| Learning Objective #1: Discuss how working conditions within the acute care setting create barriers to nures' abilities to complete the nursing process | |||
| Learning Objective #2: Describe the implications of how disruptions in the nursing process affect clinical decision making |
Objective: The purpose of this ongoing study is to identify working conditions that may trigger medical errors. This paper addresses how qualitative analysis compliments human factors engineering (HFE) methods for understanding how factors within the acute care environment disrupt the cognitive work of nurses. Design: An observational study combining HFE analysis with qualitative observation of acute care nurses. Population: Registered nurses (7) employed on acute care general medicine and neuro-medicine units were observed for five hours each during a routine day shift. Concepts Studied Together: HFE analysis identifies: psychomotor activities nurses perform during a work shift; time spent with each activity; and pattern of staff movement as the activities are performed. Qualitative analysis examines nurses conducting the nursing process. Methods: HFE analysis included work flow, task analysis, and link diagramming. Observational shadowing and interviews with nurses tracked completion of the nursing process cycle; patient assessment, problem and priority setting, completed interventions, and evaluatiion. Findings: Nurses' ability to coordinate knowledge, patient information, and the goals of patient care is hindered by their complex working environment. The nursing care process is elusive to objective HFE measurement alone. However, HFE analysis complimented qualitative observation to offer a pictorial representation (cognitive pathway) of the flow of nursing activities and the cognitive behaviors that comprise the nursing process. Preliminary analysis of our observational periods reveals that the majority of nurses were unable to complete the nursing process for all patients. Conclusion: A cognitive pathway reveals the extent interruptions, fragmented work processes, and communication barriers disrupt the nursing process. Implications: Interruptions in the nursing process cycle has implications for timely and effective clinical decision making and intervention. Disruptions in the clinical decision making process creates the potential for errors and poor patient outcomes.
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