By Jennifer Nussbaum, AIA EDAC, Director of Planning
In a NICU attention is focused first and foremost on the needs of the neonate. For an infant being treated in the NICU, clinical care comes from not only the specialist providers and nursing staff but also parents and other family members who have the opportunity to spend time with the child.
To make room for family members who are caring for and spending time with these infant patients, many NICUs are moving from an open-ward NICU model to private rooms. When deciding whether to follow a private NICU model, you should consider multiple perspectives:
- Clinical needs of staff and providers
- Family experience in providing care for their child
- Communication between clinical staff and families
- Infection control outside the isolette
Clinical Needs of Staff and Providers
Providing care to the infant regardless of the presence of family in a private model can present some challenges. For example, in NICUs with private rooms the travel distances between patients can cause staff to be away from a patient’s bed for longer times. In addition, the enclosed rooms of a private NICU can create communication issues when staff need assistance from their colleagues. Staffing models and patient care needs will be dependent on the level of NICU present. Therefore, lower-level NICUs may not need as much bedside care and are less affected by travel distances and the inherent communication challenges presented by walls and doors.
Family Experience in Providing Care for Their Child
As the family participates more in the care of their child in the NICU, their experience is becoming more important in the decision-making process for the environment of care. A family member’s ability to find privacy and minimal distraction while providing attention and care for their infant reduces stress and enhances their focus on and learning how to care for their child.
Patients in the NICU can have some of the longest lengths of stay within a hospital. NICUs also have the need for family members to be present due to the patient type. Providing space for family to comfortably stay with the infant can reduce stress for the family. And as family members have more control over choosing where to have care provided for their infant, family satisfaction and amenities can play a big role in filling the NICU.
Communication between Clinical Staff and Families
Communication is important in understanding care directives and patient and family needs throughout the stay. Whether providing private patient rooms or consult-style rooms to hold private communications, the need must be addressed. Both options have innate challenges. Private NICU rooms afford staff private space to communicate with family members. In an open configuration, consultation spaces are used for private communications, which could take the family away from the infant and may be less desirable for the family.
Infection Control outside the Isolette
Infection control in a NICU can be aided by using isolettes. However, the added expense in equipment and staff training may not be necessary for the level of NICU provided.
While adult beds are moving to primarily private rooms for infection control reasons, so too can NICUs provide infection control for the non-patient population interacting with the infant. NICUs have the added barrier opportunity of using isolettes; however, the population entering the NICU presents a challenge for bringing in all sorts of dangers for the infants not requiring the isolation of an isolette.
In a private model, with the infant mostly confined to the room, exposure to those entering the suite is limited to staff/providers and visitors directly attending that infant.
In an open model, infants can be exposed to visitors not directly there for that patient. While precautions are taken through scrubbing in to access the NICU space and limiting visitors, infants not enclosed in isolettes can be exposed without the confines of walls.