The role of physical design and informal communication

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2006; Xyrichis & Ream, 2008; Rubin & Beckhard, 1972). Rubin and Beckhard (1972) assert that the effective flow of information is central to team functioning, and anything that inhibits communication will detract from group effectiveness. 1.7 Communication Patterns in Healthcare A growing body of research suggests that despite the availability of more formal modes of information seeking, such as email and printed records, healthcare professionals prefer informal verbal conversation. Coiera and Tombs (1998) found that staff have a tendency to seek information from colleagues in preference to printed materials – 42 percent of calls for medical staff came from their medical colleagues. This finding is consistent with the work of Covell (1985) who found that about 50 percent of requests for information came from colleagues while only about a quarter came from personal notes, and even less came from laboratory data. Specifically, researchers are observing a preference for a specific type of verbal conversation – face-to-face communication. Parker and Coiera (2000) cite a study by Safran et al. (1999) who reviewed information transactions in a hospital and found that 50 percent of information transactions occurred face-to-face between colleagues. In the previously mentioned study by Coiera and Tombs (1998), results concluded that staff showed a preference for face-to-face discussion. The study observed the communication patterns of physicians and nurses in a general hospital with the following available modes of communication: face-to-face meetings, both impromptu and planned; desktop telephones; paging; written notes for colleagues in patient notes; notes at ward desks; notice boards; and pigeon holes for personal memos. The study participants made little or no use of formal sources of information, except for data from the medical record. Coiera and Tombs hypothesize that medical staff may prefer to engage in opportunistic face-to-face discussion (as opposed to 13
formal face-to-face communication not unlike that which would occur in a meeting) because face-to-face discussion is highly valued but difficult to schedule, and any opportunity is avidly seized. 1.8 Communities of Practice and Knowledge Networks The studies providing evidence of the tendency for healthcare staff to prefer informal, face-to-face conversation as a method of information seeking illustrate the communities of practice concept, which focuses on knowledge sharing across informal networks of people who share a common interest or task (Lave & Wenger, 1991). For our purposes, the network of people are the nurses, doctors, technicians, etc. who informally share information during a spontaneous encounter at, say, the nurses station as they focus on the common interest of patient care. The communities of practice framework emerged from ethnographic analysis of how groups actually worked and communicated in practice, which sharply contrasted with the work described in an organization’s manuals, training courses, and job descriptions (Brown & Duguid (1991). Horsburgh’s (1989) research confirms this notion, finding that the rhetoric and practice of the school of nursing is different from the rhetoric and practice of nursing within general hospital settings, causing graduate nurses to experience difficulty in transitioning from the classroom to their first job. Duchsher (2001) found similar results concluding that graduate nurses experienced disillusionment as they faced the inconsistencies between classroom theory and practice contexts. Brown and Duguid (1991) describe the traditional perception of training as “the transmission of explicit, abstract knowledge from the head of someone who knows to the head of someone who does not in surroundings that specifically exclude the complexities of practice and the communities of practitioners.” In contrast to this 14
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: 1.6.3 Graduate Nurses’ Sense of B
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
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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
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Blood Pressure (mmHg) 121.0 119.0 1
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3.6 Overall Summary of Findings •
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on validation, discussing patient c
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found that a major stressor for nur
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opportunities for informal learning
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unit suggests that designers and ho
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usually leads to expensive renovati
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including off the nursing unit or a
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APPENDIX A Memo Describing Study 12
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APPENDIX B Graduate Nurse Consent F
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• Members of the Cornell research
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_____________________________ _____
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Informed Consent Form for Staff Cro
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Committee on Human Subjects (UCHS)
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Modified Categories for the Clinica
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134
Page 147 and 148:
136
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APPENDIX F Survey Items Pertaining
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APPENDIX G Survey Items Pertaining
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APPENDIX H Survey Items Pertaining
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APPENDIX I Blood Pressure Recording
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APPENDIX J Competency Evaluation Fo
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APPENDIX K Competency Category Defi
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o Expert - interprets labs; consult
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14. Care Plan delegate (using the r
Page 165 and 166:
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
Page 175 and 176:
CWM Tool Task Category Definitions
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REFERENCES Adams, A., & Bond, S. (2
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Buchanan, J., & Considine, G. (2002
Page 181 and 182:
Godinez, G., Schweiger, J., Gruver,
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Lumsdon, K. (1993). Baby boomers gr
Page 185 and 186:
Stolte, K., & Myers, S. t. (1995).
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