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Fay L, Real K, Haynes S, Daneshvar Z. Examining Efficiency in Open-Bay and Single-Family Room NICU Designs. Adv Neonatal Care 2023; 23:355-364. [PMID: 36719284 DOI: 10.1097/anc.0000000000001058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is growing awareness of the relationship between physical work environments and efficiency. Two conflicting factors shape efficiency in the neonatal intensive care unit (NICU) environment: the move to single-family rooms (SFRs) and increased demand for care, requiring growth in unit size. PURPOSE The goal of this research was to understand the impact of SFR NICUs on efficiency factors such as unit design, visibility and proximity, staff time, and workspace usage by various health professionals. METHODS A pre-/postoccupancy evaluation assessed a NICU moving from an open-bay to an SFR unit composed of 6 neighborhoods. A NICU patient care manager and researchers in design and communication implemented a multimethodological design using staff surveys, observations, and focus groups. RESULTS Outcomes revealed SFR NICUs contribute to increased efficiency and overall satisfaction with design. Outside of staff time spent in patient rooms, decentralized nurse stations were the most frequented location for staff work, followed by huddle stations, medication and supply rooms, and corridors. Work at the observed locations was largely performed independently. Survey outcomes reported increased feelings of isolation, but focus groups revealed mixed opinions regarding these concerns. IMPLICATIONS FOR PRACTICE AND RESEARCH Design solutions found to enhance efficiency include a neighborhood unit design, standardized access to medications and supplies, and proximity of supplies, patient rooms, and nurse workstations. Although feelings of isolation were reported and most staff work was done independently in the patient room, the SFR unit might not be the culprit when considered alongside staff's desire to be closer to the patient room.
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Affiliation(s)
- Lindsey Fay
- University of Kentucky, Lexington (Mss Fay and Daneshvar and Dr Real); and University of Kentucky Children's Hospital, Lexington (Ms Haynes)
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Plusch J, Jane Muir K. "Doc in the Box": The impact of an emergency department move on interprofessional collaboration, patient care, and clinician job satisfaction. Int Emerg Nurs 2023; 67:101267. [PMID: 36863070 DOI: 10.1016/j.ienj.2023.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Health care organizations undergo unit space reconfiguration (e.g., expansion) projects in order to accommodate rising patient volumes with limited health care space. The purpose of this study was to describe the impact of an emergency department physical space move on clinician-perceived interprofessional collaboration, patient care delivery, and clinician job satisfaction. METHOD A secondary qualitative, descriptive data analysis of 39 in-depth interviews from an ethnography was conducted from August 2019 to February 2021 at an academic medical center emergency department with nurses, physicians, and patient care technicians in the Southeastern United States. The Social Ecological Model was a conceptual guide for the analysis. RESULTS Three study themes, "It's like an old dive bar", "spatial blind spot", and "privacy and aesthetic work environment" emerged from the 39 interviews. Clinicians perceived that the move from a centralized to decentralized work space impacted interprofessional collaboration through divided clinician work spaces. Increased square footage in the new emergency department was beneficial for patient satisfaction but contributed to difficulty monitoring patients for care escalation. However, increased space and individualized patient rooms increased perceived clinician job satisfaction. CONCLUSION Space reconfiguration projects inhealth carecan have positive implications for patient care, but may result in inefficiencies to the health care team and patient care that must be considered. Study findings inform health care work environment renovation projects on an international level.
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Affiliation(s)
- Jamie Plusch
- Medstar Georgetown University Hospital, Washington, DC 20007, USA.
| | - K Jane Muir
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA 19140, USA.
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Rowe A, Knox M. The Impact of the Healthcare Environment on Patient Experience in the Emergency Department: A Systematic Review to Understand the Implications for Patient-Centered Design. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 16:310-329. [PMID: 36541114 PMCID: PMC10133779 DOI: 10.1177/19375867221137097] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: The emergency department (ED) is a complex, volatile, and limited-resource healthcare setting. Many environmental factors, including high patient volumes, overburdened staff, long waits, and a tense atmosphere, converge in the ED. The objective of this study was to perform a systematic review of extant literature to understand how the ED environment drives patient experience and identify methodological or empirical insights for patient-centered ED design. Methods: We searched eight academic databases (Web of Science, PubMed, Scopus, Medline [Ovid], CINAHL, PyscInfo, Compendex, and IEEE Explore) to identify studies that employed observational (descriptive) or interventional (evaluative) methodology. We performed a co-citation analysis of potentially eligible articles and a qualitative synthesis of findings from studies included in our final sample. Results: Our search yielded 117 records. Of the 35 potentially relevant articles, 18 were published in the last 5 years, and 50% were authored by investigators in the United States. We used 33 articles for a co-citation analysis, revealing three interdisciplinary clusters and promising potential for collaboration across fields. Thirty articles were subjected to a full-text analysis, resulting in the identification of three overarching dimensions linking the ED environment to patient experience. Conclusion: The most commonly identified factors influencing patient experience in the ED included overcrowding and wait times, privacy, and communication; however, existing literature is limited. More research is needed to understand how ED environments configure patient experience and can be improved through design. Particularly, there is little research on participatory interventional strategies in the ED, despite strong evidence suggesting a need for stakeholder participation.
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Affiliation(s)
- Aidan Rowe
- Department of Art & Design, University of Alberta, Edmonton, Alberta, Canada
- Design x Health Research Innovation Lab (DHRIL), University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Knox
- Design x Health Research Innovation Lab (DHRIL), University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Kupec S, Reinemann M, Selley VH, Graves E, Carlson JN. Leader Standard Work: A Model for Improving Efficiencies in Leadership and Healthcare. J Nurs Adm 2022; 52:327-329. [PMID: 35608975 PMCID: PMC9154299 DOI: 10.1097/nna.0000000000001156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although several methods have been proposed to help reduce inefficiencies in healthcare, these may be inaccessible or impractical for leaders to implement given their complexity. Leader Standard Work (LSW) has been successfully utilized in other industries to help improve the efficiencies of leaders by providing individual, manageable concepts that leaders can rapidly implement to effect change. This column provides a brief overview of LSW and how it may be used to leadership effectiveness and, ultimately, healthcare.
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Habibi Soola A, Ajri-Khameslou M, Mirzaei A, Bahari Z. Predictors of patient safety competency among emergency nurses in Iran: a cross-sectional correlational study. BMC Health Serv Res 2022; 22:547. [PMID: 35462540 PMCID: PMC9036733 DOI: 10.1186/s12913-022-07962-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS This study aimed to assess predictors of patient safety competency among emergency nurses. BACKGROUND The role of emergency nurses is to provide high-quality health care to patients and ensure their safety. The patient safety competency includes the absence of unnecessary or potential harm when providing health care to patients. In providing health care, effective teamwork can affect patient safety and outcomes. Psychological safety is essential to effective teamwork. Psychological safety allows health care workers to accept the interpersonal risks needed to perform effective teamwork and maintain patient safety. METHODS This study was cross-sectional correlational research. Using convenience sampling methods, 254 emergency department nurses from five educational hospitals were enrolled in the study. Patient Safety in Nursing Education Questionnaire was used to measure the patient safety competency, the teamwork questionnaire to examine the teamwork, and Edmondson psychological safety questionnaire was used to measure psychological safety. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's r correlation coefficient, and multivariate stepwise linear regression analysis were applied using SPSS 14.0. RESULTS Participants' mean patient safety competency score was 2.97 (1-4). Between 18 independent variables evaluated in the multiple regression analysis, seven had a significant effect on the patient safety competency of emergency nurses (R2: 0.39, p < .001). CONCLUSIONS The patient safety competency of emergency department nurses was primarily related to the structure and leadership of the team and secondary to psychological safety and experience in patient safety activity. The results demonstrated that policymakers and hospital managers should improve and enhance team structure and leadership via supervision and cooperation with the nursing staff. The development of training programs in patient safety activities, improvement, and increase of psychological safety at the levels of the nursing units is essential to increase patient safety competencies in the emergency nursing program.
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Affiliation(s)
- Aghil Habibi Soola
- Department of Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mehdi Ajri-Khameslou
- Department of Critical Care Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Alireza Mirzaei
- Department of Emergency nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Zahra Bahari
- Department of Emergency nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
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Muir KJ, Keim-Malpass J, LeBaron VT. Examining the cultural impacts of an emergency department move using ethnography. Int Emerg Nurs 2021; 59:101082. [PMID: 34763250 DOI: 10.1016/j.ienj.2021.101082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/24/2021] [Accepted: 09/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this ethnographic study was to evaluate the cultural impacts of an emergency department (ED) move from an old to new physical space. METHOD Fieldwork was conducted over 14 months at an academic medical center ED in the United States. Primary data sources included participant observations and semistructured interviews. RESULTS Over 720 h of participant observation and semi-structured interviews (n = 39) with emergency nurse, non-nurse clinicians, and unit administrators were collected and analyzed. One cross-cutting theme, "decisional power," and three supporting themes "inadequate move preparation," "change fatigue," and "lack of change standardization" were identified. "Decisional power" was the perceived influence certain ED groups had making move-related decisions over others. "Change fatigue" described the impact of frequent change implementation on participants' work processes, well-being, and job satisfaction. "Lack of change standardization" described power differentials between nurses striving to standardize new move-related processes and physicians implementing work styles discordant with such processes. CONCLUSION Findings can inform recommendations for health care policy and organizational operations such as: 1) including frontline stakeholder perspectives in move-related decisions; 2) allocating adequate time for clinician/employee training/education in the pre-move period; 3) assessing clinician/employee well-being throughout move implementation; 4) increasing unit administrator sensitivity to clinician change fatigue.
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Affiliation(s)
- K Jane Muir
- University of Virginia School of Nursing, Charlottesville, VA 22903, USA.
| | - Jessica Keim-Malpass
- University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, VA 22903, USA.
| | - Virginia T LeBaron
- University of Virginia School of Nursing, Department of Acute and Specialty Care, Charlottesville, VA 22903, USA.
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Ahmadpour S, Bayramzadeh S, Aghaei P. Efficiency and Teamwork in Emergency Departments: Perception of Staff on Design Interventions. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:310-323. [PMID: 34128423 DOI: 10.1177/19375867211023156] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The goal of this study is twofold: (1) identifying design strategies that enhance efficiency and support teamwork in emergency departments (EDs) and (2) identifying design features that contribute to the spread of COVID-19, based on staff perception. BACKGROUND Due to increasing ED visits annually, an efficient work environment has become one of the main concerns in designing EDs. According to the literature, an efficient work environment and teamwork improve healthcare outcomes and positively impact staff satisfaction. During the COVID-19 pandemic, EDs faced various changes such as workflow and space usage. Few studies explored staff perceptions about the influence of design features on efficiency, teamwork, and the COVID-19 spread. METHOD An online survey with 14 open- and closed-ended questions was distributed among ED staff members to collect data about unit design features that impact efficiency, teamwork, and the COVID-19 spread. RESULTS The central nursing station was one of the preferred configurations that increased efficiency and teamwork in EDs. Decentralizing disposal rooms in small-size EDs and decentralizing the medication room in large-size EDs with more than 65 exam rooms can decrease staff walking steps. Flexibility to expand treatment spaces on demand, one-way track circulation path, and changing the air pressure in COVID-19 treatment areas were some of the staff suggestions for future EDs. CONCLUSION The findings of this study contribute to the body of knowledge that EDs' physical environments can impact efficiency and teamwork among staff and, consequently, healthcare outcomes. Compartmentalization of the ED layout can reduce the spread of COVID-19.
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Affiliation(s)
- Sahar Ahmadpour
- College of Architecture and Environmental Design, Kent State University, OH, USA
| | - Sara Bayramzadeh
- College of Architecture and Environmental Design, Kent State University, OH, USA
| | - Parsa Aghaei
- College of Architecture and Environmental Design, Kent State University, OH, USA
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Masias KAA, Santos JLGD, Erdmann AL. EMPOWERMENT OF NURSES FROM A HOSPITAL IN THE SOUTH OF CHILE. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2019-0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to identify the level of empowerment among the nurses from a hospital located in the south of Chile and verify its potential association with personal and professional characterization variables. Method: cross-sectional and descriptive study conducted with 117 nurses from a hospital in the south of Chile. Data were collected in 2018 using a personal and professional characterization form and the Spanish version of the Conditions of Work Effectiveness Questionnaire II. Data were analyzed using descriptive and inferential statistics. Results: the means of the factors of the empowerment scale were: Opportunity (4.11±0.82); Information (3.81±0.90); Support (3.81±0.86), and Resources (3.13±0.97). Statistically significant differences were found between empowerment and having greater professional experience, working in the medical-surgical unit, having from 3 to 10 patients under responsibility, job satisfaction, and intention to quit their jobs. Conclusion: the nurses reported a positive perception of empowerment in their roles, especially concerning having opportunities to perform tasks that contribute to acquiring new knowledge and skills at work.
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Zamani Z. Effects of Emergency Department Physical Design Elements on Security, Wayfinding, Visibility, Privacy, and Efficiency and Its Implications on Staff Satisfaction and Performance. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 12:72-88. [PMID: 30231637 DOI: 10.1177/1937586718800482] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to identify the role of emergency department (ED) design on ED staff satisfaction and performance. BACKGROUND High patient volume, surging workloads, and violent behaviors are expected pressures for ED staff. Literature suggests the substantial role of the physical environment in the delivery of care and its role in staff and patient experiences. Nevertheless, limited studies have explored simultaneous interactions between ED physical design elements, attributes (security, wayfinding, visibility, privacy, and efficiency), and staff satisfaction or performance. METHOD Interviews, surveys, visibility graph analysis, and agent simulations were employed to understand the connection between ED physical design, attributes, performance, and staff satisfaction. RESULTS Enhanced security, effective wayfinding, team visibility, noise reduction, adequate privacy, and accessible supplies and equipment were significant predictors of staff satisfaction and performance. Unobstructed views in waiting and triage and controlled entrances were critical for improving security. To improve wayfinding, eye-level signage, reducing surveillance obstacles, and creating direct public routes were recommended. Rectangular units with multiple perpendicularly connected corridors and linear pod arrangements enhanced movement. Including team rooms and enclosed ERs were recommended for privacy improvements. Visibility was critical for team communication and improved by including short-distanced perpendicular corridors and eliminating columns. Enhancing access to supplies or equipment and reducing noise levels improved the perception of staff efficiency. CONCLUSION The findings contribute to the general body of knowledge on the impact of ED physical design on attributes that potentially improve staff satisfaction and work performance.
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