Central Luzon Kidney and Transplant Institute: Integrating a Wellness Supportive Approach towards a Therapeutic Environment in Specialized Hospital Design
by: Sucayan, Dominic D.
Design 10 Adviser: Ar. Bernard Joy Dones
Polytechnic University of the Philippines
College of Architecture, Design, and the Built Environment
2023
In 2021, the 11th cause of death of Filipinos is due to genitourinary diseases or illnesses in the renal system such as acute renal failure, end-stage renal failure, kidney stones, and polycystic kidney disease, etc. (Philippine Statistics Authority, 2021). According to the National Kidney Foundation (n.d.), the common cause of chronic renal diseases varies, but most of it is due to age, genetics, autoimmune diseases, diabetes, hypertension, kidney stones, and other genitourinary problems such as repeated urinary infections.
According to the National Kidney and Transplant Institute (n.d.), for every hour, there is one Filipino that develops chronic renal failure or about 120 Filipinos per million population every year. In 2018 Philippine Health Statistics (PHS) by the Department of Health, it is found out that there is an increasing trend in death by renal diseases such as nephritis and other illnesses in the renal system in their data from 1998, 2008, and 2018. In addition, the 2017 Philippine Renal Health Registry identified that there is growth in cases of dialysis patients from 2002 to 2016 (NKTI, 2017).
There is an inaccessibility in organ transplant for kidney patients in the country. Chan-on (2017) reported that in 2013, there is a big gap that is observed in the prevalence rate of End-Stage Renal Disease in Filipinos and organ transplantations done in the country. Because of the rising cases of kidney failure, the demand for organ donors increases. However, the lack of donors in relation to the patients that need transplant (Promchertchoo, 2016) result in difficulties that disable Filipino patients from getting proper treatment.
The only specialized institution that caters for different and advanced kidney diseases and transplant services in the country is the National Kidney and Transplant Institute in Quezon City. It is a tertiary specialty hospital run by the Department of Health that is known for its advanced treatment and diagnosis of renal ailments, dialysis, vascular surgery, blood services, and surgical transplant of the liver, pancreas, lower intestine, bone marrow, stem cell, and kidney. Because of this, many Filipino kidney patients outside Metro Manila, especially those with other severe kidney diseases needing advanced treatment, have no other choice but to travel and stay in the region, having the additional burden of extra expenditure on top of the treatment cost. Based on the data from DOH (2019), the country had 20,603 deaths per 100,000 populations caused by diseases of the genitourinary system and 18,218 of it came from regions outside Metro Manila. This signifies a need for a distribution of the services of NKTI across the country.
Based on the data from PHS in 2019, Central Luzon is one of the regions in the Philippines leading in the number of deaths caused by genitourinary diseases with 2,323 deaths per 100,000 people. In addition, the Philippine Renal Disease Registry (NKTI, 2016) shows that the region has the highest number of new dialysis patients next to the National Capital Region with 3,103 cases in 2016. Despite the numbers of kidney patients, only five kidney transplantations were recorded in the region in the same year. Central Luzon is home to 7 provinces; however, it only has four regional public hospitals that may offer standard and affordable public renal care, diagnosis, and treatment (DOH, 2020). Specialized advanced public renal healthcare and transplant, on the other hand, can only be accessed in Metro Manila. This poses a challenge to the marginalized sectors of the region as most of the hospitals there are privately owned.
Kidney and transplant patients encounter challenges that undermine their current situations. Aside from the physiological effects of their ailments and treatments such as pain and fatigue, they also experience psychological strain that has a direct influence in their wellness and quality of life. Because of the nature of their treatment, it is revealed that kidney patients are more prone to having depression in comparison to other patients with chronic illnesses (Shirazian et al, 2017). This is because kidney patients must get treated multiple times a week. They are also prone to repeating infections, anemia, and frailty, as well as biological changes that can trigger depression (Chen et al, 2011; Pretto, et al, 2020). In the operative setting, particularly for transplant patients, patient recovery is one of the determinants of a successful operation. Many studies have noted that patient recovery is attributed to the patients' environment. It is mentioned that post-operative patients are prone to anxiety which is associated with pain and different environmental stressors such as noise, light, and temperature. In addition, during the pre-operative stage, there is already a build-up of anxiety over patients due to uncertainties and fear of the upcoming operations (Malley et. al, 2016). These stressors have an influence on the length of their hospital stay.
To provide an efficient sustainable hospital environment, it is also important that health care providers are given attention. Blomskvist et al (2005) identified that the performances of health workers are negatively affected by the lack of physical interaction and poor psychosocial support from colleagues. A study from Hamilton et al. (2018) showed that certain layouts of rooms and corridors affect the communication and interaction among nurse which leads to medical errors, anxiety, and inefficiency. In addition to this, hospital staff also experience low control over their environment due to the difficulties caused by the nature of their work which results in burnout, depression, and poor provision of services.
To address the problems discussed above, the researcher utilizes Roger Ulrich's Theory of Supportive Design as a principle in approaching the said challenges. The supportive design theory is an approach that aims to influence the psychological and physiological aspects of patients towards positive health outcomes through the manipulation of space. According to Ulrich, a space shall have the capacity to reduce stress if it manifests the following: psychosocial supportiveness, positive distractions and access to nature, and provision of sense of control. The approach corresponds to the challenges experienced by both patients and health workers such as psychological stress and work inefficiency that often result in poor health outcomes and poor services.
Prior to the application of the design, the researcher studied the challenges faced by kidney, transplant/recovering patients, and health care workers as well as their behaviors and experiences in a healthcare environment. It is found out that patients are prone to mental health illnesses and various complications particular to them that affect their mobility and daily activities. In addition, there are many environmental issues identified that aggravate health worker’s stress. The findings were synthesized to identify how the spaces will be designed for them and how the theory will be implemented to provide them a therapeutic environment that will stimulate physical and psychological wellness. This will create an impact on their medical outcomes, work productivity, and overall experience while in the hospital.
Through the Wellness Supportive Approach, CLKTI is designed to be a harmonious healthcare environment specific for kidney and transplant patients empowered by social relationships, nature, and perceived control.
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