The document discusses the design of inpatient nursing units. It describes the Nightingale ward layout from the 1800s and outlines advantages and disadvantages. Modern inpatient units are divided into five functional areas: reception, patient, support, staff/administrative, and education areas. Each functional area contains different rooms tailored to their purposes, such as patient rooms in the patient area and nurse stations in the support area. Design considerations are also outlined for specific unit types like pediatric and elderly care units.

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INPATIENT UNITS
DESIGN

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INTR OD U C TI O N
The term “nursing unit” refers to an area in a hospital or other health care
delivery setting where patients with similar needs are grouped to facilitate
health care delivery by medically trained professionals. Typically a nurse
manager is in charge of the nursing unit. There are various types of nursing
units; inpatient and outpatient units, intensive care units and other specialized
care units. The phrase hospital ward is used in the British English language and
is similarly used to describe a division of a hospital shared by patients who need
a similar kind of care.
DEF INITI O N OF INP ATI EN T NURS ING UNIT
It is a grouping of accommodation for the patients with service facilities which
enable a team of nurses to care for inpatients under the best possible conditions,
and includes under one roof patient beds, the nursing station, the service area,
storage area, work area and sanitary area.

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THE NIGH TIN G AL E WARD :
The Nightingale ward consisted of patients’ beds in two rows at right angles to
the longitudinal walls, with toilets and bathrooms at one end and the nurse’s
table, doctor’sroomand other technical facilities at the other end. (Fig. 1)
DVANTA G ES OF THE NIGH TI N GA LE WORD:
Lack of privacy to patients and not so quiet atmosphere
Danger of cross infection
Large ward of 40 patients resulted in reduction of human contact between the
nurse and patient.
Changes the inpatient area is divided into various sections based on the
patient acuity level / severity of illness and type of nursing care required as
follows: intensive care, intermediate care and self-care.

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FUNCTIONAL AREA
A Functional Area (FA) is the grouping of rooms and spaces based on their
function within a clinical service.
M ED IC A L / S UR G IC AL I N P AT IE N T U N ITS IS
ORGAN IZE D IN F IVE F UNCTIO N A L AREAS
FA 1: Reception Area
FA 2: Patient Area
FA 3: SupportArea
FA 4: Staff and Administrative Area
FA 5: Education Area

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F A 1 : RECEP TIO N AREA
Spaces within this functional area include:
Waiting.
Family Lounge / Family Pantry.
Public Toilets.
Consult Room.
Patient Education Kiosk.
F A 2 : P ATIEN T AREA
Spaces within this functional area include
Patients Rooms with Patient Bathroom.
Airborne Infection Isolation Room with Anteroom and Patient Bathroom .
Exam Room.
Dayroom, Recreation.
 Patient rooms are organized functionally to support clinical objectives. Areas
within each room include hand-washing close to entry, a provider work space
near the patient, a patient care zone, and a family zone on the far side of the
patient from the clinician work area.
 A bedside locker or built-in cupboard should be provided for each bed.
 All patient bedrooms shall be located on the perimeter of a floor and shall
have access to natural light from a window to the outside or to a day lit atrium
space.

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F A 3 : SUP P ORT AREAS
Key spaces within this functional area include Nurse Station
Telemetry alcove.
Medication and Treatment Rooms.
Clean and Soiled Utility Rooms / Clean Linen Room.
Equipment and Medical Gas Storage Rooms.
Multipurpose Specialty Storage Rooms.
Nursing station:
 A central nurse station shall be located adjacent to the public entrance to the
unit and, optimally, near the center of the unit. This location should support
three key functions :
1) Provide controlof access to the unit
2) Offer patient room observation for nearby rooms
3) Function as a central data and communication location for all staff.

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 The nurse station should be open to the corridor but separated from it with a
counter which acts as a desk as well as a barrier.
 The room has built-in cupboards for storage of drugs, dressings and
instruments, closet for narcotics and dangerous drugs and a refrigerator for
storage of antibiotics and other sensitive injectable.
 Electric panel of the nurse’s call station if provided must be located that it is
constantly visible to the nurse.
Telemetry alcove :
 Centralized data may include telemetry monitoring in an alcove that is
adjacent to a nurse station on those units authorized for telemetry. The number
of monitors on a given unit shall be determined by patient acuity and
departmental operational needs.

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Medical and Treatment Rooms:
 Frequently accessed support areas like Medication should be located near
Nurse Sub-stations. This will reduce both travel distance and time devoted to
hunting for materials, and allow nurses more time for patient interaction .
 Treatment room is where dressing, minor treatments e.g. special
examinations, lumber puncture, and other procedures which cannot be carried
out in patient’s bed are performed. One room for a ward of 25-30 beds would be
ideal.
Clean and Soiled Utility Rooms / Clean Linen Room:
 Other support spaces include a Clean Utility Room used for storage of sterile
and non-sterile medical supplies,
 A Soiled Utility Room which provides areas for pre-cleaning medical
equipment and instruments, and a Clean Linen Room in which clean linen is
stored. All these spaces can be decentralized to provide shorter travel distances
for staff on larger nursing units.

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Storage:
 Storage spaces should be planned so that the main circulating corridor on the
unit remains clear of items like carts, wheelchairs, stretchers, and mobile
electronic or clinical equipment. Alcoves off the circulating corridor can
accommodate those items which must be accessed quickly like crash carts or
stretchers .
 Larger items are stored in various storage rooms in the central core. These
rooms include Equipment and Medical Gas Storage Rooms, and Multipurpose
Specialty Storage Rooms
F A 4 : STAF F AND ADMI N IS TR A T IVE AREAS
Spaces within this functional may include
Offices as authorized for unit administrators, Physicians, Social Worker,
Dietician, and Clinical Pharmacist.
Staff Lounge, Locker Rooms ,and Toilet
 Offices for the Nurse Manager and Nurse Supervisor should be located near
the center of the unit they serve. Other office spaces under FA 4 should be
located in an area off, but close to, the unit. This reduces the level of traffic
within the unit and permits office and administrative space to be shared with
adjacent inpatient units .
 Staff respite is an important concern to reduce fatigue and lower stress .
 Staff toilets should be located close to nurse work areas .
 Staff Locker and Staff Lounge should be separate rooms .
 Ideally, to reduce noise on the unit and ensure staff respite from activity on
the unit, the Staff Lounge should be near the unit but not in the unit.
Storage
 Storage spaces should be planned so that the main circulating corridor on
the unit remains clear of items like carts, wheelchairs, stretchers, and mobile
electronic or clinical equipment. Alcoves off the circulating corridor can
accommodate those items which must be accessed quickly like crash carts or
stretchers .
 Larger items are stored in various storage rooms in the central core. These
rooms include Equipment and Medical Gas Storage Rooms, and Multipurpose
Specialty Storage Rooms

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F A 5 : EDUCATIO N AREA
When authorized, spaces within this functional area include
Office for Patient Instructor
Cubicles for interns, residents, and fellows
Conference/Classroom
Library
These functions should be near but not on the unit. This reduces the level of
traffic within the unit and permits these functions to be shared with adjacent
inpatient units with similar clinical programs.
6 CHECKP OIN TS WHEN DESIGN I NG A
P EDIATR IC HEALTHC AR E UNIT
1) LIGHTING + ACOUSTICS —TONE IT TOWN
 At night, stars appear on the ceiling—a decorative lighting element used to
make the unit feel like a nighttime space.
2) PRIVACY—OPTIONS FOR COMPANIONSHIP
 Privacy and acoustics are closely related, as noise levels can vary based on
the number of people in a room.
 The benefits of private rooms tend to vary based on a number of factors.
Pediatric cancer patients, for example, might benefit from and desire the
companionship of a roommate with a similar diagnosis and care plan.
3) POSITIVE DISTRACTION—NOT JUST PRETTY
PICTURES
 Common play areas for patients and families to interact can be a source of
healing and distraction for children and their families .
 Creating a connection between indoor spaces and the outdoor environment
can also be a successful positive distraction. Windows provide a view to the
outdoors but also help remove patients from the often-clinical feeling of the
hospital environment. This helps to restore homeostasis by providing the
horizon as a reference and also has a positive impact on the healing process.
 Using clear way finding devices that incorporate “big person” and “little
person” versions of the same element can be fun for children while alleviating
stress for their parents.

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 For example, providing animal characters at a child’s height that are tactile,
recognizable, and consistent from space to space on the same floor assists
children in finding their way in a fun and entertaining way.
FURNISHINGS—MAXIMIZING FLEXIBILITY
 Pediatric units must be fit to serve children of all ages. The care plan for a
five-year-old will be different from that of a 15-year-old. Provider, Design, and
Construction Teams must take the varying treatment scenarios into
consideration when specifying furnishings for a unit. Creating a space that is
adaptable to a variety of circumstances can help save costs and precious floor
space.
 Pediatric patients often have visitors at all hours of the day and at least one
parent spending the night. To address this problem, one manufacturer offers a
couch that can convert into two chairs and a table and can be easily made into a
bed for overnight visitors

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6). SURFACES—SEAMLESS IS BEST
 In specifying floor materials, seamless surfaces are best, particularly where
infection risk is highest, such as surgical areas. For sinks, solid surfaces with
integral sink bowls minimize seams, contributing to infection control measures.
Infection risk can also be minimized through careful selection of furnishings
and materials. The less porous a surface, the easier it is to clean and maintain.
 Shiny does not equate with clean, as a non-waxed surface takes less water,
chemicals, and down time than a highly polished waxed surface. Shiny floors
create glare that can be distracting and contribute to falls, as shiny spots are
often mistaken for wet areas. Design professionals should evaluate matte
surfaces with a high coefficient of friction to reduce fall risk.

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THE P ROGRAM OF ALL-INCLUSI VE CARE
FOR THE ELDERLY
 PACE center is comprised of a fully functioning and equipped primary care
clinic.
 Adult day center and rehabilitation therapy gym.
 It includes find dining areas, large group activity spaces.
 a PT and rehab space,
 Meditation spaces and a medical clinic capable of primary care.
 Participants can watch TV, play organized games, relax in one of the many
quiet spaces or simply talk to one another. The IDT of nurses, social
workers, dieticians, physical therapists, occupational therapists,
transportation and primary care physicians is available to attend to a
Participant’s needs.
 Corridors are approximately 8 foot wide to accommodate the number of
wheelchairs, as well as other mobility devices, and have a minimal number
of corridor bends.
 Participant socialization spaces are adjacent to one another to reduce
walking distances and are connected via large openings rather than doors.
 Specific areas are also designed for Participants with dementia related
behaviors.
 The clinic space has an average of 4-6 exam rooms that are enlarged to
accommodatewheel chairs.
 Several computer terminals with internet access are also available. A patio or
landscaped area provides Participants the opportunity to be outdoors to relax
or participate in a variety of outdooractivities.