Designing Palliative Care Facilities to Better Support Patient and Family Care: A Staff Perspective

Abstract

Objective: To contribute staff perspectives on the design of palliative care facilities to better align with the philosophy of palliative care, in support of patient, family, and staff well-being. Background: The receipt of palliative care differs from other inpatient experiences owing to its distinct philosophy of care, longer lengths of stay, a greater presence of family members, and more frequent end-of-life events. While research regarding the optimal design of palliative care environments recognizes these differences, this knowledge has been slow to exert change on the guidelines and procurement processes that determine the design solutions possible within these settings. Sustained research attention is required. Methods: An online survey, comprising a series of open-ended questions, elicited the perceptions of palliative care staff regarding the relationship between the physical environment and the distinct philosophy of palliative care. Results: Responses from 89 Australian-based palliative care professionals confirmed the high value that staff place on environments that offer privacy, homeliness, safety, and access to gardens to assist the delivery of optimum care. Conclusions: Our findings illustrate that the implications of privacy and homeliness extend far beyond the patient room and that homeliness is about more than an aesthetic of comfort. This highlights a broader capacity for design to better support the philosophy of palliative care. Importantly, the data reveal a key relationship between staff well-being and the environments in which they work; environments that are unable to match the quality of care that staff aspire to deliver can engender frustration and distress.

The Effects of the Ward Environment and Language in Palliative Care: A Qualitative Exploratory Study of Victorian Nurses’ Perspectives

“…Further, limited family space in some rooms, poor family amenities, limited or nonexistent outdoor access, and a clinical multipurpose room used for family meetings highlight the nurses’ frustration in providing care in their regional hospitals where it seemed palliative, or end-of-life care received little priority and minimal budget allocation. Recent research by McLaughlan et al (2022) reported that nurses felt frustrated and distressed when unable to provide the care they aspired to within environments that did not support the philosophy of palliative care, which was evident in the current study.…”

Experience of care from the perspectives of inpatients with palliative care needs: a cross-sectional study using a patient reported experience measure (PREM)

“…A hospital’s built environment can impact on a inpatient’s experience and outcomes [ 34 ]. Positive design features for optimal palliative care delivery include privacy and homeliness, access to private spaces, outdoor green spaces and lounge areas [ 35 ]. In particular, private spaces for receiving bad news and that are conducive for reflection are important to palliative patients and families [ 36 , 37 ].…”

Unburdening expectation and operatingbetween: architecture in support of palliative care

“…Underpinning the delivery of palliative care is the desire to provide patients and families with an inpatient experience that is markedly different to that of general hospital care, reflecting the aims of this medical specialty to improve a patient’s quality of life through the enhancement of physical, psychosocial and spiritual well-being (WHO (World Health Organisation 2020). As such, palliative care staff regard their responsibilities as extending beyond the patient, to the emotional needs of the wider family (McLaughlan et al 2022; Steele and Davies 2015). Ensuring that architectural responses reflected this differentiation emerged as a key priority for clients and their architects.…”

“…Yet, given the patient-centred focus of much evidence-based design research, the needs of staff are scarcely discussed within the literature on designing for palliative care. Further, McLaughlan et al (2022) have recently highlighted the risk that, precisely because staff share this patient-centred focus, they are likely to elevate the needs of patients and families above their own resulting in these needs being overlooked within architectural briefing processes. This risk was echoed through the comments of one architect who recounted obtaining critical insight from visiting an existing hospice where the only retreat space available for staff was a storage room:…”

“…A crucial design approach in response to the simultaneous inhabitation of physical and mental space was the extension of space beyond its limits, often physically by using views to spaces beyond, but also tacitly mental. Read in this way, the relationship to nature within palliative care settings might more closely relate to an intuitive understanding of the ‘flux’ that patients experience (MacArtney et al 2017, 631) than to the simple affordances of landscape as ‘something to overlook … something to do (take a walk) … or somewhere to sit’ (McGann 2013: 61; also refer McLaughlan et al 2022).…”