Journal article
Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting
Journal of the American Medical Informatics Association : JAMIA, Vol.17(3), pp.313-321
05/01/2010
DOI: 10.1136/jamia.2009.000422
PMCID: PMC2945713
PMID: 20442150
Abstract
To identify factors in the nursing work domain that contribute to the problem of inpatient falls, aside from patient risk, using cognitive work analysis.
A mix of qualitative and quantitative methods were used to identify work constraints imposed on nurses, which may underlie patient falls.
Data collection was done on a neurology unit staffed by 27 registered nurses and utilized field observations, focus groups, time-motion studies and written surveys (AHRQ Hospital Survey on Patient Culture, NASA-TLX, and custom Nursing Knowledge of Fall Prevention Subscale).
Four major constraints were identified that inhibit nurses' ability to prevent patient falls. All constraints relate to work processes and the physical work environment, opposed to safety culture or nursing knowledge, as currently emphasized. The constraints were: cognitive 'head data', temporal workload, inconsistencies in written and verbal transfer of patient data, and limitations in the physical environment. To deal with these constraints, the nurses tend to employ four workarounds: written and mental chunking schemas, bed alarms, informal querying of the previous care nurse, and informal video and audio surveillance. These workarounds reflect systemic design flaws and may only be minimally effective in decreasing risk to patients.
Cognitive engineering techniques helped identify seemingly hidden constraints in the work domain that impact the problem of patient falls. System redesign strategies aimed at improving work processes and environmental limitations hold promise for decreasing the incidence of falls in inpatient nursing units.
Details
- Title: Subtitle
- Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting
- Creators
- Karen Dunn Lopez - University of Illinois at ChicagoGregory J Gerling - University of VirginiaMichael P Cary - University of VirginiaMary F Kanak - VA Midwest Health Care Network
- Resource Type
- Journal article
- Publication Details
- Journal of the American Medical Informatics Association : JAMIA, Vol.17(3), pp.313-321
- DOI
- 10.1136/jamia.2009.000422
- PMID
- 20442150
- PMCID
- PMC2945713
- ISSN
- 1067-5027
- eISSN
- 1527-974X
- Grant note
- T15LM009462 / NLM NIH HHS T15 LM009462-03 / NLM NIH HHS T15 LM009462-02 / NLM NIH HHS T15 LM009462-01 / NLM NIH HHS T15 LM009462 / NLM NIH HHS
- Language
- English
- Date published
- 05/01/2010
- Academic Unit
- Nursing
- Record Identifier
- 9984370759902771
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