The role of physical design and informal communication

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The data collection period coincided with the graduate nurse’s formal orientation program. In this 12-week formal orientation period, graduate nurses are co-assigned with an experienced nurse preceptor who assists graduate nurses in their transition from the student role to the RN role. The graduate nurse’s orientation began the week of January 21st, all of which was spent in the classroom. It wasn’t until week two of her orientation that she actually started working on the unit, at which point data collection began. The data collection period was intended to continue for 11weeks, concluding with the completion of the orientation program. However, because the study of 6N was done in conjunction with the study of another unit at the same hospital, both of which addressed the same research questions and used the same methodologies, data was only collected for 9 weeks because that was the time period in which the graduate nurse on the other unit was able to be observed, and the goal was to collect comparable data over the same time period. Before data collection could begin, IRB requirements mandated that all 6N staff members be informed of the study and its purpose. To accomplish this, the researcher composed a memo briefly describing the study that was emailed to all 6N staff and was posted in various locations throughout the unit (see Appendix A). Furthermore the nurse manager as well as the clinical nurse specialists (CNS) involved with the unit informally talked with staff to create awareness about the study. Obtaining graduate nurse and Orientor consent to participate in the study was also required by the IRB. To achieve this, one-on-one meetings were held with both subjects to describe the study and answer questions, at which point consent was received (see Appendix B for graduate nurse consent form; Appendix C for Staff consent form). In addition to satisfying IRB requirements, the researcher sought to develop a deeper understanding of the workings of the unit before data collection began. 31
Meetings were held over a three month period prior to commencing formal data collection with the nurse manager and CNS to gain insight into the graduate nurse orientation period and the daily operations of 6N. Additionally, the researcher received her own informal orientation of the unit as she spent several short periods of time on the floor with the CNS. During these periods, the CNS introduced staff members, noting their title and role on the unit, and also commented on how staff use the space. 2.6.1 Clinical Work Measurement (CWM) Tool The CWM tool, developed by the Health Informatics Research & Evaluation Unit (HIREU) at The University of Sydney in Australia, uses multi-dimensional work classifications for measuring the work patterns of doctors, nurses and pharmacists. These classifications are programmed into hand-held PDAs equipped with specially developed software. An observer follows individual clinicians for periods of up to 2 hours as they undertake their daily work tasks. During this time, a PDA is used to collect information about work tasks (eg. what they are doing), as well as information about who is involved in the task and how the task is being completed (eg. with a telephone, computer, etc). Additionally, the tool allows the observer to capture interruptions and multi or parallel tasking as well as the distribution of clinicians’ time across work tasks. A major purpose of the study was to investigate ways in which the physical layout of the unit affects interaction patterns, yet the original CWM program was not designed to collect data on the location of interactions. Consequently, the existing pre-programmed “how” category, which recorded information on how the task was executed, was replaced with a “location” category (see Appendix D for modified categories). This change allowed the researcher to record where on the unit each 32
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 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: o Nursing Students The following no
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
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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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