Background: The prevailing focus on cognitive load reduction in healthcare environment standardization excludes a domain of healthcare delivery that could contribute significantly to safety and efficiency through standardization, but it has escaped discussion in the context of the biomechanics of care delivery. Inappropriate biomechanics not only can harm caregivers but compromise care delivery. Little, however, is known regarding the biomechanics of patient care and the way it interacts with the configurational issues typically targeted in healthcare environment standardization.
Objectives: Examine the types of potentially harmful or stressful actions exhibited by nurses during patient care delivery in an acute medical/surgical setting. Examine the sources influencing unsafe actions.
Method: Twenty nurses provided three types of simulated care in an experimental setting involving nine care configurations that were systematically manipulated. A kinesiology expert coded 80 simulation segments representing two types of task and two levels of environmental challenge to identify potentially stressful and harmful actions. Exploratory and regression analyses were conducted on the data.
Results: Analysis suggests that a considerable proportion of potentially harmful and stressful actions are associated with the design of the physical elements as opposed to the configurational factors typically addressed in standardization. Both of these factors interact to produce work-arounds that result in unsafe actions.
Conclusion: The standardization of healthcare environments needs a larger framework to address both cognitive lapses and the biomechanics of care delivery.
Key Words: Standardization, biomechanics, ergonomics, safety, efficiency, evidence-based design, medical/surgical unit, bed unit, inpatient unit, healthcare design, patient room
Th e contemporary focus in healthcare environment standardization has been on reducing the cognitive load of caregivers, and rightly so. The reduction of cognitive load has been addressed via the consistency of location and the design of elements in the patient care environment across all instances; for example, the concept of samehanded patient rooms, where all of the patient rooms in a unit, or across all units, in a hospital are designed to be identical in configuration and design (Cahnman, 2006; McCullough, 2006; Reiling, 2007).
The term element in this paper refers to the smallest physical entity that has an independent identity in the care delivery process. Examples of elements include the patient bed, the headwall, the medication cabinet, the supply cabinet, the intravenous (IV) pole, the patient chair, the sink, and so forth. Design of elements means the way an individual element is designed. The design of an element affects numerous actions, for instance, bed height, angle, and other attributes that influence the work of caregivers. The design of a sink determines whether hand washing can be a hands-free task; the height of a sink determines the degree of bending required, and so forth.
The distinction between design and location is crucial to the optimization of standardization. It is possible that an element (the hand-washing sink or the supply cabinet) is standardized in location (located in the exact same place in all rooms in a unit or hospital) but not in design. The reverse is also true. An element can be standardized in design but not in location. Furthermore, location has three dimensions, which can vary even though a design is standardized: the two axes representing the floor plane and vertical height from the floor.
The term configuration or physical configuration in this paper means the relative position (relative arrangement in space) of the individual elements vis-à-vis one another and the circulation paths. Thus, if the individual elements in a patient room are located to optimize a right-sided approach to the patient, it creates a right-handed configuration. …