Possibly the most important design feature of a psychiatric hospital or unit is maximizing visual observation of patients from the nurse station. If this is not addressed early in the schematic design phase, it will likely never be attainable. However, it is not unusual to find that more elements than are practical are desired to be adjacent to the nurse station and even the most comprehensive remodeling project may have difficulty addressing these desires. Compromises will have to be made, and the reasons for the decisions should be well documented.

Another consideration for design of the nurse station is that some patients like to gather around it. For this reason, providing some space near the nurse station for quiet activities such as table games or comfortable seating for reading can be a good idea. When this common operational issue is not planned for, makeshift adjustments will be improvised once the facility is in use and these usually end up obstructing corridors or inhibiting staff movement.

The number of patients per room is another major issue. The 2014 edition of the FGI Guidelines calls for a maximum of two patients per room in adult facilities. Despite a great deal of discussion about the possible advantages of single-patient rooms, no standard requires single rooms and no conclusive evidence indicates they provide either clinical or safety advantages for behavioral health patients.

The National Association of Psychiatric Health Systems polled its members regarding this issue and found a considerable amount of support for providing at least a few double rooms for certain patients who may benefit from this arrangement. Deciding whether to provide single or double rooms for a project should be carefully weighed with the client.

The 2010 edition of the FGI Guidelines called for one patient toilet room per patient room located directly accessible to the patient room without the need to enter the corridor. Some facilities are not comfortable with this requirement and prefer the staff to be able to observe when patients enter the toilet rooms. The 2014 FGI Guidelines permits such an arrangement under certain conditions.

In addition, care must be taken to avoid conflict during operation between an in-swinging patient room/corridor door and an out- swinging patient toilet room door. This conflict was observed in a newly constructed 300-bed state hospital and is very difficult to remedy after construction. A little care and awareness on the part of the designers could have prevented the staff of this facility from having to deal with this problem for the useful life of the building.

The 2014 FGI Guidelines recommends that patient room doors swing out into the corridor to reduce the ability of patients to barricade themselves in their rooms by blocking an inward-swinging door.

However, using this door swing direction often requires provision of fire code-required recesses or alcoves in the corridor, which create observation difficulties.

Corridor doors also may be required to be fire-rated and/or equipped with smoke seals and closers depending on the codes applied in a particular jurisdiction. 

Source :FGI