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

Jimenez, Francesqca E.; Puumala, Susan E.; Apple, Michael; Bunker-Hellmich, Lou; Rich, Renae K.; Brittin, Jeri

doi:10.1177/1937586718796590

Cited by 12 publications

(17 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While the 2008 literature review found that decentralized nursing stations increased staff effectiveness (by reducing staff walking time and increasing patient‐care time), 25 a more recent systematic review of the available empirical evidence found mixed results, with inconsistent findings for decentralized designs. The review went on to say that the literature on the topic was “of very low quality and show[ed] inconsistency in associated outcomes.” 26 Design characteristics, for example, were found to be diverse among studies, with a range of architectural solutions lacking standard definitions for decentralized nursing stations or consistent categorization of nursing‐station type. While much has been written about the effect of the built environment on human experience, even perception, the impact of the built environment on burnout and staff turnover remains largely unexplored.…”

Section: Case Study: Design For Outcomes In Hospital Carementioning

confidence: 99%

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

Anderson¹,

Teti²,

Hercules³

et al. 2022

Hastings Center Report

View full text Add to dashboard Cite

Decisions made in health care architecture have profound effects on patients, families, and staff. Drawing on research in medicine, neuroscience, and psychology, design is being used increasingly often to alter specific behaviors, mediate interpersonal interactions, and affect patient outcomes. As a result, the built environment in health care should in some instances be considered akin to a medical intervention, subject to ethical scrutiny and involving protections for those affected. Here we present two case studies. The first includes work aimed at manipulating the behavior of persons with neurocognitive impairments, often in long‐term care facilities. This is done to ensure safety and minimize conflicts with staff, but it raises questions about freedom, consent, and disclosure. The second concerns design science in service of improved outcomes, which involves research on improving patient outcomes or the performance of health care teams. There is evidence that in some ICU designs, certain rooms correlate to better outcomes, giving rise to questions about equity and fairness. In other cases, a facility’s architecture seems to be putting a finger on the scale of equipoise, raising questions about the intentionality of clinical judgment, freedom of choice, and disclosure. As a result of this innovation occurring outside the boundaries of traditional care delivery and oversight, important ethical questions emerge concerning both the individual patient and patient populations. We discuss, analyze, and make recommendations about each and suggest future directions for these and related issues.

show abstract

Section: Case Study: Design For Outcomes In Hospital Carementioning

confidence: 99%

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

Anderson¹,

Teti²,

Hercules³

et al. 2022

Hastings Center Report

View full text Add to dashboard Cite

show abstract

“…Early survey item development was based on a review of existing post occupancy surveys in healthcare settings, and leaned particularly on the Center for the Built Environment Occupant Toolkit [ 48 , 49 ]. Survey items underwent further iteration in response to research questions explored, and gaps identified, in the literature examining clinical caregivers’ relationship to the healthcare built environment [ 50 , 51 ]. The initial survey items were written to assess the key nurse activities and interactions identified in the literature, which included nurse walking fatigue, charting, ability to spend time with patients, and teamwork, especially in emergent situations.…”

Section: Methodsmentioning

confidence: 99%

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

Rich¹,

Jimenez²,

Bohacek

et al. 2021

PLoS ONE

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Research indicates that social support from others can settle work stress, reduce depression, and positively impact patient outcomes (Alvaro et al, 2016). Numerous studies have revealed that job satisfaction is influenced by work environment, unit layout, nursing care delivery model, organizational climate, and interpersonal relationships (Jimenez et al, 2019; Obeidat et al, 2021). Ulrich’s (1991) theory of supportive design grounds this in noting that the physical environment will reduce stress if it fosters perceptions of control and social support.…”

Section: Review Of the Literaturementioning

confidence: 99%

The Healthcare Workspace: Understanding the Role of Decentralized Nursing Stations, Corridors, and Huddle Spaces as Locations for Teamwork in a Neonatal Intensive Care Unit

Fay

Real

Haynes

2022

HERD

View full text Add to dashboard Cite

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.

show abstract

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

Cited by 12 publications

References 25 publications

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

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

The Healthcare Workspace: Understanding the Role of Decentralized Nursing Stations, Corridors, and Huddle Spaces as Locations for Teamwork in a Neonatal Intensive Care Unit

Contact Info

Product

Resources

About