Adapting and Creating Healing Environments: Lessons Nurses Have Learned From the COVID-19 Pandemic.

The purpose of this article is to discuss how nurse leaders influenced facility design decisions, quickly evaluated the outcomes, and rapidly adapted the environment based on their own observations, assessments, changing regulatory requirements, and the needs of patients, nurses, and the caring workforce. Nurses must validate their clinical voice in the future design of healthcare environments based on the adaptations discovered and instituted during COVID-19. Many lessons were learned and physical adaptations made during the pandemic. While the pandemic spotlighted the emotional and physical stress and strain on nurses, it is important to consider all adaptations made in the physical environment to improve care delivery.

Making the Case for Practice-Based Research and the Imperative Role of Design Practitioners.

The purpose of this article is to justify the need for evidence-based design (EBD) in a research-based architecture and design practice. This article examines the current state of practice-based research (PBR), supports the need for EBD, illustrates PBR methods that can be applied to design work, and explores how findings can be used as a decision-making tool during design and as a validation tool during postoccupancy. As a result, design professions' body of knowledge will advance and practitioners will be better informed to protect the health, safety, and welfare of the society. Furthermore, characteristics of Friedman's progressive research program are used as a framework to examine the current state of PBR in design practice. A modified EBD approach is proposed and showcased with a case study of a renovated inpatient unit. The modified approach demonstrates how a highly integrated project team, especially the role of design practitioners, contributed to the success of utilizing baseline findings and evidence in decision-making throughout the design process. Lastly, recommendations and resources for learning research concepts are provided for practitioners. It is the role of practitioners to pave the way for the next generation of design professionals, as the request and expectation for research become more prevalent in design practice.

The Legacy of Florence Nightingale's Environmental Theory: Nursing Research Focusing on the Impact of Healthcare Environments.

OBJECTIVE: The purpose of this paper is to explore nursing research that is focused on the impact of healthcare environments and that has resonance with the aspects of Florence Nightingale's environmental theory. BACKGROUND: Nurses have a unique ability to apply their observational skills to understand the role of the designed environment to enable healing in their patients. This affords nurses the opportunity to engage in research studies that have immediate impact on the act of nursing. METHODS: Descriptive statistics were performed on 67 healthcare design-related research articles from 25 nursing journals to discover the topical areas of interest of nursing research today. Data were also analyzed to reveal the research designs, research methods, and research settings. These data are part of an ongoing study. RESULTS: Descriptive statistics reveal that topics and settings most frequently cited are in keeping with the current healthcare foci of patient care quality and safety in acute and intensive care environments. Research designs and methods most frequently cited are in keeping with the early progression of a knowledge area. CONCLUSIONS: A few assertions can be made as a result of this study. First, education is important to continue the knowledge development in this area. Second, multiple method research studies should continue to be considered as important to healthcare research. Finally, bedside nurses are in the best position possible to begin to help us all, through research, understand how the design environment impacts patients during the act of nursing. KEYWORDS: Evidence-based design, literature review, nursing.

Impact of place on people and process: the integration of research on the built environment in the planning and design of critical care areas.

What is the role of the built environment in healing? What aspects of the built environment promote healing, staff efficiency, and patient safety? How can we know if these assertions hold true? Can scientific research help us validate these assumptions? These questions are important to explore, especially for our most vulnerable patients-those in critical care settings. This article explores the historical influences on health care design, reveals how the current health care transformation movement has accelerated the incorporation of elements of the built environment into patient safety and quality improvement effort, discusses how healing environments are constructed, and examines how the literature of health care and health care design organizations have incorporated the impact of the built environment on patient, family, and staff outcomes and satisfaction. Finally, a case study of applying "design hypotheses" and a scientific method to the design of an intensive care unit setting is offered. This article will help critical care nurses understand the role the built environment has in creating optimal healing environments.

Integrating healthcare design research into practice: setting a new standard of practice.

It seems safe to conclude that nearly 150 years ago, "the lady with the lamp," Florence Nightingale, set a course that practice-based healthcare researchers continue to follow today. In her book, Notes on Nursing (1860), Nightingale identified light, ventilation, noise, and sanitation as elements of the environment that affected the well-being of soldiers in her care. Today, we attempt to study these same relationships: those that exist between the built environment of healthcare settings, and the health and well-being of the users of these spaces. The goal of this paper is to describe how research is conceptualized, integrated, and utilized in healthcare design decision making and to address the challenges and opportunities that exist when moving a research agenda forward. Numerous examples of design practitioners and healthcare facilities that have committed themselves to integrating research into healthcare design are provided.

Centralized vs. decentralized nursing stations: effects on nurses' functional use of space and work environment.

OBJECTIVE: Evidence-based findings of the effects of nursing station design on nurses' work environment and work behavior are essential to improve conditions and increase retention among these fundamental members of the healthcare delivery team. The purpose of this exploratory study was to investigate how nursing station design (i.e., centralized and decentralized nursing station layouts) affected nurses' use of space, patient visibility, noise levels, and perceptions of the work environment. BACKGROUND: Advances in information technology have enabled nurses to move away from traditional centralized paper-charting stations to smaller decentralized work stations and charting substations located closer to, or inside of, patient rooms. Improved understanding of the trade-offs presented by centralized and decentralized nursing station design has the potential to provide useful information for future nursing station layouts. This information will be critical for understanding the nurse environment "fit." METHODS: The study used an exploratory design with both qualitative and quantitative methods. Qualitative data regarding the effects of nursing station design on nurses' health and work environment were gathered by means of focus group interviews. Quantitative data-gathering techniques included place- and person-centered space use observations, patient visibility assessments, sound level measurements, and an online questionnaire regarding perceptions of the work environment. RESULTS: Nurses on all units were observed most frequently performing telephone, computer, and administrative duties. Time spent using telephones, computers, and performing other administrative duties was significantly higher in the centralized nursing stations. Consultations with medical staff and social interactions were significantly less frequent in decentralized nursing stations. There were no indications that either centralized or decentralized nursing station designs resulted in superior visibility. Sound levels measured in all nursing stations exceeded recommended levels during all shifts. No significant differences were identified in nurses' perceptions of work control-demand-support in centralized and decentralized nursing station designs. CONCLUSIONS: The "hybrid" nursing design model in which decentralized nursing stations are coupled with centralized meeting rooms for consultation between staff members may strike a balance between the increase in computer duties and the ongoing need for communication and consultation that addresses the conflicting demands of technology and direct patient care.

Creating optimal healing environments in a health care setting.

As evidence about the benefits of healing environments accumulates, health care organizations are starting to incorporate features into hospital design that reduce stress and promote healing. This article discusses some of the research supporting healing design and provides examples of how it is being used in new construction and renovations.