Public yet private: the status, durability and visibility of handover sheets

Drawing on data from a multi-site case study of a range of clinical settings, this paper explores the form of nursing handover sheets and the processes through which they are created and updated. We argue that these documents function as both public and private documents, having relevance for the whole ward while also acting as a personal workspace. Such dual functionality needs to be supported by any technology that seeks to provide for the work of handover, if the handover sheet is to continue to act as a space for work, rather than just a repository of information

Nurses Involvement in Nursing Home Culture Change: Overcoming Barriers, Advancing Opportunities

Summarizes discussions from a 2008 interdisciplinary panel convened to identify facilitators and barriers to nurses' involvement in culture change in nursing homes and actions to promote nurse competencies in resident-directed care. Makes recommendations

Reconceptualising clinical handover: Information sharing for situation awareness

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Identifying Transfer of Care Gaps: Electronic Health Record Capture of Perioperative Handoff Communications

Transitions in patient care are held together by interdisciplinary handoff communications intended to coordinate the patient\u27s ongoing care requirements. Patients with complexity in care encumber the transfer of care process requiring a higher level of care coordination between the interdisciplinary team (Coleman, 2003; Naylor et al., 2004). While the literature is abundant on the characteristics and quality of handoff communications, it is limited on the requirements of what data is necessary for ongoing care following transfer communications (Galatzan & Carrington, 2018). This dissertation explores the verbal information transferred during Operating Room (OR) to Post Anesthesia Care Unit (PACU) nursing handoff communications and whether the data is captured in the electronic health record (EHR) to represent the information critical to ongoing patient care and care planning. the study builds on the Kennedy Integrated Theoretical Framework (KITF) (Kennedy, 2012) integrating cognition theory, patterns of knowledge theory, and clinical communication space theory to support the human-technology characteristics within perioperative handoffs. Evidence of wisdom was present in the KITF in addition to elements of non-verbal communication patterns emerging from shared common ground contributed to the framework\u27s expansion. to understand the contributions of the perioperative nursing interface terminology, the Perioperative Nursing Data Set (PNDS), makes to postsurgical care transitions, the study examines nursing diagnoses, interventions, interim outcomes and goals relationships to the handoff data communicated between OR and PACU Registered Nurses. Study findings revealed a complex fragmented process of verbal communications and electronic documentation for the handoff process. While the EHR is prominent in data procurement for the handoff process, the design of handoff artifacts (e.g., paper, electronic) significantly impact the value of information received. Incomplete handoff tools or missing EHR data adds to a cycle of information decay while contributing to increase cognitive load and potentiating opportunities for information and knowledge loss. the absence of nursing diagnoses in the automation of the PNDS challenges the integrity of the language within the documentation platform and raises considerations for hierarchical representation within interface terminologies. This study reinforces literature to reconsider user requirements in the design and functionality of healthcare information technology (HIT) to enable data and information flow and preserve knowledge development. the inclusion of mobile technology, cognitive support aids including clinical decision support tools, and other HIT will further enable the effectiveness of transfer communication, knowledge development, and the safety of ongoing patient care

Medication-related cognitive artifacts used by older adults with heart failure

OBJECTIVE: To use a human factors perspective to examine how older adult patients with heart failure use cognitive artifacts for medication management. METHODS: We performed a secondary analysis of data collected from 30 patients and 14 informal caregivers enrolled in a larger study of heart failure self-care. Data included photographs, observation notes, interviews, video recordings, medical record data, and surveys. These data were analyzed using an iterative content analysis. RESULTS: Findings revealed that medication management was complex, inseparable from other patient activities, distributed across people, time, and place, and complicated by knowledge gaps. We identified fifteen types of cognitive artifacts including medical devices, pillboxes, medication lists, and electronic personal health records used for: 1) measurement/evaluation; 2) tracking/communication; 3) organization/administration; and 4) information/sensemaking. These artifacts were characterized by fit and misfit with the patient's sociotechnical system and demonstrated both advantages and disadvantages. We found that patients often modified or "finished the design" of existing artifacts and relied on "assemblages" of artifacts, routines, and actors to accomplish their self-care goals. CONCLUSIONS: Cognitive artifacts are useful but sometimes are poorly designed or are not used optimally. If appropriately designed for usability and acceptance, paper-based and computer-based information technologies can improve medication management for individuals living with chronic illness. These technologies can be designed for use by patients, caregivers, and clinicians; should support collaboration and communication between these individuals; can be coupled with home-based and wearable sensor technology; and must fit their users' needs, limitations, abilities, tasks, routines, and contexts of use

Supporting dynamic and distributed decision making in acute care environments: Insights from a cognitive ethnography

The way that medical decisions are carried out in hospital environments has undergone radical changes in recent years, in part as a result of the changing landscape of care. To make decisions, physicians are expected to keep abreast of a growing and changing body of medical and patient knowledge, collaborate more with clinical colleagues, and utilize more technologies to inform care than ever before. This dissertation reports on a five month cognitive ethnography in an ICU in Ontario Canada, and utilizes distributed cognition to understand the challenges that physicians face in making decision in modern acute care environments. It also seeks to elucidate the strategies used by ICU physicians to cope with the challenges associated with using information from social, material and technological sources in decision-making. My findings demonstrate how information resources are (1) Objectivist, in that too much attention is paid to supporting the formalized, outcome-centered aspects of medical thinking, without due regard to the processes involved in adapting decisions to their situation; (2) Fragmented, in that, while information resources are often well-designed when considered in isolation, they force physicians to bridge gaps in the logic of access or representation when working between resources; (3) Individualistic, in that information resources are often tailored to support the cognitive needs of individual physicians, leaving the cognitive needs associated with collaboration unsupported, and sometimes undermining them. To compensate for the challenges associated with using objectivist, fragmented and individualistic information resources, physicians employed a number techniques, including relying in paper and other flexible artifacts, interpersonal clinical communications, and engaging in mobility work. This research brings us a step closer to understanding how people, paper, and technologies function together to fulfill the complex and dynamic needs associated with making medical decisions

Beyond handover: supporting awareness for continuous coverage

Abstract Hospitals are required to operate as a continuous system because patient care cannot be temporarily suspended and handover is seen as a key method for enabling this. This paper reports a study of handover in a medical admissions unit. We draw on the notion of awareness as conceptualised within the Computer Supported Cooperative Work literature to explore the role played by a variety of cognitive artifacts in supporting continuous coverage. While such awareness is typically characterised as being ‘effortless’, our study reveals that maintaining awareness in a context such as the medical admissions unit is effortful due to invisible work. We suggest that the notion of awareness is beneficial for exploring the practices of continuous coverage because it moves attention away from the moment of handover, instead encouraging consideration of the variety of practices through which clinicians display their work to, and monitor the work of, colleagues on different shifts. We argue that efforts to support continuous coverage should focus on improving awareness by increasing the visibility of information

Understanding workflow in telehealth video visits: Observations from the IDEATel project

AbstractHome telemedicine is an emerging healthcare paradigm that has the potential to transform the treatment of chronic illness. The purpose of this paper is to: (1) develop a theoretical and methodological framework for studying workflow in telemediated clinician–patient encounters drawing on a distributed cognition approach and (2) employ the framework in an in-depth analysis of workflow in the IDEATel project, a telemedicine program for older adults with diabetes. The methods employed in this research included (a) videotaped observations of 27 nurse–patient encounters and (b) semi-structured interviews with participants. The analyses were used to provide a descriptive analysis of video visits, understand the mediating role of different technologies and to characterize the ways in which artifacts and representations are used to understand the state of the patient. The study revealed barriers to productive use of telehealth technology as well as adaptations that circumvented such limitations. This research has design implications for: (a) improving the coordination of communication and (b) developing tools that better integrate and display information. Although home telemedicine programs will differ in important respects, there are invariant properties across such systems. Explicating these properties can serve as a needs requirement analysis to develop more effective systems and implementation plans

Why Medical Informatics (still) Needs Cognitive and Social Sciences.

International audienceOBJECTIVES: To summarize current excellent medical informatics research in the field of human factors and organizational issues. METHODS: Using PubMed, a total of 3,024 papers were selected from 17 journals. The papers were evaluated on the basis of their title, keywords, and abstract, using several exclusion and inclusion criteria. 15 preselected papers were carefully evaluated by six referees using a standard evaluation grid. RESULTS: Six best papers were selected exemplifying the central role cognitive and social sciences can play in medical informatics research. Among other contributions, those studies: (i) make use of the distributed cognition paradigm to model and understand clinical care situations; (ii) take into account organizational issues to analyse the impact of HIT on information exchange and coordination processes; (iii) illustrate how models and empirical data from cognitive psychology can be used in medical informatics; and (iv) highlight the need of qualitative studies to analyze the unexpected side effects of HIT on cognitive and work processes. CONCLUSION: The selected papers demonstrate that paradigms, methodologies, models, and results from cognitive and social sciences can help to bridge the gap between HIT and end users, and contribute to limit adoption failures that are reported regularly