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Safety and Security Concerns of Nurses Working in the Intensive Care Unit: A Qualitative Study

October 2022
The Center For Health Design


Why does this study matter?
Safety and security are top priorities for healthcare organizations, and are especially important in areas where patients are at their most vulnerable, such as the intensive care unit (ICU). ICU nurses and providers have intense responsibilities when caring for complex patients and a safe and secure environment of care is necessary. There is very little research on how design of the ICU environment affects nurse perceptions of safety – safety for themselves and for other patients. In addition, the research that does exist is largely based on an assumption that ICUs are safe and secure places. The current study begins to test this assumption.


How was the study done?
A researcher with experience as a bedside ICU nurse interviewed 10 ICU nurses at two hospitals in the southern United States using five questions around safety and security in the ICU. Based on these interviews, the researcher identified the recurrence of themes and determined a sufficient amount of data had been collected. This researcher and another colleague then separately analyzed the data, determined key themes, and came together to compare their findings. Using an online survey, they also shared the themes with a panel of six of the original participants who could review and confirm whether the themes accurately represented their perceptions.     


So what do we learn from the study?
First of all, researchers found that ICU nurses’ perceptions of safety and security had a lot to do with the size and configuration of the unit. Specifically, that smaller units of 12-14 rooms/beds could enhance visibility of patients, visitors, and coworkers throughout the unit, and that there should be a second means of escape from the unit. 

Secondly, they found that nurses emphasized the need for protection for patients and staff on the unit, including  complete visibility of patients from the hallway, adequate or ample staffing, patient lifts to prevent injury, and the ability to call coworkers for assistance. 

Lastly, nurses expressed the need for protection from others such as outside visitors, including the need to be able to lock down the unit and access an emergency panic button, and “airport-like” security, such as metal detectors and site-inspections of visitors’ bags.


Can we say the results are definitive?
This study provides an important first look at an area that deserves much more attention: nurse perception of safety and security. 

The interviews only included five questions and the interviewer did not ask any probing or follow up questions. In hindsight, the authors suggest that probes may have been valuable to gather more information, especially when respondents brought up safety issues related to infectious disease, a topic they did not include in the original set of questions. 

The interviewing researcher has prior experience as an ICU nurse, which the authors mention as a factor in the credibility of the study. While this background is a definite asset for building rapport between researchers and participants, it is important to consider the potential for the researcher’s own experiences to influence how they are interpreting the data (i.e., researcher bias).


What’s the takeaway?
The exploratory study in the ICU suggests the following recommendations for ICU design: smaller unit sizes, the need for improved visibility, the ability to access alternate exits, including security controls for emergencies or threats, and providing adequate staffing. 

The nurse perspective is essential in healthcare design research. The findings in this study provide a valuable set of categories to help healthcare organizations, designers, and researchers gain a better understanding of the experience of nurses and the issues they face around safety and security in the ICU.

Interested in the topic? Visit The Center for Health Design Knowledge Repository for more.

Summary of:
Keys, Y., & Stichler, J. F. (2018). Safety and security concerns of nurses working in the intensive Care Unit: A qualitative study. Critical Care Nursing Quarterly, 41(1), 68–75. https://doi.org/10.1097/CNQ.0000000000000187



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