hEALTH cLINIC ENVIRONMENTS IN GEORGIA
ELEMENTARY SCHOOLS
2005
by
SUSAN ROGERS SIMPSON
(Under the Direction of C. KENNETH TANNER)
ABSTRACT
Schools seem to be the logical place to serve the health needs of students, since children spend a majority of their time there. Design standards were not available for health clinics in Georgia elementary schools; therefore, this study examined key characteristics of an elementary school clinic in order to determine the importance of each design element. Eleven design classifications and 12 specific design elements were determined through a review of related literature. Characteristics included: components (rooms), space, and size; general design elements; location; accessibility; the waiting area; the nurseís office; the treatment room; the isolation area; the restroom (toilet); security, storage, and safety elements; and furnishings/treatments. Specific design elements included: lighting; windows; integrating nature elements into design; promoting a sense of well-being for users; security and privacy/confidentiality elements; electrical/plumbing elements; doors and wayfinding (signage); walls and ceilings; acoustics; use of color; heating/ventilation/air conditioning; and flooring elements. This information was incorporated in a survey of 12 experts involved with designing, building, and managing school facilities and 104 school nurses. An item analysis was completed on each design statement. Descriptive statistics and ANOVAs were completed on characteristics and specific design elements. Statistical significance between the groups was found for design characteristics: components (rooms), space and size; the waiting area; the nurseís office; and the treatment room. School nurses perceived these characteristics to be more important to clinic design than the advisory panel did. In addition, statistical significance between groups was found for these specific design elements: integrating nature elements; promoting a sense of well-being; security and privacy/confidentiality; and heating/ventilation/air conditioning. Again, school nurses perceived these specific design elements to be more important to clinic design than the advisory panel of architects, builders, consultants, and facility planners did. School nurses commented that the survey statements presented an ideal clinic design. The advisory panel commented that many of the survey statements were not cost effective. Establishing design guidelines for health clinics in Georgia elementary schools were recommended, and the guidelines should be written using the professional judgment of school nurses, representatives of users of the clinic, and the findings of this study.
INDEX WORDS: School Facilities, School Design, Health Clinic, Design Elements, Elementary School, School Nurse
CHAPTER 1
NATURE OF THE STUDY
Health and learning have intertwined throughout history (The Center for Health and Healthcare in Schools, n.d.a; Symons, Cinelli, James, & Groff, 1997). Therefore, schools seem to be the logical place to serve the health needs of students since children spend a majority of their time, about 14,000 hours, in schools (Barnett, Niebuhr, & Baldwin, 1998; Bradley, 1997; Carlson, Paavola, & Talley, 1995; Gump, 1978; Koenning et al., 1995; Pena, 2000). As a result, the school became the link between education, health, social services, and other support services that children and families needed (Bush, 1997; Dryfoos, 1994).
Controversy surrounds the issue of offering health care services in schools (Francis, Hemmat, Treloar, & Yarandi, 1996; Institute of Medicine, 1997). A number of developments have weakened the argument against health care delivery in schools. The literature suggests that the physical and psychological health of children has a direct impact on their academic and social development in school (Bush, 1997; Dryfoos, 1997; Hacker & Wessel, 1998; Jang, 1994; Morgan, 1987; Ouellette, 2001; Passerelli, 1994; Symons, et al., 1997; Tyson, 1999). Pena (2000) stated:
Conditions of poverty, emotional and psychological distress, child abuse, poor nutrition, disease, inadequate preventive and health maintenance practices Öweaken and imperil the academic and future lives of students. Hence, health careÖin public schools probably starts with administrators and school personnel becoming aware of the health status of students and continues with their recognizing that health care assistance is not charity. It is a right that students are entitled to by law. (p. 200)
The concept and practice of inclusion are putting significant numbers of students with disabilities in the regular classroom (Bartlett, Parette, & Holder-Brown, 1994). Existing federal legislation mandates that health services be provided for children with disabilities and health problems (Americans with Disabilities Act, 1990; Individuals with Disabilities Education Act, 1990 & 1997; Section 504 of the Rehabilitation Act, 1973).
School nurses are key players in the delivery of health services in the school setting (Passarelli, 1994). Some school nurses are itinerant staff members, some nurses are full-time sole staff members of the school health clinic, and some nurses are integral staff members of full-service health centers located in a school setting. The past and current roles of the professional school nurse are described throughout the professional literature (Brindis et al., 1998; Clemen-Stone, Eigsti & McGuire, 1991; Costante & Smith, 1997; Cromwell, 1946, 1963; Dryfoos, 1998; Edwards, 1987; Fryer & Igoe, 1996; Hacker & Wessel, 1998; Nelson, 1997; Oda, 1979; Passarelli, 1995; Small et al., 1995; Smiley, 1958; Wold & Dagg, 1978; Woodfill & Beyrer, 1991). School nurses provide ìhealth counseling, health instruction, and health services on an individual or small group basisî (Woodfill & Beyrer, 1991, p. 57).
Often, health-related procedures are performed in inadequate conditions and facilities in public schools. School settings for the health clinic vary from clinics operating from hallways and closets (Woodfill & Beyrer, 1991) to full-service clinics supported by a hospital or other medical organization (Dryfoos, 1997). Public schools need additional funding to hire school nurses and, in some instances, to remodel existing or build new facilities to accommodate the needs of medically fragile children and the increasing health needs of students. The American Federation of Teachers (AFT) manual (1992) states:
The placement ofÖmedically fragile children in public schools and the responsibilities for care these placements require have given rise toÖthe need for adequate funding, availability of appropriate facilities, new roles and responsibilities for school personnel, appropriate training, and legal and liability issues. (p. 9)
Statement
of the Problem
Since the introduction of the first school nurse in 1902, schools have provided some access to health education and care for students (Kellogg Foundation, 2000). Barnett, et al. (1998) stated that schools were ìa natural setting for the co-location of integrated community health and social servicesî (p. 99). Other researchers reported that providing health services to students in schools affected student achievement (Bush, 1997; Igoe, 1998; Jang, 1994; Koenning et al., 1995; Passerelli, 1994).
Planners for new schools and for renovations of existing school buildings have explored designs that encouraged and stimulated learning. Planners may explore adding clinics to school designs to assist students in learning. While design standards are necessary for each component of the school building, clinic design standards and characteristics are not available for Georgia schools. According to R. Nance (personal communication, July 1, 2002), an architect with the Georgia Department of Education, ìThere are no DOE standards for clinics at this time. The design decisions are left to the local system and their architect.î J. Allers (personal communication, July 23, 2001), the manager for the School Health Department of Childrenís Healthcare of Atlanta, wrote:
We are happy right now when nurses get running water, soap, paper towels, a private toilet for sick children, and a place to lock up meds, i.e. a locking file cabinet. We have nurses in GA without a health room of any kind. Phones and computers are nice.
Literature about successful classroom and school design existed and literature about successful designs for hospital and ambulatory care facilities was available; however, research and literature on design for school clinics and health clinics in elementary schools was very limited. Sanoff (1994) wrote that the people who actually used the school building rarely assisted in the design process. Instead, architects, builders and others who did not use the building designed schools. This study offered professional school nurses, as well as architects, builders, consultants, and planners of school facilities, an opportunity to express their perceptions about design characteristics for an elementary school health care clinic.
The purpose of this study was to compare perceptions of school nurses, architects, builders, consultants, and planners for school facilities regarding design characteristics of an elementary school health care clinic. To accomplish this purpose, this study included a review of the major literature on the relationship between health and learning, on factors that affect the health of students, on using schools as a healthcare delivery system, on the status of school facilities, on the history of school nurses, and on the design characteristics of an elementary health care clinic. Based on the responses, key clinic design elements items were identified and were utilized to develop recommendations for facility guidelines for an elementary school health care clinic.
Research
Questions
The research question that guided this study was: What were the perceptions of architects, builders, consultants, planners of school facilities and school nurses concerning the key design elements for an elementary school health clinic?
1. Is there a statistically significant difference between the perspectives of practicing school nurses (practitioners) and the advisory panel regarding the 11 design classifications?
a) Components, space, and size elements
b) General design elements
c) Location of the clinic
d) Accessibility to the clinic
e) Waiting area
f) Nurseís station/office
g) Examination/treatment room
h) Rest/isolation area
i) Restroom
j) Security, storage and safety for the clinic
k) Furnishings and treatments of the clinic
2. Is there a statistically significant difference between the perspectives of practicing school nurses (practitioners) and the advisory panel regarding the 12 specific design clusters?
a) Lighting/daylighting elements
b) Windows elements
c) Integration of nature elements into the design
d) Promotion of a sense of well-being for users
e) Use of color
f) Privacy, space and confidentiality issues
g) Heating, venting and air conditioning elements
h) Electrical and plumbing elements
i) Acoustics
j) Wall/ceiling elements
k) Flooring
l) Door/wayfinding (signage) elements
The research question and its components guided the review of the literature. A comprehensive survey including spaces for comments or concerns for each design element was developed based on the findings of the literature review. A small group of school nurses responded to the survey for readability and clarity. The survey was sent to the advisory panel and was administered to a larger group of school nurses to gather statistical data for this study.
Definition
of Terms
For the purposes of this study, terms were defined as follows:
1. Advisory Panelóprofessional architects, builders, consultants, and planners of facilities having expertise and certification in specialized areas of school construction and design.
2. Professional School Nurseóa person who acquired Georgia
certification in nursing and who was currently working as a nurse in a public school.
3. Design Elementsósets of principles by which facilities were planned and built.
4. Elementary Schoolóa school composed of grades pre-K through fifth.
Importance of the Study
This study will make needed contributions to the existing small research base and to the identification process of key design elements and characteristics for elementary school health care clinics. The contributions were based upon the perceptions of school nurses, architects, builders, consultants, and facility planners for elementary school facilities. The more effective and efficient clinics may improve the school nurseís impact on the health of students and staff members of the school.
Limitations of the Study
This study was limited by several factors. The survey instrument was limited to the knowledge and ideas found in the researcherís review of the literature. Open-ended comments/concerns sections were added to the survey to obtain ideas not found in the literature review. The use of a selected advisory panel and the school nurses attending a Georgia Association of School Nurses conference to complete the survey instrument prevented random selection of participants. Results were limited to the areas of their expertise. The study was limited geographically since all survey participants resided in the state of Georgia.
Assumptions
This study assumed that the staff of a clinic had expertise to offer regarding facility needs; hence, it offered professional school nurses, as well as architects, builders, consultants, and planners for school facilities, an opportunity to express their perceptions about elementary health clinic design needs. The researcher assumed that the responses of the survey and open-ended comments/concerns sections were an accurate reflection of the true perceptions of the participants.
Organization of the Remainder of
the Study
This study was organized into five chapters. Chapter 1 included the introduction to the study, the statement of the problem, the purpose of the study, the research questions, and the definition of terms.
Chapter 2 presented a review of the related literature including the relationships between health and learning and health and socioeconomic status, access to health, schools as a healthcare delivery system, facilities, the history of school nurses, specific design elements of a health care clinic, and design classifications for an elementary health care clinic. A table listing research regarding design elements was included in Appendix A.
Chapter 3 described the design of the study. This chapter included the research questions that guided the study, descriptions of the participants, the instrumentation used to gather data, the method for gathering the data, and the planned statistical treatment of the data.
In Chapter 4, all findings related to the research questions were reported, and in Chapter 5, a summary of the research study was provided along with recommendations and implications for further research for design needs for elementary school health care clinics.
Chapter
2
Review
of Literature (truncated)
Conclusion
The role and the responsibilities of the school nurse continue to be dependent on the needs of the students served and the availability of funding sources in the community. The school continues to be an efficient site for health care delivery; however, it is highly unlikely that funds will be available to implement fully staffed and equipped school-based clinics at each school. Communities and boards of education should make use of the school nurseóthe professional who represents a host of dedicated professionals working in the field of school health care.
New school facilities will continue to be built and existing school facilities will be renovated as needed. This study offered professional school nurses, as well as architects, builders, consultants and planners of school facilities, an opportunity to express their perceptions about design characteristics for an elementary school health care clinic. These design characteristics may be used to write state facility guidelines for school clinics that could assist school nurses and delegated school personnel in meeting the health care needs of students more effectively.
CHAPTER 3
DESIGN OF THE STUDY
Design standards and elements are needed for each component or room in the school building. Literature about successful classroom and school design existed and literature about successful designs for hospital and ambulatory care facilities was available; however, research on design for school clinics in elementary schools was very limited. There was little published literature to inform or guide designers, facility planners, builders, architects, or researchers about successful school clinic design.
A review of the literature examined the relationship between health and learning, the factors that affected the health of students, the basis for using schools as a part of the healthcare delivery system, the history of school nurses, and the current roles and responsibilities of school nurses. The literature review provided the identification of design elements used in hospital and ambulatory care facilities and in successful school design. The purpose of this study was to compare perceptions of school nurses, architects, builders, consultants, and planners for school facilities regarding design characteristics of an elementary school health care clinic.
Research
Questions
The research question that guided this study was: What were the perceptions of architects, builders, consultants, planners of school facilities, and school nurses concerning the key design elements for an elementary school health clinic?
1. Is there a statistically significant difference between the perspectives of practicing school nurses and the advisory panel regarding the 11 design classifications?
a) Components (rooms), space, and size elements
b) General design elements
c) Location of the clinic
d) Accessibility to the clinic
e) Waiting area
f) Nurseís station/office
g) Examination/treatment room
h) Rest/isolation area
i) Restroom (toilet)
j) Security, storage and safety for the clinic
k) Furnishings and treatments of the clinic
2. Is there a statistically significant difference between the perspectives of practicing school nurses and the advisory panel regarding the 12 specific design clusters?
a) Lighting/daylighting elements
b) Windows elements
c) Integration of nature elements into the design
d) Promotion of a sense of well-being for users
e) Use of color
f) Privacy, space and confidentiality issues
g) Heating, venting and air conditioning elements
h) Electrical and plumbing elements
i) Acoustics
j) Wall/ceiling elements
k) Flooring
l) Door/wayfinding elements
Participants
The advisory panel included architects, builders, consultants, and facility planners of elementary schools. The second group of survey participants was a small group of four school nurses. The survey was administered to 100 school nurses attending the annual Georgia Association of School Nursesí conference.
Instrumentation
The researcher generated a demographics sheet for the survey. A comprehensive survey on 100 health clinic design elements was developed based on the findings of the literature review. Spaces for comments or concerns for each design element were provided for the survey participants. A 10-point Likert Scale indicating the degree of importance for the design element, ranging from very low to very high, was used to rate each survey statement.
Method
A select group of four school nurses completed the survey for reliability, readability, and clarity. The survey was mailed to 12 selected members of the advisory panel to provide comparison data for the survey. Finally, the researcher attended the annual school nursesí conference in Savannah on July 25, 2004. One hundred school nurses attending the conference completed the survey.
Statistical
Treatment
Descriptive procedures were used to produce means and standard deviations for the 11 design classifications and the 12 specific design elements. Likert scale questions were appropriate to print means for since the number that was coded for a question gave a direction for the average answer. A minimum and maximum value showed the range of answers given by the survey population. An item analysis was computed for each of the 100 design statements or variables.
According to SPSS, a Cronbachís alpha was computed to ìmeasure how well a set of items (or variables) measure a single unidimensional latent construct. Cronbachís alpha is not a statistical test but is a coefficient of reliability (or consistency). In this study, identification of key design classifications for the health clinic was the latent construct. Cronbachís alpha was a function of the number of items and the average inter-correlation among these items. As the inter-item correlation increased, Cronbachís alpha increased as well and there was evidence that the items were measuring the same underlying construct producing high reliability. The survey instrument provided a large number of statements for review. The high alpha for the 11 design classifications indicated consistency in measuring these classifications.
Tests for homogeneity of variances were computed for the 11 design classifications and the 12 specific design elements. To find out if there were significant differences between the means of the two groupsóGroup 1, practicing school nurses; and Group 2óarchitects, builders, consultants, and planners for school facilitiesó an analysis of variance (ANOVA) was computed for the 11 design classifications and for the 12 specific design elements.
CHAPTER 4
FINDINGS
This chapter presents the results of the surveys completed by seven members of the advisory panel and 104 practicing school nurses. The results, an analysis of the results, and a summary are included in this chapter.
Survey Results
Following the data collection procedures as described in Chapter 3, an analysis was conducted on the survey data. Data from 111 surveys were used. Respondents were divided into two groupsóarchitects, builders, consultants, and planners for school facilities and school nurses. Demographic data were coded and entered as variables 1ñ31. Design element statements on the survey were considered individually, as design cluster variables, and as cluster variables for a specific design element.
A Likert scale of 1 to 10 was used to indicate the respondentís perception of the importance of the statement to the design of a health clinic in an elementary school. This analysis reported the degree of importance for each statement and for each cluster in the survey. Results for each cluster, for specific design elements clusters, and differences between groups are discussed and presented in tables in this chapter.
Design
Cluster Variables
Eleven design cluster variables were identified and abbreviated for reporting purposes. These design cluster variables occurred naturally on the survey instrument with the first statement on the survey coded as variable 32. Assigned variable numbers are in parentheses at the end of each statement on the survey in Appendix A. An item analysis in Appendix B was completed on each of the 100 variables.
The first design cluster for components, size and space requirements (CSSR), had five statements, variables 32--36. The general design elements (GDR) cluster had 13 statements, variables 37--49. Location of the health clinic (LOC) had 7 statements, variables 50--56. Accessibility (ACC) had three statements, variables 57--59. The waiting area (WAIT) had six statements, variables 60--65. The nurseís office (NOFF) had 16 statements, variables 66--81. The treatment room (TRRM) had 26 statements, variables 82--107. The rest/isolation area (ISOL) had five statements, variables 108--112. The restroom or toilet room (RESTR) had nine statements, variables 113--121. Security, storage and safety (SSS) had six statements, variables 122--127. Furnishings and treatments (FURN) had four statements, variables 128--131.
Reliability
The internal consistency of the survey statements was calculated with an alpha coefficient or Cronbachís alpha since the survey was administered only one time to the expert group and the group of practicing nurses; and a Likert scale was used to indicate preference rather than right versus wrong answers. Cronbachís alpha is a function of the number of items and the average inter-correlation among the items. The inter-item correlation produced a satisfactory alpha for each design cluster variable. Since the inter-item correlations were high, there was evidence that the items were measuring the same underlying construct. Table 1 reports the standardized alpha for each of the design cluster variables. The reliability coefficient of .65 or higher was accepted by the researcher
Design Cluster Variables
Table 1 displays
the descriptive statistics for the 11 design cluster variables for all
respondents. All design cluster variables were perceived as having at least a
medium degree of importance to clinic design. The mean score for components
(rooms), size and space requirements (CSSR) received the highest score of 8.86,
and the isolation room (ISOL) score of 5.77 was the lowest mean score.
Analysis for Design Cluster
Variables
The research question was stated as follows: Is there a statistically significant difference between the perspectives of practicing school nurses and the advisory panel regarding the 11 design classifications? The means and standard deviations for the perspectives of the two groups are given in Table 2. Group 1 identified school nurses, and Group 2 identified the advisory groupó architects, builders, consultants, and planners of school facilities.
Table 2 also shows the variances for the tests of homogeneity. Since all significance levels were greater than .05, the variances were found to be homogeneous and the spread or variance of mean scores for the two groups, nurses and the advisory panel , was approximately equal
Table 3 displays the statistically significant differences between the two groups for the following variable clusters: CSSR, WAIT, NOFF, and TRRM. For example, regarding the cluster representing components (rooms), size and space (CSSR or statements 1 through 5) F1,109 = 4.40, p < .04. Further investigation revealed that the Nurses perceived these items to be significantly more important than did the advisory panel (Mean for Nurses = 8.93; Mean for Panel = 7.89).
Table 1
Descriptive Statistics for Design Cluster Variables
|
Cluster |
Statement Number |
Variable Number |
Standardized Alpha |
N Valid/ N Missing |
Mean |
Standard Deviation |
|
Components or Rooms, Space, and Size Requirements (CSSR) |
1 - 5 |
32 - 36 |
.74 |
111/0 |
8.87 |
1.30 |
|
General Design Elements (GDE) |
6 - 18 |
37 - 49 |
.91 |
111/0 |
6.83 |
1.77 |
|
Location of the Health Clinic (LOC) |
19 - 25 |
50 - 56 |
.77 |
111/0 |
6.82 |
1.64 |
|
Accessibility (ACC) |
26 - 28 |
57 - 59 |
.69 |
111/0 |
7.05 |
1.94 |
|
Waiting Area (WAIT) |
29 - 34 |
60 - 65 |
.84 |
110/1 |
6.22 |
1.96 |
|
Nurseís Office (NOFF) |
35 - 50 |
66 - 81 |
.93 |
111/1 |
7.97 |
1.48 |
|
Treatment Room (TRRM) |
51 - 76 |
82 - 107 |
.96 |
110/1 |
6.97 |
1.84 |
|
Rest/Isolation Area (ISOL) |
77 - 81 |
108 - 112 |
.88 |
111/1 |
5.77 |
2.41 |
|
Restroom or Toilet (RESTRM) |
82 - 90 |
113 - 121 |
.81 |
111/1 |
7.03 |
1.86 |
|
Security, Storage, and Safety (SSS) |
91 - 96 |
122 - 127 |
.80 |
111/0 |
7.29 |
1.81 |
|
Furnishings and Treatments (FURN) |
97 - 100 |
128 - 131 |
.85 |
110/1 |
6.60 |
2.24 |
Table 2
Group Statistics for Design Cluster Variables
Group 1 - Nurses; Group 2 ñAdvisory Panel of Architects,
Builders, Consultants, Planners
|
Cluster |
Group |
N |
Mean |
SD |
Minimum |
Maximum |
Levene Statistic |
Degrees of Freedom |
Standardized Alpha |
|
Components, Space, and Size (CSSR) |
1 |
104 |
8.93 |
1.23 |
4.00 |
10.00 |
2.44 |
1,109 |
.12 |
|
|
2 |
7 |
7.89 |
1.90 |
5.20 |
10.00 |
|
|
|
|
|
Total |
111 |
8.86 |
1.30 |
4.00 |
10.00 |
|
|
|
|
General Design Elements (GDE) |
1 |
104 |
6.88 |
1.78 |
1.77 |
9.85 |
.63 |
1,109 |
.43 |
|
|
2 |
7 |
6.01 |
1.53 |
2.85 |
7.46 |
|
|
|
|
|
Total |
111 |
6.83 |
1.77 |
1.77 |
9.85 |
|
|
|
|
Location of the Health Clinic (LOC) |
1 |
104 |
6.88 |
1.62 |
2.14 |
10.00 |
.00 |
1,109 |
.96 |
|
|
2 |
7 |
6.00 |
1.90 |
2.00 |
7.71 |
|
|
|
|
|
Total |
111 |
6.82 |
1.64 |
2.00 |
10.00 |
|
|
|
|
Accessibility (ACC) |
1 |
104 |
7.06 |
1.93 |
1.67 |
10.00 |
.08 |
1,109 |
.78 |
|
|
2 |
7 |
6.81 |
2.24 |
3.33 |
10.00 |
|
|
|
|
|
Total |
111 |
7.05 |
1.95 |
1.67 |
10.00 |
|
|
|
Table 2 Continued
Group Statistics for Design Cluster Variables:
Group 1 - Nurses; Group 2 ñ Advisory Panel of Architects,
Builders, Consultants, Planners
|
Cluster |
Group |
N |
Mean |
SD |
Minimum |
Maximum |
Levene Statistic |
Degrees of Freedom |
Standardized Alpha |
|
Waiting Area (WAIT) |
1 |
103 |
6.34 |
1.92 |
1.67 |
10.00 |
.08 |
1,108 |
.76 |
|
|
2 |
7 |
4.50 |
1.87 |
2.33 |
7.33 |
|
|
|
|
|
Total |
110 |
6.22 |
1.96 |
1.67 |
10.00 |
|
|
|
|
Nurseís Office (NOFF) |
1 |
104 |
8.11 |
1.30 |
2.19 |
10.00 |
1.91 |
1,109 |
.17 |
|
|
2 |
7 |
5.95 |
2.39 |
1.13 |
8.88 |
|
|
|
|
|
Total |
111 |
7.97 |
1.48 |
1.13 |
10.00 |
|
|
|
|
Treatment Room (TRRM) |
1 |
103 |
7.09 |
1.81 |
1.58 |
10.00 |
1.04 |
1,108 |
.31 |
|
|
2 |
7 |
5.33 |
1.38 |
3.46 |
7.46 |
|
|
|
|
|
Total |
110 |
6.97 |
1.84 |
1.58 |
10.00 |
|
|
|
|
Rest/Isolation Area (ISOL) |
1 |
104 |
5.84 |
2.43 |
1.00 |
10.00 |
.62 |
1,109 |
.43 |
|
|
2 |
7 |
4.66 |
1.92 |
2.00 |
7.20 |
|
|
|
|
|
Total |
111 |
5.77 |
2.41 |
1.00 |
10.00 |
|
|
|
Table 2 Continued
Group Statistics for Design Cluster Variables
Group 1 - Nurses; Group 2 ñ Advisory Panel of Architects,
Builders, Consultants, Planners
|
Cluster |
Group |
N |
Mean |
SD |
Minimum |
Maximum |
Levene Statistic |
Degrees of Freedom |
Standardized Alpha |
|
Restroom (RESTRM) |
1 |
104 |
7.04 |
1.89 |
1.11 |
10.00 |
1.44 |
1,109 |
.23 |
|
|
2 |
7 |
6.84 |
1.41 |
4.78 |
9.22 |
|
|
|
|
|
Total |
111 |
7.03 |
1.86 |
1.11 |
10.00 |
|
|
|
|
Security, Storage, and Safety (SSS) |
1 |
104 |
7.35 |
1.83 |
1.33 |
10.00 |
2.29 |
1,109 |
.13 |
|
|
2 |
7 |
6.36 |
1.13 |
4.67 |
7.67 |
|
|
|
|
|
Total |
111 |
7.29 |
1.81 |
1.33 |
10.00 |
|
|
|
|
Furnishings and Treatments (FURN) |
1 |
103 |
6.70 |
2.26 |
1.00 |
10.00 |
2.70 |
1,108 |
.10 |
|
|
2 |
7 |
5.21 |
1.27 |
3.25 |
6.75 |
|
|
|
|
|
Total |
110 |
6.60 |
2.24 |
1.00 |
10.00 |
|
|
|
*p<.05
Table 3
|
Analysis of Variance
(ANOVA) for Design Cluster Variables Between Nurses and the Advisory Panel of
Architects, Builders, Consultants, and Planners of School Facilities |
||||||
|
Cluster |
|
Sum of Squares |
Degrees of Freedom |
Mean Squared |
F |
p |
|
|
|
|
|
|
|
|
|
Components (rooms), Space, and Size Requirements |
Between Groups |
7.16 |
1 |
7.16 |
4.40 |
.04* |
|
|
|
|
|
|
|
|
|
|
Within Groups |
177.57 |
109 |
1.63 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
184.73 |
110 |
|
|
|
|
|
|
|
|
|
|
|
|
General Design Elements |
Between Groups |
4.96 |
1 |
4.96 |
1.60 |
.21 |
|
|
|
|
|
|
|
|
|
|
Within Groups |
338.77 |
109 |
3.11 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
343.73 |
110 |
|
|
|
|
|
|
|
|
|
|
|
|
Location of the Health Clinic |
Between Groups |
5.04 |
1 |
5.04 |
1.88 |
.17 |
|
|
|
|
|
|
|
|
|
|
Within Groups |
292.29 |
109 |
2.68 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
297.33 |
110 |
|
|
|
Table 3 Continued
Analysis of Variance (ANOVA)
for Design Cluster Variables Between Nurses and the Advisory Panel of
Architects, Builders, Consultants, and Planners of School Facilities
|
Cluster |
|
Sum of Squares |
Degrees of Freedom |
Mean Squared |
F |
p |
|
|
|
|
|
|
|
|
|
Accessibility |
Between Groups |
.41 |
1 |
.41 |
.11 |
.74 |
|
|
|
|
|
|
|
|
|
|
Within Groups |
415.69 |
109 |
3.81 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
416.11 |
110 |
|
|
|
|
|
|
|
|
|
|
|
|
Waiting Area |
Between Groups |
22.07 |
1 |
22.07 |
5.98 |
.02* |
|
|
|
|
|
|
|
|
|
|
Within Groups |
398.31 |
108 |
3.69 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
420.38 |
109 |
|
|
|
|
|
|
|
|
|
|
|
|
Nurseís Office |
Between Groups |
30.60 |
1 |
30.60 |
15.92 |
.00** |
|
|
|
|
|
|
|
|
|
|
Within Groups |
209.53 |
109 |
1.92 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
240.13 |
110 |
|
|
|
Table 3 Continued
Analysis of Variance (ANOVA)
for Design Cluster Variables Between Nurses and the Advisory Panel of
Architects, Builders, Consultants, and Planners of School Facilities
|
Cluster |
|
Sum of Squares |
Degrees of Freedom |
Mean Squared |
F |
p |
|
|
|
|
|
|
|
|
|
Treatment Room |
Between Groups |
20.23 |
1 |
20.23 |
6.29 |
.01* |
|
|
|
|
|
|
|
|
|
|
Within Groups |
347.19 |
108 |
3.22 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
367.41 |
109 |
|
|
|
|
|
|
|
|
|
|
|
|
Rest/Isolation Area |
Between Groups |
9.18 |
1 |
9.18 |
1.59 |
.21 |
|
|
|
|
|
|
|
|
|
|
Within Groups |
629.45 |
109 |
5.78 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
638.63 |
110 |
|
|
|
|
|
|
|
|
|
|
|
|
Restroom |
Between Groups |
.26 |
1 |
.26 |
.08 |
.79 |
|
|
|
|
|
|
|
|
|
|
Within Groups |
380.44 |
109 |
3.49 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
380.70 |
110 |
|
|
|
Table 3 Continued
Analysis of Variance (ANOVA)
for Design Cluster Variables Between Nurses and the Advisory Panel of
Architects, Builders, Consultants, and Planners of School Facilities
|
Cluster |
|
Sum of Squares |
Degrees of Freedom |
Mean squared |
F |
p |
|
|
|
|
|
|
|
|
|
Security, Storage, and Safety |
Between Groups |
6.46 |
1 |
6.46 |
1.99 |
.16 |
|
|
|
|
|
|
|
|
|
|
Within Groups |
354.22 |
109 |
3.25 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
360.68 |
110 |
|
|
|
|
|
|
|
|
|
|
|
|
Furnishings and Treatments |
Between Groups |
14.40 |
1 |
14.40 |
2.93 |
.09 |
|
|
|
|
|
|
|
|
|
|
Within Groups |
531.26 |
108 |
4.92 |
|
|
|
|
|
|
|
|
|
|
|
|
Total |
545.66 |
109 |
|
|
|
*p < .05 **p
< .01
Regarding the cluster representing the waiting area (WAIT or statements 29 through 34) F1,108 = 5.98, p < .02. Nurses perceived these items to be significantly more important than did the advisory panel (Mean for Nurses = 6.34; Mean for Panel = 4.50). The cluster representing the nurseís office (NOFF or statements 35 through 50) F1,109 =15.92, p < .00. Again, school nurses perceived these elements to be significantly more important than did the advisory panel (Mean for Nurses = 8.11; Mean for Panel = 5.95). Significance for the NOFF was at the p < .01 level. The cluster representing the treatment room (TRRM or statements 51 through 76) F1,108 = 6.29, p < .01. School nurses perceived these elements to be significantly more important than did the advisory panel (Mean for Nurses = 7.09; Mean for Panel = 5.33).
Analysis of Cluster Variables for a Specific Design Element
Statements for specific design elements were clustered and identified with abbreviations for reporting purposes. Twelve statements (variables 41, 42, 46, 62, 78, 80, 81, 85, 99, 103, 12, and 124) were clustered to represent lighting (LIGHTING) design elements. Window design (WINDOWS) contained four statements (variables 37, 38, 79, and 100). Three statements (variables 38, 79, and 80) represented integrating nature (NATURE) into the clinic design. Elements promoting a sense of well-being for users (WELLBE) had eight survey statements (variables 64, 65, 106, 108, 110, 128, 129, and 130). The cluster for use of color (COLOR) in a clinic design contained three statements (variables 43, 106, and 114). Privacy, space and confidentiality (PSC) elements in a clinic were the largest grouping of 11 statements (variables 63, 66, 68, 69, 82, 84, 97, 103, 108, and 110). Heating, venting and air conditioning (HVAC) had three statements (variables 38, 44, and 17). Electrical and plumbing elements (ELEPLU)involved 10 statements (variables 69, 70, 72, 73, 74, 75, 88, 89 105, and 119). Acoustic elements (ACOUS) had six statements (variables 48, 49, 86, 103, 104, and 131). Wall/ceiling elements (WALCEI) involved five statements (variables 39, 40, 43, 48, and 114). Specific flooring elements (FLOOR) were presented in three statements (variables 49, 107, and 115). Doors and wayfinding (DOORWA) elements were given in seven statements (variables 47, 51, 57, 58, 59, 98, and 127).
Table 4 provides the descriptive statistical data used for determining the difference between groups regarding the 12 specific design elements. The means and standard deviations for the perspectives of the two groups are presented. Group 1 identified the practicing school nurses, and Group 2 identified the advisory panel of architects, builders, consultants, and planners for school facilities.
Table 4 also displays the test for homogeneity of variances. Significance (p < .05) for the cluster LIGHTING and the cluster ELEPLU (electrical/plumbing) was found. This significance indicated unequal variances between the mean scores for nurses and the advisory panel of architects, builders, consultants and planners for school facilities. Lighting and electrical/plumbing elements were not considered for further tests. The Leveneís score for the remaining clusters was non-significant indicating that the spread or variance of mean scores for the two groups was approximately equal.
Table 5 shows statistically significant differences (p < .05, p < .01) between the advisory panel and nurses on the following specific design clusters: windows (WINDOWS); integrating nature into design (NATURE); promoting a sense of well-being for the user (WELLBE); privacy, confidentiality, and security elements (PCS); and, heating, ventilation, and air conditioning (HVAC). Regarding the cluster representing
Table 4
Descriptive
Statistics for Specific Design Elements
|
Cluster |
Group |
N |
Mean |
SD |
Minimum |
Maximum |
Levene Statistic |
Degrees of Freedom |
Standardized Alpha |
|
|
|
|
|
|
|
|
|
|
|
|
Lighting |
1 |
64 |
6.52 |
1.83 |
1.75 |
10.00 |
4.44 |
1,67 |
.04 |
|
(LIGHTING) |
|
|
|
|
|
|
|
|
|
|
|
2 |
5 |
4.62 |
.73 |
3.83 |
5.33 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
69 |
6.38 |
1.84 |
1.75 |
10.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Windows |
1 |
90 |
8.78 |
2.30 |
2.00 |
12.50 |
.08 |
1,95 |
.78 |
|
(WINDOWS) |
|
|
|
|
|
|
|
|
|
|
|
2 |
7 |
6.32 |
1.95 |
3.50 |
8.50 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
97 |
8.60 |
2.36 |
2.00 |
12.50 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Integrating Nature into Design |
1 |
99 |
7.29 |
2.26 |
1.00 |
10.00 |
.09 |
1,104 |
.77 |
|
(NATURE) |
|
|
|
|
|
|
|
|
|
|
|
2. |
7 |
4.10 |
2.05 |
1.00 |
7.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
106 |
7.08 |
2.37 |
1.00 |
10.00 |
|
|
|
Table 4 Continued
Descriptive
Statistics for Specific Design Elements
|
Cluster |
Group |
N |
Mean |
SD |
Minimum |
Maximum |
Levene Statistic |
Degrees of Freedom |
Standardized Alpha |
|
|
|
|
|
|
|
|
|
|
|
|
Promotion of a Sense of Well-Being (WELLBE) |
1 |
90 |
6.91 |
1.83 |
1.25 |
10.00 |
.01 |
1,95 |
.93 |
|
|
|
|
|
|
|
|
|
|
|
|
|
2 |
7 |
5.16 |
1.85 |
2.38 |
7.63 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
97 |
6.78 |
1.88 |
1.25 |
10.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Privacy, Security and Confidentiality |
1 |
91 |
7.27 |
1.73 |
2.00 |
10.00 |
.15 |
1,96 |
.70 |
|
(PSC) |
|
|
|
|
|
|
|
|
|
|
|
2 |
7 |
5.09 |
1.58 |
3.55 |
7.64 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
98 |
7.11 |
1.80 |
2.00 |
10.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Electrical and Plumbing |
1 |
99 |
8.44 |
1.36 |
1.60 |
10.00 |
5.31 |
1,104 |
.02 |
|
(ELEPLU) |
|
|
|
|
|
|
|
|
|
|
|
2 |
7 |
6.51 |
2.32 |
2.60 |
9.40 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
106 |
8.31 |
1.50 |
1.60 |
10.00 |
|
|
|
Table 4 Continued
Descriptive
Statistics for Specific Design Elements
|
Cluster |
Group |
N |
Mean |
SD |
Minimum |
Maximum |
Levene Statistic |
Degrees of Freedom |
Standardized Alpha |
|
|
|
|
|
|
|
|
|
|
|
|
Doors and Wayfinding |
1 |
86 |
7.23 |
1.73 |
1.57 |
10.00 |
.10 |
1,91 |
.76 |
|
(DOORWA) |
|
|
|
|
|
|
|
|
|
|
|
2 |
7 |
6.51 |
1.58 |
4.00 |
8.57 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
93 |
7.18 |
1.72 |
1.57 |
10.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Walls and Ceilings |
1 |
84 |
7.03 |
1.87 |
2.40 |
10.00 |
3.27 |
1,88 |
.07 |
|
(WALLCEI) |
|
|
|
|
|
|
|
|
|
|
|
2 |
6 |
7.77 |
1.05 |
6.20 |
9.20 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
90 |
7.08 |
1.83 |
2.40 |
10.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Acoustics |
1 |
88 |
7.35 |
2.30 |
2.60 |
12.00 |
2.59 |
1,92 |
.11 |
|
(ACOUS) |
|
|
|
|
|
|
|
|
|
|
|
2 |
6 |
5.70 |
1.29 |
4.40 |
7.60 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
94 |
7.25 |
2.28 |
2.60 |
12.00 |
|
|
|
Table 4 Continued
Descriptive
Statistics for Specific Design Elements
|
Cluster |
Group |
N |
Mean |
SD |
Minimum |
Maximum |
Levene Statistic |
Degrees of Freedom |
Standardized Alpha |
|
|
|
|
|
|
|
|
|
|
|
|
Color |
1 |
94 |
6.88 |
1.99 |
1.67 |
10.00 |
.51 |
1,99 |
.48 |
|
(COLOR) |
|
|
|
|
|
|
|
|
|
|
|
2 |
7 |
6.38 |
1.97 |
3.67 |
9.67 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
101 |
6.84 |
1.99 |
1.67 |
10.00 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Heating, Ventilation and Air Conditioning |
1 |
99 |
8.15 |
1.99 |
1.00 |
10.00 |
2.58 |
1,104 |
.11 |
|
(HVAC) |
|
|
|
|
|
|
|
|
|
|
|
2 |
7 |
6.10 |
.79 |
4.67 |
6.67 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
106 |
8.02 |
2.00 |
1.00 |
10.00 |
|
|
|
|
|