Person-Environment Fit Theory

Environmental psychologists have considered the design of the physical work environment as an under recognized factor in work-related stress (Heerwagen, Heubach, Montgomery & Weimer, 1995). They observe that the relationship between the physical environment and WRS can be studied using Person-Environment Fit (PE-Fit) theory, which argues that high levels of congruence, that is, a "good fit", is essential between workers and the physical work environment to minimize WRS. Heerwagen and colleagues argue that two types of congruence exist— functional and psychosocial. Functional congruence (FC) is conceptualized as the capacity of the physical environment to facilitate workers' completion of tasks. Psychosocial congruence (PC) is conceptualized as the capacity of the physical environment to facilitate workers' psychosocial well-being. Together, functional and psychosocial congruence constitute environmental congruence (EC), which has not been studied in hospital nursing work environments. Such a study requires consideration of the relations between the physical environment, nurses' psychosocial needs within work environments, and nursing work.

Putting it all Together undergraduate dissertation

Accepting that chronic nursing shortages would continue, the lack of research on the subject is problematic. Particularly, the goodness of the "fit" or congruence between nurses, their work, and their physical environments needs to be studied and described (Ulrich & Zimring, 2004). It is important because the physical environment is a component in theories related to work-related stress (Smith & Carayon- Sainfort, 1989; Carnevale, 1992); more so since the significance of the nurse is being acknowledged in patient safety and health care quality outcomes (Page, 2004).

Examining physical work environments as they relate to nurses and nursing work may lead to useful theoretical developments and identify interventions to reduce WRS, which may help to improve nurses' performance and engagement levels, enhance patient safety, and improve the quality of care delivered. This could also contribute to a long-term solution to chronic nursing shortages.

We have used the constructs of environmental congruence as articulated by Heerwagen et al., the nature of nursing work as articulated in the IOM report "Keeping Patients Safe" and a Maslovian conceptualization of nurses' psychosocial needs (Maslow, 1943), for undertaking a study examining a specific type of hospital nursing work environment (medical/surgical units) based on the conceptual framework. The following research questions are posed:undergraduate dissertation

o How the work environment does impacts the job satisfaction and performance of nurses?

o What psychological consequences are associated with the work environment stress?

o What is the experience of nurses about stress related to their work environment?

To appreciate as to how the physical environment, nursing work, and nurses' psychosocial needs relate to the larger issue of work-related stress (WRS), it is necessary to consider findings of scholars across a number of academic disciplines including nursing, women's studies and sociology. Some of which employ a positivist view of science and epistemology that reflects a belief that the human, social world is ordered, lawful and predictable (Agger, 1998).

Literatures pertaining to physical dimension of hospital nursing work environments (whether with positivist or non-positivist perspectives) include literature related to:

1) the history of hospital design;

2) contemporary hospital design standards;

3) contemporary research related to hospital design;

4) nursing work as women's work;

5) the physical work environment;

6) WRS and the physical work environment; and

7) Person-Environment Congruence (PE Fit) theory.

Theoretical and research work related to these topics is presented next, in order to provide a context for the present study.

The History of Hospital Design

Hospitals as social and cultural phenomena have been examined by historians and scholars within a number of disciplines including architecture (Verderber & Fine, 2000), history of medicine (Thompson & Goldin, 1975), contemporary design (Marberry, 2006), nursing (Dock & Stewart, 1938; Nightingale, 1863 and sociology (Prior, 1988) - Basic assumptions being that hospitals are complex, socio-cultural phenomena that reflect beliefs and norms about a variety of issues including health, illness, cause and treatment of disease, role of women in society, and societal responsibilities in caring for persons with illness and disease (Dock & Stewart, 1938; Temkin, 2002; Thompson & Goldin, 1975a). Contemporary historiographers also acknowledge that histories of social phenomena are themselves complex, heterogeneous, subject to reinterpretation, and influenced by the historian's political and social worldviews, loyalties, and subjectivities (Carr, 1962; Lerner, 1979; Smith, 1998; Tosh, 2002). With such caveats in mind, following is an overview of the history of hospital design.

The Nightingale Era

Florence Nightingale's influence on hospital design in the late 19^th century has been heralded as the next major development in hospital design (Verderber & Fine, 2000). Her accomplishments in the Scutari Army Hospital in Turkey during the Crimean War led to a significant and lasting influence on hospital development (Thompson & Goldin, 1975a). Her belief in the miasma theory of disease—that illness was caused by foul air and noxious vapors—and knowledge of the successfully designed British army hospital at Renkoi has been posited as influencing her theory of hospital design (Gill & Gill, 2005). "Nightingale" hospitals were located on well-drained land, and consisted of single story pavilion-type structures no more than 30 feet wide. Large windows were placed between patient beds to admit light, air, and fresh air. Her influence spread throughout Europe and the United States where pavilion style hospitals were built over the next several decades.

The Rise of the Mega Hospital

Scholars have argued that the next development in hospital design occurred in the post World War II years of the 1950's in the United States (Verderber & Fine, 2000). Federal level legislation (the Hill-Burton Aet) providing federal funds for hospital development led to a building boom, whose occurrence during a time of accelerating technological development gave rise to "mega hospitals"—multidisciplinary centers in which patients of all types and acuities were housed, diagnosed, and treated.

European architect Le Corbusier built various types of structures (housing, office buildings, etc.) from steel, glass, and concrete, with little or no ornamentation. The style became known as the International Style and significantly influenced hospital design in the mid 20 century (Verderber & Fine, 2000). Hospitals were built to be highly functional with a central core, multiple stories, and linking corridors for supply distribution. Hospital nursing unit designs also emphasized functionality and their variations were developed to improve nursing efficiencies including single corridor, dual or racetrack corridor, radial, and cross-corridor designs. Architect Gordon Friesen also influenced (Weeks, 1961) future hospitals, which were designed to suit mechanization of the routine trafficking work, using a trolley delivery system that serviced patient care units from distant kitchens and laundries. "Interstitial floors", placed between floors housing patients allowed maintenance and HVAC (heating, ventilation, and air conditioning) personnel to work out of the patient's view. Nursing supplies were delivered to the "point of use" within cupboards and closets that opened two ways to exterior hallways and patient room interiors, that is, the "nurse-server". Pneumatic tube transport systems further facilitated transport of the multiple small items associated with patient care (requisitions, paperwork, lab work, etc) across departments.

This approach intended to provide nurses with an ability to spend more time with patients and a majority of larger hospitals employ these mechanical aids today, although the development of digital and electronic medical record and report processing is leading to changes in methods of communication within healthcare systems (Johns, 1997; Steen & Detmer, 1997). Further, the work environment has significant impact of job satisfaction and work related stress. So, the better the design of the hospitals, the better performance can be expected from the nursing staff.undergraduate dissertation

Current Trends

Contemporary trends in hospital design include "patient-centered design", "healing environments", and “enhancing patient safety”.

Healing Design: Scholars have argued that the "healing design" movement is a "postmodern" approach that began in the 1960's in England with the rise of the hospice movement (Verderber & Fine, 2000). "Healing Design reflects a "New Regionalism" approach to healthcare design that has emerged internationally. It reflects a critical perspective, and runs counter to the mega-hospital phenomenon. "Healing Design" emphasizes human-scaled environments that incorporate nature, environmental psychology principles, and the construct of sustainability (Verderber & Fine, 2000). It is noted that contemporary hospitals are remembering their obligation to provide "social comfort" and begun emphasizing aesthetic factors within and around (Hosking & Haggard, 1999).

The Patient Safety Initiative: The recent publication of a number of U.S. federally sponsored IOM reports (Committee on Quality Health Care in America, 2001; Kohn, Corrigan & Donaldson, 2000; Page, 2004) has heralded a new policy emphasis in U.S. healthcare design—improving patient safety, reducing health care related error, and improving the quality of care within health care environments.

The IOM report, Keeping Patients Safe (Page, 2004), raises conceptual issues related to hospital design, including organizational factors, work and workspace design, and patient acuity. The physical design of work environments is highlighted (Carayon, Alvarado & Hundt, 2003) in conjunction with the contemporary paradigm emphasizing quality improvement and the industrialization of health care (Committee on Quality Health Care in America, Institute of Medicine, 2001; Kohn et al., 2000). Regulatory groups are requiring responsible parties (administrators, clinicians) to take a systems-engineering approach to work design that is ongoing, process based, and problem-focused (Joint Commission on Accreditation of Healthcare Organizations, 1997).

Implications of these Literatures for the Present Study

The implications of the literatures related to the history of hospital design for the present study are as follows:

1) Relationship of the working environment with WRS;

2) Evaluation of the prevailing views about the nature of health and illness, including what health care is supposed to "look like" (for example, birthing centers that feature private suites and a hotel-like ambience

The Gendered Nature of Nursing Work

Another vein of research and scholarly work related to hospital nursing work environments is the gendered nature of nursing work. This work has been done by feminist scholars within a number of disciplines including nursing, architecture, human and cultural geography, environmental psychology and architecture/design. It will be presented by discipline, although its very nature makes it somewhat trans-disciplinary.undergraduate dissertation