NICU Design: An Opportunity for Change

Abstract

Ulrich and Zimring 1 performed an extensive review of the literature as it pertains to the physical environment of care and patient and staff outcomes. They presented solid evidence for reduced staff stress and fatigue in optimal physical environments, while increasing the effectiveness of delivering care, improving patient satisfaction, reducing patient stress, and improving the overall quality of health care. Newborn intensive care units (NICUs) around the world are now being redesigned as evidence is mounting to support the belief that the physical environment has significant impact on those who live and work there. A recent trend in the design of NICUs has been to increase the number of private rooms for the care of critically ill or preterm newborns and their families and incorporating the single family room (SFR) into neonatal intensive care unit design is becoming a primary feature of most new unit designs in the United States. The SFR has appeal for a number of reasons, including the positive impact of developmentally appropriate care on infant outcomes, increased importance placed on breast-feeding and kangaroo care, better infection control practices, increased family involvement, as well as the mandate to assure patient privacy enacted by the Health Insurance and Portability and Accountability Act. Moving from the historically built “baby barn” to the SFR unit involves enormous amounts of change. Although many would argue that decreasing the amount of noxious stimuli, noise, and light is a good thing, these reductions necessitate a design that increases the possibility of staff isolation and results in further separation of the patient from the caregiver. In an effort to offset these concerns for staff isolation, further changes and enhanced technologies are required. That very technology then changes work flow patterns and the way socialization occurs. Since the mid-1980s, nurses' work stress has been escalating due to the increasing use of technology, rising health care costs, and turbulence within the work environment. The rapidity with which nurses are exposed to change is staggering that may lead to tension, stress, and dissatisfaction. Although advantages to the SFR design have become more readily apparent, health care professionals unfamiliar with this design concept may be skeptical as to the opportunity to enhance the physical environment for the betterment of infants, families, and staff. The information disseminated by the Consensus Committee on Recommended Design Standards for Advanced Neonatal Care is helping guide decision makers