Study: Consult nurses when designing new hospitals

Hospital designers are turning to nurses to help design better care space, according to a new report by the Robert Wood Johnson Foundation.

"Input from nurses and other healthcare professionals are mirroring the health professions' renewed focus on quality and safety in their designs," said Matt Freeman, a spokesman for the RWJF.

According to an RWJF brief, the nation is undergoing a healthcare construction boom, with dollars spent on the construction of hospitals and other facilities nearly doubling over the last decade. That trend is expected to continue to rise as a result of healthcare reform.

"Nurses might not know how to read architectural drawings or use computer-assisted drafting tools, but they have a very important role to play in helping plan and design physical spaces that support the delivery of safe, effective patient care," authors of the brief said.

The brief details a number of specific examples of how nurses have helped with healthcare facility design:

• Eileen Malone, RN, senior partner at Mercury Healthcare Consulting and former CEO and commander emeritus of the DeWitt Army Community Hospital at Fort Belvoir, served as a consultant to the U.S. Department of Defense's Military Health System. She developed a model for the military, subsequently refined for broader application, that focuses on common strategic goals (like preventing falls) and provides a conceptual framework for examining the interplay among physical, technological and human factors.

• In New Orleans, Mary Kelly, RN, has served as clinical liaison to the planning team for the new Louisiana State University hospital, a replacement for a hospital devastated by Hurricane Katrina, according to the brief. She brought together groups of nurses, physicians and other staff to develop designs, addressing such issues as patient and family zones, standardized rooms, nurse travel times, patient visibility, controlled access and natural lighting.

• Cheryl Herbert, RN, oversaw the planning, design and construction of a new hospital built by OhioHealth. "Any place nurses would be working – the emergency department, maternity, the medical-surgical intensive care unit – we made sure to include them in our advisory group for that area," she said. "Nurses were instrumental in designing patient rooms, including the headwalls behind the beds."

According to the report, the newly built Dublin Methodist Hospital incorporates such evidence-based design features as single-bed patient rooms to reduce the risk of contagion, enhance privacy and support family involvement, sinks in every patient room and acuity-adaptable surgical ICU rooms to cut down on the moving of patients as their conditions change.

According to the brief, there are a number of "increasingly common design choices" that reflect research and nurse input. They include:

• Ventilation and filtration systems to improve air quality and remove allergens, pathogens and more;

• Ergonomically designed patient rooms, including patient lifts and handrails, as well as beds and nursing stations designed to reduce patient falls and staff injuries;

• Decentralized unit layouts designed to increase the time nurses spend at the bedside;

• Better lighting to ward off medical errors;

• More natural sunlight, in part because studies show that sunlight helps blunt the perception of pain, improves the quality of sleep and leads to shorter hospital stays while allowing nurses to better assess skin tone;

• Noise reduction features such as carpeting, acoustic tiles and handheld pagers (as a substitute for overhead systems) to improve sleep and reduce stress;

• Better direction systems, including maps, landmarks, signs, information kiosks and directories, to help patients and visitors while allowing staff to focus on their clinical duties instead of giving directions; and

• Access to nature, water features and works of art, all to reduce stress.

Several nursing schools are beginning to incorporate design issues into their curricula, including Holy Names University in Oakland, Calif., the Texas Woman's University School of Nursing and Arizona State University, the report said.

Read the entire brief here.