Article Summary
Drawing on the research and insights of Robylin Tweetie Diya, RN, MSc Health Informatics (cand.), and member of the National Digital Shared Decision-Making Council, NHS England, this article examines how ward layouts, digital access and documentation systems affect nursing practice, and why reliable data, frontline staff involvement and practical testing are essential to planning environments that support patient care and clinical decision-making.
Consider a nurse helping a patient move from bed to chair. During the transfer, she notices that the patient needs more help than they did the day before and adjusts the support accordingly. Recording that change helps colleagues understand the patient’s evolving needs and determine whether further care is required. But where can the nurse record the assessment? Is a suitable device within reach? Can she record the change without leaving the patient or compromising their privacy? Will the information be easy for the next member of the team to find? Or will it have to wait until she can reach a workstation elsewhere?
For Robylin Tweetie Diya, RN, MSc Health Informatics (cand.), and member of the National Digital Shared Decision-Making Council, NHS England, these questions belong in the design brief for a ward because the physical environment shapes the conditions in which clinical information is recorded. If that information will later inform staffing, demand modelling or estate investment, those conditions deserve attention from the beginning.
How ward design affects nursing documentation
As Diya puts it, “the relationship between buildings and documentation is not straightforward.” She points to a 2025 Dutch study that found little change in documentation time, suggesting that improvements to ward design do not necessarily translate into less time spent on paperwork.
Digital access is another part of the picture. Diya highlights an example from Geneva University Hospitals, where a 2021 study found that nurses using a bedside mobile application spent around four minutes less per hour on electronic documentation. Interestingly, however, this did not lead to a significant increase in time spent interacting with patients.
For estates teams, the practical implication here is to consider the room, the device and the clinical task together. As Diya explains,
A computer on wheels needs room to manoeuvre and somewhere to be stored and charged
Fixed workstations must also support clinical tasks without compromising screen privacy or communication with patients, while reliable wireless coverage is essential wherever staff need to access digital records.
That support must extend beyond the bedside, as not all documentation can or should take place there. Confidential discussions and concentrated reviews may require a separate space, while urgent or intimate care may need to take priority over recording. “Some documentation is best completed at the bedside; other tasks are better handled nearby,” says Diya. Ward design should accommodate these different demands, giving nurses the flexibility to exercise their judgement about when and where to record clinical information.
Capturing the meaning of nursing care
An accessible device is only useful if the record can express what matters. A tick beside “mobilised”, for example, offers limited insight into a patient’s needs, whereas a more useful record would distinguish between independent and assisted movement, identify changes from the patient’s usual level of mobility, and connect the nurse’s assessment with the action taken and the patient’s response.
This is the question at the centre of Diya’s nursing informatics research: what minimum nursing meaning must be preserved as information moves between systems and is reused? For ward projects, answering that starts with agreeing the essential information with clinical teams before deciding how it should be captured. Structured fields can provide consistency, but they must also allow room for relevant narrative and uncertainty so that the record retains the context needed to understand a patient‘s care.
The OECD’s 2026 report on healthcare interoperability places this challenge in a broader context, underlining how useful data sharing depends not only on technology and standards, but also on people, governance and working practices. Workstation refurbishment cannot resolve inconsistent definitions or duplicate forms. Estates and digital teams should therefore work with nurses and other frontline staff from the outset, ensuring that ward environments and information systems are planned around the needs of clinical practice.
Make planning reflect actual care
Two occupied beds can represent very different demands. Diya explains that
One patient may move independently, while another needs two staff members, equipment and repeated reassurance
Planning models based on occupancy alone would miss these differences, whereas consistently recorded care needs could help planners assess requirements for staffing, equipment storage, circulation space and access to assisted bathrooms.
Such uses depend on the quality of the information available, rather than simply the volume collected. Records must be sufficiently complete, comparable and relevant to the decision being considered. Sparse entries from one area, for example, might prompt a review of device access and documentation workflows before anyone concludes that its patients require less nursing input.
Documentation timestamps also need careful interpretation, as they do not directly measure the time nurses spend on clinical tasks and may not capture everything that was needed or delivered. Combining clinical records with observation, staff feedback and appropriate workload measures gives planners a more reliable understanding of the work involved and a firmer basis for assessing future requirements.
These considerations are relevant across public and private healthcare settings. For any proposed investment, the question is whether the environment supports care and produces information that can credibly inform future decisions. Local staffing models, available resources and documentation practices will shape the answer.
Test the design before committing
For estates teams planning a new ward or refurbishment, testing how the proposed environment supports nursing documentation before the design is finalised can reveal problems while there is still time to address them. A practical starting point is to walk through a routine care episode with nurses, patients, estates staff and the digital team. Tracing the process from assessment to recording, handover and review can show where information is delayed, duplicated or lost, and whether the cause lies in the physical environment, software or organisational rules.
Mock-ups and small pilots can then test practical changes. Testing should establish whether staff can access devices without unnecessarily leaving patients, position screens to preserve conversation and privacy, and retrieve recorded information without asking colleagues to repeat it. These checks should cover busy periods and different shifts, when the demands on staff and the environment may vary.
After implementation, documentation time should be evaluated alongside completeness, accuracy and usability, as well as patient experience and staff workload. Faster entry that produces poorer information would be a weak outcome; more complete records achieved through additional unpaid work would be equally concerning.
AI adds another reason to examine these foundations. Before using frontline records for prediction or planning, organisations need to establish what information is missing, whose work is represented and whether apparent differences reflect patient needs or recording conditions. As Diya notes,
Good physical design can support better data capture, but validation and professional oversight remain necessary
The quality of clinical information is shaped partly by the environment in which care takes place. By bringing the floor plan and clinical information requirements into the same discussion, estates teams could test how nurses will assess, act, record and review within the proposed space. This helps prevent design decisions from creating avoidable barriers to care or leaving clinical teams with records that fail to capture the actual work undertaken.
