Contemporary trends in the design of hospital wards in the context of ergonomic issues

CONTEMPORARY TRENDS IN THE DESIGN

OF HOSPITAL WARDS IN THE CONTEXT
OF ERGONOMIC ISSUES
Natalia Przesmycka

Architecture and Urban Planning Department, Faculty of Civil Engineering

and Architecture, Lublin University of Technology, Nadbystrzycka 38 D, 20-618 Lublin,
Poland, [email protected]

Abstract: The article presents issues related to the design and

modernization of hospital bed units in the context of ergonomic issues.
Currently in Poland, most of the health care facilities are being
modernized. However, the technical and law regulations specify only
minimum requirements and leave a lot of room for interpretation.
Designers are usually faced with the task of bringing together the needs of
users and investors on a limited budget, and the need to choose functional
and aesthetic solutions. The use of Evidence-Based Design (EBD) method,
allows to reach optimal solutions, which take into account the needs of
both the patient and the personnel.

Keywords: healthcare, hospital wards, bed wards, evidence based design

for hospital facilities, ergonomics in healthcare.

Introduction
Among the many sections of modern hospital’s daily operation, bed wards
are taking up most of the space and are a place where patients spend the most
time while recovering. Modern hospital bed wards are a fairly new architectural
concept, since it has it’s source in XIX century process of secularisation of the
hospital institution. Which instead of being primarily a charity started to play
a role of health care provider. Present-day hospital managers are faced with
tough competition in winning the patient over. The hospital building itself can
become a valuable asset in the shaping of healthcare facility’s business image.
Technological advances in health care are fast, requiring the law regulations
to change and adapt for particular spaces. It is eminently present in the modern
diagnostics and surgery wards. Hospital bed wards, as spaces primarily utilised
for recovery, rehabilitation, therapy and observation of patients, are among the
largest of hospital’s areas of functionality and are a place of work for a diverse
staff of hospital employees. Work ergonomics in a bed ward are critical for
nurses and physicians as well as for technical, cleaning and administration
employees. Following the broader definition of ergonomy which aims at
“providing organisation and material framework for a human being to achieve
physical and material state of well being, seeking optimal solutions for a wide
© 2018 The Authors. This is an open access article licensed under the Creative Commons Attribution-
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https://doi.org/10.2478/9783110617832-008 85
 ERGONOMIC FOR PEOPLE WITH DISABILITIES

range of human activities” [29], ward’s space arrangement has far reaching
consequences exceeding measurable benefits. Modern hospital facilities should
meet present day cultural, environmental and esthetic requirements.
The ergonomy of technical elements (buildings, furniture, hospital
equipment) has a social and economic value [3]. Subpar quality has both
measurable economic and immeasurable moral consequences (including
physical suffering, mental strain, low work ethic, lack of subjectiveness,
growing passiveness and pathy). On the other hand the architectural quality of
a healthcare facility, also impacts the way the facility is perceived by the local
community, increasing its’ attractiveness.
After World War II healthcare facilities have become a priority for the
government in Poland. In order to accelerate the investing process, government
agencies developed standard projects for this kind of buildings, which, similarly
to the housing market, led to the cost reduction and “rationalisation” of hospital
building. Most of the facilities of that era were erected in 1960s and 70s.
By 1970s the market saturation with county hospitals (basic health care level)
reached its peak.; other levels of the system included specialised centers
(national and university) and the government department healthcare (mining,
army and rail).
After the political system transformation, healthcare infrastructure of the
1990s was still being invested in and new healthcare facilities were built. Recent
years, following the EU access, are a time of rapid investment growth in this
branch of construction due to many opportunities for obtaining funds. Currently
there are over 1000 hospitals in Poland. The majority is after, in the midst or
expecting modernisation in order to meet the current requirements and needs.
It is an opportunity to utilise optimal design solutions, based on scientific
approach (Evidence-Based Design), which in turn will increase the quality
of service available to patients by giving the advantage in the competitive
healthcare market.

The current state of research

Qualitative research in architecture and urban planning is one of the currents

of interest common to architects, psychologists, sociologists and other
professions concerned with the advance of social and psychological sciences in
the field of behavioral theory. In the 1960s and 70s several theoretical papers
were published on the quality of urban environment, public spaces, dwelling
areas and general surrounding and its implications on the wellbeing and
behaviour of people [1, 9, 12]. Post-Occupation Evaluation (POE), developed in
the 1980s, is a new serious architectural object quality evaluation tool, which
allowed the perfecting of a design process through ex-post study. The study’s
quality criteria included: functionality, technical details, behavioral patterns
as well as organisational and economic criteria. In the following decades
POE method was enhanced with a new concept of building’s quality analysis

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Contemporary trends in the design of hospital wards in the context of ergonomic issues

through its’ entire lifecycle: planning, programming, designing, construction,

modernisation and finally demolition [19]. Preiser coined a name for this new
approach – BPE (Building Performance Evaluation). A twenty year old paper by
A. and E. Niezabitowscy states that “This method is practically unknown in
Poland. It causes controversy and suspicion in the professional design
community. Many architects are frightened by the vision of the end user
evaluation, not taking into account it’s important impact on the design skill
development” [18]. Unfortunately one has to admit not much has changed
through the time.
Evidence-Based Design (EBD) is architectural design approach based on
scientific proof. Performance and impact comparison studies performed in
a particular design solution, against proven case studies, allow to make an
optimal choice. This method’s help is appreciated in many areas of architectural
design. The model based on scientific evidence may be used in most design
decision making processes, especially in projects of complex functionality.
What is interesting, this approach may stand in contrast to the tradition of
treating every project individually, uniquely as an architectural challenge solved
only by the architect’s talent, which can overcome the lack of experience in
a particular type of project.
Since 1972 architectural space solution of a healthcare facility, was
examined from the point of view of patients’ benefit. In 1970s healthcare
buildings were under critique for their quick aging in contrast to “the
acceleration in programming and design of new hospitals.” To face the
unpredictable evolution of science and technology a break from traditional
concept of architectural object as definitely resolved and finished was needed
[25].
USA have been a leader in the field of EBD (Evidence-Based Design) in
recent decades [8]. The Center for Health Design (CHD) is propagating the use
of EBD method in healthcare facility design. The Center defines the method as
an “intentional try to base all structural decisions on best available research
evidence, aiming at improving the outcome and monitoring further success or
failure”. Method’s efficacy in designing of healthcare facilities is broadly
covered in Jain Malkin’s paper, [15] pointing to the fact that far less studies have
been made to determine the relation of the buildings’ quality with the quality of
work performed by the employees and their wellbeing [34].
Further studies have found that certain architectural solutions may promote
and some may limit the occurrence of medical error. J. Piskorski [21] formulates
a medical error as “a prerequisite for the undesired occurrence in
a healthcare system” conditioned by ergonomic factors. He finds the most
important risk factors to be material environment conditions and systems design
including organisational culture, hidden errors, information circulation and
ergonomy problems. Among the ergonomics issues several architectural
solutions are listed, which can lead to adverse events.
In the 1990s Ulrich proposed his Theory of Supportive Design [26] stating that
an optimal space arrangement of the patient's surroundings leads to lowered

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environmental stress in patients experiencing loss of control over their

immediate surroundings. Lowered levels of stress are beneficial to the process of
patient’s recovery. According to Ulrich there are three main guidelines when
designing health care buildings:
 architectural and technology solutions allowing the patient to control
their immediate physical and social environment (the ability to regulate
the physical environment’s parameters and conditions for social
interaction),
 social support availability,
 an introduction of positive elements in the surroundings, distracting
from the patient’s state of health.
Comprehensive English-language literature research up to 2015, shows
a large number of publications supporting the thesis that there is an association
between the psychological and physical well-being during the process of
recovery with the quality of the healthcare facilities’ interior [11].

Spatial arrangement’s role in the organization of bed units

The way the space of a bed ward is arranged and the architectural interior
design depend to a great extent on the work organisation system to be
implemented in the facility and the management of individual areas of healthcare
building.
The most common model for bed wards in healthcare facility development,
is based on the kind of medical condition. Bed ward intended for the treatment
of patients having certain medical conditions are a basic organisational unit of
stationary treatment in traditional healthcare. Additionally patients are split
according to their sex. Wards are typically subdivided into individual nursing
areas.
Another approach to this problem is a concept of Progressive Patient Care
(PCC) introduced in the USA in 1950s. This approach is characterised by sorting
the patients according to the severity of their condition rather than just the type
of it. PCC healthcare facilities do not have the traditional bed wards intended for
individual types of medical conditions. In PCC hospital patients’ admissions are
based on the necessary help to be administered: intensive, intermediate and
minimal care as well as self-care and convalescence. There have been instances
of a mixed approach used in medical construction industry.
Modern approach to the design of the hospital bed ward focuses on the
elasticity of used space solutions and the ability to make any future changes
according to needs. What is interesting is the fact that this “futuristic” approach
was propagated as early as 1970s. Quick technology and thus medicine advance
of that era made people aware of the probability that the building may
soon become outdated. Another aspect of this issue is the big financial cost
of healthcare building modernisation. Authors of monograph on Designing
healthcare facilities from 1973 point to possible solutions to the aging problem:

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Contemporary trends in the design of hospital wards in the context of ergonomic issues

 Demolition of buildings unfit for modernisation.

 Designing of more temporary buildings, with intended life span
of 20 years.
 Designing of buildings of form and construction easily rearranged and
rebuilt in the face of changing needs [13].
This last approach is still valid today. The expected lifespan of a healthcare
facility is counted in tens of years, meanwhile the lifespan of installation and
technical equipment is expected to be over a dozen or so years. On the other
hand the lifespan of medical equipment meeting present day standards is about
8 years long [23]. These differences are the main reason behind the fact the
designing process of healthcare buildings and their modernization, need to be
approached from a wider perspective. Unlike so far, the project is never finished
and complete, and should be treated and planned as an adapting and changing
system.
Employee work organization and comfort in the hospital bed unit, are
basically organized around the individual nursing areas. According to
architectural shaping several general types may be singled out:
 corridor arrangement,
 two corridor arrangement,
 central multilateral or round arrangement.
The majority of hospitals in Poland have wards designed along a basic
corridor arrangement. Rooms are situated on one side of a corridor and
personnel areas on the opposite side. Nurse post is situated more or less in the
middle of the ward’s length. In the immediate vicinity there should be
a bathroom to care for immobilized patients, observation and single rooms as
well as laundry. “Diagnostic and procedure areas should be located near the
entrance to the ward, meanwhile right next to it a dayroom should be situated
with the ward’s kitchenette” [20].
The two corridor arrangement allows to shorten the overall length of the
building thus making the communication routes shorter. Such arrangement
requires an inclusion of inner courts to provide the necessary amount of light.
Central arrangements are the most ergonomic of the three in the aspect of
short communication routes between the rooms and nurse stations. However
they accordingly take up most space on the parcel which is typical for a building
of scattered structure.
In order to achieve a better work organization there is a tendency in nursing
teams to be divided into smaller units surrounding the nurse station. Such
tendency may be enforced by decentralizing of spaces common to the ward.
Such spaces include laundry and linen storage which can be distributed to
several smaller storage compartments. Such arrangement is not without it’s
faults, it encourages the staff to deposit and store unintended objects [5].

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Number of beds in a hospital room

In the Polish legal system one can notice a decline in construction

requirements for healthcare facilities, and on the other hand a rise in
requirements for the technical infrastructure and equipment. Health Ministry
issued a decree on June 22, 2005 regarding the requirements that should be met
in professional and sanitary respects by rooms and devices of a healthcare
facility [31]. It detailed the precise living area norms for each bed depending on
the number of beds in room and the type of ward they were in. The number of
beds in a room dedicated to stationary recovery was limited to five. A minimal
distance between beds was determined (min. 70 cm) and between the beds and
the outside wall – min. 80 cm. The bill also detailed the requirements for general
construction in the regard to interior finish, communication, lightning etc.
Current regulations [31] describe the minimal requirements for hospital bed
rooms, however the bill itself leaves plenty of room for interpretation. The
minimal living areas and space between the beds are no longer strictly defined.
The size of the room itself is described indirectly by a number of other
regulations. The number of beds per room is limited only in particular wards. In
the Neonatology Wards “mother and child” rooms may be occupied by no more
than two mothers and two babies with the option of adding a third bed for the
newborn.
Two person rooms are regarded as the best suited arrangement for most
patients. Such rooms offer the necessary social interaction, which is especially
important in the time of crisis [17]. Ideally it would be to leave a choice to the
patient between a two and single person rooms [17]. Single and two person
rooms are also more easily arranged to have a positive impact on the process of
recovery and provide more work comfort to the personnel.
Today norms for nurse employment in public healthcare facilities are based
on mathematical formulas which take into account a number of factors. These
formulas’ outcome is a number of full time nursing position per a single hospital
bed required to provide sufficient care to patient. These formulas are constantly
negotiated by the nursing unions [32]. Zofia Małas – the chairwoman of nurses
and midwives council, defines the optimal number of patients per a single nurse
to be between 6 and 8 [36]. Finally, the current nurse employment formula’s
outcome is not unequivocal. Being able to tell the number of employed people is
crucial from the point of finding correct spatial solutions organizing the rooms,
nurse stations and social areas. The maximum number of four patients in a room,
guarantees optimal care delivery by a single person on regular check visit.
Accordingly distributing the beds in a room can improve the patient’s feeling of
intimacy, especially when using screens between the beds. Minimal distance
between beds in such arrangement should be 105 cm. Arrangement of three
neighbouring beds is significantly more uncomfortable for the patient and should
not be considered. In the newly designed hospitals the majority of rooms is
two-person, at the same time the number of beds per room rarely exceeds four
in a modernised facility.

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Contemporary trends in the design of hospital wards in the context of ergonomic issues

The modern design of healthcare facilities is characterized by its approach to

a single room as a standard. According to British Department of Health
guidelines, based on scientific research of patients preferences, at least half of
new beds are to be in single-person rooms; same applies to modernized facilities
[33]. Research shows that single patient rooms have several advantages. The
most important are: more intimate and direct patient-personnel contact, less
stress for the patient and even less risk of medical error [27]. It’s disadvantages:
the need to cover greater distances by personnel, the feeling of estrangement,
limited patient-personnel eye contact.
Turnbridge Wells Hospital in Pambury, Kent is a good example of this
approach in modern design. It’s arranged only of single-patient rooms. The
hospital won an award of the National Patient Safety Agency for providing the
patients with more friendly rooms, reducing stress, limiting the risk of infection
and supporting the presence of patient’s family [35]. However, the survey
conducted among the personnel showed that from their perspective the single-
room arrangement has several faults [6]. The personnel was concerned
predominantly with possibility of patient falling and the staff reaction taking a
long time. In a multi-bed room other patients can help alarm a member of
personnel. Another benefit of multi-bed rooms is a better interaction between the
personnel and the patients. Patients were more sympathetic and the personnel
work was more comprehensible to them. Patients in single-person rooms tended
to feel neglected and lonely.

Bed wards spatial arrangement in the light of legal requirements

According to current Ministry of Health requirements, unified hospital bed

wards should comprise of the following areas: patient room, nurse station with
adjacent preparation room, diagnostic-surgery room and sanitary areas. The
legislator allows group bathrooms, although single room bathrooms are a standard.
Patient bathrooms should be fitted with washbowls, lavatories and a shower (it may
include a specialised wheeled bath allowing to wash the bed-ridden patients).
At least one bathroom should be adopted for wheelchairs. The specificity of
certain hospital wards requires additional factors to be taken into account.
Intensive Care unit, for example, should be well communicated with other units
of the facility such as Emergency, Admissions and Surgery. The patient entering
the Intensive Care Unit should be brought in through a lock. Same rule applies to
the personnel of the Intensive ward.
General purpose areas include employee rooms (medical and administration),
ward kitchen area, toilets for staff and visitors, cleaning cupboards, magazines.
Regulations allow the shared use of such spaces between the wards but such
solution is rarely applied.

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Apart from legal obligations the need to compete with other health
facilities has influenced the rising standards. Modernisations, usually limited to
refurbishment, reconstruction or expansion

Bed ward organisation in the context of personnel’s work comfort

Work in a hospital bed ward is particularly specific for it requires the

performance of various activities. Their unpredictability is a serious stress factor
influencing the quality of work performed.
Despite the growing popularity of social participation in planning, in the
case of modernizing or creating workplaces, the decisions are made beyond the
personnel [4]. It is partially caused by the need to keep the planning process
quick while discussions and reaching compromises are a difficult and lengthy
process. Presenting the concept to the personnel or future users and interested
population is a good practice and a an intermediate solution, it should be
conducted in strict cooperation with the architect.
Nurses are a professional group particularly liable to overstrain due to
burdens at work, such as patients, equipment, medical appliances and furniture.
In a research survey covering 1500 nurses and midwives, 80% of partakers
pointed to this type of activity as most inconvenient [14]. The same survey also
shows that nurses employed in hospitals are burdened by long standing periods;
60% of responders stood for more than 3 hours per day; 30-40% is walking for
more than 3 hours per day. One third of nurses have indicated the need to
holding uncomfortable positions for more than an hour at a time (such as
kneeling, squatting etc.). 74% of surveyed employees complained about
insufficient space dedicated to performing their duties and lifting burdens
[14]. Another research survey performed in Berlin on more than 1000
respondents. It showed over 80% dissatisfaction with too long walking
distances, lack of space, bad room arrangement and lack of social space [4].
A question arises, whether modern tendencies in architectural design, can
come and meet the needs of patients as well as hospital’s personnel including
nurses in the bed wards, to help improve healthcare conditions.
As far as ergonomy issues are concerned the most important recent legal
requirements change regard: §18, §19 and §20 [31]. Previous regulations were
very specific in regard to the width of the room allowing the beds to be
individually moved without moving other beds. It has been recently changed to
be far less specific and states only the ability to move the bed [31]. Another
requirement for the minimal width of the ward’s door have been removed.
One of the most important features in the modern bed unit is the ability to
make eye contact with the patients to monitor their state of health. Most of the
time the door to bed ward should be slightly ajar allowing discreet monitoring
of patients.

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Contemporary trends in the design of hospital wards in the context of ergonomic issues

During the doctor visit in the ward and nurses checks, the interaction
between the patient and the personnel often happens in a tiresome form of an
employee standing over the patient. This discomforting situation can be
alleviated by providing the personnel with seats allowing the doctor or nurse to
maintain eye level contact with the patient. Such solution, however, requires
more space to be designed next to bed in the ward.

Patients comfort in regard to bed wards arrangement

The feeling of losing control over one’s immediate everyday surroundings,

the intrusion into one’s intimacy, dependence on personnel’s help, are only some
of the main reasons behind low psychological condition accompanying work and
stay at the hospital. According to supportive design theory [26] the ability to
control one’s surroundings is a factor in lowering of stress levels and thus
benefiting the overall state of health for the patients. The research shows that an
adjustable bed giving the patient individual control in addition to controlling
other parameters of patients surroundings (light intensity, temperature, sound)
act as an important factor in the lowering of the environmental stress [10].
The basic intimacy area for a patient in a multi-bed ward is limited to his or
hers own bed, night stand and bed control panel (lightning, communication, and
medical gas installation). Since the space for personal belongings is often
described to be problematic and insufficient; it is put forward to include separate
furniture elements in the design fulfilling the role of personal lockers.

Aesthetic issues

Modern single-bed solution used in the design of hospitals is influenced by

the design trends in the hotel industry. It expresses the EBD premise that
a healthcare facility should be hospitable and welcoming. The improvement
in standards and the extension of services available is partially caused by
a growing commercialization of healthcare service [24, 28]. Desired elements of
interior arrangement include accessible bathrooms, high quality finishes, kitchen
annexes allowing to prepare a simple drink or dish by the visitor or patient,
quality bed linens, pleasant smell and lightning. The home away from home
attitude of modern hotels, thanks to departure from traditional health facility
design, helped improve the arrangement and contributes to lowered
environmental stress and positively impacts the patient’s condition
[7]. Other small elements may also improve the overall mood, such as live
flowers, magazines or a simple greeting screen on the bed’s control panel.

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 ERGONOMIC FOR PEOPLE WITH DISABILITIES

Fig. 1. Spatial arrangement of two bed rooms in the Swissmed Hospital, Warsaw,
designed by Grupa 5
Source: Grupa 5 Architekci.

Room standardization contributes to improved work effectiveness but there

also is a need to personalize patient areas. It is directly related to the already
mentioned need to control the surroundings. There are several easy solutions
such as wall mounted message boards displaying messages directly to the
patient.
Another feature worth looking into is hybrid furniture like an adjustable
chair allowing the patient to spent time outside of bed.
Several researchers corroborate the relation of colour to the wellbeing of
human in the setting of healthcare facility [22]. In addition to colour itself the
choice of material is also important. Natural high quality materials such as stone,
wood are associated with the feeling of stability and durability. However,
the basic need is to maintain hygiene and therefore to employ solutions limiting
the growth of bacteria and facilitating disinfection (e.g. wood impregnating
agents with silver ions). Infections are constantly an important problem for the
healthcare.

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Contemporary trends in the design of hospital wards in the context of ergonomic issues

Fig. 2. Spatial arrangement of one bed rooms in the Swissmed Hospital, Warsaw,
designed by Grupa 5
Source: Grupa 5 Architekci.

Fig. 3. Spatial arrangement of one bed rooms in the Swissmed Hospital, Warsaw,
designed by Grupa 5
Source: Grupa 5 Architekci.

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The most common path of infection transmission are unwashed dirty hands.
Wash basins and sinks are a standard now but it is still difficult to make people
use them. The wash area should be equipped with non-contact taps and soap
dispensers, single-use tissue bin and dirty linen bin. The use of high quality
finish materials, which are washable and esthetic strengthening the feeling of
stability, cleanliness and safety. The only solution to encourage the staff and
patients to use the wash sinks is their attractive arrangement and design.
In the majority of Polish hospitals, patient bathrooms are located near the
corridor wall. One of the benefits of such arrangement is the possibility for easy
plumbing installation, leaving room for other arrangements like windows in the
outside wall. In modern projects the sanitary facilities are also positioned along
the outside wall speeding up access to the patient from the communication route
(corridor). Such arrangement allows for functional space solutions to be located
near the entry to the room.
In accordance with the technical construction legal requirements sanitary
facility’s door needs to open outside. It is recommended to pay attention to
leaving enough room in front of the door for easy access in case a patient
collapses in the bathroom. From the point of view of nursing personnel the size
of the bathroom should be enough to accommodate for patient with a walking
aid or wheelchair and an assisting person. All bathrooms should be equipped
with rails and supports. The best bathing solution is a low profile or floor shower
basin in minimal size of 90 x 90 cm equipped with a seat and a heavy curtain.

Family area

O Currently the hospital’s approach to visitors and family is revised. The

presence of family and close friends is an important component of the recovery
process. Bed wards with space for visitors or family have better therapy results,
since the relatives are often familiar with the therapy’s details and are involved
in the recovery process.
Unfortunately Polish hospitals are often lacking in this respect and their bed
wards do not have enough space left for the visiting family or friends. Ideally
there would be enough space to provide a possibility for private conversation.
Such social spaces are often outfitted with a self service buffet.

Conclusion
We live in an individualized society , the modern humans are afraid of being
dependent on other people, being disabled. Hospital are a place where our
valued intimacy is being affected. These are the buildings where we often realize
our own imperfection and mortality.

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Contemporary trends in the design of hospital wards in the context of ergonomic issues

Can architecture influence the process on the recovery, and to what extent?
Multiple studies have confirmed positive effects of comfortable functional and
aesthetic ward arrangement, including the patient rooms [2, 14, 20, 36]. Poor
funding of the healthcare system coerces savings in the designing and planning
phases of the construction project. The haste in which they are implemented
often results in insufficient analysis of possible consequences. Old solutions are
being used and the finish quality suffers as funds are scarce. Popularization of
the EBD method among the managers and designers of healthcare facilities
could bring better effects and positively influence modernization work being
done on hospitals and other facilities.
In modern process of designing of the healthcare facility, main accent needs
to be put on correct functional solutions, optimizing personnel’s work conditions
and providing visually attractive interiors, since it is related with a positive
impact on the patient’s process of recovery.

References
[1] Aleksander, Ch.: A Pattern Language. Town Building Construction, Oxford
University Press, 1977.
[2] Andrade, C.C., Devlin, A.S.: Stress reduction in the hospital room: Applying
Ulrich's theory of supportive design, Journal of Environmental Psychology March
41, 2015, 125-134.
[3] Andrzejczak, R., Witczak, I.: Jakość opieki zdrowotnej a ryzyko błędu
ergonomicznego, [in:] Błąd medyczny. Uwarunkowania ergonomiczne. Eds.
J. Pokorski, J. Pokorska, M. Złowodzki, Wyd. Komitet Ergonomii przy Prezydium
PAN, Kraków, 2010, 107-120.
[4] Arbeitsplatz Krankenhaus. Gesundheistforderliche Massnahmen fur Personal,
(Assistance: Franz Labryga), Berlin 1993.
[5] Atkinson, J. Hohenstein, J. McCullough, C.: Using evidence-based strategies,
Healthcare Design. May 2011, Vol. 11, Issue 5, 2011, 47-54.
[6] Donetto, S., Penfold, C., Anderson, J., Robert, G., Maben, J.: Nursing work and
sensory experiences of hospital design: A before and after qualitative study
following a move to all-single room inpatient accommodation, Health & Place 46,
2017, 121-129.
[7] Edmundson, K.: Five need-to-know trends shaping healthcare design. Healthcare
Design. Jul2011, Vol. 11, Issue 7, 2011, 24-27.
[8] Gawlak, A.: Evidence-based design in healthcare facilities, [in:] Architecture &
Health. Ed. Ewa Pruszewicz-Sipińska, Wyd. Poznań University of Technology,
Poznań 2015, 30-31.
[9] Gehl, J., Life Between Buildings: Using Public Space, Washington - Covelo -
London, Island Press, 1987 (2011 revised ed.)
[10] Huisman, E.R.C.M., Morales, E.J., Van Hoof, J. & Kort, H.S.M.: Healing
environment: A review of the impact of the physical environment. Building and
Environment, No. 58, 2012, 70-80.
[11] Iyendo, T.O., Uwajeh, P.C., Ikenna, ES.: The therapeutic impacts of
environmental design interventions on wellness in clinical settings: A narrative
review, Complement Ther Clin Pract. 24, 2016, 174-188.

97
 ERGONOMIC FOR PEOPLE WITH DISABILITIES

[12] Jacobs, J.: The Death and Life of Great American Cities, 1961.
[13] Juraszyński, J. et al.: Projektowanie obiektów służby zdrowia. Arkady, Warszawa
1973.
[14] Makowiec-Dąbrowska, T., Sprusińska, E., Krawczyk, P., Józwiak, Z.,
Sitarek, K.: Jak stworzyć bezpieczne i zgodne z zasadami ergonomii warunki
pracy dla personelu kobiecego w zakładach służby zdrowia, Instytut Medycyny
Pracy im. Prof. dra med. Jerzego Nofera, Łódź 2000.
[15] Malkin, J.: A Visual Reference for Evidence-Based Design, Center for Health
Design 2008.
[16] Malkin, J.: The business case for creating a healing environment, Cent. Health
Des. Bus. Brief. Hosp. Eng. Facil. Manag., 2003, 1-5.
[17] Meuser, P.: Hospitals and Health Centers Constructions and Design Manual,
DOM Publishers, 2011.
[18] Niezabitowska, E., Niezabitowski, A.: Badania jakościowe w architekturze
i urbanistyce, Zeszyty Naukowe Politechniki Śląskiej, Seria Architektura z. 33,
Nr kol. 1344, 1996, 77-86.
[19] Niezabitowska, E.: Od POE do BPE, Zeszyty Naukowe Politechniki Śląskiej
Seria: Architektura z. 47, Nr kol. 1787, 2008, 143-157.
[20] Orłowski, J., Ealkowski, A., Złowodzki, M.: Aspekty ergonomiczne w projekto-
waniu funkcjonalno-przestrzennym szpitali, Błąd medyczny. Uwarunkowania
ergonomiczne. Eds. J. Pokorski, J. Pokorska, M. Złowodzki, Wyd. Komitet
ergonomii prze Prezydium PAN, Kraków, 2010, 331-353.
[21] Pokorski, J.: Ergonomiczne uwarunkowania błędów medycznych, [in:] Błąd
medyczny. Uwarunkowania ergonomiczne, red. J. Pokorski, J. Pokorska,
M. Złowodzki, Komitet Ergonomii przy Prezydium Polskiej Akademii Nauk,
Kraków, 2010, 205-224.
[22] Pokrzywnicka, K.: Barwa i jej wpływ na architekturę, [in:] Projektowanie
i programowanie obiektów służby zdrowia, cz. 1, Wydawnictwo Politechniki
Gdańskiej, Gdańsk 2012, 9-26.
[23] Ponikło, W.: Infrastruktura techniczna szpitala, ABC Wolters Kluwer business,
Warszawa 2010.
[24] Raeisinafchi, C.S., Mody, M., Guarracino, G.: Hospitality Healthscapes: The
New Standard for Making Hospitals More Hospitable. Boston Hospitality Review,
Vol. 5, Issue 2, School of Hospitality Administration, 2017.
[25] Szpitale w latach 70. Architektura, based Riba Journal, 1964, 1967, 219-222.
[26] Ulrich, R.S.: Effects of interior design on wellness: theory and recent scientific
research, J. Health Care Interior Des., 3 (1), 1991, 97-109.
[27] Ulrich, R.S., Zimring, C., Zhu, X., DuBose, J., Seo H.-B., Choi, Y-.S. et al.:
A review of the research literature on evidence-based healthcare design. Healthcare
Journal. 2008, Vol. 1, No. 3, 2008, 61-125.
[28] Wu, Z., Robson, S., Hollis, B.: The Application of Hospitality Elements in
Hospitals, Journal Of Healthcare Management, American College Of Healthcare
Executives, J Healthc Manag, 2013 Jan-Feb, Vol. 58 (1), Publisher Foundation of
the American College of Healthcare Executives, 2013, 47-62.
[29] Złowodzki, M.: O ergonomii i architekturze, Wyd. Politechniki Krakowskiej,
Kraków 2008.
[30] Regulation of the Minister of Health of 22 June 2005 concerning requirements that
the facilities and equipment of healthcare center should meet (Journal of Laws
2005, No. 116, item 985).

98
Contemporary trends in the design of hospital wards in the context of ergonomic issues

[31] Regulation of the Minister of Health of 26 June 2012 concerning detailed

requirements that the facilities and equipment of entities conducting therapeutic
activity should meet (Journal of Laws 2012, item 739).
[32] Regulation of the Minister of Health of 28 December 2012 on the method of
setting minimum standards for the employment of nurses and midwives in non-
business entities (Journal of Laws 2012, item 1545).
[33] www.hberm.com/wp-content/uploads/2015/10/HBN-04-01-Supplement-1-
Isolation-facilities-for-infectious-patients-in-acute-settings-20131.pdf - accessed on
14.10.2017.
[34] www.healthdesign.org/sites/default/files/Malkin_CH1.pdf - accessed on
10.10.2017.
[36] www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?...type... - accessed on 12.10.2017.
[35] www.rp.pl/Lekarze-i-pielegniarki/306139958-Pielegniarka-nie-powinna-miec-pod-
opieka-wiecej-niz-6-8-pacjentow.html - accessed on 12.10.2017.

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