Nursing Unit Evolution and History

The role of architecture in development of healthcare facilities is as old as civilization itself. With the development of hospital design, the layout of hospital ward, which is known as inpatient unit, has undergone various changes throughout past centuries. Until a century ago most patients were cared for at home, the hospital being primarily intended for the poor sick. Social as well as medical factors and cultural values have obviously influenced hospital design as well as planning of ward. It is of great interest to observe how at different periods different needs were shaped the planning of a ward.

The hospital ward is a place where patients stay overnight and patient care is given directly to the patient. Now a day to differentiate it from the outpatient department and to differentiate it from the areas of the hospital that not directly given care to patient , it is now called inpatient unit or nursing unit respectively. The history of hospital design shows two type of hospital layout. One of that is designed hospital in which an attempt was made to plan for the function of nursing and other is derived hospital in which all the hospital function are arrange in a building that is built for other function like monasteries, palaces, estates, prisons , barracks etc. In most of the cases, the success of ward design depended until relatively on how well the building form chosen adopted to nursing purpose. For example: the barracks form seemed to make for a better nursing unit than did a monastery or palaces (Thompson& Golden, 1975). According to Thompson & Golden, if we look at the history of ward design, we could find four functional criteria that represent four element of ward design. Those are the healthful environment that it provides for patients, the amount of privacy it allows patients, the extent to which it exercises supervision and control over patients, and the efficiency with which it can be operated. These are all the four elements of ward design. Over the time the concept of ward design is changed. Today [in the United States] the patient room is seen as a place of sanctuary, privacy and safety—the place where the patient and the family are in control of their lives and environment. The patient room can now house the family, if necessary, and can be designed as an extension of the daily life of the patient, with total access to the world (Bobrow & Thomas 2000).

As there is very little evidence of well documented Hospital design in ancient era, the study has been based on review of relevant published literature, reports and evaluations related to the history of hospital ward design in Europe and United States. Therefore, The attempt of this section is to provides a brief overview of the development of the hospital ward and understand the design of nursing unit throughout the history under the following headings.

    • Ancient period: Religious based & Patient focus
    • Dark and middle age: Open ward& Charity
    • 18th and 19th Century– Focus on Advent of scientific medicine
    • 20th & 21st century Ward Design– Evidenced based