Young patients help design pediatric unit
Young patients help design pediatric unit
Renovation part of shift to family-centered care
When the 302-bed St. Vincent’s Hospital in Billings, MT, redesigned its pediatric unit to a patient-focused care model, the young patients and their families were at the hub of the planning process from brainstorming for ideas to the blueprints to the treatment plans.
As a result of their input, the entire pediatric unit has been redecorated to look like a town, complete with a train station treatment room, a circus-like playroom, interactive murals on the walls, hopscotch diagrams on the floors, and traffic lights at the intersection of corridors.
Patient satisfaction has climbed to 4.8 on a scale of 1 to 5, up from 4.2 before family-centered care was instituted three years ago.
"We hear consistently good comments and have been rated higher than any children’s hospital in our area," says Martie Moore, RN, MAOM, quality improvement/pediatrics.
When the hospital administration mandated the move to patient focused care, members of the pediatric team visited children’s hospitals nationwide and borrowed "the best of what we saw" Moore says.
But while the hospitals visited had interesting areas that appealed to children, they found none had a totally patient-focused pediatric department, Moore says.
Patients became planners
That’s when the staff at St. Vincent’s turned to their patients for help in planning.
"Through our hospital’s philosophy of patient-focused care, we wanted to identify the needs of our patients and to change our way of providing health care to suit the needs of pediatric patients," Moore says. (See related article on how the hospital accommodates families, p. 106.)
Based on comments of young patients, staff concluded the typical sterile physical environment of the hospital was threatening to children and not conducive to healing.
That posed a challenge: creating an environment that appeals to a community pediatric population from newborns to teenagers.
The staff conducted focus groups for former patients and their families and spent a lot of time brainstorming with their teenage patients. The staff supplemented this research by bringing artwork and drawings into patients’ rooms to ask what they thought.
"We found that a common theme for all of them is that we are truly a community hospital. From this, we developed a community theme for the pediatric area," Moore says.
Kids notice the darndest things
"We ran the artwork past them, and they suggested some really good changes," Moore says.
For instance, a young patient pointed out that a boy pictured in a winter scene was wearing a coat and told Moore "nobody has on a coat when he’s playing really hard."
Working with an architect and a graphic designer, Moore and her staff set out to change the entire look of the hospital.
Planning took about a year; renovation took five months, during which the pediatric patient census was at its highest level ever, Moore notes.
Each room is designed to be a house, a business, or another community building.
The treatment room is a train depot with a large-scale electric train that chugs around the room. (See photo, p. 104.) Children lying on the treatment table can enjoy pictures painted on the ceiling.
The pediatric staff use puppets, pop-up books, and music to help the children relax which offers clinical advantages in addition to simply comforting the children. For example, bubble blowing equipment is popular in the treatment room. Children are encouraged to blow bubbles at the train while they go through possibly painful procedures, such as an IV start. This decreases vascular tension, making it easier to start the IV, she adds.
"We tried to make the room as child-friendly and supportive as possible and to include a lot of diversions to help the children deal with their anxiety. We use a topical anesthesia and relaxation breathing techniques to help," Moore says.
The center of activity for the pediatric area is the playroom, which is designed with a circus theme.
Young patients who participated in the focus groups told St. Vincent’s staff that most hospital playrooms are not appealing because they are just rooms with toys in them.
St. Vincent’s playroom is structured like an early-grade classroom with centers of activities, using the theme of a circus. There is a monkey pit (an indoor jungle gym), magic mirrors, circus animals, and play activity center.
Home-like atmosphere dominates
The hallway around each patient room is decorated to look like the outside of a house. The "homes" are designed down to the smallest details. For instance, some have flower boxes at the windows with bees buzzing overhead and a tiny worm wearing a necklace and glasses sitting on one of the wooden flowers.
The room preferred by and designed by the teen-agers looks like a dilapidated old shack.
"We tried to make the environment so engaging that you never think you are in a hospital," Moore says.
Other walls in the pediatric section contain seasonal murals. There is a fair scene with hidden pictures and a magnetic wall where the patients can change the scenery. Another hall contains an art gallery where patients’ artwork is displayed.
Patients who are well enough may ride three-wheelers or be pulled in wagons along the corridors. The hospital has given the corridors names such as "Polliwog Pass" and "Feeling Groovy Boulevard" and installed traffic lights at intersections. (See photo, above.)
With so many interesting places to visit in their "community," patients are eager to get up and out of their rooms, Moore says.
"They want to go out and be kids. Having activities outside their room gets them up and walking, which helps them return to their optimal level," she adds.
Decorations are for imaginations
For the interior of the patient rooms, St. Vincent’s again turned to the patient’s ideas.
The young people told the staff during focus groups that they wanted the rooms to be attractive but not overstimulating. As a result, the rooms feature an entire wall of shelves for "stuff": corkboard, chalkboards, and video cassette recorders. The walls are cream with a border in primary colors that continues the town theme.
In the bathroom, an artist airbrushed bubbles coming out of the shower and up the walls.
The library, adjacent to pediatric intensive care, meets the needs of two diverse populations parents of critically ill children and teen-agers who want a place to hang out with friends.
The room contains books, fish tanks, a stereo system, and rheostat-controlled lighting that can be soothing or bright, depending on who is using the room.
"It’s been very successful. We’ve never had two groups try to use it at the same time. The teen-agers are very respectful, and if they see that a distressed family is in the room, they go somewhere else," Moore says.
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