The Family Support Zone consists of those spaces and functions outside of the patient room to serve family and visitors. Family support has been recognized as a significant factor in patient recovery and reduced morbidity, so it is an important element to be considered.
Patient room numbers should be clearly marked. Directional signage should be easy to read, understand, and follow. In many locations, multilingual signage should be considered. Way-finding techniques, such as landmarks, art, and floor patterns may be considered. Clearly worded requests to turn off cellular telephones, explaining the potential of interference with vital life support and telemetry monitoring, should be posted at ICU access points and in waiting rooms or family support areas. Signage should also be posted to remind staff to turn their pagers to “vibrate” mode.
A family and visitor’s lounge should be provided adjacent to or near each ICU pod, located so as to avoid disrupting patient, staff, and supply circulation patterns. Family members will tend to cluster immediately outside the patient’s room or the unit if the lounge is perceived to be too far from the ICU. Family and visitors’ lounges may be decentralized around the ICU, closer to patient rooms.
A lounge must provide for the multifaceted needs of families and visitors, affording a comfortable space to wait, privacy for conversations with healthcare personnel, communications within and beyond the ICU, and basic amenities. Seating quantity can vary substantially with the functional plan, cultural factors, and the unit’s location in the hospital. Families tend to rearrange furniture if their needs are not met. Furniture groupings should promote visual and auditory privacy for families. Partial walls and dividers can help.
The lounge should provide choice, both in the type of furniture and its arrangement. Fold-out chairs or recliners could be considered if these are not provided in patient rooms. Chairs should provide arms to assist guests in sitting and rising, as well as good back support. Some furniture should accommodate obese visitors. The selection and arrangement of furniture should allow adequate clear floor space for feet and legs, and should accommodate wheelchairs. The lounge should include seating and play areas for children.
Families will scatter personal belongings around the lounge if adequate storage is not provided. This could include shelving, closets, or secure lockers. Racks for magazines, hospital and ICU information, and educational materials should also be readily available. Accessible toilets for males and females should be reasonably close to, or part of, the lounge. Unisex toilets are sometimes used, although not generally preferred.
Carefully coordinated and selected color palettes, material choices, furniture selections, window coverings, art, positive distractions, exposure to nature, and lighting choices can all produce a calming effect. Skylights are an option if windows are not feasible. Providing visitors and families with access to a courtyard or patio is recommended. Noise-dampening materials and carefully selected music can contribute to a supportive environment for families.
The use of televisions in public spaces is controversial. Televisions in lounge areas have been shown to increase stress, especially if viewers disagree over or cannot control programming or volume. Although televisions rarely contribute to a soothing environment, they may nonetheless provide a source of distraction for distraught visitors. Consider separate rooms for televisions. If televisions are included in lounge areas, closed-captioning might be used to keep noise to a minimum, or low-volume speakers placed close to viewers (such as on end tables) to confine television noise to a smaller area. Programming options could be limited to a specific number of channels with appropriate programs for all ages. Nature videos could also be broadcast.
Rooms for private conversations between interdisciplinary team members and families are recommended. Designers should make every effort to protect privacy, although Health Insurance Portability and Accountability Act guidelines do not mandate structural design. If possible, consultation rooms should afford direct access from the unit and from the lounge, so that personnel do not need to cross the seating area. This private space can be used for patient updates, and if necessary, for grieving. Financial counseling, pastoral care, social services, and other family support is typically available to ICU families. The ICU must consider whether these functions will occur in family consultation rooms or in departmental suites elsewhere in the hospital.
Rooms near the ICU should be provided for meditation, reflection, and spiritual contemplation. Particular attention should be paid to designing restorative space for multiple cultures and faiths, so that all users feel welcome and comfortable.
Better communication between caregivers and families produces higher family satisfaction ratings. If a personal cell telephone number is not available, visitors should be provided with beepers or pagers so they can be contacted if they leave the lounge or unit. Lounges should include public telephones, including TTY (telephone typewriter)-accessible phones. Telephone booths or alcoves can provide a measure of privacy. Access to the Internet for personal and business use is a valuable amenity. Tables and chairs to support laptop computers should be available. If the hospital has a business center available to the public, a notice to this effect should be displayed.
Electric drinking fountains or another fresh water supply should be conveniently located within or near the lounge. Some hospitals provide food trays to families at meal times. Vending machines are helpful, particularly at late hours when hospital coffee shops or food services may not be available.
Some programs encourage families to bring or prepare foods familiar to patients. A kitchen or pantry can bring a touch of home to the lounge and provide respite for families and visitors. It should include a microwave, coffee pot, and refrigerator. Infection control measures should apply in this communal area. Recycling should be considered.
When possible, families and visitors should return home to rest. Some hospitals negotiate agreements with a nearby hotel to accommodate visitors and families from out of town, or provide in-hospital facilities for this purpose. The ICU may find it useful to create one or more family sleep rooms near the lounge or unit; these may or may not contain toilet and shower facilities. Policies for the use of sleep rooms must be carefully considered to ensure fair and impartial use.
Washers and dryers for patients’ and families’ clothes and linens may be housed in a dedicated room on the unit, near the family and visitors’ lounge, or adjacent to family sleep rooms. Institutional procedures should be followed for disinfecting the equipment each day or after use for contaminated items.
Ref: Thompson DR, Hamilton DK, Cadenhead CD, Swoboda SM, Schwindel SM, Anderson DC, Schmitz EV, St Andre AC, Axon DC, Harrell JW, Harvey MA, Howard A, Kaufman DC, Petersen C: Guidelines for intensive care unit design. Crit Care Med 2012, 40: 1586-1600.