1
|
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.
Collapse
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)
| | | | | | | |
Collapse
|
2
|
Hamilton DK, Kisacky J, Zilm F. Critical Care 1950 to 2022: Evolution of Medicine, Nursing, Technology, and Design. Crit Care Clin 2023; 39:603-625. [PMID: 37230558 DOI: 10.1016/j.ccc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Critical care units-designed for concentrated and specialized care-came from multiple parallel advances in medical, surgical, and nursing techniques and training taking advantage of new therapeutic technologies. Regulatory requirements and government policy impacted design and practice. After WWII, medical practice and education promoted further specialization. Hospitals offered newer, more extreme, and specialized surgeries and anesthesia enabled more complex procedures. ICUs developed in the 1950s, providing a recovery room's level of observation and specialized nursing to serve the critically ill, whether medical or surgical.
Collapse
Affiliation(s)
| | - Jeanne Kisacky
- Independent Historian, 111 Brandon Place, Ithaca, NY 14850, USA
| | - Frank Zilm
- Institute for Health & Wellness Design, University of Kansas, Lawrence, KS 66045, USA
| |
Collapse
|
3
|
Halpern NA, Scruth E, Rausen M, Anderson D. Four Decades of Intensive Care Unit Design Evolution and Thoughts for the Future. Crit Care Clin 2023; 39:577-602. [DOI: 10.1016/j.ccc.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
|
4
|
Fay L, Real K, Haynes S. The Healthcare Workspace: Understanding the Role of Decentralized Nursing Stations, Corridors, and Huddle Spaces as Locations for Teamwork in a Neonatal Intensive Care Unit. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:270-282. [PMID: 35746824 DOI: 10.1177/19375867221106503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The goal of this research was to understand the use of decentralized nursing stations (DNS), corridors, and huddle stations as places for teamwork and multidisciplinary care in the neonatal intensive care unit (NICU). BACKGROUND This article shares outcomes from a pre- and post-occupancy evaluation that assessed a NICU moving from an open-bay model to a new single-family room (SFR) unit comprised of six, 12-bed neighborhoods. This interdisciplinary research team draws upon the practical expertise of a NICU Patient Care Manager and researchers in Design and Communication to illuminate the research process, results, and lessons learned. METHODS A multi-methodological design, approved by the institutional review board, was employed that utilized an electronically distributed pre- and post-move survey of staff and observational counts of face-to-face interactions. RESULTS Survey results indicate NICU staff have statistically significant higher perceptions of job satisfaction, stress and well-being, and design satisfaction among a variety of professionals after moving to a SFR, decentralized unit design. Consistent with the literature, staff did not have significantly higher perceptions of the decentralized NICU relative to teamwork. Observations revealed frequency of conversations primarily at DNS followed by corridors and huddle stations. When examining the multidisciplinary makeup, outcomes were reversed with huddle spaces holding the largest percentage of conversations. On average, there were 2.72 individuals involved in these interactions, with the corridor seeing the largest average of group sizes. CONCLUSION The outcomes of this study demonstrate that neutral spaces such as corridors and centralized huddle stations should be considered as locations for strategic collaboration and multidisciplinary care.
Collapse
Affiliation(s)
- Lindsey Fay
- EDAC, College of Design, University of Kentucky, Lexington, KY, USA
| | - Kevin Real
- College of Communication and Information, University of Kentucky, Lexington, KY, USA
| | | |
Collapse
|
5
|
Rose SJ, Waggener L, Kiely SC, Hedge A. Postoccupancy Evaluation of a Neighborhood Concept Redesign of an Acute Care Nursing Unit in a Planetree Hospital. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:171-192. [PMID: 35389291 DOI: 10.1177/19375867221091318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A comparative study was undertaken to survey nurses working in an acute care nursing unit before and after moving to a new hospital to investigate the impact of a nursing unit designed utilizing Planetree build criteria. BACKGROUND The physical and emotional demands of frontline practitioners is a serious concern for patient safety and staff retention as the environmental design of nursing units can influence human errors from fatigue and interruption. METHOD A pre-move survey was conducted with acute care nurses in a conventional design nursing unit who were moving to a new facility. After the move to the new hospital design, the same survey was readministered to obtain comparative performance information. Qualitative responses were analyzed for triangulation with survey responses. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Press Ganey scores were collected over a 5-year period. RESULTS There were statistically significant improvements for most of the survey questions, especially for work efficiency and productivity, the design of the patient room and of support spaces, the information systems, and the environmental conditions. There were statistically significant improvements in the HCHAPS and Press Ganey survey questions. CONCLUSIONS The postoccupancy survey showed statistically significant improvements in most of the concerns highlighted in the pre-move survey and significant improvements in the workflow and overall satisfaction of nurses. Press Ganey results revealed all but five domains fell in the significantly improved category.
Collapse
Affiliation(s)
| | | | | | - Alan Hedge
- Human Factors and Ergonomics Laboratory, Department of Design and Environmental Analysis, College of Human Ecology, Cornell University, Ithaca, NY, USA
| |
Collapse
|
6
|
Rom Y, Palgi Y, Isaacson M. Analyzing the Layout of Long-Term Care Facilities: A Psycho-Spatial Approach. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:22-42. [PMID: 35510572 DOI: 10.1177/19375867211064538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
When planning long-term care facilities (LTCFs), architects strive to design buildings that support high well-being (WB) levels for those who live and work in them. To achieve this goal, architects must understand what defines WB in old age and how these qualities can be achieved through the designed physical layout. This task must be achieved while tackling additional challenges, such as considering the official planning guidelines, codes, and additional requests given by the client. During the planning process, architects use their subjective impressions by visiting similar institutions, their personal experience as architects, and their subjective assumptions on what residents and caregivers may consider desirable. Once built, there are a lack of methodological ways to evaluate an existing LTCF unit's plan as a supportive tool for higher levels of WB. The current study aims to create a methodological tool to analyze LTCF units' layout, giving scores to each plan based on five aspects of WB that they support. In our article, we demonstrate this methodology's application on 40 plans of LTCFs, demonstrating its effectiveness. We believe that the approach presented in this article will contribute to furthering the quality of planning of LTCFs benefiting residents and caregivers alike.
Collapse
Affiliation(s)
- Yifat Rom
- Department of Gerontology, University of Haifa, Israel
| | - Yuval Palgi
- Department of Gerontology, University of Haifa, Israel
| | | |
Collapse
|
7
|
Jenkins D, Burton C, Holmes D. Hospitals as total institutions. Nurs Philos 2021; 23:e12379. [PMID: 34939276 DOI: 10.1111/nup.12379] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/23/2021] [Accepted: 12/04/2021] [Indexed: 11/28/2022]
Abstract
The image of the hospital is presented to the public as a place of healing. Though the oft-criticized total institutions of the past have been notably dismantled, the totalizing practices therein are now operationalized in the health care system. Through the lens of Erving Goffman, this article offers ways in which health care institutions operationalize totalizing practices, contributing to the mortification of patients and nurses alike in service to the bureaucratic machine. This article examines the ways in which totalizing practices may disrupt the agency of both patients and nurses alike.
Collapse
Affiliation(s)
- Danisha Jenkins
- Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, California, USA
| | - Candace Burton
- Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, California, USA
| | - Dave Holmes
- University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
8
|
Obeidat B, Younis MB, Al-Shlool E, Alzouby A. A Study of Workspace Design Characteristics Exemplified by Nurses' Satisfaction Within Three Intensive Care Units in a University Hospital. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:63-78. [PMID: 34758650 DOI: 10.1177/19375867211055731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The critical conditions of intensive care patients require providing them with a higher acuity of care. Thus, it is essential to focus on critical care nurses and improve their work environment in a way that maximizes productivity, collaboration, satisfaction, and leads to improved patient care. PURPOSE This study aims to explore the role the workplace layout design play in determining nurses' satisfaction in three intensive care units (ICUs) at a university hospital. METHOD A prospective, cross-sectional, single-center, survey-based design was employed in this study. Data were obtained, via a standardized questionnaire, from 36 morning shift nurses. The nurses' self-reported satisfaction scores in three different ICUs with differing overall layouts, nursing station locations, and workplace design were statistically compared. RESULTS The study found that ICU 1 (private rooms, single corridor, central nursing station, close to supported services) had higher nursing satisfaction levels than ICUs 2 and 3 (open wards with separate service zones), F (2,34) = 5.054, p = .012. However, overall satisfaction was higher with the ICU 2 primary workspace design, possibly due to the perceived acoustic privacy in this configuration, F (2,34)= 4.492, p = .019. The ability of the ICU layout design to enhance teamwork and minimize traffic in patients care areas was found to be an important predictor of nurses' satisfaction. The primary workspace design capacity to minimize congestion and the presence of large numbers of providers in a confined workplace might account for variation in nurses' satisfaction. CONCLUSION Physical environment variables in the ICU design may contribute to staff workplace satisfaction scores and may help in guiding informed choices regarding the future ICU design.
Collapse
Affiliation(s)
- Bushra Obeidat
- College of Architecture and Design, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Bani Younis
- Princess Aisha Bint Al-Hussein College of Nursing and Health Sciences, Al-Hussein Bin Talal University, Maan, Jordan
| | - Esra'a Al-Shlool
- College of Architecture and Design, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad Alzouby
- College of Architecture and Design, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
9
|
Cai H, Spreckelmeyer K. The Continuous Learning Cycle: A Multi-phase Post-occupancy Evaluation (POE) of Decentralized Nursing Unit Design. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:134-148. [PMID: 34753331 DOI: 10.1177/19375867211051657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aims to demonstrate how multiphase postoccupancy evaluation (POE) research was integrated into multiple projects to develop a continuous learning cycle. BACKGROUND Despite the well-recognized importance of POE, few studies have reported how knowledge from POE is applied in new designs. METHOD This study is developed as a multiphase POE that spanned 3 years and across three units. Phase I POE compared an existing unit (Unit A) in Hospital A and a new Unit B in Hospital B that has implemented innovative design features such as decentralized nurse stations. The idea was to understand the challenges of the existing facility in Hospital A and gather lessons learned from the new design in Unit B to inform the design of the Hospital A expansion (Unit C). After the new expansion was occupied, the Phase II POE was conducted using the same set of POE tools in both Unit C and Unit A. The POE applied the following methods: (1) patient room evaluations using the Center for Health Design standardized POE tools, (2) space syntax analysis of visibility, and (3) a pre- and postmove analysis of Press Ganey data. RESULTS The results demonstrated that by incorporating lessons learned from the Phase I POE, Unit C has further improvement on patient room design ratings, improved patient satisfaction, and better visibility among nurse work areas compared to Unit A and Unit B. CONCLUSIONS The multiphase, multisite POE with standardized tools has demonstrated its value as an important tool for continuous design quality improvement.
Collapse
Affiliation(s)
- Hui Cai
- Department of Architecture, The University of Kansas, Lawrence, KS, USA
| | | |
Collapse
|
10
|
Verderber S, Gray S, Suresh-Kumar S, Kercz D, Parshuram C. Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005-2020). HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:368-415. [PMID: 34000842 PMCID: PMC8597197 DOI: 10.1177/19375867211009273] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005-2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge. PURPOSE AND AIM This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities. METHOD AND RESULT Each source reviewed was classified as one of the five types-opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays-and into nine content categories: nature engagement and outdoor views; family accommodations; intensive care unit (ICU), neonatal ICU, and pediatric ICU spatial configuration and amenity; noise considerations; artificial and natural lighting; patient safety and infection control; portable critical care field hospitals and disaster mitigation facilities including COVID-19; ecological sustainability; and recent planning and design trends and prognostications. CONCLUSIONS Among the findings embodied in the 135 literature sources reviewed, single-bed ICU rooms have increasingly become the norm; family engagement in the ICU experience has increased; acknowledgment of the therapeutic role of staff amenities; exposure to nature, view, and natural daylight has increased; the importance of ecological sustainability; and pandemic concerns have increased significantly in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review includes topics noticeably overlooked or underinvestigated in the 2005-2020 period and priorities for future research.
Collapse
Affiliation(s)
- Stephen Verderber
- Centre for Design + Health Innovation, John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Seth Gray
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Center for Safety Research, Toronto, Ontario, Canada
| | - Shivathmikha Suresh-Kumar
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Damian Kercz
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Christopher Parshuram
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Center for Safety Research, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Cai H, Fullam F, MacAllister L, Fogg LF, Canar J, Press I, Weissman C, Velasquez O. Impact of Inpatient Unit Design Features on Overall Patient Experience and Perceived Room-Level Call Button Response. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9747. [PMID: 34574672 PMCID: PMC8469244 DOI: 10.3390/ijerph18189747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
This study explores the relationship between inpatient unit design and patient experience and how spatial features and visibility impact patients' perception of staff responsiveness. The first part of this study is a retrospective pre-post and cross-sectional study evaluating the impacts of unit design on patient experience at the unit level. This study compares patient experiences based on Press Ganey and HCAHPS surveys in two orthopedic units (existing unit in Atrium building and new unit in Tower) with differing design features at Rush University Medical Center. The chi-square test results show that when moving from the old orthopedic unit to the new unit, almost all patient survey items related to patient experience showed statistically significant improvements. The second part of this study is a room level on the new unit. The ANOVA and Pearson correlation tests revealed that the visibility measure of metric step depth had significant impacts on patients' perception of staff's "promptness in responding to call button" and "help with toileting". This study confirms that inpatient unit design plays a direct role in improvement for patient experience and should be considered as an important area of focus for future development.
Collapse
Affiliation(s)
- Hui Cai
- Institute of Health and Wellness Design, Department of Architecture, The University of Kansas, Lawrence, KS 66047, USA;
| | - Francis Fullam
- Health Systems Management, Rush University, Chicago, IL 60612, USA; (F.F.); (J.C.); (I.P.)
| | | | - Louis F. Fogg
- College of Nursing, Rush University, Chicago, IL 60612, USA;
| | - Jeff Canar
- Health Systems Management, Rush University, Chicago, IL 60612, USA; (F.F.); (J.C.); (I.P.)
| | - Irwin Press
- Health Systems Management, Rush University, Chicago, IL 60612, USA; (F.F.); (J.C.); (I.P.)
- Department of Anthropology, University of Notre Dame, Notre Dame, IN 46556, USA
| | | | | |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Mokarami H, Eskandari S, Cousins R, Salesi M, Kazemi R, Razeghi M, Choobineh A. Development and validation of a Nurse Station Ergonomics Assessment (NSEA) tool. BMC Nurs 2021; 20:83. [PMID: 34059027 PMCID: PMC8165804 DOI: 10.1186/s12912-021-00600-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nurse stations are one of the primary units for supporting effective functioning of any hospital. They are important working environments that demand adherence to known ergonomic principles for the well-being of both staff and patients. The aim of this study was to develop a psychometrically tested tool for the assessment of the ergonomic conditions of nurse workstations in hospitals. Methods Ten hospitals, with a total of 133 nurse stations participated in this mixed-methods research. The domains and items of the tool were developed based on a literature review, an experts’ panel, and interviews with nurses. Results The final nurse station ergonomic assessment (NSEA) tool has good psychometric properties. Validity was assessed by face validity and content validity. Reliability was evaluated using inter-rater agreement and test-retest reliability analyses with a four-week interval between assessments. The NSEA is comprised of 64 items across eight domains: layout and location (7 items), workspace (11 items), security-safety (5 items), environmental conditions (8 items), counter (8 items), chair (13 items), desk (9 items), and monitor (3 items). Conclusions The NSEA adds to the literature a tool for managers to ensure they comply with legal requirements and support best practice for those working on hospital wards. The NSEA can be used to identify challenges for healthcare professionals who use nurse stations and support the execution of targeted interventions to improve human-environment interactions. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00600-8.
Collapse
Affiliation(s)
- Hamidreza Mokarami
- Departemt of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Eskandari
- Departemt of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rosanna Cousins
- Department of Psychology, Liverpool Hope University, Liverpool, UK
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Reza Kazemi
- Departemt of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Choobineh
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, PO Box 71645-111, Shiraz, Iran.
| |
Collapse
|
14
|
Jimenez FE, Rich RK, Puumala SE, Kentfield M, Schoenholtz L, Brittin J. Effects of a Decentralized Nursing Model on Patient Outcomes in Two Rural Community Hospitals. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:157-173. [PMID: 33882751 DOI: 10.1177/19375867211006491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess hypothesized effects of decentralized nursing models on adult inpatient outcomes, patient medical records and satisfaction surveys were analyzed from two rural community hospitals that transitioned from centralized to decentralized nursing unit designs in 2015. BACKGROUND The objective to place nurses closer to patients precipitates broad use of decentralized nursing unit designs over models with centralized nurse stations. Decentralized models have been hypothesized to improve patient outcomes, but few studies have empirically measured effects. METHODS A cross-sectional, pre-post study used regression and interrupted time series models of adult inpatient data. Encounter-level patient records and survey responses across both sites were analyzed for a change in length of stay (LOS) and patient satisfaction from the preperiod (centralized) to the postperiod (decentralized). RESULTS LOS decreased in the postperiod compared to the preperiod at one site, and there was no change in LOS at the other. Patient satisfaction mostly improved at both hospitals in the decentralized model; however, most upward trends started prior to the move, with no change postmove. Patient satisfaction significantly improved regarding quietness at night and overall hospital rating at one hospital and decreased regarding receiving help as soon as wanted at the other hospital. These changes occurred at the time of the move but may not be solely attributable to the decentralized nursing model. CONCLUSIONS Overall, the results were mixed. One hospital experienced positive changes while the other did not, suggesting factors apart from nursing unit design are important to assess.
Collapse
Affiliation(s)
| | | | - Susan E Puumala
- Master of Public Health Program, 158382School of Health Sciences, University of South Dakota, Vermillion, SD, USA
| | | | | | | |
Collapse
|
15
|
Rich RK, Jimenez FE, Puumala SE, DePaola S, Harper K, Roy L, Brittin J. From Fable to Reality at Parkland Hospital: The Impact of Evidence-Based Design Strategies on Patient Safety, Healing, and Satisfaction in an Adult Inpatient Environment. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:65-82. [PMID: 33176490 DOI: 10.1177/1937586720970198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This research aimed to evaluate the quantitative effects of new hospital design on adult inpatient outcomes. BACKGROUND Tenets of evidence-based healthcare design, notably single-patient acuity-adaptable and same-handed rooms, decentralized nursing stations, onstage offstage layout, and access to nature were expected to promote patient healing and increase patient satisfaction, while decreasing adverse events. METHODS Patient healing was operationalized through length of stay (LOS) and patient safety through three adverse events: falls, hospital-acquired infections (HAI), and medication-related events. Standard patient surveys captured patient satisfaction. Patient records from 2013 through 2017 allowed for equivalent time periods surrounding the move to the new hospital in August 2015. Stratified by hospital division where significant, pre/post comparisons utilized proportional hazards or logistic regression models as appropriate; interrupted time series analyses afforded longitudinal interpretations. RESULTS Observed higher postmove LOS was due to previously increasing trends, not increases after the move. In surgical and trauma units, a constant increase in falls was unaffected by the move. Medication events decreased consistently over time; medication events with harm dropped significantly after the move. No change in HAI was found. Significant improvement on most relevant patient satisfaction items occurred after the move. Call button response decreased immediately after the move but subsequently improved. CONCLUSION Results did not clearly indicate a net change in adult inpatient outcomes of healing and safety due to the hospital design. There was evidence that the new hospital improved patient satisfaction outcomes related to the environment, including comfort, noise, temperature, and aesthetics.
Collapse
Affiliation(s)
| | | | - Susan E Puumala
- School of Health Sciences, University of South Dakota, Vermillion, SD, USA
| | - Sheila DePaola
- 21114Parkland Health and Hospital System, Dallas, TX, USA
| | - Kathy Harper
- Formerly of Parkland Health and Hospital System, Dallas, TX, USA
| | - Lonnie Roy
- 21114Parkland Health and Hospital System, Dallas, TX, USA
| | | |
Collapse
|
16
|
Loveday C, Lord H, Ellwood L, Bonnici K, Decker V, Fernandez R. Teamwork and social cohesion are key: Nurses' perceptions and experiences of working in a new decentralised intensive care unit. Aust Crit Care 2020; 34:263-268. [PMID: 32943307 DOI: 10.1016/j.aucc.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Decentralised nursing stations (DCNs) have gained popularity in new hospital designs owing to their positive impact on patient safety. However, the impact on the nurses' working environment and on continuity and quality of patient care is limited. OBJECTIVES The objective of this study was to describe nurses' perceptions and experiences of the working environment and of patient care in a decentralised intensive care unit (ICU). METHODS Twelve months after the establishment of the new decentralised ICU in a tertiary teaching hospital in Sydney, Australia, a prospective cross-sectional survey of registered nurses working in the unit was undertaken. Nurses' perceptions and experiences of the working environment and patient care were evaluated using a 56-item questionnaire comprising nine domains and optional open-ended comments. Quantitative data were analysed using SPSS, version 25. Qualitative data were used to enhance the quantitative data. RESULTS A total of 128 nurses responded to the questionnaire. The mean scores for overall job satisfaction, nursing teamwork, social cohesion, continuity of patient care, and quality of patient care were 3.02 (±0.91), 2.78 (±1.05), 2.68 (1.02), 2.60 (±1.01), and 3.48 (±0.88), respectively, for a maximum obtainable score of 5. Overall mean scores for teamwork, social cohesion, and continuity of patient care were explained by nurses to be a direct result of the physical layout of the new DCN ICU. Nurses believed this influenced their ability to interact with other staff and impacted teamwork and social cohesion and in turn reflected in their current job satisfaction. CONCLUSIONS Implementation of a new model of nursing care, whereby staff members are rostered together in a pod for a period of time, along with team-building exercises, is recommended to improve the social cohesion and teamwork within the DCN ICU. Further research on nurses' experiences within a DCN ICU is required to produce robust evidence and generalisability.
Collapse
Affiliation(s)
- Clare Loveday
- Intensive Care Services, St George Hospital, South Eastern Sydney Local Health District, Australia.
| | - Heidi Lord
- Centre for Research in Nursing and Health, St George Hospital, South Eastern Sydney Local Health District, Australia.
| | - Laura Ellwood
- Centre for Research in Nursing and Health, St George Hospital, South Eastern Sydney Local Health District, Australia.
| | - Kim Bonnici
- Intensive Care Services, St George Hospital, South Eastern Sydney Local Health District, Australia.
| | - Virginia Decker
- Intensive Care Services, St George Hospital, South Eastern Sydney Local Health District, Australia.
| | - Ritin Fernandez
- Centre for Research in Nursing and Health, St George Hospital, South Eastern Sydney Local Health District, Australia; School of Nursing, University of Wollongong, Australia.
| |
Collapse
|
17
|
Designing for Efficiency: Examining the Impact of Centralized and Decentralized Nurse Stations on Interdisciplinary Care Processes. J Nurs Adm 2020; 50:335-342. [PMID: 32433113 DOI: 10.1097/nna.0000000000000894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined the impact of centralized and decentralized unit designs on an interdisciplinary team's perceptions of efficiency through the use of a preoccupancy and postoccupancy evaluation of a cardiovascular unit. BACKGROUND During the premove study, the service line was housed across 4 separate locations, each with a centralized nurses' station. The postmove design was housed on 1 floor with decentralized stations. METHODS For this qualitative study, 14 focus groups and 1 interview were conducted. Analysis of the data was guided by a developed framework for efficiency classified into 7 categories. RESULTS Outcomes reveal that efficiency was impacted by issues including walking, access to supplies and equipment, proximity to staff, and overall unit configuration and size. CONCLUSIONS Although the design of the decentralized unit positions staff members closer to patients, many feel isolated while the centralized units seemed to better promote staff proximity and access to supplies.
Collapse
|
18
|
Real K, Santiago J, Fay L, Isaacs K, Carll-White A. The Social Logic of Nursing Communication and Team Processes in Centralized and Decentralized Work Spaces. HEALTH COMMUNICATION 2019; 34:1751-1763. [PMID: 30358423 DOI: 10.1080/10410236.2018.1536940] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This pre-post multi-method study explored how nurses made sense of changes in nurse station design and how they characterized communication processes within a hospital unit before and after it moved from an existing hospital into a newly designed trauma-1 level hospital. Quantitative observations (116 h) of real-time communication were gathered in both hospitals. Additionally, 41 nursing staff (nurses, nursing care technicians, nurse managers) participated in a qualitative study. Three months before moving, four focus groups were conducted with 16 nursing professionals working in traditional centralized nurse station units. One year later, four additional focus groups were conducted with 25 nursing staff in new decentralized units. The observational data resulted in two key findings: first, nursing staff participated in about 70 percent of interactions with nurses, techs, doctors, and families. Second, nursing communication decreased in decentralized units. In-depth qualitative analysis revealed that nursing communication was more frequent, relational and supportive in centralized spaces while distinguished by fragmentation and information exchange in decentralized units. Drawing upon theories of supportive design and healthcare systems, these findings illustrate how nurses in centralized units characterized communication as proximity, teamwork and relationships. Nurses in decentralized units described communication in terms of distance, fragmentation, and information exchange. Implications of this study suggest that centralized spaces may facilitate nursing communication while decentralized units are supportive of proximity to patients. Exploring how communication and design together constitute the logic of healthcare delivery contributes to our understanding of how communication processes comprise the social organization of nursing care.
Collapse
Affiliation(s)
- Kevin Real
- Department of Communication, University of Kentucky
| | | | - Lindsey Fay
- Department of Interiors, College of Design, University of Kentucky
| | - Kathy Isaacs
- Department of Nursing Professional Practice and Development, University of Kentucky Healthcare
| | | |
Collapse
|
19
|
Xuan X, Chen X, Li Z. Impacts of Nursing Unit Design on Visibility and Proximity and Its Influences on Communication, Privacy, and Efficiency. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 13:200-217. [PMID: 31707861 DOI: 10.1177/1937586719881443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study examines the role of visibility and proximity on nurse communication patterns, perception of privacy, and efficiency in double-corridor nursing units. BACKGROUND Nurses are extremely important for the quality of healthcare. The literature suggests that visibility and proximity have a substantial impact on the delivery of care and staff experience. However, few studies have empirically examined nursing units in China. METHOD Questionnaire surveys, observations, and simulations of medication administration tasks were employed. RESULTS Visibility and proximity influenced communication patterns, perceptions of privacy, and efficiency. The type of wall in the medication room could impact nurses' perception of privacy and efficiency. A partial glass wall in the medication room could achieve balance between privacy and visibility. A medication room that is adjacent to and is easily accessed from the nurse station (NS) could provide efficient communication and efficient work. The partition type between the NS and the doctor's office and the layout of the medication room could impact communication patterns. The relative position of the NS, medication room, and disposal room could influence the flow of medication administration tasks, and a geographically contiguous spatial layout could enhance work efficiency. CONCLUSIONS The findings contribute to the body of knowledge on the impact of visibility and proximity on nurses' communication patterns, perception of privacy, and efficiency. Recommendations to improve the design of double-corridor nursing units are also provided.
Collapse
Affiliation(s)
- Xiaodong Xuan
- Department of Architecture, College of Architecture & Art, Hefei University of Technology, China
| | - Xixi Chen
- Department of Architecture, College of Architecture & Art, Hefei University of Technology, China
| | - Zongfei Li
- Department of Architecture, School of Architecture and Urban Planning, Beijing University of Civil Engineering and Architecture, China
| |
Collapse
|