Int J Med Inform - Using Cognitive Work Analysis to fit decision support tools to nurse managers' work flow.

Tópicos

{ care(1570) inform(1187) nurs(1089) }
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Resumo

RPOSE: To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager's work domain.METHODS: Data for the WDA were obtained from semi-structured interviews with nurse managers, division directors, CNOs, and other managers (n = 20) on 10 patient care units in three Arizona hospitals. The WDA described the nurse manager's environment in terms of the constraints it imposes on the nurse manager's ability to achieve targeted outcomes through organizational goals and priorities, functions, processes, as well as work objects and resources (e.g., people, equipment, technology, and data). Constraints were identified and summarized through qualitative thematic analysis.RESULTS: The results highlight the competing priorities, and external and internal constraints that today's nurse managers must satisfy as they try to improve quality and safety outcomes on their units. Nurse managers receive a great deal of data, much in electronic format. Although dashboards were perceived as helpful because they integrated some data elements, no decision support tools were available to help nurse managers with planning or answering "what if" questions. The results suggest both the need for additional decision support to manage the growing complexity of the environment, and the constraints the environment places on the design of that technology if it is to be effective. Limitations of the study include the small homogeneous sample and the reliance on interview data targeting safety and quality.

Resumo Limpo

rpose better understand environment constraint nurs manag impact need use decis support tool conduct cognit work analysi cwa complet cwa includ system analys five level work domain decisionmak procedur decisionmak strategi social organizationcollabor worker skill level describ result work domain analysi wda portion detail integr wda portion cwa report previous generat complet pictur nurs manag work domainmethod data wda obtain semistructur interview nurs manag divis director cnos manag n patient care unit three arizona hospit wda describ nurs manag environ term constraint impos nurs manag abil achiev target outcom organiz goal prioriti function process well work object resourc eg peopl equip technolog data constraint identifi summar qualit themat analysisresult result highlight compet prioriti extern intern constraint today nurs manag must satisfi tri improv qualiti safeti outcom unit nurs manag receiv great deal data much electron format although dashboard perceiv help integr data element decis support tool avail help nurs manag plan answer question result suggest need addit decis support manag grow complex environ constraint environ place design technolog effect limit studi includ small homogen sampl relianc interview data target safeti qualiti

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