Applied Research in Practice

I recently finished spending 250 hr observing critical care nurses on full 12-hr day and night shifts on six different units at four hospitals. I was watching these nurses caring for seriously ill patients in the patient room of their intensive care unit (ICU) to better understand their movement patterns and how they interacted with the physical objects in the room. It was demanding work for me, and it took a significant portion of 3 months. The magnitude of lessons for me was huge as well as surprising. I was doing this as the data collection part of my doctoral work. I still need to analyze my data and write a dissertation (which means more hard work...).[Image omitted: See PDF.]Making the Best Design Decisions in PracticeThe reason I mention this study is because it allowed me to think back and note the stark contrast with my years of practice as an architect designing hospitals and ICUs. During my practice years, I worked hard to involve the ultimate users of the space being planned in the design process. This is sometimes called a participatory process, participatory design, or user group involvement. The idea is to combine the best knowledge and experience of the designer with the knowledge, insight, and commitment of the people for whom a space is being designed. They, after all, will live in the space and will have to make it serve the intended purpose. Who better to guide important design decisions?At times, the experienced architect may have knowledge of many ICU designs and how they work, while the users have sometimes only known the unit in which they are working. At other times, the users are highly experienced, well traveled, and eager to be involved with new and innovative concepts, while the designer is embarking on one of their first critical care assignments. Finding the right mix and sensitive facilitation to make sure the design outcome is better than either party could have produced on their own is the test of a successful process.My Own Practice ExperiencePerhaps you can imagine my practice career progression from naive beginner to experienced medical planner. I was an eager sponge in the early years, continuously taking in new information and always learning. I learned to be a decent small group facilitator and made every effort to better understand the client and their needs. As a conscientious designer, I often shadowed a nurse and asked numerous questions to learn what would be needed for the new design. I prided myself on going the extra mile to learn from the doctors and nurses who worked on the units I was replacing. Nearly two decades ago, I joined the Society of Critical Care Medicine as one of a small few architects to do so and helped write their design guidelines. Eventually, as something of an expert in design of ICUs, I co-authored a book on evidence-based design for critical care ([Hamilton & Shepley, 2010]).This is where I found the clear contrast with my academic experience. As a conscientious practitioner, I am convinced I worked at the level of best practice or better in the realm of design for critical care. I had shadowed nurses in their caregiving and had seen numerous examples of good and not so good ICU designs. Yet, when compared with my 250 hr of recent observations, the observations during my practice career now seem all too superficial. I probably never shadowed a nurse for more than about 3-4 hr. I never shadowed an ICU nurse on the night shift (although at a client's request, I have spent the entire holiday night shift in the emergency department and spent the night in a patient room). I exercised a reasonable level of attention to researching my client's need, yet this hardly rises to an academic definition of research. I had almost no understanding of research methods associated with ethnographic field observations, or how to document and analyze what I had seen.Applied Research in PracticeWhat I have come to realize is that it will always be impossible for the design practitioner, even those who have added researchers to their staff, to devote the amount of time and effort that an academic researcher will be able to devote to a topic. …