Lost in translation - Silent reporting and electronic patient records in nursing handovers: An ethnographic study

Background: Electronic patient records are increasingly being implemented in hospitals around the world to promote a process of sharing information that is reliable, more efficient and will promote patient safety. Evidence suggests that in practice, adaptations are being made to how such technologies are being used in practice. Few studies have explicitly aimed to explore how electronic patient records influence on nurses’ communication of patient information in clinical practice. Objective: To enhance understanding of the impact of electronic patient records on nurses’ cognitive work, by exploring how nurses engage with the electronic patient record during handover and the representa- tion of patient information. Methods: Ethnographic fieldwork was conducted in a Norwegian hospital cancer ward where computer- mediated handover referred to as ’silent reporting’ had been implemented. The fieldwork included five months of participant observation and nine semi-structured interviews with registered nurses. Participat- ing nurses were selected to ensure representation by clinical experience. The analysis of field notes and transcripts was partly performed in NVivo 11, following thematic analysis (Braun and Clarke 2006). Findings: Four themes emerged: 1) nurses’ complex and dynamic workflow necessitated talk in handovers, 2) oral communication allowed nurses to share sensitive information on psychosocial issues, and 3) to solve uncertainties considered unsuited for the record, and 4) talk facilitated professional and moral sup- port in clinical decisions-making, as collective achievements. Talk was thereby found to be essential to nurses’ cognitive work and professional knowledge, allowing for the translation and interplay between the embodied, informal knowledge of the individual nurse, and formal knowledge inscribed in record notes. Conclusions: Silent reporting has implications for nurses’ cognitive work and professional knowledge. With the sole reliance on the electronic patient record as handover tools, it is not only information essential to nurses’ evolving, dynamic, and contextualised understanding of the patient’s situation that is lost in translation, but also the visibility and legitimacy of nursing knowledge. Nurses’ continued practices of talk in handovers can be seen as effort s to counteract these effects in ways that also increased the relevance and usefulness of the electronic patient record as a mediator of knowledge.publishedVersio

I-NURSE: Identifying and Automatically Detecting Topics in Nursing Handover Communications

I would like to thank The Ohio State University College of Arts and Sciences Honors Department for both the Summer Funding Grant and the Undergraduate Research Scholarship I received to pursue this project.Statement of the Problem Patient handovers have been described as the process of transferring primary authority and responsibility for providing clinical care to a patient from one departing caregiver to one oncoming caregiver. Patient handovers with incomplete and inaccurate information have repeatedly been identified as a patient safety risk. Recently a study using the mnemonic IPASS found that post-intervention the use of these strategies decreased medical errors by 23% and the rate of preventable adverse effects by 30%. The coding analysis used in the IPASS study and many others can be time consuming and cost-ineffective. As a result there is a desire to automate this analysis. Methodology 20 existing transcripts from a previously IRB-approved data collection of audio-recorded Intensive Care Unit Registered Nurse handovers containing 27 patient discussions collected from a single, academic tertiary care institution were analyzed for this study. First all 20 transcripts were manually coded using a codebook (IPASS) adapted from Starmer et. al’s paper Changes in Medical Errors after Implementation of a Handoff Program. Next, a novel codebook was manually generated from the transcripts in an effort to more accurately model nurse handovers. The categories which emerged were grouped into INURSE (Identification, Narrative, Unusual Symptoms, Response, Status, Expected Challenges). Finally, Linguistic Inquiry and Word Count (LIWC) software was used to identify family terms that fell under the INURSE codes Narrative Family and Expected Family Challenges. The manually coded transcripts were the gold standard against which the LIWC coded transcripts were compared. Findings The I and Sa codes from the IPASS code set were not observed. Each INURSE code was compared to the corresponding IPASS codes to observe differences between them. Overall the P code was described by 13 INURSE sub codes. The Noise category of IPASS was also described by 5 INURSE codes with few continued instances of Noise. The LIWC software had no misses and 9 false positives. Discussion Overall these findings point towards major differences between nurses and physician’s handover needs. Additionally it points to mixed usefulness of LIWC software for automated analysis. Next steps could include looking into more advanced software for automated analysis, or altering INURSE to train nurses by taking the best of IPASS as well.No embargoAcademic Major: Neuroscienc

Pain is what the patient says it is, but… : an ethnographic study of the factors which influence nurses when they make pain management decisions in a clinical setting

Barriers to effective postoperative pain management mean many patients suffer needless pain. Few studies have observed nurses as they manage postoperative pain in a clinical setting; those who used observation have demonstrated the importance of context to pain management practice. This ethnographic study aimed to examine what factors influenced nurses when they made pain management decisions, and how the culture of the clinical environment impacted on pain management practice. One hundred and fifty seven hours of participant and non-participant observation, semistructured interviews with thirty-six members of staff, contemporaneous field notes, and document analysis were used to investigate the culture of pain management in one postoperative ward. Analysis identified three themes with sub themes. First, the revealing of a pain management culture, which incorporated the ward environment and processes, and a new finding of the silence of routine pain management communication. Second, nurses’ decision-making responses to pain management opportunities including a new finding of a single pain management action. The final theme is nurses’ expectations of patient behaviours and knowledge, including how patients should look, what they should say and know, and nurses’ responses to patients who do not conform to expectations. The findings suggest culturally mediated pain management behaviours, linked to a ward culture where pain was not a priority, leading to inattention to pain management. Using Social identity theory these behaviours are presented as in-group pain management social norms; part of the culture of ‘how pain management is done around here’. These pain management in-group behaviours are presented as the critical factors influencing nurses’ pain management decision-making in a clinical setting. They are not targeted through traditional education and their explication may indicate pain management education should be directed more towards cultural change

Tabletop Tangible Interfaces for Music Performance: Design and Evaluation

This thesis investigates a new generation of collaborative systems: tabletop tangible interfaces (TTIs) for music performance or musical tabletops. Musical tabletops are designed for professional musical performance, as well as for casual interaction in public settings. These systems support co-located collaboration, offered by a shared interface. However, we still know little about their challenges and opportunities for collaborative musical practice: in particular, how to best support beginners or experts or both. This thesis explores the nature of collaboration on TTIs for music performance between beginners, experts, or both. Empirical work was done in two stages: 1) an exploratory stage; and 2) an experimental stage. In the exploratory stage we studied the Reactable, a commercial musical tabletop designed for beginners and experts. In particular, we explored its use in two environments: a multi-session study with expert musicians in a casual lab setting; and a field study with casual visitors in a science centre. In the experimental stage we conducted a controlled experiment for mixed groups using a bespoke musical tabletop interface, SoundXY4. The design of this study was informed by the previous stage about a need to support better real-time awareness of the group activity (workspace awareness) in early interactions. For the three studies, groups musical improvisation was video-captured unobtrusively with the aim of understanding natural uses during group musical practice. Rich video data was carefully analysed focusing on the nature of social interaction and how workspace awareness was manifested. The findings suggest that musical tabletops can support peer learning during multiple sessions; fluid between-group social interaction in public settings; and a democratic and ecological approach to music performance. The findings also point to how workspace awareness can be enhanced in early interactions with TTIs using auditory feedback with ambisonics spatialisation. The thesis concludes with theoretical, methodological, and practical implications for future research in New Interfaces for Musical Expression (NIME), tabletop studies, and Human-Computer Interaction (HCI)

Communication risk and strategy in temporary organizations

Communication is a critical and emerging metric for successful outcomes in the high-stakes field of project management. Professional management societies have quantified financial losses caused by ineffective communication. Consulting project management exemplifies a maximum communication risk environment - misunderstanding threatens project finances, strict deadlines, and technical benchmarks - exacerbated by the complexity of a temporary organization structure. The context of work in a temporary organization adds layers of ambiguity to project communications - an ill-structured domain in technical communication terms. Formal study of communication in temporary organizations is relatively new. Recent studies are derived from engineering and business management perspectives. This baseline study investigates risk and strategy in temporary organizations from a communication perspective. Project management consultants dialogue about their experiences of project risk and communication strategy in a critical incident interview. This research identifies the communication complexities of work in these temporary contexts. Contrasting the base communication models of professional project management, this study proposes rhetorical analysis as a systems thinking strategy for project communication. This thesis argues that professional technical communication is strategic expertise and advocates humanistic strategies to mitigate the elevated sociotechnical communication risk within a temporary organization

Being and Belonging: Identity and Community among Gay Asian-Canadians in Toronto

This thesis examines the concepts of identity, community and belonging among gay and Queer Asian-Canadian men and women who live in the Greater Toronto Area. Most of these persons emigrated from East Asia with their families through the late 1970s to 1990s and subsequently came of age in Canada. I look at the ways in which ethnicity and sexuality converge in the life histories of these individuals through a range of topics that demonstrate how individuals conceptualize themselves and each other, as well as how social networks are formed and maintained. I argue that ethnic and sexual boundaries are not always static but are rather subject to negotiation and dialectical processes in various scenarios. These life experiences are often set in the context of heterocentric and white- privileged environments in the city that do not acknowledge the challenges faced by minority groups

ICT innovations from Finland, and Finnish digilect in electronic media culture

The article deals with ICT (Information and Communication Technologies) innovations that were entirely or partially invented in Finland (Nokia mobile phone technology, IRC, Linux, input to invent SMS). In the paper we discuss the current electronic communication that developed media culture and new codes, which combine pictural and language elements: emoticons and emojis as well as texting. Finland is the first country in the world to create its own national emojis (63 so far). Finally, we show characteristics of the Finnish texting, i.e. “cyberslang” (mainly in younger people’s communication), in other words “digilect” called after publications by a Hungarian linguist Ágnes Veszelszki

WHAT NURSES SAY: COMMUNICATION BEHAVIORS ASSOCIATED WITH THE COMPETENT NURSING HANDOFF

Communication competence and medical communication competence served as the theoretical framework for this research that seeks to identify specific communication behaviors associated with what nurses say constitute a communicatively competent patient handoff at the nursing change of shift. Data collected from 286 nurses responding to an online modified Medical Communication Competence Scale posted at www.allnurses.com supported the hypotheses that information exchange (information giving, seeking and verifying) and socioemotional communication behaviors are rated more highly in the best patient handoffs than in the worst ones. Research questions found that the incoming nursing role rated behaviors associated with information verifying and socioemotional communication higher than did the outgoing nursing role, and that the worst handoffs were those in which the incoming nursing role gave the lowest ratings for information-giving behaviors. Additional insight into other communication-related characteristics associated with quality handoffs were provided as well, including location, tools/type and environment for the patient handoff at the nursing change of shift. These findings offer a foundation for future research into development of communication-based standardized patient handoff processes and training that ultimately may reduce patient care errors caused by communication failures during the patient handoff at the nursing change of shift