Ulrich and Zimring1 performed an extensive review of the literature as it pertains to the physical environment of care and patient and staff outcomes. They presented solid evidence for reduced staff stress and fatigue in optimal physical environments, while increasing the effectiveness of delivering care, improving patient satisfaction, reducing patient stress, and improving the overall quality of health care.
Newborn intensive care units (NICUs) around the world are now being redesigned as evidence is mounting to support the belief that the physical environment has significant impact on those who live and work there. A recent trend in the design of NICUs has been to increase the number of private rooms for the care of critically ill or preterm newborns and their families and incorporating the single family room (SFR) into neonatal intensive care unit design is becoming a primary feature of most new unit designs in the United States.2 The SFR has appeal for a number of reasons, including the positive impact of developmentally appropriate care on infant outcomes, increased importance placed on breast-feeding and kangaroo care, better infection control practices, increased family involvement, as well as the mandate to assure patient privacy enacted by the Health Insurance and Portability and Accountability Act.3
Moving from the historically built “baby barn” to the SFR unit involves enormous amounts of change. Although many would argue that decreasing the amount of noxious stimuli, noise, and light is a good thing, these reductions necessitate a design that increases the possibility of staff isolation and results in further separation of the patient from the caregiver. In an effort to offset these concerns for staff isolation, further changes and enhanced technologies are required. That very technology then changes work flow patterns and the way socialization occurs. Since the mid-1980s, nurses' work stress has been escalating due to the increasing use of technology, rising health care costs, and turbulence within the work environment.4 The rapidity with which nurses are exposed to change is staggering that may lead to tension, stress, and dissatisfaction.5
Although advantages to the SFR design have become more readily apparent, health care professionals unfamiliar with this design concept may be skeptical as to the opportunity to enhance the physical environment for the betterment of infants, families, and staff. The information disseminated by the Consensus Committee on Recommended Design Standards for Advanced Neonatal Care is helping guide decision makers throughout the world who are responsible for environments of care for the critically ill or preterm newborn. These standards are based on clinical experience and an evolving scientific database, the product of the ongoing efforts of many individuals from a variety of professions: health care, architectural, interior design, as well as health care regulators. Most of these recommendations have now been adopted by the American Institute of Architects and the American Academy of Pediatrics (AAP)/American Congress of Obstetricians and Gynecologists (ACOG) Guidelines.2 The intent of this special issue is to further add to the published body of knowledge as it relates to design of NICUs and to prove beneficial in assisting others building the SFR model.
In the first article, Smith, Hager, and Bajo compose a compelling argument for enhancing the “functional beauty” of today's NICUs through careful attention to aesthetics and include strategies for making these units more visually appealing. A growing body of research is showing that artwork in hospitals can reduce stress and can reduce the amount of pain medications needed for treatment.1 Positive distraction provided by nature, art, and music have also been cited as a means of mitigating stress.6
As stated above, incorporation of the SFR into NICU design is occurring in almost every newly constructed NICU either in part or in totality. Bob White, invaluable for his contributions to the development of standards for NICU design, outlines for readers the advantages and drawbacks of the SFR design and offers strategies for those considering construction or renovation of a NICU.
The amount of change that a staff may experience when moving from a “baby barn” to an SFR NICU can be astronomical.7 Staff may be challenged physically with a much larger work space, and philosophically, as they may be expected to provide more developmentally supportive care while embracing increased presence of families. New vital technology required for effective alarm management and communication in the SFR NICU is of paramount importance and can be overwhelming for those who are less technology savvy. Staffs that are educationally and emotionally prepared for change and who are involved in the decision making and planning process will transition more smoothly to the SFR NICU. Lisa Shaver examines the intricacies of designing an orientation for staff as they transition to the SFR NICU. This firsthand account will prove beneficial to many faced with these challenges.
Rachel Saucier explores the importance of design standardization from both an architectural and a clinical perspective. Her article reviews the concepts of “same-handed,” “mirror-image,” and “patient approach” and contains invaluable illustrations that aid understanding of key factors that influence room design in the NICU. If sufficient attention is paid to the invaluable content in this article, hours of unnecessary toil by both clinical and architectural stakeholders designing new NICUs will be saved.
I have also contributed to this edition on NICU design with the assistance of two colleagues, Suzanne Short, and Gary Gutcher. We report the results of a staff survey, completed as part of a quality improvement initiative, one year after the move to our new 40-bed SFR NICU. We found that most respondents felt that the SFR was better than the open unit design with regard to patient care delivery, decreased stress for the nursing staff, and provided an environment that was developmentally appropriate for preterm infants while allowing for privacy and confidentiality for parents.
Mary Coughlin's article presents a newly developed infant positioning assessment tool. As standards in patient care are becoming increasingly important, this tool may prove to be one way of standardizing an assessment of infant's positioning, which is extremely important in developmental care.
Rizzo, Rea, and White also provide relevant direction as it pertains to lighting design in today's NICUs. After reviewing the lighting accommodations required for 3 distinctly different groups of people—infants, families, and staff—the authors review some basic concepts deemed important for design considerations in the NICU. The article puts forth a goal-oriented approach to ensuring a successful lighting result, a thoughtful presentation with valuable resources throughout.
Having spent the last two decades of my career practicing in what I lovingly refer to as a “baby barn,” it has been exciting to witness the transformation of care delivery to critically ill newborns and their families. From the early days of parental restriction and knowing very little about the abilities of those born preterm to now units that embrace the notion of supporting both infants, families, and staff alike, it is with great excitement that I share the articles contained within this journal, for each of them speak to the state of the science in addressing neonatal care.
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