From ivory tower to inclusion: Stakeholders' experiences of community engagement in Australian autism research.

Autistic people, and other community stakeholders, are gaining increasing recognition as valuable contributors to autism research, resulting in a growing corpus of participatory autism research. Yet, we know little about the ways in which stakeholders practice and experience community engagement in autism research. In this study, we interviewed 20 stakeholders (academics, autistic people, family members/careers, research students, and service providers) regarding their experiences of community engagement in Australian autism research. Through reflexive thematic analysis of interview data, we generated four themes. First, our participants perceived academia as an "ivory tower," disconnected from community members' lives and priorities. Second, our participants identified that different stakeholders tended to hold different roles within their research projects: academics typically retained power and control, while community members' roles tended toward tokenism. Third, our participants spoke of the need to "bridge the gap" between academia and the community, highlighting communication, accessibility, and planning as key to conducting effective participatory research. Lastly, participants emphasized the changing nature of autism research, describing participatory research as "the way of the future." Our findings reflect both the progress achieved to date, and the challenges that lie ahead, as the field advances toward genuine co-production of autism research.

Bedside Nurses' Perceptions of Effective Nurse-Physician Communication in General Medical Units: A Qualitative Study.

Background There is a dearth of research on successful interventions to improve nurse-physician communication (NPC). An important step is identifying what matters to bedside nurses and their perceptions of effective NPC communications and actions. Methods We conducted three focus groups with a total of 19 medical unit nurses across two hospitals in one academic medical center in the United States. Using a convenience sampling strategy, five to eight nurses voluntarily participated in each focus group. The recording was transcribed verbatim and two independent coders performed coding and resolved any discrepancies in codes. Qualitative content analysis was pursued to identify themes and associated quotes. Results The presence of direct communication between physicians and nurses was identified as the first theme and perceived by nurses as very important. Additional themes related to physician communication and attributes emerged including collegiality and respect (e.g., engaging nurses as partners in patient care), attentiveness and responsiveness (e.g., listening carefully and addressing concerns), and directness and support (e.g., backing nurses up in difficult situations). Effective NPC is further facilitated by organizational structure, relationship development separate from patient care, and consistent/timely use of technology. Conclusions Hospital bedside nurses provided valuable insight into improved physician communication and what attributes contribute to more effective NPC. Most importantly, they emphasized the significance of physicians in supporting them with difficult patients.

Patient Room Design: A Qualitative Evaluation of Attributes Impacting Health Care Professionals.

The focus of this research was to identify what attributes of patient room designs are most beneficial to health care professionals and to explore whether particular professionals hold certain beliefs about patient room attributes. Acute care, progressive care, and intensive care patient room designs were analyzed through the use of pre- and postoccupancy evaluations of a cardiovascular service line. Fourteen focus groups and 1 interview among 74 health care professionals were conducted. Qualitative analysis of the data was guided by a multidimensional framework. A descriptive quantitative assessment was additionally made to reveal positive, negative, or neutral trends and determine the frequency of attributes discussed. The findings revealed outcomes in 4 primary areas: (1) clearance around the bed; (2) visibility; (3) access to the bathroom/bathroom configuration; and (4) access to daylight/views of the exterior. This study identified 8 additional categories. Outcomes illustrate perceptions from a myriad of health care professionals, but the nurses, therapists, and interdisciplinary members of the care team station offered the greatest depth of information. As patient room designs continue to evolve, building on evidence gathered as new or established models are evaluated will become increasingly important.

'I'm not just a guinea pig': Academic and community perceptions of participatory autism research.

LAY ABSTRACT: Participatory research means working together (engaging) with the community that is affected by research to make decisions about that research. Participatory research is common in some fields, but it is still rare in autism research. In this study, we wanted to find out how Australian autism researchers and community members feel about participatory research. We worked with an Autistic Advisory Group to design this study, understand the results and write this article. We asked 127 people, all working on research from the Cooperative Research Centre for Living with Autism, to complete an online survey about participatory research. The survey included some questions that were answered on rating scales, and some where participants wrote their own answers. Seventy-nine people (64 researchers and 15 community members) completed most or all of the survey. The rating scales showed that most participants (82%) supported moderate or extensive community engagement in research, and most participants (72%) thought there should be more community engagement in autism research. In general, the participants rated their experiences of participatory research positively. Using the participants' own written answers, we found four main ideas: (1) participatory research is important, but difficult; (2) many people do not fully understand what participatory research is; (3) academics and community members do not work together as = and (4) research systems are not designed for participatory research. Our results suggest that autism researchers and community members want to do more participatory research, but they might need training, support and funding to do participatory research well.

Designing for Efficiency: Examining the Impact of Centralized and Decentralized Nurse Stations on Interdisciplinary Care Processes.

OBJECTIVE: This study examined the impact of centralized and decentralized unit designs on an interdisciplinary team's perceptions of efficiency through the use of a preoccupancy and postoccupancy evaluation of a cardiovascular unit. BACKGROUND: During the premove study, the service line was housed across 4 separate locations, each with a centralized nurses' station. The postmove design was housed on 1 floor with decentralized stations. METHODS: For this qualitative study, 14 focus groups and 1 interview were conducted. Analysis of the data was guided by a developed framework for efficiency classified into 7 categories. RESULTS: Outcomes reveal that efficiency was impacted by issues including walking, access to supplies and equipment, proximity to staff, and overall unit configuration and size. CONCLUSIONS: Although the design of the decentralized unit positions staff members closer to patients, many feel isolated while the centralized units seemed to better promote staff proximity and access to supplies.

The Social Logic of Nursing Communication and Team Processes in Centralized and Decentralized Work Spaces.

This pre-post multi-method study explored how nurses made sense of changes in nurse station design and how they characterized communication processes within a hospital unit before and after it moved from an existing hospital into a newly designed trauma-1 level hospital. Quantitative observations (116 h) of real-time communication were gathered in both hospitals. Additionally, 41 nursing staff (nurses, nursing care technicians, nurse managers) participated in a qualitative study. Three months before moving, four focus groups were conducted with 16 nursing professionals working in traditional centralized nurse station units. One year later, four additional focus groups were conducted with 25 nursing staff in new decentralized units. The observational data resulted in two key findings: first, nursing staff participated in about 70 percent of interactions with nurses, techs, doctors, and families. Second, nursing communication decreased in decentralized units. In-depth qualitative analysis revealed that nursing communication was more frequent, relational and supportive in centralized spaces while distinguished by fragmentation and information exchange in decentralized units. Drawing upon theories of supportive design and healthcare systems, these findings illustrate how nurses in centralized units characterized communication as proximity, teamwork and relationships. Nurses in decentralized units described communication in terms of distance, fragmentation, and information exchange. Implications of this study suggest that centralized spaces may facilitate nursing communication while decentralized units are supportive of proximity to patients. Exploring how communication and design together constitute the logic of healthcare delivery contributes to our understanding of how communication processes comprise the social organization of nursing care.

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.

A psychometric analysis of the functional social support questionnaire in low-income pregnant women.

The purpose of this study was to examine the psychometric properties of the Functional Social Support Questionnaire (FSSQ) in pregnant women. A secondary analysis of data from 186 low-income pregnant women in their third trimester was conducted to assess the internal consistency reliability, dimensionality, and concurrent validity of the FSSQ. Cronbach's alpha was .83. Factor analysis supported the unidimensionality of the FSSQ. Correlations with the Interpersonal Support Evaluation List (ISEL) and the Center for Epidemiologic Studies-Depression Scale (CES-D) supported concurrent and construct validity. This secondary analysis provided evidence of the psychometric soundness of the FSSQ in this sample.