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Objectives: The purpose of this study was to understand how specific evidence-based design strategies are related to aspects of nurse wellness. Background: Addressing burnout among the healthcare workforce is a system-level imperative. Nurses face continuous and dynamic physical and emotional demands in their role. Greater insight into the role of the physical environment can support efforts to promote nurse wellness. Methods: This exploratory qualitative study was conducted at new Parkland Hospital in Dallas, TX. We conducted five focus groups with nursing staff in July 2018. These sessions covered five topics related to nursing work in the facility which had been redesigned nearly 3 years earlier: (1) professional and social communication, (2) workflow and efficiency, (3) nurses’ tasks and documentation, (4) ability to care for patients, and (5) nurses’ overall health. We conducted a thematic analysis and first identified different aspects of wellness discussed by participants. Then, we examined how nurses related different design elements to different aspects of their wellness. Results: Participants included 63 nurses and nurse managers. They related environmental factors including facility size, break rooms, and decentralized workstations to social, emotional/spiritual, physical, intellectual, and occupational aspects of wellness. Conclusions: It is critical to inform and integrate nurses at all levels into planning, design, and activation of new healthcare environments in order to ensure the well-being of nurses and, therefore, their ability to effectively support patients.

Objectives: This systematic literature review synthesizes and assesses quality of research addressing associations of patient and staff outcomes with inpatient unit designs incorporating decentralized caregiver workstations. Background: A current hospital design trend is to include decentralized caregiver workstations on inpatient units. A review of literature addressing decentralized unit design is needed. Methods: The systematic review methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Database searches were conducted for studies published in peer-reviewed journals through October 2017. Included were empirical studies associating patient and/or staff outcomes and unit design with decentralized caregiver workstations. Individual studies were evaluated for quality using established methods, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) guided rigorous inspection of evidence quality and strength for quantitative outcomes and qualitative findings, respectively. Results: The search yielded 1,096 records with 36 full-text articles examined and 12 articles included in the final review. This work was dominated by studies with limited analyses. Staff outcomes have been most widely studied, especially collaboration/communication and walking. Overall, studies exploring decentralized nursing as a design intervention have produced limited results for both staff and patient outcomes. Strength of evidence of the current literature with quantitative methods as a whole was rated very low quality. Conclusions: Although varying degrees of caregiver workstation decentralization in

Aim: To assess hypothesized effects of decentralized nursing models on adult inpatient outcomes, patient medical records and satisfaction surveys were analyzed from two rural community hospitals that transitioned from centralized to decentralized nursing unit designs in 2015. Background: The objective to place nurses closer to patients precipitates broad use of decentralized nursing unit designs over models with centralized nurse stations. Decentralized models have been hypothesized to improve patient outcomes, but few studies have empirically measured effects. Methods: A cross-sectional, pre–post study used regression and interrupted time series models of adult inpatient data. Encounter-level patient records and survey responses across both sites were analyzed for a change in length of stay (LOS) and patient satisfaction from the preperiod (centralized) to the postperiod (decentralized). Results: LOS decreased in the postperiod compared to the preperiod at one site, and there was no change in LOS at the other. Patient satisfaction mostly improved at both hospitals in the decentralized model; however, most upward trends started prior to the move, with no change postmove. Patient satisfaction significantly improved regarding quietness at night and overall hospital rating at one hospital and decreased regarding receiving help as soon as wanted at the other hospital. These changes occurred at the time of the move but may not be solely attributable to the decentralized nursing model. Conclusions: Overall, the results were mixed. One hospital experienced positive changes while the other did not, suggesting factors apart from nursing unit design are important to assess.

Objective: This research aimed to evaluate the quantitative effects of new hospital design on adult inpatient outcomes. Background: Tenets of evidence-based healthcare design, notably single-patient acuity-adaptable and same-handed rooms, decentralized nursing stations, onstage offstage layout, and access to nature were expected to promote patient healing and increase patient satisfaction, while decreasing adverse events. Methods: Patient healing was operationalized through length of stay (LOS) and patient safety through three adverse events: falls, hospital-acquired infections (HAI), and medication-related events. Standard patient surveys captured patient satisfaction. Patient records from 2013 through 2017 allowed for equivalent time periods surrounding the move to the new hospital in August 2015. Stratified by hospital division where significant, pre/post comparisons utilized proportional hazards or logistic regression models as appropriate; interrupted time series analyses afforded longitudinal interpretations. Results: Observed higher postmove LOS was due to previously increasing trends, not increases after the move. In surgical and trauma units, a constant increase in falls was unaffected by the move. Medication events decreased consistently over time; medication events with harm dropped significantly after the move. No change in HAI was found. Significant improvement on most relevant patient satisfaction items occurred after the move. Call button response decreased immediately after the move but subsequently improved. Conclusion: Results did not clearly indicate a net change in adult inpatient outcomes of healing and safety due to the hospital design. There was evidence that the new hospital improved patient satisfaction outcomes related to the environment, including comfort, noise, temperature, and aesthetics.