The role of physical design and informal communication

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Table 16 illustrates how GN stress ratings changed from T1 to T2, showing 1) situations where the GN stress decreased by one point, 2) situations where the GN stress increased by one point, and 3) situations where GN stress was reported as frequent or greater (rating = 3 or 4) for both T1 to T2. The situations are grouped by the six sub-scales used by Gray-Toft & Anderson (1981). There were no significant increases, decreases, or frequently stressful situations in the “Inadequate Preparation” category, yet this category had the second highest mean stress rating. Given the earlier discussion regarding poor staffing on 6N, it is not surprising that the “Work Load” category contained all situations rated as “frequently” stressful. However, note that all situations in this category decreased from T1 to T2 . This data is consistent with the fact that the new nurse manager increased the number of nursing assistants on each shift, which took effect toward the end of the data collection period, and this change in the staffing matrix decreased the work load on nurses. 101
Table 16 Change in GN stress rating from T1 to T2 grouped by Gray-Toft & Anderson categories; green arrows indicate where GN stress decreased by one point, yellow arrows indicate where GN stress increased by one point, and red circles indicate where GN stress was reported as frequent or greater. I: Death & Dying a. The death of a patient with whom you developed a close friendship b. Watching a patient suffer II: Conflict with a Physician a. Making a decision concerning a patient when the physician is unavailable III: Inadequate Preparation IV: Lack of Support a. Lack of an opportunity to talk openly about problems on the unit V: Conflict with Other Nurses a. Floating to other units that are short-staffed b. Difficulty in working with a particular nurse (or nurses) on the unit VI: Work Load a. Breakdown of a computer b. Unpredictable staffing and scheduling c. Too many non-nursing tasks required, such as clerical work d. Not enough time to provided emotional support to a patient e. Not enough time to complete all of my nursing tasks f. Not enough staff to adequately cover the unit VII: Uncertainty Concerning Treatment a. Inadequate info from a physician regarding the medical condition of a patient b. A physician not being present in a medical emergency Stress decreased Stress increased Frequent or very frequent stress 102
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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
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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 and 110: • According to the GN, the greate
Page 111: Not enough staff to adequately cove
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
Page 161 and 162: 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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