Nurses prefer mix of multi-bed bays and single rooms

Nurses struggle to monitor patients on single room only wards and may miss patients at risk of falling, a major two-year study has found.

Researchers at King’s College London's national nursing research unit reviewed the move from traditional Nightingale wards to single occupancy rooms at a new hospital, and found nursing teams caring for patients in the new layout were anxious and frustrated.

Staff walked further and found it harder to track down other nurses, meaning they were less likely to be able to observe practice, ask for assistance and share ideas.

Although two-thirds of patients preferred having their own room, noting greater comfort and privacy, less noise and better sleep, some reported feeling lonely and isolated.

Researchers interviewed patients and staff, observed care and asked staff to wear pedometers during the study on four wards before and after the move to the new Tunbridge Wells Hospital, which only has single rooms.

The number of patient falls has increased since the move, but researchers could not find evidence linking this to the use of single occupancy rooms.

More nurses were needed on three out of the four wards following the change to single rooms, and nurses reported finding it difficult to manage their time with patients.

Professor Jill Maben, who led the study, said: ‘The findings of the report show a mixed picture, with both patients and staff reporting advantages and disadvantages of 100% single occupancy rooms.’

The research concludes there are ‘strong arguments’ for having a mix of single rooms and multi-bedded bays, and this was also favoured by nurses.

This is the approach taken at the new Brunel building at Southmead Hospital in Bristol, where three-quarters of its 800 beds are in single rooms. Each 32-bed ward has two four-bed bays, which are used for more unwell or frail older patients, and the rest are single rooms.

Sue Jones, director of nursing and quality at North Bristol NHS Trust, said a lot of planning went into the move to the new building, including making all ward sisters supervisory.

‘There is a big challenge, because you can look down a Nightingale ward and see a colleague, or a patient can see a nurse, and now they may not think there are many nurses around,' she says. 'We have found having "huddles", particularly during the day, so that people can catch up regularly, has been vital. Patients talk a lot about the rest, privacy and dignity and the healing environment.

'There are some down sides that we have prepared for around ensuring that older people have a sense of time and place. Simple things like having clocks on the wall, that there is a routine in the day and putting in place intentional rounding, otherwise every hour can seem the same.’

RCN head of nursing practice JP Nolan said: ‘There are pros and cons to both, and both options are needed on wards to allow for specific patients and their circumstances.’