Differences in Nurses' Satisfaction and Demand for Spatial Design Among Different Departments of Nursing Units: A Case Study in China.

OBJECTIVES: The study aimed to extend original research and identify operational and space-related requirements for specialization from the perspectives of nursing behavior and process. BACKGROUND: Studies related to the specialty of different nursing units have been widely conducted in nursing science, while few studies have explored the specialized requirements for the physical environments of nursing units in different departments. METHOD: Questionnaire survey data were collected from 125 nurses in 11 clinical departments, and nurse shadowing (approximately 68 hr) was conducted in four clinical departments. RESULTS: The questionnaire survey showed that satisfaction with care activity, visibility, and physical environment within the existing nursing unit environment was rated differently among different departments of nursing units. However, nurses in different groups of age, education, work experience, and position indicated no statistically significant difference. Behavioral observations demonstrated that the spatial and temporal distributions of activities, spatial linkages, and communication patterns varied in distinct departments. CONCLUSION: This research found that nurses in different departments had different evaluations of satisfaction and environmental characteristics. It also explains the differences in nursing work behaviors and processes found in various departments and sheds light on specialized requirements from the behavior perspective. The findings could help optimize the design of efficient and satisfactory nursing units in different departments.

Influence of Hospital Outdoor Rest Space on the Eye Movement Measures and Self-Rating Restoration of Staff.

Objective: To investigate the effect of hospital outdoor rest space on the eye movement measures and self-rating restoration of staff. Background: Relieving the pressure of hospital staff through exposure to hospital outdoor rest space is essential, but there is a scarcity of research on the impact of hospital outdoor rest space on the eye movement measures and self-rating restoration of staff, especially for large Chinese hospitals. Methods: Cross-analysis was conducted based on the eye movement measures of 76 staff members obtained by eye movement tracking equipment in combination with the self-rating restoration scale and hospital outdoor rest space picture attributes (element proportion and position, brightness and saturation). Results: The differences in eye movement measures of different staff attributes (occupation, age, and gender) were identified, and the effects of hospital outdoor rest space picture attributes on the eye movement measures and self-rating restoration scale of staff were summarized. A number of proposals were also formulated: hospital outdoor rest space should be set up close to the working area of the group of medical staff; attention should be paid to the actual needs of senior staff members and the work pressure of junior nurses; the exposure to natural environment should be increased and the proportion of hard artificial elements should be reduced; the natural environment should be placed in the visual center; the saturation and brightness of hospital outdoor rest space should be increased; and staff members should have access to the sky environment in a variety of ways. Conclusion: The present study is an empirical study of evidence-based design on hospital outdoor rest space in China, and the results reveal the effects of hospital outdoor rest space on the eye movement measures and self-rating restoration of staff.

The Demand for Specialization and Its Influence on the Design of Inpatient Nursing Units: Can Standardized Design Be Done Once and for All?

OBJECTIVES: This study explores the specialized nursing requirements of different clinical departments and their influence on the design of nursing units, which ultimately improves the nursing staff's efficiency and work experience. BACKGROUND: Specialization of nursing work is important in the provision of quality of healthcare. Most of the research related to nursing units has focuses on general medical-surgical nursing units and has not differentiated between clinical departments. METHOD: This study was conducted in one inpatient building at a large general hospital in China. Survey data were collected from 11 clinical departments via questionnaire, and interviews were conducted in 10 of the clinical departments. RESULTS: All 11 clinical departments had significant differences in their evaluations of and requirements for the arrangement of their physical space. Specialized requirements were found in three areas: nursing work processes, arrangement and needs of clinical spaces, and allocation of facilities and equipment. CONCLUSION: Evaluation of the specialized requirements of different clinical departments would contribute to the body of knowledge on nursing unit design and has a positive effect on the development and improvement of design theory. Suggestions for how the design of nursing units could be improved to support the specialized demands of different departments are provided.

Influence of Hospital Outdoor Space on Physiological Electroencephalography (EEG) Feedback of Staff.

OBJECTIVES: To investigate the differences and relationships between different outdoor spaces of hospitals on the physiological electroencephalography (EEG) feedback (PEEGF) of staff. BACKGROUND: Relieving the pressure of hospital staff is essential, and several studies have revealed that even short-term exposure to outdoor space has a decompression effect. Yet, the focus is scarcely centered on the differences and influential relationships between the PEEGF from different outdoor spaces where the staff spend time, particularly in large-scale hospitals in China. METHODS: EEG measurement equipment was utilized to obtain the value of ß wave (vßw) that represents the stress and anxiety of staff in three different outdoor spaces: open, traffic, and rest. On the basis of EEG data, correlation analysis was conducted in accordance with the proportion of space elements. RESULTS: The proportion of natural elements, such as landscape (r = -.800** p=.005) and waterscape (r = -.782* p=.013), were negatively correlated with the vßw produced by staff, while the proportion of hard paving was positive (r = .817** p=.004) with more vßw produced by staff. In other words, the percentage of landscape and waterscape can reduce stress, while hard paving has the opposite effect. Further, there was a difference in the amount of vßw generated between nurses and administrators in the open space at the entrance of the main building (p = .043). CONCLUSIONS: The present study revealed the influence of different outdoor space elements of the hospital on the physiological feedback of staff, demonstrated the practical necessity of evidence-based design, and proposed relevant optimization suggestions.

Study of the Physical Environment of Waiting Areas and Its Effects on Patient Satisfaction, Experience, Perceived Waiting Time, and Behavior in China.

OBJECTIVES: This study examines the physical environment in the outpatient waiting area and its effects on overall satisfaction, experience, perceived waiting time, and behavior. BACKGROUND: Waiting can be a frustrating experience for patients. Previous studies on waiting areas in hospitals have been rooted mainly in the Western cultural context, and research focusing on the impact of the physical environment on the waiting experience with the denser patient concentration in China is important. METHODS: Physical environment measurements, observations, and questionnaire surveys were employed. RESULTS: The actual lighting intensity and sound level did not meet the national standards. Sound level and satisfaction with the size of the waiting area, signage system, and visual art on the wall were significant predictors (R2 = .463, p = .000) for overall satisfaction. Experiences related to the size of the waiting area, seating, signage system, and restrooms were significant predictors (R2 = .373, p = .000) of overall waiting experience. The experience related to the acoustic environment (ß = -.184, p = .006) had a significant relationship with perceived waiting time. The increase in participants' behaviors of looking out of a window and the decrease in looking at other people, looking around, dozing, and looking at a wall might result from a substantial increase in lighting and the availability of a nature view from the window. CONCLUSIONS: The effect of the physical setting of waiting areas may positively impact patient satisfaction, waiting experience, perceived waiting time, and behavior, which has implications for patient-centered design.

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.

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.

Evaluation of nutrient limitation in aquatic ecosystems with nitrogen fixing bacteria.

There has always been a great need for simple and accurate bioassays for evaluating nutrient limitation in aquatic ecosystems. Whereas organic carbon is usually considered to be the limiting nutrient for microbial growth in many aquatic ecosystems, there are, however, many water sources that are limited by phosphorus or nitrogen. A method named "nitrogen fixing bacterial growth potential" (NFBGP) test, which is based on pre-culturing of autochthonous (target) microorganisms was described. The method was applied to evaluate phosphorus or nitrogen nutrient limitation in lake and sewage water samples using an isolate of the nitrogen fixing bacterium, Azorhizobium sp. WS6. The results corresponded well to those from the traditional algal growth potential (AGP) test and the bacterial regrowth potential (BRP) test, suggesting that the NFBGP test is a useful supplementary method for evaluating the limiting nutrient, especially phosphorus, in an aquatic environment.

Distributions of polycyclic aromatic hydrocarbons in surface waters, sediments and soils of Hangzhou City, China.

Ten polycyclic aromatic hydrocarbons (PAHs) were simultaneously measured in 17 surface water samples and 11 sediments of four water bodies, and 3 soils near the water-body bank in Hangzhou, China in December 2002. It was observed that the sum of PAHs concentrations ranged from 0.989 to 9.663 microg/L in surface waters, from 132.7 to 7343 ng/g dry weight in sediments, and from 59.71 to 615.8 ng/g dry weight in soils. The composition pattern of PAHs by ring size in water, sediment and soil were surveyed. Three-ring PAHs were dominated in surface waters and soils, meanwhile sediments were mostly dominated by four-ring PAHs. Furthermore, PAHs apparent distribution coefficients (K(d)) and solid f(oc)-normalized K(d) (e.g. K(oc)= K(d) / f(oc)) were calculated. The relationship between logK(oc) and logK(ow) of PAHs for field data on sediments and predicted values were compared. The sources of PAHs in different water bodies were evaluated by comparison of K (oc) values in sediments of the river downstream with that in soils. Hangzhou section of the Great Canal was heavily polluted by PAHs released from industrial wastewater in the past and now PAHs in sediment may serve as sources of PAHs in surface water. PAHs in Qiantang River were contributed from soil runoff. Municipal road runoff was mostly contributed to West Lake PAHs.