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From the other side of the bed

How long has it been since you looked at the ambience of a hospital with a critical eye? If you practice there, have you thought about how the surroundings in this “home away from home” might influence a patient’s recovery? Currently, more than $200 billion is being spent to renovate, upgrade, and prepare today’s hospitals for tomorrow’s patients. Nurses are in a prime position to affect their design.

Evidence-based design

Evidence is driving the design of patient-centered care environments to enhance patient and staff safety, decrease patient stress, improve staff effectiveness, and improve quality of care. Florence Nightingale, in her famous 1859 book, Notes on Nursing, espoused the breadth of environmental interventions nurses could use to help patients heal: “I use the word nursing for want of a better. It has been limited to signify little more than the administration of medicines and the application of poultices. It ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and the proper selection and administration of diet—all at the least expense of vital power to the patient.” These principles stand at the center of many evidence-based design features being incorporated into healthcare facilities.

The Center for Advanced Healing cites the 10 leading design features that promote healing environments and help improve safety, reduce errors, and increase operational efficiency. Topping the list are single patient rooms. The documented benefits of single rooms range from decreases in infection rates, medication errors, transfers, and noise to increased privacy, communication, and family accommodations to greater patient satisfaction and faster recovery.

A pastoral view through a window or a floral photograph on the wall provides access to nature—an important element for healing. Natural light and visualization of nature help create positive mood changes and improve patient, family, and staff satisfaction. Some studies have shown a relationship between sunlight and decreased stress, depression, agitation, length of stay, analgesia use, and even mortality.

A family zone within the room provides an opportunity for greater involvement of family members in the patient’s care and promotes both patient and family satisfaction. A family-driven design process also can help identify important amenities—cell phone, Internet access, sofa bed, lounge, area for quiet conversation, and a resource center.

Distinct safety and comfort enhancements include high-efficiency particulate air filters for better air quality in the heating, ventilation, and air conditioning systems; ceiling lifts to decrease back injuries; sound-absorbing ceiling tiles to decrease ambient noise; and easily accessible hand-hygiene product dispensers to reduce spread of infection. Decentralized work stations promote better visual access and accessibility to patients.

Design that decreases stress

Patient rooms should have a patient zone and a staff zone to promote safe and efficient care. The patient zone includes access to the patient, sightline to the bathroom, and proximity to family members or other visitors—features that enhance privacy, safety, and comfort. The staff zone encapsulates the patient zone and should have design elements that enhance efficiency and safety, such as accessible charting surfaces and computers, supply storage, and shortest possible distance between bed and bathroom. The patient and staff space also must be conducive to team work and provide easy access to information technology, power supplies, and monitoring, utilities, and emergency equipment. The layout should distribute movement and allow circulation space. Studies show the best placement of a bathroom is on the wall contiguous with the bed, with the entrance visible from the hallway. The bathroom should have low or no thresholds for doors and showers; its door should be 6 feet wide.

Traditional nursing stations are giving way to team work stations or clinical care hubs where multidisciplinary teams can huddle to exchange information or share common resources. Better design and use of technology can improve efficiency across a patient unit. A staff respite area helps decrease caregiver stress, leading to improved job satisfaction, effectiveness, and retention. This area—close to but partitioned from the patient care rooms and active working spaces—must be near other staff, with a link to communications, appropriate lighting, technology, and staff amenities.

For the future, programs of care will take a longitudinal approach and reduce hospitalizations. Successful telehealth programs in the home and community are empowering consumers to manage their health and are moving care out of hospitals. In the meantime, nurses can serve as fresh eyes for their colleagues in facility design and construction, bringing the patient’s view from the other side of the bed to guide renovation or new construction of patient-care areas. Nurses advocating for evidence-based design also are good stewards of the patient-care environment.

Pamela F. Cipriano, PhD, RN, FAAN, NEA-BC
American Nurse Today


  1. With this said, and I am in concurrence, how about including nursing homes/rehabillitation centers? I realized this when I went to visit a dear friend who is receiving physical rehab. I noticed that the bathtub was inaccessible if a person had difficulty with standing or lifting the legs. The soap dispenser by the sink was difficult to manipulate and the the sink was not low enough if a person is in a wheelchair.

  2. Hi Pam
    I love your editorials and congrats on the IOM scholar position. Still going strong after all these years! Come visit Utah


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