The Social Logic of Nursing Communication and Team Processes in Centralized and Decentralized Work Spaces.

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.

Using Systems Theory to Examine Patient and Nurse Structures, Processes, and Outcomes in Centralized and Decentralized Units.

OBJECTIVES: This study utilizes systems theory to understand how changes to physical design structures impact communication processes and patient and staff design-related outcomes. BACKGROUND: Many scholars and researchers have noted the importance of communication and teamwork for patient care quality. Few studies have examined changes to nursing station design within a systems theory framework. METHOD: This study employed a multimethod, before-and-after, quasi-experimental research design. Nurses completed surveys in centralized units and later in decentralized units ( N = 26pre, N = 51post). Patients completed surveys ( N = 62pre) in centralized units and later in decentralized units ( N = 49post). Surveys included quantitative measures and qualitative open-ended responses. RESULTS: Patients preferred the decentralized units because of larger single-occupancy rooms, greater privacy/confidentiality, and overall satisfaction with design. Nurses had a more complex response. Nurses approved the patient rooms, unit environment, and noise levels in decentralized units. However, they reported reduced access to support spaces, lower levels of team/mentoring communication, and less satisfaction with design than in centralized units. Qualitative findings supported these results. Nurses were more positive about centralized units and patients were more positive toward decentralized units. CONCLUSION: The results of this study suggest a need to understand how system components operate in concert. A major contribution of this study is the inclusion of patient satisfaction with design, an important yet overlooked fact in patient satisfaction. Healthcare design researchers and practitioners may consider how changing system interdependencies can lead to unexpected changes to communication processes and system outcomes in complex systems.

Emergency Nurses' Perceptions of Efficiency and Design: Examining ED Structure, Process, and Outcomes.

INTRODUCTION: Due to increasing demands, it is imperative for emergency departments to improve efficiency, while providing safe and effective care. Efficient and quality healthcare delivery are impacted by interactions among the emergency department's physical structure, processes, and outcomes. Examining the interrelationship between these three components is essential for assessing quality of care in the ED setting. Studies simultaneously investigating all three aspects of this model are rare. OBJECTIVES: To study examined emergency nurses' perceptions of efficiency and satisfaction with the design of a newly constructed academic emergency department through analysis of these three assessment factors. METHODS: Data were collected using observational techniques, physical measurements of walking, and staff questionnaires. Correlation analysis was employed to investigate the relationships among specific structure, process, and outcome factors. Hierarchical linear regression was conducted to understand which structure and process variables in particular were related to the dependent variable, perceptions of efficiency and staff satisfaction with design. RESULTS: Outcomes revealed that all of the structure and process factors examined in this emergency department including unit configuration, technology, lighting, visibility, patient room layout, storage, walkability, staff stress, data access, and teamwork were significantly associated with perceptions of efficiency and staff satisfaction with design. DISCUSSION: The findings suggest that the structure of the built environment can shape healthcare processes occurring within it and ultimately improve the delivery of efficient care, thus increasing both patient and staff satisfaction. As such, the designed environment has a critical impact on enhancing performance, productivity, and staff satisfaction.

Shifting Landscapes: The Impact of Centralized and Decentralized Nursing Station Models on the Efficiency of Care.

OBJECTIVE: The focus of this research was to analyze the impact of decentralized and centralized hospital design layouts on the delivery of efficient care and the resultant level of caregiver satisfaction. BACKGROUND: An interdisciplinary team conducted a multiphased pre- and postoccupancy evaluation of a cardiovascular service line in an academic hospital that moved from a centralized to decentralized model. This study examined the impact of walkability, room usage, allocation of time, and visibility to better understand efficiency in the care environment. METHOD: A mixed-methods data collection approach was utilized, which included pedometer measurements of staff walking distances, room usage data, time studies in patient rooms and nurses' stations, visibility counts, and staff questionnaires yielding qualitative and quantitative results. RESULTS: Overall, the data comparing the centralized and decentralized models yielded mixed results. This study's centralized design was rated significantly higher in its ability to support teamwork and efficient patient care with decreased staff walking distances. The decentralized unit design was found to positively influence proximity to patients in a larger design footprint and contribute to increased visits to and time spent in patient rooms. CONCLUSION: Among the factors contributing to caregiver efficiency and satisfaction are nursing station design, an integrated team approach, and the overall physical layout of the space on walkability, allocation of caregiver time, and visibility. However, unit design alone does not solely impact efficiency, suggesting that designers must consider the broader implications of a culture of care and processes.

Coming Full Cycle.

PURPOSE: This article illustrates a collaborative, full cycle diagnostic postoccupancy evaluation (POE) conducted in an emergency department (ED) to demonstrate methods of planning a POE, conducting research to capture meaningful data, and applying outcomes through the use of a design charrette. BACKGROUND: POEs often end with the reporting of findings rather than suggesting how this knowledge feeds forward. A design charrette presents an opportunity to engage with POE evidence and integrate research into practice. METHODS: Planning for the POE resulted in a multiphased, multimethodological study. Data collection and analysis utilized objective and subjective measures yielding both qualitative and quantitative data. The design charrette then served as an interactive method to assist design practitioners in both understanding and applying the research findings in the redesign of the entry/triage sequence of the ED. RESULTS: POE findings revealed four key issues impacting the ED experience. These include workflow, communication, privacy and confidentiality, and safety and security. In analyzing the use of the charrette to link POE findings to design application, it was determined that the charrette should include an all-inclusive, collaborative process, easily interpreted evidence, active participant engagement, and feasible outcomes grounded in research. CONCLUSION: Taking the POE process full cycle is a critical component in bridging the gap between research and its application to design. The charrette process offers a positive mark of completion to the POE and helps participants gain sensitivity to the importance of evidence-based decision-making.

One size does not fit all: a diagnostic post-occupancy evaluation model for an emergency department.

OBJECTIVE: This study presents a detailed account of processes and multiple methodologies used in conducting a diagnostic post-occupancy evaluation (POE) in an urban hospital emergency department. BACKGROUND: Healthcare design POE research findings can lead to improved work environments for healthcare providers and higher levels of staff, patient, and visitor satisfaction. METHODS: This evaluation was conducted in two separate phases over 12 months, with data analysis occurring after each phase. Phase 1 involved 200 hours of observation, physical measurements, and occupancy counts. Phase 2 included surveys (n = 315) of staff, visitors, and patients. In addition, eight distinct staff focus groups (e.g., Nursing, Housekeeping, Physician, etc.) were conducted. RESULTS: To illustrate the process, one healthcare design-related issue, privacy and confidentiality, was assessed in light of the linear design model with a central core. Phase 1 observation results indicated that most confidential conversations were contained within the linear core. However, Phase 2 focus groups revealed that many staff members had concerns regarding the level of privacy and confidentiality due to the core's open design. The use of multiple methods provided greater information and a more comprehensive picture of the emergency department environment and design. CONCLUSIONS: This study presents a comprehensive framework for diagnostic post-occupancy evaluation in healthcare design. The findings indicate that a systematic, multi-methodological approach developed around a conceptual framework can lead to higher quality evaluations. Diagnostic POEs should be grounded in extant literature and customized based on the setting, the client's guiding principles, and the design team's objectives. In diagnostic POEs, one size does not fit all. KEYWORDS: Case study, design process, interdisciplinary, post-occupancy, privacy and confidentiality.