbeskrevet. På Afdeling 11 på Kunstakademiets Arkitektskole har vi arbejdet med sengestue-problematikken i en længere årrække, og ude i regionerne findes flere studier af ”Fremtidens Sengestue”. Vi ser det også som en fordel, at patientstuen er tæt på borgerne – det er et sted på hospitalet mange kender, og kan forholde sig til, og som sådan et sted, der er velegnet til at indbyde til dialog.

Endelig mener vi, at der trods mange års studier, på KADK, på tegnestuerne og i Regionerne, mangler visioner for sengestuerne. Mange af de planlagte sengestuer vil først blive bygget om 5-10 år, og dog peger de fleste nationale og internationale forestillinger om sengestuen snarere bagud. Vi er nødt til i højere grad at kaste os ud i fremtidens teknologi, hvis vi vil ramme nutiden om bare fem år. Hvis vi kan tænke en sengestue, der i højere grad indtænker den nyeste forskning og teknologi, indenfor alle vidensområder, kan vi bruge den som spydspids for udviklingen på resten af hospitalet. Baggrund I de kommende femten år 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, være velfungerende i forhold til patientsikkerhed, lægehjælp, pleje og rengøring, og samtidig befordre patientens velbefindende og helbredelse gennem positive rumligt-sanselige oplevelser. Ved at opføre en sengestue i fuld størrelse på 33-35 m2, inklusive bad og efterprøve dens muligheder i samarbejde med de forskellige brugergrupper, er det forventningen, at der kan skabes grundlag for en kritisk dialog om sengestuerne på de nye hospitaler. I projektforløbet vil det være muligt at ændre rummets dimensioner og afprøve alternative muligheder. En model, der tager udgangspunkt i, og udforsker, det fælles 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 være tilgængeligt for alle rådgivere og hospitalsansatte, der arbejder med udbygning eller nybygning af hospitaler. Det sociale samspil med objekter i det arkitektoniske rum Som et væsentligt grundlag for projektet ligger den tese, at man kan forbedre arkitekturens kvalitet målt på funktionalitet, holdbarhed, vedligehold og oplevelse, hvis man i forstudierne til designarbejdet kombinerer antropologisk metode med arkitektfaglig registrering og analyse. Her registrerer man denne adfærds fysiske aftryk i form af ting som bevægelsesmønstre, slidspor, uhensigtsmæssige elementer (som ledninger, der er i vejen). I dialogen med brugerne om de arkitektfaglige iagttagelser opdages nye potentialer og erkendelser, der måske tidligere havde karakter af ”tavs viden”. Det tværfaglige forarbejde lægger grunden til den efterfølgende integrerede designproces, også i den forstand, at det bidrager til en gensidig forståelse og anerkendelse. Denne metode, hvor antropologiske og arkitektfaglige metoder kombineres, er udviklet gennem flere år på KADK, og det er et centralt mål for projektet at få præciseret og beskrevet metoden, således at den kan blive alment tilgængelig. Perception, kunst og atmosfære I de seneste år er patientens og hospitalsmedarbejdernes livskvalitet kommet i fokus. Antologien ”Sansernes Hospital” er det væsentligste danske bud på en diskussion, der finder sted over hele verden. På tværs af faglige grænser er der en stigende forståelse af perceptionens komplekse natur. Denne bevægelse eller retning har relevans for fremtidens sengestue på to måder: dels er der et ønske 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 repræsentationer af virkeligheden. Ladcykel Afgangsprojekt Michael Høxbroe

CO2 neutral svineproduktion, Afgangsprojekt, Gry Holmskov

Spisebordsstol til børn og voksne, Afgangsprojekt, Michael Lysemose

Kuvøse til Neonatal afdelinger, Afgangsprojekt Astrid Hall

Metoder Projektet rummer tre elementer: - feltarbejde med registrering og analyse - programmering - designudvikling Denne publikation er første del af feltarbejdet med registrering. Der er naturligvis taget hensyn til etiske problemstillinger i forløbet. Mål Det, vi iværksætter nu, er et pilotprojekt, med udløb 1. 2. 2012. Målet for denne periode er at afprøve de ovenfor beskrevne metodiske elementer, og dermed det forsknings- og udviklingsmæssige potentiale, der er i projektets hovedteser. Projektet afsluttes med et seminar eller en konference åben for rådgivere bygherrer og brugere i regionerne, med fokus på udvikling af fremtidens hospital. Det er allerede nu håbet, at arbejdet fortsætter, også med integration af andre faggrupper, som f.eks. designere og ingeniører, i processen. I det fremtidige forløb vil det være oplagt også at arbejde med andre funktioner i hospitalet. Merete Ahnfeldt-Mollerup Arkitekt MAA, PhD, Lektor,


13.02 Gastrologisk Afdeling Gastrologi, eller gastroenterologi oversat fra græsk betyder læren om mavesækken og på Gastrologisk afdeling plejer og behandler man patienter med mave-, tarmeller leversygdomme. Nogle kalder afdlingen mave-, tarmafdelingen i daglig tale. Der er 290 ansatte på afdelingen, der er underindelt i flere områder: Sengeafsnit Kirurgisk Ambulatorium Medicinsk Ambulatorium Medicinsk Daghospital Operationsgang Laboratoriet Afdelingen er meget uddannelses- og forskningsaktiv indenfor pleje og behandling. Gastrologisk afdeling kerneområde omfatter mavesyrerelaterede tilstande, en række kroniske tarmbetændelsessygdomme, tilstande med diaré og mavesmerter samt sygdomme i lever-galdeveje. Under sidstnævnte hører bl.a. leverbetændelse betinget af virus, skrumpelever, leversvigt samt tilstand efter levertransplantation.

Jacob Westergaard Peter Hornstrup Signe Birkedal Pedersen


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7.00-8.00

8.00-9.00

• Møde med afdelingssygeplejerske og det øvrige personale på D113

• P1 har været i bad og går mellem værelset og bad

• Omklædning til sterilt hospitalstøj

• P2 vil have kaffe som morgenmad. Sygeplejerske henter kaffe til ham.

• Afventer af de to patienter på stue 13.02 vækkes og jeg kan gå i gang med registreringen

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• P1 vil ønske at der var en spejl på sengestuen

• Fotoregistrering starter

• P1 tager vand fra hanen på stuen

• P1 forlader rummet for at gå i bad

• P1 går ud af stuen for at hente koldt vand med isklumper • P2 får indsprøjtninger af sygeplejersken, mens han taler med sygeplejersken • P2 forsøger at få sine morgenpiller ned og drikker lidt vand • Der er helt stille på stuen og ingen bevægelser

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• P2 får et sengebord på den anden side sengen, fordi han kun havde et alt for lavt rullebord • P2 får flere piller af sygeplejerske • P1 foreslår videoovervågning af stuerne – det vil skabe tryghed, da det nogen gange kan tage op til 20 min. at få hjælp når man har rykket i alarmsnoren

• P2 sover • P1 rydder op omkring sin seng og sengebord • P2 vågner op igen – måske pga. Støj fra mit kamera


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9.00-10.00

10.00-11.00

• P1 går på toilettet

• Begge patienter sover og snorker stadig

• Der kommer meget støj fra receptionen/modtagelsen på D113 • P2 drikker din kaffe og saftevand

• P2 er vågnet og taler i mobiltelefon

• P1 kommer tilbage

• Sygeplejersker kommer og afleverer et gangstativ til P2

• P2 sover og snorker igen

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• Både P1 og P2 læser papirer med dagens program for dem • P1 kigger på lampen og redder sin seng

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• P1 går på toilettet • John skal op og gå for første gang i fire dag • Sengen køres til siden

• P1 kalder det ”Herlev-gør-det-selvHospital

• P2 går af sted med sygeplejersken til toilettet længere ned af gangen

• P1 henter to glas saftevand

• P1 går afsted med avisen og stuen er tom for første gang

• P1 ligger i sin seng

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• Meget støj fra receptionen

• Der er endnu en gang rigtig meget telefonstøj fra receptionen • Både P1 og P2 sover og snorker resten af timen

• Sygeplejersken kom ind på stuen og fortæller mig om deres dårlige arbejdsforhold, grundet de gamle og umekaniske senge • Sosu-hjælperen skifter sengetøj på P2 seng • P1 kommer tilbage for drikke proteindrik • P1 viser mig sit madskema lavet af diætisten • P1 går igen og stuen er tom

• Sosu-hjælper tømmer skraldespanden • P1 kommer tilbage med endnu en proteindrik som han blander og drikker på stuen • P2 kommer tilbage fra toilettet med hjælp fra sygeplejerske • Sosu-hjælper giver P2 strømper på • P2 seng rykkes tilbage på plads • Sosu-hjælper måler blodsukker på P2 • Sygeplejerske tjekker dagens tal på patienterne • Sosu-hjælper fylder flere håndservietter i holderen • P1 går for at hente kaffe • Sygeplejerske sætter et glycose-drop til P2 • Sygeplejerske meddeler P2 at han skal flyttes til aflastningsplads på Gentofte Hospital • P1 fortæller mig om hvordan el-stikkene på stuen ikke virker, da de laver høje brumme-lyde når man sætter noget til


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11.00-12.00 • P2 er kommet halvt op og sidde • P1 sidder på sengekanten og drikker kaffe • P1 hjælper P2 med at vikle sig ud af hans dropledning

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• Kioskvognern kommer forbi stuen, men ingen ønsker at købe noget • P1 • P1 går fra stuen mens P2 sidder og kigger ud af vinduet

12.00-13.00 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 højere seng, og ud af vinduet • Begge patienter sover og der er helt stille på stuen

• Sygeplejerske spørger P2 om han havde afføring da han var på toilettet, hvortil P2 svarer Det var så lidt, så lidt

• Døren er stadig lukket, men man kan tydeligt høre sygeplejerske og læger tale højlydt lige på den anden side af døren

• P1 kommer tilbage tils tuen og sætter sig på sengekanten

• P1 vågner og fortæller mig om sine operationer

• Sygeplejerske kommer og meddeler at der er frokost • Sygeplejerske forsøger 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 • Rengøringsdamen kommer ind og tømmer skraldespand, vasker håndvasken, vindueskarmen og panelvæggen. Hun tørrer gulvet over. Det tager ca. 3 minutter i alt • P1 kommer tilbage med sin frokost • Sosu-hjælper kommer med P2 kaffe og saftevand

• Sygeplejerske lukker for første gang døren ind til stuen

• P1 sidder i sengen og spiser sin frokost ved sengebordet

• P1 går rastlørt rundt på stuen og forstyrrer dermed P2, der skiftevis sover og vågner

• Nu er der stuegang og en sosuhjælper, en sygeplejerske og en læge kommer ind på stuen

• P1 rengør sit sengebord med vand og papir

• Lægen giver P2 besked om at han skal overflyttes i dag, hun undersøger ham i sengen (det er meget svært for lægen at komme til pga. manglende plads på stuen. Lægen har ca. 30 cm at arbejde på ved siden af sengen. Sengen er så høj at lægen må stå på tæer for at undersøge P2)

• P1 fortæller mig om at være patient på Herlev Hospital i en længere periode • P1 går ud til sygeplejerskerne og

• Efter endt undersøgelse glemmer personalet at rulle P2 sengebord tilbage til sengen og P2 kan ikke længere nå sin kaffe og saftevand • Døren bliver lukket til stuen igen • P1 hjælper endnu en gang P2 med at vikle ham ud af sin dropledning • Ove sætter sig og taler med mig om sit hospitalsforløb • P1 går igen hvilelørt rundt på stuen • Fra den ene side af sengen til den anden side • P1 går i seng for at sove til middag • P2 drikker mere kaffe og tager sin mobiltelefon op i sengen • Ove taler i mobiltelefon i sengen • P2 sover på siden, trods smerter i netop denne side • Sygeplejerske kommer og meddeler at P2 skal overflyttes kl. 15 til Gentofte Hospital • Begge patienter sover • Jeg går ud for at spise frokost kl. 12.40


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13.00-14.00 • Begge patienter sover tungt • P2 vågner for at få styr på dropledningen med glucose • Falck kommer med en båre for at flytte P2 til Gentofte • P2 vågner forvirret ved de hårde bank på døren

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• Sygeplejersken kommer overrasket ind på stue og spørger hvorfor Falck er kommet så tidligt • Sygeplejersken fjerner P2 glucosedrop • P2 forlader stuen på Falcks båre • Sygeplejersken glemme at kigge i P2 sengebord efter hans ejendele

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• P1 vågner pga. alt den larm der pludselig er på stuen • P1 går på toilettet ude på gangen • Sygeplejerske kommer ind og henter P2 seng og papirer • Stuen er tom og døren lukkes • En besøgende til P1 kan ikke finde ham på stuen • P1 kommer tilbage fra toilettet

14.00-15.00 • Tre sygeplejersker forsøger at finde P1s gæst nu hvor han er kommet tilbage fra toilettet • P1 får besøg af sin præst

• Præsten er stadig på besøg • P1 henter isvand til ham selv, præsten og mig og byder os på chokolade

• P1 flytter en stol ud midt i rummet, hvor P2 seng tidligere stod, og sætter sig på den

• Præsten og jeg taler sammen

• P1 taler med præsten om sit sygdomsforløb

• Præsten takker for i dag og går igen

• Sygeplejerske kommer ind for at høre om hun skal bede lægen komme til stuegang, men P1 takker nej, fordi han har besøg

• P1s datter kommer på besøg

• P1 og hans datter taler sammen om dagen og sygsforløbet • Der er meget mere roligt på stuen på nuværende tidspunkt • P1 fortæller at han synes at besøg fra familien godt kan blive for meget • P1 går ud og henter en proteindrik • P1 og hans datter venter stadig på besøg fra lægen, der muligvis vil udskrive P1 i dag • Jeg takker for denne gang og Jacob tager over


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Patient 1, P1, udskrives og stuen er tom for patienter. Den 10-minutters-fotoregistrering stopper her og en registrering af rummet og dets brug starter.


Flowdiagram

Flowdiagram

8.00-9.00

9.00-10.00 Patient 1

Patient 1

Patient 2

Patient 2

Sygeplejerske/sosu-hjælper/læge

Sygeplejerske/sosu-hjælper/læge

Rengøring

Rengøring

Falck-folk

Falck-folk

P1s præst

P1s præst

P1s datter

P1s datter


Flowdiagram

Flowdiagram

10.00-11.00

11.00-12.00 Patient 1

Patient 1

Patient 2

Patient 2

Sygeplejerske/sosu-hjælper/læge

Sygeplejerske/sosu-hjælper/læge

Rengøring

Rengøring

Falck-folk

Falck-folk

P1s præst

P1s præst

P1s datter

P1s datter


Flowdiagram

Flowdiagram

12.00-13.00

13.00-14.00 Patient 1 Patient 2 Sygeplejerske/sosu-hjælper/læge Rengøring Falck-folk P1s præst P1s datter

Patient 1 Patient 2 Sygeplejerske/sosu-hjælper/læge Rengøring Falck-folk P1s præst P1s datter


Flowdiagram

14.00-15.00 Patient 1 Patient 2 Sygeplejerske/sosu-hjælper/læge Rengøring Falck-folk P1s præst P1s datter


Registrering Rummet

360째 p책 sengestuen


Væg 1

Væg 2 - Vindue/udsigt

Væg 3 - Senge- og panelvæg

Væg 4 - Skab og håndvask


Glas

Ventilationskanal Gummiliste

Gummiliste Aluminium

Aluminium

Aluminium

Gips

Linoleum Skitse Rummet set fraoven

Gummiliste

Materialeregistrering af vindueskarm Snit 1:5


Registrering Arbejdsgange på sengestuen

60 cm

Sygeplejerskens 4 trin ved patienttransport med lift

Stole og evt. tøj, flyttes fra området omkring sengene

Bordene køres væk

Sængene køres ud til siden

Liften placeres i midten og opereres der fra

Den pårørendes fortrukne komfortzone under ophold på sengetsuen.


Registrering Samtale Samtale med sygeplejerske

Samtale med patient 1

Samtale med patient 1’s datter

Samtale med patient 1’s præst

• Mangler generelt hjælpefaciliteter på stuerne. Der er f.eks. ingen lift.

• Mener at man bør og kan udvikle en ny • Synes at det giver en tryghed at vide at • Mener at ideen om supersygehuse er type drop, således at patienterne unens far ikke ligger alene på stuen. Det helt forkert og det gør det sværere for dgår at skulle stikkes i hele tiden. Det betyder at der en som kan hjælpe ham patienterne at få den korrekte behan• Der er mangel på gulvplads på stuerne. bliver kun sværere og sværere at finde eller ringe efter personalet hvis han dling og dermed et længere sygdomsDet er et problem hvis der nogen har en åre jo flere gange man er blevet pludselig får det dårligt og ikke selv kan forløb. Med supersygehusene vil blive fået et fjernsyn ind på stuen, det tager stukket, da der dannes arvvæv. Det er kalde på hjælp. sendt hjem efter kort tid og skal så stort set den overskudende gulvplads. særligt relevant for patienter, som Ove, pendle mellem hjem og sygehus hele Det vil sige at hvis der er akut hjertesder har været indlagt over en længere • Faktisk synes hun at patienten burde tiden. top eller lignende, skal de kæmpe sig periode. have frit valg mellem enestue eller forbi fjernsynet for at få plads til en fleremandsstue. hjertemaskine. • Ove synes at der bør være et spejl på værelserne, så man slipper for at gå • Datteren synes som sin far at der • Skraldespanden ved håndvasken mellem toilet og værelse så mange mangler nogle dagligdagsfaciliteter på sidder på den forkerte side af håndgange. sengestuen, så som spejl, fjernsyn og vasken, hvilket gør det mere besværligt bedre/nutidens strømstik til patients for personalet at komme til den. • Han synes der helt klar bør være et opladning af mobil eller computer. fjernsyn på værelserne, måske endda • De gamle senge er helt håbløse, da de et til hver patient, da man ikke altid er mekaniske og ikke elektroniske. Det ønsker at se det samme. betyder at bevægelse med og omkring sengene skal foregå ved håndkraft. • Han ser det som et problem at der ofte F.eks. skal i små sygeplejersker helt op er mange besøgende på stuen i løbet og stå på en fodpedal med deres fulde af dagen, både ens egen familie/venkropsvægt, for at ændre på sengens ner og den anden patients familie/venhøjde. Ligeledes skal de selv løfte ner. Man har ofte brug for mere ro i et patienten op med armkraft hvis ryggen sygdomsforløb/ved indlæggelse. på sengen skal rejses. Opmåling og undersøgelse af sengebord


Sanseindtryk Lugt

Sanseindtryk Temperatur

Kl. 12.33 Lidt surt - pga. der spises frokost på stuen

Kl. 8.31 Hospitalslugt

Kl. 10.14 Lidt sødme Kl. 11.31 Den lidt tunge og dårlige lugt bliver stærkere når døren holdes lukket

Kl. 13.09 Lidt af tis Kl. 14.44 Friskere i luften nu hvor der kun er en patient på stuen

Der er en stor temperaturforskel for de to patienter på trods af at rummet ikke er særligt stort. Rummet er meget koldt ved vinudet og bliv gradvis varmere jo længere mod døren man kommer.


Sanseindtryk Blindtegning

Kl. 11.24 Lampe Kl. 11.40 patient 2 Kl. 11.44 Hjul p책 seng

Kl. 11.22 Sengebord

Kl. 11.19 Stol

Kl. 11.27 patient 1

Kl. 14.36 Patient 2s datter


Sanseindtryk Skitser


Konklusion

“Herlev Gør Det Selv Hospital”

60 cm

Patient om udfordringer der løses dagligt

De forstyrrelser der findes på sengestuen kan inddeles i to, den interne (hvor en patient eksempelvis snorker og kommer til at vække den anden eller har gæster) eller den eksterne, der er livet ude fra gangen (rengøring pusler, personalet kører med vogne eller snak fra receptionen). Patienterne er ofte meget rastløse og bruger meget energi på 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 hvileløst rundt i lokalet.

Patienten (grøn) hjælper flere gange sin medpatient. Ulempen kan være forkert behandling, fordelen

En meget vigtig iagttagelse er at hjælpen kan være et stykke tid undervejs og derfor bliver patienterne utålmodige. I dette tilfælde 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 gøres forkert, fordelen er den sociale interaktion mellem patienterne. Gæsterne kan ofte være opslidende at have på besøg, både fordi de selv har stor autoritetstro overfor lokalerne og ikke tør bevæge sig væk fra deres pårørende, patienten, og det dermed er patienten der skal vise dem hvad de må og ikke må, når nu de befinder sig i et rum de ikke kender regelsættet for. Men for patienten er det også udmattende at være “på” selvom det er dejligt med besøg.

Patienten keder sig og henter drikkelse som aktivitet.

Den pårørendes fortrukne komfortzone under ophold på sengetsuen, nye omgivelser gør gæsten utryg og bruger sengen som tryghed, for her kender han den indlagte.


10.05 Pædiatrisk Afdeling Pædiatri oversat fra græsk betyder læren om børnesygdomme og på Pædiatrisk Afdeling beskæftiger man sig med børn fra 0-15 år og kronisk syge er på afdelingen til de fylder 18 år. Hvert år indlægges omkring 6.000 børn og 11.000 kommer forbi i et af ambulatorierne På afdelingen bhandler man børn med alvorlige infektioner, der ikke kan klares hjemmefra - sværere bronkitis, lungebetændelse, falsk strubehoste, maveinfektion, blindtarmsbetændelse, meningitis og andre akutvopståede sygdomme børn der skal opereres børn med diabetes børn med en sygdom i nervesystemet børn med en sygdom der har betydning for hvordan de vokser og udvikler sig for tidligt fødte børn og syge nyfødte børn med socialtbetingede sygdomme Forældrene til de syge børn fylder meget for patienten, så personalet arbejder med et udvidet patientbegreb, der lægger stor vægt på at forklare og tydeliggøre sygdommene.

Hollie Gibbons Anna-Sofia Brune Paul Nicholas Farrell Louise Winther


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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.

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

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Patients are getting out of bed. P 3. eating in the room. The patient in bed no. 2 (P 2.) and P 3. are Everybody else is out. 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., P 1. and mum eating in the room.

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


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Room empty, the TV is left on.

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

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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.

Earlier the hallway was very quiet, but now Cleaning lady finished after approx. 10 many footsteps, voices and trolleys are minutes, and leaves the room. passing. Childrens voices and playing from hallway. The cleaning lady enters, wipes over sink, door handle, bed edges, window sills, lamps and tables. Sweeps the floor.

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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.

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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 don’t have to be outside, since it just started raining. Elin and Anette Madsen come by to say hi. P 2. enters and leaves.

P 1. and nurse enters - should be in Mum of P 1. walking around the bed, but school? Takes her outside, shouldn’t sit in has difficulties getting to the locker and the room alone. has to move sideways. Mum to P1. enters, moves the bedside table back and hangs her coat. P 3. and nurse enters and leaves.

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P 3. and nurse in and out. Nurse having brief talk with P 1.’s mum. P P 1. and mum sitting by table. Speaking 1. and mum sits on their beds. P 3. in and Icelandic. out. P 4. going in and out of the room for a while.

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.

“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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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 can´t go online and look if the dish is fine for her to eat.

P 1. didn’t 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.

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.

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.

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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.

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 daughter’s bed while talking.

P 3.’s mother is still talking loudly on the The room is now empty again, P 1.’s phone while laying in P 3.’s bed. She gets mother comes back in to turn off the TV a bag of food out of her bag and eats it, and then leaves again. spilling crumbs in the bed and on the floor. P 1.’s mother leaves the room quickly after P 3.’s mother came in.

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Empty room, Anna walks around taking Mum enters, gets some stuff and leaves - P 3. in and out. Hereafter P 2. and P 4. pictures. they are playing in the playing area. - all having balloon animals made by the In general very quiet at the department departments clown. nobody passing in the hallway. P 1. and P 4. running in to the room, leaves again straight away. 13.45 trolley with clinking glasses passes Mum of P 2. enters, takes her jacket and the door. turns the bathroom light off, on her way out. Sirens can be heard for a long time.

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

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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 she’s 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.

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.

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.

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.

Elin enters to talk. Nurse saying goodbye.


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1500 P 4. gets 2 more visitors (grandmother + 1 other lady, no relation mentioned). The nurse is speaking openly about the girl’s 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.

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”.

P 2.’s mother comes in the room, she P 4. leaves the room with her visitors to walks sideways past the dinning table to show them the school and area. P 1 leaves get to her area. She collects her bag from the room right after, following the action. the lounge chair. She speaks quickly with P 1.’s mother before leaving the room again.

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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.

P 1. has found a piece of rye bread, she P 1. and P 3. are playing together, running comes over to the dining table and starts in and out of the room, hiding under the buttering the bread standing up. She then table, behind the door etc. runs out of the room while eating the piece of bread.

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Room empty and 2 TV’s running. Minimal P 1. comes back with her mother after P 1. is sitting up in her mothers bed across Only noise is from P 1. playing with her noise coming from hallway. having taken a bath. The mother turns from her mother playing a board game and mother. Room otherwise peaceful. off the 2 TV’s, saying she gets crazy from laughing loudly. them running all the time without anybody watching.

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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 chair’s back and leaves.

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 doesn’t´have enough space for her stuff. The closets over by P 4.’s zone is used by P 4.

P 2. is by P 4.’s bed end, talking. First time P 1. is drawing, watching TV and getting I noticed her being social with the other her hair brushed by her mother while in kids in the room since I’ve come. bed. 2 x TV’s are running.

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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.

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.

It’s 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.

Not much has changed. The internet isn’t 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 P1’s corner, leading to crowding in that area.

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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.

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.

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?

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.

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.

Nurse Bridget enters, approaches P4’s 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.

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. P1’s mother attempts to adjust her bed with the foot pedal, but gives up.

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

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

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. P1’s Tv is accidently turned on somehow.

P3 and P4 watch TV together now. P1’s mother completely encloses her space and switches off the main lights. The main light sources are now P3’s lamp and television and the hallway light through the glass door panel.

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P4 returns with a friend and gently closes the door. It seems to be sleep time now. P1’s mother comes back to the main table to knit and read. Her daughter is singing for attention but she ignores it. Again P1’s TV is turned on by mistake. P4 gets up and turns it off.

Nurse returns, walks straight to P3’s 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.

P1’s 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.

P1’s mother changes her daughters nappy in the bed. P3’s 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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P4’s 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.

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.

Curtains are becoming increasingly closed, but not totally. P1’s 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.

There is one bed lamp on which casts a strong and long shadow across the floor. P1’s mother returns from the shower and gets back into bed.

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Another helicopter is landing and Denmark I have a small talk with P4’s friend. He hits P4 and friend are running around the room score in the football so the room feels his face on the glass when trying to look playing. But purposely not making a lot of significantly louder. at the helicopter, then shows me the glass noise. actually shakes from the vibrations. He goes back to the match. P1’s mother is on her laptop in bed.

The football is over and all the televisions are off. P4’s friend leaves and she closes all her curtains around herself. She is a teenager.

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P4 reclines her bed (which makes a very loud noise) and turns off her light. P2’s 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.

P1’s 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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I have taken off my shoes as they make All is still in the room. 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.


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2340 2350 Paul 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.

0000 0010 Paul leaves the room. The nurse can Try to make a recording of the sound of the be heard cleaning the drinks area in the clock ticking. All the patients are sleeping. corridor.

0020 0030 P 3. fidgets and begins to snore quietly. Noise can be heard as someone walks down the corridor.

0040 0050 All patients are still asleep. Ticking noise P 3. stirs in her bed but remains asleep. from the clock is very noticeable. The wind outside is causing the curtains to move very slightly.


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0220 0230 Talk 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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0340 0350 P 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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0540 P 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.

0550 0600 Nurse 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.

0620 0630 P 2.’s mothers checks her mobile Lights in the corridor become brighter. phone, the light can be seen through the curtains.

0520 0530 P 1. is stirring around, she eventually P 1. gets into her mother’s bed leaving her begins to lie across her mother’s bed as own bed completely vacant. well as her own.

0640 The 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.

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0650 The 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.


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Nurse getting down to patients level

patient views

patient and nurse sorting out clothes

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lunch


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mapping users

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light zones

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turning on TV

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nurses path

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The Patients

P 2.

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 demanding, and if the mother doesn't answer straight away when she's yelling - because 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 4’s 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 whether 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.

P 3.

P 1.

P 4.

The girl seems to accept the fact that she’s 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 hospital, 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 afternoon. 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 family 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.


The Room

Description of room 05 - E110 department of paediatrics

1:50

Before 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 aren´t 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.


Patients trace 1530-1630

P2

P3

P1

P2

P4

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

P2

P3

P3

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P4

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

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Patient 3 Patient trace overlay


Patients views from bed

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View from bed 2

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Patient 4 View from bed 3 View from rooms, overlay


Nurse path, checking on sleeping patients

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Colour palette in the room.

Architectural / Spatial Drawing / Diagram etc.

Personal belongings stored openly in the room.

Limited space between the closet and the curtain

Bright colours and lighting reflecting in glass prevents view into room.

The only nature present in the room.


Only permitted personalisation of space.

‘broken’ aesthetic on ceiling

Hanging cables, easily caught by patients- untidy.

Only adult sized furniture in a childrens room

no designated area for serving food or dining

Threshold between patients and doctors/ visitor threshold

play area seems too temporary

Contact with floor- design conflict.


Summary of Interview With Contact Nurses 13/10/2011 The 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 interaction 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 organisation, 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.

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 observing 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.

Plants are allowed in the room only in the form of cut flowers. Potted plants are forbidAn average day for a child patients starts at around 0800 with breakfast, starting den due to the germs that can be carried in the soil. 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 acWhen asked about the lack of headphones for the televisions the nurse said there tivities there after. From 2000 patients are expected to be more relaxed. There are no weren’t any despite the headphone sockets. The crossover of television noise was not fixed bedtimes. highlighted as a problem although it was said negatively that the TV’s were left on all day even when the patients were out of the room.


Conclusion

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 dynamic. Both patients and parents were observed assisting, aiding and keeping each other entertained. The implementation of singular rooms may create a rise in lethargy, boredom and alienation amongst patients, visitors and staff. The lack of storage for personal belongings was the most obvious problem, upon arriving 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 patient’s 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 today’s staff and patients needs.

Originally

Now

Placement of beds.

Storage.

Private zones.

Adapted design-conflicts


15.03

Gynækologisk/ Obstetrisk Afdeling Gynækologi oversat fra græsk betyder sygdomme i de kvindelige kønsorganer og obstetrik betyder videnskaben om fødsler og fødselshjælp. Fødsel og graviditet nakkefoldskanning Misdannelsesskanning Frældreaftener Kontaktjordemoder Akupunktur Speciel konsultation, herunder for sårbare gravide. Overvågning af fostret ved komplicerede forløb. Behandling af alle typer af kvindesygdomme ambulant og indlæggelse. Behandling af gynækologiske kræftsygdomme. Abortklinik. Klinik til kvinder med problemer tidlig i svangerskabet, herunder Klinik for truende for tidlig fødsel. Fertilitetsklinik Fertilitetsklinik barnløse par. Behandling af kvindesygdomme er opdelt i tre områder med hver sit behandlingsområde: Almen gynækologisk område: godartede sygdomme, Gynækologisk onkologisk område: kræft eller forstadium til kræft, Urogynækologisk område: vandladnings- eller bækkenbundslidelser

Nicholas Lee Simon Harker Eva Závodná


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

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.


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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.

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.

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.

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

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2 Patients. First patient is in bed reading a 1 patient sitting in bed reading. Nurse visits 1 patient sitting in bed reading a book 0 Patients. 1 patient returns to the room book. second patient leaves the room. the patient to cheack how she is. and using her mobile phone. The nurse after using the bathroom. and checks her visits the room with a hand held electronic mobile phone. device and a small plastic cup containing tablets.

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


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0 Patients, 1 Visitor. The patient’s 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.

1 Patient & 1 Visitor. The patient has No record. 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.

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

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1 Patient & 1 Visitor. The patient leaves 0 Patients. The room is empty until the first 0 Patients. the hospital room and then the bed is patient returns from her surgery. covered in a plastic sheet and is removed by a nurse. The room is now empty.

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

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

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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.

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0 Patients. Patient returns to room after 1 Patient, 1 Visitor. Nurse visits the patient 1 Patient, 1 Visitor. I leave the room whilst to take temperature and blood pressure. the patient changes. Guard is lifted up on surgery at 15.18 with visitor. one side of the bed.

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1 Patient, 1 Visitor. Senior nurse enters 1 Patient, 1 Visitor. Visitor leaves the room 1 Patient, 1 Visitor. Visitor uses his phone 1 Patient, 1 Visitor. The visitor leaves the room to fetch a chair. Patient is very quiet the room to chat to the patient. The visitor to make a phone call. Nurse enters the while looking out of the window. while the visitor reads a book. goes to the locker to get some items out room with food for the patient. of the patients personal bag. The visitor makes a phone call and then leaves the room.

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1 Patient, 1 Visitor. Patient has consumed 1 Patient, 1 Visitor. Visitor answers his 1 Patient, 1 Visitor. Visitor acts as a career 1 Patient, 1 Visitor. Nurse enters the her yogurt but has left the rest of her food. mobile phone two times using several for the patient by helping to prepare her room with a trolley containing medical areas of the room to speak. food. equipment and checks the mobility of the patients legs.


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1 Patient. Patient has been left on her own 1 Patient, 1 Visitor. Visitor continues to 1 Patient, 1 Visitor. Nurse enters the room 1 Patient. The patient has been left on her briefly. prepare food for the patient. briefly to check up on the patient. own briefly.

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1 Patient, 1 Visitor and 1 Nurse. The visitor 1 Patient, 1 Visitor. Nurse enters the room 1 Patient, 1 Visitor. Patient adjusts bed brings a tray of food for the patient. Nurse again with her trolley and a hand held position so that it is more upright to make inspects the patient and turns on the electronic device to monitor the patient. it easier to eat food from a tray. uplighter on the wall console behind the patient.

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. Visitor stretches their 1 Patient, 1 Visitor. Visitor leaves the room. 1 Patient. Nurse enters the room and 1 Patient. Patient leaves to go to the legs out while sitting on a side chair. removes the catheter from the patient. bathroom.


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1 Patient, 1 Visitor. Nurse enters the room 2 Patients, 2 Visitors. First patient is taken 2 Patients, 2 Visitors. Nurse enters the to examine the patient. for a walk along the corridor with her room to check up on the second patient. partner. A second patient and her partner arrive in the room after having surgery. Room suddenly feels very busy.

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

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2 Patients, 2 Visitors. The screen seems to 2 Patients, 2 Visitors. Nurse enters the 2 Patients, 2 Visitors. Both visitors sit on work better than a curtain but is still makes room and takes a blood sample from the the right hand side of their patients. This the room feel cramped. second patient. leaves very little space for the nurse to provide care to the patients.

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

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2 Patients, 2 Visitors. They chat in pairs 2 Patients, 2 Visitors. One of visitors leaves seperated by the privacy screen. and introduces himself and his partner to the other two.


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2 Patients, 1 Visitor. Second visitor leaves 2 Patients. First patient turns off her light 2 Patients. Both patients seem to be 2 Patients. Second patient recieves a room. but the second patient keeps her uplighter sleeping. phone call which wakes her up. The door on. to the corridor remains open providing some light.

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2 Patients. Both patients seem to be 2 Patients. Second patient seems to be 2 Patients. Both patients seem to be 2 Patients. One of the nurses enters the asleep. asleep while the first patient wakes and asleep. room to take the blood pressure of the then briefly sits up in bed. second patient. I then get asked to leave the room.

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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.

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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.

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Patient no. 2 vomits

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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.


Ceiling and Walls The 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.

Colour Count


Window The 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.

Ventilation

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

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


Wall Consoles

Headboard Panel

Wall 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.

The 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.

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.


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.

The Bed The 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.

Mobile stool Stool 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.


Chariot Movable 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.


Patient’s locker They 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.

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


Bathroom Light in the bathroom is very bad. By the mirror - very bright and white, makes the user’s face look pale, almost green, the ceiling lamps give yellow light, which is very dull.


Bathroom Furniture


Night The colours of the corridor are clear from artificial illuminance

Hallway Multi-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.

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


Screens They 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 can’t. 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.

Summary of discussion with Nurses

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.

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 don’t 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 façade of the hospital has a different colour. Blue is on the north façade and does not work very well – it is too cold.’ Requirements for the bathrooms. The rooms currently don’t 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.


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Functionality

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The Staff Nurses and doctors perform many quick activities in the room and use various items of equipment during rugular short visits. The nurses prefer to keep the hospital room doors open so that they are able to check up on the patient. Cleaning should be performed everyday with surfaces being sanitized and all the furniture should be moved and cleaned. The nurses currently try and adapt the environment according to the patients’ preferences as much as possible.

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Patients use their mobile phone devices extensively while in bed. Art work and media can have a positive as well as a negative effect on the patient. Patients enjoy looking out of the window which is their contact with the outside world.

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The Patients 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, etc. The room should be as flexible as possible so that they can be individually adjusted for each patients needs.

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The Future The nurses told us that it would be nice for the patients to be able to open the window for ventilation and to access fresh air which they currently can’t do. It would be nice to have the opportunity for the guests to stay overnight by having an extra bed in the room. The 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. Lighting in the rooms should be adjustable ans should be controlled by the patients as well as the nurses. The 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, etc. Overall the nurses all agreed that the benefits of a single patient bedroom far outweigh the negative points.

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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 weak patients.

Record of various users occupying the patient room over the 24 hour period.

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05

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

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04

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.

Room Occupancy Register

03

The Room Several 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.

A cleaner visits the room everyday to sanitize the most used surfaces and to rearrange the moveable furniture. The existing beds are moderately difficult to adjust. The curtains are regarded as non-hygienic and are also hard to operate by some patients. If personal belongings are placed elsewhere they can get in the nurses’ way.

18

Research Summary


5.19 Kardiologisk Afdeling Kardiologi oversat fra græsk, betyder læren om hjertet. Kardiologisk afdeling beskæftiger sig med diagnisticering og behandling af hjertesygdomme og bliver derfor også kaldt Hjerteafdelingen. Afdelingen har et sengeafsnit hvor akut syge patienter er indlagt og et ambulatorie, hvor patienter, der ikke indlægges, kan komme i dagtimerne. På de øvrige kliniske afdelinger har kardiologisk afdeling også tilsynsansvar. Det betyder at lægerne tilser alle patienter med symptomer på hjerteproblemer. Afdelingens kerneområde er at diagnosticere, undersøge og behandle hjertepatienter medicinsk. Arbejdet med hjertet er meget alsidigt og nogle af de mest hyppige undersøgelser er: cykeltest/arbejds-EKG døgnblodtryksmåling, ultralydsscanning af hjertet ultralydsscanning af hjertet via spiserøret genoprettelse af normal hjerterytme ved elektrisk stød optagelse og overvågning af hjerterytmen fosterhjertescanning i samarbejde med Obstetrisk afdeling Undersøgelser som kræver operation eller at patienten er bedøvet, foretages ikke på afdelingen.

Paulo Cunha Rikke Sørensen Lea Paulsen


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[Notes corresponding to timelapse]

Ingen patienter pü stuen. 2 senge. Enkelte personlige ejendele. Dør üben til gangen. Aktivitet og lyde fra gangen.


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Ingen patienter. Stille. Lyd; dong dong, fra patient der har trukket i snoren, lidt stressende lyd. Lidt aktivitet på gangen. Ser kun personale, ingen patienter.

Ingen patienter på stuen. Næsten ingen Stadig ingen patienter på stuen. Ingen lyd fra gangen. Dong-dong lyd kun lige på gangen. Lav snak inden ved siden af. stoppet. Svag snak fra stuen ved siden af. Dong dong lyd starter igen! Ingen kunstigt lys på stue, kun på gangen.

De to patienter ankommet til stuen: Patient #1: Mand 80 år. Patient #2: Mand 50 år. Sygeplejerske på stuen, samtale med patint#2 og han undersøges. Patinet #1 ligger i sengen og slapper af.

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Kun én patient på stuen. Stille igen. Solen Patient #1 tilbage på stuen. Snakker. står ind gennem vinduet. Dong-dong lyd begyndt igen.

Snak på stuen. Afslappet stemning. Begge patienter på stuen. Snak. Meget lys Ventetid før stuegang. Solen rammer ind på stuen. Stille på gangen. Som i et “vindues-sengen”. venteværelse.

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(mangler foto pga. samtale med overlæge!) Patient #2 i sengen. Patient #1 læser info Snak på stuen. Stille udenfor stuen. Snak på stuen. Ventetid. Helt stille på skilte på væggen. Døren stadigvæk åben Brummelyd ude fra gangen og dong dong gangen. Hyggelig stemning. Venter. ud til gangen. lyd er der jævnligt, men man ligger ikke Venter. mærke til den mere.


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#2 sidder op. Sygeplejerske snakker på Alle har forladt stuen. Helt stille overalt. #1 søger på radio i sengebord (eneste Venter på stuegang. Helt stille. Begge gangen. Patienter håber at stuegangen Regn udenfor. Mørkt i dør-enden af lokalet. underholdning) #2 har forladt stuen. patienter på stuen og venter. Snak på snart kommer til dem. Lidt bevægelse. Venter på stuegang. stuen ved siden af – mon stuegang her næste gang?

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Stille. Venter. Dong lyd.

Afslapning. Ro på stuen. Stuegang Sygeplejerske for blodprøve netop gået. Stille. Let sollys ind gennem vindue. mentalt udskudt. Tallerkener og lidt snak Begge patienter opholder sig i sengene. på gangen. #1 hører radio. Snak på gangen.

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#2 sover. #1 hører radio. Ventilationslyd Fokus på tid. Begge patienter går til Frokost. Mage mennesker fra gangen. Afslapning. Frokost begyndt. frokost. Larm på gangen. Sygeplejerske Afbræk. Ingen på stuen. Stille henter noget på stuen.

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1250 derude. Rengøring på stuen.


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#1 tilbage på stuen. #2 ude og ringe. Læge netop gået, har tilset #2. #2 går ud Begge patienter på stuen. Snakker. Står. Begge patienter venter i deres senge. Meget lys, men ikke direkte lys. af stuen. #1 snakker lidt. Bevæger sig Venter på svar. Stille. Lidt snak på gangen. Venter. rundt. Direkte sol er væk - godt for øjnene.

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Sygeplejerske kort været forbi. #1 skifter #2 gået til undersøgelse #1 ligger i sengen Læge på stuen, snakker med #1. Læge undersøger #1. #2 på vej hjem. kanal på radioen. og slapper af. Sygeplejerske inde på stuen Sygeplejerske snakker med #2. Meget Stille på gangen. kort. aktivitet. Snak. Dør åben.

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#1 venter på nye svar.

#1 henter kaffe. Sidder i sengen.

#1 på stuen

#1 samtale med læge.


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#1 ud for at ringe.

#1 ude og ringe. Ingen på stue. Ledig seng Ingen på stuen. Stille. på stuen bliver hentet.

#1 tilbage på stuen. Snakker.

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#1 sidder på sengen. Lidt støj ude på #1 kigger på trafikken. Lidt støj på gangen. Patient #1 is sitting on his bed, listening to gangen. Mindre lys på stuen. the radio and looking out on the traffic. Footsteps and low voices are heard from the hallway. Machines are softly humming and beeping every now and then.

Patient #1 is sitting on his bed, listening to the radio and looking out on the traffic. Footsteps and low voices are heard from the hallway. (See sketches) Machines are softly humming and beeping every now and then.

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Patient #1 is sitting on his bed, listening to the radio and looking out on the traffic. Footsteps and low voices are heard from the hallway. Machines are softly humming and beeping every now and then.

Patient #1 is now lying on his bed, listening to the radio and looking out on the traffic. Footsteps and low voices are heard from the hallway. Machines are softly humming and beeping every now and then.

Patient #1 is lying on his bed, listening to the radio and looking out on the traffic. Footsteps and low voices are heard from the hallway. Machines are softly humming and beeping every now and then.

Patient #1 is lying on his bed, listening to the radio and looking out on the traffic. Footsteps and low voices are heard from the hallway. Machines are softly humming and beeping every now and then.


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Patient #1’s wife and daughter comes for a visit. New patient, #2, and nurse arrive. Nurse turns on the embedded light source (upward diffuse light) on half power setting and closes the curtain a bit more. Gives pills and takes blood sample while asking questions about #2’s medical history. #2 is sitting in armchair, has no bed yet.

Patient #1 and family looks at the view, #1 Patient #1 still talks to wife and daughter. tells about sunsets and traffic jams. Wife Patient #2 finishes his tests and other wants a talk with a nurse but the nurse formalities on arrival. next door does not know anything about #1 because of changing shifts. Patient #2 talks to nurse while being examined. The nurse uses the utensils trolley. (See sketch) Door to the hallway is constantly wide open, muffled sounds are heard.

Patient #1 still talks to wife and daughter. They are all moving arround a little every now and then. Using the bed and windowsill as furniture. (See sketches) Patient #2 and nurse have left the room.

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Dinner is served in the hallway. Patient #1 and family have left to have dinner in the living room area. Empty room. Noises and activity in the hallway increases. Homelike sounds and smells sneak into the room. The nurse is calling out the menue and people are talking and joking.

Empty room. Homelike sounds and smells from hallway. The sound of people shuffling their feet, walking in a slow pace.

Empty room. Homelike sounds and smells from hallway. The sound of people shuffling their feet, walking in a slow pace.

Patient #1 comes back alone and sits down on a chair next to his bed. The nurse comes in a talks to him standing next to the bed; “I couldn’t access your record, so tell me..”. (See sketch) The sound of cutlery being handled seeps in from the hallway. Still a smell of food and all in all a more homey atmosphere. Patient #2 comes back and investigates the storage conditions. (See sketch)

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Patient #1 and #2 stands on #1’s half of the room looking out the window and discussing the view. Apparently they are acquaintances. Dinner sounds and smells from the hallway.

Patient #2’s wife comes to visit. He still does not have a bed, so they talk while standing. Patient #1 joins them to say hello to the wife. Clinking sounds from the hallway and an unknown audio sound.

Patient #2 and wife have left for the living room area. Patient #1 is reading the newspaper changes from sitting on a chair with the newspaper resting on his bed, to sitting on his bed facing the window, newspaper resting on nightstand. (See sketch) Clinking sounds from the hallway and an unknown audio sound. The two spot lights are turned on and so is the embedded light source, on half power setting. (See sketch)

Patient #1 is sitting on his bed facing the window, reading the newspaper. It is now getting dark outside. The color tones seem more saturated. Dominant colors are orange/red/yellow, secondary colors blue/turquoise. The window has a predominant mirror effect now and seem less like a window, making the room close in on itself.

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Empty room. Empty room. Empty room. Empty room. All lights are turnes on, the sound from All lights are turnes on, the sound from All lights are turnes on, the sound from All lights are turnes on, the sound from a radio channel escapes patient #1’s a radio channel escapes patient #1’s a radio channel escapes patient #1’s a radio channel escapes patient #1’s headphones lying on his nightstand. headphones lying on his nightstand. headphones lying on his nightstand. headphones lying on his nightstand. Traffic in the hallway. Traffic in the hallway. Traffic in the hallway. Still clinking sounds of cutlery. Still clinking sounds of cutlery. Still clinking sounds of cutlery.

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Empty room. Empty room. Patient #2 enters with nurse. #2 sits in All lights are turnes on, the sound from All lights are turnes on, the sound from armchair while nurse squats down next a radio channel escapes patient #1’s a radio channel escapes patient #1’s to armrest and uses a long time to locate headphones lying on his nightstand. headphones lying on his nightstand. a vain suitable for blood sampling. Nurse Traffic in the hallway. Traffic in the hallway. has pulled the trolly table with utensils Still clinking sounds of cutlery. Still clinking sounds of cutlery. closer. (See sketch) Still no bed, door completely open. (Photo taken at 2005)

Empty room. Football is on in the living room area. Sound of cutlery. Loud conversations about the coffee cart soon to arrive. Normal hospital smells now, now more food scents.

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Empty room. Football is on in the living room area. The sound of football, occational comments and small talk. Unknown audio sound.

Empty room. Football is on in the living room area. The sound of football, occational comments and small talk. Unknown audio sound. The coffee cart is now in place in the hallway, and the traffic and sounds increase. No change in the smell of hospital.

Empty room. Football is on in the living room area. The sound of football, occational comments and small talk. Unknown audio sound plus the sound of people taking out coffe and tea.

Empty room. Football is on in the living room area. The sound of football, occational comments and small talk. Unknown audio sound plus the sound of people taking out coffe and tea.


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Empty room. Football is on in the living room area. The sound of football, occational comments and small talk. Unknown audio sound plus the sound of people taking out coffe and tea.

Empty room. Football is on in the living room area. The sound of football, occational comments and small talk. Unknown audio sound plus the sound of people taking out coffe and tea.

Nurse installs bed and electrocardiogram for patient #2 and leaves again. The sound of football, occational comments and small talk. Unknown audio sound plus the sound of people taking out coffe and tea.

Empty room. Football is on in the living room area. The sound of football, occational comments and small talk. The sound of people taking out coffe and tea and walkers and different type racks being pushed up and down the hallway.

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Empty room. Football is on in the living Empty room. Football is on in the living Empty room. Football is on in the living Empty room. Football is on in the living room area. room area. room area. room area. The sound of football, occational The sound of football, occational The sound of football, occational The sound of football, occational comments and small talk. comments and small talk. comments and small talk. comments and small talk. The clock is ticking loud. The clock is ticking loud. The clock is ticking loud. The clock is ticking loud.

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Patient #1 is back and has positioned Empty room. himself on his bed, facing the window, surfing around the different radio channels. Reading the newspaper in the spot light. And trying to make his bag reachable by pushing it around with his feet. (See sketch) Sound of plugs being moved arround in the wall of nabouring room.

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Both patients are back in the room, looking Patient #1 has gone to bed, listening to at the shared monitor. Talking about their the radio and facing the window. He has heart rate. turned off his spot light, but patient #2’s spotlight and the embedded light source are still on. Patient #2 is trying to access the lockers in the back of the room, to arrange his belongings. His bed ad night stand are partially blocking the way, but he refuses to move it arround because the nurse left it like that, says “They know best..”.


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Patient #1 still in bed. Constant sound of a distant radio and the clock ticking. Rattling from the hallway and sirenes outside. Patient #2 still furnishes his locker, nightstand and bathroom. Uses the nurse call button. When the nurse arrives he asks for a nightshirt and towell. It’s time for #2’s electrocardiogram, nurse elevates the bed and closes the door a little as #2 gets undressed. Nurse asks “Have you had a good evening?”. (See sketch)

Patient #1 and #2 in bed. Patient #2 has turned his sport light off, in order for him not to have to get out of bed I offer to turn off the embedded light source, it’s switch is next to the door. Sounds of radio and clock. Now all light are off and the only light comes in through the half open door.

Patient #1 and #2 in bed. Patient #1 and #2 in bed. Sounds of the ticking clock, breaths, steps A curious nurse comes in to question me in the hallway and an occational object about my task, she whispers. being wheeled across the floor. The warm tones of the walls and floors creates a feeling of a soft and safe darkness. And the window feels less like a mirror and more like an opening to the surrounding world again. All the mobil hospital objects look like foreign bodys with all their spiky metal parts.

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The patients are sleeping. The patient next to the window keeps a chair with his clothes next to the bed. The muffled sound of a radio can be heard. There is no particular smell in the room. The door side patient has the bed totally lowered, while the other one has it in a higher position with some extra feet for stability.

A bip comes from the hallway followed by a longer sound. The sound of someone using the toilet is quite audible. The door is open. Patient #2 is exposed to the light from the hallway, but it doesn’t seem to affect him. He sleeps turned upwards, while the patient #1 sleeps sideways. They both seem to have a good degree of mobility. The window side patient sleeps turned to the window. The view is uninteresting at night, but it shows the movement at the entrance of the hospital.

A cart comes to the room next door. The noise in this room is considerable. The whole conversation is audible. The orange walls make the room very cosy. The cart comes into this room, the lights are turned on. Patient #2 is being medicated. There is no visibility in the room, because the door is now closed.

The moving cars outside are the only source of light. I can’t see what I write. The tick tack from the clock is the dominating sound, and the breathing and turning of the window side patient. It’s really hot in here, but the windows are actually really cold. The darkest spot in the room is a vent over the door. Under it the brightest, the light under the door. Another cart squishing outside.

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The bell is ringing outside. The sound is grave. It keeps ringing for some time. The room has a balcony but you can’t access it. It looks really dirty and out of use, but I can’t see it properly.

The carts are the biggest source of noise. Silence and darkness in the room. The nurse came to greet me, but closed the door again. The bell is ringing again. It’s really hot in here. Yet patient #2 has a thick blanket over him.

Silence and darkness in the room.


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Carts, steps and the bell. The patient is Sleeping sounds. Darkness in the room. snoring now.

Patients still snoring.

A continuous beep sounds from the heart monitor.

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Sleeping sounds. Darkness in the room.

The patient turned around in a grumpy The other patient turned too, but his bed Nurse came and checked on patients. The way. Some danger of a fall. has side bars. door is noisy.

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0240

Sleeping sounds. Darkness in the room.

Sleeping sounds. Darkness in the room.

Patient #1 awoke and looked at me. A few An ambulance passes outside. Blue lights turns in bed and he’s about to sleep again. flood the room. He is sleeping with one foot out of bed. A cart passes through the hallway.

0250


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Sleeping sounds. Darkness in the room.

A strong snoring can be heard from Sleeping sounds. Darkness in the room. The hallway is slightly colder than the another room. The room is in silence. The vent under the window blows constant room. A patient came out of his room and Something beeps outside. cold wind. is speaking with the nurse.

0340

0350

It’s colder overall.

Patient #1 checks the time in the middle of The bell rings. the night. He has a small flashlight. He turns on the radio. He has hearphones. He turns off the radio again.

The nurse came and offered me some coffee.

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The patient turns on the radio again. Ambulance lights again. Radio off again. The speakers outside are for the bell.

The beds are noisy when the patients The air under the window is not so cold Sleeping sounds. Darkness in the room. move. anymore. Another ambulance. This one had the sirenes on.

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Sleeping sounds. Darkness in the room.

Sleeping sounds. Darkness in the room.

Sleeping sounds. Darkness in the room.

Something that sounded like an alarm clock ringed.

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The nurse came to take a look at the pa- Patient goes back to sleep. Sleeping sounds. Darkness in the room. tients while I wasn’t in the room. I know it Patient in the room next door coughs a lot. because the door makes a lot of noise. Patient #2 went to the bathroom. He moved freely and independently.

Radio on again. Carts running outside.

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The patient takes treatment again. the car- Blood pressure and temperature is meas- Tests are done. egiver comes with a cart of his own. ured in both patients. Plenty of carts being moved in the hallway. Treatment ends at 0611.

Sleeping sounds. Darkness in the room.


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The clarity of the day is starting to show up The visibility outside increased a little. on the window half of the room.

Some electric car is passing through the A very orange light gets in under the room hallway. A vacuum cleaner probably. and reflects itself in one of the beds.

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Patient #1 is fully awake, the other is not. Lots of movement outside.

Patient #1 is watching sunrise and listening to the radio for 10 minutes now, while taking his pils. He goes back to sleep after chatting with me. The whole room is now visible and lit by daylight, although the day is cloudy and the light very diffuse.

The room is getting progressively brighter and the different colours become more perceptible. The bell is heard with much more frequency now, along with a beep and people walking. The air coming from the window vent is still cold, but not with such a difference of temperature as during the night. The sun is visible now and the patient is watching it again.

Patient #1 goes to the toilet. The patient seems very happy he can enjoy this sunrise and also the life of the city. (he was talking about how there was a blackout last monday and he could see the one building that had power, etc..)

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Patient is back in the room and wakes up the other patient talking about “morgenmad”. He’s back into his radio and sunrise. Second patient gets up. The sun gets out of the clouds and the room gets filled with very defined light. The second patient gets dressed for breakfast.

Lots of light in the room. The patients are getting ready to leave the room. Medical personnel comes in, says “God morgenen” and says he’ll be back soon.


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1630

quietness in the room

orientation towards window

1610

1710

movement in the hallway

utensils trolley moved around by nurse

1730

1810

chair, bed and windowsill as seating

nurse patient conversation and other patient

1810

1840

nurse patient concersation

patient #1 reading the newspaper


1840

2000

the light

utensils trolley

2000

2220

blood sample

reading the newspaper and pushing bag around

2300

electrocardiogram


Hvordan personalet bevĂŚger sig rundt pĂĽ sengestuen. Ankomst til stuen, samt hvor lĂŚgen og sygeplejersken placeret ved sengen/patienten.


Objects in the room at 1630

Objects in the room at 2130

One nightstand One utensils trolley One locker with tripartite division One bin (plus one on the trolley) One sink One installation panel One monitor screen Two armchairs Two side chairs Two stools Two curtains

Two beds Two nightstands One utensils trolley One locker with tripartite division One bin (plus one on the trolley) One sink One installation panel One monitor screen Two armchairs One side chair Two stools Two curtains

One bed


Når man opholder sig i længere tid på sengestuen, har man brug for frisk luft. Luften på stuen er meget tør, og man har lyst til at åbne et vindue, eller kunne bevæge si udenfor.

Electronics in the room Single wall outlet (used for lamp) Vertical panel Horizontal panel (with two spot lights and monitor plugged in plus plugs for shavers etc.)


Horizontal panel Medical equipment Embedded light source (upward diffuse light) Track for anglepoise, medical equipment etc. Monitor plug Sockets Nurse call button


Vertical panel Thermometre Heart failure call button Nurse call button Switch for the embedded light source Switch for the embedded light source - half power setting ? ? ? Switch Plug (which does not work)


Light sources Embedded light source (in horizontal panel) w. upward diffuse light Two anglepoise spot lights (fixed in horizontal panel) Small spotlight Light seeping in from the hallway Daylight

Detaljer på stuen. Snor til at tilkalde personalet, er placeret ved hvilestol modsat sengene på stuen. Væglampen er placeret ved vognene med plejeudstyr. Én læselampe er placeret ved hver senge. Belysning herudover er almen belysning placeret i panelet bag sengene. Læselampen, er den eneste arbejdsbelysning som personalet har på stuen, når de f.eks. skal lægge drop på en patient. Lampen er ikke beregnet til dette formål, og kan ofte ikke nå langt nok.


Organisation Main hallway Smaller hallway Rooms Smaller hallway works as buffer between main hallway and room. The distance it creates makes in- and outlook as well as sounds less insistent. Thus the patient can leave the door open for security and not to feel alone and isolated but still maintain a level of distance and privacy.


Signage outwards

Signage internal Skiltning pĂĽ stuen var placeret midt pĂĽ indgangsvĂŚggen over rullebord med udstyr. Der var 2xA5 noter og 5xA4 skilte. Flere forskellig former for kommunikation. F.eks. at mobiltelefoner ikke var tilladt.


Storage in room

Storage in bathroom


Storage for patient no.1

Storage for patient no.2


Adaption

Bins


Program vs use / changes over time

Program vs use / changes over time


Technical hatch to the ceiling

Noisy cart wheels


Fittings for equipment

Speakers for patient call sign


Room Occupancy Register

23

Record of various users occupying the patient room over the 24 hour period.

24

01

02

22

21

03

20

04

19

05

06

18

3

2

VI SI TO R

VI SI TO R

07

VI SI TO R

DO CT O R

CL EA NE R

17

PA TI EN T

2A

1

15 14

10 13

12

11

S T AR T

2B

PA TI EN T

PA TI EN T

NU RS E

1

16

09

Noisy door


CONCLUSION ON OBSERVATIONS THRESHOLDS

CIRCULATION OF INFORMATION

• • •

The patients overvalue safety to privacy. Doors are left open, when they usually wouldn’t be. Also, the fact that the bathrooms are outside the room further restrict the patients privacy. However the ventilation system is designed for doors to be kept closed. The small space before the rooms seems to be an important element to increase the feeling of privacy and to filter the intense movement in the hallway. A big contrast in the intensity of light in the hospital room compared to the hallway can be disturbing, especially if the patient wants to keep the door open during night time. The possibility of observing the outer world is much appreciated as it gives a notion of still belonging to society.

INTERACTION WITH OBJECTS •

MOTIVATION AND MOBILIZATION • • • •

The presence of entertainment systems in the rooms doesn’t help the mobilization of patients, which is important both for health and social reasons. The sharing of rooms is also a determinant factor in the socialization aspect, since patients cooperate which enhances motivation and mobilization. The gap of knowledge between the patients and the medical personnel generates a fear of interference with the medical procedures. That limits the interaction with the objects in the room and the patients seetlement. The idleness of some patients can be justified with this fear, but also with an idea of the modern hospital as a place where the body is perceived as an object which is processed.

LIGHT • •

The available light options are not focused enough on the function at hand, which means that the whole room has to be lit to perform any task, causing disconfort to the patients. Also the patients need some personal light with more options in terms of intensity.

The lack of an organized communication system between the staff and staff and patients, leeds to the proliferation of papers and white boards throughout the whole ward. 5 different sounds are used to communicate warnings of different importance to the caregivers. This system is prone to human error and could probably be improved. Besides, it can be stressful to the patients.

“There are some people, when they enter a hospital, they just say << I’ll just lie here in this bed, I don’t have to move, they’ll do anything for me, I can’t drink, I can’t wash myself, I can’t do anything>> and actually they can, they just left their personality at the front door.” nurse from the cardiology ward

• • •

The cleaning of the room is limited by the amount of furniture, as the cleaning staff are not entitled to move items. Therefore, the current option is to keep only the vital objects in the room and to keep a source of secondary objects in the hallway. Some objects have assigned fittings in the hallway, so that they don’t clutter it. This scarcity of furniture leeds to a creative use of the available one. Many different daily scenarios are created around the bed, according to the situation at hand, for example, reading, receiving guests, etc.. Another consequence of this scarcity is insufficient storage space and an unplanned disposition of the patients belongings. Some of the daily used objects, like beds and carts, are very noisy and hard to handle. They are in permanent use and their maintenance operations don’t reach the mobile parts.


Litteratur og web-ressourcer Albena Yaneva: Scaling Up and Down. Extraction Trials in Architectural Design. Social Studies of Science December 2005 vol. 35 no. 6 867-894 Arkitekten 07 / 2011 Kim Dirckinck Holmfeld og Lars Heslet (red.): Sansernes Hospital, Arkitektens Forlag 2007 http://www.kvalitetsreform.dk/multimedia/Erik_Juul_1.pdf http://www.fm.dk/Publikationer/2007/Aftaler%20om%20den%20kommunale%20 og%20regionale%20oekonomi%20for%202008/Aftale%20om%20regionernes%20 oekonomi%20for%202008.aspx http://www.godtsygehusbyggeri.dk/ http://www.godtsygehusbyggeri.dk/~/media/Files/Funktion%20og%20dimensionering/ DenGodeSengestue1%20%204.ashx http://www.premierinc.com/quality-safety/tools-services/safety/topics/construction/ downloads/03-review-anal-literature.pdf http://www.herlevhospital.dk/nythospital/Menu/projektet/vinderprojektet/ http://www.musicahumana.dk/documents/00010.pdf


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