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DiversityNursing Blog

See How Nurses Are Doing Less Walking And More Caring

Posted by Pat Magrath

Thu, Feb 16, 2017 @ 11:11 AM

graduates-nursing-bsn.jpgEvery Nurse I know who works in a hospital, says they are amazed how much walking they do in their 12-hour shift. If you wear a Fitbit or another step tracking device, you know you walk miles during your shift. Here’s a story about a hospital that did a study to see where they could eliminate some steps for Nurses in the design of their new building.
 
The goal was to give Nurses more time to deliver the best patient care. If you have to walk all over the building to fulfill a medication order, perhaps there is a better way to do it with less steps. Maybe the applesauce or ginger ale could be located closer to where the medicine is dispensed. Please read on for some valuable information.

You don't know what you don't know until you know it.

That's the lesson leaders at ProMedica Toledo Hospital in Ohio learned during the design of its 615,000 square-foot patient tower set to 2019.

As part of the design process, the organization took part in research to identify and refine ways to improve nursing care and efficiencies, including distance traveled during a shift.

Architects from HKS, Inc., the firm designing the building, approached Alison Avendt, OT, MBA, vice president of operations, at ProMedica Toledo Hospital about doing the research.

"We have a building that we opened in 2008, so they wanted to look at how we were using the spaces [there], and get feedback from nursing on how it was working," Avendt says.

"That was really attractive to me because I heard we had issues with the building that we were in and there were many things that we wish we could have done better. I thought if we could do a good design diagnostic and learn something from that, it would really help guide our design work."

An Applesauce Moment
During two days of onsite observation, researchers shadowed ICU nurses and intermediate-level medical-surgical nurses. The researchers assessed the existing floor plan, used a parametric modeling tool, and created heat maps to provide a graphic representation of what a nurse's 12-hour shift looked like in terms of workflow and walking distances.

"One of the big [revelations] was around our whole process of medication passing," says Deana Sievert, RN, MSN, metro regional chief nursing officer and vice president for patient care services at ProMedica.

Observation revealed that a nurse reviewed the patient's medication administration record in the patient's room, walked to the supply room to get the medication from the Pyxis machine, and then often had to stop by the patient refrigerator to get something—like applesauce—to aid in the medication pass before walking back to the patient's room to administer the medication.

"It was something that was just so ingrained in our staff nurses' normal daily activities," Sievert says. "When they did the heat mapping it was like…'Wow. [There's a] big pinch point that we as staff nurses didn't really even realize was there.' "

Avendt says the researcher called this realization "the applesauce moment."

"Nurses are masterful at just making things work. There are a lot of things that the nurses knew were not value-added or were problematic, but they would just make it work," she says.

"It was really good to flesh out what those things were by observing because if you just ask[ed] them, the nurse would often not be able to verbalize what the problem was. But by seeing it, it came to light."

The architects used this information to design a unit that would cut down on walking time. Instead of a long corridor with a common area at one end, the unit was broken up into pods and supplies were located in multiple areas so nurses could get them from the location to which they were closest.

"We were able to take them from a three-mile journey on their shift to 1.5 miles. We cut in half the steps that they were taking," Avendt says.

After the tower opens, more research will be done to see how the design is affecting workflow.

"We've since learned that [field research] is not common for people to do. We paid a little bit of money to do that, but in the scheme of things it was well worth the investment," Avendt says.

"Everybody wants to give the nurse as much time as possible to be with the patient [and] try to take away the things that are not value-added in the nurse's day."

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Topics: efficiency, patient care, hospitals, Nurse burnout

Medical Units Improved To Reduce Nursing Fatigue, Cut Costs

Posted by Alycia Sullivan

Wed, Feb 06, 2013 @ 11:25 AM

In hospitals, poor floor design, storage closet clutter and crowded corridors can contribute to nurse and medical staff fatigue. These distractions can hurt patient care quality and result in higher medical costs. 

Now, a new Cornell University study offers a spatial solution. 

Rana Zadeh, Cornell assistant professor of design and environmental analysis in the College of Human Ecology, analyzed the floor plans and work patterns within five medical-surgical units at U.S. hospitals and found numerous opportunities to boost nurses' efficiency through better design. Zadeh's research, "Rethinking Efficiency in Acute Care Nursing Units: Analyzing Nursing Unit Layout for Improved Spatial Flow," is published in the current issue of Health Environments Research and Design Journal (6:1). 

In some hospital wards, important spaces such as nourishment rooms are located far away from a nurse's typical path. Jammed patient-care corridors create excessive noise, and high foot traffic raises the potential for interruptions. Supplies are stocked in various rooms, leading nurses to "hunt and gather" to find materials. 

Experts say some nurses walk up to five miles during a typical shift. Even seemingly minor changes to improve the alignment of a facility layout for better caregiver workflow can have significant benefits. 

"Imagine if a pilot was flying an airplane and trusted with keeping passengers safe, but instead of located in the cockpit, the necessary tools and controls were spread around the cabin of the plane," Zadeh says. "New medical practices and technology have emerged during the past decade, and facility design should adapt to these changing practices so that caregivers can perform better on their critical tasks." 

Data confirms the average hospital has an infrastructure that is roughly 30 to 40 years old, says Zadeh. "They can be designed innovatively and smartly for today's fast pace of care. We hope this tool offers planners, designers and managers doing a facility renovation or addition a way to spot the missing links in their floor plans and to make work processes more efficient through research-based design." 

Original article posted on Medical News Today.

Topics: study, nurse fatigue, decrease fatigue, cut costs, efficiency, Cornell University

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