The role of physical design and informal communication

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• During an average eight-hour shift, the GN interacted 97 times at the nurses station, 81 times in the med room, and 74 times in the corridor. The average duration of interactions in the corridor (32s) was brief compared to interactions at the nurses station (51s) and in the med room (1:07). • The physical design of the med room – a room enclosed by four walls and a door – facilitated the abundance of social interaction that occurred there by serving as an acoustic and visual barrier between patients/visitors and staff. • “Knowledge Transfer” occurred mostly at the nurses station, med room, and corridor, and was most often with the Orientor and nurses. Only 7% of “Knowledge Transfer” occurred with a doctor. 3.4 Learning and Gaining Competency Through observation and focused interviews, data was collected on the unit’s approach to GN orientation. A survey was used to assess the degree to which the unit supported and encouraged learning, from the perspective of both the GN and RNs. A Competency Rating Tool was used to collect weekly quantitative data on how GN competency changed over the course of the orientation period. The Competency Rating data was complemented by information obtained in focused interviews. 3.4.1 The GN - Orientor Relationship In order to get the most out of the CWM tool data, it was important to gain insight into the unique relationship between the Orientor and the GN in this study. A quick look at the interaction data shows that the GN had less interaction with the Orientor – the designated mentor and guide during orientation – than one would have predicted. It is not unreasonable to expect that most learning and teaching would be between the GN and her Orientor, yet most of the “Knowledge Transfer” interactions 91
occurred in equal amounts with the Orientor and nurses. This can be explained by the GN’s personal learning style and the Orientor’s ability to adapt her teaching style accordingly. The GN was highly independent and desired less guidance than most GNs, according to the Orientor. The GN describes her learning style: “I think it’s personality. I don’t like to be bothered unless I need something. And as an Orientor, I would rather you not be watching everything I do because I need to know I’m capable. I don’t need someone hovering over me. It’s like, ‘don’t bother me, I’m doing my own thing. I’ll let you know if I need something’.” In fact, the GN was so independent that sometimes when the Orientor helped her, it actually hindered her learning process. When asked about obstacles that stood in the way of the GN gaining competency, the Orientor had the following response: “If I would help her with anything. She did not like that. If I would help her with anything, she felt incompetent. What ever it would be, even if it was just writing down a vital sign or something, she felt incompetent if you did any little thing for her. Or if I would do anything, she would be like ‘oh my God, I don’t know where I’m at, I don’t know what’s going on.’ If I would help her with one little thing, it threw her off track. So I had to let her do her totally own thing, let her know I’m there… She wanted to do everything on her own, and that’s why she’s such a great nurse.” This relationship is important to keep in mind when interpreting the CWM tool data as well as for understanding the GN learning process and orientation experience as a whole. 92
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THE ROLE OF PHYSICAL DESIGN AND INF
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ABSTRACT Graduate nurses experience
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Dedicated to my parents, John and L
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TABLE OF CONTENTS Biographical Sket
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LIST OF FIGURES Figure 1. 6N floor
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LIST OF TABLES Table 1. Overall per
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extraordinary opportunity to apply
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into the topic of nature as a thera
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tiles with sound-absorbing ceiling
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infections, pneumonia, cardiac arre
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try to gain a better understanding
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1.6.3 Graduate Nurses’ Sense of B
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formal face-to-face communication n
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interactive and interpersonal learn
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• Evidence-based design has the p
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concluded that high visibility work
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Joseph (2006) cites anecdotal evide
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informal learning and communication
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2.3 Site Description Crouse Hospita
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primarily composed of the nursing s
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o Nursing Students The following no
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Meetings were held over a three mon
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Figure 2 6N floor plan showing colo
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equirements, organizational require
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study by Vrijkotte, van Doornen, an
Page 51 and 52: graduate nurse’s strengths and ac
Page 53 and 54: 2.8 Data Analysis Focused interview
Page 55 and 56: CHAPTER 3 RESULTS 3.1 Organizationa
Page 57 and 58: ecause as a visitor entered the uni
Page 59 and 60: Figure 3 6N Floor Plan 48
Page 61 and 62: Figure 6 View of island work surfac
Page 63 and 64: Kitchen Locker Room Desk B1 at nurs
Page 65 and 66: Figure 13 Existing layout prior to
Page 67 and 68: Figure 15 Wall-mounted chart organi
Page 69 and 70: 3.1.2 Information Management and Te
Page 71 and 72: nurses and pharmacists and dispense
Page 73 and 74: Because patients on 6N have a parti
Page 75 and 76: There is encouragement to learn new
Page 77 and 78: There is encouragement to learn new
Page 79 and 80: “Validation,” at five times per
Page 81 and 82: Average Frequency/8hr 60 50 40 30 2
Page 83 and 84: 3) shows that all interactions were
Page 85 and 86: Table 4 Overall percent & frequency
Page 87 and 88: Transit” - 2:59:48. However, the
Page 89 and 90: Time (hh:mm:ss) 0:02:53 0:02:36 0:0
Page 91 and 92: Patient Room 28% Nurses Station 25%
Page 93 and 94: 3.3.4 Analysis of Task, Person and
Page 95 and 96: However, when asked if all of this
Page 97 and 98: Frequency (%) 50.0 45.0 40.0 35.0 3
Page 99 and 100: Frequency (%) 45.0 40.0 35.0 30.0 2
Page 101: Table 14 Frequency of person by loc
Page 105 and 106: experienced by many GNs. Figure 33
Page 107 and 108: conditions in laymen’s terms. The
Page 109 and 110: • According to the GN, the greate
Page 111 and 112: Not enough staff to adequately cove
Page 113 and 114: Table 16 Change in GN stress rating
Page 115 and 116: Blood Pressure (mmHg) 121.0 119.0 1
Page 117 and 118: 3.6 Overall Summary of Findings •
Page 119 and 120: on validation, discussing patient c
Page 121 and 122: found that a major stressor for nur
Page 123 and 124: opportunities for informal learning
Page 125 and 126: unit suggests that designers and ho
Page 127 and 128: usually leads to expensive renovati
Page 129 and 130: including off the nursing unit or a
Page 131 and 132: APPENDIX A Memo Describing Study 12
Page 133 and 134: APPENDIX B Graduate Nurse Consent F
Page 135 and 136: • Members of the Cornell research
Page 137 and 138: _____________________________ _____
Page 139 and 140: Informed Consent Form for Staff Cro
Page 141 and 142: Committee on Human Subjects (UCHS)
Page 143 and 144: Modified Categories for the Clinica
Page 145 and 146: 134
Page 147 and 148: 136
Page 149 and 150: APPENDIX F Survey Items Pertaining
Page 151 and 152: APPENDIX G Survey Items Pertaining
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APPENDIX H Survey Items Pertaining
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APPENDIX I Blood Pressure Recording
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APPENDIX J Competency Evaluation Fo
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APPENDIX K Competency Category Defi
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o Expert - interprets labs; consult
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14. Care Plan delegate (using the r
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APPENDIX L Interview Guides 154
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3. Does the current patient:nurse r
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Interview Guide - Orientor Learning
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c. Did staffing levels affect the a
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5. What unique challenges do staff
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CWM Tool Task Category Definitions
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REFERENCES Adams, A., & Bond, S. (2
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Buchanan, J., & Considine, G. (2002
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Godinez, G., Schweiger, J., Gruver,
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Lumsdon, K. (1993). Baby boomers gr
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Stolte, K., & Myers, S. t. (1995).
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