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Relationships Between Exterior Views and Nurse Stress: An Exploratory Examination

Originally Published:
Key Point Summary
Key Point Summary Author(s):
Abushousheh, Addie
Key Concepts/Context
Nursing is a stressful job, and the impacts of stress on performance are well documented. Nursing stress, however, has been typically addressed through operational interventions, even though the ability of the physical environment to modulate stress in humans is well known. This study explores the outcomes of exposure to exterior views from nurse work areas.
Examine the relationships between acute stress and alertness of nurses, and duration and content of exterior views from nurse work areas.
A survey-based method was used to collect data on acute stress, chronic stress, and alertness of nurses before and after 12-hour shifts. Control measures included physical environment stressors (that is, lighting, noise, thermal, and ergonomic), organizational stressors, workload, and personal characteristics (age, experience, income). Data were collected from 32 nurses on 19 different units at two hospitals (part of Children's Healthcare of Atlanta) in November 2006.
Design Implications
Embrace the importance of view and visual relief—especially for staff work areas—as capital planning and budgeting are conducted. Require that the programming of space requirements include a specific description of design intent (for a generous view) along with the allocation of space to accommodate these elements of design. Insist that the design of capital projects demonstrate attention to the provision of views in all areas of the workplace created for staff. This single goal, stated as a guiding principle for a project, will have an immense impact on physical design. Mandate restorative breaks as an integral aspect of operational policy. This could partly address the serious issue of patient safety that healthcare organizations are struggling with today. Insist that employees take breaks that include views—away from their work environment, if necessary, if views are otherwise unavailable.
Among the variables considered in the study view, duration is the second most influential factor affecting alertness and acute stress. The association between view duration and alertness and stress is conditional on the exterior view content (that is, nature view/non-nature view). Of all the nurses whose alertness level remained the same or improved, almost 60% had exposure to exterior and nature view. In contrast, of all nurses whose alertness levels deteriorated, 67% were exposed to no view or to only non-nature view. Similarly, of all nurses whose acute stress condition remained the same or reduced, 64% had exposure to views (71% of that 64% were exposed to a nature view). Of nurses whose acute stress levels increased, 56% had no view or only a non-nature view.
Generalizability is limited by the small sample size.
Key Point Summary Author(s):
Abushousheh, Addie
Primary Author
Pati, D.