Evidence in the healthcare community is pointing to the fact that family participation improves patient care outcomes, enhances the patient experience, and improves overall patient and family satisfaction. Medication errors decrease, patients are less confused, lengths of stay are shortened, and readmission decrease. In addition, the integration of the family in the patient’s care minimizes the family member’s anxiety, improves their coping strategies which in effect influences the patient’s recovery. With this empirical evidence, why wouldn’t we include the family as a vital user in the design of the healthcare environment?As designers and drivers of innovation, it is our responsibility to ensure family comfort, and other basic needs are considered during the design process.
In the family-centered care model, the patient and the family are recognized as the unit of care. A few years ago, families had restricted visiting hours, restricted access to certain inpatient units, and were not permitted to be present during life threatening situations. Today, families are encouraged to stay overnight with their loved one, participate in treatment plans, education and discharge preparation, and attend life threatening situations.
The best method to ensure that the new facility will meet the needs of the family-centered care model is to include them in the design process. Hospital-based family advisory groups are a great resource for the design team. The primary purpose of the advisory board is to receive the perspective of the patient and family on hospital policies and procedures, review of patient and family complaints, and to provide ideas on how to improve the care delivery model at the hospital. The advisory group has first-hand experience of how a hospital environment affects the patient journey and can quickly gather information from other patients and families where information is needed.
Areas where family wisdom and experience influences design are:
Furniture Choices: waiting room chairs, patient room chairs and furniture for sleeping
Overnight accommodation: showers and toilets in the patient room, on the unit or in another building
Technology: communication boards, wireless access and electrical outlets in patient rooms, surgery or emergency departments, and other waiting areas
Nourishment: access and provision for nourishment on the inpatient room
Space and Presence: Pre-surgery, post-surgery, during procedures, during emergency situations, etc
The Information can be obtained in many formats from an easy one on one conversation to focus groups. Like any form of communication, face-to-face encounters are best. This can be accomplished by telephone conversations, by one on one interviews or by visioning sessions. Hospital administrators are encouraged to attend visioning sessions as passive participants while the design team leads a creative session. Surprisingly, the information received provides a humanistic and insightful perspective that may otherwise be overlooked.
Hospitals committed to family-centered care often request that dedicated time be provided for families by hosting periodic design updates and mock up opportunities. Mock ups can range from the testing of furniture types to actual participation in the patient room mock up where they can evaluate the provisions in the patient room family zone. Items typically evaluated in the patient room are the accessibility and view to the patient, the type of seating or sleeping furniture, family zone lighting, the view of the television, electrical outlets, and storage for clothes and other personal belongings.
An exploratory study of families in a pediatric intensive care unit revealed that once the acuity level of a child decreases family participation in care increases. Primary care, so to speak, is transferred from the expertise of a critical care nurse to the nurturing and experience of the parent. Although this study was based in a pediatric environment, the findings are applicable to an adult environment.Questions for designers and healthcare personnel to consider in the design of the patient room are: How can we improve the flexibility of the room for the family member as they care for their family member?
How can we improve the communication between the family and healthcare provider within the patient room?
How can the room be designed to enhance the safety and satisfaction for the family?
What design features would maintain infection control guidelines and improve comfort for the family?
Similar to how multi-disciplinary care is paramount to patient health and treatment; family participation is paramount to good hospital and ambulatory care design. Complete restoration of health requires the healing and wholeness of the mind, body and soul. Without family and loved ones present during a patient’s illness, the return to health will be hindered. Our role as planners and designers is to ensure that the healthcare environment will provide each patient with the best opportunity to fully recover from their illness and this includes provisions for the family members.
1. Norris, LS. The Psychological and Environmental Needs of Family Members of Critically Ill Adult Patients. Arlington, Texas: University of Texas at Arlington, 1984.
2. Azoulay, E, Sprung, CL. Family-physician interactions in the intensive care unit. Critical Care Medicine. 2004;32(11):2323-2328.
3. Johnson D, Wilson M, Cavanaugh B, Bryden Candice, Gudmundson D, Moodley O. Measuring the ability to meet family needs in an intensive care unit. Critical Care Medicine. 1998;26(2):266-271.
4. Stichler JF. Creating healing environments in critical care units. Critical Care Nursing Quarterly. 2001;24(3):1-20.
5. Fontaine DK, Briggs LP, Pope-Smith B. Designing humanistic critical care environments. Crit Care Nurs Q. 2001;23(3):21-34.
6. Jastremski CA. ICU bedside environment. A nursing perspective. Crit Care Clin. 2000;16(4):723-34.
7. Williams M. Critical care unit design: a nursing perspective. Crit Care Nurs Q. 2001; 24(3):35-42.
8. Mitchell M, Chaboyer W, Burmeister E, Foster M. Positive effects of a nursing intervention on family-centered care in adult critical care. American Journal of Critical Care. 2009;18:543-552.
9. Ortenstrand A, Westrup EB, BrostrÖm EB, et al. The Stockholm neonatal family centered care study: effects on length of stay and infant morbidity. Pediatrics. 2010;125(2):e278-85.
10. Pati D, Evans J, Waggener L, Harvey T. An exploratory examination of medical gas booms versus traditional headwalls in intensive care unit design. Critical Care Nursing Quarterly.2008;31(4):340-356.
11. O’Connor D. Booms done right. Outpatient Surgery. 2007;8(9):1-5.
12. Williams M. Critical care unit design: a nursing perspective. Critical Care Nursing Quarterly. 2001; 24(3):35-42.
13. Azoulay E, Pochard F, Chevret S, et al. Meeting the needs of intensive care unit patient families. Am. J. Respir. Crit. Care Med. 2001;163(1):135-139.
14. Davidson J. Family-centered care: meeting the needs of patients’ families and helping families adapt to critical illness. Critical Care Nurse. 2009;29(3):28-34.
15. Verhaeghe S, Defloor T, Van Zuuren F, Duijnstee M, Grypdonck M. The needs and experiences of family members of adult patients in an intensive care unit: a review of the literature. J ClinNurs. 2005;14(4):501-9. 16. American Institute of Architects. A Patient Room Prototype: Bridging Design and Research. AIA Website: www.aia.org; 2004; 1 – 20. Printed: June 1, 2011.
RELATED ARTICLES : ...........................................................................................................................................................................................