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Practice comment

Problem solving skills can be used to overcome single room concerns 


Many nurses have anxieties about single rooms. But they must address these fears and lead the way in service design to ensure room layout optimises patient care, says Marie Batey


Nursing is using its voice to raise concerns about the drive to increase the number of single rooms across healthcare facilities (Nursing Times, 25 January, p1).

From a safety perspective we worry that we will not be able to see patients – and that they will not be able to see us. Falls may increase, drips may become dislodged and vulnerable people could wander undetected.

Our core value of person centredness has provoked fears that being in a single room will cause either a “goldfish bowl” effect with people (staff and visitors) peering in from outside, or the opposite – isolation and loneliness.

And, from a workforce perspective, we have concerns about the potential impact on clinical workload and are apprehensive that patients will actually have less direct contact time with nurses.

This disquiet is completely understandable. We want to be able to see patients and for them to see us. We do not want them to feel lonely and we do not want anything to take staff who may already feel stretched further away from the bedside. However, I also believe that many nurses would rather their patients had an undisturbed night’s sleep, access to their own toilet and washing facilities, increased privacy when discussing personal matters with their family or clinical team and the opportunity to use their mobile phone when they wish.

The tension between feeling uneasy about an issue and seeing its potential value is something that nurses have always faced, and some may remark that this can prompt nothing other than complete inertia. I disagree; we problem solve well and do it all day every day in wards, departments and other care environments. My trust’s two hospitals are full of nurses, midwives and healthcare assistants facing challenges and overcoming them in patients’ best interests and with a strong professional focus.

“We can help shape care environments and our practices for patients’ benefit as well as for staff”

In 2005 my trust was offered the opportunity to work with others to design a ward with 24 single rooms, each with its own en-suite facility. From scratch, but using the existing evidence base, we worked with patients and local people to decide the layout of the rooms. We also agreed with them many simple but significant things such as where and how storage space should be situated, where patients would eat their meals, and how visitors to the ward would access the area. We also thought carefully about the workforce and skill mix we would move into the ward (now known as Bevan). We redesigned our practice to match our new ward.

This haemato-oncology and gastroenterology ward opened 12 months ago and the past year has yielded some interesting insights. One example involves the care of patients who are disorientated or excitable due to encephalopathic processes. The charge nurse and his team have noted how these patients appear to be more settled and content, less likely to leave their room and to disturb others in the area.

We are now researching the impact of the Bevan design on patients and staff in a joint project with the Department of Health. Our findings will inform future ward builds at the trust and, we hope, will serve as a fundamental source of information for the NHS as a whole.

While I appreciate that not all trusts will have the opportunity to build new facilities, it is within our gift to shape care environments and our practices for patients’ benefit as well as for staff. This may ease our anxiety in the long term and help us to address the single room conundrum.

MARIE BATEY is director of the patient experience and nursing, The Hillingdon Hospital Trust


Readers' comments (6)

  • I work in a private hospital in Sydney and every patient has their own room. i find it is very time consuming as your running from one room to another and the patient's think they are the only ones as they can't see that you have 6 other patients. There is an increase in falls especially at night as you can't see the patient's the same as if they where nursed on a ward.
    medications are kept in the patients rooms in locked drawers which is time consuming than having a medicine trolley with all drugs in them. We also work on a pager system so if the patient call for a nurse it is sent to the pager and if your not there in time we get patient complaints.
    I say leave the wards as they are, ok the patient's have more privacy but it is very time consuming for the nurses and an increase in falls.

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  • I completely agree with the above comments(20/feb/2010 8:57am). Single rooms are good for patients and risky for nurses.

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  • Single rooms should be given only to stable patients, who do not need high level care.

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  • Phil Dup

    More glib management speak that preaches to the frontline workers of the need to do it better/faster/more efficiently blah blah blah !

    "Problem Solving Skills " - that sounds great for a headline but means absolutely nothing - we are using problem solving skills everyday Ms Batey but when we have abysmal staffing levels there is a finite point at which the problems overwhelm the Nursing staff and something in the system fails.

    For example a small team of say 5 Soldiers out in Afghanistan go on patrol and get surrounded by say 70 heavily armed Taliban.
    With good training and skills I'm sure these soldiers could hold their own for a good while - however ultimately for their safety the most pressing need is for reinforcements.
    No amount of "problem solving skills" will keep them protected forever and at some point the mission will fail.

    To put all the onus once again on outnumbered hands on Ward Nurses and in effect say ' you aint thinking enough' is a damned disgrace and just another fine example of NHS Managerspeak =
    Verbal Candyfloss = sickly sweet, high calory / low nutrient poison.

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  • pure hogwash. no wonder it came from a director who is out of touch with reality and living in a utopian dream and who earns fat cat salary.
    everytimes nurses raise a point of contention, it is nurses' fault- need to change attitudes, work more efficiently, etc.
    we need a public account committee investigation on the NHS trusts and foundations, do we really need all these fat cats.

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  • I totally agree with what has been said here, management make the rules without knowledge of the real world.
    Do not put the onus on nurses to work round their edicts.
    If problem solving in this issue was so easy then let managers manage it.

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