Associations of Patient and Staff Outcomes With Inpatient Unit Designs Incorporating Decentralized Caregiver Workstations: A Systematic Review of Empirical Evidence.

OBJECTIVES:: This systematic literature review synthesizes and assesses quality of research addressing associations of patient and staff outcomes with inpatient unit designs incorporating decentralized caregiver workstations. BACKGROUND:: A current hospital design trend is to include decentralized caregiver workstations on inpatient units. A review of literature addressing decentralized unit design is needed. METHODS:: The systematic review methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Database searches were conducted for studies published in peer-reviewed journals through October 2017. Included were empirical studies associating patient and/or staff outcomes and unit design with decentralized caregiver workstations. Individual studies were evaluated for quality using established methods, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) guided rigorous inspection of evidence quality and strength for quantitative outcomes and qualitative findings, respectively. RESULTS:: The search yielded 1,096 records with 36 full-text articles examined and 12 articles included in the final review. This work was dominated by studies with limited analyses. Staff outcomes have been most widely studied, especially collaboration/communication and walking. Overall, studies exploring decentralized nursing as a design intervention have produced limited results for both staff and patient outcomes. Strength of evidence of the current literature with quantitative methods as a whole was rated very low quality. CONCLUSIONS:: Although varying degrees of caregiver workstation decentralization in inpatient units are now common, the literature addressing the impacts of such designs is of very low quality and shows inconsistency in associated outcomes. Rigorous, well-designed studies with consistently defined design and outcome measures are needed for greater confidence in determining any effects of decentralized unit design.

A Systematic Literature Review of Empirical Studies on Decentralized Nursing Stations.

OBJECTIVES:: The objective of this systematic review of literature was to critically evaluate peer-reviewed evidence regarding the effectiveness of decentralized nurse stations (DNSs). BACKGROUND:: The DNS has become an important topic in healthcare design research and practice over the past decade with aims of improving staff efficiency and patient experience. Research has shown to be inconclusive, with studies reporting an assortment of mixed findings. METHOD:: A systematic review of literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses search process of electronic databases, citation tracking, and manual searches of references. All authors evaluated the studies independently. Studies included were empirical, peer-reviewed investigations of DNS in hospitals over the past 15 years. Each study was evaluated using an accepted healthcare design evaluation framework. RESULTS:: Over 200 studies were identified. After exclusions, 21 studies published since 2003 were available for full evaluation. Key findings from this review include (a) there is a positive trend toward patient experience in units with DNS, (b) nursing teamwork was perceived to decline in units with DNS, (c) methodological issues may be responsible for the mixed and inconsistent findings, and (d) there is no consistent categorization of nurse station typology or standard definition for DNS. CONCLUSIONS:: Based on the evaluation framework, DNS are supportive of the patient experience yet have a negative impact on nursing teamwork. Higher quality studies are needed to classify specific typologies of DNS and account for elements such as patient care models, communication, visibility, and other patient care-related factors.

Improved usability of a multi-infusion setup using a centralized control interface: A task-based usability test.

The objective of this study was to assess the usability benefits of adding a bedside central control interface that controls all intravenous (IV) infusion pumps compared to the conventional individual control of multiple infusion pumps. Eighteen dedicated ICU nurses volunteered in a between-subjects task-based usability test. A newly developed central control interface was compared to conventional control of multiple infusion pumps in a simulated ICU setting. Task execution time, clicks, errors and questionnaire responses were evaluated. Overall the central control interface outperformed the conventional control in terms of fewer user actions (40±3 vs. 73±20 clicks, p<0.001) and fewer user errors (1±1 vs. 3±2 errors, p<0.05), with no difference in task execution times (421±108 vs. 406±119 seconds, not significant). Questionnaires indicated a significant preference for the central control interface. Despite being novice users of the central control interface, ICU nurses displayed improved performance with the central control interface compared to the conventional interface they were familiar with. We conclude that the new user interface has an overall better usability than the conventional interface.

Effects of Unit Design on Acute Care Nurses' Walking Distances, Energy Expenditure, and Job Satisfaction: A Pre-Post Relocation Study.

OBJECTIVES: The purpose of this study was to determine what differences occurred in steps taken and energy expenditure among acute care nurses when their work environment moved from a hospital with centralized nurses' stations to a hospital with decentralized nurses' stations. Additional goals were to determine design features nurses perceived as contributing to or deterring from their work activities and what changes occurred in reported job satisfaction. Since design features can also affect patient outcomes, patient falls were monitored. BACKGROUND: The construction of a replacement facility for a 224-bed Level 1 trauma center provided the opportunity to compare the effects of centralized versus decentralized nurses' stations on nurses' experiences of their work environments. METHOD: A pre-post quasi-experimental design was used. RN participants completed an open-ended questionnaire and recorded pedometer data at the end of each shift, working for 3-month pre-relocation and for 3-month post-relocation. Nine months passed between the move and post-relocation data collection. RESULTS: There were significant reductions in nurses' energy expenditure ( p < .001) and steps taken ( p = .041) post-relocation. Overall, nurses' job satisfaction was high and improved post-relocation, and patient falls decreased by 55%. CONCLUSIONS: Post-relocation, a number of the dissatisfiers associated with the physical environment were eliminated, and nurses identified more satisfiers (in general and related to the physical environment). Patients are safer post-relocation as indicated by a decrease in falls. This decrease is even more noteworthy when considering that the numbers of patient beds on each unit is higher post-relocation.

An empirical examination of the impacts of decentralized nursing unit design.

OBJECTIVE: The objective of the study was to examine the impact of decentralization on operational efficiency, staff well-being, and teamwork on three inpatient units. BACKGROUND: Decentralized unit operations and the corresponding physical design solution were hypothesized to positively affect several concerns-productive use of nursing time, staff stress, walking distances, and teamwork, among others. With a wide adoption of the concept, empirical evidence on the impact of decentralization was warranted. METHODS: A multimethod, before-and-after, quasi-experimental design was adopted for the study, focusing on five issues, namely, (1) how nurses spend their time, (2) walking distance, (3) acute stress, (4) productivity, and (5) teamwork. Data on all five issues were collected on three older units with centralized operational model (before move). The same set of data, with identical tools and measures, were collected on the same units after move in to new physical units with decentralized operational model. Data were collected during spring and fall of 2011. RESULTS: Documentation, nurse station use, medication room use, and supplies room use showed consistent change across the three units. Walking distance increased (statistically significant) on two of the three units. Self-reported level of collaboration decreased, although assessment of the physical facility for collaboration increased. CONCLUSIONS: Decentralized nursing and physical design models potentially result in quality of work improvements associated with documentation, medication, and supplies. However, there are unexpected consequences associated with walking, and staff collaboration and teamwork. The solution to the unexpected consequences may lie in operational interventions and greater emphasis on culture change.

Centralized vs. Decentralized Nursing Stations: An Evaluation of the Implications of Communication Technologies in Healthcare.

OBJECTIVE: This study aims to explore the relationship between the nursing station design and use of communication technologies by comparing centralized and decentralized nursing stations. BACKGROUND: The rapid changes in communication technologies in healthcare are inevitable. Communication methods can change the way occupants use a space. In the meantime, decentralized nursing stations are emerging as a replacement for the traditional centralized nursing stations; however, not much research has been done on how the design of nursing stations can impact the use of communication technologies. METHODS: A cross sectional study was conducted using an Internet-based survey among registered nurses in a Southeastern hospital in the United States. Two units with centralized nursing stations and two units with decentralized nursing stations were compared in terms of the application of communication technologies. A total of 70 registered nurses completed the survey in a 2-week period. RESULTS: The results revealed no significant differences between centralized and decentralized nursing stations in terms of frequency of communication technologies used. However, a difference was found between perception of nurses toward communication technologies and perceptions of the use of communication technologies in decentralized nursing stations. CONCLUSIONS: Although the study was limited to one hospital, the results indicate that nurses hold positive attitudes toward communication technologies. The results also reveal the strengths and weaknesses of each nursing station design with regard to communication technologies. KEYWORDS: Hospital, interdisciplinary, nursing, technology, work environment.

Healthy work environments for the ageing nursing workforce.

AIM: The aim of this article is to describe the physical challenges that ageing nurses experience and the facility design features that can promote healthy work environments to motivate nurses to continue working. BACKGROUND: Older nurses are working longer and beyond the usual retirement age. They often experience chronic fatigue and the usual physical and cognitive changes associated with aging. Nursing is a physically demanding profession and many older nurses work in pain while providing direct patient care. The literature is replete with studies focusing on the organisational factors that retain older nurses, but little research addresses design factors that facilitate nurses working longer and more safely in direct patient care. EVALUATION: Electronic databases in medicine, nursing, psychology, and architecture were searched and evidence-based, non-evidence-based, and review articles and government and organisational newsletters were evaluated. KEY ISSUES: Hospital design can help address the physical work challenges that older nurses experience. CONCLUSIONS: Older nurses have a wealth of knowledge and expertise, and the design of nursing units can optimize their work experience. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse Managers must participate in design efforts and advocate designs that support aging nurses.

Levels and sources of sound in the intensive care unit - an observational study of three room types.

BACKGROUND: Many intensive care unit (ICU) patients describe noise as stressful and precluding sleep. No previous study in the adult setting has investigated whether room size impacts sound levels or the frequency of disruptive sounds. METHODS: A-frequency S-time weighted equivalent continuous sound (LAS eq), A-frequency S-time weighted maximum sound level (LAS max) and decibel C peak sound pressure (LC peak) were measured during five 24-h periods in each of the following settings: three-bed room with nursing station (NS) alcove, single-bed room with NS alcove (1-BR with NSA) and single-bed room with bedside NS. Cumulative restorative time (CRT) (> 5 min with LAS max < 55 dB and LC peak < 75 dB) was calculated to describe calm periods. Two 8-h bedside observations were performed in each setting in order to note the frequency and sources of disruptive sounds. RESULTS: Mean sound pressure levels (LAS eq) ranged between 52 and 58 dBA, being lowest during night shifts. There were no statistically significant differences between the room types in mean sound levels or in CRT. However, disruptive sounds were 40% less frequent in the 1-BR with NSA than in the other settings. Sixty-four percent of disruptive sounds were caused by monitor alarms and conversations not related to patient care. CONCLUSIONS: Single-bed rooms do not guarantee lower sound levels per se but may imply less frequent disruptive sounds. Sixty-four percent of disruptive sounds were avoidable. Our findings warrant sound reducing strategies for ICU patients.

Developing a virtual nurses' station for community-based nurses.

Nurses who work throughout the community need a nurses' station, just as nurses who work in a hospital. The nurses' station is the area where communication, information sharing, and documentation occur. This article describes how a virtual nurses' station was created using Blackboard technology to meet the needs of nurses who are scattered throughout a geographic area. These nurses work in several urban neighborhoods to conduct the outreach services offered through an academic nurse-managed wellness center to community-dwelling older adults. Results have been positive as the virtual nurses' station provides the nurses an area to exchange data and information, print patient health care information, and access nursing policies. Satisfaction surveys from the nurses give valuable input on the design and use of the virtual nurses' station.