Vol. 10 Issue 6 Page 27
Taking Care of Nurses
Hospital environments should enrich the lives of both patients and their caregivers
Hospital administrators, clinicians and designers have conducted countless research studies to find out what makes the best patient experience, ranging from the healing effects of homelike features and views to nature to greater patient control of their environment.
For instance, a 1984 report by Roger Ulrich examined the effects of the environment on patients who had views to either nature or a brick wall. He compared pain medication needs, minor complication issues and lengths of stay. The patients who had a nature view experienced better overall well-being and healing and recovered almost 1 day faster than those without views. The effect of such studies on hospital planning and design is substantive.
Few studies, however, have examined what makes the best environment for the nurses who take care of patients every day.
HKS Architects, working with Children’s Healthcare of Atlanta, Craig Zimring, PhD, of Georgia Tech, and Paul Barach, MD, MPH, of the University of Miami, measured the effects of views (nature versus urban) in caregiver spaces as well as the duration of exposure. The result: Views to nature and natural light indicated a reduction in perceived stress.
More than 70.5 percent of the nation’s nurses reported acute/chronic effects of stress and overwork as their top concerns, according to a 2001 survey by the American Nurses Association involving 4,826 nurses from across the U.S.
Numerous reports show how increased stress decreases alertness, causes problems with task completion and concentration, increases irritability, and can lead to errors or near errors caused by unsafe decision-making. Moreover, research shows stress slows reaction time, causes lapses of attention to detail, reduces motivation and decreases energy.
A study involving 137 hospital staff found nurses who worked in a windowless work space or far from windows reported lower levels of well-being. However, the study did not look at how the environment specifically affected the nursing staff’s stress and performance.
The HKS research study examined how nature views affected chronic stress (stress that exists for weeks, months or years), acute stress (short-term; i.e., work pressure, deadlines, minor accidents) and response readiness.
More than 30 nurses from the Children’s Healthcare of Atlanta at Egleston and Scottish Rite hospitals volunteered to participate in the research study, working in spaces designed with natural light and outdoor views while others worked in white-walled, interior spaces with limited outdoor views.
Prior to and following a typical 12-hour shift, researchers measured the levels of stress and response readiness in nurses from 19 unit types, ranging from intensive care to acute care. They also measured other stress factors and statistically controlled the data analyses. Such factors included organizational characteristics and workplace practices, physical condition of their work environment (light, noise, temperature and ergonomics), workload, and demographic factors including age, education, experience and pay scale.
Chronic & Acute Stress Impact
While views did not impact chronic stress during the 12-hour work shift, they had significant impact on acute stress levels and response readiness. Following a typical 12-hour nursing shift, chronic stress levels remained more or less unchanged regardless of view content and duration.
While the acute stress level generally went up for the whole group between the beginning and end of the 12-hour shift, nurses with access to nature views were significantly less stressed at the end of the shift than nurses without views.
Of all nurses whose acute stress condition remained the same or improved between the beginning and end of the shift, 64 percent had exposure to views (71 percent of that 64 percent were exposed to nature view). Conversely, of all nurses whose acute stress levels deteriorated between the beginning and end of the shift, 56 percent had no view during the shift or had only a non-nature view.
The presence or absence of view in the nurses’ workplace ranked second to physical environmental stressors (light, noise, thermal comfort and ergonomics) as the most common influence on acute stress in nurses. Demographic factors (age, experience, education and pay scale) ranked third in the order of influence on acute stress.
While response readiness generally went down for the group between the beginning and end of a 12-hour shift, nurses with access to nature views were at a significantly higher level of response readiness as compared to those without views.
Of all nurses whose response readiness level remained the same or improved between the beginning and end of the shift, 58 percent had exposure to an outdoor view. Conversely, of all nurses whose response readiness levels deteriorated between the beginning and end of the shift, 67 percent had no view or only a non-nature view.
The presence or absence of view in the nurses’ workplace ranked second in importance, behind only organizational stressors, as the factor bearing most influence on response readiness in nurses.
Physical environmental stressors (light, noise, thermal comfort and ergonomics) ranked third in the order of influence on response readiness in nurses.
What It Means
Why is this study critical to hospital administrators, nurses, and patients and their families?
Research shows plenty of scenic views are significant, and possibly critical to caregivers’ attention to their patients and their tasks. This finding suggests the need for change in healthcare facility planning and operational policies.
When designing a new facility, administrators should emphasize the importance of view and visual relief for staff work areas when capital planning and budgeting take place. Also, require programming of space requirements to include a specific description of design intent (for generous view) along with allocation of space to accommodate these elements of design.
Hospital leaders also should stress the importance of adequate and well-distributed space for employee respite and relaxation on breaks. Many caregivers want to remain close to patients. In turn, designing decentralized break spaces is key.
Design of capital projects should include a view in all areas of the workplace created for staff. This goal, when stated as a guiding principle for a project, will have an immense impact on physical design.
Hospital policy should mandate restorative breaks, preferably away from the immediate work environment. This could address the serious issues of patient safety healthcare organizations are struggling with today.
The environment can improve alertness and sharpen focus in an intense day-to-day work environment. On a long-term basis, it can enhance job satisfaction and retention, and thereby lower operating costs. Improved stress management can contribute to reduction of medical errors, a higher response readiness and patient safety.
Terry Ritchey is vice president/manager of the clinical advisory group, Debajyoti Pati is director of research and Tom Harvey Jr. is principal/director of the clinical advisory group, all at HKS Architects, based in Dallas.