The role of physical design and informal communication

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Interview Guide – Graduate Nurse Learning: 1. At the beginning of orientation, with what skills did you feel most competent? Least competent? How did this change during the course of your orientation? 2. We’re interested in how the design and layout of the unit affects on-the-job learning and communication with other RNs and doctors. By that I mean how the design affects how often and where you interact with others for certain types of communication and discuss certain things. I’m asking this because people often learn “on the job” from informally talking with others and asking questions. a. Is there anything about the design of the unit that would make it more or less likely to ask for or offer information, knowledge or experience? b. Is there anything about the culture of the unit that would make it more or less likely to ask for or offer information, knowledge or experience? c. What do you think were the greatest aids to increasing your competency and confidence? What was detrimental? Verification and advice: 1. I noticed that you often asked another nurse (RN, Orientor, GN) to verify your medication. Can you tell me about that process? For example, was it required that you do that with certain medications or is it just something that some nurses do? 2. I noticed that there wasn’t a lot of work-related guidance or educational communication between you and your Orientor during the times that I shadowed you. So when, if at all, and where did you communicate in this way? Did you seek out just any RN when you had a question or if you needed verification? Or did you and your Orientor communicate in this way on Fridays when the two of you went through your orientation binder? Stress: 1. During your regular shift, what did you find to be the most stressful? How did you deal with those stressful situations? a. Did the layout or design of the unit affect your stress level and your ability to deal with those situations? If so, how? b. Did the culture of the unit affect your stress level and your ability to deal with those situations? If so, how? c. Did your relationship with your Orientor affect your stress level and your ability to deal with those situations? If so, how? d. Did staffing levels affect the amount of stress you experienced? If yes, how so? 2. Has the change in Nurse Manager had an affect on the stress level of the unit? If so, in what way? 155
3. Does the current patient:nurse ratio have an affect on the stress level of the unit? If so, in what way? 4. 6N is known to be a very busy, noisy, sometimes hectic unit. How does this environment affect your stress level? Space/Layout: 1. I noticed that you often document in the hallway just outside of patient rooms. Often the only surface you have to write on is the top of the trash bin. Does this bother you? Do you wish you had a dedicated surface for that purpose? 2. How do you think the physical layout affects teamwork among staff members? 3. Are there certain locations within the unit that you feel more comfortable approaching a doctor to discuss patient care? 4. I noticed that while attending to a patient, you often had to run to the supply room. How did this affect your ability to provide optimum patient care? How could the design of the unit be changed to better accommodate you while attending to the patient? 5. I noticed that social interaction often takes place in the med room. Do you agree? If so, can you tell me why you think that is? 6. Does the social interaction that takes place in the med room ever impact your ability to concentrate or dispense meds? 7. 6N is known to be a very busy, noisy, sometimes hectic unit. Where do you go if you need a quiet place to concentrate or focus on a task? 8. You mentioned to me that the small space between the nurses’ station and the med room is a poorly designed area that is a source of frustration. Can you tell me more about that? 9. What is it about 6N that makes it such a busy, noisy, hectic unit? Do you have any ideas as to what causes such a difference between 6N and other units, say 4S? 10. If you could change aspects of the layout or physical design of your unit that would improve your work experience (communication, efficiency, walking time, etc), what would you change? Technology: 1. What are the computers used for by both nurses and doctors? 2. When there are problems with a computer, is there an IT support service? a. If so, how effective is it? 3. When was the Hill-Rom system implemented? a. Was there training for the system? b. How effective is it? c. Do you use it? How often? 156
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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
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Because patients on 6N have a parti
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There is encouragement to learn new
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There is encouragement to learn new
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“Validation,” at five times per
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Average Frequency/8hr 60 50 40 30 2
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3) shows that all interactions were
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Table 4 Overall percent & frequency
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Transit” - 2:59:48. However, the
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Time (hh:mm:ss) 0:02:53 0:02:36 0:0
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Patient Room 28% Nurses Station 25%
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3.3.4 Analysis of Task, Person and
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However, when asked if all of this
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Frequency (%) 50.0 45.0 40.0 35.0 3
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Frequency (%) 45.0 40.0 35.0 30.0 2
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Table 14 Frequency of person by loc
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occurred in equal amounts with the
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experienced by many GNs. Figure 33
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conditions in laymen’s terms. The
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• According to the GN, the greate
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Not enough staff to adequately cove
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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
Page 161 and 162: o Expert - interprets labs; consult
Page 163 and 164: 14. Care Plan delegate (using the r
Page 165: APPENDIX L Interview Guides 154
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).
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