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Emily Newcomb

on 10 May 2010

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Transcript of Literature

Communication Theortical Model Socio-ecological A multilevel interactive approach concerned with changing organizational behavior, along with the physical and socialcultural environment of communities. The Nurse Work Complexity Healthy Work Environments Nurse/Physician Relationships The Patient Why? Human Factors / Errors Workplace Safety Intensive Care Unit Why? The incidence of adverse events was found to be the highest in medical intensive care units.
(Bates et al., 1995) Current Interventions Leadership Teamwork Training Tools The Physical Environment ICU Work Environment Patient Population Hybrid Nurse Station Shortage
Burnout & Retention Behavior both affects, and is affected by, multiple levels of influence.

Individual behavior both shapes, and is shaped by, the social environment (reciprocal causation). 1st 2nd Cognitive Behavior 5 different levels of health-related behaviors:
1 What people know & think affects their actions

2 Education is essential for behavior changes

3 Perceptions, motivations, skills, and social environments influence behavior
Frameworks to support positive behavior change through the social and physical environments. Crowded, messy
Noisy monitors
Misplaced equipment
Lack of personal work space

(Gurses & Carayon, 2009)
High nursing workload situations
Patient safety
Nursing quality of working life
job dissatisfaction
burnout Issues “Communication failures account for the overwhelming majority of unanticipated adverse events in patients.”
(Leonard, Graham, & Bonacum, 2004) The physical environment can make it more difficult for providers to carry out tasks and take care of their patients.
Observing How ICU Environments Impact Nurse Communication All 3 elements impact the caregiver work experience and are critical in provide quality patient care.
(Alameddine, Dainty, Deber, & Sibbald, 2009)
Physical Emotional Professional Constant high level of activity
Patients / families / staff coming and going
Constant interruptions
Caregiver Experience + + = = Quality Patient Care ICU environment is dangerous for the patient, but also the staff that work within these environments.

Ergonomic disaster, and in terms of human factors... not planned according to the limited ability of humans to both obtain data and to respond to the patient under high pressure."

This complex work environment is taxing on the physical and mental health of ICU caregivers, and may contribute to nurses leaving the ICU and leaving the profession.

(Donchin and Segull, 1995)
ICU caregiver are constantly inundated with:
patient demands
family needs
end of life care decisions
poorly designed work spaces.

These factors contribute to staff stress which, negatively influence staff performance, job satisfaction, and patient outcomes. Therefore, teamwork, effective communication, good leadership, and thoughtfully designed work environments are critical to successful patient outcomes in intensive care units. Mortality rates in an intensive care unit are greater than any other unit within an acute care hospital.

Emotionally charged atmosphere where life and death decisions present themselves often and must be made quickly

(Alameddine, Dainty, Deber, & Sibbald, 2009)
Vulnerable Caregiving team closer to the patient Decentralized Work and communication focal point Centralized + = Improve workflow
Patient satisfaction
Caregiver efficiency

(Gurascio-Howard & Malloch, 2007) The Nurse Station Culture Changes Breakdown in communication processes/communication medium can impact nurse's cognitive thinking. “Given the limits of human performance capabilities in an environment of multiple distractions, it is reasonable to infer that interventions directed toward minimizing these distractions would benefit patient safety and increase RN satisfaction.” (Ebright, Patterson, Chalko, & Render, 2003) “The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardized communication tools, create an environment in which individuals can speak up and express concerns, and share common ‘critical language’ to alert team members to unsafe situations.” (Leonard, Graham, Bonacum 2004) is a hub of constant activity where simultaneous work processes and spontaneous interactions happen.
(Steelcase, 2005) Nursing
is a high stress job. The average age of a hospital nurse is 42, and it’ll
be 50 by the end of the decade. Registered nurses have a turnover
rate of 20%, and there’s a real shortage of nurses. Surveys show that
physical working conditions, along with compensation and support,
are key drivers of turnover and burnout. So improving the work
environment, work processes, and how well the staff is equipped to do
their job, is critical to hospitals being successful in the future.(Steelcase, 2005) is important for the wellbeing of both the patient and the caregiver impromptu meetings happen
standing height worksurface Integrated work environment
– the relationship between people,
processes, objects, and spaces.
(Steelcase, 2005) Curb Side What happens? Step-in Immersive Community Models The healthcare physical environment combined with organizational culture, work processes, and technology impact the health and safety of caregivers.
(Joseph, 2006) Culture
Work Processes Physical Environment Ergonomic Disaster for both the patient and the staff.
(Donchin and Segull, 1995)
(Donchin and Segull, 1995) "Ergonomic Disaster" for patients and staff Which is examines the interrelatedness of social elements in an environment. Behavioral & environmental changes at multiple levels.
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