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From stressful to mindful: Reactions to a proposed emergency department design for enhancing mindfulness and stress reduction among healthcare clinical staff

Originally Published:
Key Point Summary
Key Point Summary Author(s):
Keys, Y.
Key Concepts/Context

Research demonstrates that clinician burnout is a significant issue, especially in high-stress areas like emergency departments (EDs). Intentionally designed environmental features may serve to promote clinician well-being and mollify work-related stress. The results of this small, qualitative study highlight that multiple, reconfigurable workspaces, large staff bathrooms with non-institutional aesthetics, and exposure to daylight are among several features that may be beneficial to ED staff well-being.


The purpose of this study was to explore clinician perceptions of specific design features that might support staff and mitigate work-related stress.


Using a previously developed ED design proposal, researchers collected feedback from a variety of ED clinicians regarding supportive features in the proposed plan. After creating a virtual model of the proposed ED, researchers included design elements that could potentially benefit caregivers including a) an escape room, b) a centralized work lounge, c) an outdoor patio with plants dedicated to staff, d) three small flex rooms, e) a team room, f) a 93-sq.ft. bathroom, g) a family bereavement room, and h) a results waiting room. The different supportive elements provided options for varied levels of privacy. Participants were recruited from an event that included nursing and medical schools and snowball recruitment was also used. After pilot interviews with two physicians and subsequent refinement of the interview protocol, researchers showed the virtual model as a walk-through video during virtual interviews with ED clinicians. The objective was to collect the following information about the proposed design: overall impression, pros and cons, functionality, effectiveness of features, potential challenges, and suggestions for improvement. Individual interviews were 60-70 minutes long and were recorded. Ten clinicians from four different adult EDs participated, including four physicians, one resident, two nurse managers, two nurses, and one nurse practitioner. Interviews were conducted until data saturation occurred. Interview data were transcribed and researchers used thematic analysis and identified five core themes.

Design Implications
Design considerations resulting from this study include multiple options to support different kinds of breaks and work tasks; break or lounge rooms close to both team and patient areas; space for both individual and team activities; flexible furniture to support various body postures; dimmable lighting; controlled access to nature; at least one large staff bathroom; and space enabling staff to support grieving family and companions.

The five core themes identified from the interview data included 1) perceived professional value, 2) choice and control, 3) privacy and enhanced focus, 4) spatial adjacency, and 5) grief support. Professional value relates to clinician perceptions of feeling valued by the organization. Participants shared that the proposed ED features presented in the simulation demonstrated organizational regard for staff and recognition that staff have needs. The theme of choice and control represented staff appreciation for different location options to complete work tasks. Having a selection of spaces from which to choose to accomplish different work requirements was felt to relieve stress. The theme of privacy and enhanced focus represents participant partiality for the varying levels of privacy presented. Features including smart glass on flex room doors and frosted glass on medication room doors helped clinicians to focus by minimizing distractions and interruptions. While some participants noted the benefit of a results waiting room to talk privately with patients, there were differing opinions about whether such a room would effectively reduce violent behavior, distractions, or waiting time. The theme of spatial adjacency highlighted participant affinity for the proposed centralized design, the unit’s relatively small size, multiple access points to the lounge, adjacency of breakrooms to patients and colleagues, medication room proximity to the care team station; and flex rooms with access to main work areas. The final theme of grief support was more care focused and emphasized the need to include design features that enable staff to support the grieving process for patient companions when a patient death occurs. Equipping staff to attend to family bereavement needs can help mitigate the stress associated with these difficult situations and help staff feel they’ve done the best job they could.


Although small sample size is a noted limitation for this study, small samples are often characteristic of qualitative designs. An additional limitation is that the authors did not indicate whether the thematic analysis was conducted by more than one researcher, which would have strengthened the conclusions.

Key Point Summary Author(s):
Keys, Y.
Primary Author
Valipoor, S.