PDC_2008_Childrens Atlanta Study
-
Upload
upali-nanda -
Category
Design
-
view
72 -
download
0
Transcript of PDC_2008_Childrens Atlanta Study
A Caregivers View and its Effect on gPatient Well Being
Debajyoti Pati, PhD, AIIA, Director of Research, HKS Architects
Paul Barach, MD, MPH, Professor, University of Utrecht, Netherlands
2008 International Conference and Exhibition on Planning, Design and Construction™
Session ObjectivesSession Objectives
Id tif h i l l t th t t t• Identify physical elements that act as stressors to patients and staff
• State the impact of nature views on staff in relation to stress and alertness
• Discuss the importance of view in relation to other stressors
2008 International Conference and Exhibition on Planning, Design and Construction™
DefinitionsDefinitions
Ch i St Al t• Chronic Stress:– is a prolonged stress that
exists for weeks, months,
• Alertness:– a state of readiness to
respondor even years.
• Acute stress:– is usually for short timeis usually for short time
and may be due to work pressure, meeting deadlines pressure or pminor accident, over exertion…
2008 International Conference and Exhibition on Planning, Design and Construction™
Some Studies• Investigator/s:
– Ulrich, 1984• Findings:
– Patients with nature i ( d t• Setting:
– Post-surgical recovery it
view (compared to brick wall) had:
• Shorter LOSunit
• Subjects:Matched patients
• Fewer pain medication• More favorable
comments from nurses– Matched patients recovering from surgery
2008 International Conference and Exhibition on Planning, Design and Construction™
Some Studies• Investigator/s:
– Beauchemin & Hays, 1998
• Findings:– Shorter LOS in sunny
(1 d l )1998
• Setting:C di ICU
rooms (1 day less)– Significantly higher
mortality in dull – Cardiac ICU
• Subjects:Patients admitted
o ta ty durooms (5% more in dull rooms)
– Patients admitted directly to CICU
2008 International Conference and Exhibition on Planning, Design and Construction™
Some Studies• Investigator/s:
– Grantcharov et al• Findings:
– Impaired speed and i i l t d• Setting:
– Gastroenterological i l it i
accuracy in simulated laparoscopic performance after a
surgical unit in a teaching hospital
• Subjects:
night on-call• Time taken• ErrorsSubjects:
– 14 surgeons in training
• Errors• Unnecessary
movements
2008 International Conference and Exhibition on Planning, Design and Construction™
Some Studies• Investigator/s:
– Fahrenkopf et al, 2007• Findings:
– Depressed residents d i ifi tl• Setting:
– 3 urban children’s h it l
made significantly more medication errors than non-
hospitals
• Subjects:Residents in pediatric
depressed residents• 6.2x more medication
errors– Residents in pediatric residency program
2008 International Conference and Exhibition on Planning, Design and Construction™
Some Studies• Investigator/s:
– Landrigan et al, 2004• Findings:
– Interns in a traditional h d l (• Setting:
– MICU and CCU, B i h d
schedule (versus an intervention schedule) made substantially
Brigham and Women’s Hospital, Boston
more serious medical errors
• 35 9% more serious• Subjects:
– Interns
• 35.9% more serious medical errors in traditional schedule
2008 International Conference and Exhibition on Planning, Design and Construction™
Some Studies• Investigator/s:
– Lockley et al, 2004• Findings:
– Subjects on an i t ti k• Setting:
– Brigham and W ’ H it l
intervention work schedule (versus traditional schedule)
Women’s Hospital, Boston
• Subjects:
had decreased attentional failures
• Rate of attentionalSubjects:– Internal medicine
recidency training
• Rate of attentional failure less than half in intervention schedule
2008 International Conference and Exhibition on Planning, Design and Construction™
program
Some Studies• Investigator/s:
– Lockley et al 2006• Findings:
– Light quality (certain l th ) i t• Setting:
– Brigham and W ’ H it l
wavelengths) impact alertness, vigilance and performance
Women’s Hospital, Boston
• Subjects:Subjects:– Healthy adults
2008 International Conference and Exhibition on Planning, Design and Construction™
Some Conclusions
• Operational design (schedules, shift length) has a major impact on performance
• The physical environment (specifically visual) may alleviate conditions ) y
2008 International Conference and Exhibition on Planning, Design and Construction™
ContentsContentsWhy the inquiry?
• Objective• Hypothesesyp• Methods• Results• Discussions
2008 International Conference and Exhibition on Planning, Design and Construction™
We want to examineWe want to examine
• The influence of view on staff alertness and stress.
• What does that mean to patient healing and healthcare organizations?g
2008 International Conference and Exhibition on Planning, Design and Construction™
Why the inquiry?Why the inquiry?• Stressed Nurses• Stressed Nurses
– Data Suggest Nurse Fatigue Threatens Patient Safety1
– Fatigue and sleep deprivation common among medical personnel3
Safety1
– 70.5% of nurses surveyed indicated ‘acute/chronic effects of stress and
among medical personnel
effects of stress and overwork’ as one of their top three concerns: injury, disease assault allergydisease, assault, allergy, accident2
1 Tabone (2004)2 Houle (2001)3 AHRQ (2001)
2008 International Conference and Exhibition on Planning, Design and Construction™
AHRQ (2001)
Why the inquiry?Why the inquiry?• Impacts of stress• Impacts of stress
– Cognitive performance4
– Errors and near errors 5– slowed reaction time,
lapses of attention to detail, errors of omission,
– decreased alertness, problems with task completion, problems with
i i i bili
detail, errors of omission, compromised problem solving, reduced motivation, and decreased
concentration, irritability, unsafe actions, and unsafe decision making 6
energy 7
4 Reiling, 20055 ONA, 2005-66 Tabone, 20047 AHRQ, 2001; Page, 2004
2008 International Conference and Exhibition on Planning, Design and Construction™
Why the inquiry?Why the inquiry?• Physical environment as
t– Visual environment:
P ti t t istressor– The built environment– Auditory environment
• Patients : stress, pain, mood satisfaction 11
• Patients : blood pressure, heart rate, sleep deprivation, pain 8
• Staff : occupational stress 9
– Informational environment• Patients : stress, heart rate 10
8 Topf et al, 2001; Baker, 19849 Topf, 198810 Carpman, 1984; Nelson-Shulman, 1983-
8411 Ulrich et al, 1991, 2003; Leather et al,
2008 International Conference and Exhibition on Planning, Design and Construction™
2003
Why the inquiry?Why the inquiry?• Influence of viewInfluence of view
– Patients • LOS, pain drugs, minor
complications 12complications • Memory, time
orientation, hallucination, delusion 13
– Staff • Windowless room : lower
reported well being 14reported well being 12 Ulrich, 198413 Keep et al, 1980; Wilson, 197214 Verderber, 1987
2008 International Conference and Exhibition on Planning, Design and Construction™
QuestionsQuestions
• How does the view influence staff stress and alertness levels?
• How does nature view (as opposed to non• How does nature view (as opposed to non-nature view or no view) influence the staff stress and alertness levels?stress and alertness levels?
2008 International Conference and Exhibition on Planning, Design and Construction™
Study ObjectiveStudy Objective• To examine the association between the view duration
d t t t d l t l land content on stress and alertness levels
View Content
View Duration StressAlertness
OrganizationalOrganizational Characteristics
Work Load
Physical EnvironmentPhysical Environment Characteristics
Personal Factors
2008 International Conference and Exhibition on Planning, Design and Construction™
MethodsMethods• Setting:
Children’s Healthcare of• Predictor:
Vi d ti– Children s Healthcare of Atlanta
• Data collection:12 hours day shift
– View duration– View content: nature; non-
nature
C l– 12 hours day shift– Sample 32 of 55 personnel– Unit types: 19
• Design:
• Controls:– Stress from lighting, auditory,
thermal and ergonomic i t• Design:
– Observational; single measurement
• Outcome measure:
environment– Organizational stress– Work load
W k i• Outcome measure:– Chronic stress– Acute stress
Alertness
– Work experience– Personal data: age, education,
position
2008 International Conference and Exhibition on Planning, Design and Construction™
– Alertness
View TypesView Types
2008 International Conference and Exhibition on Planning, Design and Construction™
Methods StatisticalMethods - Statistical• Paired sample comparison• Multivariate regression• Joint partial F-testJoint partial F test• Multivariate regression with interaction terms
2008 International Conference and Exhibition on Planning, Design and Construction™
InstrumentsInstrumentsMeasure Instrument
Ch i t P i d St S l (PSS 10)Chronic stress Perceived Stress Scale (PSS-10)
Acute stress; Alertness Cox’s Stress/Arousal Adjective Checklist (SACL)
View duration; view content Investigator designed questionnaire
Lighting, auditory, thermal, ergonomic stress
Investigator designed questionnaireg
Organizational stress Revised Nursing Work Index (NWI-R)
Work load Investigator designed questionnaire
Work experience Investigator designed questionnaire
Age, education, position Investigator designed questionnaire
2008 International Conference and Exhibition on Planning, Design and Construction™
A. Chronic StressMean chronic stress
– before shiftMean chronic stress – after
Difference between
t-statistics Significance
shift means
14.5953 13.6961 -0.89923 1.897 0.062
*** significant at 0.001 ** significant at 0.01 * significant at 0.05
• NO STATISTICALLY SIGNIFICANT DIFFERENCE
Chronic Stress
SIGNIFICANT DIFFERENCE BETWEEN MEAN PSS SCORES
7:00 am 7:00 pm
2008 International Conference and Exhibition on Planning, Design and Construction™
p
B. AlertnessMean alertness –
before shiftMean
alertnessDifference between
t-statistics Significancebefore shift alertness –
after shiftbetween means
7.9714 4.4551 -3.51634 8.052 0.000***
STATISTICALLY
*** significant at 0.001 ** significant at 0.01 * significant at 0.05
• STATISTICALLY SIGNIFICANT DIFFERENCE BETWEEN MEAN ALERTNESS SCORES
Alertness
N SS SCO S• DIRECTION OF DIFFERENCE
SUPPORTED7:00 am 7:00 pm
2008 International Conference and Exhibition on Planning, Design and Construction™
p
C. Acute StressMean acute stress –
before shiftMean acute
stress – after Difference between
t-statistics Significance
shift means
-3.925 -1.835 2.0897 4.535 0.000***
• STATISTICALLY
*** significant at 0.001 ** significant at 0.01 * significant at 0.05
STATISTICALLY SIGNIFICANT DIFFERENCE BETWEEN MEAN ACUTE STRESS SCORES
Acute Stress
• DIRECTION OF DIFFERENCE SUPPORTED
7:00 am 7:00 pm
2008 International Conference and Exhibition on Planning, Design and Construction™
p
D. Alertness after shiftR R2 R2 adjusted F Significance
0.624 0.389 0.372 22.103 0.000***
Parameters Estimate Beta t SignificanceConstant 13.28 7.006 0.000***
View duration 0.1 0.273 4.109 0.000***Alertness Before Shift 0 511 0 502 7 106 0 000***Alertness- Before Shift 0.511 0.502 7.106 0.000
Env Stress -0.46 -0.236 -3.693 0.000***AE Index 0.47 0.159 2.464 0.015*
Work Load -0.867 -0.191 -3.119 0.002*NWI-R -3.664 -0.307 -4.851 0.000***
• View significantJoint Partial F-Test2
*** significant at 0.001 ** significant at 0.01 * significant at 0.05
• View significant• + 4.8% explanatory
power
R2 full model 0.372R2 sub model 0.324
R2 change 0.048
2008 International Conference and Exhibition on Planning, Design and Construction™
E. Acute stress after shiftR R2 R2 adjusted F Significance
0 669 0 447 0 431 28 063 0 000***0.669 0.447 0.431 28.063 0.000
Parameters Estimate Beta t SignificanceConstant -13.223 -6.348 0.000***
View duration 0.117 0.266 4.956 0.000***Acute Stress- Before Shift 0.499 0.5 9.616 0.000***
Env Stress 0.847 0.362 6.453 0.000***AE Index -0.864 -0.244 -4.174 0.000***
Work Load 0.599 0.11 1.998 0.047*NWI-R 0.902 0.063 1.157 0.249
• View significantJoint Partial F-Test
*** significant at 0.001 ** significant at 0.01 * significant at 0.05
• View significant• + 6.4% explanatory power
Joint Partial F TestR2 full model 0.431R2 sub model 0.367
R2 change 0.064
2008 International Conference and Exhibition on Planning, Design and Construction™
F. Alertness and view contentR R2 R2 adjusted F Significance
0.643 0.413 0.39 17.983 0.000***
Parameters Estimate Beta t SignificanceConstant 15.759 8.79 0.000***
Non-nature view 0.286 0.021 0.256 0.798Nature view 1.877 0.178 2.51 0.013*
Alertness- Before Shift 0.185 0.199 3.067 0.002*E St 0 679 0 384 6 283 0 000***Env Stress -0.679 -0.384 -6.283 0.000***AE Index 1.157 0.44 6.505 0.000***
Work Load -0.357 -0.091 -1.186 0.237NWI-R -2.862 -0.266 -3.728 0.000***
*** significant at 0.001 ** significant at 0.01 * significant at 0.05
Nature View
Alertness
7:00 am 7:00 pm
Non-Nature ViewNo View
2008 International Conference and Exhibition on Planning, Design and Construction™
7:00 am 7:00 pm
DISCUSSION: Alertness and view content
• Of all nurses whose response readiness level remained the same or
• The presence or absence of view in the nurses’ workplace trailed behind
improved: 58 percent had exposure to a view (100 percent of the 58 percent were exposed to a nature view)
ponly the organizational stressors as the factor bearing most influence on response readiness in nurses
• Of all nurses whose response readiness levels deteriorated between the beginning and end of the shift 67
• Physical environmental stressors (light, noise, thermal comfort, and ergonomics) ranked third in the orderthe beginning and end of the shift 67
percent had no view or only a non-nature view
ergonomics) ranked third in the order of influence on response readiness in nurses
2008 International Conference and Exhibition on Planning, Design and Construction™
Acute stress and view contentR R2 R2 adjusted F Significance
0.506 0.256 0.227 8.801 0.000***
Parameters Estimate Beta t SignificanceConstant -9.252 -4.077 0.000***
Non-nature view -0.657 -0.043 -0.429 0.668Nature view -0.724 -0.061 -0.727 0.468
Acute stress- Before Shift 0.316 0.328 4.651 0.000***Env Stress 0.513 0.256 3.759 0.000***Env Stress 0.513 0.256 3.759 0.000AE Index -0.924 -0.31 -4.238 0.000***
Work Load 0.561 0.127 1.466 0.144NWI-R 1.322 0.108 1.356 0.177
*** significant at 0.001 ** significant at 0.01 * significant at 0.05
Acute StressNature ViewNon-Nature View
No View
7:00 am 7:00 pm
2008 International Conference and Exhibition on Planning, Design and Construction™
p
Acute stress and view content• Of all nurses whose acute stress
condition remained the same or • The presence or absence of view in
the nurses’ workplace trailed behind 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
ponly the physical environmental stressors (light, noise, thermal comfort, and ergonomics) as the factor bearing most influence on acute64 percent were exposed to nature
view)
• Of all nurses whose acute stress levels
factor bearing most influence on acute stress in nurses
• Demographic factors (age, experience, education, and pay scale) 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
i
p , , p y )ranked third in the order of influence on acute stress
non-nature view
2008 International Conference and Exhibition on Planning, Design and Construction™
Impact on patients andImpact on patients and organization
Organizational CharacteristicsWork Load
l
Organizational CharacteristicsWork Load
l
St ff O t
Personal Factors Personal Factors
Physical Environment
Staff Outcome
Patient Outcome Organizational Outcome
2008 International Conference and Exhibition on Planning, Design and Construction™
Implications
• How does this contribute to a healing environment?
2008 International Conference and Exhibition on Planning, Design and Construction™
Implications
• Capital planning and budgeting:– Embrace the importance of view and visual p
relief for staff work areas• Programming:g g
– Require space requirements include specific description of design intent for generous views along with allocation of spaces
2008 International Conference and Exhibition on Planning, Design and Construction™
Implications
• Design:– Insist that design of capital projects g p p j
demonstrate attention t the provision of view in all staff work areas
• Policy:– Mandate restorative breaks as an integral
aspect of operational policies
2008 International Conference and Exhibition on Planning, Design and Construction™
STUDY LIMITATIONSSTUDY LIMITATIONS
• Sample size: nurses• Sample size: shiftsp• Follow-up recommendations:
Natural experiment design– Natural experiment design– Objective and subjective measures
L l– Larger sample– More settings
2008 International Conference and Exhibition on Planning, Design and Construction™