Application of Space Syntax Theory in the Study of Medical-Surgical Nursing Units in Urban Hospitals

Article excerpt


Additional research is needed to explore how the design of urban, medical-surgical nursing units influences communication patterns, perceptions of social support, and overall job satisfaction for nurses. Space syntax theory has typically been used to study communication in office environments; more recently, it has been applied to the study of healthcare environments. The purpose of this study was to explore the applicability of space syntax theory as a theoretical framework for studying nurses' communication in medical-surgical nursing units in urban hospitals.

Background: The nursing profession is rapidly changing, and nurses' work is psychologically and physically intense. At the same time, nurses are responsible for patient safety, optimal care delivery, and patient outcomes (Bureau of Labor Statistics, 2009; Clarke, 2007; Clarke & Donaldson, 2008; Institute of Medicine, 2000; Institute of Medicine, 2004). Nurses are central to the delivery of care and act as a conduit for communication among members of the patient care team. Some of the design characteristics that create a more appealing environment for patients, such as views of nature and single-patient rooms, may not be fully understood as they relate to nurses' tasks and responsibilities, and they could be detrimental to nursing communication.

Methods: This study analyzed three medical-surgical nursing unit floor plans using two constructs of space syntax theory, and it verified analysis through three semi-structured interviews with end users.

Results: The use of space syntax theory for analyzing medicalsurgical nursing unit floor plans is complex. Findings indicated that nurses' perceptions of two constructs of space syntax theory, visibility and accessibility, did not consistently match the anticipated benefits of the floor plan designs.

Conclusions: Understanding how and when nurses communicate with each other could help designers of healthcare spaces create more effective environments that support nurses' work and personal health and welfare. The findings of this study suggest that further exploration is needed to confirm this theory's application to healthcare environments.

Key Words: Medical-surgical nursing unit, space syntax theory, nurse work environment, stress, communication, social support, plan analysis, visibility, accessibility, designed environment


Nurses are primary contacts for all those involved in a patient's care, creating a complex system of communication responsibilities (Leppa, 1996). The work environment of nurses is complicated, stressful, detail-oriented, and it significantly influences patient outcomes. Communication between nurses and members of the patient care team is critical to the delivery of quality healthcare. Understanding how and when nurses communicate with each other could help designers of healthcare spaces create more effective environments that support nurses' work and personal health and welfare.

Several issues facing the nursing profession have been the focus of nursing literature, including job satisfaction, work stress and burnout, and the nursing shortage. Recent research on job satisfaction for nurses highlights the importance of job satisfaction as a means of minimizing the current threat of unsafe healthcare environments caused by staff shortages (Atencio, Cohen, & Gorenberg, 2003; Lynn & Redman, 2005; Ruggiero, 2005).

Nurses who leave their jobs or the profession because of stress or job dissatisfaction have a significant impact on the labor supply. In a study of staff satisfaction, 41% of nurses noted that they were dissatisfied with their jobs; nearly 40% of hospital nurses exceeded the normal levels for burnout; and 22% planned to leave their positions within 1 year (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002). The limited supply of current and future nurses emphasizes the important role an organization plays in retaining its current labor force (Hendrich & Chow, 2008). …


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