Published on : October 22, 2010

Evidence-based Design: A Nursing Strategy

Evidence-based Design: A Nursing Strategy

Due to the increasing age in the amount of baby boomers, the healthcare construction industry is expanding.  Architects are charged with designing facilities from evidence-based research to ensure a healing environment for patients and stress-reduced environments for the healthcare team. As the nursing shortage also grows, design of a nursing unit that is time-efficient is the basis for stress-reduction and staff retention. To improve patient satisfaction scores that nurses do not respond to the call-bell in a timely manner we must improve time efficiency for the nurse, thereby improving the delivery of care. 

When one of our repeat clients decided to add two additional floors to their bed-tower, Odell answered with a solution unlike others. We conducted a mini time and motion research study on each existing floor to better gage the placement of high-frequented items for the two future patient floors. We wanted the research to provide evidence for a different design. The purpose of the study was to design the additional floors to shorten the nurses’ footsteps in any given shift. By doing this, nursing efficiency will improve, thereby improving patient safety and satisfaction.  Our ultimate goal was to reduce the footsteps for a nurse by 35-50 percent and increase patient bedside time.

As a registered nurse working in a clinical advisory role for Odell, I shadowed a nurse on each floor for a 12-hour shift. Shadowing studies included Labor and Delivery/Nursery/NICU, Med. Surg. and telemetry, Oncology/Urology and Postpartum. I wore a pedometer and followed the nurse to every location including the bedside. I counted how many times the nurse visited the medication room, clean linen, nourishment, and the nursing station. The findings were enlightening. Nurses were walking between five to eight miles a day, not including the other physical exertions of bending over, moving patients, changing beds, and emptying linens. This is why there is a nursing shortage; the physical demands on a nurse are tough. By collaborating with the architects and users, the design of the next two floors became more nurse-friendly. For the planned floors, the medication room, clean linen/supplies and nourishment were pulled to a more central location. We met our goal of reducing the nursing steps by, a little over, 35 percent. 

In conclusion, it was discovered that each floor has different needs depending on the patient population. The Med/Surg. floor had many more total steps than the Labor and delivery floor. Med/Surg. typically has a higher patient to nurse ratio so there is more room for error. The better the design of the floor, so the nurse can move smoothly with the items she needs throughout the floor, the better nurse she will be for her patients. By placing the high frequented items in a more central location the nurse can reduce her footsteps. Each floor should be designed to accommodate the population determined for that floor. Even though it is easiest for designers to place standard items in the same place on each floor for a bed tower, this is not always the best layout for a nurse. Therefore, it is crucial that the architect and administrators of the hospital collaborate to determine the future of each floor.  Recommendations include placing offices for managers and environmental service closets on the outside of the end of the bed tower. This will allow more space closer to the nurse’s station for patient rooms or cubbies. 

About The Author

Berkeleigh Combs is a Registered Nurse. She works in a clinical advisory role for Odell Associates in Richmond, VA and Charlotte, NC. Odell is a nationally recognized healthcare design firm with projects all over the world. It has plans to incorporate more of these research studies into each project. Design outcomes are better, sometimes needing less user meetings. Odell wants nurse satisfaction and patient safety guiding the design. They too reduce the time it takes for a nurse to answer the call-bell and reduce the time it takes for patients to receive their medications, both of these reductions will increase patient satisfaction scores. Odell wants nurses to feel as though they have an advocate in their architects.