TY - JOUR
T1 - Using Cognitive Work Analysis to fit decision support tools to nurse managers' work flow
AU - Effken, Judith A.
AU - Brewer, Barbara B.
AU - Logue, Melanie D.
AU - Gephart, Sheila M.
AU - Verran, Joyce A.
N1 - Funding Information:
This research was funded by the National Library of Medicine (NIH) 1R01LM009516-01A1 . A complete discussion of the decision-making procedures and strategies of nurse managers summarized in this manuscript can be found in April, 2010 issue of the Journal of Nursing Administration . More complete discussions of the socio-organizational part of the CWA summarized briefly in this manuscript were published in the 2010 AMIA Proceedings, in the International Journal of Medical Informatics (in press) (see References). In addition, portions of this paper have been presented at the 42nd Western Institute of Nursing Communicating Nursing Research Assembly, April 20–23, 2009, Salt Lake City, Utah; the 43rd Western Institute of Nursing Communicating Nursing Research Assembly, April 14–17, 2010, Glendale, AZ; the 2nd Annual Institute on Systems Science and Health, June 14th, Columbia University, New York City, NY; the American Academy of Nursing 37th Annual Meeting and Conference, November 11–13, 2010, Washington, DC; and the American Organization of Nurse Executives Conference and Exhibition in San Diego, CA, April 13–16, 2011. The authors thank Dr. Ya-Chuan Hsu for her assistance with data analysis for an earlier version of this manuscript. Finally, we are grateful for the advice on conducting a CWA provided by Dr. John Lee.
PY - 2011/10
Y1 - 2011/10
N2 - Purpose: 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.
AB - Purpose: 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.
KW - Analysis
KW - Cognitive Work Analysis
KW - Decision support
KW - Nurse managers
UR - http://www.scopus.com/inward/record.url?scp=80052803438&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=80052803438&partnerID=8YFLogxK
U2 - 10.1016/j.ijmedinf.2011.07.003
DO - 10.1016/j.ijmedinf.2011.07.003
M3 - Article
C2 - 21862397
AN - SCOPUS:80052803438
SN - 1386-5056
VL - 80
SP - 698
EP - 707
JO - International Journal of Medical Informatics
JF - International Journal of Medical Informatics
IS - 10
ER -