Abstract
Rigorous healthcare design research is critical to inform design decisions that improve human experience. Current limitations in the field include a lack of consistent and valid measures that provide feedback about the role of the built environment in producing desirable outcomes. Research findings about nurses’ efficiency, quality of care, and satisfaction related to inpatient unit designs have been mixed, and there was previously no validated instrument available to quantitatively measure nurses’ ability to work efficiently and effectively in their environment. The objective of this study was to develop, refine, and validate a survey instrument to measure affordance of the care environment to nurse practice, based on various aspects of their work in inpatient units. The HDR Clinical Activities Related to the Environment (CARE) Scale Inpatient Version was developed using item design, refinement, and reliability and validity testing. Psychometric methods from classical test theory and item response theory, along with statistical analyses involving correlations and factor analysis, and thematic summaries of qualitative data were conducted. The four-phase process included (1) an initial pilot study, (2) a content validation survey, (3) cognitive interviews, and (4) a final pilot study. Results from the first three phases of analysis were combined to inform survey scale revisions before the second pilot survey, such as a reduction in the number and rewording of response options, and refinement of scale items. The updated 9-item scale showed excellent internal consistency and improved response distribution and discrimination. The factor analysis revealed a unidimensional measure of nurse practice, as well as potential subscales related to integration, efficiency, and patient care. Within the healthcare design industry, this scale is much needed to generate quantitative and standardized data and will facilitate greater understanding about the aspects of an inpatient healthcare facility that best support nurses’ ability to provide quality patient care.
Highlights
Rigorous healthcare design research is critical to advancing knowledge to inform design decisions that support desirable human outcomes
Research findings about nurses’ efficiency, ability to provide quality care, and satisfaction related to inpatient unit designs have been mixed, and measurement has been heterogenous
A total of 444 respondents who were in nursing roles and completed the nurse survey questions of interest were included in this study, 73 from Great Plains Health (GPH), 48 from Fremont Health (FH), and 323 from Parkland Hospital (PH)
Summary
Rigorous healthcare design research is critical to advancing knowledge to inform design decisions that support desirable human outcomes. High quality healthcare delivery is a complex adaptive system including interactions of agents at multiple levels [1, 2]. Viewed through the lens of human-environment research, the built environment provides an important context to influence the complex adaptive system of healthcare delivery. Current limitations in the design research field include lack of consistent and valid measures for constructs about the role of the built environment in producing desirable outcomes. Research findings about nurses’ efficiency, ability to provide quality care, and satisfaction related to inpatient unit designs have been mixed, and measurement has been heterogenous. There has been no validated instrument available to quantify nurses’ experience of the patient care environment related to unit design. The important link between the built environment, staff experience, and high-quality patient care needs to be explored and measured
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