Caring for Caregivers – Creating Respite Spaces for Healthcare Staff

Imagine that you are a nurse, subject to incredible mental and emotional stresses as you go about your daily work caring for patients during a pandemic.  You feel like you barely have enough time to eat lunch during a busy shift and are exhausted by the end of it.  Many studies document the rising burnout rates for medical staff.  “According to a national nursing engagement report released in April 2019, of the 2,000+ health care partners responding to the survey, 15.6% of all nurses self-reported feelings of burnout, with emergency room nurses being at a higher risk…burnout negatively affects the physical and emotional health of staff and contributes to rising costs. It also has been shown to have a negative impact on patient satisfaction, worsen patient outcomes or increase rates of safety events, and increase mortality.”

How can healthcare staff be encouraged take a break and get away even for a short time to take care of themselves and avoid burnout?  How do we take care of the health of those who take care of us? How can healthcare organizations counteract the increase in staff turnover?   “NSI Nursing Solutions Inc. reports the average annual cost of turnover for a bedside RN is $44,400. Each percentage change in turnover could cost — or save — a hospital an additional $306,400 a year, on average.”  Developing a culture that encourages staff to take breaks and practice self-care is one piece of a strategy, providing spaces where staff can get away and relax for even a few minutes is another piece.  In the healthcare industry we need to redefine what a break means.  As a client recently told me, a break is not just eating lunch.

Our client Froedtert Health saw a need to create more respite spaces for staff in the last year.  There was an increasing number of staff who needed to get away and refresh from the stress of caring for Covid-19 patients.  “Caring for Covid-19 patients is a very different kind of nursing.  This is stressful and weighs on staff’s minds. It can become overwhelming for them.” states Laurie Salerno, Manager of Clinical Support Resources.  Laurie has worked at Froedtert for 30 years, much of that time as an Emergency Department nurse, so she understands how stressful nursing can be at times and how important respite spaces are for staff.

Laurie reached out to me for assistance in finding rooms that could be repurposed as respite rooms within the existing facility.  “People need a calming, safe place to go and take a mental break. They want a designated space without interruptions” she stated.  To start the design process, Laurie gathered information from staff on features that were important to have in a respite space.  Nature, light, comfortable furniture and private space were all important to them, as well as a location close to the units. However, the overwhelming response Laurie received from staff was “We want to feel like we are not in the hospital, we don’t want to see anything that reminds us of Covid-19 in this room.”  Staff wanted a place to step away from the emotionally charged environment of the ICU.  We worked together and identified 2 conference rooms and an equipment room that could be converted into respite rooms.

After hearing the feedback from staff, the main goal for the room design became creating a space that didn’t feel like a hospital. Using biophilic design features has been shown to reduce stress, so I knew it would be important to include those features in the design solution.  Evidence shows that representational images of natural features such as landscapes, gardens and waterscapes can reduce stress and improve results like pain relief.” I suggested installing a large mountain landscape mural in the respite room that didn’t have an exterior window.  The respite rooms also feature calming wall paint colors and furniture that provides passive movement.

 

The respite rooms have been used by staff now for 3 months.  I recently talked with Laurie to find out what feedback staff have provided on the design and features.  She shared some very candid and insightful responses with me.  Laurie said “One of the quick wins that we had was installing dimmers on the conference room lights. Staff really love being able to control the lights in these rooms.”

LOCATION 

  • Need multiple respite spaces near treatment spaces. Staff do not want to go too far away from their unit.
  • The chapel feels too far away, staff also feel that it is too public.

PRIVACY

  • In the respite space they can totally let down in privacy, that is really important.
  • Adding screens to the larger rooms created more private spaces.

DAYLIGHT

  • Spaces with windows are limited in older, traditionally designed hospitals.
  • Architects need to design more daylighting in new designs in the future.

ARTWORK

  • No posters about being superheroes!
  • Installed a large-scale nature image in room without natural light, staff really like that feature.

LIGHTING

  • Adjustable lighting controls are important, staff want to adjust the level and type of lighting.
  • Staff don’t want harsh medical lighting; string lights make the space feel more relaxing.

SOUNDS

  • Sound machines with calming sounds like waves or chimes are appreciated.
  • Provide a relaxing environment to get away from sounds like phone calls and patient alarms.

SCENTS

  • With all of the hospital smells we decided not to use any fragrances in the rooms.

FURNISHINGS

  • Portable screens give a very warm feel to the room; silk plants add softness to the space.
  • Glider chairs that provide calming movement are a win with staff.

One of my favorite anecdotes that Laurie shared is “We put a lot of battery-operated candles in the rooms. A couple of nurses have just made it their job to go in and change the batteries every few days.”  Staff have taken ownership of the respite spaces and have expressed concerns that they would be repurposed after the number of Covid-19 cases decrease.  Laurie expressed “We don’t want these rooms to go away, we need more of them. This should be done for staff as a standard practice. There’s been a lot of small blessings coming out of Covid-19 and I think this is one of them. It has heightened awareness about the wellness of the employees, nurses and doctors and staff.”

The Zimmerman healthcare team applauds Laurie and Froedtert Health for investing in the well-being of their staff and creating new respite spaces within the existing facility.  Creatively repurposing space within a hospital to provide respite rooms offers the mental getaway that medical staff urgently need.  Investing in their mental health and providing respite spaces to support staff will help to reduce burnout, turnover rates and improve retention rates.  As we begin new design projects with our clients, creating spaces that support medical staff and provide respite opportunities will be a primary driver.

 

Lisa Jansen, ASID

Lisa Jansen, ASID

Vice President | Principal | Director of Interior Design

lisa.jansen@zastudios.com

One of Wisconsin’s leading interior and environmental specialists, Ms. Jansen’s award winning interiors have outstanding sensitivity to the user and function creating an efficient and comfortable space. Healthcare facilities are among her specialties. Ms. Jansen leads the interior design/space planning team. She works closely with the Architect/Manager, design team, and client in the formation of plans to achieve pre-determined goals and objectives. She will also work closely with the project architect in the development of all room finish schedules and review and approve shop drawings for interior finishes.

Family-Centered Design – NICU Care Extends Beyond the Patient

One of the things that I find fascinating about working in healthcare design is when we, the architects and designers, become the patient and have our own healthcare experiences in a project we designed. That shift in perspective from designer to patient is always a learning experience.  I asked my colleagues at Zimmerman what they learned during their recent healthcare experiences.  The responses I received to my informal survey varied, but the main theme was that their best experiences happened when the built environment supported family centered care and allowed them to have positive interactions with healthcare providers.

Designing for a model of family centered care is important throughout a healthcare facility, but especially in the NICU. Parents suddenly have an infant with medical needs beyond the typical newborn’s needs. They need support and education to learn how to take care of their baby. Families can spend days or months in the hospital with their baby, so it really becomes a second home. The design of the NICU can support families during their stay and make it easier for them to be involved in their baby’s care.

Wayfinding
The healthcare facility experience begins with wayfinding. In some healthcare facilities, just finding the front door can be challenging. From the beginning of the NICU project creating an easy wayfinding system for families and visitors was a major driver. The NICU project included a new department entry that is easy for visitors to find after entering Children’s Wisconsin. Within the department, the large 70 bed NICU is made smaller and friendlier by creating 6 neighborhoods. Each neighborhood has a unique color and a Wisconsin animal character to identify it, making it easier for visitors to find patient rooms.

Single Family Rooms
One of the major changes in the renovated and expanded NICU is the use of single-family rooms designed to support family centered care. “Several factors have contributed to the recent popularity of single-family rooms: (1) supportive data on infant outcomes, (2) increased understanding of the value of breastfeeding and kangaroo care (more easily accomplished in a private room), (3) the hospital wide trend toward private rooms for other populations, and (4) the success of innovative prototypes.”

It is important to provide adequate space for family next to the baby’s bed to involve family in the baby’s care and support kangaroo care.  Providing skin to skin contact between the infant and parents, known as kangaroo care, has been shown to improve sleep, weight gain and bonding.  Adequate space around the bed helps nurses involve parents in their baby’s care and teach them how to do tasks like diapering while their infant is connected to a feeding tube or monitors.

Family Amenities
Families can spend many days and even months in the NICU so providing amenities is very important. Many new parents spend weeks or months in the NICU with their infant, only going home for a short amount of time. The family lounge also provides a space where new parents can connect with other families and share their experiences.  Access to daylight and views to outside from the lounge and kitchen help parents take a break and recharge. Sleep rooms are available for parents who need a separate space to get much needed rest. Laundry facilities are also provided for families.

Milk Kitchen
A unique feature of the new NICU is the centralized milk kitchen. “Studies show that premature babies have improved growth and health outcomes when given human milk as opposed to formula. A team of experts including certified lactation specialists, neonatologists, registered dietitians, milk technicians and registered nurses all work together to ensure that each baby gets the precise formula of milk-based nutrition that will help them grow and thrive.” Mothers can use private lactation rooms or the patient room to pump breastmilk. Pumped milk can be stored in the refrigerator in the patient room. Staff then deliver it to the milk kitchen. In the kitchen, milk is analyzed and individually prepared for each infant’s feeding.

Supporting Families through Design
Through the use of design features of wayfinding, single family rooms and family amenities, the family is supported throughout their stay with their baby in the NICU.  Most importantly, the design of the NICU allows the clinical staff to provide the best care for their tiny patients and families.  The clinical staff aren’t only taking care of an infant, they care for the whole family.  For the architects and designers at Zimmerman, it is rewarding to hear what a positive impact design can have on a family’s healthcare experience.

In loving memory of our “Teddy” (11/2020-01/2021) who through his short time on earth, brought so much love. Thank you to the staff at Children’s Wisconsin for your amazing care.

Children’s Wisconsin – Milwaukee NICU

Robin Anderson, AIA, LEED AP

Robin Anderson, AIA, LEED AP

Senior Project Architect / Planner

robin.anderson@zastudios.com

Robin is a highly experienced healthcare architect and planner who enjoys developing creative and healing design solutions that enhance the built environment through operational improvements, integration of Lean design concepts and evidence based design.

Over the course of her 22-year career, Robin has accumulated a range of healthcare experience working on projects from tenant suite build outs to replacement hospitals. She provides value to clients through research and understanding market and design trends. Robin’s approach is based in collaboration and building consensus. She is skilled in coordinating and facilitating varied client, user and stakeholder groups to develop creative design solutions that improve the healthcare experience.

NICU Innovation – Design Features that Support Neonatal Care

When hearing the word ‘NICU’, the first image that appears in your mind are cute babies in incubators wearing tiny hats. If your family or friends experience the birth of a preemie, then the reality of a baby who needs specialized medical care really hits home. As an architect and a medical planner, the connection to a Neonatal Intensive Care Unit (NICU) patient and family changed the entire design project approach for me. These words from a new mom in the NICU will always resonate with me “a child, the size of your hand, with a heart the size of a grape, and a hole in their heart the size of a pea.”

While many details of architecture are only seen as lines and text, the true caring within our work is helping the frailest patients. I was fortunate to be part of the Zimmerman team that designed an impactful project for the Children’s Wisconsin – Milwaukee NICU. This NICU is the largest in Wisconsin and cares for over 700 babies each year. To achieve the project’s highest goal – creating an environment that supports the growth and safe development of these tiny patients, our team incorporated several innovative design features.

Proper Hand Washing
Infection control is paramount in the NICU, where the patients are still developing immune systems and are vulnerable to infections. At the entry of the renovated NICU, care providers and visitors alike are required to wash their hands. To ensure that everyone washes for the proper amount of time, the design team incorporated color-changing lights at the hands-free sinks. While the light color slowly rotates through the color spectrum, you wash your hands until the starting color returns. The colorful cycle of the lights helps to ensure that family and visitors wash thoroughly for the appropriate length of time.

Controlled Lighting
Controlling light levels and providing highly adjustable lighting is critical in NICU design. Designing a lighting system that can cycle and provide levels of light appropriate for day and night is beneficial for infants as well as care providers and families. In the article, Reducing Noise in the Neonatal Intensive Care Unit, the authors state, “Several research studies have shown that compared to infants who remained in constant light or constant darkness, infants exposed to cycled light (bright during the day and dim at night) spent more time sleeping while in the NICU and after discharge, had a greater rate of weight gain while in the NICU and after discharge, were able to be fed orally sooner, spent fewer days on the ventilator, and displayed enhanced motor coordination.”

In this NICU, the design team used digitally controlled lighting to provide the ability to have ‘lighting-scenes’, developed from many patient care considerations. Patients can require immediate care so medical staff have lighting controls placed in close proximity to the baby’s bed. No matter the time of day, care providers can press a single button to have an ‘all-on’ emergency lighting. A benefit of the digital controls is that changes of switching and light levels over time are possible without needing invasive wiring modifications or disrupting patient care.

Multiple lighting control points are available around the patient room, but when a switch has a unique need it was given a single location. In the NICU patient rooms, families have a zone of space designated as their comfort area. The light controls in this area support different light levels for reading, working and nighttime. Amber colored night-lights are located below the height of baby’s bed so they will not interrupt sleep but allow parents to see details at night. The lighting controls are one of the ways families can customize the patient room environment.

Proximity to Daylight
The NICU expansion project was a challenging renovation within an existing facility. To maximize the available space, some patient rooms are located on the interior of the unit, without exterior windows. This clinically approved location has a benefit for the smallest patients who are sensitive to daylight. Many studies have shown the positive effects of daylight for hospital patients and visitors, but daylight can have a negative effect on NICU patients. Direct sunlight can reduce visibility in the NICU and may even harm the developing retina of the infant. When the babies reach 34 weeks, they can be moved to windowed patient rooms to further develop their circadian rhythm and natural light responses. At the patient rooms with exterior windows, daylighting levels are controlled with window treatments. To ensure that families still have connections to daylight and views to the outside during their time in the NICU, the family kitchen and lounge have exterior windows.

Sound Level Controls
The infants’ tiny ears and high sensitivity to sound is another factor important to consider in NICU design. In the article, Reducing Noise in the Neonatal Intensive Care Unit, the authors state, “While meaningful sound (such as parents’ voices) stimulates proper development, noise in excess of 45 decibels (dB) can have adverse effects on the growth and neurodevelopment of neonates”. To help staff and family remain aware of appropriate sound levels, the patient rooms have an innovative ‘Twinkle Light’ feature. Small lights set flush on the patient headwall shift color from white to yellow to red as noise levels in the patient room increase. The lights also flash to alert the room occupants of high sound levels. The light color returns to calm white when the noise drops to the acceptable quieter levels.

Staff and families alike appreciate the quiet environment of the renovated NICU. A hospital is not often thought of as a quiet space, but our design team supported the NICU staff in reducing alarm fatigue by having required patient alarms, calls and pages routed to department cell phones. A care call escalation path permitted the quieting design of necessary hospital systems.

The walls of the patient rooms are also acoustically insulated to reduce the noise coming in from the corridor and adjacent rooms. No utilities, pipes or ducts were permitted to make openings side to side in the rooms, only at a controlled point at the corridor/door side. The patient room doors also have sound seals around the edges to help reduce the transmission of sound. These features combine to provide a quieter environment to promote the healthy development of the infants.

The renovated and expanded 70 bed, Level IV NICU opened at Children’s Wisconsin – Milwaukee in 2017. This project has been one of the most rewarding of my career.  I saw firsthand the impact that innovative design features have on the patients and their families. While the focus of our work is healthcare design and architecture, we truly appreciate seeing the way nurses care and interact for families within this very special neighborhood for tiny patients.

Children’s Wisconsin NICU Case Study

Children’s Wisconsin – Milwaukee NICU

Eric Johnson, AIA

Eric Johnson, AIA

Senior Associate | Senior Project Manager

eric.johnson@zastudios.com

Mr. Johnson is a Wisconsin Licensed Architect, Senior Project Manager, with a very diverse work portfolio including over 15 years healthcare specialization. Being responsible for daily management of the project, coordinating project design, consultants and documentation while also partnering directly with the client project team. Eric is also an insightful problem solver who confidently navigates the complexities of the medical environment and enjoys challenges.