Ascension Health, St. Louis, MO 63134, USA.
HERD. 2009 Winter;2(2):5-20. doi: 10.1177/193758670900200202.
The primary goal of this study was to test the hypothesis that nurses adopt distinct movement strategies based on features of unit topology and nurse assignments. The secondary goal was to identify aspects of unit layout or organization that influence the amount of time nurses spend in the patient room.
Previous research has demonstrated a link between nursing hours and patient outcomes. Unit layout may affect direct patient care time by determining aspects of nurse behavior, such as the amount of time nurses spend walking. The recent nurses' Time and Motion study employed multiple technologies to track the movements and activities of 767 medical-surgical nurses. With regard to unit layout, initial analysis of the data set did not detect differences between types of units and time spent in the patient room. The analysis reported here applies novel techniques to this data set to examine the relationship between unit layout and nurse behavior.
Techniques of spatial analysis, borrowed from the architectural theory of spatial syntax, were applied to the Time and Motion data set. Motion data from radio-frequency identification tracking of nurses was combined with architectural drawings of the study units and clinical information such as nurse-patient assignment. Spatial analytic techniques were used to determine the average integration or centrality of nurse assignments for each shift.
Nurse assignments with greater average centrality to all assigned rooms were associated with a higher number of entries to patient rooms, as well as to the nurse station. Number of entries to patient rooms was negatively correlated with average time per visit, but positively correlated with total time spent in patient rooms. The data describe two overall strategies of nurse mobility patterns: fewer, longer visits versus more frequent, shorter visits.
Results suggest that the spatial qualities of nurse assignments and unit layout affect nurse strategies for moving through units and affect how frequently nurses enter patient rooms and the nurse station.
本研究的主要目的是检验以下假设，即护士根据单元拓扑和护士分配的特征采用不同的运动策略。次要目的是确定影响护士在病房内时间的单元布局或组织方面。
先前的研究表明护理时间与患者结果之间存在关联。单元布局可能会通过确定护士行为的某些方面来影响直接患者护理时间，例如护士花费在行走上的时间。最近的护士时间和运动研究采用了多种技术来跟踪 767 名外科护士的运动和活动。关于单元布局，对数据集的初步分析并未检测到不同类型的单元之间的差异以及在病房中花费的时间。本报告中的分析将新颖的技术应用于该数据集，以检查单元布局与护士行为之间的关系。
从空间句法的建筑理论中借用了空间分析技术，并将其应用于时间和运动数据集。对护士的射频识别跟踪运动数据进行了分析，并将其与研究单元的建筑图纸以及护士与患者的分配等临床信息相结合。空间分析技术用于确定每个班次护士分配的平均集成或中心度。
与所有分配房间的平均中心度更高的护士分配相关的是进入病房以及护士站的次数更多。进入病房的次数与每次访问的平均时间呈负相关，但与在病房内花费的总时间呈正相关。这些数据描述了护士移动模式的两种总体策略：次数少、时间长的访问与更频繁、时间短的访问。
结果表明，护士分配和单元布局的空间质量会影响护士在单元内移动的策略，并影响护士进入病房和护士站的频率。
