Closed loop medication administration using mobile nursing information system

Through this long journey of PhD study including a research on ‘Closed Loop Medication Administration Using Mobile Nursing Information System’ and the thesis writing, I obtained a lot of knowledge and experience about research method and writing. I really very appreciate the help of all my supervisors

Understanding infusion administration in the ICU through Distributed Cognition

AbstractTo understand how healthcare technologies are used in practice and evaluate them, researchers have argued for adopting the theoretical framework of Distributed Cognition (DC). This paper describes the methods and results of a study in which a DC methodology, Distributed Cognition for Teamwork (DiCoT), was applied to study the use of infusion pumps by nurses in an Intensive Care Unit (ICU). Data was gathered through ethnographic observations and interviews. Data analysis consisted of constructing the representational models of DiCoT, focusing on information flows, physical layouts, social structures and artefacts. The findings show that there is significant distribution of cognition in the ICU: socially, among nurses; physically, through the material environment; and through technological artefacts. The DiCoT methodology facilitated the identification of potential improvements that could increase the safety and efficiency of nurses’ interactions with infusion technology

Technology Target Studies: Technology Solutions to Make Patient Care Safer and More Efficient

Presents findings on technologies that could enhance care delivery, including patient records and medication processes; features and functionality nurses require, including tracking, interoperability, and hand-held capability; and best practices

The Development of a Patient Portal for Use During Hospitalization: Pediatric Registered Nurses' Perspectives

Patient portals are innovative digital health technologies that are impacting nursing practice. A patient portal is an electronic tool that allows patients and parents to access personal health information. There has been a recent focus to implement patient portal technology when children are hospitalized. This manuscript style thesis examines pediatric registered nurses (RNs) perspectives of new technology including patient portals and its impact on nursing care. The first manuscript is a thematic literature review that was conducted to determine pediatric health care providers perceptions of patient portal implementation. Five articles were included in the analysis and only two articles focused exclusively on health care providers views. Four themes summarize the pediatric practitioner’s experiences with a portal technology: The Benefits of the Patient Portal; Impact on Provider Workload; User-Friendliness of the Patient Portal; and Health Care Providers Needs with Portal Implementation. Pediatric RNs voices are limited in currently published research. Therefore, the second manuscript is an interpretive description study conducted to explore pediatric RNs perspectives of new technology, including a proposed patient portal, on patient care. A total of 10 nurses participated in a semi-structured individual interview. Six themes represent the RNs views of new technology, including a proposed patient portal, and the impact on nursing care during a child’s hospitalization. The first three themes: Standing in Both Worlds, Reshaping the Care Triad, and Needing Support embody the nurses’ views on the implementation of technology in the pediatric inpatient units they work. The RNs previous experience with health technology implementation informs their perspectives of a new portal technology and its potential impact on patient care. The last three themes encompass the RNs views on the development of a patient portal: Improving Family Centred Care, Connecting with Care, and Anticipating Nursing Implications. Overall, the RNs are anticipating a positive impact the portal can have on the hospital experience for children and their family members. Even though the nurses report a feeling of standing in both worlds in regards to technology and its varied implementation, they are still optimistic. The RNs are also bringing awareness to the impact of all the new technology, not just a single piece, on patient care and the art of nursing. The integrated discussion provides recommendations to a larger ongoing study and discusses the impact on nursing practice, education, and research. Recruiting and involving pediatric RNs can take considerable time and effort but they can provide valuable insight and feedback on new technology, including patient portals, which may result in more sustained use.

The future of laboratory medicine - A 2014 perspective.

Predicting the future is a difficult task. Not surprisingly, there are many examples and assumptions that have proved to be wrong. This review surveys the many predictions, beginning in 1887, about the future of laboratory medicine and its sub-specialties such as clinical chemistry and molecular pathology. It provides a commentary on the accuracy of the predictions and offers opinions on emerging technologies, economic factors and social developments that may play a role in shaping the future of laboratory medicine

Creation of an Evidence-Based Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study

Background: Digital health technologies such as continuous remote monitoring and artificial intelligence–driven clinical decision support systems could improve clinical outcomes in intensive care medicine. However, comprehensive evidence and guidelines for the successful implementation of digital health technologies into specific clinical settings such as the intensive care unit (ICU) are scarce. We evaluated the implementation of a remote patient monitoring platform and derived a framework proposal for the implementation of digital health technology in an ICU. Objective: This study aims to investigate barriers and facilitators to the implementation of a remote patient monitoring technology and to develop a proposal for an implementation framework for digital health technology in the ICU. Methods: This study was conducted from May 2018 to March 2020 during the implementation of a tablet computer–based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of 7 semistructured interviews with clinical ICU stakeholders and descriptive questionnaire data. The results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework. Results: This study revealed an insufficient implementation process due to lack of staff engagement and few perceived benefits from the novel solution. Further implementation barriers were the high staff presence and monitoring coverage in the ICU. The implementation framework includes strategies to be applied before and during implementation, targeting the implementation setting by involving all ICU stakeholders, assessing the intervention’s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, considering the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects in the ICU. Conclusions: Implementation of digital health in the ICU should involve a thorough preimplementation assessment of the ICU’s need for innovation and its readiness to change, as well as an ongoing evaluation of the implementation conditions. Involvement of all stakeholders, transparent communication, and continuous feedback in an equal atmosphere are essential, but leadership roles must be clearly defined and competently filled. Our proposed framework may guide health care providers with concrete, evidence-based, and step-by-step recommendations for implementation practice, facilitating the introduction of digital health in intensive care. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT0351417

Nursing Identity and the Computer: The Impact of Care Realities on Information Systems Use

Driven by developments in technology and communication, and by social, political and economic issues, the introduction of different information systems in nursing has risen significantly in recent years. However, little is known about the understanding of these systems by the nurses who are intended to use them. Informed by a Symbolic Interactionist approach, this research explored the experience of nurses interacting with information systems. Using grounded theory methods, the main sources of data were interviews, textual analysis and observation with nurses in three Canadian cities. The key findings of this research are fourfold. First, the core category developed in this study is the care reality, a multi-faceted understanding of care that is central to the nursing identity, which adds a new level of understanding behaviour beyond the common attributes identified within nursing and information systems research. Second, this research identified the existence and importance of ready-to-hand and unready-to-hand information systems objects within nursing. Third, this research identified a care reality negotiation process, where each individual is continuously introduced to different care realities when they come into contact with co-workers or management who do not share the same care reality. The individual must then go through a negotiation process whereby each individual manages his or her care reality. The care reality negotiation process includes four phases: exposure, developing consciousness, sense-making and acclimatizing. Finally, the fourth result of this research was the identification of how an individual’s identity impacts on his or her understanding of information systems. This research produces a theoretical understanding of the experiences of nurses interacting with information systems. It identified a link between an individual’s care reality and his or her behaviour toward all technology, including information systems. The findings inform nursing research and practice, as well as contribute to the development, implementation and use of information systems in other areas of the modern healthcare system

Inpatient telemedicine and new models of care during COVID-19: hospital design strategies to enhance patient and staff safety

The challenges of the COVID-19 pandemic have led to the development of new hospital design strategies and models of care. To enhance staff safety while preserving patient safety and quality of care, hospitals have created a new model of remote inpatient care using telemedicine technologies. The design of the COVID-19 units divided the space into contaminated and clean zones and integrated a control room with audio-visual technologies to remotely supervise, communicate, and support the care being provided in the contaminated zone. The research is based on semi-structured interviews and observations of care processes that implemented a new model of inpatient telemedicine at Sheba Medical Center in Israel in different COVID-19 units, including an intensive care unit (ICU) and internal medicine unit (IMU). The study examines the impact of the diverse design layouts of the different units associated with the implementation of digital technologies for remote care on patient and staff safety. The results demonstrate the challenges and opportunities of integrating inpatient telemedicine for critical and intermediate care to enhance patient and staff safety. We contribute insights into the design of hospital units to support new models of remote care and suggest implications for Evidence-based Design (EBD), which will guide much needed future research

TURF for Teams: Considering Both the Team and I in the Work-Centered Design of Systems

Teams are an inherent part of many work domains, especially in the healthcare environment. Yet, most systems are often built with only the individual user in mind. How can we better incorporate the team, as a user, into the design of a system? By better understanding the team, through their user, task, representational, and functional needs, we can create more useful and helpful systems that match their work domain. For this research project, we utilize the TURF framework and expanded it further by also considering teams as a user, thus, creating the TURF for Teams framework. In addition, we chose to examine teams in the emergency department environment. We believe that designing a system with the team also fully incorporated and acknowledged in the work domain will be beneficial for supporting necessary team activities. Using TURF for Teams, we first conducted an observational field study in the emergency department to get a better understanding of the users, teams, tasks, workload, and interactions. We then identified the need for team communications to be better supported, especially in the management of interruptions, and further categorized the interruptions by their function in order to design a team tool that could help team members better manage their interruptions by focusing on the necessary, or domain, types of interruptions and more easily disregarding the unnecessary, or overhead, types of interruptions. We then administered some surveys and conducted a card sort and cognitive walkthrough with emergency clinician participants to help us better identify how to design interfaces for the team tool and simulation that would better match the needs of team communication behaviors observed and reported by emergency clinicians. After designing and developing the team tool and simulation, we conducted an evaluation of this system by having emergency medicine, medicine, and informatics graduate student teams go through the system and utilize the team tool and simulation as a team. Though we had a small sample size, we found that emergency medicine teams found the team tool and simulation to be very usable and they reacted favorably to its potential in helping them better understand and manage their team communications. In summary, we were able to utilize the TURF framework for incorporating teams into the design of systems, in this case a team communication tool and microworld simulation for the emergency department. Our findings suggest that TURF for Teams is a viable framework for designing useful and helpful team based systems for all work domains