The role of physical design and informal communication

More documents

Recommendations

Info

assigned patients on one side of the unit or the other, each side of the unit became spatially isolated from one another on a daily basis. This visual separation compromised teamwork because, according to nurses, they would most often seek advice from who ever happened to be in sight, and this may or may not have been the appropriate staff member to answer the question. The relocation of the large chart carousel to the west wall part way through the data collection period opened a major line of sight across the core of the unit, and, according to interviewees, increased visibility that helped to create an increased feeling of teamwork. These findings provide support for previous research demonstrating the importance of visual proximity for communication in the workplace. Becker (2007a) suggests that greater visual proximity, or “spatial transparency,” in the workplace affords opportunities for modeling behavior and sharing information. The findings of the current study align with work by Kalisch and Begeny (2005) who suggest that less visual proximity reduces the likelihood of chance encounters and the subsequent opportunities to engage in information sharing. Specifically they suggest that if a nurse is working on a unit with two hallways and no line of sight, as is the case on 6N, she will find it difficult to know how her team members are functioning and whether or not they need assistance. While this is relevant to all nurses, it is a particularly significant finding for graduate nurses who, it can be argued, could stand to benefit the most from frequent chance encounters that could potentially result in on-the-job, informal learning. 4.4 Informal Learning and Gaining Competency Focused interviews revealed that the greatest aid to learning for the GN was interaction with staff, including nursing assistants. This finding addresses the third research question: “Is there a relationship between communication patterns and 111
opportunities for informal learning and graduate nurse competency levels?” While we expected that the prime source of informal learning for the GN would be with more experienced RNs, in fact interactions with nursing assistants were highly valued. Specifically, when the GN was asked questions by the nursing assistants, it forced her to assume a teaching role on the spot which facilitated her own learning and increased her confidence. The type of learning that the GN experienced can be termed “reactive” or “opportunistic” learning as described by Eraut (2004). According to Eraut, reactive learning is near-spontaneous and occurs in the middle of action, when there is little time to think. This definition closely approximates the type of situation that occurred when a nursing assistant unexpectedly approached the GN with a question. This is in contrast to “deliberative” learning, where there is a definite learning goal and time is set aside for acquiring new knowledge (Eraut, 2004). Henry B. Slotnick, of the University of Wisconsin Medical School in Madison, conducts research on how physicians learn. Slotnick (2004) argues that “you never know anything as well as you do after you’ve taught it to someone else.” He describes a situation in which someone is asked a question unexpectedly and is required to reflect more carefully on what is taking place in order to respond to the interesting situation that has been created. This kind of reflection in the heat of the action results in new insights for both the “teacher” and the “student.” This concept can be used to explain why the GN believed she learned so much from answering the questions of nursing assistants. Another interesting finding regarding the GN learning experience was that there was perhaps less interaction with the Orientor than one would expect. In fact, interactions involving “knowledge transfer” occurred in roughly equal amounts with the Orientor and other RNs. This came as a bit of a surprise since the role of the Orientor was to be the designated mentor and guide for the GN during orientation. In 112
Page 1 and 2:
THE ROLE OF PHYSICAL DESIGN AND INF
Page 3 and 4:
ABSTRACT Graduate nurses experience
Page 5 and 6:
Dedicated to my parents, John and L
Page 7 and 8:
TABLE OF CONTENTS Biographical Sket
Page 9 and 10:
LIST OF FIGURES Figure 1. 6N floor
Page 11 and 12:
LIST OF TABLES Table 1. Overall per
Page 13 and 14:
extraordinary opportunity to apply
Page 15 and 16:
into the topic of nature as a thera
Page 17 and 18:
tiles with sound-absorbing ceiling
Page 19 and 20:
infections, pneumonia, cardiac arre
Page 21 and 22:
try to gain a better understanding
Page 23 and 24:
1.6.3 Graduate Nurses’ Sense of B
Page 25 and 26:
formal face-to-face communication n
Page 27 and 28:
interactive and interpersonal learn
Page 29 and 30:
• Evidence-based design has the p
Page 31 and 32:
concluded that high visibility work
Page 33 and 34:
Joseph (2006) cites anecdotal evide
Page 35 and 36:
informal learning and communication
Page 37 and 38:
2.3 Site Description Crouse Hospita
Page 39 and 40:
primarily composed of the nursing s
Page 41 and 42:
o Nursing Students The following no
Page 43 and 44:
Meetings were held over a three mon
Page 45 and 46:
Figure 2 6N floor plan showing colo
Page 47 and 48:
equirements, organizational require
Page 49 and 50:
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 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 and 120: on validation, discussing patient c
Page 121: found that a major stressor for nur
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
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
Page 171 and 172: c. Did staffing levels affect the a
Page 173 and 174:
5. What unique challenges do staff
Page 175 and 176:
CWM Tool Task Category Definitions
Page 177 and 178:
REFERENCES Adams, A., & Bond, S. (2
Page 179 and 180:
Buchanan, J., & Considine, G. (2002
Page 181 and 182:
Godinez, G., Schweiger, J., Gruver,
Page 183 and 184:
Lumsdon, K. (1993). Baby boomers gr
Page 185 and 186:
Stolte, K., & Myers, S. t. (1995).
show all

The role of physical design and informal communication

Create successful ePaper yourself

Delete template?

Save as template?