“I am of certain convinced that the greatest heroes are those who do their duty in the daily grind of domestic affairs whilst the world whirls as a maddening dreidel.” – Florence Nightingale (1820-1910) British nurse during the Crimean War
“It seems strange how our aversion to seeing suffering is overcome in war, how we are able to see the most sickening sights… and instead of turning away, how we hurry to assist in alleviating their pain.” – Susie King Taylor (1848-1912) African-American nurse and teacher during the Civil War
These quotes from Nightingale and Taylor reflect the work of healthcare staff during the recent pandemic. In our healthcare research, as we try to understand the workflow, environment, and culture of the nurse today, the pandemic is still front and center. The nurses we work with express feelings of exhaustion and disenfranchisement from the profession they originally embarked upon. And many are still dealing with trauma from the last few years. While we celebrate our nursing heroes during this celebration of Nurse’s Week, we also pause to think about the ways we can continue to make their work lives better.
Florence Nightingale was a visionary, and we’ve modeled so much of evidence-based design practice on her observations and theories. Few people know that along with Notes on Nursing (1860), she also wrote Notes on Hospitals (1863), in which she described important aspects of her Environmental Theory, including the impact of light, noise, and variety of surroundings on her patients’ ability to heal. Now those ideas are from 1856 . . . it’s hard not to be inspired by that thinking! Population health was another of Nightingale’s passions. To validate the impact of sanitation on decreasing infection rates of the soldiers in the Crimean War, she created flow diagrams to illustrate this impact and how the addition of hand hygiene onsite saved many lives. Today, we continue to understand the impact of these design interventions on patients.
At HGA, our researchers can be found following the workflow of nurses in academic medical centers, community hospitals, outpatient centers, clinics – we’re able to observe nurses while doing shadowing during their shifts, seeing them care for their patients—and design a more efficient unit for them so they can be more effective and spend more time with their patients. In acute care settings, we seek to understand how to design nursing workflow to increase not just their efficiency and decrease the steps they must walk every day, but to also provide physical areas for respite and support to allow them to be “off-stage”. Nurses need healing too, spaces for reflection, and time to catch their breath. Today there is even more emphasis from hospital leaders to ensure adequate amenity space for staff. Those health systems who are pushing the envelope to increase retention are even providing amenities like day care, access to wellness and exercise spaces, and seeking new opportunities to allow staff to go home less drained.
More recently our design research is focusing on nursing and health science education, to understand the needs of the educators and the students. While the core of nursing hasn’t changed, advancements like robotics, artificial intelligence, and continuous monitoring of vitals are impacting a care team’s workflow and environment. And the purposeful inclusion of voices from nurses of color are enriching the environment and culture. Pedagogy must evolve to better prepare students, especially when nursing residency is not yet a universal requirement. We know the pandemic has forever changed the education of nurses as well. Increased stress and burnout are driving the need to equip nurses with knowledge of self-care before they enter the profession, and the relationship between aspects of design and wellbeing will play a big role in medical practices and education.
HGA’s new survey for nursing and health science educators will provide us with additional insight into how programs are evolving, changing, thriving and supporting the life blood of our healthcare system, the nurse.
We know every challenge presented to nurses cannot be solved with aspects of design, but, like Florence Nightingale, we see significant improvement when the design of a nurse’s work environment can support them. Hope and healing can be found in aspects of design— and we research to provide the evidence for better design that supports and elevates the practice and education of nurses.
Happy Birthday, Flo!