The role of physical design and informal communication

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communication, and those who weren’t team members generally communicated in space formally dedicated to meetings. It would be interesting to explore whether or not these findings could be applied to the nursing unit. Iedema and colleagues (2005) conducted a video-ethnographic study of how a multidisciplinary clinical team occupies clinical space and concluded that the corridor is a crucial resource. The traditional view of the corridor is that it is “in between” space with a purpose to facilitate more important events occurring somewhere else and to provide transit routes between events and spaces. However, this study found the corridor to be a valuable resource where hierarchies and formalities can be suspended, at least temporarily, and uncertainty is tolerated. The authors conclude that the increasing complexities of healthcare in the 21 st century make the informality offered by the corridor space even more crucial to clinical communication. 1.10 Research Questions A large body of literature has documented the difficulties and high levels of stress experienced by graduate nurses during their transition from the classroom to their first job as an RN. We know that a major cause of this stress is a perceived lack of competency and lack of belonging to a team. Research suggests that peer support and informal communication among nurses greatly facilitates on-the-job learning that could have the potential to reduce stress. Studies in both the corporate workplace as well as healthcare provide evidence of the impact that the built environment can have on communication and interaction patterns. These facts provided inspiration for the current study. This thesis, while exploratory in nature, seeks to understand the roles played by the components of the nursing unit ecosystem, including culture, organizational factors, technology, and particularly the physical layout, in the opportunities for 23
informal learning and communication patterns of a graduate nurse during her orientation period. In addition, this case study examines whether or not there is a relationship between graduate nurse communication and interaction patterns, the gaining of competency, and the reduction of stress. The formation of specific hypotheses wasn’t appropriate for this study given that the topic has not been widely studied, and therefore no sound evidence exists on which to base assumptions. However, the following research questions served as a guide: 1. What are the communication and interaction patterns of a graduate nurse? More specifically, where on the nursing unit do graduate nurses interact, with whom do they interact, and for what reason? Do these patterns change over time? 2. What is the impact of the nursing unit’s physical design on informal communication and learning? Do certain physical features inhibit or facilitate interaction and informal learning? 3. Is there a relationship between communication patterns and opportunities for informal learning and graduate nurse competency levels? If so, does this relationship change over the course of the orientation period? 4. Is there a relationship between graduate nurse competency levels and stress levels? If so, does this relationship change over the course of the orientation period? 24
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 and 32: concluded that high visibility work
Page 33: Joseph (2006) cites anecdotal evide
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
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
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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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