The Influence of Daylighting on the Behavior of Nurses and Families in Neonatal Intensive Care Units (NICUS)

The neonatal intensive care unit (NICU) is a life-defining place for premature infants and other newborns with serious health conditions. The demand for newborn intensive care has been increasing in the recent years, but there is limited research on NICU room design and lighting environment. This study addresses these knowledge gaps and examines the relationship between daylighting - one of the key factors in the NICU physical environment - and nurse and family behaviors. It also explores trends of NICU design in the United States in terms of room types and daylighting modes in patient rooms. The project can be divided into two parts, including a nationwide cross sectional survey study of NICU staff, and an in-depth case study of a NICU at one hospital in the southeast United States. The nationwide cross sectional study used two surveys: (1) the online NICU Room Type & Lighting Condition Questionnaire distributed to 482 medical directors and with 89 valid responses; and (2) the paper-based NICU Nurse Satisfaction with Lighting Environment Questionnaire distributed to 192 nurse attendees at a national professional conference and with 78 completed responses. The in-depth case study used mixed methods, including 50.85 hours of behavioral observation, surveys of 21 nurses working in the NICU, and on-site lighting measurements during observations. The data were analyzed through descriptive and inferential statistics such as two-sample t-test, ANOVA, and Tukey’s test. The results from the nationwide surveys suggests that: (1) NICU room types are in transition from multi-beds to single family rooms; (2) NICUs with single family rooms have a higher percentage of rooms with access to daylighting and are perceived to have a more satisfactory lighting environment than those with multi-beds; (3) both medical directors and nurses agree on the impact of daylighting on improving work efficiency and increasing mental alertness. The results from the case study illustrated that: (1) nurses who take care of more rooms with daylighting tend to have more frequent behaviors of direct care and documentation on computer with shorter duration than those who work in rooms without daylighting; and (2) the frequency of family departure from the patient room during a visit is lower in rooms with a window compared to rooms without a window. The findings support the benefits of using single family rooms in the NICU, provide insights into the behavior of nurses and families in NICUs, and give suggestions on lighting design in NICUs to supplement existing recommendations and guidelines