Patient Room Handedness: An Empirical Examination in Acute Medical-Surgical Settings
Debajyoti Pati (PI) and Tom Harvey
Carolyn Cason, RN, PhD, Professor, School of Nursing, University of Texas, Arlington, TX
Academy of Architecture for Health Foundation (AAHF) Research Grant and Herman Miller Grant
Best International Research Project Award. International Academy for Design and Health. Toronto, Canada. 2010
What was the aim
The study objective was to examine whether standardized same-handed room configurations contribute more to operational performance in comparison to standardized mirror-image room configurations. Based on a framework that physical environment standardization supports process and workflow standardization, thus contributing to safety and efficiency, the study examined the comparative effectiveness of the standardized same-handed configuration and the standardized mirror-image configuration.
Why is it important
Patient room handedness has emerged as an important issue in inpatient unit design, with many hospitals adopting the standardized same-handed room concept at all levels of patient acuity. Although it is argued that standardized same-handed rooms offer greater levels of safety and efficiency in comparison to standardized mirror-image rooms, there is little empirical evidence either to support or refute these contentions.
WHAT DID WE DO | HOW DID WE DO IT
An experimental setting was developed where elements of the physical environment and approach to the caregiver zone were systematically manipulated. Twenty registered nurses (10 left-handed and 10 right-handed) provided three types of care to a patient-actor across nine physical design configurations, which were videotaped in 540 separate segments. Structured interviews of the subjects were conducted at the end of each individual set of simulation runs to obtain triangulation data. Video segments were coded by nursing experts. Statistical and content analyses of the data were conducted.
What did we find
Study data show that standardization of processes and workflow to the extent of force functioning staff location on the right side of the patient, in acute medical-surgical settings, may not be achievable owing to numerous factors. Thus, designing same-handed environments may not contribute to process and workflow standardization. However, data show that physical design standardization (as a construct distinct from environmental handedness), leading to familiarity with the physical work environment, constitute an advantage in acute medical-surgical settings.
What is next
Regarding the appropriate level of patient care environment standardization, this study scope did not include the entire patient room. Future studies should examine efficiency and safety implications of room level standardization, particularly the impact of bathroom location on safety and efficiency since this continues to be an area of design laden with anecdotal perceptions absent good quality research. Also, considering the influence of ergonomics on laterality and handedness, future studies should examine safety impacts of poor ergonomics, mediated through laterality and handedness of staff.