Thesis Program:

A GENERAL HOSPITAL FOR SEMINOLE

 TABLE OF CONTENTS

Page
Forward • I
Present Conditions • 1

Hospital History • •. 5

Hospital Departments • •• 8

Administration 8

General Business Office 10

Medical Records 12

General Public 13

Diagnostic and Treatment

General Laboratory 15

Radiology 1?

Physical Therapy 19
Pharmacy 21

Patient Care 23

The Patients 23

Nursing. 3.1

Nursery. • • • 3^
Obstetrics 36

Surgical 38
Intensive Care 1;1

Service Departments

Central S t e r i l e Supply. 1|2

Emergency lili
 Page
Dietary Facilities k^
General Supply 1*7
Housekeeping of Laundry k7
Maintenance of Mechanical Equipment kQ
Site 50
Budget 53
Appendix A (Community Statistics) .••...•..
Appendix B (Hospital Distrubution and Statistics)
 Foreward

On April 29, 1971, an act authorizing the creation of the Seminole

Hospital District of Gaines County, Texas became a reality. The district

created by this act is charged with the responsibility of establishing

a hospital or a hospital system within its boundaries to furnish

hospital and medical care to the residents of the district.

With this bill enacted, the board of directors has asked that

the feasability of new medical facilities for the area be studied and

action taken on the recommendations.

RESENT

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 Present Conditions

Gaines County is located on the South Plains of Texas and is on

the border with New jyfexico. The county itself is relatively young,

being created from the Bexar District in I876 and organized in 1905.

The major economy prior to the 1930's was devoted to ranching but

since then the economy has changed to oil and farming. Tha annual

sale of oil and its by-products is estimated to exceed $86,000,000

a year while the farms have an estimated yearly gross of around

$30,000,000.

Population, as well as economic indices, seem to show a moderate

but steady increase during the sixties, although it should be noted

that preliminary census returns for Gaines County show a decrease in

the county's population. The school census shows a peak in I96I4-65

school year and has declined slightly each year since then.

At the present time there are actually three hospitals serving

the population of Gaines County. There \s the Seminole Memorial

Hospital, which is a licensed 28-bed, 22-room faciJity. In this facility

22 beds conform to state standards. The Seagraves Hospital Clinic is

a 17-bed licensed facility. Two out of the 17 beds conformed to state

standards. Also directly North of the county line is the Denver City

Hospital whose trade areg extends into Gaines County. But the Gaines

County facilities also tend to draw people from the Denver City area

and therefore it can be assumed that the loss and gain of people in

the county would be offset and the medical facilities should be planned
1
for the total population of Gaines County. (See composite patient

distribution table).

The community of Seminole also contains one l6-room, 32-bed

nursing home which draws patients from an area of several counties.

Outpatient services are conducted in separate facilities near the

present hospital in Seminole, and there are presently two medical

doctors and one dentist in Seminole and one medical doctor and one

dentist in Seagraves. It is also hoped that new facilities would help

hold these people in the community and also attract more general

practitioners.

The county has recently put into service a county-wide ambulance

service which is run by the sheriff department. There is one unit

stationed in Seminole and one unit in Seagraves.

Another new program has also been recently started in conjunction

with State Hospital in Big Spring. This facility is located in a

vacated doctor's office adjacent to the Seminole Hospital.

Seagraves Clinic Hospital

This is a short term, acute, general medical and surgical hospital

with 17 beds. The supporting service includes laboratory, x-ray,

surgical, delivery, inhalation therapy and emergency. Adjacent to and

connected to the hospital is a suite of offices and examining rooms for

the doctor's use in seeing outpatients.

The land and building are owned by the county and leased to Bill

McCollough, M. D. The building itself was constructed in several stages

and covers the majority of the site. It is one story with stucco ex-

terior walls and plaster interior partitions. The age and character

of the structure does not lend itself to further expansion. A few ^f

deficiencies include the use of hsillow core doors and failure to meet

the minimum standards of the Texas State Department of Health Licensing

Division in the corridors of the patient wings. (For hospital statistical

data see Appendix B ) .

Memorial Hospital - Seminole

This is a short term, acute, general medical and surgical hospital

licensed for 28 beds, but for space reasons, should be considered a 22-

bed hospital. Supporting facilities include laboratory, x-ray, pharmacy,

dental surgical, surgery, delivery, and emergency.

The building and land are owned by the county and operated by an

appointed hospital board. The present facilities were constructed in

1952 and 1953 with the formal opening being on April 11, 195U. There

were three doctors with two examination rooms in the facility at first,

but this section was remedied in the early sixties. The space was

used for the expansion of the pharmacy, bookkeeping area, and small

chapel. Also with the doctor's suites being moved into separate facilities,

a portion of the large waiting area was converted into administrative

functions,
/

The building itself is a one-story structure with masonary exterior

Walls and masonary and plaster interior partitions. This hospital is

considered the best of the present Gaines Coimty Health Facilities.

(For statistical data see Appendix A ) .

Conclusions

It is felt that in the best interest of the citizens of Gaines

County, a single hospital facility located in '^'^nipole nould offer the

best health care for the district. The single facility would eliminate

duplication of hnildings, equimient, supplies, and SDnce. By locat'r--^

the facility in Seminole, which is near the geographical center of the

county, a convenient location for the majority of people in the county

is also achieved. Also one new and modern health facility could prove

quite attractive in helping to bring new doctors into the area.

The size of the hospital cannot be determined by any universal

formula, but several methods will give a general level in which to

work: (l) By combining the total number of licensed beds presently in

the county there would be a total of ii7 beds (28 beds in Seminole plus

19 beds in Seagraves), (2) By using the recommendations published by

the "State Plan" (which includes a use factor) there should be a total

of 50 beds, (3) By using the formula four beds per thousand population,

there would be k times 12 (11,575--preliminary count of population

for Gaines County in 1970), or J48 beds. From these calculations, it

would seem that planning should occur within the range of i;8 to ^^

beds with consideration given to future population and standards x-rhich

must be conformed to.

^•OSPITAL

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 HOSPITAL HISTORY

As the name hospital suggests, the hospital began as a place

in which a commimity discharged its responsibility for offering

hospitality to passing strangers.

The most primitive form of the hospital may have been the cave

in which early man gave refuge to a companion in despair. The earliest

known religions included certain ceremonies closely associated with

healing, and some religious leaders doubled as doctors. Medical treat-

ment was identified as part of organized religions as early as UOOO B.C.

Among the earliest organized hospitals were those in Greece,

Egypt, and India during the pre-Christian era. Greek temples, as early

as 113ii B. C , served as resting places for patients under observation

and treatment constituting what may have been the first medical schools.

Considerable impetus was given to organized medicine by the teachings

and practices of the Greek physician, Hippocrates, b o m about 1^60 B. C.

Even though forms of the hospital existed prior to Christ, credit

for the alleviation of suffering on a widespread basis must be given to

Christianity. The early Christians looked upon the hospital as a re-

fuge for travelers and victims of disaster. Romans who had been won

to Christianity established hospitals for lepers, cripples, the blind,

and the sick poor during the fourth century A, D.

Under the influence of Emperor Charlemagne, many hospitals were

established in the Holy Roman Empire, and it was common to find hospitals
adjacent to monasteries so that nuns and priests could conveniently care

for the sick. The first nursing order is considered to have been the

St. Augustine Nuns, organized about 1155.

Before it was transplanted to this continent, the hospital had be-

come a place where the community discharged another responsibility: to

care for those of its members who were unable to care for themselves.

A rapid increase in the size of communities brought about the separation

of comnnmity members needing care into specialized institutions, and by

the turn of the century, the city hospital in this country had become a

place where the critically ill and the dying poor were cared for. In

less densily populated areas all categories of the materially resource-

less were placed in "poor farms" unless they were able to work, in which

case the responsibility of caring for them was contracted out to the

highest bidder, under a system which was an outgrowth of the Elizabethan

poor law. Traces of this practice persisted into the 1920's.

During the last quarter of the nineteenth century, the Elizabethan

style of assuming the responsibility for those of the poor and otherwise

handicapped, has been replaced by a system of custodial care designed

to protect persons in these categories from exploitation.

Until relatively recently, custodial care was considered dishonor-

able, but it is now thought of as "not good enough" and the word "cus-

todial" has been stigmatized. At the turn of the present century, the

hospital was a place where poor people died, and the role of the hospital

patient was intended for persons who were dn critical condition and had

become financial burdens to society. The majority of the doctor's

patients were simply treated in their own home and unless they were

critically ill, would not go to the hospital.

During the present century, the status of the hospital has changed
from a place where poor people died to a place where most people are

now b o m , are subject to elaborate checkups, are treated for certain

diseases, undergo surgery, and eventually may die.

The hospital has become an integral part of today's m o d e m society.

Within the next few years virtually every American will be covered by

some form of health insurance sponsored by the Federal Government and

paid for by greatly increased Social Security contributions.

Today there is a constant change in hospitals due to both new

technological developments as well as new treatment techniques. Within

recent years, the layout of nursing units have evolved through circles,

triangles, and race track corridors. Trends tend to be toward single

rooms, isolation rooms, hyperbasic facilities, cardiac units and

physical facilities which are designed more for prevention and not cure.

It is felt that the care of people with chronic degenerative illnesses

will fall upon the hospital services within the next 20 years.

Because of the extremely rapid evolution in hospital technologies,

not only the hardware, lighting, air supply, operating room equipment,

but also the very nature and arrangement of spaces required| the hospital

can easily become obsolescent. Flexibility is not the pat answer for

these problems, but it is a basic part.

^ >

>

CO
 HOSPITAL DEPARTMENTS

The chief objective of the hospital is, of course, to provide

adequate care and treatment to its patients. Yet, no other building

contains such a range of functions, each with special space and

equipment requirements interrelated and connected by intricate webs

of traffic patterns and networks of mechanical and communication

systems. Each function is likely to grow and change at a different

rate and independent of all other functions. Therefore, there must

be a constant thought on flexibility.

Additional objectives which the hospital strives to achieve

are such things as easy and adequate maintenance, organizational stability

and growth, financial solvency, medical and nursing education, and

various employee-related objectives. It has been the objective of the

hospital within the past few years to operate as effectively and eco-

nomically as possible but this is not necessarily compatible with the

hospital's tradition of a humanistic orientation and the objective of

the best service to the patient. The best way is not always the most

economical way.

Admini str at ion

The hospital administration is an essential part of the hospital

operation. It reflects more sensitively and directly the character and

organization of the hospital as a whole. The hospital administrator is

the person who oversees the whole process. As chief executive officer.

8
 '.•WF^^'.'A;;"..!!!-

the administrator, is responsible to the board of directors for carrying

out established policies and for all nonmedical activities carried on

in the hospital. Board meetings are held once each month, with the

possibility of an emergency meeting anytime. The attendance at this

meeting consists of six board members, the administrator and assistant

administrator plus two people from the press and possibly the doctors.

The activities range from discussion of current problems with an expert

to watching films or slide shows and regular reports of the hospital

operation.

The administrators' chief responsibilities are as follows: (A) to

run the hospital as an institution—a place where lodging and a broad

number of technical services are provided for the sick (hire, direct and

dismiss personnel on the hospital payroll). He is responsible for the

quality of work and in charge of housekeeping and the upkeep of the

physical plant. When needed, he enforces rules and regulations which

govern the hospital and its relationships with patients. (B) to represent

the Board and ultimately the community in the effort to get the best

available medical care for every patient. (C) to represent the hospital

in its relations with the community, sharing this function with the Board

of Directors.

Much of the administrators' time is spent behind a desk doing paper

work and talking or counseling with employees about various problems.

He uses a dictating and an adding machine frequently in his work. Through-

out the day he must be available to talk with the general public, be it

a salesman, an individual or a couple, somtimes in privacy. The adminis-

trator must put forward a feeling of good public relations. There is

now instilled in the community a very friendly informal type atmosphere

because, as a general rule, most people know each other. The administrator
 10

must also work in close conjunction with the business office if a problem

arises. He must also keep up with the latest developments in hospitals^

and hospital systems. To do this, he must have easy access to many books

and periodicals on the subject, such as his private files. He will need

two filing cabinets and one bookcase for storage of his private research

information.

The Assistant Administrator shares many of the organizational res-

ponsibilities with the administrator and is capable of filling in for

the administrator if need be. The main responsibilities of the assistant

administrator lie in personnel and accounts receivable. Much of his

time is spent in conjunction with bookkeeping and in visiting the various

hospital departments and helping them with any problems. He also uses

a dictating and an adding machine frequently and must be able to discuss

a problem or causes of action with an employee in private. The assistant

administrator must have easy access to the personnel files.

A secretaiy is needed to assist the administrator and handle corres-

pondence work. She will also make appointments if necessary, to see the

administrator, and take all calls for the administrator. If there are

people waiting to see the administrator, it is the secretary's job to

see that they are seated and comfortable. It is not expected that over

three people will ever be waiting at one time. The secretary will do

typing from both dictating machines and manuscript. She may also do some

bookkeeping work from time to time.

The general business office is included within the administration.

There will be three secretaries in this branch. One secretary will be

mainly responsible for posting the patient ledger, one for insurance and

one for admitting and dismissing patients. All secretaries will be typing

and must have access to an adding machine. These secretaries will also
 11

receive and sort mail. There will be one person who will operate a PBX

switchboard. Her main function will be to operate the switchboard but

she will also be able to type or carry on other functions in the general

office. She will also have access to a cardex or listing of patient

names and room numbers and thus serve as the source of information for

the waiting public.

The admitting and dismissing secretary will gather information from

a patient's friends or relatives. In admitting, there may be two people

who admit a patient, for example, parents admitting a child. If no

previous information is available in the hospital on the patient, admit-

ting may take as long as thirty minutes. If information is available

from a previous admittance, the secretary will confirm and transfer the

infoimation from the medical records which she has access to. She will

type this information on standard forms. The patient, when possible or

relatives, must sign the admitting form, if the secretary is talking

with the patient, she will take any valuables or drugs from the person,

place them in an envelope and put the envelope in a small vault or safe

where other important records and docimients are kept.

In dismissing a patient, the secretary will return the personal

possessions and receive payment or confirm billing information from the

patient.

The patient or relatives,usually not more than two people at one

time, may also need to coimsel with the insurance secretary or give infor-

mation to her. This secretary will usually type the information on a form

as it is given, and in most instances a signature will be required on the

form itself.

It will be necessary that this department hire two future employees

 TPT"" -"^

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to ease an overload on the admitting and insurance secretary when the

workload becomes greater. Also, a posting machine for the daily posting

of patients' ledgers will be put into operation and run by the posting

secretary.

The medical records department forms a most important link between

patient care and administration. The medical record, also called the

chart, is initiated upon admission of the patient by typing on a face

sheet his name, address, and other personal information. The face sheet

is placed in a folder, and to it are added thereafter notations and ex-

planations of everything that is done for the patient: all diagnostic

procedures such as Xray, laboratory tests, physical examinations; all

diagnostic findings such as temperatures, pulse and other measures of the

patient's condition; all treatment in Xray, physical therapy, surgery.

Casts, splints, special diets, medication given; all findings of the

doctor, including the autopsy record in the case of death; the date of

discharge; all charges and payments and doctor's orders. The record

thus grows with each entry. During the time the patient is in the hospital,

his record is kept at the nursing station in the patient care divisions,

usually in a temporary metal cover identified on the outside with the

Patient's name and room number. The record must be kept readily available

for making entries and for reference each time the doctor visits the

patient; yet it must be protected from general observation because of the

confidential information it contains. The patient is seldom permitted

to see his record.

After the patient is discharged, the record is removed from the cover,

all entries are completed and closed and the record is taken to the record

librarian. The record librarian will help in the closing of some entries.

She will discard some duplicate items. If the patient reenters the hospital,
 13

she will take his old record from the file and it will start accumulating

data again. Records are stored for ten years, three of which they are

kept in the current file in four filing cabinets, which the librarian

must have easy access to. In addition to helping with closing entries

^7 typing, dictating, or transcribing, the librarian must sort and stack

the records coming out of and entering the inactive files. The records

are usually relatively thin and usually eight to ten of them can be

stacked in a one-inch thickness. The overall size is ^ ' x 11".

The record librarian must also be in charge of the medical periodicals

in the hospital. The periodicals are used by the administrators and

doctors. The doctors usually come here to relax, dictate information

or work on reports when they have time. Many times a doctor wi^es

to sleep for a few hours while waiting for an 0. B. case or other develop-

ments. At other times doctors may read, research or discuss developments

in a case with other physicians or the admGinistrator.

The General Public

The public will come to the hospital for three general reasons:

(1) to be admitted as a patient, (2) to visit a patient, (3) to see

specifically an administrator. The majority of people who come to the

hospital arrive in cars.

Since the visiting hours of the hospital are not specifically set—

the doctor decides when the patient can or cannot have visitors--there

will never be many people waiting to see a patient. Most people will

simply check with information about the room number, and then continue

to the patient's facilities. There should not be over 15 people waiting

to see patients.

A person coming to the hospital to be admitted will probably come

 Hi

with a friend or relatives. He will either go through the admission

process hitnself, go directly to the patient facilities upon entry, or

be attended to for severe injury or sickness in the emergency room, and

then be taken to the patient facilities. In the latter two cases the

friend or relatives will go through the admission secretary and the

admittee should be conducted in a semi-private atmosphere because some

information will be confidential. There may be a slight delay if the

secretary is already busy but if the insurance secretary is not busy,

she should be able to handle admissions also. There should not be over

two parties waiting to be admitted at one time. This is also true for

the insurance.

The people ^ o must wait occupy their time by reading magazines or

newspapers or visiting id.th one another. They will have at their

convenience five vending machines which will provide soft drinks, coffee,

sandwiches, candy and cigarettes. These machines will be checked and

supplied by the Women's Auxiliary i^o also maintain a small gift shop. The

gift shop handles two daily newspapers, two weekly and four monthly maga-

zines. A small selection of cards (20 types on display); four small gift

sets, several small toileture items. It is the Women's Auxiliary's job

to store the vending machine supplies and keep an inventory of items

sold. The shop is opened three hours in the morning and three hours in

the aftemoon during the fall, winter, and spring. During the summer

the Candy Stripers man the shop from 9:00 a.m. until 6:00 in the evening.

A cash box is used to hold the money used in the transactions.

The general waiting public will have access to toilets, one for

men and one for women (two fixtures in each). These are used primarily

for the convenience of the public. The administrative employees will

have access to private toilets. Some people may wish to make telephone
 15

calls out of the hospital. Many times these calls are private. It

is expectc^dcth at not over two or three people will be calling at

the same time and just two public phones should be provided.

A family may from time to time want to be isolated from the

general busiaess of the waiting public. They may have a relative or

friend in surgery or recovery and wish to have a quiet atmosphere in which

to meditate or pray while waiting to here of the patients condition.

The time spent in isolation from the public may be one or two hours,

depending upon the patients condition. The family, after hearing of

the condition, may either stay, if death has occurred, be permitted to

see the patient, go home, or return to public waiting to relax, read

a magazine or just sit.

Diagnostic and Treatment Facilities

A significant part of patient care is given by adjunct diagnostic

and treatment services. All of these are secondary in that they aid the

physician in diagnosis and treatment, are given only upon the physicians

prescription, or perhaps routinely as a standing order. In most instances

the patient goes to the department for the test or treatment but in some

cases such as some physical therapy, (BMR), the test or treatment can be

done at the patient's bedside.

The General Laboratory is where numerous types of testing and

diagnosing takes place. There are two main divisions in testing, the

chemical analysis and the microscopic analysis'.

There will be three people working within the confines of the

general laboratory but one technician will also help in the radiology

department. The testing will include chemistries, bacteriology,

serology, and hem tology. Although much of the testing can be done with
 16

a duplication of equipment each of the procedures must be briefly ex-

plained .

Hematology is connected with the count of red and white corpuscles

and with blood chemistries. Employee's in the laboratory have indicated

that this field represents about seventy-five percent of the analysis done

in the laboratory. One person and only one person will work the test

all the way through to ensure that no samples are mixed and that each

sample is done with the correct procedure. Blood samples are usually

drawn from the patient, by a lab technician just before they are given

breakfast. The blood, which is usually in marked test tubes is then

brought to the laboratory in a hand carried "basket." Once in the lab

the work begins. A quantity of blood is taken from the test tube and

mixed with different chemicals, depending on the nature of the test.

The test may then be placed in a centrifuge to separate the various

properties. After the basic blood characteristics can be studied under

a microscope, t h e findings are then written down in duplicate with one

report going into the patients chart and the second being filed in the

laboratory storage. The emergency blood bank should be readily available

for blood matching, and must be kept in refrigerated facilities. The

blood chemistries require more equipment such as a sink and a fume hood

and up to 20" of counter space should be allowed for this work and

equipment. There should be two microscopes for the laboratory.

The bacteriological work is almost wholly microscopic. The cultures

are grown in petri plates in an incubated atmosphere. The cultures

may take from one day to several weeks to grow and there may be as many

as four dozen cultivating at one time. After the cultures have been

examined the petri plate and the culture are placed in an auto-cleve,

which through heat and pressure, kills all bacteria - The remains can
 17

then be placed in a regular waste recepticle. This procedure is also

carried through by one person who will make a duplicate report after

the analysis.

Chemical analysis of urine, sputum, feces, mucous and other body

elements are also done with the blood chemistries. Most of these elements

are picked up at the nursing facilities in the early morning. All glass

ware (test tubes, slides, petri glasses) are washed in the lab and dried

in a small oven.

Many times patients are brought by wheelchair, stretcher, or on

foot from the patient care facilities to the lab technician at which time

they might be asked for a urine sample, to give blood, to t ^ e an EKG,

a BMR, or an encephalograph (EBG). The EEG requires the insertion of

electrodes into the skull and sensitive instruments for the measuring

of microscopic currents. Because of this all outside electrical inter-

ference must be screened. Patients are usually in a reclining position

when these tests are made and clean linens are required for each patient.

There will be only one patient handled at a time by the technician

and proper scheduling should adLeviate the majority of patients waiting

but on b u ^ days or in emergency instances there might be a slight delay

of five or ten minutes and never more than two patients waiting.

The technician besides diagnosing and analyzing must also see

salesmen and do paper work such as statistics and scheduling. Technicians

do not like to talk with salesmen while testing because of the complexity

of the work and the time involved, sometimes one or two hours, once

testing has started. As was said earlier when a person starts a test

he usually must finish it.

The Radiology Departments primary function is to take shadow pictures

of vital parts of the human body. This process requires costly equipment
 18

which is permanently fixed in place and all activity must occur around the

equipment. This department handles all states of sick patients from

emergency patients with superficial and internal injuries, to completely

or partially paralyzed, to amblatory patients. They will arrive on

stretchers, wheel chairs and on foot and there may be a slight delay

(never more than two patients) before entering the facilities. But,

patients usually come by appointment for a prescribed number of pictures

and the length of stay can be determined to give maximum utilization of

equipment with minimum waiting. The load on the radiology department is

soon expected to justify the use of two Radiographic-Fluor scopic units.

This equipment must be screened by lead from the other parts of the

hospital. Each unit will include a tilt table, rotating table and

buckey reciprocating diaphragm. The hospitals 300 milliampere unit will

be utilized in the new facility and a new more powerful unit will be pur-

chased.

The routine in this department will follow this general pattern.

The patient will be brought to the facilities by an orderly or nurses

aid. Once at the facilities, the radiologist will retrieve a card

from a card file which has listed on it the patients previous x-ray

record. If this is the first time there has been an x-ray, a new card

is typed out. The x-ray's to be taken are placed on the card. The

patient is then placed on the x-ray table in the proper position to take

the needed x-rays. If for some reason the person is not in a hospital

gown, he may be asked to change into one. Gowns as well as sheets and

a pillow may be used in the process of x-raying to help provide privacy

or comfort to the patient. The radiologist will then take from the

unexposed film storage an unexposed film and with small lead squares

mark it as to the picture taken (example right leg (R. L.) left arm (L. A . ) .
 19

The plate is then placed in the proper position in the x-ray table and the

scope positioned. If an assistant is required to help hold the patients

body in position, he must first place a lead lined apron and gloves on

to protect him from the radiation. The radiologist then fires the radia-

tion from a control area. Next the plate is taken from the table and taken

to the processing facilities, free from more radiation and in a dark

atmosphere. If no other x-rays are needed, the patient is allowed to

dress and leave the facility.

The developing of the film is entirely automatic. The developed

film is viewed by the doctor and radiologist on a viewing screen. (There

should be four screens) and the doctor may wish to write or dictate notes

on the diagnosis while viewing the x-rays. The radiologist, after the

film has been studied, will then store the film with the patients other

x-rays for future reference. Because of the x-rays bulky quality, the

folders are 18" x 2ii", they are stored for several years and then

microfilmed. There should be a hundred and fifty lenial feet of shelving

allowed for x-ray storage.

The radiologist must also talk to salesmen and figure patient

schedules. At the present time there is no permanent radiologist on the

staff. Instead a radiologist visits the hospital every week to review

x-rays taken and to assist with and problems encountered by the technicians.

It should be assumed that with the future load on the radiology department

and with the new facilities a permanent radiologist will be hired.

The Physical Therapy unit is another adjunct diagnostic and treatment

facility w>hich the doctor might use to help a patient recover or deter-

mine progress. Physical therapy includes exercise, manipulation, irpssage,

thermal treatment, hydrotherapy and electrotherapy. The patient may be

assigned a routine, all or any of these. Each treatment may take considerable,
 20

sometimes as manj as two hours, and hence this department, while often

busy will not handle a large number of people as say radiology.

There will be one full time therapist and one orderly in the depart-

ment to help, encourage and guide the patient in all of the various

activities. The therapist will also counsel with patients, parents, or

families on the proper procedure to be used in therapy outside the hos-

pital. He may give out brochures or pamplets at this time. His other

responsibilities include the scheduling of patients in therapy and the

purchasing of supplies for the unit.

The main purpose for the unit is to help a patient regain motor control

of a portion of his body. The equipment to be used will include parallel

bars, horizontal bars, three mats, one leg and arm i^irlpool, one full

immersion tank, two mossage areas, one exercise ramp, weight equipment, and

a finger ladder. There will also be a swimming pool for the patient.

By swimming the patients weight is supported and complete exercise of

the body is possible.

To help in the cost and upkeep of the physical therapy unit the commu-

nity will be allowed to use the facilities in the evenings for a small

fee. It is expected that 20 women and 25 men might visi^ the facility in

one evening. Once in the facilities they will need to change into the

proper clothing, A small sauna bath, six people each, is preferred for

both the men and women. Each of these should be accessible to toilet

facilities separate from the main hospital.

Other segments of the community will also use the facilities. The

Seminole Nursing Home would use the facilities from time to time and there

are possibilities that the present hospital structure, when vacated,

will be used for an extended care facility which could use the therapy

department.
 mm

21

The patients will use mainly the exercise equipment, hyctrotherapy

tanks, the pool, the toilets and the massage tables. There is a need

for sheets by the massage tables and towels are also a need at various

points.

Some patients will receive therapy in other ways. If a patient is

well enough to sit in a wheel chair or walk for short period of time,

they may wish to entertain visitors or eat a meal away from their bed.

The change in atmosphere should be a bright spot in the routine of the

patient and a psychological lift. Many times the patient may wish to

just sit, soak up some sun and get away from the hospital routine and he

may stay here for a few hours. There is usually not over five patients,

(with two visitors each) here at one time.

The Pharmacy is an important and at times indispensrble adjunct to

the doctors care of the patient. Drugs are given to the patient only

upon the doctors prescription, although the drug itself is often administered

by the nurse. The dispensing of drugs to the hospital patient and not the

outpatient is the main function of the pharmacy.

A running inventory of all drugs is kept in the pharmacy. There is

one medication nurse, one each shift (three shifts) and she is the only

person who takes drugs from the pharmacy. When she takes a drug out she

will write what has been taken and the quanity on a card. This card is

lodged into the inventory by an L.V.N, who will be in charge of all dis-

pensing in the pharmacy, central, and sterile supply. This L.V.N, will

be responsible for the ordering of all supplies needed in these areas as

well as insuring that the drugs remain potent and stay in good quality.

As long as the medication is being used by the patient, it will remain at

the nursing facilities in the patient care unit. When it is no longer needed

or the supply runs out, the bottle or package is returned to the pharmacy
 22

and checked in. Small pharmacutical items (doses of cough syrup,

aspirin, etc.) are kept in a "Brewer Machine" and are dispensed

much like a vending machine when the medication nurse places a card

and her key in a slot. The supply of this machine is also handled

by the L.V.N.

Cabinets, drawers and shelves are required for the storage of several

hundred chemicals and pharmacUticals in various forms and strengths,

which come in all types and sizes of containers. Although, it is more

economical for the hospital to purchase large containers of drugs, it

usually cannot do so because of health regulations which do not allow

transfer to smaller containers. There should be at least 125 lenial

feet of storage space. In addition to this, there must be a section for

the keeping of narcotics. As a general rule the L.V.N, in charge of the

pharmacy will be the only person who will have access to the narcotics.
TIENT e
^
 Patient Care Unit

The quality of patient care based upon the needs of the patient

should be a major factor in determining the size of a patient care unit.

There are many types of illnesses and patients, and in the patient

care unit the healing process for the patient begins. The main tjpes

of patients taken care of in the hospital are:

(1) Medical Patients - The medical patient is being treated by a

medical doctor or specialists in medicine and receives full nursing

care in and out of bed. He is likely to use both diagnostic and treatment

aids. His treatment may include rest, control of diet, medication, and

atmospheric control. Through medicine the way is made clear for nature to

effect a cure, aided by specific treatment. This process involves time

and may be accompanied by complications. Hence, the patient in medicine

can be expected to stay longer than other types of patients. An average

length of stay of about ten days for medicine, six or seven days for

surgery and five days for obstetrics could be generally accepted.

(2) Surgical Patients - Unlike the medical patient, the surgical

patient usually has his disorder diagnosed before he enters the hospital

and generally a surgical operation is indicated fairly soon after admission

and the post operative time is kept as short as possible. Some treatment

or therapy may be required after surgery.

(3) Maternity Patients - Techniques used here are essentially the

same as in surgery though most patients are uninfected and special

precautions iare necessary when infection appears.

23
 Medical Pa.ioats

Laborat-pry
\±iiission

Patient Care Bm-SKa-ss'jr

Internal .leaicine Pharmac

iJischarge Physical medicine

I Joetor3 lockersk-

Sorub I
jiiission ^ v^
Patient Gire
ses .ockjrs ^

Storile 5Upply|

scharge ^ •Intensive Care

Surs'ical p.itients
I N I . I I • •
 2ii

(U) Psychiatric Patients - Psychiatric patients resemble those in

medicine, however, hospitalization will be very limited since the new

psychiatric "outreach" facilities will have the patients transferred to

the Big Spring State Hospital when needed.

The size of a patient care unit must be based on meeting the needs

of every patient. In current practice, the head nurse is responsible for

the prescribed and routine care of all patients in the unit. The number

of patients a nurse can direct depends on many things; her own characteris-

tics, education, training, help and other factors. But it is generally

considered among nurses, all levels of administration, nursing education,

physicians and administration that 30 to 35 appears to be the maximum

number of patients that one nurse can direct successfully. Reasons for

this are: (A) The head nurse must be fully aware of the needs of all of

the patients as well as the staff. When census of the unit exceeds 30 to

35j the nurses span of control is weakened; ( B ) Staff morale and the quality

of patient care are decreased when, because of a large census, the head

nurses are unable to receive and/or assimilate a full report on each patient

or visit each patient at least once a day; (C) Relationships between medical

and nursing staffs are strained when the volume of work is compounded by a

larger census. The head nurse is unable to provide the kind of information

and observation desired by the physician; (D) Orientation of new and tem-

porary personnel is more difficult with a large census due to increased

"Business" of the unit. There should, therefore, be at least two nursing

units within the patient care unit of 50 beds in order to provide for the

needs of the patients.

Patient Care

Hospitalization at the present time tends to decrease the patients

 25

sense of social cohesion by separating him from his natural environment.

Once admitted the patient is shown to his bed and until the time he leaves

the hospital this bed will be the focal point of his newly acquired

environment. The patient will receive visitors from bed, he will eat in

bed (either recline with the head rolled up or sitting on the side) he

will read from bed, watch television or in short adapt his bed and the

surrounding environment into all the many and varied functions of livings

The patient may venture from his bed to other parts of the hospital but

it will remain as a fixed reference point away from home. The bed must

be designed to support the patient in a sitting as well as reclining and

may be adjustable in height. The patient at times may fall out of bed and

restraints should be provided to keep this from happening. Many devices

are attachable to the bed such as frames for suspension of gpi arm or leg

in a cast or for traction. A support to hold intravenous fluids and

possibly a reading light could also be attached. The patient from time to

time may need to be hooked up to an oxygen supply or miscellaneous electrical

machines such as for lab tests. This equipment should have connecting

outlets near the patient's bed.

It is difficult to generalize about the demands and needs of a patient

because every person differs so widely. However, the majority of patients

will undergo much of the following procedures.

First, the patient must make the trip to the hospital (usually comes

by car or ambulance) and enters on foot or by stretcher or wheelchair,

either through the emergency facilities or through the general admission

in the Administrative Department. Next comes the admission interview

for essential personal facts and then a trip to the patients bed, escorted

usually by a nurses aid. The patient must next disrobe and place a

hospital gown, or his private sleeping garments on. The patient's clothes
 26

are kept (usually hung) nearby. The patient will many times bring with

him a small travel bag which contains toiletries, such things as a shaver,

hand mirror, comb, purse, toothbrush, etc., and these are unpacked and

placed within access to the patient and the handbag is stored. The nurse

will check and make sure that the patient has no medications in his

possession. The patient is next given a physical examination; sometimes

in his bed or elsewhere in the patient care unit, depending upon the

extent of the procedure. His condition is diagnosed, if not known or

confirmed through the diagnostic aids such as the laboratory or x-ray.

Upon completion of the diagnosis the patient may be involved in one

or more of the following corrective procedures. He may be prepared for

surgery, (some anesthesias are given before the patient is taken to surgery)

and undergo an operation; a woman might proceed to labor and obstetrical

delivery; there might be medication of all sorts (shots, and pills given

by the nurse usually while the patient is in bed); he could undergo x-ray

therapy or physical therapy; and could receive counseling from the doctor.

In every case the patient will stay in the hospital more than a few

hours and therefore, he is the subject to detailed nursing procedures

which include: feeding, usually three meals a day, bathing and personal

grooming, voiding and evacuating, the taking of temperature and pulse

at regular intervals, the giving of pills, liquids and hypodermic injections,

questioning, and entertainment such as listening to the radio, watching

television or reading.

If the patients progress is satisfactory he will be discharged in

vAiich case he must: pack his personal items and dress, go through

billing or paying procedure, and return home.

If the patient should die there must be the procedure of removing

the body, arranging for an autopsy, which is done in the funeral home,
 27

ministering to the family, returning personal effects and settling the

hospital bill.

During these procedures, the patient as a human being and an individual,

may be lost in the somewhat mechanized systems of the hospital. He will

become supersensitive to his physical surroundings and reacts sharply to

noise, smell, glare, color, heat and cold, lack of privacy, and the atti-

tudes of all those who he comes in contact with.

During the course of a day in the hospital, a patient might have a

schedule very similar to the following:

7:00 A.M. - The patient is awakened, washed and made ready for breakfast

by raising the head of the bed. The temperature and pulse

is taken and recorded on the patient chart. If a blood

sample is needed it is also taken by a laboratory technician

at this time. Some patients also go to x-ray, BMR or surgery

before breakfast.

7:30 A.M. - Breakfast is served. The food tray is placed on a stand, which

extends over the bed, or in a convenient spot for the patient

to eat. The tray is removed after the patient is finished eating,

7:l40 A.M. - The morning paper is delivered.

8:00 A.M. - The patient visits the toilet facilities. If he is restricted

to bed then a bed pan is used in the removing of body wastes.

(The nurse will empty the bed pan in the toilet which has a

washing attachment. A bath is given, the hair fixed, back

rubbed, and general hygeine procedures followed.

9:00 A.M. - The patient receives medication, if required, and will on

regular intervals.

10:00 A.M. - The bed linen is changed by the housekeeping department while

the patient is in x-ray, therapy, surgery or forany other reason

 28

out of the bed. New linens are carried in and soiled linens

are carried out.

10:30 A.M. - The housekeeping department cleans the patient facilities.

(empties wastebaskets, ashtrays, dusts)

11:00 A.M. - The patient is visited by the doctor, a nurse and possibly

two medical students and the patient care is discussed. The

doctor may examine the patient at this time or just check

the charting records.

11:30 A.M. - The nurse prepares the patient for lunch by washing hands.

12:00 P.M. - Lunch is served with the same procedure as breakfast.

12:30 P.M. - The patient is given an opportunity to nap, watch television

or read. The nurse continues with the taking of pulse,

temperature and medication. The mail and flowers are delivered.

2:00 P.M. - The patient visits with friends or relatives that have dropped

by.

3:00 P.M. - Medication is given and the patient orders juice for a snack.

3:30 P.M. - The patient goes to take an EEG.

U:00 P.M. - The patient has more idol time. The patient may talk on the

phone, if allowed, read, nap, listen to the radio.

5:00 P.M. - The patient is cleaned up and prepared for dinner by the nurse.

5:30 P.M. - Dinner is served.

6:30 P.M. - The patient summons the nurse for a bed pan.

7:00 P.M. - The patient has more free time.

9:00 P.M. - There is more medication and the intravenous solution is

renewed. The solution must always be above the patient and

the bottles are usually equipped to be hooked up.

9:30 P.M. - At this time the patient is made ready for sleep. Medication

is given throughout the night.

 29

Although patients needs vary greatly the hospital can be meeting

the minimum physical needs and by giving attention to the psychological

and spiritual needs of the patient, achieve an atmosphere under vdiich

conducive treatment and care prevails.

The occupancy rate for a fifty bed is normally around 65^. In

a samll county hospital such as this there is need a large reserve of

beds in proportion to the total space allotted to patients. In other

words, the hospital usually needs three beds for an average of two people.

Most people prefer separate or private bed facilities. With this the

majority of people are happy, the chances of cross infection are lowered,

and an increase in the occupancy rate will occur. There should be facil-

ities for placing 35 beds in private conditions. The people ^ o will

not use the private facilities are those who have insurance which rates

a double occupancy requirement or people who wish to pay a lower rate.

If beds are placed in close vicinity to one another they must still

have some means of providing privacy. The beds must be at least 3'6"

apart and preferably h' to allow sufficient clearance for the nurses and

staff to Carry out daily procedures. Not more than four beds can be

placed together. There must be room for the nurse and possibly an aid to

move the patient from his bed to a stretcher or wheel chair and back and

for housekeeping to clean. Many times the floor becomes a conglomeration

of stands and wheels which are hard to clean and work around. This should

be avoided when possible. In many instances the patient is likely to have

visitors (an average of 2 or 3) while normal nursing procedures are taking

place and these visitors must not interfei^with the nurse.

From time to time the patient may have a relative or friend stay

during the night. There are three main reasons why this would happen:

(l) If the patient must have constant observation but is not critical
 30

enough to stay in intensive care; (2) If the patient will be eased, for

example, a parent staying with a child; (3) If the husband wishes to

room in with his expecting wife, therefore, providing guidance on a baby

Care to both parents. Although these occasions may not be numerous, they

will exist from time to time and provisions must be made.

The patients siirroundings should be cheerful and provide for the

needs and desires of a patient in a delightful way. At the same time

there are many requirements which must meet the doctors and nurses needs.

Light, for example, requires different levels of illumination for

various procedures. There is need .05 footcandles of light three feet

from the floor for nightlighting. At least two footcandles three feet

from the floor are needed for observation purposes, and ten footcandles

is the general lighting at low levels. At ten footcandles, there is not

sufficient light for detailed reading, such as thermometer, charts or

instructions. A greater amount of light will produce undesirable glare.

For reading there should be 20 to 30 footcandles nine inches from the

floor and for examination purposes the doctor may need 50 to 100 foot-

candles.

Windows are no longer needed for lighting and ventilation and their

primary purpose now is simply for the patient's view. In determining the

size, one must consider: (1) the effect of glass area on air conditioning

and heating; (2) the cost and effectiveness of light or sun control by

curtains or blinds; (3) the problem of maintaining even temperatures;

(U) whether the view justifies viewing; (5) safety and ease of operation.

Noise from many sources (cart wheels, foot steps, ventilating systems)

and following many pathways can be disturbing to the patient and should

be corrected. Ventilation should be designed so that air is not recirciaated

to other patient's rooms for sanitation reasons. The temperature, humidity,

 31

and movement of air, its smells, its freshness, ionization, and dust

content all effect the patient directly and should be controlled to

achieve the desired atmosphere.

Isolation cases will arise from time to time. The procedure of

the doctor or nurse in visiting an isolated patient is (1) to place a

gown and mask on before entering the contaminated area; (2) to examine

the patient or attend to his needs; (3) to discard the gown and mask

into a plastic bag (to be sealed and carried to the laundry) and to

scrub down all areas that were in contact with patient or not screened

from the contamination. This is done directly after leaving the conta-

minated area and before entering other parts of the hospital.

The patient should be able to be seen without entering the contami-

nated area. It is also necessary that the isolation patient have her own

shower, lavatory, and toilet to prevent contamination to other areas. The

restricted zone should be clearly marked and the patients chart is generally

kept just outside this area.

Disturbed patients will also need to be taken care of from time to

time although this will be rare. Because of the sometime violent behavior

there should be caution taken to recess hardware and reduce projections

or sharp corners. The patients stay will be quite short and he will

probably be taken by ambulance to the State Hospital in Big Spring within

twenty-four hours after admission.

Nursing

The nursing staff is built around the graduate nurse also called a

registered nurse (R.N.) who fills all professional nursing positions from

director of nursing to head nurse in charge of the patient care unit. All

R.N.'s are graduates of at least a three year course in nursing. She is

 32

responsible iter all general care given the patients and working with the

doctor she will give constant care and observations. She may be needed for

anyone who requires complex nursing. The R.N. can give intravenous

injections and medications that the nurses cannot.

The lixjensed vocational nurse (L.V.N.) has one year of special

training. She is under the guidance of a doctor or R.N. and can give

baths, feed patients, and give treatment such as changing dressings and

administering simple medications. A practical nurse has the same function

of the L.V.N, but is not licensed and therefore cannot transcribe doctoi«s

orders.

The nurses' aids are under the direction of a R. N. and will perform

such functions as dressing the patient, washing and feeding a patient, re-

porting patient requests, and making beds. She will not give any type

of nursing care.

The director of nurses, an R.N., heads up the nursing staff. She

works closely with the hospital administration as well as the nursing staff

and carries the same hours as the administration, 8:00 - 12:00 and 1:00 -

5:00. Her duties include the scheduling of personnel, conferences with

families, applications and purchasing of supplies. She will also hold

conferences with the nursing staff at various times during the month and

discuss any problems or procedures.

The activities of the nurse's center around the communications, ad-

ministering and charting center of the patient care unit. It is here that

control over the entire unit occurs. Here are kept the medical records of

all patients in the unit except when a doctor requires the record at the

bedside. Here are entered in the record, the many items of detailed daily

information about the patient, and here the doctors and nurses study the

records for information and instructions. The written record contains in

 33

memorandum fonn all that can be recorded about the patient' s condition

and progress. Its usefulness depends upon its completeness and clarity

and upon its accessibility to those who must care for the patient and

help guide his recovery. Hence, a prime concern of the nurse is to keep

the charts accessible and easy to work on. There should not be over two

doctors charting and two nurses charting at one time. The doctor will

need some privacy while charting, as well as dictating equipment for

making personal notes. The different forms are kept within convenient

reach of the doctor and nurse, but not accessible to the public. These

forms usually require one shallow drawer for storage. The ward clerk

usually stays at the charting center. She is usually an L.V.N, and her

duties include: (l) taking incoming calls; (2) making out progress

requisitions; (3) obtaining and returning charts to the medical records

department; (U) making such entries on charts as hospital policy requires;

(5) directing visitors when necessary.

The nurses' aids have nothing to do with charting, but the R.N. and

L.V.N.'s have the patients divided and each will see that their patients'

charts are kept. The R.N.'s paperwork is as limited as possible because

her main function is visiting patients. There will never be over four

people working on charts at one time. There may be six aids, two R.N.'s,

one L.V.N., and possibly two doctors working in the patient care unit

and nursing facilities simultaneously.

Besides charting, the nurses must carry on other activities such

as preparing medication, preparing patient snacks, taking flowers and

mail to the patients, helping in the examination of patients, and working

in the nursery, siu'gery, and central supply.

During the day, a nurse may aid the doctor in a detailed examination

which cannot be conducted in the patient's bed. This n^j involve looking
 3h

at x-rays, detailed probing of the patient's body, and weighing. The

examination will be given on an examination table and a sink and space

for instruments and a treatment tray will be needed during the examination.

The examination is usually held in privacy.

In medication, the drugs are first brought from the pharmacy by the

medication nurse. The drugs which the patient is currently using must

be stored in separated, individually marked spaces, usually not over two

or three small bottles per space. (Some drugs require refrigeration.)

The process a nurse would go t'hrough in preparing medication would be:

(l) wash her hands; (2) read the prescription carefully; (3) insure that

the prescribed dose has not already been given; (k) select the drug out

of the patient's storage space and check the label with the prescription;

(5) in case of dangerous drugs, the prescription should be prepared in

the presence of a witness (who checks calculations, drugs, etc.); (6)

enter the details of the drug administered in the reports section of the

nursing records. The nurse will also prepare hypodermic shots. The pre-

packaged sterile syringes, cotton, and alcohol are kept near by. These

syringes are disposable after use. Many times messages must be left for

the convenience of the other nurses and only R.N.'s and L.V.N.'s are

allowed in the medication area.

As well as preparing medication, the nurses and aids will fix juice

(four or five types) and other convenience foods (cookies, etc.) for the

patients who desire them. This food is strictly for the use of the

patients, and is placed on a small tray or poured from a large refrigerated

container into a glass which is delivered to the patient.

The nurse's aids will also deliver flowers and patient mail to the

patients after it has been brought to the nursing facilities. They will re-

supply items to patient's rooms such as water containers, glasses, hot

 35

water bottles, thermometers, and clean linens. These supplies are stored

close to the nursing facilities and are restocked from central supply

when needed. The linen storage is stocked daily. The aids will also

take stretchers and wheel chairs to a patient when needed. These items

(two stretchers and three wheel chairs) must be conveniently stored for

easy access to all patients. The soiled linen, when taken from the

Patient care unit, is sorted and left to be picked up by a laundry truck.

If some linen is fouled or badly soiled, it is first rinsed out. Trash

taken from the patient care unit leaves in rubbish carts and is placed

in large recepticles outside the building* If the trash has come from

an isolated or contaminated area, the sacks are sealed and taken to an

incinerator. If bulky disposable waste cannot be taken care of by the

patient's toilet, it is taken to a clinical sink, which is an oversized

toilet bowl with a flushing arrangement and a hot and cold water mixing

faucet.

At all times, the nurses must think of cleanliness and this requires

washing the hands before most tasks are started or finished. The nurses

have varied amounts of time to relax during their shift. During this

time, they will talk, drink coffee, and possibly play cards and read.

The nursing staff should have separate toilet facilities from the public.

Nursery

The infants are the hospital's most vulnerable patients to infection

and therefore, they should be provided the best means of care, safety,

and welfare possible. It is a general fact that the optimum number of

full-term infants that can be cared for by one member of a nursery is

eight. There diould be six bassinets in the nursery based on new births

in the previous years. Regulations also require that two incubators for

premature births be included. The infant can sijnply be termed as an

 36

isolation patient and the procedure before entering the facilities are

the same as the surgical unit, but not as extreme. A sterile gown and

mask are worn before entering, and care is taken not to take any foreign

or contaminated elements into the sterile crib area. To help prevent

cross infection between the infants, they must be either completely

separated or there must be thirty square feet per bassinet. If a suspect

infant—an infant who has developed symptoms of a communicable disease—

is discovered, he must be completely isolated from the other infants and

in easy observation of the nurse. There is a need for oxygen and suction

in the nursely.

The nurse's work outside of the isolated area will include: (1)

the charting of the infant's progress; (2) the preparing of formula

bottles. This is done by mixing the desired foimula and placing it in

sterile, prepackaged, disposable bottles and then placing the bottle in

a bottle warmer. The formula must be kept in a refrigerator and the

bottles are replaced by central supply as they are needed. (3) The

examining of the infant, changing of diapers and bassinet bedding* The

fresh linen is stored close by and the soiled linen is placed in a hamper

for delivery to the laundry. The use of various ointments and powders

is necessary for the infant at this time. (U) The nurse might also take

the baby, still in the bassinet, to the m.other's room where it may stay

for several hours at a time.

Many times a viewing window is one of the main attractions of the

public in the hospital, but this window must be of wire glass set in i

steel fraF«.

Obstetrics

The usual procedure for an expectant mother is to be first admitted

and then, when labor begins, transferred on a stretcher to the labor

 37

division which is large enough for the stretcher, and will accomodate

two nurses and her husband. A patient might also come directly from

emergency to labor. Once in labor, the mother is bathed, shaved, and

otherwise prepared for delivery. Mothers usually want privacy at this

time, and the father may be allowed with her. The mother is next moved

from labor into the general delivery facilities on a strecther or a labor

bed. The father is sent to the waiting facilities, where he may read or

smoke.

When it is time for delivery, the procedures are much like surgery.

The obstetrician and his aids scrub and don masks, gowns and gloves as

does the scrub nurse. Anesthetic may be given (techniques are the same

as surgery). Facilities must be ready to receive the new-bom infant and

to clean him and transfer him to his bassinet for the trip to the nursery.

The mother is returned to the patient care division as soon as she is

conscious. The delivery facilities are then cleaned and readied for the

next case. There will be facilities for one delivery at a time. If by

chance there are two deliveries at one time, an operating room will be

utilized.

The delivery facilities are similar to the operating facilities, in-

cluding temperat-ure and humidity; protection against explosion from

anesthesia; nurses' call; suction apparatus; and ceiling; portable and

emergency lights. Running water is not necessary but should be close by.

In cesarean delivery, there must be a heated bassinet and oxygen resus-

citation apparatus. Delivery by cesarean section will be done in an

operating room.

The doctors' and nurses' dressing facilities are used jointly with

surgery.
 38

Surgical

Operating is technically a theraputic aid in which a team consisting

of one or more surgeons, the anesthesist, and surgical nurses operate upon

and care for the patient. The length of time and seriousness of the op-

eration can vary from minutes to hours.

Doctors, nurses, and the patient all must prepare for surgery in

different ways, and this requires advancing into a completely new world

of sterilization. The operation table is the centerpoint of sterilization

and all of the staff must go through certain procedures in order to be

allowed in the sterile area (inner zone). The outer zone will be any-

where within the surgical depairtment but outside of the sterile inner zone,

The doctor will arrive at the hosbital by car or foot from his clinic,

He will enter the hospital by way of a private employee entrance and from

here he will: (1) go to the nursing facilities where he checks charts

and begin his rounds to his patients; (2) wait for developments such as

an O.B. case, or work on records; (3) precede to the surgical department

where he will begin the process of getting ready for surgery.

The doctor first removes his outer clothing and its microorganisms

and dresses in a sterilized scrub suit. The essential purpose of this

is to render personal safety to the patient. Care should be taken to

insure that thorough decontamination processes take place from the time

the doctor enters the surgical department until he enters the inner op-

erating zone. The doctor may wish to take a shower before or after

surgery and toilet facilities must also be provided. There should be

facilities to accomodate eight doctors, although there may not be but two

or three .dressing at one time. From dressing, which ircLuder scrub suit,

cap, and booties, the doctor will precede to scrubbing where he will w^sh

his hands and arms for a stated amount of time. A deep spacious sink is
 39

used for this and care must be taken not to let the hands touch any

contaminated elements after washing (faucets, doors, etc.). Next

he enters the perimeter of the inner zone and is gowned, masked and

gloved. He can then enter the sterile area, usually a 10-foot-diameter

circle surrounding the operating table. Only the people who have

scrubbed are allowed in this zone. After the operation, the doctor will

remove the gloves and mask and dispose of them. He will then re-enter

the dressing facilities discard all surgical gowns, dress, and leave

the surgical department to see the family or continue his daily routine,

A nurse will undergo the same decontamination process when she

enters the surgical unit. There must be facilities for ten nurses to

dress and undress plus toilet and shower facilities. Before the patient

arrives, the nurse will set up all equipment for the operation, including

at maximum two or three instrument tables, solution stands, dressing

stands, pads, stools and special lights, and make sure all equipment

is working. Packs containing sponges and supplies are laid out, ex-

posing the sterile fields, by prescribed techniques. A sterilized sheet

is placed on the operating table and is opened up to expose its sterile

field and another sheet is close by to cover the patient. The circula-

ting nurse, who is not scrubbed, moves around outside of the 10-foot-

diameter sterile field and hands needed items from the outside to the

scrubbed nurse in the sterile zone. There will be one nurse who controls

the surgical department and obstetrics. This nurse will handle the patient

coming to surgery and the distribution of sterile supplies which must be

readily accessible to surgery.

The patient, on the day of the operation, will be given sedation and

taken to the operating room on a stretcher. He is then transferred to

the operating table, shaved if necessary, draped with sterile linen and

made ready for anesthesia. As soon as the patient has been anesthesized,
 Uo

time becomes most important and the operation should begin at once. The

anecttiesist sits at the patient's head during the operation and administers

gas, and watches respiration during the operation. He will report to

the surgeon any significant variations in the patient's rate of respira-

tion or pulse. The storage of anesthesia takes a small space which may

hold cylinders of gas and small bottles. There should be about eight

square feet set aside for the storage.

During the operation, some equipment may be brought in, for example,

a portable x-ray machine, portable view stands or an asperator, but the

majority of equipment, instrument tables, foot stools, sponge rack and

the like are kept on the perimeter of the sterile zone, A 2U-hour

supply of sutures, solutions, trays, instruments and other materials are

stored on the perimeter. Twenty lineal feet of storage is sufficient

for storage of this equipment. The surgeon will also need the assistance

of a clock and x-ray viewer.

Upon completion of the operation, the patient may be left in the

operating room, but he is generally taken back to the patient care faci-

lities to recover from the anesthesia. If the patient is in critical

condition and must be watched or the vital functions must be monitored,

he will be taken to the intensive care unit for recovery. The anesthesist

will stay with the patient until the anesthesia has worn off. The emer-

gency room is cleaned as soon as the patient has left. The sheets and

other soiled linen are placed in hampers and will be taken to the laundry

pick-up point. The instruments are taken to sterile supply and the old

dressing and other waste are disposed of and later inc-Vaerated, The room

is then set up for the next operation.

There should be two general surgical facilities which will handle

chest, abdominal, and cranial operations as well as many minor operations

 lil

on the surface or extremities where general anesthesia is required.

Facilities are also needed for dental surgeiy and cystoscopic

operations. The dental facilities will be for operations such as full

extractions. The patient will be in a dental chair and there a dentist

or nurse will usually perform the operation. Instrument trays, dental

equipment, a spotlight and a water supply must be located near the

patient.

The cystoscopic operations, performed by the urologist, call for

special equipment but only a limited use of general anesthesia. The

patient traveling here need not pass through the main surgical facilities.

In the operation, a special table is used along with two instrument

tables. There will usually be a doctor and nurse performing the operation

and an x-rayimay be necessary. The room must at times remain completely

dark for running view tubes in the urinal track. A sink is used to wash

the patient from time to time and for the disposing of drainage.

Intensive Care

There is a growing trend to extend the provisions of intensive

post-operative care of surgical patients into other areas of patient

care, especially cardiac patients. In this unit, there is constant ob-

servation of either the patient, monitoring devices or both, by the

nurse. The nurse must see that the patient's needs are met and many

times she must asvsume his needs because he may be unconscious or semicon-

scious. She must see that the cathiters are emptied, intravenous solu-

tions are changed, bedding changed, and that the patient is resting con-

fortably. The cathiters are emptied into toilet facilities withia the

unit, and sheets are replenished and taken out every day. The nurse

must have an emergency call to other nursing facilities if help is needed

and the space around each bed must allow for easy "lovpment and t^qnri'eri-in.
 Ii2

of patients. Besides physically caring for the patients the nurse is

also responsible for their charts, which are kept in the unit.

Present I.C.U. facilities can prove a frightening experience for

the patient. In the unit the patient may have no concept of time

because there is never a change in lighting and often there is no

routine in eating since he might be fed intravenously. The patient

knows neither h o w long he has layed in bed, or been awake or i^iat all

the strange instruments are for.

Within I.G.U. there must be provisions for the oxygen, suction,

intravenous injections and other emergency equipment. The hsart

patient within this unit will usually be conscious and may receive

limited visitation which must not interfere with the nurse or other

patients.

Central Sterile Supply

Traditionally this department was part of the surgical operating

suite because most sterile supplies were used there, but recently

it has been grouped with other service departments. In this unit all

items which have been retiumed from the departments (usually surgery)

are cleaned, assembled, put up in packs, sterilized and stored for

distribution as needed. Sterile goods include all instruments used

in surgery, or delivery, or surgery, all basins, certain trays, tubing,

gloves, hypodermic needles, and in fact, anything which might be put

into the patient or come in contact with an opened wound. Pressure

steam sterilization is usually used on linens and instruments. Gas

sterilization is used on plastics.

In the central sterile supply department, the first step is to

wash all beakers, instruments, and all the rest of the iten.^ P S they
 U3

come in from operations. Linens come to central sterile supply already

clean and ready to be put in the sterilizer. Objects are inspected

and repaired if necessary.

The second step is to assemble clean items and wrap them in packs

for protection from contamination in handling. This requires a large

work table with the items easily accessible for wearing in paper or

linen. Each pack is marked for identification and put in trays or

baskets and loaded into the pressure steam sterilizer. After sterilizing,

they go to sterile storage for later distribution.

The items sterilized may be handled on the outside without

contaminating the sterile field inside. When the packs are opened,

say in surgery the sterile field is exposed to the doctor and scrub

nurse who must handle the item.

The facilities for sterilizing have been reduced within the last

few years, and the amount of storage has increased due to the large

amounts of presterilized packaged disposable items bought by the hos-

pital. Sterile and nonsterile supplies have also begun to merge

because of the packaged sterilized qualities. All items used in

surgery as well as many items used in the patient care unit (such things

as thermometer, syringe, baby bottles, dressings, courtesy trays,

sterile soap pads) are stored in central sterile supply. The list is

extensive but it must be noted that all the items issued from C.S.S.

come from cases and are distributed to the different departments as

needed. There should be allowed two hundred square feet for the storing

of these items.

There will be an L.V.N, who is in charge of ordering and inventory

of the pharmacy, central sterile supply and the general storage. Her

job will include: (l) purchasing supplies and drugs, (2) inventorin^
 hh

items as they are received and keeping a running inventoiy, (3) issuing

items from C.S.S. and general supply in small quanities as needed,

(U) the supervising of the sterilizing activities.

Emergency Facilities

Traditionally, the emergency department has emphazied surgery

because of accidents but emergencies also appear in patients who receive

medical and obstetrical care as with heart attack, shock, stroke,

fainting, and sudden fever. The emergency department will be opened

2k hours a day but it will be directed by the on duty nurse' s in the

nursing facilities during the night hours. During the evening and

night shifts, the emergency room will take on some of the responsibili-

ties of admitting but its main function is to provide the means for

true emergency care immediately upon direct admission.

The main functions of the emergency room will be: first, the

reception of patients and attendants and provisions for waiting;

second, the treatment of patients, leading to their discharge, or

referral to a specific department; and third, the housing of some

patients for a short time for observation before being discharged or

admitted.

The patient will arrive either by ambulance or in a private car

and may be brought in on a stretcher or in an wheel chair. If friend?

or relatives have come with him they will be asked to wait outside the

treatment area. There should never be over six people waiting at one

time and they should have access to a public telephone and toilet

facilities. The emergency facilities should accomodate at least two

nonsurgical cases. The nurse or doctor in treating these patientr will

need from simple examination equipment such as p thei-rnonnt-'-- or a blood

pressure machine to a heart defibulator brought from I.C.U. Storage is

required for a small item such as syringe, dressing, shots and towels.

Dietary Facilities

The recovery of the patient, in many cases, and the reputation of

the hospital are in a largeraeasiiredependent on nutritious, appetizing

food with eye appeal. The preparation of such food can not happen

unless there is an efficient kitchen and food service. The functional

elements of the service include procurement, preparation, distribution,

and disposal.

The procurement of food is handled by the dietition and she is the

one who does the menu planning, requisitioning of food, and ordering.

The receiving, checking, storing, and issuing of bulk food, except

perishables, are done by a central general store. Perishables go

directly from receiving to preparation centers or refrigerated storage.

The food preparation can be further subdivided into processing of

meats, vegetables, salads, desserts, and pastries. Meat cuts are bought

ready for preparation and are stored in the deep freeze. Sausages,

ground meats, fowl, and soup stock is also stored in the meat refrigerator.

Meat taken from storage is passed to a preparation table anc iiifin en to

a cooking center with ranges, ovens, steam kettles, and deep fryers.

Vegetables are taken from storage to be washed, trimmed, and prepared

for cooking. Salads also originate with the fruit and vegetable re-

frigeration but are made up separately, usually in advance, and stored

in separate refrigerators until ready to serve. Dairy products have

their own refrigerators and are taken out as needed.

The products from cooking, baking, and salad preparation will then

be placed on the individual food trays ?nd sent out to the patient
 he

facilities and served to the hospital staff in the dining facilities.

There may be up to twenty people eating in the dining area at one time.

The dining area will also be used throughout the day by the employees or

a place to drink coffee and chat.

Counter space will be needed for the preparation of vegetables and

salads must include a vegetable peeler, sink, drainboard, and waste

grinders. A range, and oven will serve the cooking, baking, and roasting

needs. A deep fat fryer and broiler are also need along with vegetable

steamers.

Special diets must be prepared from time to time and this must be

done so under the supervision of the dietician.

The nonperishable supplies that will be used for the ensuring

twenty-four hour period will be taken from the general storage facilities

and stored near the kitchen. All cases which have been opened will

stay here until used up. Dry vegetables, and fruits are also kept here

for use in the kitchen.

There will be six employees in the dietary facilities, one cook,

one assistant cook, and four helpers plus the dietician. They will

feed on an average of UO patients a day (three meals) plus twenty-five

to thirty employees at lunch.

As the food carts are returned from the patient care unit the trays

are removed and the soiled dishes are scraped and stacked for washing.

The employees will bring their soiled dishes to the washing facilities.

In the washing process care must be taken to keep the employees who

handle the soiled dishes from also handling the clean dishes. After

the dishes are scraped the stacked dishes will be placed in the dish-

washer. The trays will be washed and sterilezed by machine. After

the dishes are dry they are stored for the next meal.
 hi

Equipment involved in dishwashing will include sinks, food grinders,

drains, dishwashing machine, and counter area for the soiled dishes.

The tray carts, and garbage recepticles will be washed and stored

until needed again.

The dietician will oversee the entire food processing area, and

must be close to the work at all times. Here other jobs will include the

preparation of food schediiles and ordering of supplies.

General Supply

The general supply department is involved in the handling of larger

supplies than the central sterile supply. It will handle such items as

bed pads, all housekeeping supplies, all equipment not being used, (bed

tables, chairs, I.V. stands, extra mattresses and beds), and all bulk

foods, nonperishable and other packaged supplies. There should be a

thousand to twelve hundred square feet provided for this storage.

The items will be received by truck, unloaded, checked and in-

ventoried before being stored. The products will be issued as needed.

The L.V.N, in charge of the department will have an assistant here, as

well as in central sterile supply to help issue.

Housekeeping and Laimdry

The housekeeping department does the light cleaning for the hospital,

gives general maid service, and handles all of the linen. There will be

three housekeepers and they will distribute such supplies as paper towels,

soap, toilet paper, linens, and gather and dispose of refuse. The house-

keeper will work during the daytime hours only and they generally work

from a moveable equipment cart. The housekeeper^ tasks will be li^-'^t,

and the janitors will handle the heavy work, such as washin^: and waxing

floors, replacing and cleaning shades. There will be four janUors and
 148

they will work from various locations throughout the hospital.

All laundry is done by a commercial company. Fresh linen will

be brought by truck twice weekly and the soiled linen is removed

at this time. The soiled linen is sorted and counted before taken out

and the fresh linen is left in bundles.(sheets, pillow cases, towels,

gowns, etc.) and stored before it is distributed by housekeeping.

The service staff should have locker facilities for the kitchen

employees and housekeeping which will allow for the changing into uniforms

and the storage of street clothes.

Maintenance and Mechanical Equipment

The maintenance department is responsible for the repair and

upkeep of the building and its equipment. There is one maintenance

engineer and one assistant and they will have under their control the

four janitors and one yard man (two in the summer months). The engineer

will oversee all operations and has immediate access to all hospital

plans, equipment layouts and site utilities. He must do some scheduling

and make out all work orders, as well as talk to salesmen.

The work of maintenance department has two main functions: (l)

the maintenance of the building and equipment—carpentry, masonry,

plastering, floor covering, painting, plumbing, heating, ventilating,

air conditioning, refrigeration, electric systems, lighting communication,

motors and controls; (2) the operation of the building equipment—boilers,

pumps, heavy equipment, inceneration or ground rnaintenanace, and service

repairs.

The Future

All aspects of the h o s p i t a l are constantly changing due t o the rreat

s c i e n t i f i c and medical advances. The advancer have changed nanr functions

 - »^s

U9

in the hospital and many more will be changed. Examples of the many

changes would be the possible elimination of a post-anesthesia recovery

area due to the improvement of aseptic techniques or in chemical anti-

septic which could eliminate sterilization. Chemotherapy may even reduce

the quantity of surgery. Likewise, equipment is constantly being changed

and made better.

The hospital should, therefore, be able to work within the confines

of the present and still have the ability to change and grow when needed.
s/
^

^
 ^•i!!"

SITE

Seminole is located very near the geographical center of Gaines

County and is the county seat. It is at the merging point of two U.S.

Highways. U.S. 3^5 is a divided highway up to the city limits and runs

north and south. U.S. l80 runs east and west and is presently a good

two-laned road. Right-of-ways have been purchased and procedures have

been started for making U.S. l80 a four-laned divided highway. The major

cities surrounding Seminole are Hobbs, New Msxico, 28 miles; Odessa, Texas,

63 miles; Lubbock, Texas 80 miles; and Midland, Texas, 83 miles. The

people of Seminole rely on these cities for commercial air transportation,

special medical facilities, and as a shopping point.

The present Memorial Hospital facilities are located between U.S.

Highway I80 west and State Highway 211;, the Denver City Highway. The

present site contains 2.72 acres and the majority of it is covered by the

building, parking lots and driveways. Located to the north, the backside

of the present facility, are two out-patient facilities. One facility

houses the two medical doctors and the other facility houses a dentist.

Located directly to the east is another clinic which has been teamed into

the Outreach Facilities m m by the Big Spring State Hospital. (See land

use map.)

The site selected for the new facilities is approximately sir and

one-half blocks and is located directly to the northwest of the present

facilities. This seems the most practical site for the following --asons;

(1) Primarily, it is close to the present facilities, both hospital and cliDlC:

50
 ^

51

Future plans for the present hospital include an extended care unit and

facilities^for the housing of medical students from the Texas Tech School

of Medicine; (2) By this location, no major arteries of traffic will have

to be crossed when traveling from present facilities to the new facilities;

(3) There is no other large tract of land in the vicinity i^ich could be

obtained.

The purchase of the land will be from the Amerada Hess Corporation;

Amerada Division, G. W. Clifford, a private individual; and the Seminole

Independent Sqhool District. The only significant deed restrictions con-

cern the pump jack (well A) and previous well (well B ) , both being on the

perimeter of the site. (See land use map.) The provisions state that

the oil company will not be held responsible for any damage done by line

breakage and that no construction can occur within 100 feet of the wells.

Amerada Hess has volunteered to move the flow line of well A around the

site at their own expense.

The land has a gentile slope to the N.N.W. and is presently covered

in mesquite bushes. There is a sandy top soil with a caliche base.

The climate is mild with an average temperature of 6l degrees. The

annual rainfall measures I6.37 inches with an average of 2 inches of snow-

fall each year.

There are adequate utilities located on the site. There is a 12"

water distribution line running north and south where 9th Street would

run. This line runs directly through the center of the site and is I8"

deep. There is a 6" sewer line running east and west under Northwest

Avenue C. This line is 1;' deep. The only road presently on the site is

Northwest 8th Street and it runs through the east end of the site.

Vehicles traveling to the site will come from -ill parts of the coui.ty

although the majority of out-of-town traffic will come from Seagraves and
 52

Denver City. Exterior traffic includes: (1) patients arriving or leaving

by automobile or ambulance; (2) patients arriving or leaving by foot;

(3) the visiting public should have adequate parking—13 spaces; (l;)

medical staff members should have six reserved spaces; (5) employees

should have 20 parking spaces; (6) delivery of incoming supplies; (7) '

and removal of refuse.

 ~s.
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 jVUXtMMlMJJUm

L A N D USE

Footbcil
Stadium

Baseball
B^eld
Athletic
Facilities

Practice
Field

I • Present \ Youth
' •Clinics \ Center
Piimp-jac)^
Present
Ch*i-fch Hospital • ! arch
•-Outreic
a

"..jradc'' ^

n
r*\r

N
 mm

S^P A D'DlTilO;^ 3 il'' B •> 13 14 a 9 10 il I, 14 e I 3 ,' i .J .'

0 4 :;.25 '24^
(;''» 5 4 3 ? I 7 5 5 4 ^ 2 I
120 'i 71 00 r>4 f>< 60' 7n' rr 77' I rn.n flO 80 'A AO
.i.*i.i'.^j)««J*'«n!rsi«aLit:-!t]J tm.j muMaMnanaixBUj;-iim •K1 •^<>' 6 0
«—hinJiiMrtaat-iiAitx^ rga
N W.
AVENUE
•0^1'
>zo' 501./

SEMINOLE i CONSOLIDATED

SCHOOL DISTRICT CITY • Of

NO. .1
•i )

SEMINOLE CONSOLIDATED SEMINOLE

'Z N.VV. 2
"o .140"

t 1.

SCHOOL DISTRICT GAINES

^ NO. I ; •
HOOL §(65 k 4

7 5 U) «
•• 6

t 7 COUNTY
'» « ! - » • 380

AVENUE NAV.
i-o'
140 16 16 1 •
s\ 1 ^ . ,
s 1

15 13 2 -
J A5\ 2
14 14 3 14\ 3 X

I ' "M A:;^ i

~.<^ 12 12 \
00 i/^ • : ii
6 11
: : )
10 10 7
8
r
o
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,9
CITY 1
.ni<»0
20
o
N.W. AVE.NUE 2 CI
^i
16 16 80" : j
H-
15 ii'- 15 2 • PARK 1
14
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12
11
^

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" ^ MEMORIAL Z ^00* *•

20'
'2 AVENUE
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-.^^' '^0
•2 12 (^*N»,. HOSPITAL
II A 2
2)' '
•• 9 V '7 »
i
i
= 8
5
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WEST AVENUE
i'jO ' 50,-! 80'
12 12 12

II II 11 5 4 3 2

10 W til.
10
4 3
4 ' > )
II
SCSOOL
V

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ijJO'
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14^7- {•^o'^ 140' 140

AVENUE
 ^

O C\ 7^ C

Existing I. xkin^

pyoposed Use of Sxistin^ Hospital

 ,-4H!tH'. . : ^ ^'.i4*i4yii^HJiili^''-

BUDO^
 "mm^

BUDGET

A bond election was held in May of this year for the people in

Seminole Hospital District and passed for the amount of $2,750,000.

This includes the acquisition and remodeling of the clinics to meet •

any new incoming doctors needs as well as the partial remodeling of the

present hospital.

No federal funds have been applied for to avoid any unnecessary

restriction or regulations, but safety stands will meet in order to

receive proper accreditation. The major codes followed will be Hospital

Liscensing Standard and the Southern Building Codes.

53
 PROPOSED BUDGET

For

Seminole H o s p i t a l D i s t r i c t of Gaines County

Memorial H o s p i t a l

E'^tornate for Estimate for

July 22, 1971 Oct. 1, 1971
to to
EXPENSES Oct. 1, 1971 Oct. 1^ 1972
Salary V 60,9214 $328,800
Health and Life I n s . 5.328 8,61^0
Social Security 1,200 17,098
Retirement 12,175 23,016
Administrative 11,813 16,512
Drugs 3,529 21,220
Oxygen 220 1,291;
A n e s t h e s i a , Supplies 287 l,68l4
I ? Solutions 819 14,801
Medical, S u r g i c a l Supplies 3,306 19,385
Nursing Service 213 1,000
Pathologist 61^3 3,770
Cardiologist 357 2,091
Radiologist 1,665 9,693
Drug Consultant 116 900
Blood 5'17 3,032
Lab and X-Ray i,i;-5l 8,398
Utilities 1,-07 7,500
Housekeeping and Bldg. J^laintenance '4,2 3« 25,150
Food Service 3,157 17;100
Equipment l.,630 12,000
Building Insurance 7,700 6,691
Debt Service ? 7 n "1
-0-
TOTAL EXPENSES ^—-;_:
$125,li96
INCOME
cH
Transfer from Couiity $ 39,375 -0-
CollectionG 86,121 ;0l;, 99 7
Current Taxes -0-
TOTAL INCOME r-, r , r-^i A
 TAX STRUCTURE FOR SEMENOLE HOSPITAL DI.ST:lICT OF nAp^o COUNTY

August 1 8 , 1971

100^ Value $639,963,925

Assesment Percentage
Assesment Value $ 86,395,130
Tax Rate li5^ @ 9k%
C o l l e c t i o n Rate $365,li5l
Maximum of 75^

Tax Rate 50^ @ 9\\%

C o l l e c t i o n Rate $1|06,057

PRELIMINARY COST ESTHETE

3d H o s p i t a l 148,900 square f e e t @ $35.00 $1,712,000.00

work O n - s i t e paving & sidewalks 35,000.00
O f f - s i t e paving 8,000.00
scaping 15,000.00
ingency (3^) 53,000.00

Sub-total $1,823,000.00

i t e c t s - E n g i n e e r s - C o n s u l t a n t s Fees (7.863/0) 1143,3^0.00

I n v e s t i g a t i o n & Survey, Testing 3,500.00
p 11 & 111 Equipment ($3750/Bed) 183,750.00
ic A q u i s i t i o n . ? 61,250.00
ic Remodeling ? 90,000.00
Fee for Remodeling C l i n i c (7.863,':^) 20,000.00
Acquisition 1,570.00
Handling, F i n a n c i a l Advisor 5: Legal 50,000.00
r Well? lii,o3^-'^0
irements of A f f i l i a t i o n with Tech Medical School? 6,000.00
tid C l i n i c A c q u i s i t i o n or P a r t i a l Remodel of Old Ho-pital? ^,0,000.00
on handling Equipment Bidding & Purchase? i'4,1450.00

Total $2,750,000.00

Budget As I t
Stands Now
 COMMUNITY SURVEY

State of Texas. County of ...- Ga.ines Q^y of .SEMINOLE

Distance to major cities-...H9.i^b?^ New Mex^^ T e x a s - 80 m i l e s ,
MA^l.^.^.^/----T.?.?^^s..-...8.l3AA.^-?.^..9.4.f.s^^ m i l e s ; A b i l e n e , T e x a s - 185 m i l e s .

CLIMATE
Month Average Temp. Month Avg. Rainfall
Coldest month .. J.an.. 42°.... Wettest month May 2.5
Hottest month July 80 Dryest month Jan. .5
Annual average er Aimual rainfall 16.37" 5^5
Annual Average
Days over 90 degrees 60
Days between killing frost 2 K)
Snow fall 2"

1940 1950 1960 19.7XX

County .8w-13.6. 8.,aQ9. .12.,.26.7. .ll.,5.75..
City 1,760 3^479 5,609 ...5..P.11..

TRANSPORTATION
Air — nearest commercial air service .?.„ miles at .^5„-..?..'...??.?y...^??^.^.H?-
Names of commercial carriers

Nearest local airport — runway length 5./-QQP f t , paved? -X§.?.

Lights? Yes. Instrument let down? 3.9. Charter eind private
facilities at local airport Yes

Rail — names of railroads & no. daily freight trains .None

Truck — no. carriers & no. daily schedules .....Two..car.rier.s...daily...

MAJOR MANUFACTURERS (attach additional pages as necessary)

Name Product Employment Union
Male Female
Hp.n.ey...B.e.e Mfg. Co.. .CamE.e.rs... 6 1 .. No
Cities Service..Oil G a s o l i n e , ..LP.G 20 Yes
Co.l.umb.i.a..Fvie.l...C.o.rp...., S.ulph.ur 8 Yes
For r e s t .Lumb.er .Co.. Me t a.l...P r odu c t s 3 1 No
Phillips Petroleum C o . Natural _Gas^ 10 1 Yes
Seminole Sentinel Newspaper 2 4 No
Seminole News Newspaper 2 4 No
SemlnQl.e...Rea.dy...Mi.x..... .C.o.nc.r.e.te.... 5 1 No
Camp.-S.i.t.e...M_f.g.,_ .Camp.e.rs 15 1 No
Seminole Safety Anc^^^ .^.richprjs 5 1 No
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Finance: As of call dated Qc.t9.^e.?...28.,...1970
No. banks _ ......4-. Total resources ?-?.jt.?2.l7.P.2.?...6.6
Total deposits .?.?./.6.41/.7.7.9. 3 1 T^^al loans ?.i'..1.3.9../.13.6.71
Total capital Total surplus
No. savings & loans .J-. Total «a^«at Asset.s. .$.2.1x9.6.5^.04.1..9.3.
Total deposits ....$.19,.3.7..8..5.46.,.17
Government Installations (List type of facility and employment by military-civilian):

3t5
SCHOOLS
Public Students Parochial Students
Number of:
Elementary schools .3 ly..1.4.3....
Junior highs .1. .....3.4.1.... _..
Senior highs .....1. .§.9.9....
Public schools: no, of teachers .1.1.9 Avg. classroom load ....1.7.
Public school budget 19.7.Q/.71$...2^..0.4.2.,.887.,.00 Bonded indebtedness ?..1.?.434.,.000
Are there needs or plans for expansion?

Denominations of parochial schools

Local colleges _.
Enrollment Colleges within commuting distance F.9.^...y?.i.t.hAn...8.0 . m i l e s

Adult education courses and programs available at public schools, colleges, or other sources:

LOCAL GOVERNMENT
Type city government .MaY.or-Councii No. coimcilmen (including
mayor) .§. Police (no. men) .§- No. police cars
Other law enforcement officers in area .?. -
Fire department: total no. men - Volunteers .?-4. Paid
Description of equipment Four.truc^.,„.one..emeraenc3^.veh^^^

City financing: 19...7.0.. Total operating budget (including water, sewer, etc., but not capital
improvements or debt retirement) ?- '- -*-
Total tax collections ?..1.6.0,.8.0.0.,.00 Payment on bonds & capital ex-
penses $.117 , 4 8 3 ..0.0 Bonded debt — general obligation .$616,.ppp .00
Revenue bonds ....$.3 58.,.0.00...0.0. Does city have zoning? Xe.?.
Does city have a master plan? .Y.e.s
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 Population Graph

11,5^5

GaiTics County ———

oeiiiinole

Segraves
PATIENT DISTRIBUTION BY RESIDENCE
 POPULATION GROWTH
GAINES COUNTY

Year Gaines County Seminole Seasraves

1880 8 - -

1890 68 - -

1900 55 - -

1910 1,255 - -

1920 1,018 - -

1930 2,800 - 505

1940 8,136 1,,761 3,225
1950 8,909 3,,479 2,101
1960 12,267 5,»737 2,307
*1969 13,100 - -
^ **1970 11,575

*Estimated - 1 April 1969 by U.T. Population Research Center

**
Newspaper report of June 2, 1970, giving preliminary census
reports.
 xtMtMbiMMMW

COMPOSITE PATIENT DISTRIBUTION BY RESIDENCE

1 April 1970 Sampling

CITY HOSPITALS ,
Total No. % of
Memorial Clinic of Patients Total
Seminole 476 47 523 37.43
Seagraves 31 620 651 46.59
Loop 3 30 33 2.36
(Gaines County) (510) (697) (1,207) (86.38)
Denver City 10 11 21 1.50
Hobbs, N.M. 37 8 45 3.22
Brownfield 0 32 32 2.29
Plains 2 18 20 1.43
Various (33) 36 36 72 5.15

TOTAL 595 802 1,397 100%

This is intended to show the percentage of patients residing in Gaines

County that are served by the two hospitals combined.
For the true percentage of patients for each hospital refer to the
individual schedules. The apparent conflict between Seminole and
Seagraves in the total percentage columns is caused by the fact that
the sampling of patients at Seagraves was accomplished by counting a
greater number of admittance cards.
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 PATIENT DISTRIBUTION BY RESIDENCE
1 April 1970 Sampling
SEAGRAVES CLINIC HOSPITAL
Seagraves, Texas

City No. Patients Percent of Total

Seagraves 620 77.31

Seminole 47 5.86
Brownfield 32 3.99
Denver City 11 1.37

Fort Worth 1
Gorman 1
Hobbs, N.W. 8 1.00
Lamesa 1
Levelland 1
Loop 30 3.74
Lovington 2
Lubbock 3
Monahans 2
O^Donnell 5
Olton 1
Plains 18 2.24
San Benito 1 I
Sand 1
5 I'
Tokio 6
Welch 6
Wellman
Total 802 100%
 < t

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^ ^ , • * ; , < ; , ' •

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't 1

. y«

MEMORIAL HOSPITAL DATA

J S , :-i : . -•••...

mi
 "^"•"nm 111

SEMINOLE MEMORIAL HOSPITAL (Existing)

April 23, 1970
(Based on 28 Beds)
Page 1
DEPARTMENTAL BREAKDOWNS
NO. DEPARTMENT SQUARE FOOTAGE % OF DEPTS. SQ.FT.PER BED

ADMINISTRATION 1.453 8.21 51.90

lA MEDICAL RECORDS 175 0.99 6.25
IB EDUCATION/TRAINING

IC PHOTOGRAPHY

2. LABORATORY 305 1.72 10.89

3 RADIOLOGY 385 2.18 13.75
3A THERAPY

3B DIAGNOSTIC
4 PHYSICAL THERAPY

5 INHALATION THERAPY

6 EKG. EEG. BMG. CARDIO

7 PHARMACY 127 0.71 4.53

8 OUTPATIENTS 465 2.63 16.60
8A ADULTS

8B CHILDREN
9 NURSING 3,533 20.00 126.17

10 INTENSIVE CARE

PSYCHIATRIC

PEDIATRICS

NURSERY 230 1.30 8.21

OBSTETRICAL 4M0 j_* 58 ^'.71

SURGICAL 763 4.32 27.25

CENTRAL STERILIZING SUPPLY 198 1.12 7.07

EMERGENCY 300 1.69 10.71

 SEMINOLE MEMORIAL HOSPITAL ( E x i s t i n g )
April 23, 1970

Page 2
DEPARTMENTAL BREAKDOWNS

NO. DEPARTMENT SQUARE FOOTAGE % OF DEPTS. SQ.FT.PER BED

18 DIETARY 879 4.97 31.39

19 GENERAL STORAGE 385 2.18 13.75
20 EMPLOYEES FACILITIES
21 HOUSEKEEPING 100 0.52 3.57
22 MECHANICAL FACILITIES 1,025 5.30 36.60
23 LAUNDRY
24 LIVING QUARTERS
24A STUDENT QUARTERS

24B PRIESTS QUARTERS

24C SISTERS QUARTERS

24D NURSES QUARTERS
24E BROTHERS QUARTERS
25 CIRCULATION 4.522 25.60 161.50
26 EXTERIOR AND INTERIOR 2,450 13.84 87.50

PARTITIONS, ETC.

rOTAL SQUARE FOOTAGE 17,660 100% 630.71

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1962

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00 to CM r^ o o r ^ r ^ o o t o r ^ o c n
to
cn r ^ t o t n o (ninroror*>.tororM
rH iN.totor>» L n L n t o t O L n i o t o r « .
ro 00 r>» 00 o o c M r H r r o c n r H t o
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cn cMincnm incMcnhxorooor^
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tn to 00 in inr^CTtcnrHtooro
1966

to rH CO m oorHr>.i^cMcorroo
r-i zi- r-i m orrcMcnoorHrHo
r>«. to r>. rN. r**r^toinrrtoi^to
^ HOSPITiS

^ o r>. r^. oooooocMrrtor<.ro

PERCENT OF' OCCUPANCY

1965

rH ro rr in inoooor^Lnr»^inCT>
• • • • • • • •
* • • • rrrrcMrrvor^roio
ro r^ to ro rrrrmmrrr^ioto
r^ r-* to in
rr O 00 CM o torroorotnocnrr
pa to in CM CM cn r^CMrHOOOOOrHin
OLE MEMO

cn rH to O^ to ooinrHorrtoiOrH
r-i in in in rr intotototDintoi^
ro rr rr o c n o o C T i t o t o r o r r o o
1953

CT) rH r r <o c n c n c n a - r ^ H c M C M
s h.* r^ in «n L n r ^ L n o e n r H L n m
rr in to rr t n a - t n i n r r r r r r r r
CO
to r r r r rr r>. rH (M ro tn to r>.
1962

00 O CM to 00 CM tn rr ro CO i-«»
• 1 • •
rr 00 rr rr • • • • • • •
to in rr ro i o o r > . t D r H r r c M c n
rorrrororrrrrrrr
OOtO OOOCMtOOCMOOCM
to cnrH L n c n m o o t n o o o o r H
en rHtnrHcn oorN.CT>CMr^roCTirr
toiniorr rrmrorrrotorrrr
po to 00 r^ r»^
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to rr r r r r i n t o i n t n L n
CT»
u
(U uu
01 (U
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d }u a "H
to cu ^
(U >» d 4-» o Q) •i-i
C ^ B &! H?I dd rH bo CU -P
d d cu o CD
to 01 to p4 to •-? t^ < CO o
O CU
•^ PH S < S
:2i o
 SEMINOLE MEMORIAL HOSPITAL

SURGERY

^ - 1960

^TH MINOR MAJOR DENTAL TOTAL

luary
aruary
pch
ril
y 10 5 15
ne 18 16 34
ly 11 .13 24
gust 19 10 29
ptember 17 15 32
tober 12 12 24
member 19 12 31
•ember 16 7 23

m - 1961
nuary 17 7 24
bruary 10 11 21
cch 19 10 29
nil 5 6 11
V 14 7 21
ae 13 12 25
9 6 15
Ly ,
TUSt 15 3 18
ptember 8 22 30
tober 9 9 18
member 15 7 22
member 20 8 28

\R - 1962
luary 17 5 22
)ruary 14 9 23
?ch 12 8 20
^il 12 8 20
r 8 6 14
le 16 8 24
14 4 18
-y 22
pjst 18 4
16 8 24
•tember 25
:ober 17 8
15 10 25
ember 22
lember 12 10

SCHEDULE - 9-A
 SEMINOLE MEMORIAL HOSPITAL
SURGERY

iR - 1963

™ MINOR MAJOR DENTAL TOTAL

luary 18 12 30
jruary 14 7 - 21
?ch 14 11 - 25
?il 25 6 - 31
^ 18 14 - ..•;,• : . ' r : . ; 32
le 23 11 - 34
ty 24 6 44
.14 2 35
just 24
)tember 12 9 4 25
tober 14 9 5 29
;ember 14 10 3 27
seiiiber 10 10 3 23
•• 10

VR - 1964

luary 14 10 1 25
jruary 18 6 1 25
?ch 19 10 1 30
?il 18 7 5 30
if 20 6 1 27
le 23 12 6 Ml
Ly 25 6 6 37
rust 24 12 3 39
)tember 17 12 2 31
rober 12 12 1 25
'ember 13 9 2 24
leniber 24 14 3 41

01 - 1965
luary 18 7 3 28
9 2 28
>ruary 17 31
'ch 21 7 3
18 6 6 30
•il
r 18 6 4 28
14 6 1 21
le 25
18 3 4
y 5 9 43
^ist 25 18
itember 10 4 4
21 14 4 39
ober
14 5 6 25
ember 17
ember 11 4 2

SCHEDULE - 9-B
 SEMINOLE MEMORIAL HOSPITAL

SURGERY

[ - 1966

m MINOR MAJOR DENTAL TOTAL

lary 11 11 1 23
?uary 7 7 3 17
:h 24 4 3 31
LI 13 12 0 25
15 9 6 30
3 25 12 5 42
/ 20 8 4 32
JSt 17 9 5 31
bember 10 16 2 28
3ber 5 18 0 23
2mber 13 13 5 29
smber 16 6 1 23

^ - 1967

jary 16 1 2 19
ruary 11 4 2 17
ch 28 7 3 38
il 3 18 0 21
10 9 7 26
o 8 17 8 33
17 4 3 24
/
JSt 19 4 7 30
tember . 1 2 4 7
Dber 19 10 2 31
2mber 18 13 3 34
*mber 5 4 2 11

I - 1968
1 11 5 17
lary
7 6 22
:'uary 9 19
2h 12 4 3
10 6 37
LI • 21
9 4 30
17
2 5 20
3 13
5 6 21
/ 10
8 16 44
ISt 20
2 2 24
:ember 20 19
7 8 .U
)ber 21
imber 11 3 7
6 3 21
imber 12

SCHEDULE - 9-C
ii*. fitiUMM

SEMINOLE MEMORIAL HOSPITAL

SURGERY

R - 1969

TH MINOR MAJOR DENTAL TOTAL

uary 5 7 2 14
ruary 4 5 1 10
ch 13 3 4 20
11 24 3 7 34
13 1 0 14
e 16 5 2 23
y 20 7 7 34
;ust 13 5 8 26
tember w: 8 8 1 17
ober 14 5 1 20
ember 15 6 6 27
lember 26 13 3 42

R - 1970

Luary 40 33 3 76
iruary 26 37 5 68
'ch 35 31 3 69
'il •• : ; . - * . . • •

le
•y
;ust
itember
ober
ember
lember

R -
uary
ruary
ch
il

e
y
ust
tember
ober
ember
ember
SCHEDULE - 9-D
 "•Tflr7hHirnfflftn>lrtftti<r<iai<i i

SEMINOLE MEMORIAL HOSPITAL

MEDICARE PATIENT STATISTICS

(Included in.General Statistics)

(Medicaid Only)
1967 1968 1968 1969

ADMISSIONS 164 235 (24)

IN-PATIENT DAYS 1,472 2,240 (167)

DISCHARGES 168 231 (24)

AVERAGE LENGTH
OF STAY (DAYS) 8.76 9.7 (6.97)
 BIBLIOGRAPHY

Field^^mnna, Patients are Peopl., Hew York: Colvmbia University ft-ess,

Georgopoulos, B a s i l , The CoMminitv neneral H o . p i t . 1 . Kew lork- The

MaoHillian Company, 1962. J-UIK.. j.ne
Ginsburg, F . , "Operating Room Forum: Space, Traffic 55UDD:V Pn„-ir™=r,+
Required Study i n Planning O.R.," L d e ^ / ^ S S t ^ V o ^ . ' S S f
February, 1970, page 118. "—^ ' "^^
Ives, 0. Bernard, "Planning Nurseries for Newborn in the General
Hospital," A r c h i t e c t u r a l Rec^nrH, v o l . I33, March, 1963 m^ec: 179-8?
"Lighting Hospital Patient Rooms" Architectural ZZr^ IJ' i T ' ^^ ^^•
November, I963, pages 192-3. " ~" ' '
Lindheijn, Roslyn, "X-ray and Lab Analysis," AIA Journal. Vol. h^
February, I966, pages U6-^3. — '
M l l e r , Richard, "Hospitals," Architectural Forum. Vol. 11?, October
1962, page 98. ' '
Mills, Angle, "Surface Finishe£> in a Hospital," I n t e r i o r s , Vol. 12^
August, 1965, pages 8 1 - ^ . ' ^'
Mincklet, B. B . , "Space and Place i n Patient Care," American Journal of
Nursing, Vol. 68, March, I968, pages 510-6.
"Planning the P a t i e n t Care Unit in the General Hospital," Architectural
Record, September, I962, pages 172-81.
Robinson, Geoffrt A., Hospital Administration, London: Butterworths, I962.
Rubin, A. P . , "Work of Anethesist" Lancet, Vol. 1, May 30, 1970, Page I I 7 0 .
Southmaid, H, J . , Small Community Hospitals, New York, Oxford Press, 19hh,
Smith, Warick, Planning the Surgical Suite, New York, McGraw-Hill, I962.
Smalley, H. E . , Hospital I n d u s t r i a l Engineering, Reinhold Publishing
Corporation: New York, I966.
Taylor, Carol, In Horizontal Orbit: Hospital and the Cult of Efficiency,
New York: Holt, Rinehart, Winston, 1970.
Voorhis, G. C , "Eraeiigency.Care in Small Hospitals," American Medical
Association J o u r n a l , Vol. 192, I4ay 31, 1965, page 787.
Wheeler, Edwards T . , Hospital Design and Function, New York: McGraw-Hill,
1969.
"Which Nurse Does What," Good Housekeeping, Vol. I6I4, May, I967, pages 190-1
 Thasis:

THli: SSmNOL,^ M3H0-I..L HOSPITAL

James H. Dirks

Architecture 425

Spring, 1972
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CO
 GHANG33 IN THE PaOGR.^M

There were a few minor change3 made 'dthin the pro;-ram itself before

the design process started.

1) On page 13 it v/as found that the librarian would have an assist-

ant to help with the paper work and assist the doctors with charting

Information.

2) On page 14 it was found that three vending raachines would be

suf ricient.

3) On pago 52 the number of visitor parking spices was found to be

inadequate and has been changed to 40 cars. This allows for a visiting

car per patient at 80;^ occupancy, which is a very high occupancy rate,

4) On page 51f in reference to the school iaPiCi boin^; bou-^^ht, it

was found that the school would not sell tae land ouc would let the

hospital use it if necessary. Therefore, 3.1 eCfort should be made to

avoid buildiny; on the land.

W R I T T ^4,
A

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 INTRODUCTION

The desi,;n of the Seminole Memorial Hospital was brought about

to fulfUl the medical needs of the residents of Gaines County in a simple

pleasing way. The hospital, being a public institution, should neither

be officious looking aor overly showy or ostentatious. It should express

a spirit o: kindness, generosity, sympathetic understanding, efficiency,

scientific accuracy, and economy. Much emphasis was placed on planning

and functional re.lationships vri.thin the hospital. It should be noted

that the hospital is not b dnp; built oecauoe of the need for more patieat

care space. Its main purpose is to simplify, update, and consolidate a^-l

present facilities in the county. There is no e/icence to support the

fact that any future expansion to the hoo.ital vriLll be needed, in terms of

patient beds, due to the declining population .vithin the area. However,

due to the constant changing systems within the hospital, I L is necessary

to provide for easy internal change. An emphasis on tills internal change

and maximum control -vith a minimum of personnel played a oi.?; roLe in the

design process.

Site Development

The si be for the Seminole Memorial Hospital iid previously been

selected for reasons seated in the pro^rcim. (pige 51) The rag or f.ow of

traffic to the site is alon^ Northwest 3th Street. (3 ine 2) Since mosL

traf'ic would be usin:^ this approach, it was decided to loo Le Jie main

entrance facing east lor easy public orient :/uion. The eistern side of the
building is also less susceptible to strong winds ..'hich usually come out

of the southwest and rarely from the east. Northwest Avenue C was extended

through the southern portion of the site to ease the load on rJorthwest 8th

and to provide access to service, emergency, and parking areas. People

arriving at the site can enter from Northwest 8th and either proceed to the

parkins area or drop a patient off at the entrance and then proceed to the

parking area. The visitors will park in the eastern parking lot while the

staff will park in the southern lot. A pleasing walk to the entrance from

the parking area is achieved by the use of overhanging trees and a pmall

intimate scale brought forth by the use of brick-lined walks and planters.

The vacated staff parking ar-a will be used in the evening by people entering

the therapy unit during the evenings. The southern portion of the building

is molded around the therapy court and club entrance to the physical

therapy department. The dining facilities and the indoor pool area are

provided with a pleasing view into the court.

All services and emergency traffic are handled on the western si.^e of

building. The vie:.' to the west is the Lea:;t pleasin- -^!? "11 oecause it

overlooks the oil well service operations on Northwest 11th Street. No

windows were used on this side of the building because of the intense sun.

Therefore, functions which do not x-equire dndo'S were placed here. The

emergency area does iiave .windows, buL the mech-inical aroa nets as a shield

against the sun and '.rind for the -norgency enlr_.rije. Tno inuA . ouildinv

and mechanical a.^ea are also connected ny a 30"/^r roof .-diLCh protects ohe

emergency entrance. Till pooulc^r tr ^es also lino tne eninru;:ncv entrance

to he:.p nhield the sun. Doctors' parkin:j: .nd euiQr:;^n::j vehiclo p.^.r::in:j is

provided next LO .he emergency entrance. A. -called area nexL to ^ne ..^..chea

nnovldes for oras'i pick-ap and truck tui^n-u'ound next to tne docx nrea.

The a;.i.iti:;:: :'e also .r su^ht in for the western side od ;di3 site.
 mmm^^s^

The patient rooms are located on the northern si e. By doing this,

full advantage could be taken of the northern lipht and the oest viev/ from

the site. The patient care area is separated from the rest of the

hospital except at the nursing area. Small courts are formed between

the patient care area and other portions of the hospital to upgrade the

quality of the patient view.

Design Analysis

A hospital has inmy interrelated functions and comi.:onents, all of

which enter in;.o the design and decision making process at some time or

another. In analyzing this design, I will examine the larger components

in relationship to each other ind then progress to ihe more intricate

functions within these components.

Ma.jor Components (slide ^)

The major components of the hospital we-e arran;ied to pive easy con-

trol to the nursin,^ staff, especially dunins the nijht shifts idien per-

sonnel './ill be at a minimum. It is also desi;:^necl to Iceep che patient

travel as close to the patient caro unit ns possible, and un :er the supar-

vision of the sta'T ';Jhen at all possible. The nursing unit therefore

becomes the center of all acti-^itv. 4ny travel froia or to the oati^nt

care ani:. is controlled by the nur inp Soalion. A-SO the ennr-ency en-

tr:.nce (admitting staLio.. at nipht), intansiv-^ c ^re uni' (I. J. U.), .nd

nursery c^n be easily s-^en and •.ra\'"eled bo ro:.: tno nursan_: rbicion. .....

entire patient area can tnerofore be fulxp contro^lod .y :n:; or two

nurses, loa^iny the other nurses free to circulrte in the patic-nL care ^;.it.

Circulation froia the patient care nnbt to the diadnoo:ic ?r tre t:aent

f• cilities is also chocKod by the nursinp station. T:iO xioorao,;.ry ...d

x-ray ficiiitles nr^^ locat-d diro;ct^y beh\::' ;he nurslnj anit -o thnt a
 IM

nurse could easily bo summoned from . job ir. the ;rarninr anit if help

was needed in returning a patient to or from a room. Also after leaving,

a patient in the diagnostic <area. the nurse could easily resume a nursin-

function. An eas- access to the laboratory is also ..ecessary because

the nursing staff must be able to check the lab equipment if anyt-dng

should go wrong. The radiology area was placed closer to the surgical and

emergency area to minimize patient travel between the areas when it is

necessary.

The physical therapy department and kitchen ar.. located at the greatest

distance from the patient care area because the level of travel to and

frora these areas is loss and the7 have a higher noise level. The use

of the physical therapy department at nirht by the tov/nspeople also dic-

tated a separate entrance from other hospital functions.

The surgical and eraer^^ency components have a strong relationship

with the nursinr station because of the I. C. U, component. The I. C. U.

component is located, near the surgical irea for use by recovery patients

and close to the nursin ; station for constant care. The ..•r.i urgency com-

ponent can or vievjed b," the nursiny station for control and the emergency

area is next to the sur;pic-il unit for prompt patient c^jro.

The puolic and adainistrativo .i/aa carries on m niy aci.ivities with

the nursing station during .he day. Ml tray-- oy the puolic is controlled

by the nursin^:^ station. Most of the travel along ch::. oo a idor .'ill oe

fr.om the adinmistration and iii.>dicai recoris .arua to ana xrom uae .aLTsin^

station,

:Jrealv'doaan of Coraoonents
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The administration and nualic entrance (slide 5 -^nd 6) is :.cc r.rd

on the eastern ride of the building. The e:vtrance nas a c^.- .red drivr
to protect entering patients from the elements. Visitors or patients

entering are controlled by the P, B. X. operator as soon as they enter.

The waiting area is partially divided and broken up by planters and

plexiglass partitions to allow for some privacy. A small exterior court

is used to afford a special view from the waiting area and also from

some patient care rooms. This court-type setting is then carried into

the patient care area.. Any patient entering the admitting process need

not pass.throughtthe waiting area to get to the patient care unit. Instead,

the patient may be shown to hisroaa by continuing through to the hall.

The admitting and insurance area will be screened completely from the

business office after the two additional secretaries are added.

The library centers around the doctor:^' lounge and administrator's

office and is controlled hy the medical records department. The library

was designed for the daily use oy hosjiitai personnel, although there will

be a monthly meeting of the hospital board in the area. The business

office is designed as an open area vith movable partitions to allow for

easy change as new equipment and employees are added.

The physical therapy component (slide 7) viill be used by the patients

during the day and br the townspeople during the evening, as explained

in the progr.am. There is provided a uuffer of storage between the admin-

istrative and theraputic units. There aro tuo ;.iajor areas, one being the

gym area, and one oaing the vet area containing the pool and hydrotherapy

equipment. Both of these areas aro open spaces idiich allor ''or flexi-

biLlity and ease of circulation. One side of the ptol area is nhe-tned in

glass and has a view into the therapv court.to holp acaieve a pLeaaing

outdoor atmosphere of theraputic value. Tow .snoople en -rin; the unit

from there proceed into the locker facilities and oa into ahe a-.it itselx .
 The diagnostic and treatment component (slide 8) contains both the

radiology and laboratory area. The waiting area for these two functions

was combined and entrances into the x-ray room and examination room
were
all centered off the same space. This enables more comtrol of the area

by one person. Future expansion of the area has been planned into the

space if it is ever necessary. The x-ray rooms will work off one developing

area which leads into the viewing and filing area. The laboratory has

no visual partition in it. Flexibility is achieved by modular plaiining

in terms of desks and the setting of dividing partitions.

The nursing component (slide 9) contains not only the nursing station

or control area, but all activities which the nurse is expected to help

with, or must have for the proper care of the patient. The supply nurse,

an L. V. N., will control the lov/er area of the unit containing the steri-

lizing area, central sterile supply (C. 3. S.), and the pharmacy. The

C. S. 3. is located so that it can b:. easily reached by the nurses in

the patient care area and by the nurses from the surgical component.

Nurses will also have to help in the steriling area. Other nursing acti-

vities from the lounge to medication and pantry are locatad in the nursing

unit to keep the nurse within easy control of function and are.s. The

I, C, U. and nursery are located d-irectly in back of the lursin station

so that they can b- easily reached when needed, yet still not require

the constant oroaencc of a iiuroe. The nursery is al..;0 located lov es^-^yy

view by the public.

The goneraa suaply area (slide LO) v/as locatad to yroride ea.y moving

of bulk suppli^:s "into the kitchen area and tne C. 3. S. area in the nursing

component. It also provides for the storage of soiled and clean linen.

The kitchen area works off a central tray service bac_.uoe the s^, stea

will keep the numt: .^r of employees down and will .arovide a greater patient
 mm

satisfaction with the capacity of the "hot and cold" tray carts. This

system also allows for increased distance in transporting the trays.

The kitchen area itself is kept as flexible as possible b:^ putting much

of the kitchen apparatus on wheels whereby making it easp to create an

arrangement to suit the varying menus.

The different elements of the surgical component (slide 11) .are all

branched off a single corridor which leads into the area. This cooridor

screens out any unnecessary traffic from travel within the area. O^.ce in-

side, the area, patients may enter directly into'the outer sterile zone of

the operating suites or into the other treatment areas. The doctors and

nurses will enter their dressing facilities from this area, go through de-

contaminating procedures and exit into the outer sterile zone to scruo up.

The central core of the surgical area also provides room for temporary

storage of stretchers or wheelchairs for patients in the non-operating area.

The emergency room is also connected to the operating suite by way

of this inner core. The entrance to the emergency room is covered to pro-

tect patients and attendants IVom bad weather. The entr .nee can also be

seen from the nurses sv^ai-ajn for eas: conr.rol.

The patient care unit (slide la) :/as foiaiea. to gave a fi-oasing, rest-

ful, homelike atmospho-e to the patient withDUt loss of control by the

nurse. The nursing station can easily control visitors and all other travel

within the area. Most of the other travel will be bv the hosoital staff

tending their appointed duties.

All patient rooms contain their onn toilet ana shorer, with the lava-

tory located in the patient room itself for use by .ho patiant and a..iff.

The cabinet arrangenent is such to allow far a controiloa view :ut the w...-

dow or an interior view. Located next to the bed is a c ...sole of switches

and ou-tloto biich allow the patient to control his onyiro.iment, call .he
nurse, or meet his entertainment needs. There are no overhead lights

in the room to blind or make the patient feel uncomA)rtable. Instead,

a reading and examination light is provided next to the oed* Reflective

spot lights are on the opposite wall and a Lam* lighting system over the

sink-area, (slide 13) The accoustical ceiling and walls are a neutralized

white, except the wall at the head of the bed, which like the carpet, is

a neutralized aright prluary color to help dramatize the patient. The

furnishings are wood grained and coordinate with the rest of the hospital.

The patient will either have a pleasing vi.aw of the surrounding area

or a view into an enclosed court area. These court areas provide a place

where patients can sit, sun, and relax.or visit with friends if they are

able. The courts are meant to provide a theraputic aid and a mental up-

lifting for the patients and the staff, (slide 1^)

Structural and Mechanical

In deciding on a structural system, the main oojec^ive was to,..achieve

a flexible inner space adiich could adapt to an- nej system or equipment

change. A system of opened weo steel joisting proved suitable for t.ie

necessary spanning, proved lo be within the coot range, inf allowed for

easy coordination of ducts, conduit and pipin;:. The aall oartitions are

made of layers of gyosem roard clipped to metal s.-.u:3. Tnis provides

rapid and dry construction as /ell ns adeaua.e souna .^roofin^ and facili-

tates raceway for electrical conauit and smaller pipes. The aoor in ^he

patient care ar.:a is nylon carpeted to help a. a feel .ng of .ar:a,d. and

friendliness anf to halo cut down on .ha noite lev:!. The ceilings are

a.coustical panels and the corridors ar. If ;ntod oy a row of fluoresce.!

'•i:-:tures hun;; from the :aa.ls.

The exterior stucco tre..tment (.lide 15) .-.a. uscJ .o help achieva a
 10

warm friendly feeling and a feeling of permanence. The exterior was also

designed for low maintenance. The overhang on the exterior of the building

was used to help provide protection from the sun and to reduce the cooling

load,

A forced air system (slide l6) serves all of tna hospit 1 except the

patient care unit. The patient rooms will have ..heir ov/n conditioning

unit working off a four-pipe hot and chilled water system and filtered

fresh air for individual comfort. Return air aill come from all sections

of the building back to the mechanical area located on the west side of

the building. The surgical unit will have its own filtered fresh air

supply and is not returned but exhausted. The area also has an overpressure

to help keep unwanted substances out.