Clinician Perceptions of a Changing Hospital Environment

Maguire, David; Burger, Kristina J.; O’Donnell, Patricia; Parnell, Lisa

doi:10.1177/193758671300600306

Cited by 21 publications

(22 citation statements)

References 38 publications

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“…However, important issues that require further research include concerns about potential additional workload, 4 stress 79 and risks to staff; 30,77,80,81,85 less patient surveillance; 11,37,38 and patients feeling isolated or alienated. 38,68,69 There is limited evidence about the costs and economic outcomes of higher proportions of single room accommodation.…”

Section: Discussionmentioning

confidence: 99%

“…A US study using comparative design to investigate how clinicians perceive, evaluate and adjust to a new hospital environment found the single-patient room model increased the workload of many clinicians and their stress had increased after 15 months. 77 The study showed that employees with 3 or more years of service had significantly higher stress than others, suggesting that staff with established work patterns may find it more difficult to adjust to new hospital designs. Staff stress could be greater if they feel less able to monitor patients, have less time for direct care or are less visible to patients.…”

Section: Introductionmentioning

confidence: 96%

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Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Maben

Griffiths

Penfold

et al. 2015

Health Services and Delivery Research

177

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BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Maben

Griffiths

Penfold

et al. 2015

Health Services and Delivery Research

177

View full text Add to dashboard Cite

show abstract

“…, Verderber & Todd , Maguire et al . ). However, as Verderber and Todd () point out, the prioritisation of single rooms in the USA has been associated, predominantly, with private healthcare where single‐family rooms are seen as a mark of progressiveness and a marketable asset to potential users.…”

Section: Introductionmentioning

confidence: 97%

“…Spatial aspects are particularly pertinent given the trend, over recent years, for an increase in the number of single rooms, sometimes referred to as single-family or private rooms, and concomitant decrease in semi-private, or shared rooms (or bays) within paediatric hospitals internationally. 1 This change, initiated within the United States (US), has been justified in relation to claims for improved ambient qualities (including better light, reductions in environmental noise), enhanced infection control and assumed consumer preference (Kotzer et al 2011, Stevens et al 2012, Verderber & Todd 2012, Maguire et al 2013. However, as Verderber and Todd (2012) point out, the prioritisation of single rooms in the USA has been associated, predominantly, with private healthcare where single-family rooms are seen as a mark of progressiveness and a marketable asset to potential users.…”

Section: Introductionmentioning

confidence: 99%

The impact of single and shared rooms on family‐centred care in children's hospitals

Curtis

Northcott

2017

Journal of Clinical Nursing

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“…As such, a greater proportion of single rooms are often incorporated into the design of new ICUs. There is, however, less known about the impact of single room environments on other workplace issues (Maguire et al, 2013) such as learning in the workplace (Walsh et al, 2006).…”

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confidence: 99%

Effectiveness of nursing rounds in the Intensive Care Unit on workplace learning

Tobiano

Murphy

Hervey

et al. 2019

Intensive and Critical Care Nursing

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Objectives: To evaluate the implementation of a regular Nursing Round as an educational strategy for workplace learning in an intensive care unit with a single room environment. Research Design: A multiple methods design was used. Fifty-four Nursing Rounds were observed, and nurses (n=40) completed bespoke evaluative surveys. Structured observational data and open-ended survey responses were submitted to content analysis and descriptive statistics were used to analyse survey findings. Results: Nursing Rounds involved a diverse range of participants, most frequently nurses. The content most frequently discussed was empirical clinical issues, and nurses decided on nursing care actions to address these issues. The most frequently observed outcome of Nursing Rounds was knowledge translation. Nursing Rounds were perceived to positively influence application of evidence in practice, identification of areas for practice improvement and ability to communicate clinical information. Two categories emerged from analysis of open-ended survey questions; (1) 'Positive learning environment', where nurses described Nursing Rounds as a social learning experience; and (2) 'Impediments to Nursing Rounds', including difficulty attending Nursing Rounds due to competing priorities. Conclusion: Nursing Rounds enabled evidence-based learning that enhanced inter-disciplinary collaboration. Further investigation may be required to understand how to enable nurses to attend more frequently, and generate a more holistic, evidence-based discussion.

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Clinician Perceptions of a Changing Hospital Environment

Abstract: Healing environments, organizational transformation, patient-centered care, pediatric, satisfaction.

Cited by 21 publications

References 38 publications

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

The impact of single and shared rooms on family‐centred care in children's hospitals

Effectiveness of nursing rounds in the Intensive Care Unit on workplace learning

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