An effective Neonatal Intensive Care Unit (NICU) often helps stabilize medical conditions and can be critical to infant survival. According to a recent study conducted by the American Academy of Pediatrics, NICUs are often high stress environments yet, "the potential benefits of family-centered care include improved satisfaction with care, decreased parental stress, increased parental comfort and competence with post-discharge care, improved success with breastfeeding, shortened hospital lengths of stay, decreased readmissions post discharge, and increased staff satisfaction (1)."
Following the success of the first Patient Experience Simulation Lab, introduced at the 2012 Healthcare Design Conference, we are proud to focus this year's program on the hospital's tiniest patients. We will start with a design challenge to develop solutions for an environment that enables parents to remain with their infants in the NICU.
The work preceding this year's simulation lab at HCD2013 is not only a design competition, but also an analysis of what really impacts infants and parents, the end users. According to the American Academy of Pediatrics, "parents play the central role in providing for most children's emotional, physical, social, and developmental needs, yet historically they have been limited in participating in their child's care in the NICU (1)." It is the Institute's goal to communicate the needs of patients and families in order to help designers create a supportive environment in which babies can have successful outcomes in the NICU.
Row 1 (l to r):Jaynelle Stichler, Mardelle Shepley, Kimberly McMurray; Row 2 (l to r): Tammy Thompson, LaShawna Heflin, Robert White; Row 3 (l to r): Meghan Boyd, Jodi DeJoseph, Elicia Jacob
The Institute is fortunate to have an outstanding team of nine jurors, many who will attend the simulation lab as subject-matter experts. They come from various backgrounds including clinicians, designers, patient advocates and even parents with first-hand experience in the NICU. The panel of jurors includes Dr. Jaynelle Stichler, co-editor of the Health Environments Research & Design (HERD) Journal and Professor Emeritus of Nursing Leadership in Health Care Systems at San Diego State University; and Dr. Mardelle Shepley, NICU design expert, author and professor at Texas A&M University.
Jurors from the Institute's leadership team include Kimberly McMurray, Health Facility Design Director with WSV Architects, Inc. and VP of Design for the Institute; Tammy Thompson, the Institute's president who will contribute her expertise as an architect and the mother of a former NICU patient; and LaShawna Heflin, the Institute's advisory group member and a nurse of 13 years with experience in women and infants care.
According to Heflin, when she began her career, most NICU spaces were open bays that often held 20 or more isolates and offered little privacy. Now, Heflin says there is "an upward trend and the NICUs have gotten better (Heflin, 2013)." Her idea of a perfect NICU design would include a fluid NICU with individual bays and a quiet nutrition room strictly for patients and mothers, making the environment more convenient for overnight parents and sensitive babies.
Juror Dr. Robert White, Director of the Regional Newborn Program at Memorial Hospital of South Bend, Indiana, has had a long-standing interest in the effect of the NICU environment on infants, families, and caregivers. During his career, Dr. White has witnessed many changes in NICU spaces. "I vividly remember people showing pictures of new units and technology was the highlight. We were just beginning to learn that lighting and noise were probably not optimal environments for babies, let alone adults in intensive care units (White, 2013)." Dr. White believes "the optimal environment for a newborn is in the arms of a mother or father." This theory is supported by research. A study conducted by the Reproductive Health Library, shows that "skin-to-skin contact between mothers and babies after birth reduces crying, improves mother-infant interaction, keeps the baby warmer, and helps mothers to breastfeed successfully (2)."
While the evidence exists, the challenge is to convince hospital administrators of the needs in the NICU, explains Dr. White. "In the long run, you save money by allowing families to stay with the babies during this important time." Dr. White insists that change is incremental and once hospital administration embraces environmental improvements, a family centered NICU becomes something a hospital can be proud of.
Attorney Meaghan Boyd, one of our most inspiring jurors, can testify to the importance of a supportive NICU. Meaghan and her husband, Jared founded Piper's Friends after their daughter, who lived a day and a half, spent the majority of her life at Grady Health System in Atlanta, Georgia. The mission of Piper's Friends is to provide high-quality, comfortable family sleeping and waiting areas in the NICU at Grady Hospital, as well as educational and support materials for parents and families whose babies receive care in Grady's NICU. Boyd says "we saw a need when we left Grady and we wanted to do something to help (Boyd, 2013)." Within the past year, Piper's Friends has contributed new furniture, linens, artwork and flooring to the family waiting area at Grady. Her family's experience will be invaluable, as she participates in the panel of jurors.
Juror Jodi DeJoseph, a supervisor/educator for the NICU at WakeMed Health and Hospitals in Raleigh, North Carolina, believes that families are an important part of the NICU environment. She believes that it is important to make the family feel comfortable. "We often focus on the technological needs and so many times the parents and families are in the background," she says (DeJoseph 2010). Having contributed to the design of WakeMed's renovated NICU, she explains that "it's about empowering the family." When asked about her expectations for the design competition, Jodi is certain that she would like to see "the little things that are not apparent," noting, "sensitivity to the patient and families" as a high priority.
Finally, juror Elicia Jacob, Director of Nursing for the University of Alabama at Birmingham Women & Infants Service (the largest private-room Regional NICU and Continuing Care Nursery in the country), describes the NICU environment as a place that can be calming, comforting, controlled and/or chaotic. She explains that "parents and loved ones of the newborn housed in the NICU are often in an understandable state of extreme concern or anxiety for the well-being of a sick newborn. They can be intimidated by the various procedures performed, machines, IV tubing [and other equipment] required to sustain life and optimize outcomes (Jacob, 2013)." As a juror, she places privacy, comfort for the patient and family, as well as efficient workflow for the clinicians at the top of her list for NICU design.
Institute for Patient-Centered Design is excited about this upcoming challenge. We will release our Call for Submissions in April 2013 for this year's design competition. Winners will receive a free full conference pass to the 2013 Healthcare Design Conference in Orlando, Florida. Like last year, the winners will be honored during our annual reception, and design features from the winning submissions will be on display in our full-scale model on site. Please visit www.patientcentereddesign.org regularly or join our mailing list for updates.
1. Roger P. Saunders, RN, MSN, PNP, Marie R. Abraham, MA, Mary Jo Crosby, RNC,
NNP, MS, Karen Thomas, APRN, BC, William H. Edwards, MD. Evaluation and Development of Potentially Better Practices for Improving Family-Centered Care in Neonatal Intensive Care Units. Pediatrics Vol. 111 No. Supplement E1 April 1, 2003, pp. e437 -e449. Pediatrics, the official journal of the American Academy of Pediatrics (Online). March 13, 2013. http://pediatrics.aappublications.org/content/111/Supplement_E1/e437.full#content-block
2. Puig G, Sguassero Y. Early skin-to-skin contact for mothers and their healthy newborn
infants: RHL commentary (last revised: 9 November 2007). The WHO Reproductive Health Library; Geneva: World Health Organization. RHL website (Online). March 12, 2013. http://apps.who.int/rhl/newborn/gpcom/en/index.html