Module 4: Organizing
Module 4.2: Physical Layout of Nursing Unit & Necessary Facilities
Learning Objectives
Overall objective is to understand about the lay out of nursing unit , and facilities available which was rendering to carry out the nursing care in the hospital setup.
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Learning Objectives
Overall objective is to understand about the lay out of nursing unit , and facilities available which was rendering to carry out the nursing care in the hospital setup.
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Learning Outcome At the end of of this module the the students students will be able to: to: •
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Explain about the Nursing unit Designs List out the facilities of Nursing Unit Describe about the nurses Station Enumerate the lighting; lighting; physical access; location, location, layout layout and and noise Enlist Enlist the adequate adequate space; space; furnitur furnituree and ergonomics ergonomics;; and amenities, amenities, Organisation and preparedness; and windows Privacy and security, and visual access Explain the circular Nursing Unit.
List of Topics •
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Introduction Nursing unit Designs Facilities of Nursing Unit Nurses Station Lighting; physical access; location, layout and noise Adequate space; furniture and ergonomics; and amenities Organisation and preparedness; and windows Privacy and security, and visual access Circular Nursing Unit Summary References
Introduction •
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The term “nursing unit” is used in the United States and refers to an area in a hospital or other health care delivery setting where patients with similar needs are grouped to facilitate health care delivery by medically trained professionals. Typically a nurse manager is in charge of the nursing unit. There are various types of nursing units; inpatient and outpatient units, intensive care units and other specialized care units. The phrase hospital ward is used in the British English language and is similarly used to describe a division of a hospital shared by patients who need a similar kind of care. Historically, the nursing unit originated with the construction of the modern hospital. At the present time, staffing of nursing units is complex as hospitals must consider staff team composition, care delivery model, organizational culture and the physical environment where services are delivered (Hamilton, 1993). Current challenges also include an increased level of patient acuity and a shorter average patient length of stay.
Introduction •
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Design that helps maximize work organization and supports preparedness is the fifth most important characteristic of a well planned nursing workspace. Preparedness in the workplace design enables staff to act quickly in case of emergency. Sufficient room that allows easy organization and visual and physical access to supplies and equipment improves efficiency and reduces time spent hunting and gathering. Consistent organisational features among nurse stations, medication rooms, and supply areas are important for time efficiency and boosting productivity. Designated spaces for staff and well marked equipment areas are key. Design elements that enable staff to identify quickly or mark non functional equipment, and spot missing or non stocked supplies could lead to considerable improvement in productivity. Furthermore, designated workspaces for RNs, physicians and social workers and those who undertake rounds, such as physicians and physical therapists will enhance work organisation and reduce disturbances when staff leave their stations.
Nursing Unit Designs Linear Corridor Unit Designs: •
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The linear corridor unit designs also called “race track” design occur as a single corridor or double corridor layout. Most existing original floor plans typically have one nursing station on each unit. Most corridor floor plans are organized around the central station where charts, orders, medications and supplies are concentrated. The nursing station functions as the heart of patient care activities and allows responsive access to all patient rooms and good visibility to the patient rooms in close vicinity to the nursing station.
Nursing Unit Designs •
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Negative aspects include long walking distances for nurses and restricted visual control over patient rooms further away from the nursing station (Shepley, 2002; Trites et al. 1970). The courtyard nursing unit design consists of corridors in square or rectangular configuration surrounding a central courtyard area. This nursing unit design is more common in Europe. Invariably this design creates a need for additional nursing stations, limits visibility further and increases walking distances. As nurses spend much of their time walking up and down the halls, Hamilton (1993) concludes that the secret of workability for nursing staff in the corridor unit is a combination of bed numbers, nursing station numbers and nursing station placements.
Nursing Unit Designs Cluster Designs: •
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The Unit 2000 symposium held in Huston 1990 was organized as an attempt to generate ideas on the ideal nursing unit configuration of the future and to anticipate future trends in nursing unit design. For the first time, cluster bed pods were introduced in one case study which aimed to accomplish a more human scale nursing unit. In the cluster designs, patient rooms are organized around the nursing station dedicating one station as a main nursing location or entry reception station. Compact clustered unit designs were not only aimed to reduce walking distances but also to eliminate centrally located nursing stations, to place the provision of drugs closer to patients and to take full advantage of visibility.
Nursing Unit Designs Cluster Designs: •
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Patient support services were decentralized with each pod consisting of six to twelve beds and one decentralized nursing station with amenities for charting data, preparing medication, etc. By the 1990’s, bedside computerization enabled nurses to enter patient care data into a terminal at the patient’s bedside. Health care services were now literally brought to the patient. Decentralized nursing stations were complemented with an information station located outside each patient room. Information flow revolved around the patient bed and around the decentralized nursing station.
Nursing Unit Designs Radial Nursing Unit Designs: •
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The radial nursing unit designs maximize visualization, patient rooms are organized around nursing sub-stations within each unit. Nurses have an unobstructed view of each patient room from each decentralized nursing station. This design also accommodates fewer nurses on staff during night shift. Radial units are space consuming and tend to be smaller in bed numbers which increases construction and staffing costs. Nursing staff have expressed greater satisfaction with the radial unit compared to single and double corridor shapes (Trites et al. 1970) and in ICU units’ nurses preferred the semicircular unit (MacDonald et al. 1981).
Nursing Unit Designs Radial Nursing Unit Designs: •
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Radial unit design cannot accommodate an adequate number of private rooms without a tremendous waste of central core space (Hamilton, 1993). The trend towards larger patient rooms cause restrictions on the radial in terms of the remaining space for a nursing station and supplies. The development towards increased numbers of single and larger patient rooms in the United States has generated the use of alternative unit designs such as the triangular and horseshoe shapes.
Facilities of Nursing Unit •
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Nursing units shall consist of up to forty certified beds. The commissioner may approve nursing units with additional beds, provided that patient care is not adversely affected and appropriate arrangements are made for patient care and supervision. Single bedrooms shall be a minimum of one hundred square feet in size and multi bed rooms shall be a minimum of eighty square feet per bed, exclusive of toilet enclosures, lockers, closets and vestibules. Patient beds shall not be spaced closer than three feet from each other and sides of beds shall be at least two feet from walls.
Facilities of Nursing Unit •
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Window sills shall not be higher than three feet above the floor and shall be above grade. Hand washing facilities, with other than hand controls, shall be provided for each patient bedroom. Each patient bedroom shall have a toilet directly adjacent to it. Where this is not feasible, toilets shall be provided in each nursing unit, in such proximity to the patient rooms served as to adequately provide for patient needs, in a ratio of not more than eight patient beds for each centralized toilet served. Water closets shall have appropriate grab bars. At least one centrally located shower or tub within each nursing unit shall be provided for each twenty patients, or fraction thereof, served. Bathtubs and appropriate grab bars. A nurses' calling system shall be provided. A locker or closet shall be provided for each patient, to be located within or directly adjacent to each bedroom, sufficient in size to hold normal wearing apparel and personal effects.
Facilities of Nursing Unit •
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In multi bed rooms, flame-retardant cubicle curtains shall be provided for each bed. Nurses' stations shall be located to provide adequate supervision of patient corridors. Use of a convex mirror for such purpose shall be permitted. A staff water closet and lavatory shall be located in the vicinity of the nurses' station, if such facilities cannot be provided directly adjacent to the nurses' station. Each nursing unit shall include a medication room with a sink, refrigerator, and locked storage cabinets, or a separate and distinct part of the clean utility room or the nurses' station with double-locked storage cabinets, refrigerator, and a sink, which shall be used to prepare and store medications.
Facilities of Nursing Unit •
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Each nursing unit shall include separate clean and soiled utility rooms. Clean utility room facilities shall be equipped with a sink with hot and cold running water and other than hand control faucets; a soap and paper towel dispenser; and self-closing waste receptacles. Clean utility room facilities shall be located in a separate area in the nurses’ station when no other space is available. One nourishment pantry shall be provided on each patient floor. When no other space is available, the nourishment station may be included with, but shall be a separate and distinct part of, the nurses' station. The soiled utility room shall contain a hand washing sink, work counter, waste receptacle, and soiled linen receptacles. A clinical sink or equivalent flushing rim fixture shall be included, unless other satisfactory means of disposing of sanitary wastes are provided. Provision shall be made for the administration of suction and oxygen to patients, with built-in or portable equipment.
Facilities of Nursing Unit •
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At least one janitor's closet for each patient floor shall be provided. A stretcher and wheelchair parking area, or alcove, shall be provided on each patient floor. A minimum of one dayroom per patient floor shall be provided. Isolation rooms shall be provided on the basis of one for each thirty beds or major fraction thereof, unless the hospital has a separate contagious disease unit. Each isolation room shall provide for: Only one patient per room A lavatory within the patient room, or toilet room A view-window for nursing observation A separate toilet room with bath or shower An entrance from the corridor through a vestibule space, which may be a closed anteroom or an open passageway, with adequate facilities to maintain aseptic conditions including lavatory or sink. One closed anteroom may serve several isolation rooms.
Nurses Station Adequate Workspace: •
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Provide adequate circulation spaces and workstations to ensure that nurses are not interrupted when undertaking charting work, and to prevent clutter. Consider that, at times, doctors, ancillary staff and RNs gather simultaneously around the nurse station. Anticipate how the space accommodates staff during shift-change reports, when the number of staff doubles while critical patient information is communicated to those on the next shift. Additional foldable or appropriately sized furniture can be stored. Lack of space disturbs privacy and can undermine the atmosphere of teamwork, and cause conflict.
Nurses Station Appropriate Lighting: •
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Provide bright, glare-free and soft light and design to allow for as much natural day lighting as possible. One nurse stated: “Natural lighting keeps [me] from getting depressed”; another commented: “I would like to be able to see well when working on patient charts and retrieving medication.” Fluorescent lighting or finishes, which give a sense of institutional atmosphere, should be avoided. Apply finish surfaces that “look good, fresh and clean”. Remember that nurses work long hours, so use warm colours and peaceful themes. Nurses report that they “get eye strain when all their surroundings are … stark white”.
Nurses Station Furniture and Ergonomics: •
Provide workplaces that are designed ergonomically to maintain the health and performance of staff. Easy-to-reach supplies without the need to bend or stretch constantly, and chairs and tables that are adjustable and comfortable, reduce fatigue and improve health.
Amenities: •
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Anticipate adequate supplies and equipment, such as phones, computers, printers, fax machines, etc. Provide ample reachable power outlets. Provide easy access to bathrooms and refreshments. Consider access to music or radio for individuals, as RNs noted that music “could help the day pass”. Frequently accessed resources, such as linens, medication, nourishment, supplies and refreshments, should be nearby, within “quick access to the hub”.
Nurses Station Organisation and Preparedness: •
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Design “consistent features and organisation at each desk/work area”. Designate spaces for staff and allocate areas for organising equipment, materials, and supplies. Anticipate designated spaces for RNs, doctors, social workers and other staff. Label storage spaces for supplies and ensure they are easy to reach and visible. One nurse requested “supplies in a visible order for ease of use and restocking”. Anticipating design features that help signal missing supplies for restocking or broken equipment is an effective way to reduce wasted time. Informed by unit staff, designers should designate areas for that which is most important (eg vital-signs machines) in the nurse station, or within a few feet.
Nurses Station Physical access, location and layout: •
Layout is key to work performance. Locate the most frequently accessed supplies around the nurse station “with the least amount of walking to patient nourishment, linens and medication”. The ideal layout, as visualised by RNs, is one where the “nurse station is the hub for a unit, with the patient rooms being not too far from it”.
Noise: •
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Noise must be suitably controlled, so consider movable and fold down screens that can be deployed as needed. Nursing staff often “have difficulty concentrating when [it is] noisy” and are “frequently distracted”, but the use of acoustic surfaces and physical barriers, such as glass, to control noise should ensure that nurses can concentrate during their work.
Nurses Station Privacy and security: •
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The outside windows opening into nurses’ stations should “be semisecluded from public eye” to respect patient-information privacy. One nurse suggested that the hub should be “surrounded by glass windows above the countertop, with easy access points; this will reduce noise and help keep the patient records private”.
Windows: •
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Include windows in nurses’ workstations. Nurses stated their desire for a “view to [the] outside or nature,” “pleasant scenery” in the form of artwork, or a soothing and stress-reducing artefact “like a fish tank, flowers or trees”. Such features are restorative for cognition and help with mental balance during work. A well-designed workspace does not “isolate staff in a box without windows, [or without an] open view of [the] workplace”. Nursing areas should have good ventilation and ambient temperature. As one nurse expressed, staff need “clean air to breathe”.
Nurses Station Visual access: •
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Visibility to the surroundings is critical. Consider patient visibility for every location, specifically those areas where nurses frequently work. “Enable nursing staff to see the patients, with the least amount of walking” and provide views of the hallways and rooms.
Lighting, Physical Access, Location, Layout and Noise
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Adequate Space, Furniture, Ergonomics and Amenities
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Organisation and Preparedness and Windows
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Privacy and Security, and Visual Access
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Centralized Nursing Station
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