Academic journal article HERD : Health Environments Research & Design Journal

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

Academic journal article HERD : Health Environments Research & Design Journal

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

Article excerpt


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). The nursing shortage has been perceived as a detriment to quality nursing care and the work environment, causing unnecessary delays in patient care and more reported patient complaints, and interfering with staff communication (Buerhaus, Donelan, Ulrich, DesRoches, & Dittus, 2007). These statistics have enormous implications for hospital organizations and patient care.

To date, the majority of attention in healthcare design research has been given to the design of the nursing unit and how it can directly or indirectly affect work efficiency, staff fatigue, and worker and patient safety, and reduce nosocomial infection rates (Berry & Parish, 2008; Chaudhury, Mahmood, & Valente, 2009; Pati, Harvey, & Barach, 2008; Rashid & Zimring, 2008; Ulrich et al., 2008). Less research has studied how the design of nursing units influences staff in terms of informal communication, learning opportunities, job stress, and satisfaction (Becker, 2007).

Likewise, to date space syntax theory, which provides a framework for studying how spatial characteristics might have social consequences for the occupants of a built environment, has been applied primarily to an examination of the influence of office design on productivity. It is possible that the application of this theory to healthcare environments could be beneficial to nurses and patient outcomes.

Literature Review

The literature review focused on (1) the nursing profession; (2) the importance of communication and social support to nurses' level of stress and therefore to patient outcomes; (3) types and designs of medical-surgical nursing units in ur- ban hospitals; (4) the impact of medical-surgical nursing unit design on nurses' communication and social support; and (5) examining space syntax theory as a framework to investigate these relationships. All literature examined was published between 2000 and 2009.

The Nursing Profession

The nursing profession is complex, rapidly changing, and 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, 2004). Nurses are one of the most important members of the patient care team, which consists of many disciplines who are involved from an internal, external, or dual perspective. …

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