The role of physical design and informal communication

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traditional view, Wenger (1998) posits that learning is an integral part of our everyday lives, and it is not exclusive to classrooms, training sessions, and text books. He also presents a social theory of learning, which assumes that humans are social beings, and we learn through active participation in the practices of social communities. Becker’s (2007a) discussion of knowledge networks describes how “tacit knowledge,” or knowledge primarily in the heads of people, flows through an organization primarily as a result of informal social networks and less as a result of formal programs and processes. Baldwin and Ford (1988) cite a statistic from the work of Georgenson (1982) stating that of the $100 billon annually spent on formal training and development in the U.S., no more than 10 percent of these expenditures actually result in transfer to the job. On the other hand, the communities of practice framework, which emphasizes organic, spontaneous, informal learning that results from shared information among networks of informally bound people, has proven to be successful for a number of organizations (Wenger & Snyder, 2000). One factor worth noting that affects the propensity of an organization’s employees to engage in a community of practice and benefit from informal learning is the organization’s culture. The culture includes formal and informal values, policies, and practices about who can communicate with whom, what the preferred communication modalities are, and how much emphasis is placed on scheduled vs. impromptu and chance meetings and interactions (Becker, 2007a). If the organization’s perception of “real work” (Becker, 2007b) doesn’t include spontaneous, unplanned, opportunistic communication, then it will leave the organizational resource of informal knowledge networks untapped. Hunter, Spence, McKenna, and Iedema (2008) describe the subculture of the nursing unit as the beliefs, norms, attitudes, and assumptions that are usually manifested subconsciously, learned over time and shared by unit staff. In their ethnographic study exploring how nurses learn, they found that 15
interactive and interpersonal learning includes intuitive understandings of “how we do things here.” 1.8.1 Impact of Informal Learning on the Graduate Nurses Experience Currently a range of “formal” learning strategies aimed at easing the graduate nurse transition are being implemented, including orientation programs, internships, and the use of a preceptor (Godinez, Schweiger, Gruver, & Ryan, 1999). Although these programs can be beneficial in terms of increasing clinical competencies and reducing nurse turnover, they can be expensive. Maiocco (2003) provides estimates ranging from $18,000 for an 8-week orientation period to $25,000 for a 12-week period. She also states that orientation programs are not only costly in terms of dollars, but also in terms of experienced nurses’ time and energy, now at a premium due to the nursing shortage. However, formal learning strategies may not be the only solution to the problem. Informal learning opportunities may also facilitate the gaining of competencies among new nurse graduates. By overemphasizing the importance of formal learning strategies and failing to realize the value in informal, participatory learning, an organization can “undercut the various processes by which they can become effective learning organizations” (Wenger, 1999). The communities of practice perspective can be applied to the healthcare organization: Opportunities for informal, on-the-job learning and opportunistic communication - such as impromptu questions asked while passing a preceptor in the corridor or striking a spontaneous conversation while engaged in another task at the nurses’ station - may help to increase graduate nurse competencies, thereby reducing levels of stress. 16
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: formal face-to-face communication n
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 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
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• 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
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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).
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