bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of Space Syntax Theory in the Study of Medical-Surgical Nursing Units in Urban Hospitals
Authors: Trzpuc Stefnee J. , Martin Caren S.
Published: February 2015

Additional research is needed to explore how the design of urban, medical-surgical nursing units influences communication patterns, perceptions of social support, and overall job satisfaction for nurses. Space syntax theory has typically been used to study communication in office environments; more recently, it has been applied to the study of healthcare environments. The purpose of this study was to explore the applicability of space syntax theory as a theoretical framework for studying nurses' communication in medical-surgical nursing units in urban hospitals.

Background:

The nursing profession is rapidly changing, and nurses' work is psychologically and physically intense. At the same time, nurses are responsible for patient safety, optimal care delivery, and patient outcomes ( Bureau of Labor Statistics, 2009 ; Clarke, 2007 ; Clarke & Donaldson, 2008 ; Institute of Medicine, 2000 ; Institute of Medicine, 2004 ). Nurses are central to the delivery of care and act as a conduit for communication among members of the patient care team. Some of the design characteristics that create a more appealing environment for patients, such as views of nature and single-patient rooms, may not be fully understood as they relate to nurses' tasks and responsibilities, and they could be detrimental to nursing communication.

Methods:

This study analyzed three medical-surgical nursing unit floor plans using two constructs of space syntax theory, and it verified analysis through three semi-structured interviews with end users.

Results:

The use of space syntax theory for analyzing medical-surgical nursing unit floor plans is complex. Findings indicated that nurses' perceptions of two constructs of space syntax theory, visibility and accessibility, did not consistently match the anticipated benefits of the floor plan designs.

Conclusions:

Understanding how and when nurses communicate with each other could help designers of healthcare spaces create more effective environments that support nurses' work and personal health and welfare. The findings of this study suggest that further exploration is needed to confirm this theory's application to healthcare environments.
Making the Case for Evidence-Based Design in Healthcare: A Descriptive Case Study of Organizational Decision Making
Authors: Shoemaker Lorie K. , Kazley Abby Swanson , White Andrea
Published: February 2015

Objective:

The aim of this study was to describe the organizational decision-making process used in the selection of evidence-based design (EBD) concepts, the criteria used to make these decisions, and the extent to which leadership style may have influenced the decision-making process. Five research questions were formulated to frame the direction of this study, including: (1) How did healthcare leaders learn of innovations in design? (2) How did healthcare leaders make decisions in the selection of healthcare design concepts? (3) What criteria did healthcare leaders use in the decision-making process? (4) How did healthcare leaders consider input from the staff in design decisions? and (5) To what extent did the leadership style of administrators affect the outcomes of the decision-making process?

Background:

Current issues affecting healthcare in the community led the principal investigator's organization to undertake an ambitious facilities expansion project. As part of its planning process, the organization learned of EBD principles that seemingly had a positive impact on patient care and safety and staff working conditions. Although promising, a paucity of empirical research addressed the cost/benefit of incorporating many EBD concepts into one hospital setting, and there was no research that articulated the organizational decision-making process used by healthcare administrators when considering the use of EBD in expansion projects.

Methods:

A mixed-method, descriptive, qualitative, single-case study and quantitative design were used to address the five research questions. The Systems Research Organizing Model provided the theoretical framework. A variety of data collection methods was used, including interviews of key respondents, the review of documentary evidence, and the Multifactor Leadership Questionnaire.

Results:

A participatory process was used throughout the design decision phases, involving staff at all levels of the organization. The Internet and architects facilitated learning about EBD. Financial considerations were a factor in decision making. The prevalence of the transformational leadership style among the organization's administrators exceeded the U.S. mean.
A Conceptual Framework for the Domain of Evidence-Based Design
Authors: Ulrich Roger S. , Berry Leonard L. , Quan Xiaobo , Parish Janet Turner
Published: February 2015

The physical facilities in which healthcare services are performed play an important role in the healing process. Evidence-based design in healthcare is a developing field of study that holds great promise for benefiting key stakeholders: patients, families, physicians, and nurses, as well as other healthcare staff and organizations. In this paper, the authors present and discuss a conceptual framework intended to capture the current domain of evidence-based design in healthcare. In this framework, the built environment is represented by nine design variable categories: audio environment, visual environment, safety enhancement, wayfinding system, sustainability, patient room, family support spaces, staff support spaces, and physician support spaces. Furthermore, a series of matrices is presented that indicates knowledge gaps concerning the relationship between specific healthcare facility design variable categories and participant and organizational outcomes. From this analysis, the authors identify fertile research opportunities from the perspectives of key stakeholders.
Integrating Healthcare Design Research into Practice: Setting a New Standard of Practice
Authors: Zborowsky Terri , Bunker-Hellmich Lou
Published: February 2015

It seems safe to conclude that nearly 150 years ago, “the lady with the lamp,” Florence Nightingale, set a course that practice-based healthcare researchers continue to follow today. In her book, Notes on Nursing (1860) , Nightingale identified light, ventilation, noise, and sanitation as elements of the environment that affected the well-being of soldiers in her care. Today, we attempt to study these same relationships: those that exist between the built environment of healthcare settings, and the health and well-being of the users of these spaces. The goal of this paper is to describe how research is conceptualized, integrated, and utilized in healthcare design decision making and to address the challenges and opportunities that exist when moving a research agenda forward. Numerous examples of design practitioners and healthcare facilities that have committed themselves to integrating research into healthcare design are provided.
Testing the Birth Unit Design Spatial Evaluation Tool (BUDSET) in Australia: A Pilot Study
Authors: Foureur Maralyn J. , Leap Nicky , Davis Deborah L. , Forbes Ian F. , Homer Caroline S. E.
Published: February 2015

Objective:

To pilot test the Birth Unit Design Spatial Evaluation Tool (BUDSET) in an Australian maternity care setting to determine whether such an instrument can measure the optimality of different birth settings.

Background:

Optimally designed spaces to give birth are likely to influence a woman's ability to experience physiologically normal labor and birth. This is important in the current industrialized environment, where increased caesarean section rates are causing concerns. The measurement of an optimal birth space is currently impossible, because there are limited tools available.

Methods:

A quantitative study was undertaken to pilot test the discriminant ability of the BUDSET in eight maternity units in New South Wales, Australia. Five auditors trained in the use of the BUDSET assessed the birth units using the BUDSET, which is based on 18 design principles and is divided into four domains (Fear Cascade, Facility, Aesthetics, and Support) with three to eight assessable items in each. Data were independently collected in eight birth units. Values for each of the domains were aggregated to provide an overall Optimality Score for each birth unit.

Results:

A range of Optimality Scores was derived for each of the birth units (from 51 to 77 out of a possible 100 points). The BUDSET identified units with low-scoring domains. Essentially these were older units and conventional labor ward settings.

Conclusion:

The BUDSET provides a way to assess the optimality of birth units and determine which domain areas may need improvement. There is potential for improvements to existing birth spaces, and considerable improvement can be made with simple low-cost modifications. Further research is needed to validate the tool.
Estimates of Crowding in Long-Term Care: Comparing Two Approaches
Authors: Algase Donna L. , Antonakos Cathy , Beattie Elizabeth , Beel-Bates Cynthia , Song Jun-Ah
Published: February 2015

Objective:

Because studies of crowding in long-term care settings are lacking, the authors sought to: (1) generate initial estimates of crowding in nursing homes and assisted living facilities; and (2) evaluate two operational approaches to its measurement.

Background:

Reactions to density and proximity are complex. Greater density intensifies people's reaction to a situation in the direction (positive or negative) that they would react if the situation were to occur under less dense conditions. People with dementia are especially reactive to the environment.

Methods:

Using a cross-sectional correlational design in nursing homes and assisted living facilities involving 185 participants, multiple observations ( N = 6,455) of crowding and other environmental variables were made. Crowding, location, and sound were measured three times per observation; ambiance was measured once. Data analyses consisted of descriptive statistics, t-tests, and one-way analysis of variance.

Results:

Crowding estimates were higher for nursing homes and in dining and activity rooms. Crowding also varied across settings and locations by time of day. Overall, the interaction of location and time affected crowding significantly ( N = 5,559, df [47, 511], F = 105.69, p < .0001); effects were greater within location-by-hour than between location-by-hour, but the effect explained slightly less variance in Long-Term Care Crowding Index (LTC-CI) estimates (47.41%) than location alone. Crowding had small, direct, and highly significant correlations with sound and with the engaging subscale for ambiance; a similar, though inverse, correlation was seen with the soothing subscale for ambiance.

Conclusions:

Crowding fluctuates consistent with routine activities such as meals in long-term care settings. Furthermore, a relationship between crowding and other physical characteristics of the environment was found. The LTC-CI is likely to be more sensitive than simple people counts when seeking to evaluate the effects of crowding on the behavior of elders—particularly those with dementia—in long-term care settings. aging in place.
Toward a “Smart” Nightstand Prototype: An Examination of Nightstand Table Contents and Preferences
Authors: Brooks Johnell O. , Smolentzov Linnea , DeArment Amy , Logan William , Green Keith , Walker Ian , Honchar Julia , Guirl Chris , Beeco Rebekkah , Blakeney Carrie , Boggs Amy , Carroll Carson , Duckworth Kenna , Goller Linda , Ham Sloan , Healy Stan , Heaps Carolyn , Hayden Caroline , Manganelli Joe , Mayweather Lyndsay , Mixon Hillary , Price Koty , Reis Ashley , Yanik Paul
Published: February 2015

Objective:

Two studies were conducted to obtain an understanding of the types of items seniors keep in their nightstands and to understand how users feel about the possibility of “smart” furniture.

Background:

To enable aging in place and universal design, it is vital to understand the needs of a broad range of aging individuals, especially since there is little research on nightstand usage and design.

Methods:

Study 1 allowed for the development of a structured inventory of nightstand use today in assisted living and rehabilitation facilities. Study 1 led to Study 2, demonstrating the need to conceptualize new ideas for smart nightstands. Feedback was obtained from intergenerational participants who could discuss their needs and preferences for a smart nightstand.

Results:

In Study 1, more than 150 items were recorded and categorized into 25 different groups. The authors found that participants utilized the top portion of their nightstand as opposed to the lower sections; most items were found on top of the nightstand or in the top drawer. In Study 2, the authors found that the vast majority of participants are willing to consider the use of a smart nightstand. Participants discussed key functions and design preferences, which included carefully designed storage, the ability to move the nightstand up and down, contemporary design, and interaction through voice activation.

Conclusion:

Existing nightstands do not meet the needs of current users. This research provides greater understanding of the existing limitations associated with nightstands. Study 2 confirmed that user-centered design and the use of technology can be used to enhance daily living. Smart furniture may play a role in promoting the health and independence of diverse user groups.
Healthful Environments for Hospitalized Infants
Authors: Marshall-Baker Anna
Published: February 2015

Purpose:

Medical and technological advances dominate the design of infant incubators because of their essential role in the survival of critically ill neonates. Yet other important design considerations, such as caregiver interaction, discomfort at bedside, and harmful materials, often are overlooked. The purpose of this paper is to consider the effects of existing incubator designs and to suggest criteria for the next generation of infant incubators.

Background:

Incubators of the mid-1940s established an industry standard that exists to this day: portholes in an infant chamber positioned over a mechanical system, resting on top of storage cabinets or drawers. This design is unresponsive to many of the infants' needs and significantly influences parent/infant interaction. The physical effects and social barriers that the incubator presents to the health and well-being of infants are compounded by the use of unhealthful substances and materials such as formaldehyde. Collectively, these conditions call for an incubator that not only ameliorates physical and social obstacles, but also uses benign materials.

Conclusions:

Simple alterations to existing incubator design, such as introducing color and pattern, providing arm rests, and freeing space beneath the infant chamber to accommodate seated caregivers, would encourage more prolonged periods of contact with the infant occupants, thereby improving their behavioral organization and recovery. Replacing harmful materials with alternatives such as formaldehyde-free substrates in the cabinetry also will improve the developmental outcomes of the infant occupants. These types of recommended changes embrace the intent of the incubator to provide a controlled, secure environment while acknowledging that incubators are not merely medical equipment, but the living spaces of their infant occupants.
Arousing Curiosity: When Hospital Art Transcends
Authors: Rollins Judy Ann
Published: February 2015

Evolutionary and emotional congruence theoretical perspectives support the use of certain types of artwork to reduce stress and promote improved outcomes in healthcare settings. This paper explores the artwork of three artists whose work falls outside the traditional representational art supported by these theoretical perspectives. The concept of curiosity as a common thread is proposed as the underlying theory in an effort to explain the success of such work in achieving positive outcomes for patients, families, and staff. Other concepts are explored as contributing theoretical frameworks. Research is needed to determine the impact of this emerging type of artwork and the implications of findings for individuals who create—as well as for those who select—art for healthcare settings.
Lactation Space Design: Supporting Evidence-Based Practice and the Baby-Friendly Hospital Initiative
Authors: Thompson Tammy Smith , Heflin LaShawna
Published: February 2015

The design of spaces where lactation occurs within a healthcare facility often lacks careful attention to the environmental requirements of breastfeeding. Although numerous studies evoke overwhelming support for lactation initiation in hospitals, few designers may understand the importance of such spaces. Furthermore, many designers may be unaware of the contributions they may make to this initiative. Countless studies that support the philosophy that breast milk is the best nutritional option for babies have been conducted. There are many health and economic advantages of breastfeeding for babies, mothers, and communities. Research suggests that exclusive breastfeeding for the first 6 months of life reduces the rate of illness throughout infancy and beyond, saves lives, and could save billions of dollars in the United States each year.

The Baby Friendly Hospital Initiative is a global program established to promote within healthcare facilities the facilitation of breastfeeding infants from birth. Results of this initiative show a significant increase in breastfeeding rates in many countries. The intuitive design response to such favorable research is to enhance the lactation environment, assuming that mothers who feel comfortable in lactation spaces will use them more frequently, which promotes lactation in healthcare facilities. Considering the numerous research-supported advantages of breastfeeding, designers would be prudent to seek and apply knowledge of the environmental needs to the design of lactation spaces. This may be achieved by becoming familiar with lactation procedures to understand the circulation, adjacencies, and spatial requirements of lactation programs. Incorporating this information into the design may allow the development of ideal spaces that facilitate lactation.
Influence of Positive Distractions on Children in Two Clinic Waiting Areas
Authors: Pati Debajyoti , Nanda Upali
Published: February 2015

Objective:

To examine the influence of positive distraction on the behavior and activity of children in two clinic waiting areas.

Background:

People spend a considerable proportion of time waiting in hospitals. Studies show that the quality of waiting environments influences the perception of quality of care and caregivers, that perception of waiting time is a better indicator of patient satisfaction than actual waiting time, and that the waiting environment contributes to the perception of wait time. In fact, the attractiveness of the physical environment in waiting areas has been shown to be significantly associated with higher perceived quality of care, less anxiety, and higher reported positive interaction with staff. Can positive distractions in waiting areas improve the waiting experience, as indicated by the behavior and activities of children waiting for treatment?

Method:

Five distraction conditions were randomly introduced in the waiting area of the dental and cardiac clinics of a major pediatric tertiary care center through a single plasma screen intervention. The attention, behavior, and activities of waiting children were recorded. Data on 158 pediatric patients were collected over 12 days during December 2008 and January 2009.

Results:

Data analysis shows that the introduction of distraction conditions was associated with more calm behavior and less fine and gross movement, suggesting significant calming effects associated with the distraction conditions. Data also suggest that positive distraction conditions are significant attention grabbers and could be an important contributor to improving the waiting experience for children in hospitals by improving environmental attractiveness.
Flexibility: Beyond the Buzzword—Practical Findings from a Systematic Literature Beview
Authors: Carthey Jane , Chow Vivien , Jung Yong-Moon , Mills Susan
Published: February 2015

Objective:

The goal was to identify practical, cost-effective, design-related strategies for “future-proofing” the buildings of a major Australian health department.

Background:

Many health buildings become obsolete before the end of their effective physical lives, requiring extensive reconfiguration or replacement. This study sought to move beyond the oft-used buzzword flexibility to seek effective strategies to accommodate future change (future-proofing) that could be further explored in Australia and other developed countries.

Methods:

A systematic literature review compiled definitions of flexibility and adaptability from a range of sources. Nineteen case studies were identified that illustrated various future-proofing strategies. A matrix was developed to classify different approaches to flexibility and then used to assess the case studies.

Results:

Analysis was hampered by inconsistent use of terminology and limited availability of quantifiable methods for assessing the long-term success of approaches to future-proofing. Several key strategies were identified, classified, and discussed in terms of their relevance and application.

Conclusions:

More rigorous definitions of flexibility, adaptability, and related terms are needed to enable more useful comparisons of the strategies implemented to future-proof health projects. Local conditions often affect both the strategies adopted and the degree to which they can be considered successful. Many of the case studies analyzed in this research were not operational long enough to enable assessment of their claims of being future-proofed. Therefore, review of lifetime facility costs, including the service life periods of major facility components, should be considered, and some older projects should be evaluated in terms of these criteria.
Integrated Healthscape Strategies: An Ecological Approach to Evidence-Based Design
Authors: Becker Franklin , Bonaiuto Marino , Bilotta Elena , Bonnes Mirilia
Published: February 2015

Aim:

This paper explores some of the premises of evidence-based design (EBD) and suggests that greater attention to and differentiation of the various purposes of research are needed, along with the development of an ecological theory that reflects the complexity of the health systems studied and more varied ways to communicate with and engage practitioners.

Background:

Problems with the American healthcare system are well known. For the past 20 years, an intervention that has gained increasing attention has been the physical design of healthcare facilities—hospitals in particular. EBD has been advocated as one means of using research to examine the relationship between design and healthcare to improve patient safety and the quality of care.

Conclusions:

The concept of integrated healthscape strategies is proposed to focus not only on research “evidence” and the methods used to collect and analyze it, but also on the different purposes research serves, the role of theory, and the use of EBD research in practice.
An Evaluation of Operating Room Safety and Efficiency: Pilot Utilization of a Structured Focus Group Format and Three-Dimensional Video Mock-Up to Inform Design Decision Making
Authors: Watkins Nicholas , Kobelja Mark , Peavey Erin , Thomas Stephen , Lyon John
Published: February 2015

Objective:

The purpose of this investigation was to identify safety and efficiency-related design features for inclusion in operating room (OR) construction documents.

Background:

Organizations are confronted with an array of challenges when planning an OR, including inefficiencies in operations, adverse events, and a variety of innovations to choose from. Currently, techniques that can be used in design practice and to inform design decision making for implementable OR solutions are limited.

Methods:

The project team used a structured focus group format with mixed methods to solicit 19 varying surgical team members' reactions to a three-dimensional video mock-up of a proposed OR. Data from the 19 participants were analyzed using stepwise multiple regression and content analysis of open-ended responses.

Results and Discussion:

Results demonstrate that several features of the proposed OR design predict meaningful outcomes, including flexibility and satisfaction with the OR setup, adverse event prevention, team performance, and distractions and interruptions. Participants' suggested solutions include universal booms to support anesthetic and perfusion capabilities, a fixed circulating nursing workstation that faces the patient and is at the foot of the operating room table, a wall-mounted monitor across from the surgeon, and wiring to support a touch-screen control arm in OR surgical fields.

Conclusions:

Findings from structured focus groups with mixed methods lead to implementable design solutions for construction documentation. The expeditious qualities and objectivity of the format are value-adds to the design decision-making process. Future research should use various techniques such as virtual technologies and building information modeling.
The Impact of Bedside Technology on Patients' Well-Being
Authors: Tanja-Dijkstra Karin
Published: February 2015

Objective:

This paper presents a study to gain insight into the effects of the visibility of medical equipment on the well-being of patients.

Background:

Encounters with healthcare situations are characterized by stress and anxiety. The presence of wires, tubes, and monitors near the bedside may contribute to these feelings. One of the trends in healthcare design is to organize the headwalls of patient rooms in such a way as to reduce clutter and minimize the visibility of medical equipment, but no experimental studies are available that investigate the effects of the visibility of medical equipment in patient rooms.

Methods:

This experiment employed a single-factor between-subjects design (medical equipment visible vs. medical equipment out of sight) exposing participants ( n = 42) to a scenario and a picture of a hospital room.

Results:

Placing medical equipment out of sight leads to reduced feelings of stress in patients. This stress-reducing effect is mediated by feelings of pleasure. Placing medical equipment out of sight leads to a more positive emotional state, which in turn leads to feelings of reduced stress in patients. Moreover, placing equipment out of sight leads to people having more trust in the healthcare provider.

Conclusions:

The current study emphasizes the importance of the built healthcare environment and shows what role the visibility of medical equipment can play in the healing process of patients.
Comparison of Private Room with Multiple-Bed Ward Neonatal Intensive Care Unit Environments
Authors: Van Enk Richard A. , Steinberg Florence
Published: February 2015

Objective:

This study determined whether a private room or open ward design better met optimal environmental conditions for a neonatal intensive care unit with regard to sound level, light level, temperature and humidity.

Background:

Multiple-bed designs for hospital neonatal intensive care units were the standard until recently. Now, private room designs promise to provide better conditions for neonate development and patient care quality.

Methods:

The study compared an eight-bed open ward design with a private room design of a 45-bed neonatal intensive care unit, measuring the environmental parameters of sound, light, temperature, and humidity before and after the construction and occupation of a new private room unit.

Results:

Average light levels were higher in the private room design because of the increased number of windows, but both designs were within the recommended levels. Mean temperature readings were two degrees cooler in the private room environment, and readings were more stable. Mean humidity readings in the two environments were the same, but humidity levels in the private room design were more stable. Median sound level in the private room design was lower than the open ward design, but the range was similar.

Conclusion:

The private room design allows for a more controlled patient care environment that can be maintained within a smaller range of variation nearer optimal environmental conditions.
Control and Mitigation of Healthcare-Acquired Infections: Designing Clinical Trials to Evaluate New Materials and Technologies
Authors: Sharpe Peter A. , Schmidt Michael G.
Published: February 2015

Hospitals clean environmental surfaces to lower microbial contamination and reduce the likelihood of transmitting infections. Despite current cleaning and hand hygiene protocols, hospital-acquired infections (HAIs) continue to result in a significant loss of life and cost the U.S. healthcare system an estimated $45 billion annually. Stainless steel and chrome are often selected for hospital touch surfaces for their “clean appearance,” comparatively smooth finish, resistance to standard cleaners, and relative effectiveness for removing visible dirt during normal cleaning. Designers use wood surfaces for aesthetics; plastic surfaces have become increasingly endemic for their relative lower initial cost; and “antimicrobial agents” are being incorporated into a variety of surface finishes.

This paper concentrates on environmental surface materials with a history of bactericidal control of infectious agents and focuses on the methods necessary to validate their effectiveness in healthcare situations. Research shows copper-based metals to have innate abilities to kill bacteria in laboratory settings, but their effectiveness in patient care environments has not been adequately investigated. This article presents a research methodology to expand the evidence base from the laboratory to the built environment. For such research to have a meaningful impact on the design/specifying community, it should assess typical levels of environmental pathogens (i.e., surface “cleanliness”) as measured by microbial burden (MB); evaluate the extent to which an intervention with copper-based materials in a randomized clinical trial affects the level of contamination; and correlate how the levels of MB affect the incidence of infections acquired during hospital stays.
Reconsidering the Semiprivate Inpatient Room in U.S. Hospitals
Authors: Verderber Stephen , Todd Lindsay G.
Published: February 2015

In the past 5 years, U. S. hospitals have virtually abandoned the semiprivate inpatient room. The inconclusiveness of recent research, however, indicates that this room type remains a potentially viable care delivery setting in both developed and developing countries for specific patient cohorts and care scenarios during hospitalization. Although the U.S. healthcare industry has embraced the all-private room hospital, does the semiprivate room have a place at all in the 21st-century American hospital? Literature on the subject, both for and against, is summarized. This is followed by a proposal for a case study prototype and its functional integration within a conventional medical/surgical unit in a U.S. hospital. The results suggest that a tempered reintroduction of semiprivatism affords opportunities for socialization, patient-family transactions and amenities, and staff effectiveness without compromising patient safety. Implications for environmental stewardship with respect to the carbon-neutral hospital of the 21st century are cited, as are priorities for further evidence-based design research on this issue.
The Impact of Daylight and Views on ICU Patients and Staff
Authors: Shepley Mardelle McCuskey , Gerbi Raymond Peter , Watson Angela E. , Imgrund Stephen , Sagha-Zadeh Rana
Published: February 2015

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.
Wall Finish Selection in Hospital Design: A Survey of Facility Managers
Authors: Lavy Sarel , Dixit Manish K.
Published: February 2015

Objective:

This paper seeks to analyze healthcare facility managers' perceptions regarding the materials used for interior wall finishes and the criteria used to select them. It also examines differences in wall finish materials and the selection process in three major hospital spaces: emergency, surgery, and in-patient units. These findings are compared with healthcare designers' perceptions on similar issues, as currently documented in the literature.

Background:

Hospital design and the materials used for hospital construction have a considerable effect on the environment and health of patients. A 2002 survey revealed which characteristics healthcare facility designers consider when selecting materials for healthcare facilities; however, no similar study has examined the views of facility managers on building finish selection.

Methods:

A 22-question survey questionnaire was distributed to 210 facility managers of metropolitan, for-profit hospitals in Texas; IRB approval was obtained. Respondents were asked to rank 10 interior wall finish materials and 11 selection criteria for wall finishes. Data from 48 complete questionnaires were analyzed using descriptive statistics and nonparametric statistical analysis methods.

Results:

The study found no statistically significant differences in terms of wall finish materials or the characteristics for material selection in the three major spaces studied. It identified facility managers' four most-preferred wall finish materials and the five-most preferred characteristics, with a statistical confidence level of greater than 95%.

Conclusions:

The paper underscores the importance of incorporating all perspectives: facility designers and facility managers should work together toward achieving common organizational goals.
Using Data to Drive Emergency Department Design: A Metasynthesis
Authors: Welch Shari J.
Published: February 2015

Objective:

There has been an uptick in the field of emergency department (ED) operations research and data gathering, both published and unpublished. This new information has implications for ED design. The specialty suffers from an inability to have these innovations reach frontline practitioners, let alone design professionals and architects. This paper is an attempt to synthesize for design professionals the growing data regarding ED operations.

Methods:

The following sources were used to capture and summarize the research and data collections available regarding ED operations: the Emergency Department Benchmarking Alliance database; a literature search using both PubMed and Google Scholar search engines; and data presented at conferences and proceedings.

Results:

Critical information that affects ED design strategies is summarized, organized, and presented. Data suggest an optimal size for ED functional units. The now-recognized arrival and census curves for the ED suggest a department that expands and contracts in response to changing census. Operational improvements have been clearly identified and are grouped into three categories: input, throughput, and outflow. Applications of this information are suggested.

Conclusion:

The sentinel premise of this meta-synthesis is that data derived from improvement work in the area of ED operations has applications for ED design. EDs can optimize their functioning by marrying good processes and operations to good design. This review paper is an attempt to bring this new information to the attention of the multidisciplinary team of architects, designers, and clinicians.
Innovation Pilot Study: Acute Care for Elderly (ACE) Unit—Promoting Patient-Centric Care
Authors: Krall Eva , Close Jacqueline , Parker Joseph , Sudak Maria , Lampert Susan , Colonnelli Kim
Published: February 2015

Purpose:

Older patients, defined as age 65 years or older, comprise more than 40% of admissions to the acute care environment. These patients' needs are different; cognitive impairment, chronic health issues, caregiver burden, and maintenance of functional level present challenges to healthcare organizations when caring for this population on a general medical-surgical unit.

Background:

A pilot project, the creation of a six-bed Acute Care for Elderly (ACE) unit situated within a 33-bed medical-surgical unit, was established to meet the unique needs of this older patient population.

Conclusions:

Outcomes including falls, pressure ulcers, functional level (the latter as measured by the KATZ), and length of stay were examined and demonstrated marked improvement compared to similar patients outside the ACE unit. Older patients need individualized care planning by staff competent in elder care and a specialty unit to address their specific needs
Making Acuity-Adaptable Units Work: Lessons from the Field
Authors: Zimring Craig , Seo Hyun-Bo
Published: February 2015

Objective:

Because there have been no clear directions on how to implement acuity-adaptable units (AAUs), this paper describes actual tactics and strategies that have worked in multiple institutions.

Background:

AAUs have been used in hospitals for the past decade, but reports in the literature have indicated both successes and difficulties in meeting operational goals and objectives. Despite various views regarding acuity adaptability, there is little in the literature that suggests why it works in some hospitals and not in others.

Method:

As part of a larger construction project, this project team interviewed the leaders of six hospitals to determine what was associated with the successful implementation of AAUs.

Results:

This paper reports on themes that emerged from these interviews, namely: choose the right specialty for medical centers; adopt the AAU model for the entire facility in community hospitals; bring in and train the right people; change culture through communication; and use acuity-adaptable unit clusters.

Discussion and Conclusions:

Main themes, predictable patient progress, and culture change are further discussed and key recommendations are described.
Target Value Design: Applications to Newborn Intensive Care Units
Authors: Rybkowski Zofia K. , Shepley Mardelle McCuskey , Ballard H. Glenn
Published: February 2015

There is a need for greater understanding of the health impact of various design elements in neonatal intensive care units (NICUs) as well as cost-benefit information to make informed decisions about the long-term value of design decisions. This is particularly evident when design teams are considering the transition from open-bay NICUs to single-family-room (SFR) units. This paper introduces the guiding principles behind target value design (TVD)—a price-led design methodology that is gaining acceptance in healthcare facility design within the Lean construction methodology. The paper also discusses the role that set-based design plays in TVD and its application to NICUs.
A Comprehensive Comparison of Open-Bay and Single-Family-Room Neonatal Intensive Care Units at Sanford Children's Hospital
Authors: Stevens Dennis C. , Helseth Carol C. , Thompson Paul A. , Pottala James V. , Khan M. Akram , Munson David P.
Published: February 2015

Objective: This paper summarizes the results of a comprehensive comparison of open-bay (OPBY) and single-family-room (SFR) neonatal intensive care unit (NICU) designs.

Background: The NICU expanded from 7000 ft2 in two large rooms to 27,000 ft2 with 45 individual family spaces.

Results: Sound measurements indicated a significant reduction in the unoccupied SFR to less than half of the levels in the OPBY NICU. However, respiratory support equipment generated levels well above those of the ambient environment. Illumination was significantly reduced in the SFR. Ambient illumination in nursing work areas was less than recommended. In other comparisons with the OPBY NICU the SFR NICU was shown to have: a shorter interval until full enteric feedings were established; improved parent satisfaction; improved staff perceptions of the environment and care; a decrease in nurses State-Trait Anxiety scores; an increased need for total numbers of staff and nursing staff per shift; increased walking per shift by nurses and nurse practitioners; and improved sleep time in a very small sample of patients. Analysis of the cost of construction showed comparable cost per ft2; however, the cost per bed in the SFR NICU was much greater because of the increased area of this facility. Highly notable findings of this investigation included the same incidence of adverse outcomes of care and a reduction in the adjusted direct cost of care in the SFR NICU.

Conclusion: These data overwhelmingly support the SFR NICU in preference to the traditional OPBY facility. They substantiate that the SFR NICU should be the new standard for NICU care.
Image and Emotion: From Outcomes to Brain Behavior
Authors: Nanda Upali , Zhu Xi , Jansen Ben H.
Published: February 2015

Aim: A systematic review of neuroscience articles on the emotional states of fear, anxiety, and pain to understand how emotional response is linked to the visual characteristics of an image at the level of brain behavior.

Background: A number of outcome studies link exposure to visual images (with nature content) to improvements in stress, anxiety, and pain perception. However, an understanding of the underlying perceptual mechanisms has been lacking. In this article, neuroscience studies that use visual images to induce fear, anxiety, or pain are reviewed to gain an understanding of how the brain processes visual images in this context and to explore whether this processing can be linked to specific visual characteristics.

Conclusions: The amygdala was identified as one of the key regions of the brain involved in the processing of fear, anxiety, and pain (induced by visual images). Other key areas included the thalamus, insula, and hippocampus. Characteristics of visual images such as the emotional dimension (valence/arousal), subject matter (familiarity, ambiguity, novelty, realism, and facial expressions), and form (sharp and curved contours) were identified as key factors influencing emotional processing. The broad structural properties of an image and overall content were found to have a more pivotal role in the emotional response than the specific details of an image. Insights on specific visual properties were translated to recommendations for what should be incorporated—and avoided—in healthcare environments.
Staff Perceptions before and after Adding Single-Family Rooms in the NICU
Authors: Bosch Sheila , Bledsoe Tamara , Jenzarli Ali
Published: February 2015

Objective:

The purpose of this study is to evaluate staff perceptions of environmental quality before and after the renovation of an existing open-bay neonatal intensive care unit (NICU) and the addition of 23 single-family NICU rooms in the Wasie Neonatal ICU at Joe DiMaggio Children's Hospital. Background: In recent years there has been an increase in the design and construction of single-family rooms (SFRs) because they provide more privacy for families, offer better control over environmental stimuli such as lighting and noise, and possibly reduce infections. On the other hand, this model can cause staff members to feel isolated from one another, reduce their ability to respond quickly in a crisis situation, or impose additional demands on them. Few studies document the advantages and disadvantages of the SFR NICU model.

Methods:

This study utilized pre- and post-move surveys to investigate staff perceptions of the NICU.

Results:

Overall, staff members perceive the quality of the work environment, and the safety and quality of the environment provided to patients and their families, as better in the renovated, combination NICU design (SFR and open bay) when compared to the open-bay, pre-move design.

Conclusion:

In spite of the potential drawbacks of having SFRs in the NICU, the study demonstrates that nurses may perceive associated benefits, such as a reduction of job stress and improvements in parental privacy, along with other positive outcomes.
Sound Levels, Staff Perceptions, and Patient Outcomes During Renovation Near the Neonatal Intensive Care Unit
Authors: Trickey Amber W. , Arnold Cody C. , Parmar Ankit , Lasky Robert E.
Published: February 2015

Objective:

Sound levels, staff perceptions, and patient outcomes were evaluated during a year-long hospital renovation project on the floor above a neonatal intensive care unit (NICU).

Background:

Construction noise may be detrimental to NICU patients and healthcare professionals. There are no comprehensive studies evaluating the impact of hospital construction on sound levels, staff, and patients.

Methods:

Prospective observational study comparing sound measures and patient outcomes before, during, and after construction. Staff were surveyed about the construction noise, and hospital employee satisfaction scores are reported.

Results:

Equivalent sound levels were not significantly higher during construction. Most staff members (89%) perceived the renovation period as louder, and 83% reported interruptions of their work. Patient outcomes were the same or more positive during construction. Very low birth weight (VLBW infants were less likely to require 24+ hours' mechanical ventilation during construction: 54% vs. 59% before ( OR = 1.6, p = 0.018) and 62% after ( OR = 1.48, p = 0.065); and they required a shorter total period of mechanical ventilation: 3.6 days vs. 8.0 before ( p = 0.011) and 9.5 after ( p = 0.001). VLBW newborns' differences in ventilation days were mostly in the upper extremes; medians were similar in all periods: 0.6 days vs. 1 day preconstruction and 2 days postconstruction.

Conclusions:

Construction above the NICU did not cause substantially louder sound levels, but staff perceived important changes in noise and work routines. No evidence suggested that patients were negatively affected by the renovation period. Meticulous construction planning remains necessary to avoid interference with patient care and caregiver work environments.