The role of physical design and informal communication

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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). 21
Joseph (2006) cites anecdotal evidence that staff members who move from a centralized unit to a decentralized unit often feel isolated and miss the camaraderie and support of the centralized unit. A similar reaction was echoed by staff at Sutter Roseville Medical Center in Roseville, California where lack of spatial transparency in a decentralized unit inhibited interaction and collaboration among staff (Flynn & Barista, 2005). The horseshoe shaped decentralized stations left the nurses feeling isolated and unable to effectively support each other. The Clinical manager reported that the stations were so decentralized that the staff would not even know if everyone showed up for a shift. Dutta (2008) conducted a pre-post design study to assess the impact of decentralized vs. centralized nursing station layout on opportunistic communication and interaction patterns. He found that the frequency of communication between medical staff decreased in a decentralized layout. In fact, in the new decentralized unit, there were 54% fewer short interactions per hour than in the old centralized unit. 1.9.1.2 Location of Communication on the Nursing Unit To date, very little attention has been paid to where on the nursing unit different types of staff tend to communicate and for what reason. Developing a better understanding of the location of interactions could help designers plan nursing units that better support the desired forms of communication among the multidisciplinary healthcare team. The previously cited study by Stryker (2004) that investigated the effect of workplace design on face-to-face communication found that team communication was positively related to the informal spaces – corridors, break areas, informal meeting spaces – and non-team communication was associated with formal office space. Stated another way, members of the team took advantage of what are commonly perceived as unproductive, ancillary areas for opportunistic 22
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 and 30: • Evidence-based design has the p
Page 31: concluded that high visibility work
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
Page 161 and 162:
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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