Have a personal or library account? Click to login
Inpatient unit visibility, space use, and social networks of communication Cover

Inpatient unit visibility, space use, and social networks of communication

Connections
Volume 46 (2025): Issue 1 (June 2025)
By: Julie Zook,  Rachel Culpepper,  Kerstin Sailer,  Chase Miller and  Jennifer Worley  
Open Access
|Jun 2025

Figures & Tables

Figure 1

View origins, viewsheds, and isovist connectivity diagrams for two patient heads-of-bed. Note: The top row of plans marks patient heads-of-bed as several points (in red, circled). The second row shows the viewshed from these two points (in blue). The third row, in orange, marks the area visible from the initial blue viewshed and represents the concept of isovist connectivity.
View origins, viewsheds, and isovist connectivity diagrams for two patient heads-of-bed. Note: The top row of plans marks patient heads-of-bed as several points (in red, circled). The second row shows the viewshed from these two points (in blue). The third row, in orange, marks the area visible from the initial blue viewshed and represents the concept of isovist connectivity.

Figure 2

Annotated diagrams of the two inpatient units with color-coded viewshed sizes. Note: red indicates larger viewsheds, while blue indicates smaller viewsheds. AAU, acuity adaptable unit; MSU, medical-surgical unit.
Annotated diagrams of the two inpatient units with color-coded viewshed sizes. Note: red indicates larger viewsheds, while blue indicates smaller viewsheds. AAU, acuity adaptable unit; MSU, medical-surgical unit.

Figure 3

Sample behavior maps. Note: In these behavior maps, dots mark the locations of members of the care team observed during a behavior mapping session in the AAU (left) and MSU (right). Both maps were taken near noon on the same day. AAU, acuity adaptable unit; MSU, medical-surgical unit.
Sample behavior maps. Note: In these behavior maps, dots mark the locations of members of the care team observed during a behavior mapping session in the AAU (left) and MSU (right). Both maps were taken near noon on the same day. AAU, acuity adaptable unit; MSU, medical-surgical unit.

Figure 4

Histograms of viewshed sizes for the AAU (upper) and MSU (lower). AAU, acuity adaptable unit; MSU, medical-surgical unit.
Histograms of viewshed sizes for the AAU (upper) and MSU (lower). AAU, acuity adaptable unit; MSU, medical-surgical unit.

Figure 5

Densities of presence and talking by quadrant on each unit. Note: In these density maps, a darker tone represents higher observed densities of care team workers. The top row shows the density of care team workers present, and the bottom row shows the density of care team workers talking. The left column is the AAU and the right column is the MSU. Both units have densities concentrated toward the entry (left quadrant), with the AAU showing a more even distribution of care team workers across the unit. AAU, acuity adaptable unit; MSU, medical-surgical unit.
Densities of presence and talking by quadrant on each unit. Note: In these density maps, a darker tone represents higher observed densities of care team workers. The top row shows the density of care team workers present, and the bottom row shows the density of care team workers talking. The left column is the AAU and the right column is the MSU. Both units have densities concentrated toward the entry (left quadrant), with the AAU showing a more even distribution of care team workers across the unit. AAU, acuity adaptable unit; MSU, medical-surgical unit.

Figure 6

Sociogram of network density for any patient-related communication. Note: In these sociograms of network density, the AAU appears on the left and is a denser network. The less-dense MSU network is on the right. Blue nodes represent RNs, pink nodes represent PCAs, and yellow notes represent other care team workers. AAU, acuity adaptable unit; MSU, medical-surgical unit; PCAs, personal care assistants; RNs, registered nurses.
Sociogram of network density for any patient-related communication. Note: In these sociograms of network density, the AAU appears on the left and is a denser network. The less-dense MSU network is on the right. Blue nodes represent RNs, pink nodes represent PCAs, and yellow notes represent other care team workers. AAU, acuity adaptable unit; MSU, medical-surgical unit; PCAs, personal care assistants; RNs, registered nurses.

Figure 7

Sociogram of indegree for frequent or constant patient-related communication. Note: In these sociograms of indegree, the AAU appears on the left and MSU is on the right. The size of each node reflects the indegree value, with large nodes corresponding to higher indegree. Blue nodes represent RNs, pink nodes represent PCAs, and yellow notes represent other care team workers. Note that in the MSU sociogram, two RNs are isolates. AAU, acuity adaptable unit; MSU, medical-surgical unit; PCAs, personal care assistants; RNs, registered nurses.
Sociogram of indegree for frequent or constant patient-related communication. Note: In these sociograms of indegree, the AAU appears on the left and MSU is on the right. The size of each node reflects the indegree value, with large nodes corresponding to higher indegree. Blue nodes represent RNs, pink nodes represent PCAs, and yellow notes represent other care team workers. Note that in the MSU sociogram, two RNs are isolates. AAU, acuity adaptable unit; MSU, medical-surgical unit; PCAs, personal care assistants; RNs, registered nurses.

Nursing unit attributes_

AAUMSU
Patients admittedProgressive, medical surgicalMedical surgical
Staffing
Day staffing ratio4 patients:1 nurse5 patients:1 nurse
Night staffing ratio4 patients:1 nurse6 patients:1 nurse
Additional staff to nurses and patient care assistantsUnit secretary (day)Unit secretary (day)
Monitor technician
Transport nurse
Supports for communication
Team nurse stations (w\ fixed workstations)41
Decentralized nurse stations (w\ fixed workstations)20, single seat18, two seats each
Badge-based communications deviceYesYes
Staff-only corridors through core21

Average presence density and talking density by quadrant_

AAUMSU
Percent observations with communication 46%33%
324 observations353 observations
149 yes; 175 no115 yes; 238 no
Presence density, 2-day average normalized per 1,000 ft 2
West quadrant48.7257.76
North quadrant23.2930.69
East quadrant22.9128.49
South quadrant30.820
Range (max–min)25.8137.76
Talking density, 2-day average normalized per 1,000 ft 2
West quadrant27.524.23
North quadrant8.6411.16
East quadrant8.657.22
South quadrant113.82
Range (max–min)18.8620.41

PCA and RN indegree_

Any communication Re patient care
AAUMSU
Day 1
RN average indegree8.35.4
PCA average indegree8.86.3
PCA:RN indegree (ratio)1:0.941:0.86
Day 2
RN average indegree7.63.1
PCA average indegree75.5
PCA:RN indegree (ratio)1:1.091:0.56
2-Day average
PCA:RN indegree (ratio)1:1.021:0.71

Network density and total ties_

Any communication Re patient care
AAUMSU
Day 1
Density76%66%
Total ties208120
Day 2
Density70%55%
Total ties12886
2-Day average
Average density73%60.5%
Average total ties188103

Staffing and census on behavior mapping days_

AAUMSU
Day 1
Staff1714
10 RNs8 RNs
3 PCAs5 PCAs
1 sitter1 unit secretary
1 unit secretary
1 monitor technician
1 respiratory therapist
Census2732
Nurse–patient ratio1:2.71:4
Day 2
Staff1514
8 RNs9 RNs
3 PCAs4 PCAs
1 sitter1 unit secretary
1 unit secretary
1 monitor tech
1 resp therapist
Census2630
Nurse–patient ratio1:3.251:3.33

Summary of key values_

AAUMSU
Visibility values
Avg. viewshed size, unit699 ftb,*608 ftb
Avg. mean depth,a unit 3.34*3.48
Avg. isovist connectivity, nurse stations1,280 ftb 1,269 ftb
Behavior mapping values
Percent observations with communication46%33%
Quadrant range (max–min) for presence density25.8137.78
Quadrant range (max–min) for talking density18.8620.42
SNA values
Average network density, any communication73%60.5%
Average network density, frequent/constant communication34.5%18%
PCA-to-RN indegree ratio, any communication1:1.021:0.71
PCA-to-RN indegree ratio, frequent/constant communication1:1.141:0.78

SNA questionnaire respondent attributes_

AAUMSU
Day 1
Participants12 of 17 on shift9 of 14 on shift
Response rate71%64%
RNs8 of 12 on shift7 of 10 on shift
PCAs2 of 4 on shift1 of 3 on shift
Other care team workers1 of 1 on shift1 of 1 on shift
Shift PCA-to-RN ratio1:31:3.3
Day 2
Participants/Total12 of 14 on shift7 of 13 on shift
Response rate86%54%
RNs9 of 10 on shift6 of 8 on shift
PCAs3 of 3 on shift1 of 4 on shift
Other care team workers2 of 2 on shift0 of 1 on shift
Shift PCA-to-RN ratio1:21:2
DOI: https://doi.org/10.2478/connections-2025-0003 | Journal eISSN: 2816-4245 | Journal ISSN: 0226-1766
Journal RSS Feed
Language: English
Page range: 39 - 55
Submitted on: Jun 7, 2024
Accepted on: Oct 16, 2024
Published on: Jun 19, 2025
Published by: International Network for Social Network Analysis (INSNA)
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Keywords:
Nurse communication,
Social network analysis,
Floorplan layout,
Hospital,
Space syntax
Related subjects:
Social sciences,
Social sciences, other

© 2025 Julie Zook, Rachel Culpepper, Kerstin Sailer, Chase Miller, Jennifer Worley, published by International Network for Social Network Analysis (INSNA)
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Previous articleVolume 46 (2025): Issue 1 (June 2025)Next article