Increased privacy versus perceptions of performance has emerged as the dichotomy of design at PCH, with nurses forced to walk nearly twice as far.
Research by Curtin University found that the design of Perth’s new Children’s Hospital had positive outcomes for privacy and natural light, but initially left nurses feeling exhausted, isolated, and less visible to patients and their families.
The research, published 10 January 2023 in the Journal of Health Services Research & Policy, employed a pre and post move design using healthcare improvement principles to measure the impact of the new physical environment on time spent by nurses providing patient care and patient, family, and nurse experience.
The design strategies evaluated included the predominance of single patient rooms, a 65% larger floor area, V-shaped ward design and architectural features to maximise natural light, quietness, and views of nature, as well as the implementation of a new digital hands-free communication technology.
Lead researcher Associate Professor Fenella Gill, from Curtin’s School of Nursing, said the study found that while nurses spent double the amount of time walking in the new hospital, they spent the same amount of time at patients’ bedsides.
“At the time of planning this study, the influence of building design with single rooms on patient, family and nurse experience and workflow in a children’s hospital was unquantified. We looked to address that knowledge gap by measuring the effects from a nursing, patient, and family point of view,” Associate Professor Gill explained.
“Our research revealed both benefits and challenges. Patients and families liked the new environment, yet also recognised how the design resulted in reduced visibility of nurses and a sense of isolation.
“Nurses reported that the new environment resulted in them initially experiencing exhaustion; less visibility to families and other nurses; and decreased capacity to supervise less experienced nurses, but over time they did adjust to their new working environment and their experiences did improve.”
However, the experience of increased walking persisted, and similarly, despite the hard data of no change to nurse time spent at patients’ bedsides, the perception and experiences of children, families and nurses were that nurses were less visible and spent less time with patients.
“Focus groups revealed nurses felt there was an insufficient number of nurses to provide patient care, and through surveys they also reported a large decrease in staffing and resource adequacy from 70.4 per cent pre-move to 57.1 per cent post-move,” Associate Professor Gill said.
The study, funded by The Channel 7 Telethon Trust, was conducted from November 2017 to September 2019 with data collected at three time points: pre-move T1 (November 2017–January 2018); during the move T2 (June 2018); and post-move T3 (September 2018–November 2018) and T4 (May 2019–September 2019).
Study participants were inpatient children and their families, as well as nurses employed at both the old and new paediatric hospitals at the time of data collection, including enrolled nurses, registered nurses, clinical nurses, and senior registered nurses, and all surveys were completed using the National Paediatric Toolkit – an electronic survey tool designed to engage children in patient experience feedback using interactive features.
“We collected a total of 59.6 hours of data before the move and 64.0 hours one year after the move,” the authors said.
“Nurses’ mean time spent with patients fell from 47.6 hours at T1 to 40.8 h at T4, but this difference was not statistically significant.
“Time spent documenting significantly fell, as did time spent undertaking ward activities and indirect care activities, including supervision of others, while time communicating with other staff increased.”
Incredibly, time spent walking almost doubled, from an estimated 10 min at T1 to around 20 min at T4, but there was no significant change in time spent conducting direct care activities.
“We identified four key themes that provided further explanation for the decrease in nurse staffing and resource adequacy reported,” the authors said.
“These were adapting to ward design and managing workflow, which was closely related to nurse experience of reduced visibility, interlinked with care and responsibility and technological communication.”
Despite these concerns, a year after moving to the new children’s hospital, many nurses preferred single rooms, saying they thought that patients and families were happier, noting that “It takes a little bit of work, but you do adjust to the actual working environment … we support each other a little bit more.”
And once they became familiar with using the technology, nurses especially valued the digital hands-free communication technology for working with reduced visibility.
Individual item responses confirmed families’ preferences for the space, privacy, and quiet of single rooms but families also observed at T3 that nurses appeared to be working in a more pressured environment and were less visible to them.
“Because a lot of the time … you look and there’s often not anyone visible,” one parent commented.
“But for some reason that never seemed to happen at the old hospital, the people always seemed to be on the ward.”
Yet overall, the experience of care reported by families increased after the move while children’s experiences were unchanged.