The role of physical design and informal communication

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The staff (n=8) mean stress rating was 2.08 (σ=.53), 4.5% higher than the GN mean rating. According to the staff ratings, the two most stressful situations were “Unpredictable staffing and scheduling” (X 2 =3.5; σ=.93) and “Not enough staff to adequately cover the unit” (X 2 =3.63; σ=.74) - the same as those reported as most stressful by the GN. As shown by Figure 36, most of the GN and staff ratings averaged below 3, or “Frequently” stressful. Note that the situation “Not enough time to provide emotional support to a patient” was rated the third most stressful and is also related to poor staffing levels. This concern over being too busy to spend time emotionally supporting patients was echoed in all focused interviews. One nurse explained: “It feels like you’re getting away from the whole nursing thing the way the staffing is because you’re more task-orienting. And that’s not what it’s about. Some of these people are finding out that they have life-altering diagnoses or cancer or that they’re dying and you feel like you don’t have enough time to talk and sit and emotionally connect with your patients. It’s awful. You feel so awful.” Table 15 Mean GN stress ratings, grouped by Gray-Toft & Anderson categories I: Death & Dying 1.86 II: Conflict with Physicians 1.90 III: Inadequate Preparation 2.00 IV: Lack of Support 1.83 V: Conflict with Other Nurses 1.60 VI: Work Load 2.80 VII: Uncertainty Concerning Treatment 1.80 99
Not enough staff to adequately cover the unit Uncertainty regarding equipment operation Not knowing what to tell a patient/family N o physician during medical emergency No time to complete all of my nursing tasks Wo rking with a unit nurse No time to provide emotional support to a patient Too many non-nursing tasks required A physician ordering inappropriate treatment Unpredictable staffing and scheduling C riticism by a superviso r Unprepared to meet patient's emotional needs Working with a non-unit nurse Watching a patient suffer Floating to other units M aking a decision when the physician is unavailable Giving an unsatisfactory answer to a patient Inadequate information from a physician No opportunity to express my negative feelings Unprepared to meet family's emotional needs Disagreement concerning treatment P hysician not being present when a patient dies The death of a patient with whom close to Lack of an opportunity to share Fear of making a mistake C o nflict with a physician The death of a patient Lack of an opportunity to talk openly Listening/talking to a patient about death C onflict with supervisor Feeling helpless when a patient fails to improve P rocedures that patients find painful C riticism o f physician Breakdown of a computer GN RN 0 1 2 3 Figure 36 Mean RN and GN stress survey responses (where 1= never stressful and 4=very frequently stressful 100 4
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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
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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 and 108: conditions in laymen’s terms. The
Page 109: • According to the GN, the greate
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
Page 159 and 160: 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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