Evaluation of Multisensory Interactions Between the Healing Built Environment and Nurses in Healthcare Nursing Stations: Case Study of Tehran Hospitals.

BACKGROUND: Nursing stations are important features of medical centers that are constantly in use. As nursing is an inherently stressful occupation, nursing stations should be designed to minimize stress on those who must spend time there. AIM: This study evaluated the effect of environmental design factors on mitigating the stress levels on nurses in nursing stations by determining the environmental factors that most influence the perceptual senses that affect physical and psychological comfort. METHODS: A quantitative approach was used to evaluate the parameters that affect the sensory perceptions of nurses in nursing stations at four hospitals in Tehran. A survey was conducted to identify environmental design parameters that affect the visual, auditory, tactile, kinesthetic, and olfactory senses. RESULTS: The results revealed that the olfactory category scored highest, followed by the auditory, visual and tactile categories, which had similar scores, and kinesthetic was ranked last. CONCLUSION: A connection was revealed between the educational level of the nurses and environmental factors affecting their sensory perception in terms of materials, aesthetics and the appropriate number of windows as a visual sense, and ergonomics as a kinesthetic sense. Significantly, the gender variable differed in the Furniture variable based on comfort of seating with respect structure. Based on the results of this study, a combination of olfactory, visual, and auditory factors should be required at the nursing stations to decrease the stress level of nurses.

Key Flow Processes on Wards.

OBJECTIVE: The aim of the study is to test a new nurse movement route analysis (NMRA) method for measuring nurses' traffic volume between rooms on wards. BACKGROUND: The World Health Organization calls for urgent investment in nurses. On the other hand, the challenges in the availability, direct care activity, and staffing of registered nurses make increasing the quality of care by process improvement a central objective for nursing. METHOD: The method is based on cellular operations with from/to matrix that describes nurse movements between rooms on a ward. The NMRA can be implemented by traditional manual observation or with a novel internet-of-things solution named SKAnalysis. RESULTS: The greatest nurse flows led to patient rooms, nurses' stations, and medicine rooms. The manual NMRA recorded a total of 3,040 room visits by nurses; visits to patient rooms accounted for 33% of all room visits, while visits to nurses' stations accounted for 28%, and visits to the medicine room for 10%. The internet-of-things NMRA recorded a total of 25,841 room visits by nurses; patient room visits accounted for about 43% of all room visits, while nurses' station visits accounted for 26% and medicine room visits for about 8%. Based on the results, researchers present the development examples and priorities for nursing. CONCLUSIONS: NMRA works and is a new universal method for analyzing nurses' traffic which is a basic premise for improving working methods and productivity on the wards. Internet-of-things solution makes the implementation of NMRA six times more efficient than by the manual NMRA.

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

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.

Concordance of SARS-CoV-2 RNA in Aerosols From a Nurses Station and in Nurses and Patients During a Hospital Ward Outbreak.

Importance: Aerosol-borne SARS-CoV-2 has not been linked specifically to nosocomial outbreaks. Objective: To explore the genomic concordance of SARS-CoV-2 from aerosol particles of various sizes and infected nurses and patients during a nosocomial outbreak of COVID-19. Design, Setting, and Participants: This cohort study included patients and nursing staff in a US Department of Veterans Affairs inpatient hospital unit and long-term-care facility during a COVID-19 outbreak between December 27, 2020, and January 8, 2021. Outbreak contact tracing was conducted using exposure histories and screening with reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2. Size-selective particle samplers were deployed in diverse clinical areas of a multicampus health care system from November 2020 to March 2021. Viral genomic sequences from infected nurses and patients were sequenced and compared with ward nurses station aerosol samples. Exposure: SARS-CoV-2. Main Outcomes and Measures: The primary outcome was positive RT-PCR results and genomic similarity between SARS-CoV-2 RNA in aerosols and human samples. Air samplers were used to detect SARS-CoV-2 RNA in aerosols on hospital units where health care personnel were or were not under routine surveillance for SARS-CoV-2 infection. Results: A total of 510 size-fractionated air particle samples were collected. Samples representing 3 size fractions (>10 µm, 2.5-10 µm, and <2.5 µm) obtained at the nurses station were positive for SARS-CoV-2 during the outbreak (3 of 30 samples [10%]) and negative during 9 other collection periods. SARS-CoV-2 partial genome sequences for the smallest particle fraction were 100% identical with all 3 human samples; the remaining size fractions shared >99.9% sequence identity with the human samples. Fragments of SARS-CoV-2 RNA were detected by RT-PCR in 24 of 300 samples (8.0%) in units where health care personnel were not under surveillance and 7 of 210 samples (3.3%; P = .03) where they were under surveillance. Conclusions and Relevance: In this cohort study, the finding of genetically identical SARS-CoV-2 RNA fragments in aerosols obtained from a nurses station and in human samples during a nosocomial outbreak suggests that aerosols may have contributed to hospital transmission. Surveillance, along with ventilation, masking, and distancing, may reduce the introduction of community-acquired SARS-CoV-2 into aerosols on hospital wards, thereby reducing the risk of hospital transmission.

Library tools at the nurses' station: exploring information-seeking behaviors and needs of nurses in a war veterans nursing home.

Objectives: Analyze the information-seeking practices and identify the information and education needs of nurses in a war veterans nursing home. Develop an online toolkit for use at the nurses' stations to meet nurses' health information needs. Methods: Investigators employed mixed methods to determine the health information needs of the participating nurses at the skilled nursing facility using an online questionnaire and in-person observations. Resulting data was compared to determine how nurses' self-reported data corresponded with investigator observations. Results: Twenty-seven out of a total of thirty-five nurses responded to the online questionnaire. The study principal investigator also observed a total of twelve nurses working across all shifts. The online questionnaire asked nurses to identify when they need health information for an acute clinical scenario. Nurses self-reported feeling most confident in assessing falls and pain, followed by medication adherence and skin integrity. Issues most frequently encountered during observation of nurses were falls, interventions surrounding cognitive ability or dementia, and use of antibiotics. Nurses reported and were observed to consult colleagues most frequently, followed by drug handbooks and relying on nursing experience. Conclusion: Nurses in skilled nursing facilities will benefit from ready online access to current drug handbooks as well as information resources surrounding commonly encountered clinical issues and stated needs. An outcome of this project is an online toolkit site using a LibGuide created specifically for this purpose. Researchers purchased laptop computers that were installed at each of the nurses' stations to provide ready access to the toolkit site.

Assessing Preferences and Perceived Restorative Qualities of Break Spaces for Nurses in China.

OBJECTIVE: This study investigated Chinese nurses' preferences for (a) proximity of break areas, (b) functionality of break areas, (c) amenities, and (d) nature-related environmental features. BACKGROUND: While nurses in China need support to adequately perform their jobs, little is known about how restorative spaces impact their mental and physical health. METHODS: Data were collected through interviews (N = 12), survey questionnaires (N = 88), and visual assessments (N = 88) from nurses who worked in inpatient settings in China. RESULTS: Nurses preferred the break room to be close to nursing stations; to have visual privacy from patients; and to provide space and facilities for drinking, taking naps, dining, and chatting with colleagues. Balconies and windows were shown to have a significant restorative effect. Well-designed break areas were perceived to have positive impacts on nurse perceived levels of well-being and increase nurses' satisfaction levels with their work environment. CONCLUSION: The study outcomes emphasize the importance of restorative spaces for inpatient nurses and recommend including natural elements in the break rooms.

Web-Based Intravenous Fluid Treatment Monitoring Platform in Nursing Station.

BACKGROUND: Intravenous fluid treatment is the most common way to take care of inpatients. Because of the global pandemic, the number of inpatients is increasing rapidly, leading to constant demand in the contactless system. PURPOSE: In this article, we suggest a web-based intravenous fluid treatment monitoring platform in the nursing station to unburden the medical staff's workload.

The Continuous Learning Cycle: A Multi-phase Post-occupancy Evaluation (POE) of Decentralized Nursing Unit Design.

PURPOSE: This study aims to demonstrate how multiphase postoccupancy evaluation (POE) research was integrated into multiple projects to develop a continuous learning cycle. BACKGROUND: Despite the well-recognized importance of POE, few studies have reported how knowledge from POE is applied in new designs. METHOD: This study is developed as a multiphase POE that spanned 3 years and across three units. Phase I POE compared an existing unit (Unit A) in Hospital A and a new Unit B in Hospital B that has implemented innovative design features such as decentralized nurse stations. The idea was to understand the challenges of the existing facility in Hospital A and gather lessons learned from the new design in Unit B to inform the design of the Hospital A expansion (Unit C). After the new expansion was occupied, the Phase II POE was conducted using the same set of POE tools in both Unit C and Unit A. The POE applied the following methods: (1) patient room evaluations using the Center for Health Design standardized POE tools, (2) space syntax analysis of visibility, and (3) a pre- and postmove analysis of Press Ganey data. RESULTS: The results demonstrated that by incorporating lessons learned from the Phase I POE, Unit C has further improvement on patient room design ratings, improved patient satisfaction, and better visibility among nurse work areas compared to Unit A and Unit B. CONCLUSIONS: The multiphase, multisite POE with standardized tools has demonstrated its value as an important tool for continuous design quality improvement.

Evaluating the Effective Factors of Hospital Rooms on Patients' Recovery Using the Data Mining Method.

OBJECTIVES: This study aims to investigate the effective environmental factors of hospital rooms in patients' recovery through data mining techniques. BACKGROUND: Previous studies have shown the positive effect of the interior environment of the hospitals on patients' recovery. The methods of these studies were mainly based on the evidence and patients' perception while hospital environments are associated with a large amount of data that make them an appropriate case for data mining studies. But data mining studies in hospitals mainly focused on medical and management purposes rather than evaluating the interior environment condition. METHODS: We analyzed the hospital information system data of a hospital using Python programming language and some of its libraries. Preprocessing and eliminating the outliers, labeling and clustering of diseases, data visualization and analysis, final evaluation, and concluding were done using the knowledge discovery in databases process. RESULTS: Pearson coefficient value for rooms' area was .5 and, respectively, for the distance from the ward entrance and nursing station were .75 and .70. The χ2 values for the variables of room types, location, and occupation were 24.62, 18.98, and 21.53, respectively, and for the beds' location was 0.12. CONCLUSIONS: The results confirmed the correlation of the length of stay with the room types, location, and occupation, distance from the nursing station and ward entrance and also showed a moderate correlation with the rooms' area. However, no evidence was found about the relationship between the beds' location in rooms and patients' length of hospital stay.

Space Use and the Physical Attributes of Acute Care Units: A Quantitative Study.

This article shares the results of a quantitative analysis of the space use and physical attributes of 140 acute care units (ACU) completed since 2007. OBJECTIVE: To fill a gap in the literature with respect to the state of practice for ACU design over the study period by investigating relationships among the physical characteristics and density of completed ACUs. BACKGROUND: Robust industry interest about the topic-further agitated by the dearth of large-scale quantitative research regarding ACU space use-motivated completion of the study. METHOD: Through extraordinary collaboration by participating firms, floor plans of 140 new ACUs from the study period were gathered, systematically measured, and then analyzed. RESULTS: Structural bay size, nurse station location, and the number of beds per unit were found to have significant relationships to ACU floor-gross area per bed. Additionally, nine significant associations among the explanatory variables were found, including moderate relationships among bay size, nurse station location, room handedness, and toilet room placement. CONCLUSION: The results suggest that project design teams tend to bundle key physical attributes together when planning ACUs. Moreover, density increases resulting from bay size reduction diminish as the bay size drops below 31'. Any impacts resulting from the major external events demarking the last decade were not sufficient to appreciably affect ACU density. Lastly, those concerned with increasing density and controlling ACU floor gross area are alerted to explore design options featuring bay sizes of approximately 30' in conjunction with a centralized nursing model containing more than 32 beds per unit.

Characteristics of Home-Visit Nursing Stations that Accept Children Requiring Long-Term Medical Care after Discharge from Neonatal Intensive Care Unit.

Many cultures are witnessing high-risk births due to the increasing trend of delayed childbearing. This has resulted in a higher proportion of children requiring long-term medical care (CLTM). The number of home-visit nursing stations available for pediatric patients should increase to provide care for CLTM at home. Through a questionnaire-based cross-sectional survey of 338 home-visit nursing station managers, this study aimed to identify the determinants of the acceptance of CLTM by analyzing the characteristics of the stations, managers, staff, and registered children, and the volume of home visits. Chi-squared tests and logistic regressions were applied to determine the independence of the variables of acceptance and analyze their significance, respectively. The response rate was 14.6%, the number of pediatric patients registered in the past was 914, and the average number of registered pediatrics was 2.7. The results indicate a correspondence between the increase in home visits by nursing staff and the number of CLTM accepted for home-visit nursing services after discharge from neonatal intensive care units. Additionally, stations whose managers have three or more years of pediatric care experience accept more CLTM, and their employees are better equipped to facilitate these acceptances. Nonetheless, the number of facilities with pediatric departments has declined; thus, nurses will face increasing difficulty gaining pediatric work experiences. Therefore, enhanced seminars and training on pediatric medical care for managers and nurses, as well as strengthened collaboration/coordination with pediatric wards, clinics, and multidisciplinary occupations should be implemented as countermeasures. Our findings illustrate issues and strategies for acceptance.

Lessons Learned From Decentralization of an Elective Surgery Medical-Surgical Unit.

OBJECTIVE: The objective of this study was to examine changes in healthcare practitioners' perception of supportiveness of their physical work environment, and trend in patient fall, when moving from a centralized to a decentralized unit configuration. BACKGROUND: Previous studies on decentralization have not uniformly provided findings consistent with desired outcome. METHOD: A pretest-posttest study was conducted in an elective surgery medical-surgical unit in the mid-Atlantic region of the United States. The independent variable was the physical design supporting centralized versus decentralized nursing models. Data were collected from healthcare staff with a self-report survey "before" (September 2017; n = 42) and "after" (June 2019; n = 22), and interviews. Before-after data were analyzed using both parametric and nonparametric tests to identify significant differences. Qualitative responses were analyzed to identify triangulating evidences. Monthly patient fall data were collected for a 3-year period and analyzed using log-linear Poisson Regression model. RESULTS: Results show favorable assessments in the areas of overall supportiveness of design, equipment and soiled utility location, peer support, process flow visualization, and overall satisfaction. A reduction in patient falls was observed. Unfavorable outcomes were found in the contexts of walking distance, multidisciplinary collaboration, alarm audibility, nurse station size, and PPE location. CONCLUSIONS: This study underscores that the success of a unit cannot be achieved without coordinated and successful interventions in the areas of operations, processes, policies, culture, and the physical design.

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.

Carga de trabalho de enfermagem na consulta à pessoa com diabetes mellitus: estudo preliminar / Workload in the nursing consultationto the person with diabetes mellitus: preliminary study

Introduction and objectives: Evaluating the activities developed in the consultation and determining the associated workload becomes relevant insofar as it influences safety and the quality of care. The purpose of this study was to identify the assistance and non-assistance activities carried out within the scope of the consultation; determine the execution time of the performed activities and set the average time of the consultation. Methodology: An exploratory descrip-tive study of quantitative nature was carried out. 16 primary health care nurses of 3 health units participated in the study. The instrument evaluates three dimensions: sociodemographic characterization of the clients, nursing and non-care nursing activity that integrates the previously defined categories and actions and socio-professional characterization of the nurse. The study was carried out between February and May 2018. Data was processed using SPSS25(R). Results and discussion: 103 nursing consultations were performed. It was identified that the most accompli-shed assistance activities belonged to the evaluation and health education categories. The documented non-care activities were the reception of the patient; infection control procedures and documentation of the provided care. The mean time of consultation was 24 minutes, the maximum time was 76,6 m and the minimum time was 7, 91 m. Conclusion: Identifying what activities were carried out and determining the associated workload allows us to know what work is being done and its implications in the provided care

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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.

The Impact of Infusion Center Layout on Workflow and Satisfactions in Two Cancer Infusion Centers: A Case Study on Staff and Patients.

OBJECTIVE: The objective of this empirical research is to compare nurses' operational workflow and nurses' and patients' satisfactions of two different infusion center designs. One center has a traditional open bay design and the other has semi-private bays. This study also intends to gather baseline data to compare to a future post-occupancy evaluation of a new infusion center where the two existing centers will be combined. BACKGROUND: The increasing number of patients with cancer diagnosis who refer to infusion centers highlights the importance of design of these centers. METHOD: The mixed-method approach of this study involves shadowing nurses and surveying nurses and patients. Data collection captured nurses' activities, activity durations, and nurses' and patients' satisfaction with the design of clinics. RESULTS: Comparison of shadowing data indicated that although the infusion centers have different layouts, there are no significant differences in the activities or time spent by nurses in different areas among the centers. Staff, however, have different satisfaction levels with visual and speech privacy, ability to concentrate without distraction, collaboration with other staff, and the process of medication delivery. Patients also had slightly different satisfaction levels with their ability to communicate with staff and design of bays. CONCLUSION: This research sheds light on operational workflows and satisfaction of staff and patients in two different infusion center design. Considering the limited studies on these settings, this study serves as baseline data to compare to other studies on cancer infusion centers and addresses issues of benchmarking and staff and patient satisfaction.

Knowledge, beliefs and practices on antibiotic use and resistance among a group of trainee nurses in Sri Lanka.

OBJECTIVES: Nurses are the main communication link for healthcare messages to hospitalized patients and also play a crucial role in preventing the emergence and spread antibiotic resistant bacteria through antibiotic stewardship and infection control programmes. This requires them to possess correct knowledge and attitudes towards antibiotic use and resistance. This study was carried out to identify the level of knowledge, attitude and practices on antibiotic use and antibiotic resistance among student nurses. RESULTS: A descriptive cross-sectional study was conducted using a pre-validated, self-administered questionnaire with closed and open ended questions, among 199 student nurses at a government nurses training school in Sri Lanka. Scores and proportions were analysed with non-parametric methods and thematic analysis was done for the qualitative data. The study cohort had a mean knowledge score of 71.9% (SD 14). However, close to 40% believed that taking antibiotics will help to prevent cold from worsening and make recovery faster. Infection control was identified as the main method that nurses can engage in preventing antibiotic resistance. While the knowledge among our study cohort appeared to be good, some misbeliefs were present. Our findings can be used in developing the nursing curricula on antibiotic use and resistance.

[Study on the Issues Faced by Home-Visit Nursing Stations for Repletion and Reinforcement of Disasters Preparedness].

BACKGROUND: Amid concerns about the occurrence of large-scale disasters, preparation for such disasters is an emergency issue. PURPOSE: In this study, we clarified new burdens in repletion and reinforcement of disaster preparedness in home-visit nursing stations that support home care patients and their families. METHODS: A questionnaire survey was conducted in homevisit nursing stations of areas where large-scale disasters are predicted to occur. Based on the survey, the burdens in preparation were analyzed. RESULTS: Based on the obtained data, three categories were formed:"a burden related to presupposition of the preparation","a burden related to concretization of the preparation", and "a burden related to practice of the preparation". DISCUSSION: For an appropriate reduction in the burdens, a necessity for further studies was indicated; these included studies on the complete picture of suitable disaster preparedness for home care, studies on the development of models that enable practical, effective, and efficient preparation, and studies on positioning of the system.