Familial caregiving architectural provision in Nigerian hospital wards

Abstract

The focus in hospital design now is on providing facilities that promote patients’ wellbeing and restoration. Recent trends in improvement of healthcare environment is approached from patient-centred perspective that has concerns for patients’ needs and preferences. Social support from family was found to be among the major patients’ needs and preferences during hospitalisation. Inevitably, family involvement in caring for their hospitalised relatives is an essential aspect of restoration, particularly in developing countries where the extent of family involvement goes beyond the provision of psychological and emotional support to the patients. In spite of the benefits ascribed to the family involvement in care, it appears as if there is little or no consideration given to their accommodation in the hospital wards, especially in developing countries like Nigeria. Therefore, this study is aimed at proposing an architectural design framework that will provide for familial caregiving in Nigerian hospital wards with a view to informing design decision. Accordingly, a pragmatic phenomenological approach was employed to elicit data related to familial caregiving concept and its implication on hospital ward spaces. This was achieved through (1) interview with 14 patients, (2) three rounds of non-participant observation and a behavioural mapping in a surgical ward setting of Federal Medical Centre (FMC) Gombe, (3) survey questionnaires administered to 144 respondents, (4) scrutiny of architectural drawings, and (5) conducting a visioning charrette with five professional bodies. Consequently, the data were analysed using content analysis and structural equation modelling (SEM). The result shows that familial caregiving is a crucial aspect of the hospital ward procedures that is inevitable in Nigerian hospital wards due to cultural etiquettes and the need to support poor hospital ward operations. Similarly, the study further identified family transaction spaces requiring design attention to be the bedside, corridors and foyer, camp, and open spaces. Consequently, further analytical interpretation of the findings identified the core familial caregiving activities, spatial ordering and spatial considerations as the design indicators required to inform design decision. This leads to a rethink in how hospital ward spaces can be restructured to allow for family presence and participation. Ultimately, based on this evidence-based approach, a design framework that suggests a redefined familial caregiving hospital ward typology is therefore achieved.