The role of physical design and informal communication

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technologies. He posits that one cannot understand organizational performance, including informal learning, by examining any single facet, component, or element of the overall system. Rather, the focus must be placed on the interdependencies among them. But because the organizational system is so large and complex, he suggests that one point of intervention is the planning, design, and management of physical space. The degree to which the physical environment affords physical and visual proximity for its occupants has been shown to affect communication and interaction in the workplace. Based on his research and experience, Becker (2007a) has proposed the idea of “spatial transparency” which suggests that the greater the opportunity for employees to easily see and hear what others are doing from inside their own work space and as they move in and around their team, department, and other unit’s work space, the greater the opportunities for modeling behavior and sharing information. This allows less experienced employees to learn by observing the behavior of the most experienced members of the organization. The concept of spatial transparency is evident in the findings of numerous research studies. Becker and Sims (2001) conducted a study of small start-up firms to investigate how office design influences communication patterns. They compared the communication and interaction patterns in closed offices, high-paneled cubicles, and visually transparent team-oriented workstation clusters. The findings revealed that more open, visually transparent team-oriented clusters supported naturally occurring informal learning of a variety of types. Stryker (2004) found similar results in his exploration of workplace design and face-to-face communication in R&D project teams. The findings suggest that workstation visibility (defined by both type of workstation – open workstation vs. closed office - and worker visibility from major circulation paths) is a key variable in promoting team communication and can be said to reduce the impediments to communication in the physical work environment. He 19
concluded that high visibility workstations appear to promote communication by allowing face-to-face communication to occur more easily. Dutta (2008) cites a study by Allen (1977) who found that physical proximity in an R&D setting played a key role in the amount of interaction that occurred. The results showed that the likelihood of communication and collaboration between team members decreased rapidly with distance. In fact, communication reached its lowest point after the first twenty-five or thirty meters. 1.9.1 Impact of Nursing Unit Design on Communication Although a moderate body of research exists concerning the effect of the physical design of space on communication in corporate settings, very little research has been conducted with the same focus in healthcare settings. Research in hospitals has confirmed the importance of communication not only for team functioning, which impacts the quality of patient care and nurse job satisfaction, but also for tacit knowledge transfer and informal learning. However, a gap in the literature exists when it comes to the influence of nursing unit design on opportunistic communication and on-the-job learning. 1.9.1.1 Centralized vs. Decentralized Nursing Unit Designs The concept of spatial transparency that has been illustrated in many studies of corporate environments is applicable to healthcare as well. Visual and physical proximity and its impact on communication is particularly relevant in the current debate concerning centralized vs. decentralized nurses’ stations. Researchers are beginning to explore their implications for quality of care and staff efficiency and are discovering that while the advantages of decentralized units, including a reduction in the time spent walking and being away from the patient, appear to surpass those of 20
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 and 28: interactive and interpersonal learn
Page 29: • Evidence-based design has the p
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
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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
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
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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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