The Center For Health Design
Why does this study matter?
General medical-surgical units within a single facility tend to have a similar layout, but are often designated to provide specialized care for orthopedic, nephrology, cardiac, neurology, or other specialized patient groups. Few studies have looked at how to tailor a general nursing unit layout to meet the needs of specialized populations. Walking areas for post-operative patients, heightened infection control for wound care patients, and areas to prepare peritoneal dialysis treatments for nephrology patients are among several considerations that would enhance the efficiency of associated nursing work on general nursing units.
How was the study done?
The researchers developed a survey that included demographic questions and 44 questions addressing nursing movement (circulation), communication, teamwork, visibility, facilities and equipment, and the physical environment. The survey was subsequently distributed to several different types of general units including: urology, orthopedics, neurosurgery, neurology, gastroenterology, respiratory, and cardiology. Approximately 125 nurses responded. Additionally, ten nurses, each from a different type of unit, were interviewed. The semi-structured interviews included five open-ended questions and lasted about 30-minutes each. Interview topics included patient care routines, equipment, and the physical environment.
So what do we learn from the study?
From the survey results, we learned that variations based on caregiving activities for distinct patient populations could have contributed to the statistically significant differences in nurse perceptions of walking distance, position of the clinical space, communication privacy, visibility of staff and patients, facilities and equipment storage, acoustics, lighting, and thermal comfort. From the interviews, we learned that although nurses felt there was enough work similarity to justify a uniform unit layout across general nursing units, there were differences in terms of specialized caregiving activities required for unique patient populations, differences in spatial requirements for those caregiving activities for different patient populations, and differences in allocation of space for equipment for some patient populations.
Can we say the results are definitive?
Each unit in this study was described as having two single-patient rooms, four double-occupancy rooms, and 10 three-patient rooms, but there was also an ICU/regular room on the figure provided. The model of care represented with this type of layout and a cursory reference to adding ICU wards to the nursing unit may not represent conventional units. Although the researchers described a pilot study to develop the instrument used in this research, they included no information about instrument reliability or validity. Finally, the discussion section mentions findings from “follow-up field investigations” that are not mentioned elsewhere in the manuscript.
What’s the takeaway?
Deliberate design of outdoor spaces and access to these spaces can not only provide positive distraction to patients, but can also be part of an intentionally designed therapy program. According to participants, patients often found the outdoors motivating suggesting outdoor spaces have the potential to support rehabilitation therapy goals. Including a variety of typological features provides a real-world setting for a variety of passive and active activities and leisure with visitors that can improve user experiences and optimize patient outcomes. Conducting a pre-occupancy evaluation or similar type of assessment in such a strategic way, will hopefully result in a new facility that meets the needs of a variety of user groups.
Interested in the topic? Visit The Center for Health Design Knowledge Repository for more.
Summary of:
Xuan, X., Duan, X., & Feng, Z. (2022). The demand for specialization and its influence on the design of inpatient nursing units: Can standardized design be done once and for all? HERD: Health Environments Research & Design Journal, 15(3), 154–170. https://doi.org/10.1177/19375867221089706
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Yolanda Keys is a registered nurse and brings over 25 years of nursing experience that has included roles as a clinician, leader and academician. With doctorates in healthcare administration and nursing, her research focuses on nurse leaders and healthy work environments – especially the built environment. She is an active member of the Nursing Institute for Health Design (NIHD), serving as president in 2017 and acting as an NIHD liaison for The Center’s Knowledge Repository for many years. She brings a clinical perspective to the research team, as well as a deep understanding of the important contribution nurses can have during planning and design.