title: Transition from an open-plan to a two-cot neonatal intensive care unit: a participatory action research approach.
abstract: OBJECTIVE
  To facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design.
  
  
  BACKGROUND
  In 2012, an Australian regional neonatal intensive care unit transitioned from an open-plan to a two-cot neonatal intensive care unit design. Research has reported single- and small-room neonatal intensive care unit design may negatively impact on the distances nurses walk, reducing the time they spend providing direct neonatal care. Studies have also reported nurses feel isolated and need additional support and education in such neonatal intensive care units. Staff highlighted their concerns regarding the impact of the new design on workflow and clinical practice.
  
  
  METHODS
  A participatory action research approach.
  
  
  METHODS
  A participatory action group titled the Change and Networking Group collaborated with staff over a four-year period (2009-2013) to facilitate the transition. The Change and Networking Group used a collaborative, cyclical process of planning, gathering data, taking action and reviewing the results to plan the next action. Data sources included meeting and workshop minutes, newsletters, feedback boards, subgroup reports and a staff satisfaction survey.
  
  
  RESULTS
  The study findings include a description of (1) how the participatory action research cycles were used by the Change and Networking Group: providing examples of projects and strategies undertaken; and (2) evaluations of participatory action research methodology and Group by neonatal intensive care unit staff and Change and Networking members.
  
  
  CONCLUSIONS
  This study has described the benefits of using participatory action research to facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. Participatory action research methodology enabled the inclusion of staff to find solutions to design and clinical practice questions. Future research is required to assess the long-term effect of neonatal intensive care unit design on staff workload, maintaining and supporting a skilled workforce as well as the impact of a new neonatal intensive care unit design on the neonatal intensive care unit culture.
  
  
  CONCLUSIONS
  A supportive work environment for staff is critical in providing high-quality health care.
authors.affiliation: Neonatal Intensive Care Unit, Department of Neonatology, Centenary Hospital for Women and Children, Australian Catholic University, Canberra, ACT, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Broom
authors.affiliation: School of Nursing, Midwifery and Paramedicine (Signadou Campus), Australian Catholic University, Canberra, ACT, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Gardner
authors.affiliation: Neonatal Intensive Care Unit, Department of Neonatology, Canberra Hospital, Australian National University, Garran, Canberra, ACT, Australia.
authors.forename: Zsuzsoka
authors.initials: Z
authors.lastname: Kecskes
authors.affiliation: Midwifery Research Unit, School of Nursing and Midwifery and Mater Health Service, University of Queensland, Brisbane, Qld, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Kildea
mesh_terms: D001315:Australia; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D011787:Quality of Health Care; D012107:Research Design; D011795:Surveys and Questionnaires; D017132:Workplace / Q000523:psychology*
keywords: clinical practice; intensive care; neonatal; participatory action research; work environment