How Can We Mitigate Stress for Frontline Healthcare Workers?

Evidence-based Strategies to Build Worker Resilience During the COVID-19 Pandemic and Beyond

September 28, 2020

NCIDQ LEED® AP Senior Associate I Interior Designer, NBBJ

Editor’s Note: This post was co-authored by Katie Davis, Sarah Markovitz and Andrea Rufe. 

 

The impact of COVID-19 touches all aspects of healthcare, but is especially acute when it comes to the wellbeing of frontline workers. Communities look to first responders during times of crisis, which is why the wellness of these individuals is critically important now. The pandemic’s impact on the mental health of these workers is profound, causing psychological distress. It also increases burnout, which can lower work performance and raise the risk of errors. Yet the coronavirus crisis also creates opportunities for positive change.

Key neuroscience insights illuminate strategies to help alleviate the challenges frontline workers face. These findings paired with designs that bring moments of calm and foster connections can create a roadmap for healthcare facilities — from hospitals to ambulatory centers and clinics — now and in the months ahead.

Backed by neuroscience research from NBBJ’s Fellowship Program, this post examines three ways to boost healthcare employee resilience through changes to physical environments, operational protocols and organizational systems. The ideas center on a variety of practices and respite areas — each of which can be implemented at various scales — both in traditional and non-traditional healthcare settings.

 

Support Spaces

Spaces that offer opportunities for caregivers to turn to one another for support and share solutions, especially through talk therapy, can strengthen resilience and happiness. Offer frontline workers ways to connect with someone trained to listen, such as dedicated staff or virtual mental health services. Existing rooms that provide privacy can be repurposed for these conversations with comfortable seating and couches, tables and video conference support. Furthermore, a focus on total wellness via health coaching stations with programmed nutrition, mental health and exercise classes can offer a comprehensive growth-oriented suite of amenities to build a strong support network, improve memory, enhance cognitive function and create a better quality of life.

Restorative Zones

Restorative zones create space for frontline caregivers to recharge — in the good times, but especially so in times of crisis. Restorative zones are hyper flexible: they can leverage underutilized spaces for a moment’s rest such as a quiet alcove at the end of a hallway with a window that overlooks a garden. They could include comfortable high-backed sound-absorbing chairs with ottomans to rest one’s feet and a table to place a rejuvenating refreshment or inspiring book. On a larger scale, a refuge room filled with plants, natural light and the sound of running water — or even a digital wall of nature imagery — can provide an immersive sensory experience.

Mindfulness Rooms

Spaces that facilitate mindfulness can promote mental wellness and greater resilience to challenging situations. Mindfulness can be promoted at various scales. A small niche with room for a yoga mat can help build mindfulness techniques, like deep breathing, that can be called upon anytime during the workday. Mindfulness micro practices can also be cultivated during daily routines by incorporating biophilic design in transitional spaces like stairwells. In addition, meditation, yoga and massage rooms can offer regular mindfulness sessions and promote connections between staff outside of their normal work tasks.

 

Wellness for frontline staff encompasses a whole-health approach for individuals, departments and organizations. It’s powered by meaningful work, relationships and uplifting spaces that support strength in and outside the work environment.

These ideas are part of a comprehensive report by the NBBJ Fellowship Program which outlines ways to mitigate stress for frontline healthcare workers, how to create new work rhythms and how to remain human in a hybrid virtual-physical world. To learn more about these concepts and the supporting research, please email socialmedia@nbbj.com.

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Person-Centered Design: The Importance of Balance in an Era of Constant Change

September 10, 2020

Principal, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

 

As a child, I loved seesaws — one moment having my feet on the ground and the fate of the other person in my control, the next second trusting them to lift me so high into the sky I could see over my mom. I learned to create a balance of sorts across from my older brother by sitting far back or scooting closer so that he had a harder time throwing me off.

I’ve been thinking a lot about balance lately. As designers we use it as a basic element in composition; as a civilization we equate it with stability and fairness; as humans we need it to simply stand upright — all dynamic equilibriums needing our attentiveness lest an unknown thing threaten the equation.

This is how the world seems to many of us right now — all was moving along fairly balanced with a degree of control until the pandemic sent us teetering.

Recently, I’ve started two projects that have me thinking deeper about what role balance plays in design, specifically in creating hospitals for person-centered care. Person-centered care is the compassionate perspective that we are all individual human beings first before we are anything else: spouse, parent, student, friend, employee, patient.

Founded by Planetree — an organization that promotes the thoughtful response of healthcare systems to individuals’ human need for respect, control and supportive care — this philosophy focuses on creating environments for positive human interactions between patients, families and care givers. Primary tenets include empowerment with information, integration of the arts and complementary therapies and the nurturing aspects of nutrition, spirituality and human touch — all creating better outcomes.

The physical space within a hospital or clinic plays an important role for connection to take place. It can bring equilibrium between the often-conflicting goals of human-centered experiences and operational efficiencies — that’s where our design teams come in.

So how do I design something centered around another person when I barely feel centered myself in these turbulent times? Can my environment be a part of my solution just as we expect it to be for the patient?

The real work for the patient — and for me in this pandemic — comes from within. Perhaps the space we build outside the patient is only successful if it enables the construction of a healthy space inside the person.

One way to empower this internal effort is to create environments that anticipate personal needs. For example, we know through inquiry and observation that the most frequently asked question at information desks is often the location of the restrooms. Anticipatory design places those elements in easy sightlines before patients stop to ask. By developing experience maps, we can identify and eliminate the outside struggle with blockades that throw people off.

Another aspect is to make spaces that become easy portals to colleagues, friends, and family — more thoughtfully crafted to individual needs, making connections readily available to overcome the disruption of distance. Smart televisions in patient rooms that can accept a video chat from a private phone accompanied by an overbed table device to hold the phone camera would connect families during this isolated time.

By removing barriers to compassionate human interactions in the healthcare setting, we can create conditions for the patient to do the hard work of centering themselves emotionally in their new world of diagnosis, treatment and healing. To find a fulcrum for grounding. To feel themselves again.

On a seesaw, when both people put their feet on the ground, they create a bridge between them, a stable connection built on trust. Design created through a lens of person-centered care enables both those receiving care and those providing it to create balance, building bridges between them.

In a world that is teetering, perhaps extra attentiveness to human-centered design is our chance as architects to scoot closer to those for whom we design, stretch our feet down to the ground and bring back some balance on both ends.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy Adobe Stock.

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How to Reduce Social Isolation for Healthcare Workers and Patients During the Coronavirus Pandemic

September 1, 2020

Principal, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

This post initially appeared on Forbes. It was co-authored by Bryan Langlands and Teri Oelrich.

 

COVID-19 increases social isolation for almost everyone, but especially for caregivers on the frontlines and patients in hospitals. This is in part due to critical infection prevention systems, safety protocols and social distancing measures, such as multiple layers of PPE, single-patient isolation rooms and no-visitor policies.

Studies reveal isolation, which can lead to loneliness, can both increase anxiety and depression as well lower trust, energy and social engagement. Yet despite countless conversations with healthcare workers on the front lines — from nurses to pastoral care — who say social isolation is a challenge for both caregivers and patients, there is hope. Below are key insights from these discussions, as well as strategies to create environments that ease isolation.

How to combat the effects of isolation

Because of the increased isolation due to COVID-19, the pandemic takes a toll on both extroverted and introverted staff. Extroverted staff that gain energy from social interactions may have a more difficult time than introverts, who typically enjoy more time alone. Yet while it may be easier for introverts to cope in the short term, introverts need social time as well in addition to downtime that’s not just with a patient. For example, in conversations with frontline workers, they report missing  the after-work informal socialization at restaurants and bars. How can caregivers be connected to others so they’re not fighting the battle by themselves? Here are a few strategies that may help.

Offer space for enhanced communication

Studies show that body language may account for up to 65% of all communication or more, so it’s crucial to employ innovative ways to communicate. Masks and PPE hide dialogue, greetings and facial cues, which are all crucial ways to convey not just critical patient information, but also ideas, feelings and beliefs.

Clinical staff who work with patients on isolation could use glass doors to communicate with colleagues outside the room by writing notes to each other on the transparent surface. In addition, digital and analogue message walls can provide opportunities for staff to share more informal, personal notes of encouragement that can be pushed from their smartphone or posted via sticky notes. Furthermore, nursing units with decentralized nurse stations could help minimize social isolation.

Boost opportunities to personally connect

It’s important for caregivers to share experiences and connect personally outside of work tasks, as well as celebrate milestones and work successes. Staff potlucks, birthdays and holiday celebrations are a mainstay on nursing units, and an important way for staff to interact and connect with one another.

In feedback from frontline caregivers, there are valuable opportunities to provide better break rooms. These areas could feature operable windows for fresh air, sunlight, and views of green plants, to not only create a more pleasant space for socializing, but to help boost mood, improve cognition and decrease stress. The size of break rooms should also be considered if social distancing is required when eating because a room which previously held 10-12 staff might only hold 3-4 now.

In addition, stairwells and the ends of corridors could serve as places to catch up with colleagues, and instead of places solely dedicated to circulation, they could also serve as destinations. Feedback from staff who work in hospitals where staircases are along glass perimeters of a building tell us that they become a “found” place for restorative respite, to take a moment to pause or to encourage exercise. Staircases with daylight and generous width and landings are highly popular with staff as a place to take phone calls, meet with a colleague, take a “time out” moment, and for some, to even have lunch.

Expansive windows with views, soft bench seating and even small side tables could help create a welcoming environment. These areas could also serve as informal touch down spaces for virtual team building events, such as Zoom coffee breaks, to provide ways for distributed teams to connect. And when able to step away from the floor for a rare longer break, or before or after a shift, easily accessible green roofs and healing gardens are especially important.

Another change since the pandemic has been that hospitals are decreasing the number of entrances and exits to facilities. Staff are usually diverted to one entrance where they can get their scrubs for the day and change their shoes. This area could also be an opportunity to create positive communication and gathering outside this door.

Enable peer support and mindfulness

A solid support system is crucial — especially at work. Employees who have a best friend at work are seven times as likely to be engaged in their job. When people have more friends in the workplace, they are more productive and less stressed. Calming spaces filled with comfortable furniture and soothing lights for healthcare workers to listen to one another and provide emotional support — such as affect labeling or putting feelings into words — as well as planning and problem solving, could help. These rooms could also provide spaces for staff to connect with a virtual therapist.

In addition, opportunities for caregivers to cultivate mindfulness and seek individual respite allow staff a way to recharge and find ways to cope with the stress of social isolation. Multi-sensory decompression rooms filled with gentle lights, sounds of nature  and images of a verdant forest, could promote rejuvenating, meditative retreats.

Strategies to Decrease Patient Isolation

As many hospitals reduce visitors, social isolation can be incredibly debilitating for patients too. While some hospitals allow one visitor, others maintain a no-visitor policy. Although a hospital with fewer visitors can be a quieter, more restful place, it can be lonely for patients, especially during their most vulnerable times. This is especially true because patients feel more comfortable and trusting of care when a family member is present, not to mention that it helps staff communicate with the family about the patient’s history and medications.

At times, these restrictions also require healthcare workers to take on the role of caregiver, family and friend to their patients. These challenges are also compounded with PPE requirements. In the era of the coronavirus crisis, communication between caregivers and patients is more nuanced and complex. Below are a few ideas to overcome isolation for patients.

Employ creative communication methods

In discussions with caregivers, patients and healthcare staff alike are retraining their communication methods. Many facial expressions and of course speech, are tied to the mouth, but facial coverings mask these cues and soften spoken words. Instead, eye and eyebrow movements may be even more essential to convey meaning.  One patient shared that they were not concerned about seeing their caregiver’s face because they “believe that people smile with their eyes.” This patient’s advice was to “focus on what you can see, not what you can’t.”

Increased focus on intentional or physical communication is key: staff can put photos of themselves on their PPE so patients can see what they look like behind their masks, while patients can also include photos of themselves and their families in their rooms. Celebratory rituals could also minimize patients’ isolation. When patients reach a certain milestone, or are discharged from the hospital, upbeat music and simple encouragement can be immensely uplifting.

Offer engaging technology

Technology can bring people closer together and provide positive distractions to help improve the patient experience. Wall-mounted screens in inpatient rooms that work in tandem with patient smartphones and iPads  could display medical information and history, but also provide video conferencing,entertainment options and relaxing music. These custom, built-in screens could also provide translation assistance to supplement current services. The post-traumatic stress for staff who have had to hold a phone up to a family member’s ear during their loved one’s last moments or being the vehicle for the patient to Facetime with family who are restricted from visiting is tremendous. We can do better.

Streamline entrances and exits

For hospitals that do allow visitors, streamlining entrances and exits with clear, direct signage is critical. For example, using recognizable shapes like circles and unusual colors like pink within the visual signage allows for visitors to navigate their way to, around and through the hospital.

Provide meaningful spiritual care

Spiritual care may offer a powerful means for patients to share their wishes, desires and fears. Within a hospital we tend to focus on the physical and medical, but not the spiritual. Patients who have no visitors want someone to listen to how their lives and their family’s lives have been impacted by their illness. Focusing on spiritual care is essential and can allow patients to reflect on life’s joyous and challenging moments.

A disconnect between caregivers and their work environment, and patients and their families, can create emotional exhaustion. Thoughtful and considered design does not need to come with a high price tag. Look for opportunities in planning and design where a small move can be the difference between functional and generous. From extra inches in stair widths and landings to ending corridors in glass instead of drywall to larger and more staff lounges, these design choices show the emotional well-being of the staff and patient is as important as clinical care and patient safety.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy Chuck Choi.

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