The Hospital Room: Not Just Four Walls
Submitted by Debbie Croome Hancock, MN, RN, CPN and Kay J. Cowen, MSN, RN-BC
In the past, hospitals had wards, semi-private rooms, and just a few private rooms. The rooms were very small with little space for nurses to work. Parents or family members were not allowed to stay. Paper charts were used and vital signs were taken manually. The current trend in many hospitals is to have private rooms and provide a recliner or bed for a family member to stay. Computers for charting in the room are available, and electronic equipment is used to assess vital signs and provide intravenous fluids and enteral feedings. While all of this equipment increases accuracy and convenience, in a sense it reduces the privacy of the room. The patient’s privacy is also compromised when nurses enter the room way too often to use the computer and monitor the equipment and the patient.
As nursing faculty, do we teach our students that it is a privilege to be able to walk into a room and literally share the most intimate details of a patient’s life? Do we teach our students to respect the privacy of their patients and families? As nurses, do we respect the patient’s room as their room, or do we barge in to do what we need to because it is “our unit”? Nurses go in and out of hospital rooms to take care of patients and families on a regular basis. It is very important for nurses and nursing students to realize that the patient room is more than just four walls and to get a sense of the emotion that goes on in these rooms.
The authors asked student nurses what their impression was of a patient room when they first walked in. Some comments were related to the size and space and included “big, lots of room”, “spacious”, “big windows where sun can come in”, “well organized with storage space”, “colorful”, organized, “homelike”, “well lit”. Other comments focused on the patient and family and included “Dad and son could move around freely”, “Little girl doing art work”, “Couches and chairs for the family”, “Place for parents”, “tried to make it like home with television, recliner/chair, sink, mirror and computer in room”. One student noted that the computer was placed so that the nurse’s back was to the patient/family when charting.
Certain rooms may hold a good memory or a bad memory for patients, families and nurses. As a nurse, you may remember a patient who spent time in a certain room, or a room where a long code occurred. Parents, patients, or spouses may have memories of a room where a loved one spent a long time, where good news or bad news was received, or where a loved one died. The patient room is a place where patients/families learn about an illness and a treatment plan; where procedures are performed and medications are administered, where patients get better or they get worse, where patients recover and go home, or where they die. The room may be a place of comfort, for rest, for prayer, where loved ones visit for the first time or the last time. All of these are special, intimate moments in which nurses and nursing students may have the opportunity to participate.
Some units present special challenges to nursing students, such as pediatric and maternity units. Many hospitals, especially pediatric units, have televisions with DVD players and game systems available. Over the years as hospitals have focused on family centered care, policies have changed that allow parents or other family members to spend the night. On a pediatric unit, both parents may be staying. A pediatric nurse recounts walking in to a patient’s room to find the parents being intimate on the couch. Another nurse remembers opening the bathroom door without knocking to empty a urinal, only to find the dad pulling up his pants. Faculty need to provide students with strategies to handle uncomfortable situations that can occur in the hospital room. Providing case scenarios during clinical orientation should give students the confidence to gracefully handle surprising situations.
We also need to teach students how to recognize an appropriate and an inappropriate time to be in the patient’s room. For example, if a social worker is meeting with a parent to discuss financial matters, the student should come back another time, unless something must be done at that moment for the health and safety of the patient.
Occasionally, a student may come into a room when a patient and/or family member is receiving bad news. It is essential that students learn how to be quiet and respectful during this time. If, however, a student enters a room and the physician is discussing the plan of care with the patient or family member, staying in the room provides education to the student about the treatment plan.
It is important for us to help students understand that it is a privilege to provide care to patients and their families and to share time with them in their temporary room. Whether they witness the birth of an infant, the death of a loved one, the care of an injured person, the surgery of a patient, or procedures on a child, students have been provided the privilege of being part of a profound time in the life of that family and it is their responsibility to be respectful and compassionate.