The role of physical design and informal communication

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“Feedback from the Orientor and working with aides. Having to delegate to aides and them even asking me questions…Just interaction with other staff.” It is important to note that the exchange between the GN and nursing assistants, whose level of required knowledge is lower than that required of an RN, forced the GN to assume a teaching role on the spot in many instances. According to the GN, the process of answering the nursing assistants’ questions facilitated her own learning process and increased her confidence. 3.4.4 Summary of Findings: Gaining Competency Analysis of the nursing unit as a learning environment and the GN’s process of gaining competency can be summarized as follows: • The unique GN learning style had a significant impact on the GN – Orientor relationhip and consequently on the interactions between them as well. According to both the GN and Orientor, the GN was highly independent and required little guidance. • Survey results showed that the unit supported and encouraged learning, and that the GN found the unit to be a supportive environment for gaining competency during the orientation process. • The GN competency ratings reached 8.44 by week 9, putting her close to the “Expert” level. At week 9, “Computer: Patient Education” was the category with the lowest competency rating. • With the exception of week 1, every time the average competency rating plateaued or decreased, the GN’s patient assignment increased, possibly reflecting the difficulty experienced when the GN must adjust to caring for one more patient per shift. 97
• According to the GN, the greatest aids to learning were feedback from the Orientor and interaction with nursing assistants. Being asked questions by the nursing assistants put the GN in a teaching role which facilitated her own learning in the process. 3.5 Biological and Perceived Stress The GN’s perceived and psychological stress levels were assessed over the course of orientation. Perceived stress was assessed through the stress section of the survey and was compared with the mean stress ratings of the unit staff. Biological stress was assessed by taking blood pressure readings three times daily (twice at each recording) from week 2 through week 9. Mean weekly blood pressure readings were then compared to weekly competency ratings. 3.5.1 Perceived Stress: Survey Responses The GN mean rating for T1 and T2 of the stress survey was 1.99. The means for T1 and T2 decreased slightly from 2.12 to 1.85. The ratings for each question didn’t change by more than one point from T1 and T2. When the survey items were grouped by the six sub-scales used by Gray-Toft & Anderson (1981), situations relating to “Conflict with Other Nurses” had the lowest mean rating (Table 15). Situations relating to “Work Load” had the highest mean rating. In addition, the two situations reported as the most stressful (both given the highest mean rating of 3.5) by the GN were “Unpredictable staffing and scheduling” and “Not enough staff to adequately cover the unit.” The fact that “Work Load” was reported as the largest perceived stressor is not surprising given the shortage of nursing assistants on 6N as described by nurses in interviews. 98
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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
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graduate nurse’s strengths and ac
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2.8 Data Analysis Focused interview
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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 and 102: Table 14 Frequency of person by loc
Page 103 and 104: occurred in equal amounts with the
Page 105 and 106: experienced by many GNs. Figure 33
Page 107: conditions in laymen’s terms. The
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
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Page 147 and 148: 136
Page 149 and 150: APPENDIX F Survey Items Pertaining
Page 151 and 152: APPENDIX G Survey Items Pertaining
Page 153 and 154: APPENDIX H Survey Items Pertaining
Page 155 and 156: APPENDIX I Blood Pressure Recording
Page 157 and 158: 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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