The role of physical design and informal communication

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Adams’ (2008) study, 28% of all interactions were with her Orientor versus 16% with an RN. In contrast, the GN in the current study spent 13% of all interactions with her Orientor compared to 14% with an RN. One explanation for this inconsistency could be differing learning styles. The GN in this study was highly independent and desired less guidance than most GNs, according to the Orientor. The literature proposes that to be able to direct their own learning, people should first know that they learn and how they learn (Barrie & Pace, 1998). Berings et al. (2007) suggests that knowledge about their own and others’ on-the-job learning styles can make nurses aware of their options and choices in learning behavior and therefore offer opportunities for adaptation. Further they suggest that awareness can improve communication and collaboration between team members. In order to help nurses improve their learning skills, Berings et al. (2007) have developed an instrument, called the “On-The-Job Learning Styles Questionnaire for the Nursing Profession,” to help raise nurses’ awareness of their on-the-job learning styles. Had this study and Adams’ (2008) study included this instrument in data collection, it would have been interesting to compare the learning styles of the GN in each study, and to find out if there was a corresponding pattern in interaction with the Orientor. 4.5 Implications for Practice: Communities of Practice The current study provides support for the importance of embracing the communities of practice framework which focuses on knowledge sharing across informal networks of people who share a common interest or task (Lave & Wenger, 1991). Many of the key findings of this study point to the importance of the role that the physical environment plays in fostering these informal networks of people through which information is shared. The fact that staff members reported compromised teamwork and communication resulting from obstructed sightlines across the nursing 113
unit suggests that designers and hospital administrators need to consider the way unit design affords opportunities for visual connectivity that can have a profound impact on communication among staff members. White et al. (2008) similarly reports that ready accessibility of information from colleagues who were on the floor was crucial in influencing the learning ability of nurses. Reducing or eliminating visual barriers such as solid walls and large obtrusive columns and replacing them with three- to five- foot half-walls or glass panels could increase spatial transparency. White et al. (1998) provided a quote from a nurse in their study that may best summarize this important implication for practice: “…the easier the access, the easier the learning.” A second major finding that highlights the role that the physical environment plays in fostering informal networks of people is that backstage spaces were found to be key sites for social support. The fact that 27% of all interactions were social may be alarming at first glance given that it was almost as frequent as discussing patient care, at 30%. However, this time spent in social conversation – that is, venting about difficult work experiences or socializing about life outside of work – should be considered valuable. This is time invested in fostering the personal relationships that build the cooperation, commitment, and trust that forms the social capital that provides team members with the resources (e.g. information and support) they need to learn and do their job effectively (Becker, 2007). The implication for practice here is two-fold. First, hospital architects should consider backstages as valuable spaces that promote the formation of trust and personal relationships that build teams when allocating square footage. The fact that 45% of social interaction occurred in the med room, reportedly because the space was completely enclosed and afforded acoustic and visual privacy, suggests that in the absence of planned backstage areas, staff will create their own from existing spaces, even when doing so may, as in the case of the med room, reduce patient safety by 114
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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
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3.1.2 Information Management and Te
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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 and 122: found that a major stressor for nur
Page 123: opportunities for informal learning
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
Page 171 and 172: c. Did staffing levels affect the a
Page 173 and 174: 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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