KIEAE Journal

There is a vacuum of design related research regarding designs which are connected with reduced error and injury [2]. This paper enhances the visibility and accessibility for all the patient’s bed from nurse station.

There is a need for multidisciplinary research team to assess data from the STEP-UP (Study To Enhance Prevention by Understanding Practice) [3], where a randomized clinical trial is performed to improve the technique of Evidence-Based Design precautionary services in prototypical Korean ICUs. The goal is Patient Centered Care (PCC)which is an important component of prevention [4].

The two determinants of conceptualizing the nurse’s position in the patient- environment process are firstly is to imagine of the nurse as being in the environment of the patient for care which is generally familiar concept [5]. In this view, nurse and patient are viewing each other from same vantage point into the similar environmental domain [6]. The nurse, together with the patient, patterns the environment to promote healing and comfort. The questions asked here which is the focus of the study, “what can the nurse do to create (pattern) an environment that is more healing?” [7].

To develop a quality assessment of the following steps where followed: (1) prioritizing the ICU as a clinical area to be computed; (2) walking and visibility are selected as the type of determinants; (3) define and design specifications on NS; [8] (4) t-test selected as developed data collection tools; (5) there is a test of data compilation tools and evaluate the authority, reliability, and viability of measures on LogWare stop sequence software (a tool from Supply Chain Management) and Space Syntax [9] (6) then there is a development of scoring and analytical specification on SPSS (Statistical Package for the Social Science); and (7) obtain baseline data of step by step nurse movement [10]. Here authors propose an outline research design for nurse therapy and healing environment [11], and other clinical and health care matters, and in which the research design [12] (1) adapt these information requirements into liable questions[13]; (2) trace, with maximum competence, the best prove with which to respond them (from the NS design clinical assessment from study evidence) [14]; (3) critically review the data for its authenticity (nearness to the truth) and utility (clinical applicability on the hospitals [15]); (4) Finally there is an integration that this appraisal with researchers clinical expertise and apply it in routine on set of selected hospitals; and [16] (5) evaluate the research design and performance [17].

Methodological plans have been achieved with combination of concentric pods with upcoming bedside computer aided software e.g. Space Syntax [18] and Stop Sequence [19].

The objective is to reduce the travel time up to 30% and to further drop towards 20% since nurse is walking with supplies at hand and aim to is for fewer unnecessary trips and one way shortest round route design simulation. Second objective is to design walk in a way so more patient bed heads will be seen with each nurse step by step walk. The quest for utmost efficiency in ICU [20] design to facilitate nurse and to reduce the probability of error [21] due to efficiency shortcomings is been investigated in several recent research [22][23], thus suggestion for monitoring ICU, organizing nurse activities, improvement in communication are suggested.

The hospital designs: HUMC, SSMU and DUMC with similar spatial and technical system organization for ICU design is analyzed consisting matrix of I shape, U shape and L shape nurse station configuration for caregiver work path, addressing a minimum amount of travel for caregivers.

The hypothesis of EBD has been fundamental to nursing’s model from the time when Florence Nightingale [26] suggested health and nursing paradigm; there has been key emphasis on healing environment theory [27] in the literature associated with nursing.

A thoughtful philosophy is as a rule influential for care providers when it is supplemented by a perception of intention, precision about their responsibility and those of their colleagues, skilled in supervising with dealings, and a dedication to tender all patients in the ICU in ways that are significant to them [28]. When nurses, combined health professionals and their colleagues own their practice and consciously create environment of healing, their efforts evidently affect the practitioners, the routine and physical space. Initiating and sustaining a therapeutic relationship with patients is predominant to carting and healing environment.

Caregivers’ faces fatigue while serving patients due to excessive walk as Gadbois discussed [19]. To assure patient safety in Korean hospital ICU layout in a patient care center, author considered “care giver safety” [29] as highest priority. The Surgical Intensive Care Unit 9)(SICU) which is a 20-bed, fast-paced (high-acuity, multi-specialty critical care unit) and because of the high pace the SICU has a special task for all the 20 beds to be visible and accessible easily.

To facilitate nurse visibility and to reduce walking a two prong strategy is designed as a conceptual frame. Three typo-morphologies are analyzed to compute the best configuration which helps nurse to heal i.e. ecological and healthy.

The pattern based ranking of the general plan type is similar, for example linear, L-Shape, U- Shape, parallel, or hybrid complex combination as shown in Table.1 where the percentages of the shapes used in each hospital are narrated. Although a considerably compact concentric plan is usually more systematic and efficient.

LogWare estimated walking pattern for all the wards collectively and space syntax [9] illustrates the visibility pattern according to the shape of NS for both PDR and POR t- test analysis.

HUMC was inaugurated in the district of Seoul, in 2012 September. This hospital in Dongtan is constructed on a complete site of 21,000 m² the third floor plan is shown in Fig.1. Author continued this study to 2014 to compare the post occupancy evaluation compared with other hospital MICU and SICU which are following similar L- Shape pattern.

Fig. 1. 
The mirror image of 20 bedded SICU and MICU blue and red shows the eye view and connectivity from the NS to the patient from counter clockwise: comparison of first and second nurse, comparison of third and sixth nurse vision diagram

A pre-occupancy inauguration session with nurse artificial simulation was conducted at Sacred Heart Hospital, Hallym University Medical Center Dongtan (HUMC) in collaboration with the Korean Institution of Healthcare Architecture.

Since interaction and consultation is a major affair in the ICU, there is a requirement to design research to determine improved ways to support and improve it.

LogWare is able to simulate the precise pattern to validate the set hypothesis for possible reduced nurse walking without effecting efficiency. Fig.2 is a planned circulation translates finding into interactive tools, such as framework to allow nursing teams to interact with the content, play with the defined path by changing according to the combined willingness, hence trigger critical thinking.

Fig. 2. 
LogWare simulation of nurse visit to each bed

The U –shape ICU design is been simulated on Logware in Fig.2 where 54.8 meter distance is calculated to be the shortest distance which has to be travelled by a set of nurses. Here EBD can be regarded as a natural progression of “healing environment” [30], where nurse walking progress towards patients is aimed to be improved, three month research analysis was conducted by author on three sites, there is a health related quality of life (HRQoL)10),which is a multi-dimensional concept is applied; here on PDR which includes a combination of quantitative analysis and qualitative technique.

In Fig.1 the blue colour coded mirror image of the SICU and MICU is been analysed, in terms of visual connectivity. Here similar pattern was followed to analyse the visibility and walkability of nurse as well as the typology as similar studies shows [31]. Fig.3. The depth map simulation of isovist and visibility for the U-shaped Critical Care Unit. On site PDR simulation of the nurse practicing viewing and walking photo taken by author on 10th September 2012 at 10:30 am.

Fig. 3. 
represents the Nurse Station relationship and the photograph taken by author on eye level along with the space syntax analysis

Because this is a PDR Healthcare trends research which is more interactive and participatory, combination where author’s herself took part of Pre Occupancy Evaluation, for HUIH where she had availed the opportunities to view for the ICU NS and could practice the travel path of nurse on site as shows in Fig.1, such exercise results in EBD innovation design activities results to make better sense of complex trends.

This case study is based on POE, Dongguk University Hospital inaugurated in June 2005, Ilsan has 800 hospital beds in total. As shown in Fig. 4, the ICU beds are in direct views from NS there are 60 beds in total covering 7.5% of the total area of Entire Hospital. There are 20 beds in Medical Intensive Care Unit (MICU), 20 beds in Surgical Care Unit (SICU) and 20 beds in Neuro Surgical Intensive Care Unit (NSICU 20), 8 beds in Critical Care Unit (CCU) and 12 beds in Korean Oriental Medicine Intensive Care Unit (KOMICU).

Fig. 4. 
The layout in terms of walking NS1

The following Fig.4 represents the graph where red round spot represent nurse position as entered in the X and Y coordinates, the square black dots in the graph shows the position of the 1-11th patient bed.

The grid is planned on the stop sequence software of Supply Chain Management representing red dot from where nurse origins.

The LogWare simulation provided the minimum distance covered by the nurse from both the station. The photograph in Fig. 4 shows the knee level analysis.

NS 2 patient lay out is shown in Fig. 6 where each patients bed is first marked on X and Y axis on the grid, these data is transformed on stop sequence to get the efficient NS walking route in Fig. 6

It could be inferred that if the nurses are trained in a workshop for the routine round, in a collaborative settings, which may communicate initial round scenarios to propose new healthcare experience.

The Fig. 4 & 5 shows the circulation one way without overlap or reverse movement from nurse station to beds. The Nurse configuration is in L-shape, as shown in Fig. 6. Two determinants are studied here on t-test; since there are two components, walkability is shown is red and yellow analysis of circulation datum [18], visibility is shown in the photograph from NS, and walking pattern, which are analyzed for the DUIH on LogWare .

Fig. 5. 
NS two lay out on Log Ware the graph shows L-Shape formation

Fig. 6. 
Analysis of 5 NS at SSMU and Author photograph on 13th June 2014, while filling the questionnaire (photo used by permission)

The Catholic University of Korea Seoul St. Mary’s Hospital inaugurated on March 2009 has twelve hundred bed with 60 side view or laterally viewed from NS as shown in Fig. 7., here ICU area covers approximately 5% of the entire hospital area. CCU comprises on 18 beds, where as SICU consists of 22 beds, there are 20 beds in MICU.

Fig. 7. 
the graph of first NS of SSMU—U shape configuration

Fig. 8. 
the graph of fourth NS of SSMU

Fig. 9. 
fifth NS walking in zigzag along with lateral view

It was found that the minimum possible round was at SSMU where 5 NS are functional simultaneously where NS1 walks 40 meter; NS 2 walks 30.35 meters, whereas NS 3 walks 65.6 meter, NS4 walks 57.33 meters and NS5 walks 79.48 meters.

“No hidden patient” [32] or “out of sight out of reach” [33] is the most significant motivation for this research, since nurse has a critical role in ICU, her ecology in terms of health ‘first do no harm’ and fatigue reduction is the aim. Therefore the design here in Fig. 6 & 7 is able to facilitate and allow nurse to see as much as possible and walk as less as possible without compromising the efficiency. Thus at planning stage ecological healing environment is incorporated for flexible design, though it is not complete at schematic stage (as seen in case one: HUIH), neither is it finalized after completion of ward (as seen in case two and three: DUIH and SSMU).

The stop sequence [34] shows the U- shape movement which is utmost according to the results. Photograph by author shows the ICU Nurse Station view and the patient bed arrangements in a zigzag or lateral fashion.

The aim is to improve the typology of Nurse Station and morphology of the viewing pattern from Nurse Station to the patient. The POE suggested that visibility is 20% less then I-Shape and L -shape whereas walking is also relatively higher than previous cases.