Mardelle McCuskey Shepley

Recommended standards for newborn ICU design, eighth edition

This is the eighth edition of the Recommended Standards for Newborn ICU Design. It contains substantive changes in recommendations for patient room size and feeding preparation areas, and a number of refinements of previous Recommended Standards with respect to family space, hand hygiene, lighting and other aspects of the newborn intensive care unit (NICU) design.

The impact of single family room design on patients and caregivers: executive summary

Objective:To explore the implications of the single family room (SFR) care environment of neonatal intensive care units (NICU) compared to Open-bay, Combination and Double-occupancy configurations, focusing on family experience, neonate outcomes, staff perceptions, cost and environmental design.Study design:This study uses a multimethod design with 11 Level III NICUs. Space allocations, construction costs, staff preferences and perceptions, and occupant behaviors were evaluated.Results:SFR NICU design provides solutions for increasing parent privacy and presence, supporting Health Insurance Portability and Accountability Act compliance, minimizing the number of undesirable beds, increasing staff satisfaction and reducing staff stress.Conclusion:The analysis of this study suggests that there are benefits to SFR NICU. This study is an initial, comprehensive effort, the purpose of which is to spawn future, narrower, in-depth studies focused on SFR NICU design.

Open-Bay and Single-Family Room Neonatal Intensive Care Units: Caregiver Satisfaction and Stress

The purpose of this study is to explore the implications of neonatal intensive care unit (NICU) single-family rooms (SFRs) relative to open-bay arrangements. A recent trend in the design of NICUs has been to increase the number of private patient rooms for neonates and their families. Several factors have contributed to the popularity of SFRs, including compliance with the Health Insurance Portability and Accountability Act, which mandates the need to provide patient privacy. Surveys of NICU medical staff (N = 75) explored the preferences and experiences of individuals providing care in two facilities, an SFR NICU and a combination unit with open-bay infant stations and SFRs. The results of this study indicate that SFR NICU design may increase staff satisfaction and reduce staff stress.

The stress-reducing effects of art in pediatric health care: art preferences of healthy children and hospitalized children

Art is assumed to possess therapeutic benefits of healing for children, as part of patient-focused design in health care. Since the psychological and physiological well-being of children in health care settings is extremely important in contributing to the healing process, it is vitally important to identify what type of art supports stress reduction. Based on adult studies, nature art was anticipated to be the most preferred and to have stress-reducing effects on pediatric patients. Nature art refers to art images dominated by natural vegetation, flowers or water. The objective of this study was to investigate what type of art image children prefer, and what type of art image has potentially stress-reducing effects on children in hospitals. This study used a three-phase, multi-method approach with children aged 5—17 years: a focus group study (129 participants), a randomized study (48 participants), and a quasi-experimental study design (48 participants). Findings were evaluated from three phases.

Predesign and Postoccupancy Analysis of Staff Behavior in a Neonatal Intensive Care Unit

This research provides data on behavioral issues associated with the design of neonatal intensive care units (NICUs). Behavior was examined utilizing both predesign research (PDR) and postoccupancy evaluation (POE) techniques; data were collected prior to the remodeling of a NICU and after the remodeling was completed. Infants in the original unit were located in closed bays. Infant beds in the new unit were distributed in an open floor plan with 60% more area. Behavioral mapping, interview, and questionnaire methods were used to examine medical staff activity patterns and perceptions of the modified environment. One hundred twenty-four hours of predesign and postconstruction mapping data were gathered. The hypothesis that the total amount of time staff spent walking from activity to activity would be reduced was not supported, although when the data were weighted to reflect the impact of the size of the large unit, the ratio of time spent traveling to a total unit area was found to be less in the open-bay plan. Trends in the data supported the hypothesis that staff in the remodeled unit would spend more time with infants and families, but the results were not statistically significant. The number of transactions with families, however, did increase significantly. The hypothesis that activities involving supply storage would take less time did not receive support. The amount of time on a single supply transaction, however, did decrease significantly. Conclusions are drawn regarding the behavioral mapping technique used and the efficacy of combined PDR-POE research. Also discussed is the relation between design decisions and implementation of operational protocols in support of these decisions.

The role of positive distraction in neonatal intensive care unit settings

The neonatal intensive care unit (NICU) is a stressful environment for both families and caregivers. Positive distraction is a means of mitigating stress. A review of research reveals that several factors in the physical environment can contribute to positive distraction, the most prominent of which are nature, art and music. Design interventions that provide positive distraction and can be introduced into the NICU setting are window views of pleasant outside vistas, soothing artwork and the ability to listen to music.The neonatal intensive care unit (NICU) is a stressful environment for both families and caregivers. Positive distraction is a means of mitigating stress. A review of research reveals that several factors in the physical environment can contribute to positive distraction, the most prominent of which are nature, art and music. Design interventions that provide positive distraction and can be introduced into the NICU setting are window views of pleasant outside vistas, soothing artwork and the ability to listen to music.

Influences of Physical Environment on Corridor Walking Among Assisted Living Residents Findings From Focus Group Discussions

Walking has multiple physical and psychological benefits for older people. This study explores corridor walking behaviors and perceptions of corridor walkability in assisted living residents. Focus groups were conducted with 50 residents in six assisted living facilities in Texas. The data were analyzed by the constant comparative method. The findings revealed three types of corridor walking: walking to destination, walking for exercise, and walking for interaction. Residents’ perception of corridor walkability was related to the themes of safety, comfort/convenience, and aesthetics. Qualities of design elements that residents used to judge corridor walkability included continuity and graspability of handrails, coverage of carpeted floor, availability of seating, appropriate size of the corridor (i.e., width and length) and the elevator, appropriate locations of activity spaces and restrooms, and presence of artwork, window views, and plants. The findings provide insights to environmental interventions that may promote walking among sedentary residents.

The Impact of Daylight and Views on ICU Patients and Staff

Objective: Using a pre-test/post-test quasi-experimental study in two New Hampshire ICUs, the impact of daylight and window views on patient pain levels, length of stay, staff errors, absenteeism, and vacancy rates were examined. One ICU was operational until 2007, the second opened in 2007. ICU patients were randomly selected from cardiac surgery, pneumonia, and chronic obstructive pulmonary disease admissions of one or more days, 58 from the old ICU, and 52 from the new. Regular medical staff members assigned to the unit between October 2006 and September 2007 (old unit) and March 2008 and February 2009 (new unit) were included. Results: Variables other than unit design had a more significant impact on relative pain levels in each unit. Comparing light levels independent of ICU assignment supported the hypothesis that increased light levels reduce pain perception and length of stay, but the relationship was not statistically significant. One trend, not statistically significant, suggested that view was associated with reduced pain perception. A decrease in incident filings supported the hypothesis that improved natural light and views reduced errors, but results were not statistically significant. Some subcategories demonstrated significance. Mean absenteeism per person decreased from 38 to 23 hours from the old unit to the new (p = 0.05). Average vacancy rates decreased by 25% (from 10.12% to 7.49% staff openings per year) in the old and new units (p = 0.04). Conclusion: High levels of natural light and window views may positively affect staff absenteeism and staff vacancy. Factors such as medical errors, patient pain, and length of stay require additional research.

Eco-Effective Design and Evidence-Based Design: Perceived Synergy and Conflict

Eco-effective design (EED) and evidence-based design (EBD) are two powerful trends currently shaping healthcare architecture. EED addresses whether/how the design and operation of buildings improve ecological value and enhance human health. EBD addresses whether/how the design and operation of buildings support positive health outcomes in the built environment through a growing collection of solutions informed by research and practical knowledge. The primary hypothesis of this study was that EBD and EED are compatible approaches to health facility design, especially when addressing the impact of the environment on human health. To explore this hypothesis, healthcare facility administrators were surveyed regarding their perceptions of the relationship between EED and EBD. Input from focus groups and EED and EBD experts was used to formulate the administrator questionnaire. The study concluded that the relationship between EED and EBD typically was synergistic.

Restorative Design Features for Hospital Staff Break Areas: A Multi-Method Study

Objectives: The study investigated the main restorative components of staff break areas in healthcare facilities, by assessing usage patterns, verbal/visual preferences, and perceived restorative qualities of specific design features found in break areas for hospital staff. Background: Nurses are extremely important to the healthcare industry, and maintaining the quality of nursing care is a central concern for healthcare administrators. While healthcare leaders are concerned about improving nurses’ satisfaction, performance, and job retention, they may overlook the importance of respite for nurses and underestimate the value of designing staff break areas to maximize their restorative potential. Methods: A multi-method approach combined qualitative explorations (focused interviews and narrative survey questions) with quantitative measurements (discrete survey questions and a visual ranking of break-room spaces), and the results were compared and triangulated. Results: It was found that staff break areas are more likely to be used if they are in close proximity to nurses’ work areas, if they have complete privacy from patients and families, and if they provide opportunities for individual privacy as well as socialization with coworkers. Having physical access to private outdoor spaces (e.g., balconies or porches) was shown to have significantly greater perceived restorative potential, in comparison with window views, artwork, or indoor plants. Conclusions: The results of this empirical study support the conclusion that improvements in the restorative quality of break areas may significantly improve nurses’ satisfaction and stress reduction, potentially leading to improved care for the patients they serve.