Inpatient Corridor Visibility and Care Team Communication.

OBJECTIVE: This article aims to investigate the impact of fine-grained differences in unit layout on care staff corridor communication. BACKGROUND: Corridor design can be undertaken with greater emphasis on space and cost efficiency or with greater emphasis on affording quality knowledge workspace. Building on prior research on care team communication and inpatient unit design, this study aims to gain a better understanding of how corridor layout properties affect care team communication. METHOD: This study used space syntax analysis to characterize inpatient unit design, specifically floor-plan layout. Two approaches were used to capture care team communication: behavior mapping with recording of care team member locations and whether they were communicating and the HDR CARE Scale, Inpatient Version. The two units were part of a vertical tower expansion project, and, though constructed at separate times, they maintain the same organizational culture, floor plate, and location of key vertical elements. RESULTS: The newer unit was found to be more visually open using three measures from space syntax. More nursing staff verbal communication was observed on this unit. Across both units, nursing staff were more likely to be observed verbally communicating in locations that were more visually connected (i.e., at locations with larger viewsheds). There were no significant differences between nursing staff self-report on work using the HDR CARE Scale, Inpatient Version. CONCLUSION: We conclude that care team communication may tend to be encouraged by visual connectivity that can be promoted through floor-plan layout.

Optimizing Nurse Workflow Efficiency: An Examination of Nurse Walking Behavior and Space Accessibility in Medical Surgical Units.

OBJECTIVE: This study aimed to investigate the effect of spatial adjacencies on nurses' walking patterns and the subsequent impact on staff satisfaction with perceived accessibility and adjacency-related issues. BACKGROUND: Recognizing the crucial importance of spatial adjacencies in healthcare facilities is essential, as they significantly affect staff morale, fatigue management, operational efficiency, error reduction, and overall patient care excellence, highlighting the need for objective assessments to evaluate the impact of facility layout and space configuration on workflow patterns and staff satisfaction in patient care units. METHODS: Integrating on-site observations with survey data, we explored how spatial adjacencies affect staff walking behavior and satisfaction in two med-surgical unit floors. RESULTS: The findings highlighted a significant frequency of movements between nurse stations, patient rooms, and medication areas. Regression analysis identified several contributing factors to staff satisfaction, including the proximity of supplies, team visibility, ease of access across departments, and the location of equipment rooms. Specifically, satisfaction with the proximity of supplies was positively associated with increased provider satisfaction with workflow, quality of care, and workplace. Additionally, valuable feedback from staff revealed concerns regarding break room placement, medication area functionality, and disparities in the availability of supplies. CONCLUSION: This study highlighted the critical need for carefully planned spatial adjacency strategies to enhance workflow efficiency and raise clinical staff satisfaction within healthcare facilities. The actionable insights gleaned from this research offer valuable direction to architects, healthcare administrators, and design professionals, enabling the creation of environments that positively resonate with healthcare providers and improve healthcare operations.

Development of a Shelter-based Health Empowerment Program for Pregnant and Parenting Youth Experiencing Homelessness.

BACKGROUND: Pregnancy and parenthood are common among youth experiencing homelessness and are associated with significant health risk for both parent and child. Yet, little is known regarding how to best promote health among this vulnerable population. OBJECTIVES: To understand stakeholder perceptions of needs and factors required for successful implementation of a shelter-based health empowerment program for pregnant and parenting youth experiencing homelessness and their children. METHODS: Applying frameworks from implementation science, we conducted interviews and focus groups with three groups of stakeholders (youth experiencing homelessness [n = 17], shelter staff [n = 8], community experts [n = 5]). We used qualitative content analysis to identify program content areas and design elements required for successful implementation. We then used a consensus-building process to engage community stakeholders in selecting and adapting an evidence-informed intervention. RESULTS: Stakeholders described several desired content areas for a group-based curriculum: sexual and reproductive health, mental health and child health. With respect to program design, stakeholders emphasized adaptability; a strengths-based, culturally responsive, and trauma-informed approach; a skills-oriented focus; staff training; access to health care; and the integration of youth voices. Driven by these findings, our community-based team proposed a health empowerment program with three elements: 1) a weekly health empowerment group, 2) health training and support for shelter staff, and 3) shelter-based health care services. CONCLUSIONS: Our study is among the first to assess the health care needs of pregnant and parenting youth in shelter, and to describe factors associated with the development and implementation of a shelter-based health empowerment program specifically targeting this vulnerable population.

Comparison of Resistance Exercise Perceived Exertion and Muscle Activation at Varied Submaximal Durations, Loads, and Muscle Actions.

Hollander, DB, Worley, JR, Asoodeh, M, Wakesa, D, Magnuson, M, Dantzler, DK, Didier, JJ, and Kraemer, RR. Comparison of resistance exercise perceived exertion and muscle activation at varied submaximal durations, loads, and muscle actions. J Strength Cond Res 31(5): 1387-1394, 2017-Previous studies investigating muscle activation from dynamic, plate-loaded, concentric (CON) and eccentric (ECC) muscle contractions have not accounted for the greater absolute strength of ECC contractions. The purpose of the study was to determine the effect of different dynamic muscle contraction durations, loads, and contraction types (CON and ECC) on perceived exertion and muscle activation differences in 6 women (mean ± SD age, height, weight, body mass index 22.83 ± 2.56 years, 1.65 ± 0.261 m, 68.56 ± 2.72 kg, 25.26 ± 4.39 kg·m). The participants were recruited and trained to move weight at the appropriate duration (2, 3, 4, and 5 seconds) for leg extension using a displacement apparatus (sonic emitter, auditory) and a computer program (visual feedback of bar displacement). Concentric and ECC 1 repetition maximum (1RM) were determined for leg extension for the midrange 3-second duration. Thirty, 50, and 70% of either CON or ECC 1RM were loaded for the remainder of the sessions. Subjects were then assigned to complete trials in a counterbalanced fashion for load, contraction type, and contraction duration. Rating of perceived exertion (RPE) significantly increased in response to load (30, 50, and 70%) regardless of contraction type as did electromyography (EMG) root mean square amplitude. Greater time under tension significantly increased RPE regardless of contraction type during knee extension exercise. The EMG amplitude was less distinguishable between 2, 3, 4, and 5 seconds of contractions. The data highlight the effort sense distinctions made by women at submaximal exercise loads during knee extension. These findings should be used to develop effective resistance exercise protocols that facilitate positive perceptions and adherence resistance exercise loads, durations of contraction, and contraction type.

No effect of menstrual cycle phase on glucose and glucoregulatory endocrine responses to prolonged exercise.

INTRODUCTION: Prolonged exercise requires increased utilization of blood glucose and adjustment of glucoregulatory hormones. Estrogen can reduce hepatic gluconeogenesis which could affect insulin concentrations. Amylin is co-secreted with insulin and controls influx of glucose into the blood. PURPOSE: To determine the effect of menstrual cycle stage on glucose, leptin, and pancreatic hormone responses to prolonged (90 min) exercise. METHODS: Five healthy, eumenorrheic women (24.6 ± 5.1 years; 67.4 ± 1 kg) were monitored for 3 months to determine menstrual cycle length. Subjects completed a preliminary session to determine exercise workloads and, in a fasted condition, completed two randomized 90-min treadmill exercise trials at 60 % VO2max during the early follicular (EFX) and mid-luteal phase (MLX) of their menstrual cycle. Blood samples were analyzed for glucose, insulin, C-peptide, amylin, glucagon, leptin, and cortisol concentrations at rest (-30 and 0 min), during exercise (18, 36, 54, 72, and 90 min) and after 20 min of recovery. RESULTS: No changes in amylin, leptin, or cortisol occurred for EFX and MLX trials. A significant (p < 0.05) time effect occurred for glucose, insulin, and glucagon with reduced insulin across the exercise trial and increases in glucose and glucagon later in the trial, but there were no differences between the EFX and MLX trials. CONCLUSIONS: Menstrual cycle stage does not affect glucose, insulin, C-peptide, amylin, glucagon, cortisol, and leptin responses to prolonged exercise; however, the exercise reduces insulin and increases glucose and glucagon concentrations. This is the first study to determine acute effects of exercise on amylin and other glucoregulatory hormone responses in women.

Metabolic responses to Wii Fit™ video games at different game levels.

The Wii Fit™ is a form of interactive gaming designed to elicit health and fitness benefits to replace sedentary gaming. This study was designed to determine the effectiveness of Wii Fit™ fitness games. The purpose of the study was to determine the %VO2max and energy expenditure from different Wii Fit™ games at different levels including the step and hula games. Eight healthy young women completed a preliminary trial to determine VO2max and later played the Wii Fit™ during 2 separate counterbalanced trials. During each session, subjects played levels of Wii Fit™ games for 10 minutes each level. One session involved beginning and intermediate hula, and the other session involved beginning and intermediate steps. The VO2 was measured continuously via metabolic cart, and rating of perceived exertion (RPE) was assessed at the end of each game level. The lowest %VO2max, kcal·min, and RPE occurred during the beginning step game and the highest values occurred during the intermediate hula game. Respiratory exchange ratio was significantly higher in the intermediate hula than beginning hula game but was not significantly different between step game levels. The intermediate hula and step games produced the greatest energy expenditure with an equivalent effect of a walking speed of >5.63 km·h (>3.5 miles·h). This is the first study to determine the percentage of VO2max and caloric expenditure elicited by different Wii Fit™ video games at different game levels in adults. Findings suggest that the Wii Fit™ can be used as an effective activity for promoting physical health in this population.