Environmental affordances: designing for family presence and involvement in patient care.

Objective: This comparative study in two ICUs examines the impact of the patient-centered unit design on family involvement, operationalized as percentages of family presence and family-patient/family-staff interaction in patient rooms.

Background: As hospitals have become more patient-centered, there has been a trend toward including a family area inside the patient area to promote family presence, support, and involvement in patient care. There is growing evidence that family members play an important role in supporting patient care, and that the physical environment affects family involvement. However, few empirical studies have attempted to show the effectiveness of the patient-centered design on family members' presence and their behavior.

Methods: This study compared the degree of family presence and family-patient and family-staff interactions in two intensive care units (ICUs) with different physical environmental conditions, but housing patients of similar acuity and disease type.

Results: The analysis identified a significant difference in family presence in patient rooms (t = -2.176; df = 79.0; p = 0.03) between the traditional and the patient-centered units. Patients in the family-centered care unit (M = 37.77; SD = 34.02) spent significantly more time with their family members in patient rooms than did patients in the traditional unit (M = 23.89; SD = 21.90). Patient-related variables other than unit design had no significant impact on family presence and interactions.

Conclusions: Findings demonstrated that the patient-centered unit (5K) was associated with increased family presence in the patient rooms and increased family interaction with patients, when compared with the traditionally designed unit.

Keywords: Critical care/intensive care, evidence-based design, patient-centered care, quality care, social support.