The Impact of Infusion Center Layout on Workflow and Satisfactions in Two Cancer Infusion Centers: A Case Study on Staff and Patients.

OBJECTIVE: The objective of this empirical research is to compare nurses' operational workflow and nurses' and patients' satisfactions of two different infusion center designs. One center has a traditional open bay design and the other has semi-private bays. This study also intends to gather baseline data to compare to a future post-occupancy evaluation of a new infusion center where the two existing centers will be combined. BACKGROUND: The increasing number of patients with cancer diagnosis who refer to infusion centers highlights the importance of design of these centers. METHOD: The mixed-method approach of this study involves shadowing nurses and surveying nurses and patients. Data collection captured nurses' activities, activity durations, and nurses' and patients' satisfaction with the design of clinics. RESULTS: Comparison of shadowing data indicated that although the infusion centers have different layouts, there are no significant differences in the activities or time spent by nurses in different areas among the centers. Staff, however, have different satisfaction levels with visual and speech privacy, ability to concentrate without distraction, collaboration with other staff, and the process of medication delivery. Patients also had slightly different satisfaction levels with their ability to communicate with staff and design of bays. CONCLUSION: This research sheds light on operational workflows and satisfaction of staff and patients in two different infusion center design. Considering the limited studies on these settings, this study serves as baseline data to compare to other studies on cancer infusion centers and addresses issues of benchmarking and staff and patient satisfaction.

Impacts of Nursing Unit Design on Visibility and Proximity and Its Influences on Communication, Privacy, and Efficiency.

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.

Knowledge, beliefs and practices on antibiotic use and resistance among a group of trainee nurses in Sri Lanka.

OBJECTIVES: Nurses are the main communication link for healthcare messages to hospitalized patients and also play a crucial role in preventing the emergence and spread antibiotic resistant bacteria through antibiotic stewardship and infection control programmes. This requires them to possess correct knowledge and attitudes towards antibiotic use and resistance. This study was carried out to identify the level of knowledge, attitude and practices on antibiotic use and antibiotic resistance among student nurses. RESULTS: A descriptive cross-sectional study was conducted using a pre-validated, self-administered questionnaire with closed and open ended questions, among 199 student nurses at a government nurses training school in Sri Lanka. Scores and proportions were analysed with non-parametric methods and thematic analysis was done for the qualitative data. The study cohort had a mean knowledge score of 71.9% (SD 14). However, close to 40% believed that taking antibiotics will help to prevent cold from worsening and make recovery faster. Infection control was identified as the main method that nurses can engage in preventing antibiotic resistance. While the knowledge among our study cohort appeared to be good, some misbeliefs were present. Our findings can be used in developing the nursing curricula on antibiotic use and resistance.

An Empirical Examination of Nursing Units in China Based on Nurse Experience.

OBJECTIVES:: To create opportunities to increase nursing staff's satisfaction and operational efficiency and eventually improve nurses' experiences through better design in unit layout. BACKGROUND:: The majority of research performed on nursing units in China only focused on the spatial design itself, and few studies examined the nursing unit empirically based on nurses' experience. Nursing units need to be designed with understanding nurses' behavior and experience in China. METHOD:: A mixed-method approach was conducted in four double-corridor nursing units in China. Observation and interview data were collected to explore how physical environments for managing administrative duties, medications, and caring patient were used in nursing units. RESULTS:: The most frequent activities were communication, medication, and patient-care activities. The places in which nurses spent the most of theirs working times were the nurse station (NS), patient room, workstation on wheels (WoW), and medication room. The important clinical work spaces were the patient room, NS, WoW, medication room, doctor's office, disposal room, examining room, and back corridor. The important traffic linkages were between NS and medication room, patient room and WoW, and medication room and patient room. CONCLUSIONS:: This article revealed the frequency of nurse activities; how they spent their time; how they use the clinical spaces; identified important clinical spaces, linkages, and driver of inefficiency in nursing work and nursing unit design; and finally generated recommendations for double-corridor nursing unit design in China which can be used by medical planner, hospital administrator.

Exploring the Relationships Between Patient Room Layout and Patient Satisfaction.

This retrospective, exploratory study examined 8,366 patient responses to surveys on patient satisfaction and patient room spatial layout in a large academic teaching hospital consisting of 17 nursing units and 382 patient rooms. This study included four spatial measures: average distance to the nurse station, room handedness, location of bed, and location of first encounter-and explored their statistical associations with two types of patient satisfaction surveys (Hospital Consumer Assessment of the Healthcare Provider and Systems and third party). The study had two phases: a preliminary study of 3,751 patient respondents in a limited diagnosis-related group (DRG) over 5 years and a general study of 4,615 patient respondents with a broader range of DRG's over 2 different years from the preliminary study. Findings indicated statistically significant relationships between all four spatial layout measures and specific survey questions pertaining to perception of nursing, physician, individual care, and overall room environment. Results emphasize the importance of hospital design-and spatial layout in particular-on patient satisfaction.

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.

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.

Noise Levels in Patient Rooms and at Nursing Stations at Three VA Medical Centers.

OBJECTIVES: To conduct an assessment of sound, dB(A) levels, in two areas of the hospital: patient rooms and nurse stations using sound meters (SMs). BACKGROUND: The World Health Organization (WHO) recommends sound levels of 35 dB(A) during the day and 30 dB(A) during the night; however, many hospitals exceed these recommended levels. Assessing post-occupancy sound levels enables hospital administrators and healthcare workers to identify whether interventions to improve sound levels are needed. METHODS: Sound assessments were conducted at three healthcare facilities in both patient rooms and nursing stations, and we include information on facility characteristics. An Amprobe SM-20A Sound Level Meter was placed for a 24-hr period and recorded decibel levels every 8 min. These sound levels were averaged for each hour for reporting purposes. Averages as well as highest and lowest readings are reported for both daytime (8 a.m.-10 p.m.) and nighttime (10 p.m.-8 a.m.) for each facility. RESULTS: All three sites are considered urban and are classified with the highest complexity level (1a). Average daytime measurements for patient rooms and their corresponding nurses stations were as follows: Site A-63 dB(A)/56 dB(A), Site B-52 dB(A)/55 dB(A), and Site C-42 dB(A)/59 dB(A). Average nighttime measurements for patient rooms and nurses stations were Site A-62 dB(A)/55 dB(A), Site B-48 dB(A)/55 dB(A), and Site C-42 dB(A)/60 dB(A). CONCLUSION: Our findings, considered independently and collectively, showed that facilities in this study exceeded the WHO-recommended sound levels for patient rooms of 35 dB(A) during daytime and 30 dB(A) during nighttime. Research has reported negative patient outcomes, for example, decreased satisfaction, sleep disturbance, and higher incidence of rehospitalization in patients staying in areas with higher noise levels.