except the provision of waiting and resting space for families
outside the NICU, and corridors and signage for wayﬁnding.
As these two environmental factors are identical for Hospital 2,
we can assume that the data are inconsequential.
According to staff, single rooms are superior to open bays in
terms of providing privacy to families and infants. This is most
strongly articulated in Hospital 1, which is limited to SFRs.
However, while the SFR-only NICU is perceived as less stressful
than the SFR portion of the combined unit, very little difference
was found in response to the question ‘the environment supports
the family’s presence and participation.’ This suggests that
common factors that are not associated with the physical
environment may be contributing to stress levels.
Consistent with their high ratings of the physical environment,
members of the nursing staff in Hospital 1 report less stress and
more satisfaction with their job than their counterparts in Hospital
2. Within this context, the most problematic areas in all three
locations were workload, inadequate preparation, death and dying,
and conﬂicts with physicians, all factors that are typically
independent of the physical environment. These factors have been
demonstrated in other studies to be challenging for nursing staff.
The study conﬁrmed that nurse job satisfaction may be higher
in the SFR conﬁgurations. This satisfaction is corroborated by other
data indicating lower stress levels and perceptions of a higher
quality experience for families.
The purpose of this study was to explore the implications of SFR
design of NICUs comparison to other current design conﬁgurations.
We used a review of the literature and the results of this study to
provide practitioners with recommendations for the design of
NICUs and to present researchers with an agenda for future, more
focused research studies.
Based on the results of this study, SFR NICU design provides
solutions for increasing parent privacy and presence, supporting
HIPAA compliance, minimizing the number of undesirable beds,
increasing staff satisfaction and reducing staff stress. Potential
limitations of the SFR design are reduced parent-to-parent social
contract and isolation of both parents and staff. In the projects
reviewed in this study, construction cost was not notably inﬂuenced
by design conﬁguration.
This study was supported by a research grant from the Coalition for Health
Environments Research (CHER) and is available at www.cheresearch.org. Support
was also provided by the Regional Newborn Program at Memorial Hospital, South
Bend, IN. Preliminary data were presented at the High Risk Infant Conference,
Orlando, FL, 27 January 2006. We thank the participating hospitals, architecture
ﬁrms and construction companies. We especially thank the other members of the
research team: Stanley Graven, MD; Leslie Parker, ARNP; Beverly Johnson; Judy
Smith, MHA; Teri Oelrich, RN; and Kathleen Philbin, PhD for their contributions
to the completion of this project.
Statistical Reviewer: Xiaobo Quan, M ARCH, College of Architecture, Texas
1 Als H Lawhon G, Duffy F, McAnulty G, Gibes-Grossman R, Blickman J.
Individualized developmental care for the very low birth-weight preterm
infant – medical and neurofunctional effects. J Am Med Assoc 1994; 272:
2 Ferber SG, Makhoul IR. The effect of skin-to-skin contact (kangaroo care)
shortly after birth on the neurobehavioral responses of the term newborn: a
randomized controlled trial. Pediatrics 2004; 113(4): 858–865.
3 Mathur NS. A single-room NICU – the next-generation evolution in the
design of neonatal intensive care units. Am Inst Archit Acad J 2004,
Retrieved November 12, 2004, from http://www.aia.org/AAh_a_Jrn/
4 Miles MS, Funk SG. Parental Stressor Scale: Neonatal Intensive Care Unit.
1998 [cited July 15, 2005]; Available from: http://nursing.unc.edu/crci/
5 Bialoskurski M, Cox C, Wiggins R. The relationship between maternal needs
and priorities in a neonatal intensive care environment. J Adv Nurs 2002;
6 Cescutti-Butler L, Galvin K. Parents’ perceptions of staff competency in a
neonatal intensive care unit. J Clin Nurs 2003; 12: 752–761.
7 Conner J, Nelson E. Neonatal intensive care: satisfaction measured from a
parent’s perspective. Pediatrics 1999; 103(1): 336–349.
8 Kent W, Tan A, Clarke M, Bardell T. Excessive noise levels in the neonatal
ICU: potential effects on auditory system development. J Otolaryngol 2002;
9 Chang Y, Lin C, Lin L. Noise and related events in a neonatal intensive care
unit. Acta Paediatr Taiwanica 2001; 42(4): 212–217.
10 Gray L, Philbin M. Effects of the neonatal intensive care unit on auditory
attention and distraction. Clin Pediatr 2004; 31(2): 246–260.
11 Philbin M. The inﬂuence of auditory experience on the behavior of preterm
newborns. J Perinatol 2000; 20(8 Part 2): S77–S87.
12 Philbin M, Gray L. Changing levels of quiet in an intensive care nursery.
J Perinatol 2002; 22(6): 455–460.
13 Philbin M, Klass P. Hearing and behavioral responses to sound in full-term
newborns. J Perinatol 2000; 20(8 Part 2): S68–S76.
14 Berens R, Weigle C. Cost analysis of ceiling tile replacement for noise
abatement. J Perinatol 1996; 16(3): 199–201.
15 Johnson A. Adapting the neonatal intensive care environment to decrease
noise. J Perinatal Neonatal Nurs 2003; 17(4): 280–288.
16 Ulrich R, Zimring C. The Role of the Physical Environment in the Hospital
of the 21st Century: A Once-in-a-Lifetime Opportunity. The Center for
Health Design: San Francisco, CA, 2004, May.
17 Oren I, Haddad N, Finkelstein R, Rowe J. Invasive pulmonary aspergillosis in
neutropenic patitents during hospital construction: before and after
chemoprophylaxis and institution of HEPA ﬁlters. Am J Hemotol 2001;
18 Dharan S, Pittet D. Environmental controls in operating theatres. J Hosp
Infect 2002; 51(2): 79–84.
SFR NICU design implications
DD Harris et al
Journal of Perinatology
Home design ideas: Adding a modern edge to a nautical lake house
26 Best Gifts for Cousins in 2022
Interior Designer Shares 10 Things Not to Have in Your Living Room