User Needs Assessment | hospice

1. User Needs Assessment | hospice

2. Define the User | PATIENTS • Age • 65-80+ years old • Hospice patients are terminally ill, and typically have as few as 6 months to live. These patients are most often mentally capable but have lost most of their mobility. • Patient diagnoses include: • Cancer • Pulmonary Disease • Heart Disease • Alzheimer’s Disease • Other Neurological Disorders “Patients and families who choose hospice are the core of the hospice team and are at the center of all decision making.” – Hospice Foundation of America

3. Define the User | CARE PROVIDERS • Physicians/Nurses • Hospice physicians control pain and symptoms to the • best of their ability, while nurses assess and manage • pain • Health Aides • Help with bathing and overall patient care • Social Workers • Provide emotional support and ease the burden of • financial planning for the patient and their family • Chaplains • Work with the patient and family’s beliefs, offering spiritual or religious support • Bereavement Specialists • Grief counseling, as well as organized services and support for the families of departed patients • Volunteers • Trained by the hospice provider to give companionship and help with therapies, such as pet therapy

4. Define the User | FAMILY • Families of hospice patients are very important to the process, and many hospice services are meant to assist them as well, such as grief counseling and spiritual support • Families expect to be near the patient at all times, sometimes spending the night • When family members of hospice patients experience this process in a comforting and caring environment, it can ease the fear of dying for both them and the patient

5. Define the User | Demographics • Marital Status • 54.8% Married • 10.9% Divorced • 8.2% Widowed • Household Income • ~35,000-49,999 • Ethnicity • 81.3% Hispanic • 16.1% White • Age • 26.1% between 60-80+ • 62% female; 38% male

6. Define the User | Characteristics • Cultural Make-up of User Population Hispanic • According to the Chadwick Center, certain Hispanic cultural values affect patient and family relations in a hospice setting: • Hispanic families maintain very close relationships, from immediate family and close friends, to even extended family • Hispanic families value warm and genuine relationships, even towards medical professionals • Hispanic families tend to have a respect for medical professionals, and may have a hard time expressing any disagreement with them • Spiritualty and religion are often very important for Hispanic families, therefore relying on spiritual support in a hospice setting

7. Define the User | Characteristics • Physical Assistance Level and Mental Competence • Hospice patients are usually mentally competent, but because of terminal illness, have lost most of their physical mobility • They rely on Nurses and Aides to help with personal care such as bathing, as well as the support of family members • Wayfinding Specifics • Language barriers may be an issue because of the largely • Hispanic population, but having signs legible in English • and Spanish may solve most of the issue

8. PHYSIOLOGICAL | REQUIREMENTS • Equipment for Physiological Needs • Walkers and Wheelchairs • Catheters • Pain, Anxiety, Constipation Medications • Oxygen • Mobility, visual, and hearing impairments are all possible; but dedicated staff members aide in any difficulty patients might have.

9. Psychological | REQUIREMENTS • Psychosocial Care Needs • This type of care deals with the psychological experiences and fears patients and families need when facing death and the loss of loved ones. • Enables patients and families to express their thoughts and feelings on sickness and death • Means to improve psychological and emotional well-being of patients and families • Supportive Care Needs • A focus on quality of life • Care involving both the patient and their families • Respect for the patient’s choices • Clear communication of emotions and feelings

10. Psychological |REQUIREMENTS • Alternative Therapies for Stimulation • Relaxation Therapies • Biofeedback • Aromatherapy • Pet Therapies • Music/Creative Expression

11. Psychological |REQUIREMENTS • Privacy Needs • Privacy of Medical Information (HIPAA) • Hospice patients should have a room to themselves • Hospice patients should have a safe quiet place to discuss treatment and make decisions with family members and medical professionals • Hospice patients have the option to deny medications, treatments, and services • Acoustic privacy is essential

12. Psychological |REQUIREMENTS Adequate Color Choices for a Hospice Setting • Corridor • Warm – light orange, pale green, orange-yellow • Cool – light beige(one wall), pale green (other) • Patient Rooms • Warm – pale orange (one wall), slightly darker orange (others) • Cool– pale green (one wall), sandstone color (others) • Nurses Station (to promote healthy work environment) • Hues and tints of orange, yellow, and blue-green

13. User Needs Assessment | Preventative care

14. Define the User | demographicS Hispanic (93.2%) White alone (6.2%) Two or more races (0.3%) Black alone (0.10%) Asian alone (0.1%) American Indian alone (0.06%) Other race alone (0.01%)

15. Define the User | demographicS

16. Define the User | demographicS

17. Define the User | demographicS

18. Define the User | demographicS • Miami-Dade County Students: • 13% were obese • 7% did not eat fruit • 11% did not eat vegetables • 13% drank a can, bottle, or glass of soda or pop three or more times per day • 19% did not participate in at least 60 minutes of physical activity on any day • 54% did not attend school physical education (PE) classes in an average week • 38% watched television 3 or more hours per day on an average school day • 38% used computers 3 or more hours per day on an average school day

19. Define the User | Characteristics Obesity Factors

20. Define the User | Characteristics Shocking Stigma: Labeled by Society Tyrese: Fat People Are Big Because They Earned It - Huffington Post Should We Shame Fat People Into Losing Weight? One Researcher ... Shaming fat people into losing weight is the only way to solve ... Should obese people pay for two airline seats? | Debate.org Fat Americans Need a Healthy Dose of Shame | The Philly Post

21. Define the User | PATIENTS • Risk of type 2 diabetes • Heart disease • Cancer • Chronic and debilitating health problem • Discrimination in family, Social, Education, and Employment settings • Treating Obese patients with a lack of dignity in the hospital setting might cause them to be reluctant to seek medical care because of feelings of embarrassment and shame. • Respectful and nonbiased communication can be achieved by using supportive language. • Patients over 350 pounds were weighed on the scales located on the loading dock of hospitals. This was very humiliating and embarrassing to the patients.

22. PHYSIOLOGICAL | REQUIREMENTS • Building entries • Building entry points need to be designed with ramps with handrails and should have door widths a minimum of 3 feet, 2 inches • Space for ample-sized wheelchairs should be available at the front doors • Public toilets as well as waiting rooms should be constructed for the needs of obese patients • Elevators • Special elevators need to be considered for this population • A 6,000- to 6,500-pound capacity elevator is needed to provide sufficient space for a 40-inch-wide, 90-inch-long bed. • These elevators can hold the obese patient, bed, equipment and two staff members. • It is preferable that elevator doors have a minimum width of 54 inches to 60 inches. • Patient rooms • Patient rooms need to be larger than typical rooms to allow for larger beds, some recommendations suggest be designed with 100 additional square feet

23. PHYSIOLOGICAL | REQUIREMENTS • Because obese patients often have obese family members, the family accommodations need to be geared toward the 272 square feet, compared with the average private room size of 176 square feet • This allows for 5 feet of clear space around three sides of the patient’s bed to provide ample room for wheelchairs (including a 72-inch turning radius), walkers and portable lifts • Toilet rooms – Toilet rooms need to have a wider door width of 3 feet, 6 inches and adequate space for two caregivers to assist a patient • The toilet should be placed toward the center of the wall to allow room on each side of the commode for assistants • At a minimum, toilet centerlines should be 24 inches from a wall in lieu of the 18 inches required by the ADA. Toilet room walls should have extra-strength blocking to support grab bars (to support up to 800 pounds), as well as sinks that are capable of supporting the additional weight LEFT A bathroom with a double-leaf door provides easy access for patients. RIGHT This fixture from the Great John Toilet Co., Laredo, Texas, is ceramic-tested to handle 2,000-pound loads and was part of an inpatient unit renovation at the 600-bed Tucson Medical Center in Arizo

24. PHYSIOLOGICAL | REQUIREMENTS • Toilets and sinks • Use floor-mounted stainless steel toilets with a capacity of 5,000 pounds • Should be floor-mounted • Toilets should be 24 inches on the centerline, versus 18 inches on the centerline for a standard size toilet • Wheelchairs • Seat widths of up to 48 inches and require a 6-foot or larger turning radius • Doors • Recommended to be 3 feet, 6 inches wide, with 4 foot opening size • Waiting areas • Care should be taken to avoid creating “obese only” sections in general waiting areas. Loveseats can be a discreet way to mix this furniture with the standard waiting room furniture. Again, designers should also consider obese family members when apportioning this space. Install a split lavatory seat and provide a specimen collector with • a handle.

25. PHYSIOLOGICAL | REQUIREMENTS • Equipment and fixtures • Exam tables • High-quality beds address the challenges and provide patients with comfort and mobility • The bed is 98 inches long when extended and 61 inches wide with safety sides in place. Primary considerations include weight and size capacity, ranging from 600- to 1,000-pound weight capacity, in addition to specialized features such as in-bed scales and a mechanism to raise the head of the bed while lowering the foot of the bed to bring the patient to a sitting position. • Furnishings • Many pieces are designed with load capacities up to the 600- to 700-pound range • 10 percent to 20 percent of all general seating in bariatric sizes

26. PHYSIOLOGICAL | REQUIREMENTS An overhead ceiling lift system in operation at a health care facility. Patient lifts Overhead patient lifts can result in a significant decrease in staff and patient injuries. Well-designed lifts simplify patient transfer and can reduce staff injuries involved with lifting patients.

27. Define the User | STAFF • The rate of staff injuries is normally very high with over 20 percent stemming directly from the handling of obese patients • These lifts have helped cut that rate down to about 3 percent • Weigh patients privately and only when necessary • Create an accessible and comfortable office environment • Provide extra large examination gowns • Use large adult blood pressure cuffs or thigh cuffs on patients with an upper-arm circumference greater than 34 cm. • Have a weight scale with adequate capacity (greater than 350 pounds) for obese patients

28. Define the User | REQUIREMENTS Key Factors in Better Wayfinding Design Signage and directory information that is provided in an all-text format is a barrier. Way-finding maps make it virtually impossible for a person with certain cognitive impairments. For Patients with mild dementia, non-reader, the non-english reader, or person with dyslexia (a reading impairment), directories that only provide text offer no source of help at all.

29. Define the User | REQUIREMENTS Color and lighting are both useful in wayfinding design. Design architectural features such as archways, columns, varied ceiling heights, and differentiated fenestration. These distinct architectural features help in creating orientation points in a cognitive map. Provide spatial overview opportunities so that individuals can view a building’s layout from various vantage points Overall space Layout could be improved thorough use of color, lighting, landmarks, and signage to clearly mark paths and exiting areas.

30. Define the User | REQUIREMENTS • Landmarks • Distinct in shape and color • Appropriately illuminatedto orient people in the space and provide directional egress information • Appropriate Signage • Conveys important information • Guides evacuation decisions • Useful in communicating necessary information • All-text formats are not universally accessible • Sensory input such as sound or smell can be effective in creating a stronger cognitive map • Should be placed perpendicular to the path of travel, above eye level, and appropriately illuminated

31. Define the User | REQUIREMENTS UNIVERSAL DESIGN

32. Psychological | REQUIREMENTS • Obese children and adolescents are at risk for psychological and social adjustment problems, including lower perceived competencies than normative samples on social, athletic, and appearance domains, as well as overall self-worth • Obese patients suffer higher rates of diseases associated with obesity, namely diabetes and cardiovascular disease • Men and women living in urban cities were more likely to be obese than men and women in sub-urban cities • Urban/Sub-Urban differences in physical activity were found among all adults with the urban propensity for inactivity, greatest among low income people • Obese children and adolescents in our study also missed a mean of 4.2 days of school in the month prior to evaluation • Built Environment and Health: What Have We Learned? • Increased levels of sprawl are associated with increased obesity, decreased physical activity, and poorer health

33. Psychological | REQUIREMENTS • Features of the Built Environment that Encourage Physical Activity: • Presence of sidewalks • Streetlights • Interconnectivity of streets • Population density and use mix • Neighborhoods with a mixture of land use types including commercial, industrial, residential, and office promote physical activity. • A study of Chicago public housing play space found that children in highly vegetated spaces played more (by a factor of two) than children in non-vegetated spaces. • Street trees, along with other pedestrian amenities, have been found to be a promoting factor in physical activity. • People with low incomes, most likely have less time to be physically active because they are working multiple jobs, and because they are more likely to be concentrated in neighborhoods without the necessary amenities.

34. Psychological | REQUIREMENTS • Culture and Personal Space: • Family is the nucleus of Hispanic life • Hispanic’s tend to have closer personal space and value physical contact • Hispanic’s are more spiritual • The Hispanic "family unit” includes not only parents and children but also extended family • Modesty and privacy are important • Stigmatized health issues should be discussed through an interpreter and not family members • When a family member is used as an interpreter, if the issue is personal, try to use a family member of the same gender • Sexuality issues are hard to discuss • Family involvement in health care is common and health care providers are strongly advised to encourage such involvement and to include the family as a resource and focus of care in health planning, whether for individuals or a community • Important decisions are made by the whole family, not the individual • Family often includes non-blood-relatives, including compadragos(when a couple baptizes the child of another) • It is common for several family units to live in close proximity to one another and there is usually a strong reliance on family in day to day functions and crises

35. User Needs Assessment | mental health

36. Define the User | PATIENTS Demographics Ages 18 to 28 (Average age is 23) Women 19,844 (55.3%), Men 16,031 (44.7%) 0.4% American Indian/Alaskan Native 3.1% Asian 12.3% Black / African-American 69.3% Hispanic / Latino 1.4% Multi-race (not Hispanic / Latino) 0.1% Native Hawaiian / Pacific Islander 12.1% White

37. Define the User | PATIENTS Physical / Mental Competence and Self-supporting potential? • Men: high rate to hide their problem • Women: less than men • They can have individual counseling, group counseling and couple counseling • They can get more information through the phone, and either the website or at the counseling center

38. Define the User | STAFF FIU Counseling and Psychological Services Demographics: (Wide variety of age, gender, and cultural background for diverse students) Psychologists Social workers Mental Counselors

39. Physiological | REQUIREMENTS • ADA Requirements for Physical Mobility Impairments: • 6’ wide corridors and wheelchair-accessibility to all areas • Body support and equipment • Bigger size chairs for larger persons • Visual Impairments: • Cove lights are recommended • Use solid and neutral colors toprevent stimulating the patients emotionally • Wood grain patterns make warm and calming environment • Hearing Impairments: • Acoustics are essential at all areas to reduce noise for others • Other Requirements: • Enclosed spaces are necessary where the counselors are treating individuals • It is necessary for security. A security bell and camera can be installed • Perceived human scale is significant for knowing how much space the areas need to create a comfortable environment for staffs and patients • It is not necessary to have a open public spaces, however the corridor must be open for high visibility • This space doesn’t allow for refuge, but can be prospect to interesting views • The way-finding /signage is also important • Ample lighting help to be seen clearly

40. Psychological | REQUIREMENTS • Ambient Considerations for Cognitive Stimulation: • Sensory stimulation must be concerned in not over-stimulating the patients, but rather keeping them calm • The environment must provide comfort to patients and staffs • Privacy Considerations: • Privacy is important for individual counseling • Successful acoustics can help increase privacy • Visual privacy also needs to be considered • Sociopetal arrangements for couple counseling. • Sociofugal arrangements for group counseling.

41. Psychological | REQUIREMENTS • Extended Relationship Considerations: • Dining area (Kitchen) and lounge to interact during their break • Personal Space: • The standard for personal space is around 140 sq ft • Culture and ethnicity can be a factor for variation • Values and beliefs can’t be a factor • The Homogeneous Nature of the User Population: • Average age is 23 years old • Hispanic • Both male and female • Heterogeneity Support Potential: • As the environment is for counseling only, it doesn’t need to support a variety of activities

42. REFERENCES • Crook, K. Designing for dignity. Strategies for accommodating obese patients. Health Facilities Management. Retrieved from http://www.hfmmagazine.com/hfmmagazine/jsp/articledisplay.jsp?dcrpath=HFMMAGAZIN E/Article/data/03MAR2009/0903HFM_FEA_Interiors • Feikema, R. (2012). Color and lighting schemes for a hospice facility aimed at improving the residents’ quality of life. (Master's thesis, California State University)Retrieved from http://scholarworks.csun.edu/bitstream/handle/10211.2/2528/RachelFeikema.p df?sequence=1 • Health-Related Quality of Life of Severely Obese Children and Adolescents Jeffrey B. Schwimmer, MD; Tasha M. Burwinkle, MA; James W. Varni, PhD JAMA. 2003;289(14):1813-1819. doi:10.1001/jama.289.14.1813. • Hospice patients and staff. (n.d.). Hospice Foundation of America, Retrieved from http://www.hospicefoundation.org/patientsandstaff • Jeffrey, D. (2003). Chapter 1: What do we mean by psychosocial care in palliative care?. 1-12. Retrieved from http://fds.oup.com/www.oup.co.uk/pdf/0-19-851540-5.pdf • Lopez, R., & Hynes, P. (2006).Obesity, physical activity, and the urban environment: public health research needs. Environmental Health Journal. Retrieved from: http://www.ehjournal.net/content/5/1/25

43. REFERENCES • Perez Ph.D., M. (n.d.). Cultural values. Latino Adaptation Guidelines-Cultural Values, Retrieved from http://www.chadwickcenter.org/Documents/WALS/Adaptation Guidelines - Cultural Values Priority Area.pdf • White, D. J. (2010). Hospice basics. Retrieved from http://www.allabouthospice.org/basics.html • 33165: Demographics. (n.d.). Retrieved from http://zipskinny.com/index.php?zip=33165&x=0&y=0 • Hispanic culture: http://hogarhispano.homestead.com/hispanichealth.html • http://www.businessinsider.com/shocking-facts-obesity-america-2010-12?op=1#ixzz2ecUXIFv6 • www.informedesign.umn.edu