In acute care settings, the physical environment plays an important role in staff efficiency and patient safety. Some research suggests that poor environments can result in staff stress, anxiety, and distractions due to noise; artificial lighting; improper or inadequate ventilation; and disorienting layouts of nursing units. There is less research on how environmental factors affect nursing staff health, effectiveness, errors, and job satisfaction.
This two-part study included an extensive review and analysis of the literature related to healthcare design and medication/nursing errors, staff efficiency and safety, infection control, and patient outcomes, as well as multidisciplinary acute-care focus groups working in three hospitals. The research questions, which were designed to elicit practical insights for reducing medical errors, included:
(1) What are the effects of physical environmental variables on nursing errors, nurses’ efficiency, and quality of patient care in medical/surgical nursing units?
(2) What are the effects of physical environmental variables on nurses’ job satisfaction and performance, health, and safety in medical/surgical nursing units?
For the literature review, the researchers identified, analyzed, and assigned degree-of-evidence ratings based on the rigor of the study (i.e., sample size, research design, tools used, and method of analysis) 352 relevant journal articles, books, book chapters, and reports. The researchers classified literature that presented evidence-based research as empirical (204), while they classified descriptive or conceptual literature as nonempirical (148), which they then further subdivided into expert opinion and anecdotal information. The investigators also conducted three focus groups of multidisciplinary staff at three hospitals in the Pacific Northwest to specifically understand the potential role of the physical environment on medication errors.
By integrating the major issues identified in the literature review with the key findings from the focus groups, the researchers recommended four design-related principles: balance between patient accessibility and reduction of disruptions, automation, minimize staff fatigue, and promoting a culture of safety. According to the results, the focus groups identified design responses related to errors associated with medication ordering, storage, delivery, dispensation, preparation, and administration. The authors report that the literature review suggests that the key physical environmental variables that have the most real or potential effect on workplace errors are noise, lighting, ergonomics/furniture/equipment, and design/layout. The results also suggest that high noise levels negatively affect both patients and healthcare workers, and thus compromise patient care. The findings also reveal that nurses function more effectively in environments that minimize artificial lighting and maximizes natural daylight and task lighting. Further, ergonomics, furniture, and equipment create the optimal working conditions for efficiency and safety. Finally, the authors note that the design and layout of the built environment should be convenient, accessible, safe, secure, conducive to the patients’ sense of well-being, and enable connections between patients and staff and the outside world.
The authors note that conducting this research in two parts—review of empirical and nonempirical literature and user focus groups in several hospital settings—strengthened the degree of generalizability of this study and its findings. However, as an exploratory study, variables, outcomes, and metrics were not clearly defined.