Impact of the environment on patients, families, and staff: Profile of studies at Edward Hospital
Edward Hospital & Health Services (EHHS) in Naperville, Illinois, has been involved in a series of renovation and new construction projects to provide much-needed healthcare services to its service area. These projects include a new heart hospital, a renovated pediatric emergency department, renovated pediatric and pediatric intensive care units, an outpatient oncology center, a main emergency department, and endoscopy suites; EHHS is currently building a medical office building and outpatient center. A new hospital in Plainfield, Illinois, is still in the approval/planning stage.
As a Pebble Project partner, EHHS has incorporated different aspects of a healing environment into its design, such as private rooms with family spaces, healing gardens, open nurses' stations, and other features that cater to the specific needs of different populations (e.g., cancer patients, children, women, etc.). EHHS also has conducted focused research studies that assess the effects of the physical environment on patients, staff, and families, in terms of satisfaction, stress, privacy, comfort, use of pain medication, infection, and ergonomics. The purpose of these studies has been twofold: to provide critical information to support design decision making for the proposed building projects within EHHS, and to share information within the healthcare community.
Two research projects are described in this article: One looks at the effect of flooring materials on staff ergonomics, and the other assesses the effects of nursing unit design on patient, staff, and family satisfaction and other perceived outcomes. Additional studies are also briefly described.
New carpet tiles (A) and synthetic “wood” fl ooring (B) tested at Edward Hospital & Health Services in Naperville, Illinois
Study 1. Evaluation of Floor Surfaces in an Inpatient Obstetrical Unit—Researchers: Patti Murphy, MSN, RN; Patti Ludwig-Beymer, PhD, RN; and Vicki Broberg, PT
This study was designed to obtain staff input on floor coverings used in an Obstetrical Unit corridor and to determine the ergonomic properties of the carpeting. Carpeting helps to reduce noise, and patients and families find carpeting warm and comforting. However, staff members have historically been less positive about carpet. They often cite concerns about difficulty in pushing carts and patient beds down carpeted hallways and about carpet as a possible reservoir for infectious pathogens.
Staff members (seven nurses, one patient care technician, and three OB techs) were asked to compare existing carpet to new carpet tiles, with evaluations about ease of pushing on the surface and ease of cleaning (on a scale of one to four, where four was most difficult).
Nurses' stations in the Ortho/Neuro Unit in the bed tower (A) and The CTU in the new Heart Hospital (B) at Edward Hospital.
The force required to pull carts and beds was measured on four flooring surfaces: carpet tiles, synthetic “wood” flooring, existing carpet in the bed tower corridor, and existing carpet in the OB corridor (figure 1). To provide information on the relative force required to move various pieces of wheeled equipment, several pieces of equipment were tested: an obstetrical-unit bed with linen and a 175-pound manikin, a trash cart loaded with cardboard, and a cleaning cart. Force was measured in pounds, with sustained force readings recorded over a 10-foot distance. Force readings were also recorded for making a 90-degree turn with the bed and manikin. All pull tests employed a single cable attached to the equipment. The Chattalon, a gauge used to measure push/pull forces, was used to measure peak force and sustained force.
For the housekeeping equipment, the force to initiate movement was highest for the carpet tiles, followed by the other carpeting. For the bed with the manikin, the existing carpet required the highest force to initiate and the highest force to sustain, followed by the carpet tiles. The age and pile compression of the carpet in the bed tower provided an ergonomic advantage for ease in pushing. For every piece of equipment, the synthetic wood surface had both the lowest force to initiate and the lowest force to sustain. The 90-degree turns for the bed with the manikin were most difficult on the carpet tiles and easiest on the old carpet.
Staff found it difficult to push carts and beds on both types of carpeting but found it less difficult to roll on carpet tiles (an average score of 3.17 for carpet tiles versus 3.42 for the existing carpet). Staff preferred cleaning carpet tiles rather than existing carpeting (3.38 versus 3.92), although both scores were negative. As these data show, the new carpet tiles did not score much better than the old carpet in the hospital in terms of pushing and pulling activities. In fact, 90-degree turns were most difficult on the new carpet tiles. The tiles were, however, perceived as being marginally easier to clean.
Another study currently under way at EHHS is examining the other big issue with carpet—infection control. This study is being conducted to document use patterns and activities contributing to flooring contamination in a hospital corridor and to test contamination at carpet-tile seams for pathogens related to nosocomial infections, asthma, and allergies. The study is being funded by Interface Flooring Systems, Inc., and is being conducted by Debra Harris, PhD, and Juli Mitchell from the University of Florida.
Study 2. Heart Hospital Environmental Design Study—Researcher: Lynn Cochran, MS, RN, ACNP
This study collected data from staff members in the Cardiac Telemetry Unit (CTU) and from patients and family members in two locations: the CTU in the Heart Hospital (opened November 2002) and the Ortho/Neuro Unit in the bed tower (a more traditional unit, opened in 1991). The CTU has single patient rooms, an open nurses' station, and a family kitchen. The Ortho/Neuro Unit has single patient rooms, a traditional nurses' station, and no family kitchen. The paper-and-pencil satisfaction survey included questions related to privacy, comfort, trust, communication, stress, and healing.
Surveys were completed by 123 family members (77 from CTU, 46 from Ortho/Neuro), 191 patients (94 from CTU, 97 from Ortho/Neuro), and 60 CTU staff members. Nurses on Ortho/Neuro were not asked to complete surveys.
Responses from CTU families were generally more positive than those from Ortho/Neuro families. Specifically, families in the CTU more often felt that the unit was calming to loved ones and that the surroundings helped loved ones to feel less stress. Although only 68% of the families reported using the family kitchen, 81% indicated that the kitchen provided comfort.
Responses of patients in the CTU also tended to be more positive than those of patients in the other unit. Compared with patients in the Ortho/Neuro Unit, these patients more often felt that the environment made them comfortable, that the environment was quiet enough, and that the design of the nurses' station provided a comfortable setting for visitors to gather.
For the most part, staff and family responses did not differ much. There were a few questions, however, on which their responses were significantly different. Nurses disagreed that the design of the CTU nurse's station (figure 2A and B) promoted trust, protected patient privacy, and promoted patient and family comfort. More nurses than family members or patients viewed the music on the CTU as being healing. Last, the artwork was more often viewed as calming by patients and families than by staff.
Another study conducted at EHHS compared patient, family, and staff satisfaction related to comfort, stress, communication, noise levels, and safety in the old and new pediatric emergency departments. In that study, Lisa DiMarco, MBA, RN; Mary Pat Martin, RN; and Darlene Wozniak, RN, found that pediatric patients, parents, and staff were very pleased with the new environment. Several other studies are under way at the Cancer Center at EHHS: One examines the effects of the environment on patients, patients' families, and staff members in terms of stress levels, privacy, and concerns about safety. Another looks at the effect of the environment on pain perception during bone marrow aspiration in three settings: the old Cancer Center, the new Cancer Center, and the new Cancer Center with music therapy.
The findings from these studies and others conducted at EHHS have provided critical feedback to the organization, which it intends to use in future renovation and construction projects. These studies are also a valuable contribution to a growing body of knowledge shared by the healthcare community. HD
Patti Ludwig-Beymer, PhD, RN, is the Administrative Director of Education and Research at Edward Hospital & Health Services located in Naperville, Illinois. With more than 30 years' experience in healthcare, Patti has held positions in practice, education, and administration.
Anjali Joseph, PhD, is the Director of Research at The Center for Health Design, a nonprofit research and advocacy organization headquartered in Concord, California.
The Pebble Report focuses on the research efforts and interests of The Center for Health Design's Pebble Project partners, a project that began in 2000 with one provider and has grown to more than 30.