Hui Cai

Objectives: The purpose of this article is to compare three different methods to assess the complexity of a long-term care (LTC) environment for wayfinding before and after an environmental design intervention. The methods include space syntax (SS), the Wayfinding Checklist (WC), and the Tool to Assess Wayfinding Complexity (TAWC). Background: Wayfinding is important to maintain older adults’ independent functioning. The design of environments can impact wayfinding ability by providing support; this can be via building structure or by environmental design features such as signage and landmarks. Few methods or tools have been scientifically validated to assess environments for wayfinding complexity. In order to compare environments in terms of complexity and to measure the impact of interventions, valid and reliable tools are necessary. Methods: This article discusses the results of the use of three wayfinding design assessment tools using three routes in one LTC environment. The results of the three tools are discussed. Results: SS analysis could quantitatively measure the complexity of routes using integration values, which indicates connectedness. The TAWC and the WC were able to measure differences in visual field scores pre- and postenvironmental intervention. There were limitations to each tool: the lack of psychometric properties for the TAWC and the WC, and the lack of ability to measure changes in design features within visual fields with SS. Conclusions: Multiple tools to assess environments for wayfinding design may be needed in studies that test environmental interventions. Future research is needed to provide psychometric testing for the tools.

Objectives: Evaluate the relationship between nurses’ perception of the long-term care (LTC) environment, specifically having visible and accessible hand hygiene stations (HHS), and nurses’ fatigue during the COVID-19 pandemic. Background: LTC nurses experience not only heavy workloads and fatigue but also a high risk of infection during the COVID-19 pandemic. Few studies have evaluated the relationship between safety measures such as having visible and accessible HHS and nurses’ fatigue. Methods: The cross-sectional COVID-19 Impact on Nurses Study (COINS) was an online survey distributed to members of the American Association of Post-Acute Care Nursing through the REDCap survey platform, between June 1, 2020, and January 31, 2021. Logistic regression modeling was conducted to identify the relationship between nurses’ perception of having visible and accessible HHS and fatigue among LTC nurses. Results: The majority of LTC nurse respondents (78.35%) reported having moderate to very severe fatigue. Nurses who reported not having enough visible and accessible HHS in their work environment have statistically significantly higher odds (odds ratio [ OR] = 0.37, 95% confidence interval [CI] [0.20, 0.70], p = .002) of reporting experiencing moderate to very severe fatigue compared to nurses who perceived there was adequate HHS. The logistic regression is significant while controlling for sociodemographic differences, guilt for family and patients, support from work, and confidence in the future of LTC. Conclusions: This study reveals the LTC environment that incorporates better considerations of more visible and accessible HHS might mitigate nurses’ fatigue during the pandemic. A conceptual framework has been proposed for future studies.