The role of physical design and informal communication

centralized units, centralized units may hold one advantage that should not be
neglected.
Centralized unit designs typically include a centrally located nurses’ station
with patient rooms positioned around the perimeter. A defining characteristic is that
this design concentrates all of the patient information, and hence the multitude of staff
who need access to this information, in one location. The disadvantage to this type of
arrangement is that it necessitates frequent trips between the patient room and the
nurses’ station to locate supplies, chart patient information, fill meds, and so on
(Joseph, 2006). Consequently, most of the nurses’ time is spent walking around the
unit, and this is time that is taken away from direct patient care. Additionally, the core
of the unit often becomes crowed, producing excessive noise that is stressful for both
patients and staff (Wade, 2006). With the advent of the Planetree movement, which
advocates more time spent by nurses with patients and their families, as well as
advances in technology that allow for electronic record keeping, the decentralized unit
has received more attention. A decentralized design brings staff and supplies visually
and physically closer to patients, which helps reduce the time spent walking for nurses
(Joseph, 2006). The decentralized unit accomplishes this by featuring multiple small
computer workstations distributed around the unit as well as workspace outside of
each patient room. However, the fact that this type of design disperses staff all around
the unit is grounds for concern when it comes to the issues of interaction and
information transfer. Conversely, the centralized unit causes staff to converge in one
location providing more opportunities for frequent communication that leads to
informal on-the-job learning. While the decentralized unit holds promise in terms of
reducing staff walking and increasing time spent in direct patient care, researchers
warn this type of design may have a negative impact on staff interactions (Joseph,
2006).
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