The need for neonatal intensive care units (NICU) is increasing at a time when research suggests their designs need to change to provide a developmentally appropriate healing environment. One approach is a private room NICU model versus a large multibed ward. However, such a radical design change could be challenging to implement.
This article presents the experience of one unit in the design and transition from a traditional setting to the private room model.
This study evaluated the experiences of neonatal nurses and families in one unit of a Level III regional 261-bed private hospital in the Midwest that moved from a traditional multibed ward setting to a new 27-bed private-room NICU. To guide the process, the facility used Reddin’s theory of planned change: (1) diagnosis, (2) mutual setting of objectives, (3) group emphasis, (4) maximizing information, (5) discussion of implementation, (6) use of ceremony and ritual, and (7) resistance interpretation.
Based on the staff pre/post transition survey, the researchers found improvement in job satisfaction, change, team support, and input. In addition, the survey found that the nurses’ concerns about patient assignments, proximity to patients, and patient ratios were less troublesome than anticipated. The authors also note that while staff maintained 100% productivity, nurses had to cope with a considerable volume of new information, coupled with new ways to practice, and continued information reinforcement was needed. On the parent side, the researchers noted that the pre/post transition survey showed a dramatic improvement in privacy, noise, light, and confidentiality. According to preliminary financial reports, the average length of stay decreased modestly from 10.9 to 10.3 days. Multidirectional communication that included hospital administration, architects, vendors and suppliers, ancillary units, and the families of NICU patients was cited as the key to transitioning to the private room model. The research also revealed that the importance of close proximity and cross collaboration of novice and expert nurses was underestimated. Thus, safety issues may outweigh the benefits of a private room NICU in some facilities, especially those with chronic staffing problems.
Case study outcomes inherently limit generalizability. Another limitation of this study was that it failed to carefully define design variables, metrics, measurement methods, and outcomes.