Trading company for privacy: A study of patients’ experiences

Abstract

Ethical considerations

The study was conducted according to the principles of Declaration of Helsinki, and was approved by the Norwegian Social Science Data Services.

Objective

To describe patients’ experiences of staying in multiple- and single-bed rooms.

Patients and methods

This qualitative study employed a descriptive and exploratory approach, and systematic text condensation was used to analyze the material. Data were collected in a hospital trust in Norway. A total of 39 in-depth interviews were performed with patients discharged from the medical, surgical, and maternity departments.

Results

Patients had ambiguous views on whether multiple-bed rooms or single-bed rooms were to be preferred. Main results include how patients cherished “the importance of others” but at the same time valued “the importance of privacy.” Being hospitalized in multiple-bed rooms was for many patients a very positive experience in terms of social interaction. Patients in single-bed rooms reported being more dependent on nurses to maintain social contact and obtain safety.

Conclusion

This research provides new knowledge on how the need for privacy can be in contradiction with the need for socializing with other patients. When hospitalized, the physical structure of a hospital impacts with whom patients interact and to what extent they depend on the nursing staff to have their social needs met.

Keywords

Loneliness nursing privacy qualitative research togetherness ward design

Introduction

Already in 1920, Bacon,¹ a superintendent at the Presbyterian hospital in Chicago, described in his article the benefits of single rooms in efficient hospitals. Claiming that single rooms could offer flexible bed management as well as elimination of contagious diseases, Bacon¹ suggested that this type of design should be imperative when planning a hospital. However, hospitals have traditionally been designed based on Florence Nightingale’s idea of multiple-bed rooms with large wards and shared facilities.² Large wards consisting of an open room gave nurses a good overview of the patients, but did not provide much privacy for those admitted.³

Today, new hospital design policies across the world seem to prefer an increased use of single rooms, thus creating a change for how nurses are organized. Single rooms have become standard in construction of hospital facilities in the United States;⁴ and in Great Britain, the National Health Service is recommending new hospital projects to have a certain amount of single-bed rooms.⁵

According to previous studies, many patients experience sharing room with others as rather positive.^6
–8 Being able to socialize, provide and receive support, and share information is recognized as valuable.^7,8 Arguments against multiple-bed rooms include loss of privacy, less control,⁸ increased noise level,⁹ increased risk of medication errors,¹⁰ less integrity, and worrying about other patients. Several argue that single rooms are preferable as they improve the patient’s privacy and dignity, increase patient safety, reduce medical errors, and ensure confidentiality.^6,11
–13 Single rooms are also said to play an important part in infection control,¹³ contributing to enhanced sleep,¹² enhancing communication with healthcare professionals,¹¹ and accommodating space and interaction with visitors.^10,14 Arguments against single rooms are the perception of not being seen and confirmed as a human being due to less surveillance of staff and lack of communication with co-patients.⁶ Several studies indicate a higher number of inpatient falls among patients being hospitalized in single rooms,^9,15,16 whereas others found no increased rate of inpatient falls.¹⁴ On the topic loneliness among older patients, Singh et al.⁹ find a significantly higher sense of loneliness, whereas Reid et al.¹⁴ argue that older patients do not feel lonely or isolated in single rooms.

In conclusion, the current evidence base is not conclusive on whether multiple-bed rooms or single rooms are to be preferred, thus stating the need for more research on this topic. This study is part of a project called “From an old to a new hospital,” which aims to describe different themes in regard to patients, nurses, and nursing students’ experiences. The purpose of this study is to describe patients’ experiences of staying in multiple- and single-bed rooms.

Materials and methods

Design

This study employed a descriptive and exploratory approach. Systematic text condensation inspired by Malterud¹⁷ was used to analyze data.

Settings and entrance to the field

In 2015, a Norwegian Hospital Trust relocated to a new clinical building with only single rooms.

In the new hospital, there were 27–36 single rooms organized in three to four bed courts. All rooms had private bathrooms and television. In every ward, there was a dining room with buffet options for the patients, but no other common areas. In the old hospital, the number of beds on the wards varied between 14 and 30 with one common working station for the nurses. The rooms were mostly multiple-bedded with shared bathrooms, and single rooms were scarce. In each ward, a common living room with a television was available for the patients to use.

The study was carried out during autumn 2015 and autumn 2016, and the procedure was conducted in the same way in both rounds of interviews. The contact person (nurse or secretary) on each ward delivered verbal and written information about the study to patients ready for discharge from the hospital. The inquiry to the patients concerned, first, participation in a quantitative study describing/exploring patient’s perception of the quality of care.¹⁸ In addition, the patients received a written inquiry asking for their consent to be contacted for in-depth interviews. In total, 196 (32.7%) of the 599 participants included in the quantitative study were positive to being interviewed; of these, 40 were randomly drawn out. Inclusion criteria to join the study were the following: that the patients should be 18 years of age or older, should be able communicate in Norwegian, that the nurses assessed that their physical and psychological health status permitted participation, and that they had been admitted to a medical ward, a surgical ward, or a maternity ward. The hospital setting provided wards in both psychiatric and somatic disciplines, and patients from all the somatic wards were included in the sampling criteria.

Participants

The sample consisted of 39 patients. There were 19 women and 20 men ranging from 26 to 77 years of age; the median age was 58 years. The patients had experience of staying in multiple-bed rooms or in single rooms, respectively. A total of 20 patients with experience of staying in multiple rooms in the old hospital were interviewed in 2015, and 20 patients with experience of staying in single rooms in the new hospital were interviewed in 2016. Due to acute illness, only 19 patients were available for interview. Of the 20 interviewed patients in 2015, 13 had been admitted to a medical ward, four to a surgical ward, two to a maternity ward, and one patient did not know which ward he had been admitted to. For the 19 patients who were interviewed in 2016, 15 of them had been admitted to a medical ward, two to a surgical ward, one to a maternity ward, and one patient was unaware of which ward he had been admitted to.

Interviews—fall 2015	Ward	Room type	Gender	Age	Interviews—fall 2016	Ward	Room type	Gender	Age
1	Medical	Multiple-bed rooms	Female	70	21	Medical	Single-bed rooms	Male	63
2	Medical	Multiple-bed rooms	Female	64	22	Medical	Single-bed rooms	Female	41
3	Medical	Multiple-bed rooms	Male	74	23	Medical	Single-bed rooms	Female	68
4	Medical	Multiple-bed rooms	Male	70	24	Maternity	Single-bed rooms	Female	35
5	Surgical	Multiple-bed rooms	Male	56	25	Medical	Single-bed rooms	Female	59
6	Medical	Multiple-bed rooms	Male	54	26	Surgical	Single-bed rooms	Male	68
7	Medical	Multiple-bed rooms	Male	71	27	Unknown	Single-bed rooms	Male	62
8	Medical	Multiple-bed rooms	Female	60	28	Medical	Single-bed rooms	Female	62
9	Medical	Multiple-bed rooms	Male	59	29	Medical	Single-bed rooms	Female	44
10	Maternity	Multiple-bed rooms	Female	27	30	Medical	Single-bed rooms	Female	53
11	Maternity	Multiple-bed rooms	Female	26	31	Medical	Single-bed rooms	Male	59
12	Medical	Multiple-bed rooms	Male	67	32	Medical	Single-bed rooms	Female	47
13	Surgical	Multiple-bed rooms	Male	50	33	Medical	Single-bed rooms	Female	79
14	Surgical	Multiple-bed rooms	Female	65	34	Surgical	Single-bed rooms	Male	52
15	Surgical	Multiple-bed rooms	Female	67	35	Medical	Single-bed rooms	Male	55
16	Surgical	Multiple-bed rooms	Female	46	36	Medical	Single-bed rooms	Male	59
17	Medical	Multiple-bed rooms	Male	59	37	Medical	Single-bed rooms	Male	53
18	Unknown	Multiple-bed rooms	Male	77	38	Medical	Single-bed rooms	Female	51
19	Medical	Multiple-bed rooms	Male	64	39	Medical	Single-bed rooms	Female	50
20	Medical	Multiple-bed rooms	Male	72

Data collection

An interview guide with questions concerning the experience of patients staying in a multiple-bedded facility and in single rooms was used. The interviews started as open dialogues in which the participants were encouraged to talk freely about their experiences (e.g. can you please tell me your experience of staying in multiple-bed room/single room when being hospitalized?). Probes were used when needed, by, for instance, asking, “Can you tell me more about this?” Asking the participants to explain or elaborate their answers was done in order to gain a deeper understanding. All interviews but three, which were conducted in a private office in a public building, were collected in privacy at the patients’ home. Most interviews were conducted with the patient alone; however, in four interviews, the patient’s partner was also present. The second and last author, who are experienced interviewers, conducted the interviews.

All interviews were recorded and transcribed verbatim. The interview duration ranged from 12 to 60 min. The median length of the interviews was 36 min. The total data collection, after 19 and 20 interviews, respectively, provided an adequate and information-rich dataset grounded in empirical data.¹⁷

Data analysis

In line with the process of systematic text condensation inspired by Malterud,¹⁷ the analysis process consisted of the following steps. First, a total impression of the patients staying in both a multiple-bedded facility and single rooms was established by discussion with the research team. Second, the first author reviewed all the interviews line by line in order to identify meaningful units. Then, a systematic abstraction of the meaning units (decontextualization) was carried out. All the experiences were analyzed together. After this step, the research team developed descriptions and concepts providing credible stories that elucidated patients’ experiences of staying in multiple-bed rooms and single rooms (recontextualization). Components from the participants’ stories, their elaborations, and statements were used to obtain understanding about the themes. Categories developed from the data through meticulously analyzing the text and by discussion with the research team. The research team used a spreadsheet where all statements, meaning units, subgroups, artificial quotes, and description of content were noted. By doing this, the findings could be easily organized as well as compared, and this served as the basis for developing the main categories and then the subcategories.

Ethical considerations

The study followed the principles of the Declaration of Helsinki.¹⁹ The study was approved by the Norwegian Social Science Data Services (NSD) (number: 44034). Written permission was obtained from the director of the hospital trust as well as the heads of the actual/different departments before the study was conducted. The participants were verbally informed and given written information stating the purpose of the study, that the data would be handled confidentially, and that they had the right to withdraw at any time without any consequences for them. Informed consent was given by all participants. All information and requests for participation in the study were passed from health personnel; the researchers had no contact with the patients prior to data collection. As the study was part of a quality assurance and evaluation project, the Regional Committee for Medical and Health Research Ethics (REC)²⁰ did not request any further approvals.

Results

Two categories with three subcategories each emerged from the data, describing patients’ experiences of staying in a multiple-bedded facility and in a single room facility. The category “the importance of others” contains the subcategories togetherness, loneliness, and social connectedness. The category “the importance of privacy” contains the subcategories exposedness, hygiene, and control.

The importance of others

Data show that patients valued and recognized the importance of others. The three subcategories were togetherness, loneliness, and social connectedness.

Togetherness

The presence of co-patients was desired by some of the participants given that the co-patient was not too ill or showing an unacceptable behavior. Data suggest that if patients shared the same kindred spirit and could communicate well, interacting with others in the room was greatly appreciated. One patient expressed,

I have been placed in a multiple bed room several times, and I have often developed a kind of a comradeship with my fellow patients, and if you have that, I think it’s quite nice to share a room. That’s no problem.

In addition to a multiple-bed room, results also imply that a common living room played an important role as a place where patients could socialize and also enjoy leisure activities such as watching television. A man said,

We went to the TV lounge to watch football matches together and I really enjoyed that.

Results therefore suggest that being together with co-patients can unite, promote activity, and also initiate dialogue between patients. To have the opportunity to share experiences from being ill and being a patient is also valued. One patient stated,

You are often very open when you lie there. People are talking. The whole life story whether it’s good or bad, well it just pops out.

Through dialogue, stories of illness, suffering, family, relations, and residential background were shared. In the material from patients who had stayed in multiple-bed rooms, they described their fellow patients in a rich and detailed way. Such information was not found in the material from patients in a single-bed room, suggesting that the presence of other patients is something that goes unnoticed when alone.

In the new hospital, not having a living room where one could be together was greatly missed as several patients expressed the need for having a place where they could seek company with others when they felt so. Patients mentioned there was a seating area adjacent to the food station, but because the area felt uninviting and had uncomfortable chairs they chose not to eat or socialize there. Results suggest that patients did not consider it a place for gathering as one patient stated:

There were no venues where you could meet like you could at the old hospital.

Results imply that when common venues did not have the facilities or were unwelcoming, patients chose not to sit down in togetherness, but brought their food trays to their room to eat alone.

Loneliness

Some patients described being in a single-bed room as boring and having a feeling of being left in solitude. One of the patients with such experience stated,

It was a strange experience. I felt very lonely.

Bedridden, especially older, patients who did not have the option to seek out contact with others seemed to be less satisfied with single rooms. One of the patients described having to be by himself as miserable, claiming he needed much more supervision and care. Another patient said that if the door to her room was closed, she was isolated and without contact with the outside world. In our material, it became evident that some patients had to depend upon family members, friends, or nursing staff to initiate social interaction, should they have their needs for social contact met, simply underlined by one patient as follows:

I didn’t see any other patients.

Another patient stated,

I get the impression they (the nurses) do checkup rounds. Those rounds made me feel less lonely, because I knew there was someone that would come by.

The results therefore imply that the feeling of being left by oneself and the sense of being isolated, for some, are more present in a single-bed room, creating a need for nurses to come by on a regular basis.

Social connectedness

When left in solitude with no other patients to talk to, data show that nurses as well as the in-room television set played an important part in ensuring social connectedness with the outside world. When nurses came by to look after the patients, it was stressed by several as contributing to feeling of safety, comfort, and having social needs met:

I liked that the nurses came by and asked how I was, it meant a lot to me.

One patient mentioned that he had come to care deeply for the staff, and one patient said,

The nurses sat down with me and we were talking, we had a conversation and they were sharing a little about their personal life.

Patients who were hospitalized in single rooms showed a greater interest in and involvement with the staff, versus patients in multiple-bed rooms. Results therefore imply that staff play a more important role for patients in single rooms.

As patients told that they had to spend most time by themselves, watching television in the room was an important pastime. Being able to choose which television channels to watch was welcomed by several, but many were concerned with missing remote controls, causing lack of entertainment. Results therefore suggest that some patients had to depend on the nurses as well as the television set for social connection with the outside world. No patients mentioned the use of telephones, tablets, or computers as a way of connecting themselves with others.

The importance of privacy

Several patients described that having to share rooms with others sometimes could be of concern, and the importance of privacy was stressed by many. The three subcategories are exposedness, cleanliness, and control.

Exposedness

To be exposed to others’ illness and suffering without having the possibility to withdraw was perceived by most patients as a burden. One patient who had been sharing a room with four others stated,

Well, let’s just say it was a bit stressful. The others had a lot of pain and stuff, and there was so much noise all the time.

Hearing and learning sensitive matters about others was perceived as difficult and unwished-for. During rounds, patients described that although doctors and nurses were trying to maintain privacy by pulling out a curtain to separate the beds, this did not prevent them from overhearing the conversation. One patient stated,

There are things you really shouldn’t hear. There was a fellow patient that was told he only had a few weeks left…The curtains are not exactly soundproof.

Displaying your own health problems and private concerns could make patients feel vulnerable and exposed, as one patient expressed:

For me, this admission wasn’t a very private matter, but it’s the whole setting you know, because suddenly something may come up. Or maybe I would have wanted to ask about something that I didn’t want the others to hear.

Becoming an involuntary recipient of this kind of information was dealt with in different ways. Some patients tried to just let go of what they heard, some started talking with the intent of drowning the conversation, and some opted to leave the room. Several claimed that it was an unwritten rule to not share this unintentional information with others, and results reveal that discretion was shown in these situations.

Most patients said they appreciated the privacy of a single-bed room where they did not have to relate to such information:

I didn’t have to listen to all the other patients’ stories about suffering, and I didn’t have to be present and listening in when doctors were making rounds and talking about all that stuff that really is confidential.

The privacy of a single-bed room was regarded by the patients as a good alternative for those who were seriously ill or needed discretion. One patient stated,

So, when you’re sick after coming out of surgery or something like that, I think a single-bed room is preferable. If you are lying there with your private parts on display, or having a urine catheter removed or something, then a single-bed room is more discreet.

Having to share a room with sick patients showing bodily discomfort was described as distressing, especially when dealing with your own health problems. One patient stated,

There was a lady that was going in to dialysis, she had a catheter put in and she got sick. I lay there and heard everything—and wished I could be somewhere else. She was throwing up and they had to clean it up and no, it was awful. And she was lying there right next to me and I thought of the vomit on the floor.

Data show that such experiences could be hard to cope with especially when the patient was fragile himself. Fear of contracting a disease because of being exposed to others’ human waste made patients feel anxious. Results therefore suggest that being exposed to others’ illness and having to expose yourself were stressful and unwanted, and that single rooms were preferable in such matters.

Cleanliness

Patients considered the multiple-bedded rooms with their shared facilities in the old hospital as worn, somewhat unclean but still homely. The single rooms, and new hospital overall, were described as white, sterile, cold, and spotless. Despite the austerity in the single rooms, patients expressed enjoyment about the immaculate room, the overall cleanliness, and the adjacent private bathroom. Proper facilities and amenities were mentioned by all as important, as one patient stated:

It’s so neat with a place where everything is clean and well-functioning, and from a hygienic point of view, it’s so nice to have my own toilet.

Patients who had been admitted to a multiple-bed room told about the challenges with sustaining hygienic measures in a setting where facilities were inadequate and general maintenance had not been carried out. The general lack of cleanliness made them unwilling to use the common sanitary facilities:

Well, yeah there was a shower. But it was not tempting.

However, not all the respondents minded surroundings with obvious need for refurbishing or lack of facilities. For some, the environment meant less than an emergency:

No, I didn’t care so much about that, but I do understand those who do. Let’s just say, I am happy that I was taken care of. That I got the treatment I should.

Control

To be able to decide private matters and maintain a normal, daily routine proved to be important for patients in a single-bed room. No data were found in the material from patients in a multiple-bed room regarding this. Being able to control the temperature, sound, and surroundings without taking others into consideration was appreciated:

I could watch any television channel I wanted to, I could turn it off when I wanted to. I could doze off during the day and I slept so much better at night.

Having the possibility to have family and friends come over, without having to respect visiting hours, was also mentioned as a bonus of a single-bed room:

I loved that my husband could come and go as we pleased.

Not having to talk to anyone or be disturbed was also mentioned as a positive effect of a single-bed room, as one patient stated”:

It was such a pleasant experience to be by myself.

Discussion

The aim of this study was to describe patients’ experiences of staying in multiple-bed rooms and in single rooms. The two main categories are the importance of others and the importance of privacy.

The results described in the importance of others suggest that hospital architecture and design have an important impact on how patients are together, how being hospitalized in a single-bed room causes loneliness, and also a greater dependence on nurses and an increased attention to the in-room television set.

Patients who had been hospitalized in multiple-bed rooms reported that sharing a room gave a sense of feeling united with other patients. Being able to seek the company of others and have someone to talk to was clearly appreciated. Patients expressed that they valued the support from others and the experience other patients could provide. They also enjoyed the possibility for friendship to evolve and the activity that took place in a shared room. This result is in line with Album,⁷ Malcolm,²¹ and Larsen et al.¹¹ who argue that sharing the experience that comes from being a patient can enhance understanding, develop knowledge, and improve how well one copes with illness. In this study, the feeling of togetherness with the other patients and connectedness proved to be important for many patients when they were hospitalized. According to Kim,²² social support can intervene on how well an individual handles stress and adapts to illness, while Malcolm²¹ describes social support among patients as a positive aspect. Results related to valuing social interaction with others were, however, under the preconditions that patients felt alike. This is in line with the work of Larsen et al.¹¹ who claim that fellow patients have time to listen and that can lead to a positive interaction. Patients also expressed that others should not be too sick or display either an unpleasant behavior or show bodily discomfort. If so, patients in this study preferred a single-bed room.

Patients in single rooms experienced a greater sense of loneliness than the ones in a multiple-bed room. Some expressed the feeling of being bored, isolated, and left in solitude with no one to talk to. Other studies imply that being cut off from contact with others can have negative impact on mental health and have people doubt their own existence.²² Too much privacy has also been described as leading to boredom.²³ Since the ward design in the new hospital is based on single rooms and no common living rooms, patients reported having reduced possibility of social interaction with other patients, and many felt lonely and confined. This result is in accordance with other studies,^2,24
–26 but inconsistent with Reid et al.¹⁴ who claimed that patients in single-bed rooms do not feel more lonely or isolated. As human behavior is formed and developed by sensory influence, sensory deprivation that comes from not socializing with others can lead to a sense of disconnectedness with the outside world.²² Experiencing disconnectedness not only makes patients more dependent on the nursing staff, but it also takes away the possibility of sharing experiences, learning, and helping each other.^7,25 Based on our results, the importance mentioned of in-room television for patients in this study can be interpreted as a replacement for the need for togetherness and dialogue with others in an environment that does not promote human interaction. MacAllister et al.²⁷ claim that having access to a television set makes patients feel calmer as it is a positive distraction from being hospitalized. None of the participants mentioned the use of electronic devices as a way of connecting with others. This is a surprising find as these devices are frequently used and owned by many people in Norway.

Another interesting result was that since interactions with other patients were absent for those in a single room, patients had to rely on nurses making rounds in order to have their social needs met. This is also described by Maben et al.²⁶ who found that nursing rounds were important to prevent isolation and tending to patient’s needs. Another result related to rounding was that regular supervision by staff enhanced patients’ feeling of safety. In a previous study, Donetto et al.²⁵ found that single rooms make it impossible to have an oversight of several patients at a time, thus leading to nursing staff feeling anxious about safeguarding patients. It is therefore likely to think that less presence of nurses can contribute to patients’ sense of loneliness and lack of feeling safe. Donetto et al.²⁵ claim that because patients in single-bed room do not see other persons regularly, they occupy more of the nurses’ time and crave social relations, whereas MacAllister et al.²⁷ mention the importance of having nurses present in order to obtain a healing environment for the patients. Based on previous research and results in this study, one can assume that nurses who work in hospitals with single rooms must be prepared for a different kind of interaction, allowing nurses to become the social objects who fulfill patients’ need for socialization as well as attending to regular nursing tasks. In the material from patients in multiple-bed rooms, this need was filled by co-patients offering a different and often valued interaction. This result can be understood in light of Kim’s²² statement that “Each individual in a social environment projects to another person certain meanings through his or her presence.” Album claims that it can be difficult for a nurse to fulfill this need as a nurse will never be on the same level in terms of developed experiential knowledge. Ward design therefore have significant implications not only on the patient’s sense of togetherness and loneliness but also on how patient feel connected to the world outside the room.

The other main category “the importance of privacy” suggests that patients in multiple-bed rooms feel vulnerable when they are exposing themselves or are being exposed to sickness and illness. Environmental factors such as cleanliness and how one can or cannot control the surroundings seem important. As a concept, privacy can be vague and complex to define;^21,23,28 it is, however, often linked to core values in nursing such as respect, confidentiality, dignity, autonomy,^21,29 and personal space²³ and has been described through various dimensions.^30,31 According to Deshefy-Longhi et al.,²⁹ it is a paradox that patients have to sacrifice both privacy and confidentiality in order to receive needed healthcare. In our findings, patients with experiences from multiple-bed rooms were referred to each other with little possibility to retreat. Because of the rooms’ physical structure, patients were so adjacent that privacy was hard to maintain, but few other options were available causing patients to feel exposed. Literature shows that being in need of help and revealing private matters to strangers make patients feel exposed and fragile,^7,32 as well as having impact on patients’ autonomy.²³

Previous studies have stated that being exposed to others’ illness can be perceived as difficult. When other patients are suffering from severe illness or are showing bodily discomfort, sharing a room is not wished for.^7,33,34 With only a curtain to separate their beds, patients in this study considered it to be a problem when they overheard information that was being given. This information was hard to process as it could contain serious or delicate matters about other people’s personal health and life circumstances. The fact that curtains are insufficient in preventing others from hearing is also described by Malcolm²¹ and Maben et al.²⁶ as being only a visual hindrance leading to added stress for patients being ill themselves. Although curtains were used in the effort of trying to maintain privacy, this only hindered visual impact but did not hinder other patients from listening, causing privacy to be violated.

Deshefy-Longhi et al.²⁹ stress that it is essential to pay particular consideration to “vulnerable populations” or patients with “certain medical conditions” in order to maintain their special needs for privacy. According to Hasan Tehrani et al.,³¹ having control and ownership of personal information is something that patients expect and want to be in command of.

Patients in this study found it hard to process unintended information and imposed themselves upon maintaining confidentiality, suggesting that being assigned to each other in a multiple-bed room creates a sense of respect in safeguarding others’ private matters. The fact that patients in multiple-bed rooms are considerate to each other is also found by Persson and Maatta.⁶ In our material, patients expressed that sharing a room with others included fear of contracting contagious diseases that come from being exposed to others’ human body waste. If or when they were really sick with less control over their body, patients in our study preferred a single-bed room. While patients are uncomfortable when subjected to an illness that, for instance, causes smell,^10,35 not conducting oneself in a way one would like to present oneself or are expected to behave is considered a violation of social expectations.^7,22 According to Lawler,³² nurses need to acknowledge how patients become vulnerable when their body and bodily functions are exposed in unknown surroundings and in front of others. In most societies, it is generally recognized to attend to hygienic matters in private. A person’s vulnerability can therefore be challenged by unwanted exposure of others or lack of controlling one’s own bodily functions.³² This might explain why patients in this study stressed the importance of having private sanitary facilities, thus maintaining their body integrity and privacy as well as reducing the possibility of embarrassment.

Results also suggest that patients in a multiple-bed room could control their environment to a lesser extent than the ones in single rooms. Patients in multiple-bed rooms tried to adapt to the shared facilities, taking into account the need of others and the limitations of the ward. According to Chaudhury et al.,⁴ the lack of control can manifest itself as negative patient outcomes. Previous studies have stated that when patients can control their individual space, this leads to less stress for the patients⁴ and helps facilitate recovery.³⁴ When being confined to a room, this room becomes your world and the room becomes your individual space.² Allowing patients to establish a personal and individual space creates a sense of homeliness.³⁴ This is easier to achieve in a single-bed room. Being able to control the environment becomes more important for the patient as he goes through the stages from being dependent to being able to care for himself.³⁶ Having a room which facilitates the possibility to connect and control has in previous studies been shown to be essential in the patient’s feeling of comfort and well-being.^33,36 This can explain why such a thing as a functioning remote control was mentioned by patients in a single-bed room to be so important, as this can be interpreted as something the patient could control without assistance from the nurses. Patients expressed enjoyment about being able to control what they could control, such as temperature, lighting, and what TV channels to watch. In this study, patients in single rooms were also pleased that they could have visitors whenever they wanted, and this added to their feeling of being able to control their surroundings.

Conclusion

This research provides new knowledge on how the need for privacy can be in contradiction with the need for socializing with other patients. Being hospitalized in multiple-bed rooms was for many patients a positive experience when it came to social interaction, but lack of privacy and negative aspects with exposing and being exposed were mentioned. Patients in single rooms enjoyed being able to control the environment and a better hygienic environment, but experienced loneliness and were missing common venues with opportunities to socialize. Patients in single rooms were also more dependent on nurses to maintain social contact and obtain safety, than those in multiple-bed rooms.

The insights obtained from this study should have implications for future hospital planning as well as informing nurses about patients’ experiences. The concept of single rooms can be said to have many advantages, but the concept has room for improvements. When trading company for privacy, one must be aware that loneliness among patients can occur. Facilitating common venues where patients can socialize is advised. Nursing leaders and nurses tending to patients in single-bed rooms must also take into consideration the importance of organizing and performing regular rounds to prevent loneliness and increase safety. Based on the findings in this study, researchers have received funding to perform a qualitative study where nurses will be asked to share their experiences on tending to patients in a hospital with single-bed rooms.

Strengths and limitations

This study was designed to capture the experience of patients who had stayed in multiple-bed rooms and in single rooms.

Methodological strengths in this study include interviewing a total of 39 patients, which can be said to be a rather substantial number of participants for a qualitative study. The material therefore generated a large amount of rich information, providing the opportunity to address the study’s intent thoroughly. Throughout the process, the authors collaborated closely with each other, making sure results and conclusions were in accordance with the material. The fact that the participants are distributed in the previously mentioned numbers from the different wards reflects upon how the hospital is organized and the actual patient population. Gender and age were also distributed evenly. Given the sample size and how thorough the research was conducted add to its validity. However, as patients were randomly selected and not selected based on ward affiliation, this limits the possibility of comparing patient experiences.

Other methodological limitations include a wish for having gone even further into the thematic. More follow-up questions could sometimes have been asked in order to elaborate the patients’ experiences even more deeply. A survey could also have been undertaken to add a quantitative side to the data. Another possible weakness was that two different persons conducted the interviews with the patients. An attempt was made to reduce as much as possible any potential disparities in understanding of the questions and answers, by regular discussions by the two interviewers.

Footnotes

Acknowledgements

The authors wish to thank the patients who participated in the study, sharing generously their time and experience.

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Anne Karine Østbye Roos

Ann Karin Helgesen

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