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This literature review discusses the evidence that modem wards divided into small bedrooms or bays, require higher nurse staffing levels. Aspects of ward design and operation such as patient privacy, nursing efficiency, patient dependency and ward organization are outlined and methods for establishing staffing levels which take ward design into account are described. The majority of ward evaluation studies concerned with nurse staffing concentrate on two areas, the use of the nurses’ time (particularly in travel) and user opinion of wards.

The conclusions drawn suggest that the two main measures of ward layout which relate to effective and efficient nursing care are short travel distances and features which facilitate the maximum contact between nurses and patients. Further, how these two principles are incorporated effectively into a ward will depend upon a number of other factors which effect nursing work viz, the number and characteristics of the patients and ward staff and the policies and practices of the nurses themselves.