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Content
Journal of Pediatric Oncology Nursing
http://jpo.sagepub.com
The Influence of Two Hospitals’ Designs and Policies on Social Interaction and Privacy as Coping
Factors for Children With Cancer and Their Families
Judy Ann Rollins
Journal of Pediatric Oncology Nursing 2009; 26; 340 originally published online Aug 17, 2009;
DOI: 10.1177/1043454209339734
The online version of this article can be found at:
http://jpo.sagepub.com/cgi/content/abstract/26/6/340
Published by:
http://www.sagepublications.com
On behalf of:
Association of Pediatric Hematology/Oncology Nurses (APHON)
Additional services and information for Journal of Pediatric Oncology Nursing can be found at:
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The Influence of Two Hospitals’ Designs
and Policies on Social Interaction and
Privacy as Coping Factors for Children
With Cancer and Their Families
Journal of Pediatric Oncology Nursing
26(6) 340–353
© 2009 by Association of Pediatric
Hematology/Oncology Nurses
Reprints and permission: http://www.
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1043454209339734
http://jopon.sagepub.com
Judy Ann Rollins, PhD, RN
Abstract
Children with cancer and their families benefit from both social interaction and privacy in attempting to cope with
the stresses of a child’s hospitalization and illness. An analysis of findings from a study of stress and coping for children
with cancer evaluated design features affecting social interaction and privacy at a hospital in the United Kingdom and
a hospital in the United States and some of the ways in which these features and related hospital policies uphold the
philosophy of family-centered care and support coping. Implications of these findings with the current call for single
occupancy rooms in both countries are explored.
Keywords
hospital design, cancer, child, hospitalized, adaptation, psychological
Children with cancer are frequently hospitalized during
diagnosis and the course of their treatment. Although the
primary source of psychosocial support for children in
hospitals will always be families and caregivers and their
programs, conscientious designers attempt to provide
spaces that support the endeavors of these individuals
(Shepley, 2005).
Environmental psychology—the study of transactions
between individuals and their physical settings (Gifford,
1987)—is a new science, the basic tenets of which are
steadily being formulated (Shepley, 2005). This relatively young field deals with several important psychosocial issues, two of which are privacy and social interaction.
Evidence exists that the hospital environment can influence the amount and degree of interaction that occurs
(Shepley, Harris, White, & Steinberg, 2008).
Another influence on the amount and degree of social
interaction and privacy children and their families experience is related to the hospital’s philosophy of care and
resulting policies related to space. Although different
terminology might be used, philosophies of care in both
the United Kingdom and the United States are similar.
Both countries emphasize the whole patient and whole
families, incorporating the concept of family-centered
care.
In the analysis of findings from an exploratory study
comparing stress and coping for children with cancer
aged 7 to 18 years in the United Kingdom and the United
States, four coping themes emerged among the 22 participants: (a) being prepared, (b) being connected, (c) shutting it out, and (d) working it through (Rollins, 2003).
Some of the coping strategies children use that reflect
these themes might be easier to initiate in a hospital environment that encourages social interaction; for others, an
environment that provides privacy might likely prove
more effective. In some instances, both social interaction
and privacy might be appropriate.
The purpose of this analysis was to explore how differences in designs of these two hospitals and their policies related to space might influence children’s ability to
use these coping strategies. The aim was to describe
some of the ways in which the physical aspects and policies of a UK hospital and a US hospital fostered coping
for children with cancer and their families.
Literature Review
Children and families need a hospital environment that
provides a balance of social interaction and privacy and
policies that support these conditions. Social support can
positively influence children’s coping and health care outcomes during hospitalization (Johnson, Jeppson, &
Corresponding Author:
Judy Rollins, PhD, RN, 1406 28th Street NW, Washington, DC 20007
E-mail: [email protected].
Downloaded from http://jpo.sagepub.com by on May 27, 2010
341
Rollins
Redburn, 1992; Rollins, 2005; Shepley, 2005). Child-tochild and family-to-family support does not seek to replace
professionally mediated support but, rather, is a unique
resource that promotes individual and family strengths
through shared experience (Johnson et al., 1992).
Maintaining links to familiar environments, routines,
and activities is a critical factor in helping children cope
with hospitalization (Joseph, Keller, & Kronick, 2008).
Providing opportunities for children to interact with
peers who are hospitalized is one way to help achieve
this goal. Studies indicate that contact with peers results
in significant benefits in social and communication skills
and in the development of greater self-confidence and
independence among pediatric patients (Fels, Waalen,
Zhai, & Weiss, 2001; Said, Salleh, Abu Bakar, &
Mohamad, 2005). Peer-to-peer interaction is particularly
important for hospitalized adolescents (Hutton, 2002,
2003).
Parents also seem to benefit from interactions with
other parents sharing similar experiences. Peer-provided
support is unique, complements professional-provided support, and may have an impact lasting beyond the initial
reasons for contact (Ahmann, 1999). Parent-to-parent
support provides parents with information, emotional
support, a sense of being understood, friendship, mentoring, role modeling, assistance with problem solving, and
a base for advocacy efforts (Ahmann & Rollins, 2005).
Support from other parents is more likely to be accepted
than formal support because it makes parents feel less
“needy” (Dunst, Trivette, & Deal, 1988). Parents have
cited support from other parents as an essential factor in
helping them cope successfully with the stress of a hospital experience (Johnson et al., 1992). In one mother’s
words:
Other parents provide me with a context—often
just by listening without trying to reassure me;
sometimes by reinforcing half-formulated plans of
action; occasionally by confiding fears that mirrored my own. (Oster, 1985, p. 30)
Childhood cancer brings families into a new and different
world, with new routines, new experiences, new reality,
and a new circle of friends being brought into their existing lifestyle (Bradwell & Hawkins, 2000). According to
the American Cancer Society (2005), when dealing with
the fear at the time of a child’s diagnosis, it is often helpful for children and parents to hear how other children
and parents have coped. Particularly with frequent and
lengthy hospital stays, parents, as do their children with
other children, establish friendships and networks of support with other parents. Bradwell and Hawkins (2000)
offer the following quote from a mother:
During the treatment, the lives we lived on the
ward, the other parents and myself, were lived in
each other’s pockets. Much of the time we were
experiencing incredible, intense emotion, and as a
result, incredibly intense friendships were formed.
(p. 344)
Parents who are supported are better able to help their
child with cancer cope with the stresses of illness,
treatment, and hospitalization. The ability to support
one’s child is important but particularly so for parents of
children in middle infancy throughout the preschool
years, especially children aged 15 to 30 months
(Hockenberry & Wilson, 2006). As separation is the
greatest stressor for this age group, parental presence
with a well-supported parent who is able to support the
child is a most effective coping intervention. Parentto-child support minimizes disruption in family routines
(Johnson et al., 1992) and has a positive effect on
children’s adjustment to hospitalization (Brain & Maclay,
1968).
Privacy is directly related to control issues in that
privacy can be defined as the selective control of social
interactions (Altman, 1975). Children and their families
might want to control access not only to themselves but
also to groups with which they identify. According to
Shepley (2005), this ability to control interactions is so
important that these skills may be even more important
than the interactions themselves. The single-occupancy
room provides this privacy, maximizes family involvement and participation in care (Joseph et al., 2008),
and is increasingly an expectation of families and
patients in the United States (Mulhall, Kelly, & Pearce,
2004).
An additional concern is auditory privacy (Shepley,
2005). In shared space, other patients, family members,
and visitors often hear others’ discussions with the medical staff and phone conversations. Lack of privacy may
also result in grieving parents withholding their response or
not demonstrating their grief publicly.
Hospital policies related to family-centered care have an
impact on the allocation and use of space. Family-centered
care is a philosophy of care that recognizes the family as the
constant in a child’s life (Shelton, Jeppson, & Johnson,
1987). According to the Institute for Family-Centered Care
(n.d.), family-centered principles, processes, and approaches
are both supported by and expressed in health care environments.
The sterile, bland, clinical environment of
the past is replaced by warm, inviting colors and
textures; welcoming and easy-to-read signage;
Downloaded from http://jpo.sagepub.com by on May 27, 2010
352
Journal of Pediatric Oncology Nursing 26(6)
(Haines, Perrott, & Weir, 2006; Owens, Thompson,
Elixhauser, & Ryan, 2003). We are already witnessing a
decrease in the number of children who are able to engage
in activities with others outside their rooms (R. Hart, personal communication, December 1, 2008). If we believe
that social interaction can be an important condition for
coping for the child with cancer, how will we address this
issue?
Perhaps it is time to consider new models for inpatient
hospital units for children with cancer. The 1-plus-4
dormitory-type suite common on college campuses and
in recent years, military bases, might provide a starting
point. This style would have 4 children and their families
sharing a common living area, but having their own bedroom and bathroom. The close proximity of the bedrooms to the common area would likely provide greater
opportunity for children and families to interact. A cluster of these suites could surround a central nurses’ station. The model offers the benefits of privacy and a
comfortable, accessible area for social interaction.
Architects are beginning to think about new models that
would better meet the needs of today’s hospitalized children and their families (Shepley et al., 2008).
In developing new models, additional factors need to
be taken into account. Based on the literature review
recently conducted by the National Association of
Children’s Hospitals and Related Institutions (NACHRI)
and The Center for Health Design (2008), there are six
key areas where future research is needed on designing
health care environments for children and adolescents:
· role of design in reducing noise levels and associated negative outcomes;
· effect of natural light in reducing depression and
improving outcomes;
· impact of unit design (ie, decentralization) and
patient room design on staff time at the bedside
and staff efficiency;
· impact of unit design and acuity adaptable room
design on patient transfers and errors;
· impact of positive distractions such as artwork
and music on stress reduction and anxiety; and
· cost-effectiveness of various design innovations. (Sadler & Joseph, 2008, p. 4)
Thus, we have much to learn about the ways in which our
current hospital designs and those on the horizon
influence social interaction and privacy, and in turn
coping, for children with cancer and their families. We
can also take heart in knowing that children and families
often seek out what they need, and as with the converted
closet mini lounge, caring staff members often anticipate
these needs and find creative solutions to meet them.
Acknowledgments
The author would like to acknowledge the International
Society of Nurses in Cancer Care and the Paediatric
Oncology Division of the Leicester Royal Infirmary for
funding this study, the children who so graciously shared
their experiences, and the assistance from the dedicated
team members in the United Kingdom and the United
States sites who lovingly care for these children and their
families.
References
Ahmann, E. (1999). Family-centered care. In M. Broome
& J. Rollins (Eds.), Core curriculum for the nursing care
of children and their families (pp. 373-392). Pitman, NJ:
Jannetti.
Ahmann, E., & Rollins, J. (2005). The child with special healthcare needs. In J. Rollins, R. Bolig, & C. Mahan (Eds.), Meeting children’s psychosocial needs across the health-care
continuum (pp. 175-219). Austin, TX: ProEd.
Altman, I. (1975). The environment and social behavior. Monterey, CA: Brooks/Cole.
American Cancer Society. (2005). Children diagnosed with
cancer: Dealing with diagnosis. Retrieved November 26,
2008, from http://www.cancer.org/docroot/CRI/content/
CRI_2_6X_Dealing_With_Diagnosis_7.asp?sitearea=CRI
Bradwell, M., & Hawkins, J. (2000). Survivorship and rehabilitation. In H. Langton (Ed.), The child with cancer: Familycentred care in practice (pp. 311-351). London: Bailliere
Tindal.
Brain, D., & Maclay, I. (1968). Controlled study of mothers and
children in hospital. British Medical Journal, 1, 278-280.
Chaudhury, H., & Mahmood, A. (2003). Advantages and disadvantages of single-versus multiple-occupancy rooms in
acute care environments. Environment and Behavior, 37,
760-786.
Dowdeswell, B., Erskine, J., & Heasman, M. (2004). Hospital
ward configuration. Determinants influencing single room
provision. A report for NHS Estates, England. Stockton-onTees, UK: EU Health Property Network.
Dunst, C., Trivette, C., & Deal, A. (1988). Enabling and
empowering families: Principles and guidelines for practice. Cambridge, MA: Brookline Books.
Fels, D., Waalen, J. K., Zhai, S., & Weiss, P. (2001). Telepresence under exceptional circumstances: Enriching the connection to school for sick children. In Proceedings of IFIP
INTERACT01: Human-Computer Interaction 2001 (pp. 617624). Tokyo, Japan: IFIP Technical Committee No. 13 on HumanComputer Interaction.
Fournier, M. (1994). L’amenagement des aires d’attente dans
les unites de soin intensif pour adultes [The design of family waiting rooms in intensive care units for adults]. Unpublished master's thesis, Laval University, Quebec, Canada.
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Gifford, R. (1987). Environmental psychology: Principles and
practice. Boston: Allyn & Bacon.
Haines, C., Perrott, M., & Weir, P. (2006). Promoting care for
acutely ill children: Development and evaluation of a paediatric early warning tool. Intensive and Critical Care Nursing, 22,
73-81.
Henriksen, K., Isaacson, S., Sadler, B., & Zimring, C. (2007).
The role of the physical environment in crossing the quality chasm. The Joint Commission Journal on Quality and
Patient Safety, 33, 68-80.
Hockenberry, M., & Wilson, D. (2006). Wong’s nursing care of
infants and children. St. Louis, MO: C. V. Mosby.
Hughes, M., McCollum, J., Sheftel, D., & Sanchez, G. (1994).
How parents cope with the experience of neonatal intensive
care. Children’s Health Care, 23, 1-14.
Hutton, A. (2002). The private adolescent: Privacy needs of
adolescents in hospitals. Journal of Pediatric Nursing, 17,
67-72.
Hutton, A. (2003). Activities in the adolescent ward environment. Contemporary Nurse, 14, 312-319.
Institute for Family-Centered Care. (n.d.). Environment and
design. Retrieved November 28, 2008, from http://www
.familycenteredcare.org/advance/topics/enviro-design.html
Johnson, B., Jeppson, E., & Redburn, L. (1992). Caring for
children and families: Guidelines for hospitals. Bethesda,
MD: Association for the Care of Children’s Health.
Joseph, A., Keller, A., & Kronick, K. (2008). Transforming care
in children’s hospitals through environmental design: Literature review. In Evidence for innovation: Transforming
children’s health through the physical environment (pp. 18-95).
Alexandria, VA: NACHRI.
Mulhall, A., Kelly, D., & Pearce, S. (2004). A qualitative evaluation of an adolescent cancer unit. European Journal of
Cancer Care, 13, 16-22.
National Association of Children’s Hospitals and Related
Institutions and The Center for Health Design. (2008).
Evidence for innovation: Transforming children’s
health through the physical environment. Alexandria, VA:
NACHRI.
Olds, A., & Daniel, P. (1987). Child health care facilities. Washington, DC: Association for the Care of Children’s Health.
Oster, A. (1985). Keynote address. Comprehensive care
for medically vulnerable infants and toddlers: A parent’s
perspective. In Equals in this partnership: Parents of
disabled and at-risk infants and toddlers speak to
professionals (pp. 26-32). Washington, DC: National Center for Clinical Infant Programs.
Owens, P., Thompson, J., Elixhauser, A., & Ryan, K. (2003).
Care of children and adolescents in U.S. hospitals. Rockville, MD: Agency for Healthcare Research and Quality.
Rollins, J. (2003). A comparison of stress and coping for children with cancer in the United Kingdom and the United
States (British Library: DXNO64479). Doctoral dissertation, DeMontfort University, Leicester, UK.
Rollins, J. (2005). Tell me about it: Drawing as a communication tool for children with cancer. Journal of Pediatric
Oncology Nursing, 22, 203-221.
Sadler, B., & Joseph, A. (2008). Executive summary. In Evidence for innovation: Transforming children’s health
through the physical environment (pp. 1-17). Alexandria,
VA: NACHRI.
Said, I., Salleh, S., Abu Bakar, M., & Mohamad, I. (2005).
Caregivers’ evaluation on hospitalized children’s preferences concerning garden and ward. Journal of Asian Architecture and Building Engineering, 4, 331-338.
Shelton, T., Jeppson, E., & Johnson, B. (1987). Family-centered
care for children with special health care needs. Bethesda,
MD: Association for the Care of Children’s Health.
Shepley, M. (2005). The healthcare environment. In J. Rollins, R. Bolig, & C. Mahan (Eds.), Meeting children’s
psychosocial needs across the health-care continuum (pp.
313-349). Austin, TX: ProEd.
Shepley, M., & Davis, K. (1996). AIDS/HIV Nursing unit
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(Eds.), Public and private places: Proceedings of the 27th
Annual Conference of the Environmental Design Research
Association (p. 246). Salt Lake City, UT: EDRA.
Shepley, M., Fournier, M., & McDougal, K. (1998). Healthcare
environments for children and their families. Dubuque, IA:
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Shepley, M., Harris, D., White, R., & Steinberg, F. (2008,
November). Impact of single family NICU rooms on family behavior. Paper presented at the 6th annual conference
HealthcareDesign08, Washington, DC.
Bio
Judy Ann Rollins, PhD, RN, is President, Rollins & Associates, and adjunct assistant professor, Department of Family
Medicine and Department of Pediatrics, Georgetown University School of Medicine, Washington, DC.
Downloaded from http://jpo.sagepub.com by on May 27, 2010
http://jpo.sagepub.com
The Influence of Two Hospitals’ Designs and Policies on Social Interaction and Privacy as Coping
Factors for Children With Cancer and Their Families
Judy Ann Rollins
Journal of Pediatric Oncology Nursing 2009; 26; 340 originally published online Aug 17, 2009;
DOI: 10.1177/1043454209339734
The online version of this article can be found at:
http://jpo.sagepub.com/cgi/content/abstract/26/6/340
Published by:
http://www.sagepublications.com
On behalf of:
Association of Pediatric Hematology/Oncology Nurses (APHON)
Additional services and information for Journal of Pediatric Oncology Nursing can be found at:
Email Alerts: http://jpo.sagepub.com/cgi/alerts
Subscriptions: http://jpo.sagepub.com/subscriptions
Reprints: http://www.sagepub.com/journalsReprints.nav
Permissions: http://www.sagepub.com/journalsPermissions.nav
Citations http://jpo.sagepub.com/cgi/content/refs/26/6/340
Downloaded from http://jpo.sagepub.com by on May 27, 2010
The Influence of Two Hospitals’ Designs
and Policies on Social Interaction and
Privacy as Coping Factors for Children
With Cancer and Their Families
Journal of Pediatric Oncology Nursing
26(6) 340–353
© 2009 by Association of Pediatric
Hematology/Oncology Nurses
Reprints and permission: http://www.
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1043454209339734
http://jopon.sagepub.com
Judy Ann Rollins, PhD, RN
Abstract
Children with cancer and their families benefit from both social interaction and privacy in attempting to cope with
the stresses of a child’s hospitalization and illness. An analysis of findings from a study of stress and coping for children
with cancer evaluated design features affecting social interaction and privacy at a hospital in the United Kingdom and
a hospital in the United States and some of the ways in which these features and related hospital policies uphold the
philosophy of family-centered care and support coping. Implications of these findings with the current call for single
occupancy rooms in both countries are explored.
Keywords
hospital design, cancer, child, hospitalized, adaptation, psychological
Children with cancer are frequently hospitalized during
diagnosis and the course of their treatment. Although the
primary source of psychosocial support for children in
hospitals will always be families and caregivers and their
programs, conscientious designers attempt to provide
spaces that support the endeavors of these individuals
(Shepley, 2005).
Environmental psychology—the study of transactions
between individuals and their physical settings (Gifford,
1987)—is a new science, the basic tenets of which are
steadily being formulated (Shepley, 2005). This relatively young field deals with several important psychosocial issues, two of which are privacy and social interaction.
Evidence exists that the hospital environment can influence the amount and degree of interaction that occurs
(Shepley, Harris, White, & Steinberg, 2008).
Another influence on the amount and degree of social
interaction and privacy children and their families experience is related to the hospital’s philosophy of care and
resulting policies related to space. Although different
terminology might be used, philosophies of care in both
the United Kingdom and the United States are similar.
Both countries emphasize the whole patient and whole
families, incorporating the concept of family-centered
care.
In the analysis of findings from an exploratory study
comparing stress and coping for children with cancer
aged 7 to 18 years in the United Kingdom and the United
States, four coping themes emerged among the 22 participants: (a) being prepared, (b) being connected, (c) shutting it out, and (d) working it through (Rollins, 2003).
Some of the coping strategies children use that reflect
these themes might be easier to initiate in a hospital environment that encourages social interaction; for others, an
environment that provides privacy might likely prove
more effective. In some instances, both social interaction
and privacy might be appropriate.
The purpose of this analysis was to explore how differences in designs of these two hospitals and their policies related to space might influence children’s ability to
use these coping strategies. The aim was to describe
some of the ways in which the physical aspects and policies of a UK hospital and a US hospital fostered coping
for children with cancer and their families.
Literature Review
Children and families need a hospital environment that
provides a balance of social interaction and privacy and
policies that support these conditions. Social support can
positively influence children’s coping and health care outcomes during hospitalization (Johnson, Jeppson, &
Corresponding Author:
Judy Rollins, PhD, RN, 1406 28th Street NW, Washington, DC 20007
E-mail: [email protected].
Downloaded from http://jpo.sagepub.com by on May 27, 2010
341
Rollins
Redburn, 1992; Rollins, 2005; Shepley, 2005). Child-tochild and family-to-family support does not seek to replace
professionally mediated support but, rather, is a unique
resource that promotes individual and family strengths
through shared experience (Johnson et al., 1992).
Maintaining links to familiar environments, routines,
and activities is a critical factor in helping children cope
with hospitalization (Joseph, Keller, & Kronick, 2008).
Providing opportunities for children to interact with
peers who are hospitalized is one way to help achieve
this goal. Studies indicate that contact with peers results
in significant benefits in social and communication skills
and in the development of greater self-confidence and
independence among pediatric patients (Fels, Waalen,
Zhai, & Weiss, 2001; Said, Salleh, Abu Bakar, &
Mohamad, 2005). Peer-to-peer interaction is particularly
important for hospitalized adolescents (Hutton, 2002,
2003).
Parents also seem to benefit from interactions with
other parents sharing similar experiences. Peer-provided
support is unique, complements professional-provided support, and may have an impact lasting beyond the initial
reasons for contact (Ahmann, 1999). Parent-to-parent
support provides parents with information, emotional
support, a sense of being understood, friendship, mentoring, role modeling, assistance with problem solving, and
a base for advocacy efforts (Ahmann & Rollins, 2005).
Support from other parents is more likely to be accepted
than formal support because it makes parents feel less
“needy” (Dunst, Trivette, & Deal, 1988). Parents have
cited support from other parents as an essential factor in
helping them cope successfully with the stress of a hospital experience (Johnson et al., 1992). In one mother’s
words:
Other parents provide me with a context—often
just by listening without trying to reassure me;
sometimes by reinforcing half-formulated plans of
action; occasionally by confiding fears that mirrored my own. (Oster, 1985, p. 30)
Childhood cancer brings families into a new and different
world, with new routines, new experiences, new reality,
and a new circle of friends being brought into their existing lifestyle (Bradwell & Hawkins, 2000). According to
the American Cancer Society (2005), when dealing with
the fear at the time of a child’s diagnosis, it is often helpful for children and parents to hear how other children
and parents have coped. Particularly with frequent and
lengthy hospital stays, parents, as do their children with
other children, establish friendships and networks of support with other parents. Bradwell and Hawkins (2000)
offer the following quote from a mother:
During the treatment, the lives we lived on the
ward, the other parents and myself, were lived in
each other’s pockets. Much of the time we were
experiencing incredible, intense emotion, and as a
result, incredibly intense friendships were formed.
(p. 344)
Parents who are supported are better able to help their
child with cancer cope with the stresses of illness,
treatment, and hospitalization. The ability to support
one’s child is important but particularly so for parents of
children in middle infancy throughout the preschool
years, especially children aged 15 to 30 months
(Hockenberry & Wilson, 2006). As separation is the
greatest stressor for this age group, parental presence
with a well-supported parent who is able to support the
child is a most effective coping intervention. Parentto-child support minimizes disruption in family routines
(Johnson et al., 1992) and has a positive effect on
children’s adjustment to hospitalization (Brain & Maclay,
1968).
Privacy is directly related to control issues in that
privacy can be defined as the selective control of social
interactions (Altman, 1975). Children and their families
might want to control access not only to themselves but
also to groups with which they identify. According to
Shepley (2005), this ability to control interactions is so
important that these skills may be even more important
than the interactions themselves. The single-occupancy
room provides this privacy, maximizes family involvement and participation in care (Joseph et al., 2008),
and is increasingly an expectation of families and
patients in the United States (Mulhall, Kelly, & Pearce,
2004).
An additional concern is auditory privacy (Shepley,
2005). In shared space, other patients, family members,
and visitors often hear others’ discussions with the medical staff and phone conversations. Lack of privacy may
also result in grieving parents withholding their response or
not demonstrating their grief publicly.
Hospital policies related to family-centered care have an
impact on the allocation and use of space. Family-centered
care is a philosophy of care that recognizes the family as the
constant in a child’s life (Shelton, Jeppson, & Johnson,
1987). According to the Institute for Family-Centered Care
(n.d.), family-centered principles, processes, and approaches
are both supported by and expressed in health care environments.
The sterile, bland, clinical environment of
the past is replaced by warm, inviting colors and
textures; welcoming and easy-to-read signage;
Downloaded from http://jpo.sagepub.com by on May 27, 2010
352
Journal of Pediatric Oncology Nursing 26(6)
(Haines, Perrott, & Weir, 2006; Owens, Thompson,
Elixhauser, & Ryan, 2003). We are already witnessing a
decrease in the number of children who are able to engage
in activities with others outside their rooms (R. Hart, personal communication, December 1, 2008). If we believe
that social interaction can be an important condition for
coping for the child with cancer, how will we address this
issue?
Perhaps it is time to consider new models for inpatient
hospital units for children with cancer. The 1-plus-4
dormitory-type suite common on college campuses and
in recent years, military bases, might provide a starting
point. This style would have 4 children and their families
sharing a common living area, but having their own bedroom and bathroom. The close proximity of the bedrooms to the common area would likely provide greater
opportunity for children and families to interact. A cluster of these suites could surround a central nurses’ station. The model offers the benefits of privacy and a
comfortable, accessible area for social interaction.
Architects are beginning to think about new models that
would better meet the needs of today’s hospitalized children and their families (Shepley et al., 2008).
In developing new models, additional factors need to
be taken into account. Based on the literature review
recently conducted by the National Association of
Children’s Hospitals and Related Institutions (NACHRI)
and The Center for Health Design (2008), there are six
key areas where future research is needed on designing
health care environments for children and adolescents:
· role of design in reducing noise levels and associated negative outcomes;
· effect of natural light in reducing depression and
improving outcomes;
· impact of unit design (ie, decentralization) and
patient room design on staff time at the bedside
and staff efficiency;
· impact of unit design and acuity adaptable room
design on patient transfers and errors;
· impact of positive distractions such as artwork
and music on stress reduction and anxiety; and
· cost-effectiveness of various design innovations. (Sadler & Joseph, 2008, p. 4)
Thus, we have much to learn about the ways in which our
current hospital designs and those on the horizon
influence social interaction and privacy, and in turn
coping, for children with cancer and their families. We
can also take heart in knowing that children and families
often seek out what they need, and as with the converted
closet mini lounge, caring staff members often anticipate
these needs and find creative solutions to meet them.
Acknowledgments
The author would like to acknowledge the International
Society of Nurses in Cancer Care and the Paediatric
Oncology Division of the Leicester Royal Infirmary for
funding this study, the children who so graciously shared
their experiences, and the assistance from the dedicated
team members in the United Kingdom and the United
States sites who lovingly care for these children and their
families.
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Bio
Judy Ann Rollins, PhD, RN, is President, Rollins & Associates, and adjunct assistant professor, Department of Family
Medicine and Department of Pediatrics, Georgetown University School of Medicine, Washington, DC.
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