Date of Award
8-2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Planning, Design, and the Built Environment
Committee Chair/Advisor
Anjali Joseph
Committee Member
Dina Battisto
Committee Member
Thomas Britt
Committee Member
Lucinda Easler
Abstract
Many people who become nurses feel called to help others with high-quality, compassionate, empathetic care in alignment with the nursing profession’s core values. However, the reality of modern healthcare often conflicts with these values, leading many nurses to feel disheartened and drained, contributing to severe burnout, turnover, and dropout that plague health systems and harm patient care.
Person-environment (PE) fit is critical to well-being and satisfaction in nursing. Poor PE fit can involve conflicts between an employee’s abilities and job demands, inadequate resources to complete tasks, and more. It can also arise from incongruence between an employee’s values and aspects of their job. Studies show that nurses experience negative feelings and poor job outcomes – like burnout, role stress, dissatisfaction, intention to leave, and drop out – when they cannot provide care in alignment with their values. Although not always considered in PE fit or value alignment, built environments can provide affordances and resources that support fit, create fit-hindering demands and stressors, and communicate messages that can conflict with an organization’s or employees’ values. Such conflicts could be especially salient in behavioral care, where nurses must balance competing demands and ethical quandaries with few resources.
This sequential exploratory mixed-methods study investigated whether inpatient behavioral care nurses experience value incongruence or support in their built environments and how these experiences impact job outcomes. In-depth interviews with nurses at two hospitals in the Southeastern United States informed the creation of a nationwide survey that quantitatively assessed the impacts of perceived built environmental value support on burnout, turnover intention, and job satisfaction. The research findings and focus groups with nurses and design professionals inspired a new design toolkit to help healthcare organizations and designers plan, design, and evaluate inpatient behavioral care environments that align with nurses’ values, support their well-being and job outcomes, and ultimately benefit patient care and organizational objectives. Although many factors affect nursing, this study’s findings suggest that perceptions of value alignment in built environments tangibly impact nurses. The built environment is one tool that healthcare organizations can use to help improve nurses’ job outcomes, increase retention, and enhance patient care.
Recommended Citation
Gripko, Monica K., "Perceived Value Incongruence in the Built Environment and Nurse Outcomes in Inpatient Behavioral and Psychiatric Care Settings: A Sequential Exploratory Mixed-Methods Study" (2025). All Dissertations. 3985.
https://open.clemson.edu/all_dissertations/3985
Author ORCID Identifier
0000-0001-6995-6893