Space Allocation in the Award-Winning Adult ICUs of the Last Two Decades (1993-2012): An Exploratory Study

This is the author's accepted manuscript. The original published version is available at http://her.sagepub.com/content/7/2/29.abstract.OBJECTIVE: This exploratory study describes space allocation among different generic categories of functions in adult intensive care units (ICUs) showing how the amount of space of any one functional category is related to that of another functional category, and how different strategic choices, such as size, construction type, specialty type, and layout type, affect space allocation in these ICUs. BACKGROUND: Even though critical care practice has already undergone significant changes in the last few decades, it is still an evolving domain of medical practice. As a result, ICU design is also evolving as new regulatory standards, new technologies, and new clinical models are being introduced. A good understanding of the above issues regarding space allocation may help us better guide the evolution of ICU design. METHODS: The study includes a set of 25 adult ICUs that were recognized between 1993 and 2012 by the Society of Critical Care Medicine (SCCM), the American Association of Critical Care Nurses (AACCN), and the American Institute of Architects Academy of Architecture for Health (AIA AAH) for their efforts to promote healing of the critically ill and injured patients through the design of the critical care unit environment. RESULTS: The study finds notable differences in space allocation among different generic categories of functions between the ICUs of the first decade (1993–2002) and the second decade (2003–2012). The study also finds notable differences in space allocation among different generic categories of functions in relation to size, construction type, specialty type, and layout type. CONCLUSIONS: Despite several limitations, the study should help design better adult ICUs based on an evidence-based understanding of the relationships between space allocation and strategic choices

Two Decades (1993-2012) of Adult Intensive Care Unit Design: A Comparative Study of the Physical Design Features of the Best-Practice Examples

In 2006, Critical Care Nursing Quarterly published a study of the physical design features of a set of best-practice example adult intensive care units (ICUs) [1]. These adult ICUs were awarded between 1993 and 2003 by the Society of Critical Care Medicine (SCCM), the American Association of Critical Care Nurses (AACCN), and the American Institute of Architects/Academy of Architecture for Health (AIA/AAH) for their efforts to promote the critical care unit environment through design. Since 2003 several more adult ICUs were also awarded by the same organizations for similar efforts. The present study includes these newer ICUs with those of the previous study to cover a period of two decades from 1993 to 2012. Like the 2006 study, the present study conducts a systematic content analysis of the materials submitted by the award-winning adult ICUs. Based on the analysis, the study compares the 1993-2002 and 2003-2012 adult ICUs in relation to construction type, unit specialty, unit layout, unit size, patient room size and design, support and service area layout, and family space design. The study also compares its findings with the 2010 Guidelines for Design and Construction of HealthCare Facilities [2] of the Facility Guidelines Institute (FGI) and the 2012Guidelines for Intensive Care Unit Design [3] of the Society of Critical Care Medicine (SCCCM). The study indicates that the award-winning ICUs of both the decades used several design features that were associated with positive outcomes in research studies. The study also indicates that the awardwinning ICUs of the second decade used more evidence-based design features than those of the first decades. In most cases, these ICUs exceeded the requirements of the FGI Guidelines to meet those of the SCCM Guidelines. Yet, the award-winning ICUs of both the decades also used several features that had very little or no supporting research evidence. Since they all were able to create an optimal critical care environment for which they were awarded, having knowledge of the physical design of these award-winning ICUs may help design better ICUs

Islamic Architecture: An Architecture of the Ephemeral

Written as an introduction to the Architecture of the Muslim world, this paper discusses the underlying similarities of different regional architectural styles developed by Muslims over a vast geographical area during a period between the late seventh century and the early twentieth century. After briefly describing regional variations, the paper describes the basic building types, both religious and non-religious, that Muslims built in different regions. Among the important building types briefly described are mosques, tombs, caravansary, and urban dwellings. Following this, the paper describes gardens built by Muslims and their design principles and symbolism. An important feature of architecture and landscape architecture of the Muslim World, gardens represented the Qur’ānic promise of a heavenly garden in paradise as a reward for faith and purity. With water and trees, these gardens created places of respite and calmness in mostly hot arid zones of the Muslim world. After gardens, the paper describes the guiding principles of decorations in the architecture of the Muslim world. Rich in their symbolism, decorations were among the most important unifying aspects of architecture and fine arts in the Muslim world. They were often used for imparting a sense of impermanence to the material world, and for providing a visual demonstration of the infinite extensiveness of Allah. The paper also describes the basic elements of decorations in art and architecture, which include calligraphy, architectonic elements, vegetal elements and arabesque, human and animal figures, color, light and geometry. After decorations, the paper describes the underlying principles of the architecture of the Muslim world. Often used unconsciously, these principles helped establish a connection between the symbolic as¬pects and the formal aspects of the architecture of the Muslim world. They include a perpetual relationship between the sacred and the secular, a search for harmony between verticality and horizontality, a search for unity in the interior, and a search for expressiveness on the exterior. Finally, the paper describes many unifying forces, such as religion, language, and migration, which might have helped produce the hidden similarities underneath the apparent differences seen in the architecture of the Muslim world

A Study of the Effects of Colocation on Office Workers’ Perception

This is the author's accepted manuscript. The original published version is available from http://www.emeraldinsight.com/doi/abs/10.1108/JCRE-07-2012-0015.Purpose– The purpose of this study was to understand the effects of colocation on office workers' perception of workplace design and interaction freedom in organizations. Design/methodology/approach– The study was conducted at six different departments of an office organization that moved from geographically dispersed office buildings to one office building. The pre‐move data were collected three to six months before the move, and the post‐move data were collected almost one year after the move through questionnaire surveys. Out of 284 workers, 169 office workers filled out the questionnaire in the pre‐move survey, and 175 filled out the questionnaire in the post‐move survey. Findings– Based on statistical analyses of the data, the study found that colocation did not help improve office workers' overall perception of interaction freedom in the organization, but it helped eliminate perceptual disparities concerning interaction freedom among its different departments. The study also found that office workers' perception of workplace design support for interaction and workstation location were strong predictors of their perception of interaction freedom in the organization. Overall, the findings of the study indicated that the purpose of colocation might be defeated if organizational behavior and culture were not modified simultaneously to promote workers' perception in support of interaction freedom. Research limitations/implications– The study considered only one type of colocation that involved bringing people of different organizational units together from geographically dispersed places to one place. Therefore, these findings cannot be generalized for all other types of colocation. Practical implications– The findings of the study are important for corporate real estate (CRE) strategists and organizational leaders who are actively considering colocation as a strategy to improve interaction and team effectiveness in the organization. Originality/value– The study investigates different mechanisms involving the effects of colocation on office workers' perception of workplace design and interaction freedom in organizations; and identifies important distinctions to consider for achieving the benefits of colocation in terms of face‐to‐face interactions in the workplace

Research on Nursing Unit Layouts: An Integrative Review

This is the author's accepted manuscript. This article is (c) Emerald Group Publishing and permission has been granted for this version to appear in KU ScholarWorks (kuscholarworks.ku.edu). Emerald does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from Emerald Group Publishing Limited. - See more at: http://www.emeraldgrouppublishing.com/authors/writing/author_rights.htm#sthash.J18UbKQW.dpufPURPOSE: To present an integrative review of the research studies on nursing unit layouts. DESIGN/METHODOLOGY/APPROACH: Studies selected for review were published between 1956 and 2014. For the purpose of this review, a framework for integrative review was developed using research orientations. The three primary dimensions–technical, psychological, and social– of the designed environment and various combinations of these dimensions were used to define the research orientations of these studies. FINDINGS: Of all the publications reviewed for the paper, 21 presented technical orientations, 16 psychological orientations, 3 social orientations, 20 psychotechnical orientations, 10 sociotechnical orientations, 2 psychosocial orientations, and 13 presented psychosociotechnical orientations. With only a few exceptions, several issues related to nursing unit layouts were investigated no more than one time in any one category of research orientations. Several other seemingly important issues including patient and family behavior and perception, health outcomes, and social and psychosocial factors in relation to unit layouts have not been studied adequately. RESEARCH LIMITATIONS/IMPLICATIONS: Future studies on nursing unit layouts will need to focus on patient and family behavior and perception, health outcomes, and social and psychosocial factors in different units. They will also need to focus on developing theories concerning the effects of layouts on the technical, psychological, and social dimensions of nursing units. ORIGINALITY/VALUE: Despite a long history of research on nursing unit layouts, an integrative review of these studies is still missing in the literature. This review fills in the gap using a novel framework for integrative review developed based on research orientations

A Decade of Adult Intensive Care Unit Design: A Study of the Physical Design Features of the Best‐Practice Examples

This is the author's accepted manuscript. The original publication is available is available at http://journals.lww.com/ccnq/pages/default.aspx.This article reports a study of the physical design characteristics of a set of adult intensive care units (ICUs), built between 1993 and 2003. These ICUs were recognized as the best-practice examples by the Society of Critical Care Medicine, the American Association of Critical Care Nurses, and the American Institute of Architects. This study is based on a systematic analysis of the materials found on these ICUs in the booklet and videos jointly published by the above organizations in 2005. The study finds that most of these examples of best-practice adult ICUs have the following negative characteristics: (1) they are built as renovation projects with more health and safety hazards during construction; (2) most of them are mixed-service units with more safety and staffing problems; (3) the overall layout and the layout of staff work areas in these ICUs do not have any common design solutions for improved patient and staff outcomes; and (4) in these ICUs, family space is often located outside the unit, and family access to the patient room is restricted, even though family presence at the bedside may be important for improved patient outcomes. Some of these negative characteristics are offset by the following positive characteristics in most ICUs: (1) they have only private patient rooms for improved patient care, safety, privacy, and comfort; (2) most patient beds are freestanding for easy access to patients from all sides; (3) they have handwashing sinks and waste disposal facilities in the patient room for improved safety; and (4) most patient rooms have natural light to help patients with circadian rhythms. The article discusses, in detail, the implications of its findings, and the role of the ICU design community in a very complicated design context

The relationship between geometry and numeric ratio as an open problem in Ledoux's architecture: a study of the floor plans of the barrières of Paris

This is the author's accepted manuscript. The original publication is available from http://www.tandfonline.com.The floor plans of Ledoux's barrières of Paris, designed during the 1780s, are described using simple geometric constructions. Based on a study of these geometric constructions and the ratios of their parts, it is suggested here that the architect did not treat geometry or numeric ratio as an ideal model of architecture. Rather, he treated the relationship between geometry and numeric ratio as an open problem foreshadowing the attitude of the modern architect

Developing Scales to Evaluate Staff Perception of the Effects of the Physical Environment on Patient Comfort, Patient Safety, Patient Privacy, Family Integration With Patient Care, and Staff Working Conditions in Adult Intensive Care Units: A Pilot Study

This is the author's accepted manuscript. The original publication can be found online at http://journals.lww.com/ccnq/pages/default.aspx.Studies suggest that the physical environment can be important for patient comfort, patient safety, patient privacy, family integration with patient care, and staff working condition in adult intensive care units (ICUs). In the absence of any measuring scales, however, evaluations of the physical environment of ICUs in terms of any of these dimensions have remained vague. For rigorous evaluations of ICU designs from the viewpoint of clinical staff, a self-report instrument with several multiple-item scales was created. These scales were tested in a pilot survey that was administered among a small group of nurse managers and ICU directors at several best practice example sites. Reliability analysis of the survey data showed some scales to be internally consistent. For the other scales, factor analysis revealed multiple components, which were then combined to create additional subscales. Using these scales and subscales, the underlying effects of design on staff perception were studied at the best practice example sites that participated in the pilot survey. The results, limitations, and the future directions of the study are discussed

Environmental Design for Patient Families in Intensive Care Unites

This is the publisher's version, which is also available electronically from: http://dx.doi.org/10.1260/2040-2295.1.3.367The purpose of this paper is to define the role of environmental design in improving family integration with patient care in Intensive Care Units (ICUs). It argues that it is necessary to understand family needs, experience and behavioral responses in ICUs to develop effective models for family integration. With its two components—the “healing culture” promoting effective relationships between caregivers and care seekers, and the “environmental design” supporting the healing culture—a “healing environment of care” can be an effective family integration model. This paper presents evidence showing how environmental design may affect families in ICUs, and proposes design recommendations for creating a healing environment of care promoting family integration in ICUs