Neonatal Intensive Care Unit Layout and Nurses’ Work

Abstract

Neonatal intensive care units (NICUs) remain one of the few areas in hospitals that still use an open bay (OPBY) design for patient stays greater than 24 hr, housing multiple infants, staff, and families in one large room. This creates high noise levels, contributes to the spread of infection, and affords families little privacy. These problems have given rise to the single-family room NICU. This represents a significant change in the care environment for nurses. This literature review answers the question: When compared to OPBY layout, how does a single family room layout impact neonatal nurses' work? Thirteen studies published between 2006 and 2015 were located. Many studies reported both positive and negative effects on nurses' work and were therefore sorted by their cited advantages and disadvantages. Advantages included improved quality of the physical environment; improved quality of patient care; improved parent interaction; and improvements in nurse job satisfaction, stress, and burnout. Disadvantages included decreased interaction among the NICU patient care team, increased nurse workload, decreased visibility on the unit, and difficult interactions with family. This review suggests that single-family room NICUs introduce a complex situation in which trade-offs occur for nurses, most prominently the trade-off between visibility and privacy. Additionally, the literature is clear on what elements of nurses' work are impacted, but how the built environment influences these elements, and how these elements interact during nurses' work, is not as well understood. The current level of research and directions for future research are also discussed.

Psychosocial support for parents of extremely preterm infants in neonatal intensive care: a qualitative interview study

“…Single-family-room NICUs also have their disadvantages, however. This type of layout can potentially exacerbate the effects of the organizational problems described above, since it increases nurses’ workload and makes interaction among staff more difficult [36, 37]. It also gives parents fewer opportunities for mutually supportive contact with other parents [38] and may even increase parents’ sense of insecurity and stress [39, 40].…”

The heuristics of nurse responsiveness to critical patient monitor and ventilator alarms in a private room neonatal intensive care unit

“…Research has shown that nurses do not respond to all alarms but, in fact, integrate information from multiple sources in a heuristic fashion in their decision making [ 2 , 11 , 12 ]. Within the context of a private room, with limited visual oversight, increasing patient surveillance via technological means and the potential need to cover long distances to reach the bedside, the complexity associated with addressing alarm fatigue acquires new dimensions [ 13 ]. Surprisingly, limited research has been carried out on alarm management, the clinical relevance of alarms and the factors that modulate nurse responsiveness, especially for private room settings [ 14 ].…”

Layout Planning in Healthcare Facilities: A Systematic Review

“…Nurse wards often contain major flows of people, medications, and supplies and thus require special attention in planning (Yi & Seo, 2012). Doede, Trinkoff, and Gurses (2018) reviewed the impact of single-family designs on nurses’ work in neonatal ICUs. Hua, Becker, Wurmser, Bliss-Holtz, and Hedges (2012) compared the effects of centralized and decentralized nurse wards on staff communication, quality of care, and patients’ health.…”