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Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Healing architecture is a defining feature of contemporary hospital design in many parts of the world, with psychiatric in-patient facilities in Denmark at the forefront of this innovation. The approach rests on the contention that designed clinical spaces and the particular dispositions they express may promote patient recovery. Although the idea that health may be spatially mediated is well-established, the means of this mediation are far from settled. This article contributes to this debate by analysing medical encounters in the context of a new purpose-built psychiatric hospital opened in Slagelse, Denmark in late 2015 as an example of healing architecture for the region. Grounded in qualitative research conducted in two wards between 2016 and 2017, we explore the key material and social effects of the hospital's healing architecture, and the spaces and practices it enacts. Following the work of Michael Lynch, we consider both the designed 'spatial order' of the in-patient wards and the 'spatial orderings' unfolding therein with a particular interest in how order is accomplished in psychiatric work. With much of the existing discussion of healing architectures focusing on their impacts on patient wellbeing, we consider how healing architectures may also be transforming psychiatric work., (© 2019 Foundation for the Sociology of Health & Illness.)

Introduction: Attempting to expedite delivery of care to wounded war fighters, this study aimed to quantify the ability of medical and surgical teams to perform lifesaving damage control and resuscitation procedures aboard nontraditional US Navy Vessels on high seas. Specifically, it looked at the ability of the teams to perform procedures in shipboard operating and emergency rooms by analyzing motion of personnel during the procedures., Methods: One hundred and twelve damage control and resuscitation procedures were performed during a voyage of the US Naval Ship Brunswick in transit from Norfolk, Virginia, to San Diego, California. The ability of personnel to perform these procedures was quantified by the use of motion link analysis designed to track the movement of each participant as they completed their assigned tasks., Results: The link analysis showed no significant change in the number of movements of participants from the beginning to the end of the study. However, there was a learning effect observed during the study, with teams completing tasks faster at the end of the study than at the beginning., Conclusion: This shows that the working conditions aboard the US Naval Ship Brunswick were satisfactory for the assigned tasks, indicating that these medical operations may be feasible aboard nontraditional US Navy vessels., (© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: There is an international policy trend for building government hospitals with greater proportions of single-occupancy rooms. The study aim was to identify advantages and disadvantages for patients and nursing staff of a pending move to 100% single-room hospital, in anticipation of the challenges for nurse managers of a different ward environment. This paper presents these findings, summarizing potential advantages and disadvantages as well as comparison with findings from similar studies in England., Methods: Mixed method case study design was undertaken in four wards of a large hospital with multi-bed rooms. Three components of a larger study are reported here: nurse surveys and interviews, patient interviews of their experiences of the current multi-bedroom environment and expectations of new single-room environment. Integration was achieved via data transformation where results of the nursing staff survey and interviews and patient interviews were coded as narrative allowing for quantitative and qualitative data to be merged., Results: Four constructs were derived: physical environment; patient safety and comfort; staff safety; and importance of interaction., Conclusion: There are important factors that inform nurse managers when considering a move to an all single-room design. These factors are important for nurses' and patients' well-being., Implications for Nursing Management: This study identified for nurse managers key factors that should be considerd when contributing to the design of a 100% single-room hospital. Nurses' voices are critically important to inform the design for a safe and efficient ward environment., (© 2019 John Wiley & Sons Ltd.)

There is controversy today about whether decentralized intensive care unit (ICU) designs featuring alcoves and multiple sites for charting are effective. There are issues relating to travel distance, visibility of patients, visibility of staff colleagues, and communications among caregivers, along with concerns about safety risk. When these designs became possible and popular, many ICU designs moved away from the high-visibility circular, semicircular, or box-like shapes and began to feature units with more linear shapes and footprints similar to acute bed units. Critical care nurses on the new, linear units have expressed concerns. This theory and opinion article relies upon field observations in unrelated research studies and consulting engagements, along with material from the relevant literature. It leads to a challenging hypothesis that criticism of decentralized charting alcoves may be misplaced, and that the associated problem may stem from corridor design and unit size in contemporary ICU design. The authors conclude that reliable data from research investigations are needed to confirm the anecdotal reports of nurses. If problems are present in current facilities, organizations may wish to consider video monitoring, expanded responsibilities in the current buddy system, and use of greater information sharing during daily team huddles. New designs need to involve nurses and carefully consider these issues.

Review Question/objective: The objective of this review is to identify the impact of single room neonatal intensive care unit (NICU) design on infant outcomes compared to alternative design.The specific question is: what is the impact of single room design on outcomes of infants cared for in intensive care units compared to those in alternative designs?

Catherine Zeliotis, healthcare leader and senior associate at global healthcare architectural practice, Stantec (pictured), discusses the latest thinking in the design of cancer centres, providing best practice examples from Stantec projects throughout the world.

Objective: The aim of this study was to describe the infrastructures supporting research in Magnet® hospitals., Background: Hospitals undertaking the journey toward Magnet designation must build research and evidence-based practice (EBP) infrastructures that support the infusion of research and EBP into clinical practice., Methods: An electronic survey was developed and distributed to the chief nursing officer or Magnet coordinator of all Magnet hospitals between June 10, 2015, and July 8, 2015., Results: Of the 418 Magnet hospitals invited, 249 responses (60%) were received. Resources dedicated to nursing research were difficult to isolate from those for EBP. Supporting clinical nurses' time away from the bedside remains a challenge. Nearly half (44%) indicated that research is conducted within the nurses' usual clinical hours, and 40% indicated that nurses participate on their own time., Conclusions: Hospitals use a variety of resources and mentor arrangements to support research and EBP, often the same resources. More targeted resources are needed to fully integrate research into clinical practice.

Three teams of perinatal expert nurses participated in planning and designing a new maternity unit, operationalizing the move to the new space, and evaluating care processes and workflows after the move. The hospitals involved were University of California, San Francisco Benioff Children's Hospital, Prentice Women's Hospital of Northwestern Memorial Healthcare in Chicago, IL, and Florida Hospital Orlando, Florida Hospital for Women. Although each team discussed specific details and lessons learned, there is remarkable consistency among the experiences of these teams and with the discussion of the process by the team at Mercy Hospital St. Louis published in this issue of MCN The American Journal of Maternal Child Nursing. Extensive planning, flexibility, involving key stakeholders, evaluating and simulating workflows, and adequate staffing and patient safety on move-day were reported to be essential to success. Reevaluation after settling in to the new unit and making changes as needed were discussed. Being part of the leadership team involved in planning and moving to a new maternity unit in what was likely a once-in-a-lifetime experience was viewed as a career highlight. Their commentary adds to what is known about planning and designing new maternity units, moving into the new space, and adjusting unit operations and care after making the new unit home.

Importance: There is an increasing trend toward designing hospitals with patient-centered features like reduced noise, improved natural light, visitor friendly facilities, well-decorated rooms, and hotel-like amenities. It has also been suggested that because patients cannot reliably distinguish positive experiences with the physical environment from positive experience with care, an improved hospital environment leads to higher satisfaction with physicians, nursing, food service, housekeeping, and higher overall satisfaction., Objective: To characterize changes in patient satisfaction that occurred when clinical services (comprised of stable nursing, physician, and unit teams) were relocated to a new clinical building with patient-centered features. We hypothesized that new building features would positively impact provider, ancillary staff, and overall satisfaction, as well as improved satisfaction with the facility., Design: Natural experiment utilizing a pre-post design with concurrent controls., Setting: Academic tertiary care hospital., Participants: We included all patients discharged from 12 clinical units that relocated to the new clinical building who returned surveys in the 7.5-month period following the move. Premove baseline data were captured from the year prior to the move. Patients on unmoved clinical units who returned satisfaction surveys served as concurrent controls., Exposure: Patient-centered design features incorporated into the new clinical building. All patients during the baseline period and control patients during the study period were located in usual patient rooms with standard hospital amenities., Main Outcomes and Measures: The primary outcome was satisfaction scores on the Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems survey, dichotomized at highest category versus lower categories. We performed logistic regression to identify predictors of "top-box" scores., Results: The move was associated with improved room- and visitor-related satisfaction without significant improvement in satisfaction with clinical providers, ancillary staff, and only 1 of 4 measures of overall satisfaction improved. The most prominent increase was with pleasantness of décor (33.6% vs 64.8%) and visitor accommodation and comfort (50.0% vs 70.3%)., Conclusion and Relevance: Patients responded positively to pleasing surroundings and comfort, but were able to discriminate their experiences with the hospital environment from those with physicians and nurses. The move to a new building had significant impact on only 1 of the 4 measures of overall patient satisfaction, as clinical care is likely to be the most important determinant of this outcome. Hospital administrators should not use outdated facilities as an excuse for suboptimal provider satisfaction scores., (© 2014 Society of Hospital Medicine.)

The physical design of hospital wards is associated with transmission of pathogenic organisms and hospital-acquired infections. A novel hospital unit, the Medical Ward of the 21st Century (W21C), optimizes features for infection prevention and control practices. Ethnographic research on the W21C versus conventional hospital wards examined the experiential and behavioural elements of the different designs. Three recurring themes emerged regarding the design features on the W21C and included visual cues, 'having a place for things', and less sharing of spaces and materials. Observational data of healthcare worker practices demonstrated significantly higher compliance with hand hygiene opportunities on the W21C compared with older hospital units. These findings suggest how the physical design of a hospital ward may enhance infection prevention and control practices.

Cassandra Coleman, business development manager at international healthcare consultancy, MJ Medical, discusses the challenges of designing healthcare facilities today that will cope well with, and adapt to, the changing clinical demands, patient care pathways, and advances in both diagnostics and treatment, that will inevitably characterise healthcare in the next 2-3 decades and beyond.

It is critical now more than ever for today's healthcare facilities to serve as more than just a backdrop to the care provided--they can, and should, be an integral part of that care. In addition to promoting efficacy, delighting the senses, and placing patients and families at ease, facilities need to be high-performing, sustainable, and healthy environments. Creating today's healthcare facilities requires breaking through barriers in unexpected ways, and it often requires looking outside the healthcare profession for guidance. In this article, we explore current trends in health facility planning, design, and construction. Our focus is on the buildings that serve as venues for the provision of healthcare services across the full continuum, from prevention to critical care. In particular, we discuss four current broad trends and conclude with thoughts on future developments.

Palomar Medical Center, like many California healthcare institutions in the 1990s, faced the challenge of needing to meet state building seismic requirements. As a result of the mandate and infrastructure demands that would need to be made to accommodate the new standards, the health system set out to assess the larger needs of the communities served, evaluate the medical and technological changes that would be part of future clinical care delivery systems, and assess our capability to meet the financial impact such changes would have on the organization. This article shares our journey to build a new hospital--one that could be studied by other health systems facing the same or similar challenges. It incorporates elements associated with the concept of "Fable Hospital"--a design promulgated by leading architects and designers from around the world and researched by the Center for Health Design--which considers the use of evidenced-based principles gathered over the past 20 years that, when incorporated, can lead to the creation of buildings that enhance the quality of care, provide safety for patients and staff, and meet the needs of patients and families in meaningful ways. Finally, Palomar Medical Center is an environment that allows for effective, flexible integration of technology and expansion of staff while improving the efficiency of operations that are critical to the management of the hospital in a changing healthcare delivery world.

There has been an increased focus on place and space within maternity and neonatal care and how configuration of space influences the experiences of parents, babies and staff. Furthermore, although there is increasing emphasis upon family-centred care, research shows wide differences in NICUs' provision of facilities to enable parental presence and involvement. In this article we refer to key findings from a recent ethnographic study on parents' and staff experiences related to feeding preterm babies in four NICUs in England and Sweden. We describe the ways in which design of space in NICUs influences infant feeding experiences and the developing parent-baby relationship.

Healthcare-associated infections (HAIs) are a serious threat to patients and healthcare providers. Although human factors are commonly studied in an attempt to reduce HAIs, less is known about the effect of specific facility design features on mitigating the transmission of pathogens from human to human. This facility design department aims to expand nurse leaders' knowledge and competencies in health facility design. This article discusses the state of the science in the relationship of facility design on reducing HAIs.

Designing a smart ICU is a time-consuming, complex, multiphased, political, and costly exercise. This process begins with two notions: First, all hospital parties agree that a new or renovated ICU is required, and second, the hospital has agreed to allocate space, personnel, and fiscal resources for the project. In this first of a three-part series on innovative designs for the smart ICU, we will explore the roles of the ICU design team in managing the design process. The team must be administratively empowered, knowledgeable, and forward thinking. The first charge of the design team is to develop a clear vision for the goals, look and feel, and functionality of the new ICU. This vision must be guided by the imperative to positively impact patients, staff, and visitors. The team must concentrate on innovative but practical ideas that are in compliance with building codes and design guidelines and address issues related to renovation vs new construction. Mock-ups, both physical and computer generated, and a simulation laboratory for advanced technologies should be used to test design assumptions and reveal problems well in advance of actual ICU construction and technology implementation. Technology platforms need to be standardized within the ICU and equipment purchases protected against early obsolescence. The ramifications and expectations of the new ICU must be thoughtfully considered and dealt with during the design process. Last, it is essential that the design group continue its involvement in the new ICU during construction, occupancy, and post occupancy.

Including end users in evidence-based design is vital to outcomes. The physical environment impacts caregiver efficiencies, safety, satisfaction, and quality of patient outcomes. End users are more than members of the organization: patients should have representation as well. Patients bring value by offering insight from a different perspective. Timing is key; therefore, it is critical in obtaining desired outcomes, to include end users as early as possible, gaining the most insight into the design of the build. Consideration should also be given to best practice standards, regulatory compliance, progressive sciences, and technologies. Another vital factor is education of the end users on their role and expectations for participation in a design team. When end users are educated and understand the significance of input, the design team will be able to conceive a critical care unit that will meet needs for today and be able to adapt to needs for the future.

The role of simulation in surgical education, initially confined to technical skills and procedural tasks, increasingly includes training nontechnical skills including communication, crisis management, and teamwork. Research suggests that many preventable adverse events can be attributed to nontechnical error occurring within a ward context. Ward rounds represent the primary point of interaction between patient and physician but take place without formalized training or assessment. The simulated ward should provide an environment in which processes of perioperative care can be performed safely and realistically, allowing multidisciplinary assessment and training of full ward rounds. We review existing literature and describe our experience in setting up our ward simulator. We examine the facilities, equipment, cost, and personnel required for establishing a surgical ward simulator and consider the scenario development, assessment, and feedback tools necessary to integrate it into a surgical curriculum., (Copyright © 2013 Elsevier Inc. All rights reserved.)

There are approximately 5,700 hospitals in the United States, 3,000-4,000 that are antiquated or obsolescing. To meet increased service demands, remain financially viable; meet needs to upgrade aging infrastructure and incorporate medical and technology advancements, healthcare facilities are in a perpetual state of construction. Outbreaks of nosocomial infections have historically been documented in association with construction and renovation actives within health care facilities. For most healthy individuals, environmental exposures to etiological agents, results in no adverse effects but in immune-compromised patient, they are left susceptible to inadvertent exposures during construction to opportunistic bacteria, fungi and viruses. Evidence scientifically linking construction work and nosocomial infections as well as the efficacy and clinical relevance of infection control precautions is somewhat lacking but the empirical evidence and recommendations to support protective measures is steadily growing. Opening a "Pandora's Box" during construction can unleash unintended consequences therefore; it is imperative that a thorough, multidisciplinary approach towards an infection control plan is put clearly and firmly in place allowing health care construction projects to move forward with confidence that patient safety is the first specification.