The "hybrid" nursing design model in which decentralized nursing stations are coupled with centralized meeting rooms for consultation between staff members may strike a balance between the increase in computer duties and the ongoing need for communication and consultation that addresses the conflicting demands of technology and direct patient care.

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

It seems safe to conclude that nearly 150 years ago, "the lady with the lamp," Florence Nightingale, set a course that practice-based healthcare researchers continue to follow today. In her book, Notes on Nursing (1860), Nightingale identified light, ventilation, noise, and sanitation as elements of the environment that affected the well-being of soldiers in her care. Today, we attempt to study these same relationships: those that exist between the built environment of healthcare settings, and the health and well-being of the users of these spaces. The goal of this paper is to describe how research is conceptualized, integrated, and utilized in healthcare design decision making and to address the challenges and opportunities that exist when moving a research agenda forward. Numerous examples of design practitioners and healthcare facilities that have committed themselves to integrating research into healthcare design are provided.