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

Care Service Production, Service(s), Products, Technology

The current demographic change, the weakening dependency ratio in Finland means that there is a decreasing amount of working people taking care of children, elderly and disabled. Thus, there is a need to find ways to produce care services more efficiently but also with higher quality. The client of this thesis owns a technology for care service environments the purpose which is to support personnel’s daily tasks in a work that aims to fulfill the end customer’s needs holistically. The purpose of this thesis was to find development needs and opportunities for both the technology and for the transformation of care services. The technology was considered to be a part of care services, thus it was researched as a whole. The work utilized methodologies discussed within Product Service System literature and service design. Customer journeys, actor network maps, system diagrams, use cases revealed regularities, touchpoints, and aspects that were seen as urgent needs or opportunities for development. Information for the work was based on literature reviews, interviews, and observations at care service premises. The insight and ideas were formulated into three differentiated visualizations the purpose of which purpose was to communicate the main role of the technology as well as new ways to produce the care service with higher quality and in a meaningful manner. Key findings related technology were that availability of information and flow of it between different actors can have an impact on how the caregivers are able to give quality care, and on the other hand, that the technology can block the workflow and thus decrease the service performance. Other findings on the care services suggest that the service mentality can vary a lot in different service units which also relates to how relatives and other actors around the end customer are able to contribute on one’s life. The work proposes that in the current care service production the workflow of caregivers should be streamlined by automating and pre-filling certain daily tasks, and that platform for shared information between different actors is required. However, this would not provide any kind of platform for a radical change in the current care service production. Thus, the more appealing areas for development could found in between consumers, their social networks, and different nongovernmental organizations. In this context the implications for wellbeing could be more significant

Designing with community health workers: feedback-integrated multimedia learning for rural community health

Community Health Workers (CHWs) are an integral part of the rural health system, and it is imperative that their voices are accommodated in digital health projects. In the mobile health education project discussed in this thesis (The Bophelo Haeso project), we sought to find ways to amplify CHWs' voices, enabling them to directly influence design and research processes as well as technological outcomes. The Bophelo Haeso (BH) project equips CHWs with health videos on their mobile phones to use for educating and counselling the rural public. We investigated how to best co-design, with CHWs, a feedback mechanism atop the basic BH health education model, thus enabling their voices in the design process and in the process of community education. This thesis chronicles this inclusive design and research process - a 30-month process that spanned three sub-studies: an 18-month process to co-design the feedback mechanism with CHWs, a 12-month deployment study of the feedback mechanism and, overlapping with the feedback deployment study, a 17-month study looking at the consumption patterns of the BH educational videos. This work contributes to the field of Human Computer Interaction (HCI) in three distinct ways. First, it contributes to the growing knowledge of co-design practice with participants of limited digital experience by introducing a concept we termed co-design readiness. We designed and deployed explorative artefacts and found that by giving CHWs increased technical, contextual, and linguistic capacity to contribute to the design process, they were empowered to unleash their innate creativity, which in turn led to more appropriate and highly-adopted solutions. Secondly, we demonstrate the efficacy of incorporating an effective village-to-clinic feedback mechanism in digital health education programs. We employed two approaches to feedback - asynchronous voice and roleplaying techniques. Both approaches illustrate the combined benefits of implementing creative methods for effective human-to-technology and human-tohuman communication in ways that enable new forms of expression. Finally, based on our longitudinal study of video consumption, we provide empirical evidence of offline video consumption trends in health education settings. We present qualitative and quantitative analyses of video-use patterns as influenced by the CHWs' ways of being and working. Through these analyses, we describe CHWs and their work practices in depth. In addition to the three main contributions, this thesis concludes with critical reflections from the lessons and experiences of the 30-month study. We discuss the introduction of smartphones in rural villages, especially among elderly, low-literate, and non-English-speaking users, and present guidelines for designing relevant and usable smartphones for these populations. The author also reflects on her position as an African-born qualitative researcher in Africa, and how her positionality affected the outcomes of this research

An Exploratory Study of Patient Falls

Debate continues between the contribution of education level and clinical expertise in the nursing practice environment. Research suggests a link between Baccalaureate of Science in Nursing (BSN) nurses and positive patient outcomes such as lower mortality, decreased falls, and fewer medication errors. Purpose: To examine if there a negative correlation between patient falls and the level of nurse education at an urban hospital located in Midwest Illinois during the years 2010-2014? Methods: A retrospective crosssectional cohort analysis was conducted using data from the National Database of Nursing Quality Indicators (NDNQI) from the years 2010-2014. Sample: Inpatients aged ≥ 18 years who experienced a unintentional sudden descent, with or without injury that resulted in the patient striking the floor or object and occurred on inpatient nursing units. Results: The regression model was constructed with annual patient falls as the dependent variable and formal education and a log transformed variable for percentage of certified nurses as the independent variables. The model overall is a good fit, F (2,22) = 9.014, p = .001, adj. R2 = .40. Conclusion: Annual patient falls will decrease by increasing the number of nurses with baccalaureate degrees and/or certifications from a professional nursing board-governing body

Situating mHealth in the workplace: a coordination studies perspective

A central assumption of extant mHealth literature is that the technology empowers health care staff and leads to increased efficiency in service delivery. This assumption foregrounds the transformative potential of mHealth and the active appropriation of the technology, but obscures how it integrates with existing workplace arrangements. To interrogate the limitations of this dominant assumption, this research examines how mHealth is coordinated in the workplace in practice, and the perceptions and experiences of health care staff of the place mHealth takes in their daily concerns. In this way the research reveals how existing workplace arrangements influence the way that mHealth operates in practice, and builds on extant research to clarify how this can shift responsibility for the success of the implementation onto those staff with the least recognition and security. An interpretive case study explores the coordination of mHealth in the workplace, and analyses unexpected outcomes to identify their implications for theory and practice. In order to highlight this phenomenon the research focussed on the experiences of the clinic staff who were responsible for mHealth implementation, but were not the end users and who did not receive direct benefits themselves. The analysis drew on coordination studies to identify social and artefact-based coordination mechanisms, as well as the significance of relationships in mHealth in the workplace, yielding robust evidence that social coordination mechanisms rather than the fitness for purpose of the specific technology shaped the coordination process. Issues arising from the specific setting also influenced coordination in important ways that were not predicted in the official training material. The research makes three theoretical contributions that advance understanding of mHealth in the workplace through abduction. First, it identifies two novel coordination mechanisms: role flexibility and covert routines. Second, through the novel concept of multiple accountability, it challenges one of the key integrative principles proposed in the coordination studies perspective, problematising it and proposing that relationships between health intermediaries and local communities are far more influential for the coordination of mHealth than extant theory has so far proposed. Third, it carries important implications for future mHealth (and, more broadly, technology coordination) scholarship, providing evidence that existing coordination mechanisms and relationships may be as influential as the transformative potential of the technology itself. The research also contributes to practice by enhancing understanding of how health intermediaries may be empowered to effectively employ mHealth in the workplace. In a context of policy and funding uncertainty, this research contributes to an emerging literature identifying the practical mHealth issues primary health care staff face in a resource-poor environment, interrogating approaches that fail to recognise these realities

Navigating the Patient Room: Critical Care Nurses' Interaction with the Designed Physical Environment

abstract: The physical environment influences the physiology, psychology, and the societal interactions of those who experience it. The environment can also influence human behavior. Critical care nurses are in constant interaction with the physical environment surrounding their patients. High acuity ICU patients are vulnerable and at risk for harm, infection, and poor outcomes while the physical and cognitive workload of nurses presents a demanding and continuous challenge. The goal of this qualitative study was to explore and understand the way critical care nurses navigate within the patient room and interact with its features. The study of critical care nurses interacting with the patient room environment was conducted in five critical care units at three tertiary care institutions in the Eastern United States, along with another unit in the pilot study at a community hospital in the Southwest United States. Nurses were observed in their typical work environment as they performed normal tasks and patient care activities for entire day and night shifts. The study involved ethnographic field observations, individual semi-structured participant interviews, and examination of photographs and floor plans. The exploratory study resulted in a comprehensive model for nurse navigation that includes both cognitive and action components, along with a conceptual framework for nurse behavioral activity. Repetitive patterns of nurse movement were identified and named. The findings produced recommendations for nurses’ effective use of space and architectural design of ICU patient rooms to improve patient outcomes.Dissertation/ThesisDoctoral Dissertation Nursing and Healthcare Innovation 201

Improving Patient Satisfaction with the Virtual Handoff Process through the Utilization of Educational Pamphlets in the Emergency Department

Boarding patients in the emergency room while waiting to transfer the patient to the proper unit can be harmful to clinical care and have significant financial opportunity costs. At one local hospital it was found that on average patients were being boarded in the emergency room (ED) for approximately 85 minutes waiting to be transferred. Several barriers that caused this delay were found including, delay in room cleaning, nurse staff shortage, and inability to give report to the nurse receiving the patient. In an attempt to combat this delay which may be caused by a difficulty in giving patient report, this organization is rolling out a virtual bedside handoff process. While virtual technology is not a new concept, there are many patients that may not be comfortable with the technology. The purpose of the evidence-based project was to provide a written educational pamphlet that details the how’s and why’s of the virtual handoff process to the patient to be given upon admission. The goal of the educational pamphlet was to increase the patients’ satisfaction with the process. A pre-survey was given to a group of patients after they experienced the virtual handoff process to assess their comfort level. These results were compared to the post-survey results of patients that received the educational pamphlet prior to experiencing the virtual handoff process. Ten pre-surveys and seven post-surveys were analyzed utilizing SPSS and descriptive statistics. The analysis concluded that the participants who received the educational pamphlet felt more prepared for the virtual handoff process

Health Information Systems Affordances: How the Materiality of Information Technology Enables and Constrains the Work Practices of Clinicians

The IT artifact is at the core of the information systems (IS) discipline and yet most IS research does not directly theorize the IT artifact or its nomological network (Benbasat and Zmud 2003; Orlikowski and Iacono 2001). This research seeks to answer a repeated call for more direct engagement with the IT artifact and its nomological net with affordance theory adopted as the basis for this theoretical work. An exploratory case study was conducted to answer the research question, how do the material properties of health information systems enable and constrain the work practices of clinicians? The study was conducted at a large urban acute care hospital in the Midwestern United States with registered nurses working on inpatient care units as the clinicians of interest. Through interviews with nurses and other clinical stakeholders and the observation of nurse’s work practices on three patient care units in the hospital, theoretical insights were developed on the nature of affordances for information systems research. IS affordances are defined in this study as relationships between abilities of an individual and features of an information systems within the context of the environment in which they function. The concepts of an affordance range and an affordance threshold are proposed as theoretical constructs in the nomological network of affordances that help to explain the use of information systems as a function of the difficulty of acting on IS affordances. The relationship between affordances and constraints is theorized and linked to the affordance range and threshold with the assertion that constraints are closely associated with the difficulties experienced by users in acting on IS affordances. The challenge of studying IS affordances in all their complexity is discussed with the suggestion that researchers take the user’s perspective of affordances to alleviate the need for repeated decomposition. Finally, the role of information systems in facilitating social interaction is emphasized through the concept of affordances for sociality. The contribution of this research to the IS field is a more nuanced understanding of the nature of the IT artifact and its relationship to the users of that technology