Ask the Expert: The Impact of HealthCare Design

In her responses to the questions that follow, Dr. Susan O’Hara discusses HealthCare Design and its integral connection to nursing education.

Please start with a brief introduction about your work and your role.

I am a nurse scientist with more than 40 years of experience in direct nursing care, from critical care to home care environments. During this time I started a health care consultancy to support architects and nursing leadership on optimal healthcare design. My current career, as assistant professor in the School of Nursing at Clemson University, has been to teach community health nursing. In addition, I developed the environmental component of the nursing metaparadigm connecting the School of Nursing with School of Architecture initiatives.

What is HealthCare Design?

It is the creation of a healing environment. HealthCare design is a specialty area of architecture for either the built environment or community environments. Licensed professionals, including architects and those involved in the construction of health care facilities, such as construction managers and builders, are part of a team to ensure building codes are followed to provide a safe and quality-driven facility. HealthCare Design is more than a façade or the look of the building – it is about the role of access to improve the health of individuals and the community.

Talk to me about how this impacts nursing education.

Nursing education is focused on Florence Nightingale’s four components of nursing: person, health, nursing/caring, and the environment. The “place of healing” is vital to the way we provide care. When we look at the way we teach nursing students, and the theoretical approach to nursing research, we need to incorporate all dimensions of the metaparadigm. In her Notes on Nursing, Nightingale defined nursing as “the act of utilizing the environment of the patient to assist him in his recovery.”

From your perspective as an expert in HealthCare Design, what significant trends or gaps do you see in this context relating to nursing education?

I see the gap as simply not making connections, or having an in-depth understanding of where we provide care. For example, when teaching community health nursing, I believe we need to educate students about the home assessment as much as the patient assessment. This is the holistic approach to nursing care. As we move closer to precision medicine, we need to evaluate a uniquely tailored design approach, one that incorporates a greater understanding of not just the patient and family, but of the greater community and the effect of space on care delivery.

What insights can you share related to the value of this work in nursing education for health care organizations, now and in the future?

Currently, nursing education does not focus on HealthCare Design as part of the curriculum. It is embedded in other courses, but I believe we need to teach the process of design and the implications of poor design to students so they can provide better and more informed care. Understanding the layout of an inpatient unit, for example, can lead to better outcomes and reduce the negative impact of spaces that lead to patient falls and unsafe work environments. Furthermore, having this understanding leads to greater efficiency for patient care. Applying a neighborhood conceptual approach to nursing care delivery informs the use of existing spaces and the design of future spaces. Nurse educators can encourage students to see spaces and become informed members of design teams.

What advice do you have for nurse educators that might help them embrace HealthCare Design as we prepare our next generation of professional nurses?

My advice is to learn about the many roles for nursing in HealthCare Design. From working with the Joint Commission to being on teams to achieve Magnet status, nurses are required and requested. Even more importantly, with the support of organizations such as the Nursing Institute for Healthcare Design ( and the Center for Health Design (, nurses educators can connect patient safety and care delivery to evidence in research and practice.

Clemson University School of Nursing, under the leadership of Director Dr. Kathleen Valentine, saw a need for this education and responded by establishing the Academy of Nursing Excellence in Design. The School of Nursing also supported the Inaugural International Conference for Excellence in Healthcare Design ( and will hold a second conference July 12-14 ( We will have a certificate program, “Leadership and Innovation in Health + Design,” with graduate courses in the School of Nursing and the School of Architecture (pending final approval from the South Carolina Commission for Higher Education). Our goal is to connect nursing with architecture and, as educators, seek to improve the safety and quality of care delivery for patients, families, and care providers. In every course in a nursing curriculum, HealthCare Design is and should be a key component. This is the future of nursing education.

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