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.
Source: Author s contribution.
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.
Source: Author s contribution.
Table 1
Nursing unit attributes.
| AAU | MSU | |
|---|---|---|
| Patients admitted | Progressive, medical surgical | Medical surgical |
| Staffing | ||
| Day staffing ratio | 4 patients:1 nurse | 5 patients:1 nurse |
| Night staffing ratio | 4 patients:1 nurse | 6 patients:1 nurse |
| Additional staff to nurses and patient care assistants | Unit secretary (day) | Unit secretary (day) |
| Monitor technician | ||
| Transport nurse | ||
| Supports for communication | ||
| Team nurse stations (w\ fixed workstations) | 4 | 1 |
| Decentralized nurse stations (w\ fixed workstations) | 20, single seat | 18, two seats each |
| Badge-based communications device | Yes | Yes |
| Staff-only corridors through core | 2 | 1 |
AAU, acuity adaptable unit; MSU, medical-surgical unit.
Source: Author s contribution.
Table 2
Staffing and census on behavior mapping days.
| AAU | MSU | |
|---|---|---|
| Day 1 | ||
| Staff | 17 | 14 |
| 10 RNs | 8 RNs | |
| 3 PCAs | 5 PCAs | |
| 1 sitter | 1 unit secretary | |
| 1 unit secretary | ||
| 1 monitor technician | ||
| 1 respiratory therapist | ||
| Census | 27 | 32 |
| Nurse–patient ratio | 1:2.7 | 1:4 |
| Day 2 | ||
| Staff | 15 | 14 |
| 8 RNs | 9 RNs | |
| 3 PCAs | 4 PCAs | |
| 1 sitter | 1 unit secretary | |
| 1 unit secretary | ||
| 1 monitor tech | ||
| 1 resp therapist | ||
| Census | 26 | 30 |
| Nurse–patient ratio | 1:3.25 | 1:3.33 |
AAU, acuity adaptable unit; MSU, medical-surgical unit; PCAs, personal care assistants; RNs, registered nurses.
Source: Author s contribution.
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.
Source: Author s contribution.
Figure 4
Histograms of viewshed sizes for the AAU (upper) and MSU (lower). AAU, acuity adaptable unit; MSU, medical-surgical unit.
Source: Author s contribution.
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.
Source: Author s contribution.
Table 3
Average presence density and talking density by quadrant.
| AAU | MSU | |
|---|---|---|
| Percent observations with communication | 46% | 33% |
| 324 observations | 353 observations | |
| 149 yes; 175 no | 115 yes; 238 no | |
| Presence density, 2-day average normalized per 1,000 ft 2 | ||
| West quadrant | 48.72 | 57.76 |
| North quadrant | 23.29 | 30.69 |
| East quadrant | 22.91 | 28.49 |
| South quadrant | 30.8 | 20 |
| Range (max–min) | 25.81 | 37.76 |
| Talking density, 2-day average normalized per 1,000 ft 2 | ||
| West quadrant | 27.5 | 24.23 |
| North quadrant | 8.64 | 11.16 |
| East quadrant | 8.65 | 7.22 |
| South quadrant | 11 | 3.82 |
| Range (max–min) | 18.86 | 20.41 |
AAU, acuity adaptable unit; MSU, medical-surgical unit.
Source: Author s contribution.
Table 4
SNA questionnaire respondent attributes.
| AAU | MSU | |
|---|---|---|
| Day 1 | ||
| Participants | 12 of 17 on shift | 9 of 14 on shift |
| Response rate | 71% | 64% |
| RNs | 8 of 12 on shift | 7 of 10 on shift |
| PCAs | 2 of 4 on shift | 1 of 3 on shift |
| Other care team workers | 1 of 1 on shift | 1 of 1 on shift |
| Shift PCA-to-RN ratio | 1:3 | 1:3.3 |
| Day 2 | ||
| Participants/Total | 12 of 14 on shift | 7 of 13 on shift |
| Response rate | 86% | 54% |
| RNs | 9 of 10 on shift | 6 of 8 on shift |
| PCAs | 3 of 3 on shift | 1 of 4 on shift |
| Other care team workers | 2 of 2 on shift | 0 of 1 on shift |
| Shift PCA-to-RN ratio | 1:2 | 1:2 |
AAU, acuity adaptable unit; MSU, medical-surgical unit; PCAs, personal care assistants; RNs, registered nurses; SNA, social network analysis.
Source: Author s contribution.
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.
Source: Author s contribution.
Table 5
Network density and total ties.
| Any communication Re patient care | ||
|---|---|---|
| AAU | MSU | |
| Day 1 | ||
| Density | 76% | 66% |
| Total ties | 208 | 120 |
| Day 2 | ||
| Density | 70% | 55% |
| Total ties | 128 | 86 |
| 2-Day average | ||
| Average density | 73% | 60.5% |
| Average total ties | 188 | 103 |
| Frequent/constant communication Re patient care | ||
|---|---|---|
| AAU | MSU | |
| Day 1 | ||
| Density | 35% | 17% |
| Total ties | 96 | 30 |
| Day 2 | ||
| Density | 34% | 19% |
| Total ties | 62 | 30 |
| 2-Day average | ||
| Average density | 34.5% | 18% |
| Average total ties | 79 | 30 |
AAU, acuity adaptable unit; MSU, medical-surgical unit.
Source: Author s contribution.
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.
Source: Author s contribution.
Table 6
PCA and RN indegree.
| Any communication Re patient care | ||
|---|---|---|
| AAU | MSU | |
| Day 1 | ||
| RN average indegree | 8.3 | 5.4 |
| PCA average indegree | 8.8 | 6.3 |
| PCA:RN indegree (ratio) | 1:0.94 | 1:0.86 |
| Day 2 | ||
| RN average indegree | 7.6 | 3.1 |
| PCA average indegree | 7 | 5.5 |
| PCA:RN indegree (ratio) | 1:1.09 | 1:0.56 |
| 2-Day average | ||
| PCA:RN indegree (ratio) | 1:1.02 | 1:0.71 |
| Frequent/constant communication Re patient care | ||
|---|---|---|
| AAU | MSU | |
| Day 1 | ||
| RN average indegree | 3.1 | 1.3 |
| PCA average indegree | 3.5 | 1.3 |
| PCA:RN indegree (ratio) | 1:0.89 | 1:1 |
| Day 2 | ||
| RN average indegree | 3.2 | 3.1 |
| PCA average indegree | 2.3 | 5.5 |
| PCA:RN indegree (ratio) | 1:1:39 | 1:0.56 |
| 2-Day average | ||
| PCA:RN indegree (ratio) | 1:1.14 | 1:0.78 |
AAU, acuity adaptable unit; MSU, medical-surgical unit; PCA, personal care assistant; RN, registered nurse.
Source: Author s contribution.
Table 7
Summary of key values.
| AAU | MSU | |
|---|---|---|
| Visibility values | ||
| Avg. viewshed size, unit | 699 ftb,* | 608 ftb |
| Avg. mean depth,a unit | 3.34* | 3.48 |
| Avg. isovist connectivity, nurse stations | 1,280 ftb | 1,269 ftb |
| Behavior mapping values | ||
| Percent observations with communication | 46% | 33% |
| Quadrant range (max–min) for presence density | 25.81 | 37.78 |
| Quadrant range (max–min) for talking density | 18.86 | 20.42 |
| SNA values | ||
| Average network density, any communication | 73% | 60.5% |
| Average network density, frequent/constant communication | 34.5% | 18% |
| PCA-to-RN indegree ratio, any communication | 1:1.02 | 1:0.71 |
| PCA-to-RN indegree ratio, frequent/constant communication | 1:1.14 | 1:0.78 |
aMean depth (Hillier & Hanson, 1984) is the measure of integration used.
b p < 0.0001.
AAU, acuity adaptable unit; MSU, medical-surgical unit; PCA, personal care assistant; RN, registered nurse.
Source: Author s contribution.