ASSESSMENT OF THERA PEUTIC RECREATIONAL SPACES IN ORTHOPAEDIC HOSPITALS IN MINNA, NIGER STATE

ABSTRACT

There is a growing interest about the impact of the physical  environment  on the recovery process  of patients  among  health  care providers  and designers.  Healthcare  settings  and their surrounding  outdoor spaces are regarded as the most complex and challenging of all public institutions  due to the numerous  activities  carried out within these facilities. ”We shape our buildings  thereafter our buildings  shape us”  this notion  has been recognised and emphasised by researchers  in recent times.   The trend now is to have hospital environments   that  brings  patients   close  to  nature  so  as  to  enhance  their  recovery. However, very little attention has been given to incorporating  recreational  spaces that are amenable in hospital settings as a therapeutic  tool that can aid patients with limitations  in mobility  acquire  or  maintain  skills  that  will  allow  them  to  function  optimally  in  the society.  More also, orthopaedic  patients  often stay longer during recovery  depending  on the severity  of their  injury.  The  aim  of this research  therefore, is to assess  the impact recreational  spaces that are amenable in a hospital setting.  A descriptive research method was adopted  for this study, both quantitative  and qualitative  data were obtained through reviewing  of literatures,  the use of observation  schedule, questionnaires,  and interviews. A  total  of  150  questionnaires   were  randomly   administered   to  patients   in  five  (5) purposively  selected  tertiary  hospitals  in Northern  Nigeria  of which  128  were returned. One observation  schedule  for each hospital  while  interviews  were conducted. The data collected was analysed using SPSS. The results were further presented  in table and chats. Findings reveals courtyards 36%, common rooms 23% are the most available recreational spaces, seating areas 29%, plants 27%, and shades 25% are the major  attractors  to these spaces, patients  asserted  that  gardens  40%  and covered  porches  35% were  located  far away  from the wards,  conveniences  46%  was highlighted  as the least  appealing  space with the hospital. The research brings to fore certain recreational  spaces such as gardens, courtyards,  water bodies,  indoor  gym,  seating  areas, walkways,  and active  sport courts, that  can  be  integrated  in  the  design  of health  facilities  due  to  the  enormous  benefits derived  from them.  Furthermore,  these  spaces  should be located  as close as possible  to the patients in order to encourage participation. This thesis recommends  that orthopaedic hospitals  should have healing gardens and other active land and water based sports.

CHAPTER ONE

1.0       INTRODUCTION

1.1       Background to Study

Orthopaedics  is a branch of medicine that deals with prevention,  correction  of bones, muscles and joints disorder (Oliver, 2010). Accidents are part of everyday life; it can only be reduced  to a minimal  level but may not be completely  eradicated.   The result of accidents ranges  from bums  to dislocation, fractures  or even death in extreme  cases. These injuries or disorders of the skeletal system requires aftermath correction. However not all cases of skeletal disorder result from accidents. Some are caused by congenital anomaly, absence of a limb, or the malformation of one or more limbs.  Other causes of orthopaedic  impairments  may be as a result  of degenerative  diseases  which  includes childhood obesity, arthritis and muscular dystrophy. These can result in difficulty in the joint  movement  and  stiffness  called  contractures  that  would  require  patient  to  seek medical attention from traditional care givers or from a modem healthcare facility.

In Nigeria, as with other developing nations the level of accidents recorded annually still remain relatively high.  According to surveys carried out by World Health Organization (WHO) and Federal Road Safety corps (FRSC) both reported an average of 7000 deaths from road accidents  in 2014  of which  1098  children excluding  2708 injured  victims. Aside  Boko Haram  crisis,  one of the leading  causes accounting  for violent  death  in Nigeria is the number of road accidents recorded annually, this highlights the precarious situation commuters find themselves when plying the roads in the country (Chen, 2016). Although, not all accidents result in deaths, some leave victims needing orthopaedic care such as corrections to bones, muscles and joints.  The poor state of health care delivery system in Nigeria due the state of affairs such as inadequate supply ofprofessionals, poor distribution of health facilities, over stretching of the few available ones has resulted in a large  proportion  of Nigerians  especially  those  in  the  rural  areas  not  having  access affordable health care (Erinoso, 2012). Majority of this populace have had to access other alternative  source  of health  care  such  as  the  traditional  medicine  which  is  readily accessible and affordable  to them.  Subsequently this has resulted in continual patronage of traditional  care givers despite the advent of modem  health  care and the educational exposure (Orjiolioke, 2005). In Nigeria, traditional bone setting (TBS) is relatively extensive  so  much  so that  it  enjoys  significant  patronage  by  the  indigenous  people. However, TBS treatment has it own shortcomings and the outcome of the intervention is usually poor with long time effects on the patient (Dada et al.,  2009).

The Eastern part ofNigeria is mainly dominated by the Igbo ethnic group. Traditionally, the tribe is elaborate about its cosmology that connects wellbeing, illness,  healing  and deviance. According to Nwoko (2009), who   stated  that  in  Igbo  ideology the believe is that every sickness  consists of two main components; the unseen,  or spiritual origin and the seen or the physical  origins. Consequently, various healers are classified as Dibia under the Igbo therapeutic system. The healer is believed to have the ability to serve the role of a mediator between the invisible and the visible realms.  Similarly,  the Yoruba healers (babalwo) are accustomed to playing the role of diviners, engaging the use water based rituals to confront spirits and gods, who are often viewed as principal  cause of deviance or madness (Rinne, 2001). Furthermore, Onuminya (2005), opined that among others, the notion that ailments and accidents have spiritual components that ought to be attended to alongside treatment  is one among many reasons why TBS treatment  still enjoys  enormous  patronage.     However,  Epko  et  al.  (2005),  argues  that  poverty, superstition  and ignorance  are the mam  factors  responsible  for continues  patronage enjoyed by traditional health givers despite complications.  Subsequently, Ogunlusi et al., (2007)  suggests  that  both  traditional  and  modem  medicine  can  efficiently  coexist simultaneously   while   enjoying   patronage   by  patients.  Nevertheless,  the  researcher believes that there are certain knowledge  aspects  of traditional medicine  that cannot be disputed.  This explains why different  regions  in the country pass this vital knowledge down the generational line. Unfortunately, most at times the outcome of their intervention in trauma  care frequently  results  into permanent  loss of the limbs,  lifelong deformities and sometimes in extreme cases leads to death. Hence, the practice is a relevant issue of public  health  which  requires  a thorough  study.  A  thorough  study  of this  practice  is therefore an issue of public health importance.

Healthcare  facilities and their extended outdoor surrounding  are some of the largest and most complex of all public institutions, because of the various activities carried out within this setting.  Generally, people tend to be phobic about visiting (Y~cel,  2013).  Moreover, it is segregated spatially, in the urban layout in people’s mind and entered sole in the case of an emergence or only when the need arises (Neducin et al., 2010).   However, to soften this public perception it is important to introduce a different  design approach away the old philosophy of hospital planning which regards these institutions as a place solely for treatment   of  ailments   (Adams,   2008).   However,   to  eliminate   this  psychological perception of the sick being segregated and distanced from the public there is need for a more  patient  centred  approach  to  hospital  planning  and  design  with  the  growing understanding  on the impact the physical environment can have on the quality of health care and safety of patients,  visitors and staffs.  particularly  with scenic green areas and more outdoor spaces considered as a supportive extension of the interior areas which set aside for the treatment ofpatient and have traditionally been prioritized. The environment within the hospital ought to have the basic things that encourage the enjoyment of nature and to promote a healthy life.  It should help forget weakness,  worries and encourage a positive outlook,  everything in it should be serene and happy. No scene of melancholy, no memorial of mortality  should be permitted to intrude  (Ulrich,  2002).  The increasing interest in research studies all over the world on the benefits of physical surrounds as it affects  health and well-being  is based  on the realization  that good indoor and outdoor design do not only procreates  functional efficiency, but also strengthen health processes (Dilani,   2001).   Furthermore,   Gupta  et  al.,   (2017)  highlight’s  that  The  surrounding landscapes of the hospital is deemed not only essential but also of good benefit.

The importance of nature in hospital environment has resulted in renewed interest with research within this scope documenting the fore deal of nature as being able to subside stress,  improve  healthcare  satisfaction  and enhance  mood  (Ananth,  2008).  There  is, therefore, the need for a patient-centred architectural design ofhealthcare facilities among landscape architects and other service providers (Reiling, 2006). Patient-centred  design (PCD) involves a process were close attention is paid to the design and evaluation of the users of a facility with regards to the outcome of healing processes and the human factors that affects them. The health care designers are required to put in effort as to shaping and reshaping the healing environment, assessing patients need while providing satisfactory healing experiences and achieving a favourable outcomes of perceived service quality (Gutteling et al.,  2008).

1.2      Statement of the Research Problem

Orthopaedic patients are often required to stay relative longer recovering in the wards depending on the severity of their injury,  there is a glaring lack of recreational  spaces (indoor and outdoor) that can aid the patient’s recovery. This lack affects  health care service delivery in the field orthopaedics in government owned hospitals in Niger Sate.

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1.3       Aim of the Study

The aim of the research is to design an orthopaedic hospital that integrates therapeutic recreation within the hospital environment in order to aid in therapeutic healing.

1.4      Objectives of the Study

The objectives of this research work are to;

1.        Assess  existing  spaces  provided  for  recreational   in  orthopaedic  wards  and hospitals.

11.        Analyse  how  outdoor  recreational  spaces  influences  the  recovery  rate  of its occupants

111.          Assess behavioural responses to healing gardens amongst patient and employees of the hospital.

iv.      Propose a design that incorporates therapeutic outdoor facilities that are amenable to hospital protocols.

1.5      Research Question

i.  What recreational spaces can be applied in orthopedic hospital to aid recovery of patients.

ii. How have these recreational spaces been applied in existing orthopedic hospitals.

1.6      Scope of the Study

Orthopaedic hospitals are specialize healthcare  settings devoted to the care of diseases and injuries diseases connecting  the bones  and usually  combines  these three roles of providing   health care delevery, research and education in this field.  Orthopaedic cases can be categorised into:  congenitals and  traumatology.  The research covers five (5) of the ten orthopaedic hospitals in northern Nigeria.  Cases studies were carried out in these hospitals with emphasis on recreational  spaces, such as the general landscape, relaxation spots,  liesure, water features and gardens, its impact on the recovery rate of of patients.

1.7      Justification of Study

Most patients  with  severe cases of musculo-skeletal  injuries or disorder  that require therapeutic care during recovery are usually referred to gyms and other facilities (Dada, et al., 2009).  Hence,  adopting recreational  spaces in healthcare  settings has proven to have a positive effect on the length of stay of patients during recovery.  This however, remains relatively unharnessed due to the limited knowledge on the benefits that can be derived from in cooperating these features in design. The research thus will provide an insight on which recreational spaces has therapeutic values.

This thesis provides  a good understanding  on ways in which therapeutic  recreational spaces can be incorporated in the design oforthopaedic hospitals. Furthermore, this study has contributed  to existing knowledge  by highlighting  the vast impact of therapeutic spaces have on patient recovery and wellbeing. This will serve as a guide in future policy and planning decisions concerning the subsequent orthopaedic hospital designs.

1.9    Study Area of the Research

The location  of the study  area for this research work is within Minna metropolis which serves  as the capital city of Niger state, a state situated in the North central geo-polit ical region  of Nigeria  (Figure  1. 1 ).  Niger  State  is  on latitude  80° to  11 °30′  North  and Longitude 03° 30′ to 07° 40′ East.

Notably, Niger state has towards its East, the Federal Capital Territory and a border with the Republic of Benin in the direction of its West. Niger State has an total estimated land mass covering about 74,244km. There is a distinct dry and wet season and annual rainfall between 1,200mm and 1,600mm from the north to the south of the state,  the highest rate of rainfall is estimated at 150 days in the northern regions and approximately  120 days in the south of the state. The temperature of Minna is hottest between March and June, while the coolest periods are usually in December and January with a maximum and minimum temperature  of 42°C and 22°C respectively

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