This issue of Critical Care Nursing Quarterly is devoted to the creation of critical care healing environments through architecture and design. A sequential approach is presented throughout this issue by expert clinicians who advocate for improved clinical work environments in their everyday careers. Over the past ten years, nurses have become influential in advocating for the clinical workspace. Architectural firms, construction firms, engineering firms, furniture companies, hospital facility planning departments, and interior design firms are hiring nurses to bridge the gap between the design and function of clinical spaces. Nurses have a unique opportunity to advocate and improve the clinical work environment through intentional evidence based design.
The issue begins with Kerri Cardon and Doug Bazuin's Physical and Psychological Considerations in Designing Critical Care Areas. Kerrie provides a unique perspective as a nurse and architect, while Doug is a mechanical engineer with a research focus. Kerrie and Doug present ways in which architecture, interior design, and behavior contribute to a healing ICU environment. The implications of family involvement and allocation of family space will be presented with research findings showing that family involvement/presence has decreased an ICU patient stay by fifty percent. Many elements of the environment contribute to healing and improved patient outcomes. Kerrie and Doug present background information to educate the reader the value of elements to consider when designing or renovating the critical care environment.
Terri Zborowsky, interior designer and nurse, and Lou Bunker Hellmich, Senior Research Associate, AECOM continue discussion with "Impact of Place on People & Process: The integration of research on the built environment in the planning and design of Critical Care areas". They discuss the historical influences on healthcare design, the current transformation movement, and a case study. The Optimal Healing Environment Model (OHE), reveals the importance of the integration and relationship of People, Place, and Process. In the article, they present resources and guidelines that are available for clinicians as they navigate through the design process of their environment. This academic research approach takes the reader to a new level of cognitive process building a foundation for designing an environment that promotes healing and decreases stress.
Focusing on the "Place", Joyce Durham, a clinician and architect, presents research comparing space allocation of fifteen recently completed critical care units. Her knowledge of master planning, detailed functional space planning and operations further defines preliminary benchmarking data to assist organizations for evaluating their existing critical care units or planning replacement units. In "Comparison of Space Allocation in Recently Completed Critical Care Units", she defines the space and square footage to educate regarding current trends and metrics.
Planning spaces for the support of family is vital in any Critical Care Area. Jennie Evans and James Thomas take a unique approach in the article, "Understanding Family Requirements in the Intensive Care Room." As they focus on Pediatric Intensive Care Units, four families with children in the intensive care unit were interviewed about their environment. Evans and Thomas summarize the discussion and present guiding principles for designers and healthcare personnel to consider when creating critical care spaces. These standards can translate to other critical care environments in creating and optimizing the family support space.
Health information technology has taken a central role in our complex healthcare system today. The explosion of technology is changing the process of the nurse and patient interaction. Martha Buckner reminds us in the article, "Point of care technology: Preserving the caring environment" that caring is a core value in nursing reflected in the human interactions between nurse and patient. Through history, scientific literature, and case examples, Buckner and Gregory illustrate the conceptual underpinnings of utilizing technology to enhance and manage information necessary to deliver care with a patient centered approach. Solutions from current literature, needs for the future as well as design considerations are presented to establish the foundation and thought leadership for the ongoing research and best practice implications for the critical care environment.
In conjunction with the design development of the critical care area, the next two articles reinforce the importance of Equipment Planning and Considerations for Finishes and Furnishings. Cathy Gambacorta, R.N. and Lisa Charrin, AIA, ACHA detail the important considerations for equipment planning in "Equipping the Critical Care Environment". Depending on the setting of adult versus pediatric, surgical versus medical, and specialty care units for critical care, the equipment demands will be introduced with specialty critical care implications and trends. Planning considerations involving budgeting, integration, innovation and participation by end users are important.
In the article, "Finishes and Furnishings: Considerations for Critical Care Environments", Misty Chambers, Nurse and Clinical Operations/Design Specialist, and Ken Bowman, Interior Designer, emphasize the invaluable clinical knowledge and experience of the caregiver in determining the human needs of the unit and its design elements. Design regulations, guidelines, and codes are in place for public safety and welfare, however: the selections and specifications for interior finishes and furnishings must be considered for product properties, functionality and longevity.
Recent innovations in medical and building technology are shaping the future of ICU design as described in Dr. Mahbub Rashid's article, "Technology and the Future of ICU Design". Taking a very broad look at the trends and innovations in ICU design will help the practitioner gain an overview of the current status and look to the future for guidelines and best practices.
Designing the ICU with family in mind is an important part of the mind, body, and spirit for the critically ill patient. Open visitation as adopted hospital policy is often controversial among nurses. While some nurses feel that open family visitation impedes patient care; others maintain that the benefits to the patient and family are invaluable. Sarah Whitton and Laura Pittiglio present a review of ten empirical studies in their article, "Open Visiting Hours". A review of the literature, patient and family perceptions and nursing implications define a strong basis for best practices for family visitation policies in the critical care environment.
To conclude this special design and construction issue, three additional resources will be provided: 1) HIMSS Position Statement on Transforming Nursing Practice through Technology Informatics. 2) AONE Guiding Principles: Hospitals for the next generation. And 3) Workforce Ecosystem: Creating Healthier Environments.
As nurse leaders, our role should include advocating for the healthcare work environment and the continual creation of optimal healing environments. Informed and inspired, nurses should be influencers and decision leaders at the design table promoting practices that positively impact our work flow, ergonomics, safety, and the delivery of care. As you glean insight and inspiration from these healthcare design experts and industry leaders, become the advocate at your facility for thoughtful and intentional design that best reflects the "heart of nursing"-a caring, safe and healing patient centered environment.
-Debbie D. Gregory, BSN, RN
Issue Editor
[email protected]