Connecting Architecture with Nursing
Well-planned design makes a difference for nurses and their patients.
By Diane E. Scott, RN, MSN. Artwork: HKS, Inc. Architecture, Richmond, VA

Located in the heart of Richmond is Virginia Commonwealth University Medical Center’s new Critical Care Hospital. HKS Architects designed the tower utilizing the latest research to make the building better for nursing and safer for patients.

Imagine a hospital that was designed to enable nurses to give more effective and efficient care. Some new construction at hospitals caters to the needs of today's busy nurse. The design not only improves patient safety but also reduces a nurse's stress and fatigue. A revolution in "evidence-based design" is taking place as architects collaborate with nurses more than ever before.

"Utilizing proven architectural methods for making the physical environment better for nurses to care for their patients is one of our primary goals when designing new health care spaces," says Leslie Hanson, vice-president of HKS Architects in Richmond.

These concerns are reflected in the expansion of the Virginia Commonwealth University Medical Center in Richmond . The $110 million facility will expand the medical center's critical-care capacity with new intensive-care units for surgical trauma, neonatal, neuroscience, cardiac, medical respiratory and burn center patients.

In designing the state-of-the-art critical care tower, HKS referred to rigorous studies to make each working environment conducive to positive staff and patient outcomes. The architects, for example, used evidence-based design to reduce noise levels. Recent studies have shown that loud working environments are perceived as stressful, leading to emotional exhaustion and burnout among nurses. During VCU's expansion of its neonatal ICU, noise was a particular concern, Hanson says. "Noise reduction is not only essential to this fragile patient population, it is important to lessen the stress for the nurse in this critical care area." Special ceiling tiles are also being used to absorb noise in hospital departments to decrease stress.

“The Three Bears” Gift Shop will offer patients and families a respite during stressful hospitalizations. This new gift shop will contain an expanded assortment of snacks and gifts.

As architects have become more attuned to the needs of caregivers, they are designing nursing stations to enhance, not inhibit, work flow patterns. "Each department has unique qualities and should be designed around what the caregivers require. Our job, as architects is to help nurses do their job and not hinder their processes." Hanson says. Telemetry units, for example, are being designed with monitoring stations that are accessible to the nursing staff instead of being placed in dark rooms where they are not easily available for nurses to see.

Also decreasing the stress for nurses is the redesign of nursing departments to lessen the amount of walking a nurse does during a shift. Creative layouts for nursing stations are putting nurses closer to the bedside when handling charts and obtaining supplies. A recent study by the Robert Wood Johnson Foundation demonstrated that less walking for a nurse in her daily routine leads to more time with patients and a greater satisfaction among nurses.

The Critical Care Hospital’s design will be family friendly. The new concourse will make it easier for patients’ families to find their loved ones.

In designing medication rooms, architects are now examining nurses' work flow patterns to determine the best design to decrease the chance of medication errors. "Medication rooms are a major focus when planning a new department," says Hanson, "This is one of the most important spaces in any hospital department, and we want to give every advantage to the nurse to help her have safe medication practices."

Other studies have produced convincing evidence that better designed patient rooms help nurses reduce the infection rate among patients. It is well known that the hands of health care staff are the primary cause of contact transmission from patient to patient. Architects are now using research to determine ways to design rooms that will produce a sustained increase in hand washing. In particular, the evidence suggests that installing alcohol-based dispensers at beside improves hand washing. Several other studies have focused on the ratio of sinks to beds. In short, the more sinks, the more hand washing occurs by nurses and other caregivers.

Infection control was one of the premier focuses for the new burn unit. Air flow patterns were designed to decrease transmission of life threatening diseases to this special population.

When examining ways to reduce infection rates among patients, nurses have advocated for years the benefits of private rooms. Findings from multiple research studies concur that not only are private rooms preferred by patients and families, they also decrease infection rates. Private rooms are being equipped with attention to air-flow patterns and antimicrobial air filters to greatly reduce the pathogen transmission outside the patient room to other patients. Semi-private rooms also offer a challenge during patient discharge as it is far more difficult to decontaminate a room shared by another patient. As the number of immune-suppressed patients increase, every advantage a hospital design can give to decrease infection rates among patients is a distinct benefit.

Private rooms also help nurses be more effective with patient care. "Nurses can speak more freely to patients and families in a private rooms," says Ruth Hall, RN, BSN. "Patients will converse more with a nurse when teaching or discharge planning if they know their concerns will be private."

Nurses around the country concur that the design of their work environment matters to them. Beyond having esthetically pleasing places to work, they want health care spaces that help them provide quality care to their patients. Hanson agrees. Nurses are among most important people in medicine today, she says. "It is our job to design the best spaces we can to help them care for their patients."