How does the environment of a UK hospice impact on the social wellbeing of older inpatients? : an ethnographic study

Rigby, Janet and Milligan, Christine and Payne, Sheila Alison (2014) How does the environment of a UK hospice impact on the social wellbeing of older inpatients? : an ethnographic study. Palliative Medicine, 28 (6). ISSN 0269-2163

Abstract

Background: Little is known about how to design inpatient hospice buildings to maximise the wellbeing of the growing number of patients aged 65yrs or over. Aim: To investigate the impact of a hospice environment on the social wellbeing of older inpatients. Method: Interviews were conducted with10 staff, 2 visitors and 7 older in-patients at a UK hospice with 8 single and one 4-bed rooms, to elicit their views on the building, and 120 hours of non-participant observation, to find how space was used. Field notes and interview transcripts were subject to thematic analysis using NVivo X, using concepts derived from therapeutic landscapes theory. Results: (1) Supervision and independence -The building was constructed around a long blind-ended corridor, with a nurses’ station near the entrance. Those who were terminally ill or restless were allocated to single rooms near the nurses’ station. Frequent room transfers occurred in response to changing needs, and older patients disliked these. Room doors were kept open during the day, enabling staff to monitor occupants as they walked along the corridor. There were several complaints of loneliness from those in rooms at the end of the corridor, as staff visited less often. (2) Private and public space - Older patients spent most of their time in their rooms, usually seeing visitors at the bedside. Of the available social spaces, the hospice garden was the most visited, and older patients enjoyed contact with nature. They rarely entered the two patient lounges and conservatory, which were often occupied by staff for meetings, family conferences and meal breaks. Conclusions: To maximise older inpatients’ social wellbeing, the hospice environment should be designed to balance the need for supervision and independence, and for private and public space. Staff working practices should ensure that the use of the environment is patient-centred.