Building New Evidence for Nursing Unit Designs

Abstract

This issue of HERD features several articles that focus on the design of nursing units, which is one of the most important units for careful study and consideration when designing a new hospital or renovating an existing facility. The nursing unit is also known as the patient care unit. There is a reason the terms nursing unit and patient care unit are often used interchangeably: patients are hospitalized primarily for 24-hour nursing care. It is true that patients are admitted to hospitals for diagnostic services, medical interventions, and surgery, but in all of these cases, they are admitted pre- or post-event for nursing care. Nearly all diagnostic services, medical interventions, surgery, patient education, and consultation can be done in an outpatient setting, but the need for 24-hour nursing observation and care is the tipping point in decisions to admit a patient to an inpatient setting (whether it is a patient care unit, intensive care unit, or observation/short-stay unit).So imagine my chagrin when, visiting another city for a new hospital opening recently, I heard a television advertisement in which the chief executive officer of the hospital announced to the public that it had been designed entirely by physicians, and therefore the new hospital would be more technologically advanced, patient-centered, and environmentally healing than any other hospital in the region. Perhaps I should stop here and admit my obvious bias-I am a nurse-so I found it strange that my physician colleagues, many of whom spend less than 1 hour per day at the patient's bedside making rounds, would know more about designing a nursing unit than the nurses who work there 24/7 or the designers who have years of education and experience in healthcare design. Although physician input is important in designing any room or collection of rooms (a unit), nursing input is not only important; it is absolutely critical!Physicians are often viewed as the top of the healthcare hierarchy, and they deserve tremendous respect for their years of education and training, but few have had the experience of spending hours or days administering care to patients on a general, acute care nursing unit. Typically the work of physicians is in their offices seeing patients, with the exception of physicians who are hospitalists or hospital based because they perform specific diagnostic procedures or medical or surgical interventions. These specialized physicians usually do not work on a general acute care nursing unit either; rather, they may spend more time in the work flow of an intensive care unit or a radiological, surgical, or emergency department. Nursing units are the work environment of the nurse and other interdisciplinary care partners. Nursing units are also the care environment for patients; hence the alternate name, patient care unit.Changes in the Design of Nursing UnitsIt is hard to believe that only a few decades ago, the nursing unit was a large open ward of beds, and that this design still exists in many countries. Fortunately, great strides have been made over the past two decades to create a more hospitable environment for both patients and healthcare providers. These changes in the design of nursing units have dramatically changed the workflow on the unit, the communication among care providers, the observation of patients, the distribution of supplies, and the medical and nursing documentation process. Significant changes have also been noted in patient room design, with a major emphasis on the all-private room design. Patient rooms now have larger window sizes allowing for better views of nature outside, multiple lighting options, and edutainment systems that give patients full control of both natural and artificial lighting levels and television systems that provide the patient personalized information, health education, and a variety of entertainment choices. All of these changes are meant to reduce patient anxiety and provide helpful distractions from the patient's current state. …