“Throughout the review, a general finding was that the lack of single rooms and use of multiple bed bays means that patients and relatives are not afforded the dignity that they deserve. Although generally the wards allowed for a degree of gender separation, this was not always the case with there being several examples of mixed gender wards and bed bays. It is recognised best practice to separate male and female patients into different wards, or areas. This is clearly to provide each with dignity, privacy and respect. Where this is not possible, it completely breaches privacy and dignity issues, which may become heightened where a person is nearing the end of life and may require more levels of personal support and intervention. The ward layouts did not tend to allow for any significant level of privacy for patients or visitors from an acoustic or visual perspective given that the main bed complement of the wards is based on multiple bed bays. This was particularly apparent in the older estate facilities where there were poor ward layouts and not enough space between each bed on the ward. … Noise levels where often high in many of the wards visited. … In general, there was a lack of quiet spaces, interview or relatives’ rooms across all sites, preventing opportunities for confidential discussion and/or quiet reflection”.
The same review found mortuary facilities were deficient in terms of viewing rooms, waiting rooms, interview rooms, and rooms for preparing and storing bodies.
In 2008 the actor Gabriel Byrne launched launched ‘Design & Dignity Guidelines for Physical Environments of Hospitals Supporting End-of-Life Care which were developed by the HFH Programme with the support of HSE Estates. At this same event Prof. Roger Ulrich, of the A & M University in Texas and the Center for Health Design, made an overwhelming case for the renewal of Ireland’s healthcare infrastructure and for widespread access to single rooms in hospitals.
The National Audit of End-of-Life Care in Hospitals shows that on average, about 15% of beds in acute and community hospitals are in single rooms. Despite this, a third of patients (33%) spent most of their last week of life in a single room, and more than four in ten (44%) died in a single room. This suggests that hospital staff try to allocate single rooms to patients in order to facilitate a more dignified death, itself indicating an awareness of the importance of single rooms at the end of life. Nevertheless, given that nearly half of all patients who died in a shared room would have preferred a single room (45%), a significant degree of unmet need clearly remains.’ In Northern Ireland 70% of patients die in single rooms in hospitals.
The HFH Programme has secured government support for the development of a Design & Dignity Challenge Fund to assist projects aimed at enhancing the dignity of people who die in Irish hospitals and of their families. Following the confirmation of €750,00 of from the Department of Health and Children, philanthropic organisations and individuals will be asked to match, and preferably double, the amount contributed by the state.
“… It is now widely recognised that well designed physical settings play an important role in making hospitals less risky and stressful, promoting more healing for patients, and providing better places for staff to work” (Ulrich, Zimring, Zhu et al., 2008)