The role of physical design and informal communication

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In their study of the factors that influence the learning ability of nurses, White et al. (1998) found that learning from peers facilitated integration of knowledge into nursing practice. Information from focus group interviews revealed that peers were perceived to be “unofficial resources” who provided education “on an as-needed basis – informal learning.” Ready accessibility of information from colleagues who were on the floor was crucial. One nurse summarized by saying: “…the easier the access, the easier the learning.” In an ethnographic study designed to investigate how nurses learn, Hunter, Spence, McKenna, and Iedema (2008) found that the orientation of new staff included informal, incidental, interpersonal, and interactive forms of learning. On-the-job learning took the form of role modeling where nurses who were skilled at performing certain procedures supported those who were unaccustomed to the practices. Less-experienced nurses called on their more experienced peers for advice, and this practice mediated the overwhelming feeling that resulted from being in such an intense learning environment. We can summarize the literature reviewed up to this point with the following broad statements: • Work-induced stress in nurses significantly contributes to high rates of nurse turnover, which exacerbates the current national nursing shortage. • In the transition from the role of a student to the role of an RN, graduate nurses experience tremendous amounts of stress largely due to a perceived lack of knowledge and skill that is required to function independently in the clinical environment. 17
• Evidence-based design has the potential to not only improve patient outcomes but also reduce stress and burnout in nurses, which could positively affect nurse retention in hospitals. • Effective communication is critical for the success of teamwork among healthcare professionals, which is proven to enhance patient care and nurse job satisfaction. A sense of belonging to a team can also help graduate nurses overcome the stress of a first job. • Informal communication and the sharing of information among informal knowledge networks in the workplace is a crucial factor in graduate nurses’ ability to learn and become effective members of the team. Informal communication across knowledge networks has been shown to aid graduate nurses’ learning process, which could reduce the stress caused by feeling incompetent. Evidence-based design could hold promise in addressing these issues. The next section focuses on how the built environment affects communication in the workplace. 1.9 Impact of the Built Environment on Communication in the Workplace The study of the role played by the physical design and layout of the workplace in communication and informal learning can best be understood in the context of “organizational ecology.” Becker (2007a) introduced the concept of “organizational ecology” which recognizes that the workplace of all organizations is a complex system in which physical design factors both shape and are shaped by work processes, the organization’s culture (e.g., formal and informal values, norms, expectations, policies, and practices), workforce demographics, and information 18
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: interactive and interpersonal learn
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
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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
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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
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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
Page 185 and 186:
Stolte, K., & Myers, S. t. (1995).
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