The role of physical design and informal communication

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two statements that were reverse coded so that a ‘7’ meant “Strongly Disagree” and a ‘1’ meant “Strongly Agree. These statements were: “My training didn’t cover the basics I need to know” and “There is little encouragement to learn new skills.” The GN survey responses were analyzed separately from the unit staff survey responses to provide mean ratings for each of the three constructs measured (stress, opportunities for informal learning, and unit culture). In addition, the T1 and T2 GN responses were analyzed separately to gauge whether or not there was a change over the course of the orienting period. The competency evaluations were analyzed to provide an overall mean competency rating for each week by averaging the weekly ratings from all 18 categories. This data was used to determine how overall competency changed over the course of the orienting period. 43
CHAPTER 3 RESULTS 3.1 Organizational Ecology of the Nursing Unit Field observation, focused interviews with staff members, and survey results were analyzed to obtain an understanding of the organizational ecology of 6N. The system was analyzed from three perspectives: Physical layout, Information Management & Technology, and Organization & Unit Culture. 3.1.1 Physical Layout The physical layout of the nursing unit can be described as a traditional centralized design where patient rooms are wrapped around a central core service area (Figure 3). Three large, rectangular desks, represented by Desk B1, are situated at the entry to the unit and are equipped with computers and telephones (Figures 4 and 5). These desks are primarily used by doctors for charting and making phone calls. Nurses and allied health staff also sit here to document. Behind these desks is a large island work surface at standing-height where nurses stand to do charting, represented by A1 (Figure 6). This is also a common place for nurses to gather for “report,” otherwise known as handoff which occurs at the end of one shift and the beginning of another. The patient charts are located at this island on a large, tall rotating chart carousel. At the back of the unit is Desk B2 which is home to the charge nurse and the unit receptionist – two staff members who must work closely together (Figure 7). Since the unit takes on overflow patients from cardiology, Desk C has been designated the telemetry station where a staff member sits and monitors patients’ heart activity on computer screens (Figure 8). 44
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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 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: 2.8 Data Analysis Focused interview
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
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conditions in laymen’s terms. The
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• According to the GN, the greate
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Not enough staff to adequately cove
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Table 16 Change in GN stress rating
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Blood Pressure (mmHg) 121.0 119.0 1
Page 117 and 118:
3.6 Overall Summary of Findings •
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on validation, discussing patient c
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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
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• Members of the Cornell research
Page 137 and 138:
_____________________________ _____
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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
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APPENDIX G Survey Items Pertaining
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APPENDIX H Survey Items Pertaining
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APPENDIX I Blood Pressure Recording
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APPENDIX J Competency Evaluation Fo
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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
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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
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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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