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Considerations for a physical therapeutic environment for children’s palliative care

Author: Sue Boucher
27 April 2017

A 'Throwback Thursday' article for those considering building a children's hospice or facility that cares for sick children. Originally published in July 2014, the article still holds relevance today.

The role of architecture in palliative care and healthcare design is a growing area of study and has revealed that a well designed physical environment not only improves safety, but is more healing for patients and improves the morale and the efficiency of the staff.  

Children's Palliative Care: Considerations for a physical therapeutic environment, a paper written by Prof Julia Downing, Joan Marston and Edwina Fleming (Architect) and published in the Summer  2014 edition of the Journal of Palliative Care, looks at what to consider when designing a therapeutic built environment for children, such as those needing palliative care.   

The authors assert that too few settings are designed to support patients therapeutically. Often, particularly in less resourced settings, the buildings used as children's hospices or in which treatment is offered to children, were built originally for other purposes and have been adapted for their current use. 

The authors note that the environment in which a child is cared for has a strong impact on the child and can also profoundly affect the child's family, making it easier or more difficult for them to deal with their particular circumstances. In fact, the building can even affect the child's immune system. 

The point is made that consideration of design has been an element of good palliative care from the beginning, quoting Dame Cicely Saunders, founder of the modern hospice movement, as saying that the facility at St. Joseph's Hospice in Hackney, UK, "provided her with both spiritual and architectural inspiration." 

In more recent times the chief executive of Noah's Ark Children's Hospice in London is quoted as saying,:

"We do not want the hospice to feel institutional or like a hospital, although at the same time it has to be an environment in which we can deliver the highest standards of medical and social care.   

We worked really hard with the architects to understand how people would be using the spaces and what would be happening, both inside and outside the building. We are trying to make this a really human space, providing a positive environment that feels like home and, much more importantly, is a place people want to come to.

The design had to incorporate our basic requirements in terms of facilities, but it also had to be a fitting building for what is a wonderful environment. As a team we talked a lot about the link between the building and the nature that surrounds it. In the hospice we see the circle of life and this is also what is going on around the building, so we embraced this vision." 

Initial steps
The authors encourage those planning on building a children's palliative care facility to take the following initial steps:

  • Assess the needs of the organisation, the child, the child's family, the health care providers and other staff members
  • Designate the function of each space and each zone and identify the interaction among them
  • Determine which activities will take place in each space and zone
  • Calculate space requirements, keeping in mind what equipment and furniture is needed in each room
Stress is reduced and working conditions enhanced when the design of the building addresses the needs of the staff, staff education and training, support, supervision and resources. The paper provides a detailed table showing an example of space allocated to different zones within a children's palliative care facility. 

Because first impressions count, the facility's arrival area should express the ideals of the facility and convey a sense of security and support. It is also important that signage is clear and unambiguous which enables families and visitors to feel welcome and to make an easier adjustment to being there. Take into account that children may be physically vulnerable and traumatised on their first visit so the external view of the building should offer visual reassurance.

Flexible design approach
Colour, form, shape and scale are all important considerations and a child's scale is quite different from that of an adult, so a flexible design approach is needed. The different needs of young children and adolescents are also addressed and the paper looks at including in the design places where the older children can go to relax, listen to music and enjoy normal teenage activities.

In conclusion, the authors stress the importance of taking into consideration the specific needs of the local patient population, cultural factors, and available resources. Buildings should meet not only the physical needs of the child and the families but also their psychosocial and spiritual needs. 

Each paediatric palliative care facility will be different depending on the range of specific factors that influence its creation, but all will share some essential qualities.

Should you wish to know more, please send an email to ICPCN using the subject title: Building design for CPC

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