The role of physical design and informal communication

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ACKNOWLEDGMENTS There are several people I would like to acknowledge for their support and assistance throughout this study: My advisor, Professor Frank Becker, for his guidance, encouragement, patience, and insight. His passion, enthusiasm, and leadership in healthcare research and design is what inspired me to pursue it as a career, and I feel fortunate for the opportunity to have learned from and worked with him. Professor Paul Eshelman, my minor advisor, for his encouragement and support over the last five years and for believing in me in uncertain times. Todd Olrich and Elizabeth Duxbury of Crouse Hospital for their invaluable support, insight, and feedback and for their genuine interest in this research. Rosie Adams, my fellow researcher, for her encouragement, support, advice, and most of all for her friendship. And finally, my parents who always encouraged and believed in me when times were tough and without whose endless love, guidance, humor, and support none of this would have been possible. v
TABLE OF CONTENTS Biographical Sketch ...................................................................................................... iii Dedication ..................................................................................................................... iv Acknowledgements ...................................................................................................... v List of Figures .............................................................................................................. viii List of Tables ................................................................................................................. x Chapter 1: Introduction 1.1 Opportunity for Change .............................................................................. 1 1.2 Evidence-Based Design............................................................................... 2 1.2.1 Examples of Patient-Centered Evidence-Based Design................. 3 1.2.1.1 Access to Nature............................................................. 3 1.2.1.2 Social Support ............................................................. 4 1.2.2 Examples of Staff-Centered Evidence-Based Design .................. 5 1.2.2.1 Acoustic Environment ................................................. 5 1.2.2.2 Nursing Unit Layout .................................................... 6 1.3 Nursing Shortage......................................................................................... 7 1.4 Job Stress in Nurses..................................................................................... 8 1.5 Graduate Nurse Transition and Stress....................................................... 9 1.6 Teamwork in Healthcare............................................................................ 10 1.6.1. Impact of Teamwork on Patient Outcomes.................................. 10 1.6.2 Impact of Teamwork on Nurse Job Satisfaction.......................... 11 1.6.3 Graduate Nurse Sense of Belonging to a Team............................ 12 1.6.4 Importance of Communication for Effective Healthcare Teams............................................................................................ 12 1.7 Communication Patterns in Healthcare...................................................... 13 1.8 Communities of Practice and Knowledge Networks................................. 14 1.8.1 Impact of Informal Learning on the Graduate Nurse Experience.................................................................................... 16 1.9 Impact of the Built Environment on Communication in the Workplace.................................................................................................. 18 1.9.1 Impact of Nursing Unit Design on Communication..................... 20 1.9.1.1 Centralized vs. Decentralized Nursing Unit Designs......................................................................... 20 1.9.1.2 Location of Communication on the Nursing Unit.............................................................................. 22 1.10 Research Questions.................................................................................. 23 Chapter 2: Methods 2.1 Research Design......................................................................................... 25 2.2 Site Selection.............................................................................................. 25 2.3 Site Description.......................................................................................... 26 2.4 Physical Layout.......................................................................................... 27 vi
Page 1 and 2: THE ROLE OF PHYSICAL DESIGN AND INF
Page 3 and 4: ABSTRACT Graduate nurses experience
Page 5: Dedicated to my parents, John and L
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 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
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Kitchen Locker Room Desk B1 at nurs
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Figure 13 Existing layout prior to
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Figure 15 Wall-mounted chart organi
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3.1.2 Information Management and Te
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nurses and pharmacists and dispense
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Because patients on 6N have a parti
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There is encouragement to learn new
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There is encouragement to learn new
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“Validation,” at five times per
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Average Frequency/8hr 60 50 40 30 2
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3) shows that all interactions were
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Table 4 Overall percent & frequency
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Transit” - 2:59:48. However, the
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Time (hh:mm:ss) 0:02:53 0:02:36 0:0
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Patient Room 28% Nurses Station 25%
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3.3.4 Analysis of Task, Person and
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However, when asked if all of this
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Frequency (%) 50.0 45.0 40.0 35.0 3
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Frequency (%) 45.0 40.0 35.0 30.0 2
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Table 14 Frequency of person by loc
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occurred in equal amounts with the
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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
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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
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opportunities for informal learning
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unit suggests that designers and ho
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usually leads to expensive renovati
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including off the nursing unit or a
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APPENDIX A Memo Describing Study 12
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APPENDIX B Graduate Nurse Consent F
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• Members of the Cornell research
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_____________________________ _____
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Informed Consent Form for Staff Cro
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Committee on Human Subjects (UCHS)
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Modified Categories for the Clinica
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134
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136
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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
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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
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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
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CWM Tool Task Category Definitions
Page 177 and 178:
REFERENCES Adams, A., & Bond, S. (2
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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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