Integrating caregivers into design decisions

Architects can glean learnings on health care design by conducting observational studies and surveys.

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The health care physical environment can both help and hinder the work of caregivers, presenting challenges for designers. Three recent research studies from The Center for Health Design’s Knowledge Repository highlight nuances of caregiver activities.

First, a research team led by Xuan used surveys and close to 68 hours of observations to explore nurse activity on specialized medical-surgical departments in a large Chinese hospital. Findings demonstrated that nurse satisfaction with care activities, visibility and the physical environment varied significantly across specialties.

Observations also revealed differences in nurse travel patterns and activities by specialty. Nurses on two surgical units (orthopedic and neurosurgery) traveled most frequently between patient and treatment rooms, patient rooms and workstations, and nurses stations and treatment rooms, with frequent travel between dressing-change rooms and nurses stations. Nurses on two medical units (gastroenterology and cardiology) traveled most frequently between their workstations and nurses stations, and between workstations and patient rooms. These findings support the need to consider how nursing care varies for specific populations to optimize team communication and efficient workflows.

Next, Zamani, Joy and Worley used real-time observations and surveys to study nurse walking behaviors across two medical-surgical units. After gathering 33 hours of nurse travel behavior, investigators determined that walking distances were significantly shorter in a newly renovated unit featuring four centralized nurses stations and two medication rooms when compared to an unmodified floor with two centralized nurses stations, 12 decentralized alcoves and one medication room. This makes sense as the most frequently traveled route was between centralized nurses stations and patient rooms.

Survey results from 143 staff members in a variety of roles suggested that supply proximity was a main driver of satisfaction with patient flow, care quality and the workplace. Interestingly, there were no statistically significant differences in staff member perceptions of stress and anxiety between the two floors studied.

Finally, Roos and colleagues collected nurse input to understand how both the physical layout of their unit and technology implementation affected their workflows. Twelve registered nurses who worked in either medical or surgical wards at a hospital in Norway were interviewed. Researchers categorized the data into the two main themes of “being absent” and “being present.”

With regard to being present, nurses felt the single-room design, unit layout and associated technology enhanced patient communication, optimized patient placement and improved the quality of one-on-one nursing care. In terms of being absent, nurses highlighted concerns about patient loneliness (especially for elderly patients), the burden of technology (especially when there were not enough computers) and the time-consuming consequences of long, L-shaped units that resulted in long walking distances, reduced patient visibility and difficulty locating co-workers.

Observations and caregiver input are two ways to incorporate caregiver insights into health care design, but simulations offer other benefits (see the “Design Discoveries” from the September/October 2024 issue of Health Facilities Management). You can find articles on this and other health care design topics in The Center for Health Design’s Knowledge Repository.

Research used for this column

The following research citations from The Center for Health Design’s Knowledge Repository of health care design resources were used by the author when writing this column:

• X. Xuan, et al., “Differences in Nurses’ Satisfaction and Demand for Spatial Design among Different Departments of Nursing Units: A Case Study in China,” HERD: Health Environments Research & Design Journal, vol. 17, no. 2 (2024): 129–45.
• Z. Zamani, T. Joy and J. Worley, “Optimizing Nurse Workflow Efficiency: An Examination of Nurse Walking Behavior and Space Accessibility in Medical Surgical Units,” HERD: Health Environments Research & Design Journal, vol. 17, no. 3 (2024): 269–89.
• A. K. Ø. Roos, V. A. Grøndahl and A. K. Helgesen, “Present but Absent—Nurses’ Experiences of How a Hospital Design with Only Single Bedrooms and the Technological Shift Affect Nursing,” Nursing Reports, vol. 14, no. 4 (2024): 2651–67.

About this column

“Design Discoveries” highlights research from The Center for Health Design’s Knowledge Repository, a user-friendly library of health care design resources. This research effort is supported by the American Society for Health Care Engineering, the American Institute of Architects, the Academy of Architecture for Health Foundation and the Facility Guidelines Institute.