The COVID-19 pandemic has placed unprecedented emotional and physical stress on healthcare staff, bringing the need for restorative staff break areas in healthcare facilities to the forefront, according to speakers at the 2021 HCD Expo in Cleveland, during the session “Caring for the Caregiver: The Role of Culture and the Built Environment on Nurse Respite.”

Kicking off the discussion, presenters Carolyn Blake, technical practice leader/partner at Gresham Smith (Jacksonville, Fla.); Lesa Lorusso, PhD, healthcare director of research and insights at Gresham Smith (Orlando, Fla.); and Robin Maddelena, regional healthcare manager at Steelcase Health (Delray Beach, Fla.), said that even before the pandemic the industry was faced with high national turnover rates for nurses and staff shortages. The global pandemic and increasing inpatient acuity have placed greater stress on staff, compounding the issue. Linda Lawson, DBA, associate vice president of nursing for UF Health North (Jacksonville) planned to speak but could not due to patient and hospital commitments.

While existing research suggests that the built environment may help reduce staff burnout, Gresham Smith, along with partners UF Health and Steelcase, set out to evaluate the impact of the quality of nurse break rooms. During the session, the speakers highlighted findings from the first part of a two-year study that showed how intertwined both workplace culture and the built environment are when designing spaces for restorative breaks. “We wanted to know if nurses take breaks, where they take breaks, and what design features impact nurses’ engagement and satisfaction with breaks,” Lorusso said.

As part of the study, the Gresham Smith team designed break rooms at UF Health North’s new facility in Jacksonville, using evidence-based design (EBD) principles. Blake noted that while EBD research has been used to show the impact of the built environment on patient well-being, some of those same principles can apply to the design of staff spaces, as well. “Giving clinical staff access to spaces where they can fully disconnect from the demands of patient care and take a break is key to restorative break,.” Lorusso added. “Attracting and retaining qualified nursing staff is critical to the success of our healthcare organization. Due to the global pandemic, inpatient acuity has spiked and the nursing shortage has increased which, in turn, has greatly increased stress for staff. Retaining good staff is incredibly important.”

For example, elements like daylight and vistas, proper lighting levels, and quiet greatly reduce a patient’s stress. Blake said, “Taking these lessons and applying them to staff areas will allow us to study the effects and design better spaces in the future.”

As part of the study, Gresham Smith’s team studied the nurses use of all break areas throughout the medical tower including outdoor courtyards, cafeterias, and a fitness center as well as nurse specific break rooms on two identical med-surg floors: a quick break room near the nurses’ station and a quieter lounge farther away from the action. “We designed the lounges differently on two of the floors to study the nurses’ preference using a mixed methods approach which included design thinking focus groups, behavior mapping and analysis of staff turnover and breakroom usage rates through passive infrared sensors (PIR) in the furniture and card swipe room access,” Lorusso said.

Among the findings were that perceived culture, the distance to the lounge, and the lack of certain amenities affected use, Blake said. For example, the location of a respite space needs to be conveniently and closely located to their primary workspace, ideally with one located nearby every nurse unit so that each team has a sense that the space “belongs to them,” said Maddelena.

Another important feature is flexibility. “Needs are changing and the furniture needs to be comfortable, offer some visual privacy, and move easily,” Maddelena said.

During the study, Lawson observed that organizational culture was a major factor in the nurses’ engagement with restorative versus quick bio-breaks. The study also found that critical breakroom preferences including nutrition and sensory elements, such as natural light, sound, and scent, are essential. Finally, in light of COVID-19, safety is also a critical component, with clear cleaning protocols and clean air flow systems in place, the speakers noted.

“Our team is currently developing part two of this study which includes both cultural and environmental interventions identified in the first part of the study,” Lorusso said. “The importance of teamwork within our collaborative research team can’t be underestimated. The UF Health North administration is implementing an organizational emphasis on the meaning and importance of restorative breaks while the design research team is revising the med-surg break rooms to include the critical environmental components identified by the nursing staff. The impact of these interventions will be studied using the same mixed methods approach, and we are looking forward to incorporating the findings into future healthcare designs.”