Need help designing a new hospital? Ask a nurse

Many players weigh in on the design of new healthcare facilities. One group that's increasingly providing input is nurses.

"Nurses have a very unique perspective on patient and family needs; therefore their informed voice at the design table is absolutely critical," Jaynelle Stichler, DNSc, RN, founding co-editor of HERD Journal, professor emerita at San Diego State University and research consultant for Sharp Metro Campus, told Healthcare Design Magazine.

Nurses have assumed roles as project directors or agents of the hospital directly interfacing with architects and other design professionals. Increasingly, nurses employed at hospitals are providing input at design meetings, sharing clinical insight and expertise about the needs of patients, families and care providers. The Nursing Institute for Healthcare Design is an association that exists to engage and integrate clinical expertise and planning into the design of healthcare environments. More than 505 of their members represent architect and design firms, transition and activation planning companies, and provide organizational leadership strategically responsible for construction and renovation of healthcare spaces.

A new book from the Nursing Institute for Healthcare Design and Herman Miller Healthcare, Nurses as Leaders in Healthcare Design: A Resource for Nurses and Interprofessional Partners, is set for release this fall as a reference and resource for nurses and others involved in the design process. Including nurses as leaders in the design process is discussed in the book using the foundation of Florence Nightingale's work as a pioneer in healthcare design and statistical measurement of the design on healthcare outcomes.

The Journal of Nursing Administration also features a column focused on the nurse leaders' roles in influencing the design of healthcare facilities.

Why nurses influence design

One reason nurses are being sought out for design projects is the growing use of evidence-based design, according to Kathy Okland, president of the NIHD and an executive editor of the book. In evidence-based design, decisions about architecture planning and design are based on credible research that will create the most effective outcomes for patients and providers.

"The first cost of a completed project is a fraction of the recurring costs over the life of the building [estimated at 50 years]," Ms. Okland says. "Relevant research, as well as nurse involvement, is informing design decisions today as a standard. A building cannot heal on its own."

Additionally, with more patient care provided in outpatient settings, inpatient facilities must be equipped for a higher acuity patient population, according to Ms. Okland. And there is a belief that translating those patient care trends is a responsibility best placed in the hands of nurses, who understand the work flow and patient care processes and handoffs that occur when caring for a complex patient population.

"As the complexity of care increases, the nurse coordinates care with more interprofessional disciplines, more technology and more intervention. In each of these instances, space becomes a therapeutic modality. Therefore, the value of input from nurses who represent the patient's care experience is essential," Ms. Okland adds.

Real-life examples

Houston-based Texas Children's Hospital has sought nurse feedback for numerous construction projects. One such project was the Texas Children's Pavilion for Women, established for the care of women and their babies.

The 115-bed, 15-story hospital, which has one of the most comprehensive fetal centers in the U.S., opened its outpatient areas in late 2011 and its inpatient services in March 2012. This year, the hospital expects to deliver about 6,000 babies.

From the beginning, nurses were involved in the development of the hospital. A consulting group that did market research for the project interviewed more than 50 OB-GYN physicians, 50 women who had recently delivered a baby, and nursing team members to gather input regarding the ideal patient experience.

Cris Daskevich, senior vice president of Texas Children's Hospital and executive leader for the Pavilion for Women, says her team had plenty of data about the patient, physician and nursing experience before they even began working with the architects. "And the architects actually used that data to help us shape the guiding principles for the building," she says.

Once the architects created blueprints, nurses looked at mocked-up rooms and made significant changes in the design before building began. They looked at how furniture and equipment should be placed, how much space is needed in each patient care area, such as the neonatal resuscitation area, distances between supplies and patient care areas, where plugs should go and many other important issues.

And nurses continue to be involved as the hospital works to make the facility better, according to Ms. Daskevich.

"They know their patients. They know how patient flow works. They know the day-to-day hospital operations and experiences better than anyone. And so I can't imagine ever designing a building or redesigning space or work flows without having nursing right there at the table with the physicians and the administrative team," she says. "We have a philosophy of shared leadership, and it truly has been that in every phase of building and operating this facility."


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