The role of physical design and informal communication

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of confidence in their clinical skills was a distinguishing source of stress for inexperienced nurses (Charnley, 1999; Brown and Edelmann, 2000), we expected the stress level of the GN to decrease as competency levels increased over the course of orientation. However, the findings of the current study did not align with this evidence-based assumption. While the GN competency steadily rose to just under “Expert” level by week nine, her biological stress showed a highly variable pattern and was actually slightly higher in week nine than in week two. In contrast, Adams (2008) found a negative relationship between competency and stress. At week six, when the competency was increasing, both the systolic and diastolic blood pressure were decreasing. There are two possible explanations for the lack of a relationship between competency and stress in this study. First is the issue of low staffing levels on 6N. Focused interviews with nurses revealed that there was a shortage of nursing assistants on the unit that dramatically increased the workload of RNs. Questionnaire data confirmed the concern over poor staffing levels. On the section of the survey that measured perceived stress, work load proved to be the most stressful component of the job for the GN as well as the RNs. Given the nation-wide nursing shortage, other research has explored the effect that poor staffing levels have on nurse stress, and these findings are consistent with the observations and findings on 6N. The American Nursing Association (2001) posted a national nursing survey online. Quantitative data revealed that increased patient load and decreased time to provide direct patient care led 40-60% of respondents to report frequently skipping meals and breaks to care for patients and feeling increased pressure to accomplish their work. Interviewees in the current study also reported experiencing stress resulting from having to perform the duties of a nursing assistant in addition to the duties of an RN because of low staffing levels. This finding corresponds with a study by Buchanan and Considine (2002) who 109
found that a major stressor for nurses was having to perform duties other than their specialty due to lack of staff. In addition, Chang et al. (2005) cited the results of a study by Healy and McKay (2000) reporting that work overload was found to be a major source of stress for nurses. The second possible explanation for the lack of an inverse relationship between competency and stress in this study is the fact that the particular unit studied was inherently noisy, busy, and chaotic. This medicine unit experienced a broad range of diagnoses with patients having a wide variety of healthcare needs. Consequently the unit required more and varied types of staff. These higher staff numbers produced a much noisier environment than more specialized units (e.g., cardiology, oncology) and created an overall feeling of chaos on the unit. In contrast, Adams (2008) studied an oncology unit which, according to hospital staff as well as observation, was much calmer and quieter as a result of patients having similar diagnoses and a relatively static, small group of doctors and other staff on the unit on a day-to-day basis. According to previous research, the noise generated from the high activity level on 6N could be one reason why the GN stress levels did not decline. Joseph and Ulrich (2007) cited a study by Morrison et al. (2003) who found that noise was strongly related to stress and annoyance in nurses. 4.3 Sightlines and Teamwork All interviewees reported concern regarding limited visibility across the nursing unit and its impact on teamwork and communication. These findings address the second research question: “What is the impact of the unit’s physical design on informal communication and learning?” Nurses reported that the placement of two solid walls on the east and west sides of the unit obstructed sightlines that would otherwise visually connect the two sides of the unit. Because nurses were generally 110
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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
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Figure 6 View of island work surfac
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Kitchen Locker Room Desk B1 at nurs
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Figure 13 Existing layout prior to
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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 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: on validation, discussing patient c
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 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
Page 163 and 164: 14. Care Plan delegate (using the r
Page 165 and 166: APPENDIX L Interview Guides 154
Page 167 and 168: 3. Does the current patient:nurse r
Page 169 and 170: 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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