The role of physical design and informal communication

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2.5 Sample Size and Selection.......................................................................... 28 2.6 Data Collection........................................................................................... 30 2.6.1 Clinical Work Measurement (CWM) Tool................................... 32 2.6.2 Survey........................................................................................... 34 2.6.3 Blood Pressure Recordings........................................................... 37 2.6.4 Competency Evaluations.............................................................. 39 2.6.5 Focused Interviews....................................................................... 40 2.8 Data Analysis............................................................................................. 42 Chapter 3: Results 3.1 Organizational Ecology of the Nursing Unit.............................................. 44 3.1.1 Physical Layout............................................................................. 44 3.1.2 Information Management and Technology................................... 58 3.1.3 Organization and Unit Culture...................................................... 60 3.2 Graduate Nurse Familiarity with 6N.......................................................... 65 3.3 Communication and Interaction Patterns................................................... 66 3.3.1 Analysis by Task........................................................................... 67 3.3.2 Analysis by Person....................................................................... 73 3.3.3 Analysis by Location.................................................................... 78 3.3.4 Analysis of Task, Person and Location......................................... 82 3.3.5 Summary of Findings: Communication and Interaction............... 90 3.4 Learning and Gaining Competency............................................................ 91 3.4.1 The GN-Orientor Relationship..................................................... 91 3.4.2 Unit Approach to Orientation and Support for Learning............ 93 3.4.3 Weekly Competency Ratings...................................................... 95 3.4.4 Summary of Findings: Gaining Competency.............................. 97 3.5 Biological and Perceived Stress............................................................... 98 3.5.1 Perceived Stress: Survey Responses........................................... 98 3.5.2 Biological Stress: Blood Pressure............................................... 103 3.5.3 Summary of Findings: Stress...................................................... 105 3.6 Overall Summary of Findings.................................................................. 106 Chapter 4: Discussion and Conclusions 4.1 Social Interaction and Backstage Spaces................................................. 107 4.2 Relationship between GN Competency Levels and Stress Levels........... 108 4.3 Sightlines and Teamwork......................................................................... 110 4.4 Informal Learning and Gaining Competency........................................... 111 4.5 Implications for Practice: Communities of Practice................................. 113 4.6 Implications for Practice: Value of Observation...................................... 115 4.7 Overall Conclusion................................................................................... 116 4.8 Study Limitations..................................................................................... 117 4.9 Directions for Future Research: The Healthcare Team............................ 118 4.10 Directions for Future Research: Rethinking the CWM Tool Categories............................................................................................... 119 vii
LIST OF FIGURES Figure 1. 6N floor plan.................................................................................................. 27 Figure 2. 6N floor plan showing color-coded location zones...................................... 34 Figure 3. 6N floor plan................................................................................................. 48 Figure 4. View of Desk B1 upon entry to the unit....................................................... 49 Figure 5. View of work surface from behind Desk B1................................................ 49 Figure 6. View of island work surface from in front of Desk B2................................ 50 Figure 7. Charge Nurse and Unit Receptionist at Desk B2 ......................................... 50 Figure 8. Telemetry work station at Desk C ............................................................... 51 Figure 9. View of med room location from in front of Desk B1.................................. 51 Figure 10. View of corridor separating nurses’ station from support spaces from behind Desk B1................................................................................. 52 Figure 11. Sitting area in small break room................................................................. 53 Figure 12. View out of break room to elevator lobby.................................................. 53 Figure 13. Existing layout prior to arrival of new nurse manager............................... 54 Figure 14. New layout showing changes made by new nurse manager....................... 55 Figure 15. Wall-mounted chart organizer at location A2............................................. 56 Figure 16. Floor plan showing obstructed sightlines and limited visibility across the unit.............................................................................................. 57 Figure 17. Mean RN response to culture section of survey......................................... 64 Figure 18. Mean RN and GN responses to culture section of survey.......................... 66 Figure 19. Overall frequency of communication tasks by type................................... 69 Figure 20. Average frequency per 8-hour shift of communication tasks..................... 70 Figure 21. Frequency of communication tasks that show a pattern of change over time...................................................................................................... 71 Figure 22. Average time of a single interaction for each communication task............ 73 Figure 23. Average frequency per 8-hour shift of who the GN interacted with.......... 74 Figure 24. Weekly frequency of who the GN interacted with..................................... 75 Figure 25. Average time during an 8-hour shift the GN spent with each person......... 77 Figure 26. Weekly analysis of average time per single interaction with patient and nurse..................................................................................................... 78 Figure 27. Frequency per 8-hour shift of where the GN interacted............................. 79 Figure 28. Overall frequency of where the GN interacted over 8 weeks of data collection.............................................................................................. 80 Figure 29. Average time of a single interaction by location........................................ 81 Figure 30. Frequency of task by person with tasks grouped to emphasize Knowledge transfer..................................................................................... 86 Figure 31. Frequency of task by person with tasks grouped to emphasize knowledge transfer...................................................................................... 88 Figure 32. Frequency of location by person................................................................. 89 Figure 33. Mean RN and GN learning survey responses............................................. 94 Figure 34. Average competency ratings by week and GN patient assignment............ 95 Figure 35. Competency ratings by category in weeks 1 and 9..................................... 96 viii
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: TABLE OF CONTENTS Biographical Sket
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
Page 63 and 64:
Kitchen Locker Room Desk B1 at nurs
Page 65 and 66:
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
Page 77 and 78:
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
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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
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REFERENCES Adams, A., & Bond, S. (2
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Buchanan, J., & Considine, G. (2002
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Godinez, G., Schweiger, J., Gruver,
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Lumsdon, K. (1993). Baby boomers gr
Page 185 and 186:
Stolte, K., & Myers, S. t. (1995).
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