Nursing Times Award Winner

Why every patient should be in sight of a window

“I have seen the most acute suffering produced from the patient not being able to see out of the window and the knots of the wood being the only view” Florence Nightingale 1860

When I was five I caught measles, complicated by pneumonia. I was sent to Hammersmith Hospital in London and nursed in isolation. For the first few days I was in an oxygen tent. I nearly died.

It was the winter of 1963 and the snow was everywhere. We lived in twelve miles from the hospital and my Mum didn't drive. She stayed while I was critically ill but went home overnight once I had passed that stage so that she could care for my baby sister who was also ill.

The building next door was Wormwood Scrubs. Lying alone in my little room, I can remember staring out of the window at the chimneys. Some birds had nested there and I watched for hours as the mother went back and forth with food to feed her young. I was too young to read on my own and I didn't have a television in my room, so it was my only entertainment when I was alone and feeling very weak. I don't remember being sad. I was mesmerised.

Then one day, I didn't need the oxygen tent any more. The big machine that had been behind my bed was moved and my bed was pushed back against the wall. Suddenly I wasn't looking at the birds any more. My view was an empty sky. It wasn't anyone's fault. I didn't say anything. It was just the way it was.

I was a vulnerable five year old. In hospital today there are thousands of patients who have dementia who are equally, or more vulnerable. On their own, they have no voice. All too often they are put in beds that have no view, either because they are not near a window or because their area of the ward only has windows that look onto an internal atrium. Nobody means to be unkind. Staff just don't think 'what if that was me?'

We all rely on a sense of time and space. Generally, we go to bed when its dark and wake up when it’s getting light. People who work nights often wake up feeling disorientated, and they’re more likely to suffer depression. Most of us can be thrown by the slightest change in routine. Remember the last bank holiday? You thought Tuesday was Monday, didn’t you? And when the clocks change, it takes at least a couple of days before your internal timekeeper catches up. So what must it be like if you’re admitted to a hospital or care home, and you can’t see out the window? It’s not just the view you’d miss, but the connection with the wider world.

This is particularly important for people with dementia. I believe that all beds should be in sight of a window. Even if the room is on a higher floor with only the sky as a view, it does at least remind people of day and night. And, by looking at the clouds, or seeing the rain and snow fall, a sense of the weather and passing seasons.

As Brits, we are all fascinated by the weather. Most of us get up in the morning and the first thing we do is to pull back the curtains to look outside and assess the day. It might bring a groan or a smile but, either way, we will get some idea of what to wear. To see the snow and the rain, to watch the trees sway in the wind, to enjoy spring sunshine – these are all things that are fundamentally important to us.

Yet many people in hospitals and care homes are denied this simple pleasure for months at a time. They may have a window in their room but the bed may not face it. Many people are put in the same chair every day and, if it doesn't face a window, they have no idea what's going on in the world beyond that room.

At Kissing it Better, we regularly arrange for groups of young people to visit and learn from older people as part of their syllabus. We ask that the students shake hands with residents and introduce themselves the moment they arrive. The first time we arrived in Home a lady, whose chair was not in sight of a window, gripped a young girl's hand and was surprised how cold it was. The girl told her that it was freezing outside and the journey across the snow had been both cold and slippery.

The lady replied quite simply: 'Oh, has it been snowing?'

It was January 2011. It had been snowing, off and on, for more than a month. Throughout that time she had not been near enough to a window to see the beauty of it.

When my mother was in hospital, following a major brain haemorrhage, she couldn't speak or move. For weeks I asked if she could be moved nearer to a window. I didn't know what her thoughts were but I believed if anything was going to mean anything, seeing the outside world and the changing seasons would be near the top of the list.

But my pleas went in vain. For nearly four months her bed was the one tucked in the corner of the ward, out of sight of any window. When she was up in a chair, I could move her to the window but for the many hours that she was in bed, her view was a bare wall where no pictures from home could be displayed because of the infection risk.

Then, one day, the opportunity to move her to a bed by a window became a reality. But once she was settled in her new space, I realise the window was too high for her to get a view of the garden outside, I asked if the bed could be raised slightly. Like all hospital beds, it had the ability to do almost anything. But I was told that raising it higher than the bed next door would look odd. I asked why that would matter. It wasn't going to block anyone's view and she couldn't move so wasn't going to fall out. What was the problem?

In the end, someone decided that there wasn't a issue after all, so the bed was raised.

But there were more challenges ahead. The curtain that framed one side of the window, even when pulled back, was restricting Mum's view. If the one nearest her could be unhooked at one end so that it could be pushed to the other end of the window each morning, I argued that she would have a wider view and more light. Even better, if I was allowed to open the window, she could feel the air, smell the summer flowers and hear the outside noise.

Such a simple request, but again, not easy to resolve.

I was told that my request to 'unhook a curtain' was a maintenance job and was not likely to happen quickly as the department had other priorities. In other words, I surmised, not likely to happen at all.

So, just like those pupils at strict schools who often choose to break the rules they consider to be stupid, often putting themselves in far more danger than if the rule had never been there in the first place, I seized the moment and jumped onto my mother's bed and unhooked the curtain myself.

The effect was immediate. The light flooded in, and my mother’s eyes slowly turned to the window. It was very moving.

Spurred on by my success, my next move was to contact the rehabilitation unit of the hospital and ask if they could make some bird tables in one of their workshops for the open spaces outside the ground floor windows. They agreed and soon birds were visiting to wash, play and feed on the food, supplied by relatives, all delighted to do something positive to help their loved ones.

We constantly urge hospitals to make decisions based on what they might do if the hospital was their own home. Endless television programmes tell us that the best houses are the ones that seamlessly connect with their gardens and use every possible way of letting in the light, the smells and the noise of the natural world.

Would anyone buy a house without windows, whatever the fancy lighting inside? Yet across the country new hospitals are being built with rooms that have no windows or windows that overlook an atrium. Fine, maybe, for a cloakroom where people spend limited time but not for offices and certainly not for wards. Building hospitals without enough windows to allow people to stay connected with day and night, the weather or the seasons must surely be a step in the wrong direction.

As springtime approaches, enjoy the crocuses, tulips, daffodils and baby lambs that herald the new season. If possible, take your loved one outside to see them. If that’s not an option, make sure they have access to a window so they can delight in these signs of Spring.

Carers of patients with dementia are encouraged to 'open every window to their disappearing world'. Let’s make that literal, and not just metaphorical.

Jill Fraser

Jill Fraser

Jill Fraser

Inspire others: Submit your idea