Macrocognition in the Healthcare Built Environment (mHCBE): A Focused Ethnographic Study of “Neighborhoods” in a Pediatric Intensive Care Unit

OʼHara, Susan; Klar, Robin Toft; Patterson, Emily S.; Morris, Nancy S.; Ascenzi, Judy; Fackler, James C.; Perry, Donna J.

doi:10.1177/1937586717728484

Cited by 14 publications

(13 citation statements)

References 31 publications

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“…To assess efficiency and workflow paired with the Planetree criteria of minimizing physical barriers to promote communication and compassionate interactions, the perception of increased walking post-move was contrary to expectations as the walking distances to the support rooms were relatively the same in the pre- as in the post-movement environment (Table 1). Similar findings regarding communication and physical barriers have been reported (O’Hara et al, 2018). The design intent of the 36-bed, 3 neighborhood floor plan was to bring all pathways in a small footprint through duplication of support rooms per 12-bed increments (Hua et al, 2012; Zadeh et al, 2012).…”

Section: Discussionsupporting

confidence: 89%

Postoccupancy Evaluation of a Neighborhood Concept Redesign of an Acute Care Nursing Unit in a Planetree Hospital

Rose

Waggener²,

Kiely

et al. 2022

HERD

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Objective: A comparative study was undertaken to survey nurses working in an acute care nursing unit before and after moving to a new hospital to investigate the impact of a nursing unit designed utilizing Planetree build criteria. Background: The physical and emotional demands of frontline practitioners is a serious concern for patient safety and staff retention as the environmental design of nursing units can influence human errors from fatigue and interruption. Method: A pre-move survey was conducted with acute care nurses in a conventional design nursing unit who were moving to a new facility. After the move to the new hospital design, the same survey was readministered to obtain comparative performance information. Qualitative responses were analyzed for triangulation with survey responses. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Press Ganey scores were collected over a 5-year period. Results: There were statistically significant improvements for most of the survey questions, especially for work efficiency and productivity, the design of the patient room and of support spaces, the information systems, and the environmental conditions. There were statistically significant improvements in the HCHAPS and Press Ganey survey questions. Conclusions: The postoccupancy survey showed statistically significant improvements in most of the concerns highlighted in the pre-move survey and significant improvements in the workflow and overall satisfaction of nurses. Press Ganey results revealed all but five domains fell in the significantly improved category.

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Section: Discussionsupporting

confidence: 89%

Postoccupancy Evaluation of a Neighborhood Concept Redesign of an Acute Care Nursing Unit in a Planetree Hospital

Rose

Waggener²,

Kiely

et al. 2022

HERD

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“…Physicians and nurses often differ in preferred workflow locations, with nurses proportionally favoring areas with higher targeted visibility toward patient beds and physicians favoring areas with generic visual connectivity and large open spaces ( Lu & Zimring, 2011 ). In a single-center study evaluating the PICU environment, O’Hara and colleagues (2018) concluded that maximization of visibility through the design of corner work zones can enhance team interactions and patient observation, creating opportunities for macrocognition and cognitive adaptation to complex situations. For severely ill patients admitted to the ICU, one study found a significantly higher hospital mortality rate in patients admitted to rooms with low visibility from the central nursing station ( Leaf et al, 2010 ).…”

Section: Icu Spatial Configuration and Amenitymentioning

confidence: 99%

Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005–2020)

Verderber

Gray

Suresh-Kumar

et al. 2021

HERD

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Background: The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005–2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge. Purpose and Aim: This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities. Method and Result: Each source reviewed was classified as one of the five types—opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays—and into nine content categories: nature engagement and outdoor views; family accommodations; intensive care unit (ICU), neonatal ICU, and pediatric ICU spatial configuration and amenity; noise considerations; artificial and natural lighting; patient safety and infection control; portable critical care field hospitals and disaster mitigation facilities including COVID-19; ecological sustainability; and recent planning and design trends and prognostications. Conclusions: Among the findings embodied in the 135 literature sources reviewed, single-bed ICU rooms have increasingly become the norm; family engagement in the ICU experience has increased; acknowledgment of the therapeutic role of staff amenities; exposure to nature, view, and natural daylight has increased; the importance of ecological sustainability; and pandemic concerns have increased significantly in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review includes topics noticeably overlooked or underinvestigated in the 2005–2020 period and priorities for future research.

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“…There were, however, important exceptions to these trends. In addition to the Blennerhassett et al (2018) pre and post ward redesign study, there were other targeted studies with quantitative observation data that similarly did not produce specific conclusions about the environment from their observation methods (Anåker et al, 2018; Broom et al, 2019; Edgerton et al, 2010; Lu & Zimring, 2012; Miller & Keith, 1973; Newall et al, 1997; Pachilova & Sailer, 2020; Scrivener et al, 2019; Shannon et al, 2019; Shepley, 2002; Stahler et al, 1984), and there were some notable examples of exploratory studies with qualitative observation data which did produce specific conclusions (Eriksson et al, 2010; Hamilton, 2019; Karlsson et al, 2019; Kelley et al, 2011; O’Hara et al, 2018). The conclusions drawn from these exploratory studies tended to be layered, with multiple implications for hospital design.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, 37% of the included publications were classified as drawing specific conclusions from their observation data (n ¼ 25), 43% were classified as drawing nonspecific findings (n ¼ 29), and 19% could not be determined (n ¼ 13). Of the 29 studies with nonspecific findings, 59% were unspecific about both the environment and behavior in their results (n ¼ 17), while 41% were specific regarding particular aspects of behavior but provided limited information in regard to the environment (n ¼ 12), as in the Blennerhassett et al (2018) observation data that similarly did not produce specific conclusions about the environment from their observation methods (Ana ˚ker et al, 2018;Broom et al, 2019;Edgerton et al, 2010;Lu & Zimring, 2012;Miller & Keith, 1973;Newall et al, 1997;Pachilova & Sailer, 2020;Scrivener et al, 2019;Shannon et al, 2019;Shepley, 2002;Stahler et al, 1984), and there were some notable examples of exploratory studies with qualitative observation data which did produce specific conclusions (Eriksson et al, 2010;Hamilton, 2019;Karlsson et al, 2019;Kelley et al, 2011;O'Hara et al, 2018). The conclusions drawn from these exploratory studies tended to be layered, with multiple implications for hospital design.…”

Section: Aims Addressed and Conclusion Drawnmentioning

confidence: 99%

Mapping Healthcare Spaces: A Systematic Scoping Review of Spatial and Behavioral Observation Methods

Lipson-Smith

McLaughlan

2022

HERD

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Objective: To provide a taxonomy of spatial observation methods that are commonly used in healthcare environments research and to describe their relative success. Background: Spatial observation is a valuable but resource intensive research method that is often used in healthcare environments research, but which frequently fails to deliver conclusive results. There is no existing catalog of the different spatial and behavioral observation methods that are used in healthcare design research and their benefits or limitations. Methods: The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ten key databases were searched, and articles were screened by both authors. Results: Across 67 included studies, 79 observation methods were reported. We categorized those into four, distinct methodological approaches, outlining the benefits, limitations, and suitability of each for obtaining different types of results. Common limitations included difficulty generalizing to other contexts and a lack of detailed description during data collection which led to key environment variables not being recorded. More concrete conclusions were drawn when observation methods were combined with complimentary methods such as interview. Conclusions: The relative success of spatial observation studies is dependent on the fit of the method selected relative to the research question, approach, and healthcare setting; any complimentary methods delivered alongside it; and the analysis model employed. This article provides researchers with practical advice to guide the appropriate selection of spatial observation methods.

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Macrocognition in the Healthcare Built Environment (mHCBE): A Focused Ethnographic Study of “Neighborhoods” in a Pediatric Intensive Care Unit

Cited by 14 publications

References 31 publications

Postoccupancy Evaluation of a Neighborhood Concept Redesign of an Acute Care Nursing Unit in a Planetree Hospital

Postoccupancy Evaluation of a Neighborhood Concept Redesign of an Acute Care Nursing Unit in a Planetree Hospital

Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005–2020)

Mapping Healthcare Spaces: A Systematic Scoping Review of Spatial and Behavioral Observation Methods

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