Nursing Care Delivery at Fitzsimons

from Caring For Our Future, Spring 2004

By Susan Koch, MSHA, RN, Director of Clinical Planning and Development

The new Children's Hospital will have abundant
natural light, and corridors will feature "soothing"
uplighting.

For more than 90 years, The Children’s Hospital has existed to provide care to children and their families. The challenge that faces us now is to continue with that mission while integrating new technology, new programs and a new location. The main issue facing The Children’s Hospital is that many of the buildings on the main campus are 80 years old and in need of renovation. The additions over the past 20 years, although necessary, have created an inefficient and confusing maze-like circulation pattern. Many of our infrastructure systems such as electrical power and lighting have not kept up with the demands of an increasingly higher-acuity child being cared for daily by the nursing staff. The double rooms are a constant source of complaints and create extra work for nurses because of infectious disease cohorting issues. The rooms themselves with shared bathrooms, televisions and thermostats are not nurse-friendly or family-friendly, which increases stress for all providers.

As the design of The new Children’s Hospital unfolds, it is apparent that it will be a supportive design in every way possible. As the project’s principal designer, Robert Packard, said, “We must create an environment and an experience that is welcoming, comforting, and that ultimately plays an active role in the healing process.” Designers have developed ways to deal with climate conditions such as wind, snow and sun. They also have improved circulation and wayfinding and designed ways to meet clinical program requirements and functionality. How do these guiding principles translate into advantages for nursing staff?

The Children's Hospital will soon be an
integral part of the landscape at Fitzsimons.

The first change nursing staff will notice is the campus-like feel. There will be approximately 6.5 acres left open in the southwest corner of the site. This will feel like the hospital’s front yard. Parking is always a very important consideration. Providing enough parking that is safe and convenient is the goal. Every effort is being made to meet that goal.

Upon entering the hospital, there will be a mixture of art in a variety of media done by children and community artists. There will be an abundant amount of natural light in the four-story atrium. Corridors will have soothing “up lighting.” Waiting areas will have durable but interesting lighting that will make the areas playful or restful depending on the intent of the area. Signage and wayfinding will efficiently lead visitors to services. Unlike our circuitous circulation patterns of today, the building layout will be logical and easy to navigate.

The new hospital will have five entrances, down from 28 at our present site. The ability to limit access to the units will provide a family-centered environment that provides intimacy for the family and chosen visitors. Including technological support for the security system frees up precious time for nurses so they are not policing the unit but instead are able to concentrate on caring for families.

The next difference between today’s hospital and Fitzsimons will be private rooms for patients. Each family on the medical/surgical units will have their own room and bathroom. Each room has a family zone that will include a twin-size sleeper couch and a reclining sleeper chair. The zone for families allows nurses to do their work without interfering with the family. Each room will have a TV that functions as an entertainment center. TVs will allow for movie-watching, video game-playing and even Internet access, controlled of course. Laptops and cell phones will be welcome.

Personal communication devices will eliminate pagers, spectralinks and yelling. This area of technology is evolving so fast that it is impossible to know exactly what form these devices will take. Charts will be electronic. Tube systems will become less of a lifeline in the new hospital as bedside labs become more prevalent and orders will no longer be tubed to pharmacy as they will be electronic as well.

Rooms will be larger, and units bigger. To avoid increasing walking time, much thought has gone into the design of the flow of equipment and materials. Having supplies closer to the bedside than today’s unit will save steps and allow more time for nurses to fulfill their job responsibilities. Decentralized charting stations will be located between every two beds. There has been great care taken in the design to ensure that these alcoves will function for the nurses in terms of height and viewing into the patient room.

In the critical-care units, patient rooms also will have space for two family members to sleep. There will be an opportunity for the PICU and CICU nursing staff to use an outdoor space in the middle of the building. Often the staff in these areas cannot retreat too far from their units, so this option may help relieve some stress. The mock-up rooms have provided opportunities for staff to experiment with the room design. This pre-work will help in achieving the best ultimate design.

Adequate equipment storage rooms and alcoves will provide an opportunity to clear the corridors that are prone to being “parked” with wagons, wheelchairs and stretchers. Staff lounges will be generous in size and will have good views wherever possible. Amenities in the staff lounges will vary but include ovens, hot water dispensers and coffee makers.

Another noticeable difference between the current facility and the new hospital will be the food delivery system. Patient meals will be delivered on a patient-demand schedule. A room-service model will be implemented. A nurse can offer a child a meal at any time. Family members can also have meals delivered from the hospital kitchen to the family lounge for a small charge. Outside seating will of course still be available.

We are still imagining and designing what the hospital will need – and need to be – decades from now. These are just some of the new and exciting amenities nurses will find at the new Children’s Hospital. We hope to embody what Frank Lloyd Wright said 50 years ago as he urged fellow architects to harness the healing power of design. “Hospital patients should never be imbued with the idea that they are sick,” he insisted. “Health should be constantly before their eyes.” Nurses play a key role in insuring that that vision becomes a reality.