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This issue of Critical Care Nursing Quarterly is part 2 in a 2-part series of articles focused on the design of critical care facilities. As more hospitals support interprofessional collaboration across all units, administrators are seeking collaboration even beyond the direct patient care team-to information technology (IT) professionals, biomedical engineers, and facility designers and engineers. Nurse involvement is on the rise, and everyone in the hospital is opening to the notion that everyone in a hospital-and everything-has a role to play in maximizing patient outcomes. The recognition of our physical environment as a key component of treatment continues to grow, as evidenced by this journal's back-to-back editions on the topic.


Starting off this issue is an article addressing the important societal issue of environmental sustainability. In "Environmental Sustainability in the Intensive Care Unit: Challenges and Solutions," Katie Huffling and Elizabeth Schenk challenge the industry to take greater responsibility for human health-not just within the walls of the intensive care unit (ICU) but in the environment at large. With environmental degradation to blame for much disease and injury, hospitals should ensure that they aren't contributing to environmental contamination as they strive to be centers of healing. Critical care units are among the most resource-intense environments, and this article looks at ICUs through the lenses of energy use, waste, toxic chemicals, and the healing environment. Most helpfully, the article gives concrete suggestions to nurses on how they can become more involved in every area, taking personal responsibility for driving environmental improvement.


Sandie Colatrella and Jeff Clair address drug-resistant bacteria in the next article, "Adapt or Perish: A Relentless Fight for Survival, Designing Superbugs Out of the ICU." With microorganisms rapidly exhibiting a startling upper hand on antibiotics, it's time to outthink pathogens once again with new methods of combat. Colatrella and Clair suggest several evidence-based design strategies as potential solutions in the critical care unit, where high-risk patients are the most vulnerable. These strategies are noted in the areas of advanced handwashing, universal decolonization, collaboration between infection control and housekeeping staff, cleaning agents and tools, ATP-based monitoring systems, and other innovations. Key areas of facility design, such as plumbing system design, room layout, door and flooring selection, heating, ventilation and air conditioning (HVAC) design, and surface technology, also present important infection control strategies. The article discusses new solutions such as portable ultraviolet units and hydrogen peroxide vapor generators.


In "Point of Care Technology: Integration for Improved Delivery of Care," Martha Buckner and I continue our exploration of technology in critical care, and the nursing response to technological innovation that shows no sign of slowing. In the 2011 design edition of Critical Care Nursing Quarterly, we focused on the challenge of maintaining focus on the critical care patient because distractions such as lights, alarms, and demands of technology threaten to draw greater attention away from the patient. In this article, we address the need for greater integration to control the increased technological impact in the ICU, and integrating active interprofessional collaboration among nurses, patients, vendors, and people from biomedicine and IT.


Marie Engwall, Isabell Fridh, Ingegerd Bergbom, and Berit Lindahl discuss the human circadian rhythm in "Let There Be Light or Darkness: Findings From a Prestudy Concerning Cycled Light in the Intensive Care Unit Environment." They suggest that healing might be improved in the ICU with a more strategic approach to lighting. This article speaks to the technological domination referenced in the previous article, and the threat of that technology to disrupt natural healing cycles. The authors present evidence that cycled light, which more closely mimics sunlight than conventional artificial lighting, can have a positive effect on preterm infants in a neonatal ICU setting.


As the name suggests, "Physical Design Correlates of Efficiency and Safety in Emergency Departments: A Qualitative Examination" is a detailed analysis of how the characteristics of 16 specific physical design domains affect efficiency and safety in critical care settings. Debajyoti Pati argues that enhancing efficiency in the design of the emergency department will improve workflow, having naturally positive effects on safety as well as security. This article contributes to the large and growing body of evidence that facility design can significantly affect patient outcomes.


Mahbub Rashid, Diane Boyle, and Michael Crosser discuss ICU work areas, and how key design features may assist in the productivity of those work areas. An instrument for evaluating primary workspaces and the features that contribute most to an improved work environment is needed as a first step toward actually improving the work environment. Clinicians in critical care settings would benefit greatly from better workspace design, but without a means to evaluate design alternatives, inferior workspaces will continue to make a stressful work environment even more difficult. "Developing Nurse and Physician Questionnaires to Assess Primary Work Areas in Intensive Care Units" outlines a means of creating a survey program to determine what features clinicians find most helpful in delivering safe and quality care.


Finally, Odette Comeau, Jamie Heffernan, Jason Sheaffer, and Foster Sayles II present issues and problems associated with transforming an adult ICU burn unit to accommodate pediatric burn patients displaced from their specialty hospital in the aftermath of a hurricane. Their article, "Rising to the Challenge: Transforming an Adult ICU Into an Adult and Pediatric ICU" considers how one medical center modified the physical features of their adult burn unit and cross-trained its staff to ensure ongoing quality care for both patient populations until the pediatric burn hospital could eventually be reopened.


As these articles illustrate, the evolution of health care design will depend on the successful collaboration of many. Nurses, physicians, and others who have always considered themselves as caregivers will be working more closely with those who may never have considered themselves caregivers-facility designers, IT managers, and housekeeping staff, for example. As the industry experiences a degree of interprofessional collaboration greater than at any time in the past, professionals from direct and indirect health care disciplines are working together to achieve facility designs that actively promote better workflows and improved patient outcomes.


-Debbie D. Gregory, BSN, RN


Issue Editor