STAGES IN CONSTRUCTION OF NEW PATIENT CARE FACILITIES

Long-Range Planning

 The goals and needs of the community and the organization itself are considered and future
needs are projected.
 Involves both long-range goal setting and the gathering of demographic and other data to
support the legitimacy of goals

Marketing Plan

Design of Facilities

 First block schematics are drawn to show how major areas to be built will relate to each other,
both horizontally and vertically.
 When dealing with block schematics, the nurse executive must be careful to note the common
pathways by which patients flow from one department to another.

Single-Line Sketches

 Actual space constraints such as internal columns, elevators and corridors are drawn to scale,
and rooms are designed with beds and room equipment also drawn to scale.
 Entrances and exits are indicated in the single-line drawings
 Finished single-line drawings reveal the configuration of each unit, the size and shape of planned
spaces, and the functional relationships between planned units.

Design Development Drawings

 Include structural, mechanical, electrical systems, as well as any built-in equipment.

Development of Blueprints

 Refinements of the design development drawings.

Building Phase

 By then it is usually too late for any changes unless a catastrophic error is discovered. Indeed, if
a major error is discovered at late this date, it means that the executive did not give enough
attention to the project at an earlier stage.
NURSING SERVICE INPUT

Need and Feasibility Studies

Programming

Architecture and Engineering

Equipment

Construction

 During this phase, the nurse administrator can begin personnel planning.
 Should take account of the many new procedures that will be introduced in the new facilities.

Opening and Changeover

 A smooth changeover can take more than a year of planning.

 Factors to be considered:
 Preparation of new nursing procedures
 Orienting personnel to the new equipment and facilities
 Planning for patient comfort during the changeover days
 Anticipating malfunctions during the transitions

Checklist

Questions nursing administrators might seek answers to with the stages of design or redesign of
facilities in mind:

 What, where, how, when, and why functions are to be performed?

 What functional spaces and dimensions are required?
 What fixed equipment is required?
 What environmental conditions are required?
 What workloads and workflows are entailed?
 What staffing complements and patterns are needed?
 What portable equipment will be needed for a properly functioning department?
 What communication and transport networks are involved?
 What intramural and extramural relationships are to be accommodated?
 What provisions should be made for possible future changes?

NURSING SERVICES FACILITIES DESIGN

Within the nursing services department, activities can be analyzed as to three functions:

Administration

 Supports the activity of a department

  Consists of offices, files, and reception areas.

Functioning Area

 Prime reason for the department’s existence

 Occupies the greatest amount of space within a department.

Ancillary

 The people who operate the department require convenience space such as a rest
area, personal hygiene facilities, and a place to eat.
 Lockers and showers may also be necessary.
 Facilities specifically assigned for use by the nursing services department consist of:
 Office space for the director and assistant director of nursing services
 Nursing stations on each of the patient areas and units that enable the nursing
personnel and the medical staff to conduct activities associated with patient
care
 Utility rooms which are in most cases adjacent to the nursing stations and
used for storage of needed supplies and portable equipment
 Linen closets for storage of laundry items
 And on two floors small conference rooms seating four to six people and used
for medical consultations.
 Equipment and furnishings are much the same in each of the nursing stations and
consist basically of:
 Charting desks
 Patient charts
 Medicine preparation tables and cabinets
 Minimum of paging and communication equipment
 Portable equipment such as
 Resuscitators
 Chest respirators
 Irrigation apparatus charged to the department

ARCHITECTURAL CONCERNS

During the planning phases for building or renovating a nursing unit, the nurse executive will
need to consider the proposed architecture as it relates to:

1. Flow patterns for patients, staff, and visitors

2. Security needs
3. The facility’s proximity needs
 4. Movement of equipment and supplies
5. Placement of nursing offices and managerial space as they relate to the space of other key
managers
6. Patient’s convenience in use of the facilities

BASIC PLANS FOR PATIENT UNITS

Single Corridor Design

 Oldest and least satisfactory design

 Patient rooms as well as nurse’s stations, treatment rooms, and other service areas all are
rooms off the same long hall
 Calls for many man hours spent walking than needed with more compact designs.

Double Corridor Design

 Patient rooms branch off halls located on both sides of a central core containing the work areas
of the unit
 Advocates of this design claim walking time is cut nearly by half, compared to time required for
a single corridor with the same number of patient rooms.
 Some nurses are uncomfortable with the fact that this design cuts down visibility of hall
activities because only one-half of the floor can be seen at any one time.

 Each variation in unit design has both advantages and limitations.

 The square, triangle, and circle designs usually simplify the nursing logistics but
tend to waste space by having more central work area than really is necessary.
 T-shaped units attempt to solve this problem while still shortening the length of
any given corridor.
 Typically the nurse executive prefers smaller units than does the architect or
perhaps his or her boss, who is looking more for economy than for convenience
and ease in the provision of nursing care.

PATIENT ROOMS

 Most rooms are semiprivate or multibed accommodations, with two, three, four, or even up to
six beds in one room.
 More recently, there has been a trend toward the private or single-bed accommodation.
 Whether the patient rooms are private or multi-accommodations, they will vary in size.
 It has been suggested that the minimum size for a private room should be not less than 125
square feet, with a minimum width of at least 12 feet, 6 inches.
  As to two-bed accommodation, a minimum of 160 square feet is usually provided, with the neds
separated by cubicle curtains.
 For a four-bed room, the minimum is generally considered to be 320 square feet.
 The hospital bed is generally 86 inches long, 36 inches wide, about 27 inches from the floor, and
can be varied electrically or mechanically into different positions.

GUIDELINES FOR NURSING SERVICES ADMINISTRATIVE OFFICE SPACE

The nursing services administrative offices generate moderate to heavy traffic. A central
location, convenient to the executive unit in the administrative block, is appropriate.

Reception Area

-functions as a reception and waiting area for visitors to the unit and controls traffic to and from
the secretarial and clerical work area and the offices of the various officials.

-this area is not routinely required in the nursing services administration unit of a 100-bed
hospital

-there it is usually satisfactory for visitors to enter the secretarial and clerical work area directly
from the administrative corridor, with one of the secretaries functioning as a receptionist as an
additional duty.

Office of Director of Nursing

(Director and up to six visitors)

Total area required:

100 beds – 169 square feet

300 beds – 223 square feet

500 beds – 223 square feet

Assistant directors of nursing

100 beds- four assistant directors of nursing services (one for days, one for evenings, one for
nights, and one for relief duty), and three visitors: 192 square feet

300 beds- five assistant directors of nursing services (one for days, two for evenings, and two for
nights), and four visitors: 192 square feet.

500 beds- six assistant directors of nursing services (two for days, two for evenings, and two for
nights), and four visitors: 296 square feet.
Nursing Education Director

 Office may be located either in this department or in the nursing services administration unit.
 In general, offices for assistant nursing education directors and/or instructors, as well as
classroom facilities, will be remotely located with respect to the administrative block.

Secretarial and Clerical Work Area

 This area provides administrative secretarial and clerical support for the nursing services
administration unit
 For the 100-bed hospital, it also provides for the initial reception and control of visitors.
 This area also provides for visitor traffic to and from the adjacent offices and conference room.

Estimated Requirements

100 beds- secretary, reception secretary, and waiting area for three visitors: 287 square feet

300 beds- three secretaries: 444 square feet

500 beds- three secretaries and one clerk typist: 544 square feet.

Conference Room

 This room provides a limited area for conducting meetings, group discussions, and
conferences involving the administrative, educational, and supervisory personnel
responsible for the hospital’s nursing services program.
 These meetings are frequent and vital to an adequate program of nursing services and
nursing education

Toilet and Locker Room

 Provides toilet facilities for personnel of the nursing services administration unit and dressing
space for administrative personnel of the unit to put on uniforms.

Total area required:

100 beds- 80 square feet

300 beds-108 square feet

500 beds- 108 square feet

Storage Room

-Provides storage space for inactive files, including secured files, and short-term inventory office
supplies.

-Space allocated ranges from 40-88 square feet.