title: Finding a Middle Ground: Exploring the Impact of Patient- and Family-Centered Design on Nurse-Family Interactions in the Neuro ICU.
abstract: OBJECTIVE
  This comparative study of two adult neuro critical care units examined the impact of patient- and family-centered design on nurse-family interactions in a unit designed to increase family involvement.
  
  
  BACKGROUND
  A growing evidence base suggests that the built environment can facilitate the delivery of patient- and family-centered care (PFCC). However, few studies examine how the PFCC model impacts the delivery of care, specifically the role of design in nurse-family interactions in the adult intensive care unit (ICU) from the perspective of the bedside nurse.
  
  
  METHODS
  Two neuro ICUs with the same patient population and staff, but with different layouts, were compared. Structured observations were conducted to assess changes in the frequency, location, and content of interactions between the two units. Discussions with staff provided additional insights into nurse attitudes, perceptions, and experiences caring for families.
  
  
  RESULTS
  Nurses reported challenges balancing the needs of many stakeholders in a complex clinical environment, regardless of unit layout. However, differences in communication patterns between the clinician- and family-centered units were observed. More interactions were observed in nurse workstations in the PFCC unit, with most initiated by family. While the new unit was seen as more conducive to the delivery of PFCC, some nurses reported a loss of workspace control.
  
  
  CONCLUSIONS
  Patient- and family-centered design created new spatial and temporal opportunities for nurse-family interactions in the adult ICU, thus supporting PFCC goals. However, greater exposure to unplanned family encounters may increase nurse stress without adequate spatial and organizational support.
authors.affiliation: Plural Space, LLC, Atlanta, GA, USA alrippin@hotmail.com.
authors.forename: Allyn S
authors.initials: AS
authors.lastname: Rippin
authors.affiliation: Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Zimring
authors.affiliation: Neuroscience Critical Care, Emory Healthcare, Atlanta, GA, USA.
authors.forename: Owen
authors.initials: O
authors.lastname: Samuels
authors.affiliation: Georgia Institute of Technology, Atlanta, GA, USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Denham
mesh_terms: D064648:Critical Care Nursing / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D022143:Family Nursing / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D065816:Neuroscience Nursing / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D011368:Professional-Family Relations; D014481:United States
keywords: critical care; evidence-based design; nurse–family interactions; patient- and family-centered care; stress