June 15, 2005

Design of Neonatal Intensive Care Units Critical to Infant Health

Partially presented at the COLLEGE STATION, June 15, 2005 - Effective neonatal intensive care units (NICUs) provide more than just services - they're designed in a way that contributes to the health of the infants being treated, says a Texas A&M University authority on health care facility design and environmental psychology.

Mardelle Shepley, a professor of architecture at Texas A&M, says properly designed NICUs can potentially result in a number of health-related benefits for the infants in them, but the design of NICUs should be handled appropriately because these infants are exceedingly vulnerable. Some of the benefits, she says, include infants conserving energy, improved ability by infants to manage their environment, growth, decreased respiratory support, decreased lung disease and decreased length of stay.

"Conscientious architects are becoming increasingly aware of the impact of design decisions on the sensory environment of the neonatal intensive care unit," Shepley says. "Since the first symposium on health care design in 1988, the notion of creating healing environments has evolved from a tangential, subjective design consideration to an intervention based on science."

In other words, designers of NICUs are taking into account things such as lighting, noise, and the physical layout of the facility, not only for the infants, but for the staff and families as well, Shepley explains.

Modifications to NICU environments can reduce stress among staff members by allowing them to better care for infants and their families, she notes. For example, an improved environment can enable nurses to spend more time engaging in patient and family support activities instead of walking around searching for supplies - an activity that previous research by Shepley identified as occupying a significant portion of nurses' time.

What's more, research shows that routine activities, management roles and lack of knowledge are often perceived as the most stressful by NICU nurses. Variation in the form of window views and differing lighting levels can energize routine activities, and technology that supports supervision can better support management activities, Shepley says.

As it pertains to the infant, the intensive care unit should be designed in a way that fosters sleep opportunities because research suggests that sleep is critical to brain development, she notes. Visual and auditory stimulation should be controlled because these senses are less developed in infants than are other senses and are more susceptible to disruption.

Lighting in these units, Shepley says, should be adjusted to reinforce natural daily light variations, and the lighting level should be controlled in a way that allows for gradual changes in the level. Light levels should be no brighter than needed to complete a task, and individualized lighting should be available at each baby station, Shepley recommends. Individualized lighting, she explains, is the best compromise to meet the needs of the infant and the staff because lighting needed by infants may not be comfortable to staff. Reduced lighting also has been shown to significantly reduce conversation levels among staff, the primary contributor to noise in an intensive care unit.

Numerous studies identify noise as a primary stressor for infants, patients and staff of health care facilities, with infants particularly disoriented by noise because their hearing is still immature, Shepley says. Noise can prevent an infant from reaping the developmental benefits of sleep, but noise can be reduced through acoustic and configuration modifications to the facility and modifications in staff behavior through educational programs. However, some forms of noise, such as music, have been shown to be effective in reducing stress in infants by reducing cortisone levels in the brain that are associated with stress, she notes.

Visual and spatial elements of NICUs are rarely addressed because it is assumed that infants in intensive care have limited visual ability and lack consciousness to be affected by visual and spatial cues, but Shepley says these areas merit attention and could have an impact on staff and family perception and behavior. Color selection relative to infants is largely inconsequential, she says because of their lack of visual perception, but with regard to adults, studies have indicated persons in high anxiety situations prefer pastels rather than saturated colors. Common sense, she says, dictates that color schemes should be subdued so they don't interfere with accurate reading of the infants' skin color.

"The future of evidenced-base design for infants and staff in NICUs is hopeful," Shepley notes. "The stage has been set to enable the design disciplines, the medical establishment and the academicians to work together to significantly improve the quality of life for infants, families and staff in neonatal intensive care units."

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