Exploring the Relationship Between Perceived Visual Access to Nature and Nurse Burnout

The Relationship Between Rest Breaks and Professional Burnout Among Nurses

BACKGROUND

Professional burnout is a well-studied phenomenon marked by feelings of depersonalization, emotional exhaustion, and decreased accomplishment. Affecting nearly half of all nurses, burnout presents a threat to health outcomes of the nurse, patient, organization, and society. Despite a growing literature on professional burnout, specific interventions that address key contributing factors have not been well described.

OBJECTIVE

The primary aim of this integrative literature review was to evaluate the relationship between rest breaks and professional burnout among registered nurses.

METHODS

A literature search was performed in the APA (American Psychological Association) PsycInfo, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Cochrane Library, Embase, and PubMed databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a reporting guideline.

RESULTS

Five articles were selected for final synthesis; 1 was of "high" quality and 4 were of "good" quality. The literature showed that rest breaks were protective against professional burnout among registered nurses, especially when integrated with nursing management support, staffing support, and complementary strategies. Several threats to validity were identified as limitations among the articles selected for final synthesis.

CONCLUSIONS

Rest breaks are effective in decreasing professional burnout among registered nurses, especially when combined with management support, staffing support, and complementary strategies. Future research should focus on a deeper evaluation of staffing support models, as well as identifying how nursing leaders can integrate complementary strategies across health care settings to reduce burnout.

Therapeutic Hospital Gardens: Literature Review and Working Definition

AIM

This review explores the role of purposefully designed and well-integrated therapeutic hospital gardens (THGs) for the benefits of patients, their families, and staff.

BACKGROUND

Significant benefits are realized when people are in contact with nature in the city. Although hospital gardens are prevalent and the beneficial effects of nature on health are widely acknowledged, the establishment of a consistent definition for hospital gardens that promote health is vital to attain reliable and quantifiable health outcomes.

METHODS

Twenty-eight peer-reviewed journals were critiqued for the period of 2016-2021 and updated with 12 articles from 2021 to 2023 to analyze and synthesize the latest thinking and development in this emergent field. Subsequently, current books and exemplar practice literature were synthesized with the results of the literature review to produce a working definition of THGs.

RESULTS

Three themes and 14 subthemes were established showing the interconnectedness of THG definition, user needs and experiences, and the benefits and values of THGs. Two original findings can be established-a need to have a consensus on terminology and to establish design processes. The working definition was produced as a foundational step to guide stakeholders in implementing THGs.

CONCLUSION

THGs can play a role in improving well-being when they are purposefully designed and well-integrated in hospital programs and health policy. Hospital CEOs, designers, and healthcare experts can use the findings and working definition to assist the establishment of such health promoting gardens.

Evidence-Based Design in the Hospital Environment: A Staff's Burnout Study in the COVID-19 Era

OBJECTIVE

This study aimed to evaluate the evidence-based design of the hospital physical space effect on the burnout of nurses and physicians during COVID-19. The research question was to identify the connection between daylight, nature-view windows, and hospital staff burnout during Covid-19.

BACKGROUND

The evidence-based design in the hospital environment affects the health of the medical staff. The promotion of the hospital environment has a significant effect on healthcare system improvement.

METHODS

This cross-sectional study was performed on 406 nurses and physician's burnout in Guilan province in 2020. Three questionnaires were used: demographic, physical space of the hospital, daylight, nature-view windows, and Maslach Burnout Inventory. Logistic regression (LR) analysis was used to determine the association between burnout and the hospital environment. The significance level was considered with p < .05.

RESULTS

The results showed statistically significant correlations between patient units and the environmental characteristics of the hospitals with staff's burnout (p < .001). Of note, 62.9% of physicians and 71.9% of nurses had moderate work-related burnout. The highest burnout score was seen among staffs of emergency departments adjusted multivariate LR model revealed that 27.1% of work-related burnout in nurses and physicians was predictable with age, light, marital status, and hospitals. Our results showed that accessing more daylight could reduce burnout (p = .018, odds ratio [OR] = 0.910).

CONCLUSION

Based on the result, the daylight impact on burnout reduction is more significant than other factors. It is suggested that adequate lighting, proper environmental design, and nature-view windows could create appropriate space for enhancing medical staff satisfaction and reducing burnout.

The Role of Healthcare Facility Design on the Mental Health of Healthcare Professionals: A Literature Review

OBJECTIVE

This study aims to review and synthesize the empirical evidence about the connection between healthcare facility design and the mental health of healthcare professionals by reviewing the relevant literature.

BACKGROUND

Mental exhaustion of healthcare professionals is becoming a critical issue in healthcare, especially during the pandemic. The physical design of healthcare facilities has significant potential to reduce and prevent the mental exhaustion of healthcare professionals by removing environmental stressors and providing restorative experiences. However, the built environment is not fully utilized as an intervention to support healthcare professionals.

METHODS

Relevant articles were identified from the Medline, PsycINFO, PubMed, and Web of Science databases using a combination of search terms representing environmental design factors and health outcomes. Identified articles were reviewed by their titles, abstracts, and full texts using the inclusion and exclusion criteria.

RESULTS

The search yielded 27 empirical articles investigating the relationships between environmental design factors and staff mental health outcomes, including stress, fatigue, job satisfaction, burnout, and well-being. Healthcare design aspects that were investigated in the identified articles include overall facility and perception (e.g., aesthetic appeal and impression, belonging to the surroundings, safety), specific spaces (e.g., patient area, staff workspace), intangible elements (e.g., exterior view, light, sound), and interior space and ergonomics (e.g., material finishes, furniture).

CONCLUSIONS

Through the synthesis of the current literature regarding the relationships between healthcare facility design and the mental health of healthcare professionals, this study provides implications for supporting healthcare professionals through the design of the healthcare facility.

Hospital Outdoor Spaces as Respite Areas for Healthcare Staff During the COVID-19 Pandemic

The COVID-19 pandemic has created considerable implications for healthcare staff around the globe. During the pandemic, the frontline healthcare workers experience intense anxiety, stress, burnout, and psychological breakdown, with severe implications on their mental and physical well-being. In addition to these implications, anxiety and stress can hinder their productivity and ability to perform their duties efficiently. The literature indicates that hospital gardens and contact with nature can help alleviate psychological distress among hospital staff. However, few studies investigated the role of outdoor spaces as areas for respite and work breaks in healthcare facilities during the pandemic. The present opinion paper highlights the challenges of job stress and psychological distress health workers face during the pandemic. This article also underscores the role of hospital outdoor spaces and garden facilities in coping with the challenges. While other measures to reduce stress among hospital staff and ensure their health and safety are important, hospital administrators and relevant government agencies should also emphasize the provision of gardens and open spaces in healthcare facilities. These spaces can act as potential areas for respite for hospital staff to help them cope with the stress and anxiety accumulated through working under crises.

Influence of Hospital Outdoor Rest Space on the Eye Movement Measures and Self-Rating Restoration of Staff

Objective

To investigate the effect of hospital outdoor rest space on the eye movement measures and self-rating restoration of staff.

Background

Relieving the pressure of hospital staff through exposure to hospital outdoor rest space is essential, but there is a scarcity of research on the impact of hospital outdoor rest space on the eye movement measures and self-rating restoration of staff, especially for large Chinese hospitals.

Methods

Cross-analysis was conducted based on the eye movement measures of 76 staff members obtained by eye movement tracking equipment in combination with the self-rating restoration scale and hospital outdoor rest space picture attributes (element proportion and position, brightness and saturation).

Results

The differences in eye movement measures of different staff attributes (occupation, age, and gender) were identified, and the effects of hospital outdoor rest space picture attributes on the eye movement measures and self-rating restoration scale of staff were summarized. A number of proposals were also formulated: hospital outdoor rest space should be set up close to the working area of the group of medical staff; attention should be paid to the actual needs of senior staff members and the work pressure of junior nurses; the exposure to natural environment should be increased and the proportion of hard artificial elements should be reduced; the natural environment should be placed in the visual center; the saturation and brightness of hospital outdoor rest space should be increased; and staff members should have access to the sky environment in a variety of ways.

Conclusion

The present study is an empirical study of evidence-based design on hospital outdoor rest space in China, and the results reveal the effects of hospital outdoor rest space on the eye movement measures and self-rating restoration of staff.

Assessing Preferences and Perceived Restorative Qualities of Break Spaces for Nurses in China

OBJECTIVE

This study investigated Chinese nurses' preferences for (a) proximity of break areas, (b) functionality of break areas, (c) amenities, and (d) nature-related environmental features.

BACKGROUND

While nurses in China need support to adequately perform their jobs, little is known about how restorative spaces impact their mental and physical health.

METHODS

Data were collected through interviews (N = 12), survey questionnaires (N = 88), and visual assessments (N = 88) from nurses who worked in inpatient settings in China.

RESULTS

Nurses preferred the break room to be close to nursing stations; to have visual privacy from patients; and to provide space and facilities for drinking, taking naps, dining, and chatting with colleagues. Balconies and windows were shown to have a significant restorative effect. Well-designed break areas were perceived to have positive impacts on nurse perceived levels of well-being and increase nurses' satisfaction levels with their work environment.

CONCLUSION

The study outcomes emphasize the importance of restorative spaces for inpatient nurses and recommend including natural elements in the break rooms.

Caring for COVID-19 infected patients admitted to redesignated coronavirus ICUs: Impact on nurse stress and burnout

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic globally impacted healthcare due to surges in infected patients and respiratory failure. The pandemic escalated nursing burnout syndrome (NBS) across the workforce, especially in critical care environments, potentially leading to long-term negative impact on nurse retention and patient care. To compare self-reported burnout scores of frontline nurses caring for COVID-19 infected patients with burnout scores captured before the pandemic and in non-COVID-19 units from two prior studies.

METHODS

The descriptive study was conducted using frontline nurses working in eight critical care units based on exposure to COVID-19 infected patients. Nurses were surveyed in 2019 and in 2020 using Maslach Burnout Inventory (MBI), Well Being Instrument, and Stress-Arousal Adjective Checklist (SACL) instruments. Researchers explored relationships between survey scores and working in COVID-19 units.

RESULTS

Nurses working in COVID-19 units experienced more emotional exhaustion (EE) and depersonalization (DP) than nurses working in non-COVID units (p= .0001). Pre-COVID nurse burnout scores across six critical care units (EE mean = 15.41; p= .59) were lower than burnout scores in the COVID-19 intensive care units (EE mean = 10.29; p= .74). Clinical significance (p= .08) was noted by an EE subscale increase from low prepandemic to moderate during the pandemic.

CONCLUSION

Pinpointing associations between COVID-19 infection and nurse burnout may lead to innovative strategies to mitigate burnout in those caring for the most critically ill individuals during future pandemics. Further research is required to establish causal relationships between sociodemographic and work-related psychological predictors of NBS.

The HDR CARE Scale, Inpatient Version: A validated survey instrument to measure environmental affordance for nursing tasks in inpatient healthcare settings

Rigorous healthcare design research is critical to inform design decisions that improve human experience. Current limitations in the field include a lack of consistent and valid measures that provide feedback about the role of the built environment in producing desirable outcomes. Research findings about nurses’ efficiency, quality of care, and satisfaction related to inpatient unit designs have been mixed, and there was previously no validated instrument available to quantitatively measure nurses’ ability to work efficiently and effectively in their environment. The objective of this study was to develop, refine, and validate a survey instrument to measure affordance of the care environment to nurse practice, based on various aspects of their work in inpatient units. The HDR Clinical Activities Related to the Environment (CARE) Scale Inpatient Version was developed using item design, refinement, and reliability and validity testing. Psychometric methods from classical test theory and item response theory, along with statistical analyses involving correlations and factor analysis, and thematic summaries of qualitative data were conducted. The four-phase process included (1) an initial pilot study, (2) a content validation survey, (3) cognitive interviews, and (4) a final pilot study. Results from the first three phases of analysis were combined to inform survey scale revisions before the second pilot survey, such as a reduction in the number and rewording of response options, and refinement of scale items. The updated 9-item scale showed excellent internal consistency and improved response distribution and discrimination. The factor analysis revealed a unidimensional measure of nurse practice, as well as potential subscales related to integration, efficiency, and patient care. Within the healthcare design industry, this scale is much needed to generate quantitative and standardized data and will facilitate greater understanding about the aspects of an inpatient healthcare facility that best support nurses’ ability to provide quality patient care.

Exploring the Relationship between Window View Quantity, Quality, and Ratings of Care in the Hospital

Hospital ratings reflect patient satisfaction, consumer perception of care, and create the context for quality improvement in healthcare settings. Despite an abundance of studies on the health benefits of the presence and content of window views, there is a gap in research examining how these features may impact patient satisfaction and consumer perceptions of the quality of care received. A quantitative exploratory study collected data from 652 participants regarding their previous stay in the hospital, their perception of windows in their room, and their perception of their room, the hospital, and the quality of care received. On a scale of 0–10, participants with access to windows gave a 1-unit higher rating for the hospital. Access to window views from their bed provided a 1-unit increase, and having a view to green spaces resulted in a 2-unit increase in hospital ratings. Statistically significant results were also found for room ratings and care ratings. Windows in the patient rooms impact the key patient satisfaction measures and patient experience during the hospital stay. Patient room design, bed set up, and quantity and quality of window views may play an important role in shaping the patient’s experience.