Keys, Y. & Stichler, J.F Critical Care Nursing Quarterly, Volume 41, Issue 1, Pages 68-75

Transcription

1 OBJECTIVES The bjective f this study was twfld: the first was t explre and describe the perceptins f nurses f their persnal safety and security within the ICU envirnment, and the secnd was t understand hw ICU nurses perceived design features as cntributry t their assessment f safety and security fr themselves and their patients. Keys, Y. & Stichler, J.F. 2018Critical Care Nursing Quarterly, Vlume 41, Issue 1, Pages Vulnerability, instability, and cmplexity define mst patients requiring intensive care. The intensive care unit, r ICU, setting hence has tw primary rles, accrding t the authrs t ffer a dedicated space fr such patients t be cared fr by clinicians and t ffer a supprtive envirnment fr effective and efficient caregiving. Studies s far have fcused n activities within the ICU, perating n the premise that ICUs are safe places. This by itself, the authrs surmise, necessitated a study t examine if ICUs are safe spaces. Structured interviews were cnducted with 10 ICU nurses by telephne, fllwed by an nline survey t crss check the interview findings. Analysis f the interview transcripts yielded five themes and 14 elements relevant t safety and security within an ICU. This was a qualitative study, where 10 ICU nurses were interviewed by telephne. The eight clinical nurses, ne nurse manager, and ne nurse educatr wrked in cardivascular, neurlgical, trauma, surgical, and medical ICUs in tw hspitals in the suthern United States. They were asked five questins. The transcripts f the digital recrdings f the interviews were analyzed and the respnses thematically arranged. These themes were then presented t the participants as an nline survey t determine the level f agreement (n a scale f 1-8) with the findings frm the interview analyses. Cpyright 2018 The Center fr Health Design. All Rights Reserved.

2 The analysis f the interview transcripts revealed five categries and 14 elements pertinent t the safety and security in an ICU. General security design elements prtectin frm utsiders: The participants mentined that patients, their families, and staff needed security frm utsiders, as there had been instances f threats frm gang members and family members. They suggested the fllwing precautinary measures: Lcked unit Outsiders wuld need a security badge t access the ICU. Have a remtely-cntrlled audivisual system t grant entry int the ICU Multiple entry pints int the ICU were cnsidered a prblem, as they made the unit mre accessible. Need fr multiple emergency panic buttns within the ICU T call fr security assistance t manage situatins with aggressive intruders and visitrs T e-lck the entry int the ICU Security cameras at several pints in the ICU all mnitred frm a centralized security area Size and cnfiguratin f the ICU: Large decentralized units made the participants feel unsafe and islated frm cwrkers, especially shuld they need assistance in aggressive r vilent situatins. They cnsidered cluster designs, where sme rms are islated, as an impediment t visibility. They recmmend: Smaller units with beds r rms Visibility f entire unit in the hallway Ability t see cwrkers and visitrs in the hallway U-shaped r circular cnfiguratin this wuld heighten visibility and safety and minimize caregiving steps 2 Cpyright 2018 The Center fr Health Design. All Rights Reserved.

3 Centralized nursing statin with a view f all rms and decentralized nursing statins fr bserving the patient An emergency exit dr frm the patient rm r the unit int a secure, staff-nly-accessible hallway in case f an active shter Need fr prtectin f patients: The participants indicated that patients safety and security necessitates their being cmpletely visible frm the hallway. The recmmendatins: Curtains and blinds t ensure privacy Lw windws in decentralized nursing statins t enable visibility while caregiver was seated Fldaway r breakaway glass drs int the unit t Imprve visibility Prvide quick access t the patient with emergency equipment and carts Prvisin fr cntinuus visual mnitring f patients frm a central nurse statin t Lessen patient falls Increase security Need fr caregiver prtectin: The health and security f caregivers in an ICU are ptentially at risk. Participants recmmended: Ceiling-munted lifts fr psitining and mvement f patients in beds and frm beds t chairs Mechanisms t call fr cwrker help in emergencies emergency buttns, audivisual link t central statins, and ther devices Other recmmendatins: Metal detectrs and prvisin fr n-site inspectin befre visitrs and utsiders enter the ICU Security desks in mnitred waiting areas 3 Cpyright 2018 The Center fr Health Design. All Rights Reserved.

4 The findings frm the nline survey: All items n the survey shwed a mean scre higher than 4 the mid-pint n a 1-8 scale. Participants did nt agree as strngly with the fllwing tw items: Centralized nursing statin with a view f all rms and decentralized nursing statins fr bserving the patient (M=5.83) Fldaway r breakaway glass drs int the unit (M=5.67) Authrs identified their study t have several limitatins: It was a single-site study. Nurses frm ther hspital systems may have respnded differently. The interview was structured; ther questins may have elicited different respnses. There were n fllw-up questins t the riginal five questins. It may be nted that the study was an explratry ne. The implicatins fr design frm the findings f this study include: Lcked unit with cntrlled entry access Need fr multiple emergency panic buttns within the ICU Centrally mnitred security cameras at several pints in the ICU Smaller units with beds r rms with ability t see cwrkers and visitrs in the hallway U-shaped r circular cnfiguratin t heighten visibility and safety Centralized nursing statin with a view f all rms and decentralized nursing statins An emergency exit dr frm the patient rm r n the unit int a secure, staff-nly-accessible hallway in case f an active shter Lw windws in decentralized nursing statins t enable visibility while caregiver was seated Fldaway r breakaway glass drs int the unit fr better visibility and fr quick access t the patient with emergency equipment and carts 4 Cpyright 2018 The Center fr Health Design. All Rights Reserved.

5 Ability fr cntinuus mnitring f patients frm centralized nurse statin Ceiling-munted lifts fr psitining and mvement f patients t prevent staff injury Mechanisms in patient rm t call fr cwrker assistance in emergencies emergency buttns, audivisual link t central statins, and ther devices Metal detectrs and prvisin f site inspectin befre visitrs and utsiders enter the ICU Security desks in mnitred waiting areas The Center fr Health Design advances best practices and empwers healthcare leaders with quality research that demnstrates the value f design t imprve health utcmes, patient experience f care, and prvider/staff satisfactin and perfrmance. Learn mre at d 5 Cpyright 2018 The Center fr Health Design. All Rights Reserved.