Family-focused care revives New Jersey children’s hospital
Architecture solidifies new caregiving philosophy
At Children’s Regional Hospital in Camden, NJ, staff have made sure their newly adopted family-centered philosophy of care is set in stone — and bricks and mortar.
Administrators spent $3.5 million renovating one of the pediatric wings so it would reflect physically the hospital’s cultural change. To mask the institutional feel of a hospital, the 14,000-square-foot wing resembles a neighborhood dotted with Victorian houses and a park. Rooms are loaded with amenities, such as an extra bed and two televisions to accommodate parents who want to spend their days and nights with their children.
"We wanted the building, the bricks and mortar, to embody our guiding philosophy," says Claire Cowen, MA, CCLF, the child life coordinator. "We wanted everyone to know this is the way it’s going to be."
While this hospital spent a large sum on its overall renovation, many of the features are affordable and can be adapted to any unit of your hospital. For example, almost any hospital can designate a special treatment room for invasive procedures such as drawing blood so children are not afraid to be in their own rooms. (See related story, p. 28.)
Children’s Hospital, part of the 554-bed nonprofit academic teaching center of Cooper Hospital/University Medical Center, adopted the family-centered care philosophy in the fall of 1995. The changes followed the model set forth by the nonprofit Institute for Family-Centered Care in Bethesda, MD. Nine staff, including physicians, nurses, and a social worker, attended a conference at the Institute and were captivated by the model. The model stresses collaboration between the family, the physicians, and other clinicians in the treatment of the child.
"The idea is we’re working as partners with the family in the care of the patient," Cowen explains. "It makes sense. It’s not just the hospital telling the family what they need to know. It’s recognizing the family has something to contribute. Who knows more about the child’s needs than the family?"
In September 1995, staff attended in-house educational sessions to learn about the new philosophy of care. The sessions featured parents of chronically ill children. They related their experiences with hospital stays and explained their needs and concerns and offered solutions.
The hospital has subsequently formed a family care advisory board that includes parents as members.
While staff learned about family-centered care, the architectural redesign committee was also meeting. The team included hospital staff, patients’ families, and Karan Hoffman, a senior health care architect with Ewing, Cole, Cherry, and Brott, based in Philadelphia.
The melding of the philosophical and physical occurred in September 1996 when the new wing reopened.
Here, Hoffman and the staff at the Children’s Hospital describe the unit’s new look:
• Unit.
The unit is colored in pastels and is designed to look like the outdoors. Floor tiles resemble grass and sidewalks and the ceiling features cloud-like formations. At night imbedded lights glow like stars. The rooms sport facades that look like houses, complete with picket fences. The facades differ so children can identify their respective rooms.
The walls are decorated with paintings by local artists. The art features scenes from nearby towns, parks, and rivers, as well as people of different ethnicities. The familiar pictures add to the child’s sense of security, Cowen says.
The rooms can house patients ranging in age from one week to 17 years. The unit, which contains 24 beds, 14 of which can be turned into singles, also has four positive- and negative-pressure isolation rooms.
The organization of the unit around two nursing stations allows it to expand or contract according to the patient census.
The unit also contains a tub room with a jacuzzi, an idea Hoffman got when she asked her own children what they would want if they were hospitalized.
• Patient rooms.
The patient rooms, including the isolation rooms, have been reorganized so the clinicians can see into all the rooms from the nursing station and the patients can see out, a feature than enables the children to feel connected to others. If the family wants privacy they can draw the curtains.
Each room contains a bed and sleep chair for parents, two video game systems, and two televisions. (See photo of patient’s room, p. 27.)
"If parents decide they just can’t watch Barney anymore, they can turn on the news on the other television," Hoffman says.
A centrally located desk provides space for parents to pay bills or children to draw pictures or study for school.
Also, a bedside lamp was added so parents can read after the room lights have been turned out at bedtime for the children.
To make children feel comfortable in their rooms, staff are prohibited from performing any invasive care such as drawing blood there. These tasks are done in the treatment room. (See related story, p. 28.)
• Child life area.
Patients can play in the community area where sun pours in from a skylight and a wall of windows provides a bird’s-eye view of the medical center’s campus.
The play room contains a 200-gallon aquarium, computers, televisions, a video library, and dozens of toys and games appropriate for both children and teens. A playhouse is shaped like a lighthouse to accommodate children with IV poles. A padded alcove along one wall allows acutely ill children to be near the activity.
The play room is reserved strictly for play. No doctors, nurses, or other clinicians are allowed, unless they are helping children stack building blocks, color, or read.
"We’ve had patient/staff Foosball games before, and doctors will come in if they have the time to play with the children, but they will not do any medical care. Not even taking a temperature or blood pressure is allowed," Cowen says.
• Nurses’ station.
The nurse’s station is under a gazebo, complete with a trellis. Medical gasses such as oxygen are located at a counter at the station so children who would otherwise be bedridden can visit with staff. Nurses are routinely seen working on paperwork while holding a child in their laps.
"This was real important," Hoffman says. "This is an urban hospital. It’s sad, but some of these children don’t have families to come and visit them. They need that physical contact. We tried to make it so their lives would be as normal as possible."
Other architectural changes facilitate team collaboration and work flow. A common problem at the old nursing station was overcrowding.
"This is a teaching hospital, and there’s a lot of people running around," Hoffman explains.
To ease the congestion, computers sit on the two wings of the nursing station for doctors to log in orders. Doctors also have their own dictation room and conference room.
Conference rooms were also built for care teams to meet with parents and for patient and family education.
Space shortage also used to force nurses to skirt around playpens and swings located in the hallways. With the redesign, these infants and toddlers can now swing or play in an area carved out for them.
• Roles and processes.
In addition to the architectural and philosophical changes, the hospital has also began redesigning job roles and processes. In February, it graduated its first class of multi-skilled clinicians, says Carole Dubocq, RN, MSN, CNAA, vice president of patient care services. The new position, called a patient care technician, performs standard nurses’ aide tasks, but is also trained to draw blood and administer EKGs.
Moving admissions to the same floor as the pediatric unit also improved processes. Previously, parents would remain on the first floor while the child was whisked away to the sixth-floor unit.
"Parents have a need to be in close proximity to their child, especially in a crisis situation" Cowen explains. "They want to know they are close to their child. It really helps. For one thing they can focus on the questions they’re being asked if they know their child’s right down the hall."
The ongoing meetings with families have also prompted changes in departments outside the unit. For example, radiology asked parents how it could make their young patients feel more comfortable. Staff met with parents and learned the difference between working with adults and children.
"Telling an adult you’re putting a catheter in his or her arm is perfectly acceptable, but you can’t tell that to a child," Cowen says. "You have to speak in terms they know." Now, when treating children, the radiologists call the catheter a plastic straw. They also added a television and toys to the waiting room to distract children before the procedures.
[Editor’s note: For more information, contact Carole Dubocq or Claire Cowen at the Children’s Regional Hospice, Cooper Hospital, University Medical Center, One Cooper Plaza, Camden, NJ 02103. Telephone: (609) 342-2000.
Or contact Karan Hoffman at Ewing, Cole, Cherry, and Brott, Federal Reserve Building, Independence Mall West, 100 N. 6th St., Philadelphia, PA 19106-1590.]
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