Better teamwork encourages critical care nurses to take restorative breaks

Nurses in critical care units who perceive higher levels of teamwork with their colleagues are more likely to take breaks during their shifts, according to new research from The Center for Health Design published in American Journal of Critical Care (AJCC).

"Unit Layout and Critical Care Nurses' Perceptions of Visibility, Teamwork, and Taking Breaks" examined how the physical design of a critical care unit influences the nursing culture, finding that units that foster connection and collaboration may encourage break-taking behaviors. For the study, a diverse sample of critical care nurses completed an online survey, with a total of 96 completed surveys.

The Center for Health Design is a nonprofit professional organization with members throughout the spectrum of the healthcare design industry that aim to advance the use of an evidence-based design process to improve health, safety and business outcomes. The study was conducted by Yolanda Keys, PhD, DHA, RN, NEA-BC, EDAC, research associate, and Ellen Taylor, PhD, AIA, MBA, EDAC, vice president for research. Keys discussed takeaways from the study in a video interview that accompanies the journal article.

The layout of critical care units has evolved significantly, and many newly designed units have decentralized workstations with individual alcoves between patient rooms. The potential unintended consequences of these unit layouts include increased feelings of isolation and fewer opportunities for collaboration. We will continue to study how the built environment contributes to unit culture and patient outcomes."

Yolanda Keys, PhD, DHA, RN, NEA-BC, EDAC, research associate

Prior research has found that leadership support, adequate staffing and intentionally designed break areas are essential to encourage nurses to take restorative breaks, mitigate burnout, retain a viable nursing workforce, encourage health-promoting behaviors, and foster resilience.

Taking breaks during a shift is associated with lower rates of burnout, but breaks are often skipped, interrupted or compromised by workload factors. Of the nurses who responded to the survey, less than half (43%) were very likely or extremely likely to take a 30-minute meal break during a 12-hour shift, and 50% indicated they were not likely at all to take any nonmeal breaks.

For the study, participants first selected which of 13 simple-to-interpret unit layouts most closely represented their own. The layouts were variations of three broad categories of unit types: racetracks with a closed middle section, racetracks with open centers where staff members are able to see across the entire unit, or variations of pod layouts.

They then completed an online survey that included the Nursing Teamwork Survey and demographic questions, plus a researcher-developed scale asking about their ability to see patients from both a central location and in a patient room.

In open-ended questions, approximately 80% of respondents also elaborated on physical barriers that prevented them from seeing co-workers or patients. The most frequently cited barriers to visibility included built environment obstructions, such as walls, columns and doors. Curtains, either on doors or inside rooms, were the second most mentioned barrier. Other barriers mentioned were long hallways and caregiving equipment.

The team received an Impact Research Grant from the American Association of Critical-Care Nurses (AACN) to support the study.