Possibly the most
important design feature of a psychiatric hospital or unit is maximizing visual
observation of patients from the nurse station. If this is not addressed early
in the schematic design phase, it will likely never be attainable. However, it is
not unusual to find that more elements than are practical are desired to be
adjacent to the nurse station and even the most comprehensive remodeling
project may have difficulty addressing these desires. Compromises will have to
be made, and the reasons for the decisions should be well documented.
Another consideration
for design of the nurse station is that some patients like to gather around it.
For this reason, providing some space near the nurse station for quiet
activities such as table games or comfortable seating for reading can be a good
idea. When this common operational issue is not planned for, makeshift
adjustments will be improvised once the facility is in use and these usually
end up obstructing corridors or inhibiting staff movement.
The number of
patients per room is another major issue. The 2014 edition of the FGI
Guidelines calls for a maximum of two patients per room in adult facilities.
Despite a great deal of discussion about the possible advantages of
single-patient rooms, no standard requires single rooms and no conclusive
evidence indicates they provide either clinical or safety advantages for
behavioral health patients.
The National
Association of Psychiatric Health Systems polled its members regarding this
issue and found a considerable amount of support for providing at least a few
double rooms for certain patients who may benefit from this arrangement.
Deciding whether to provide single or double rooms for a project should be
carefully weighed with the client.
The 2010 edition of
the FGI Guidelines called for one patient toilet room per patient room located
directly accessible to the patient room without the need to enter the corridor.
Some facilities are not comfortable with this requirement and prefer the staff
to be able to observe when patients enter the toilet rooms. The 2014 FGI Guidelines
permits such an arrangement under certain conditions.
In addition, care
must be taken to avoid conflict during operation between an in-swinging patient
room/corridor door and an out- swinging patient toilet room door. This conflict
was observed in a newly constructed 300-bed state hospital and is very
difficult to remedy after construction. A little care and awareness on the part
of the designers could have prevented the staff of this facility from having to
deal with this problem for the useful life of the building.
The 2014 FGI
Guidelines recommends that patient room doors swing out into the corridor to
reduce the ability of patients to barricade themselves in their rooms by
blocking an inward-swinging door.
However, using this
door swing direction often requires provision of fire code-required recesses or
alcoves in the corridor, which create observation difficulties.
Corridor doors also
may be required to be fire-rated and/or equipped with smoke seals and closers
depending on the codes applied in a particular jurisdiction.
Source :FGI
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