Identification of Environmental Factors That Increase Complexity in Acute Care Settings

2.50
Hdl Handle:
http://hdl.handle.net/10755/160585
Type:
Presentation
Title:
Identification of Environmental Factors That Increase Complexity in Acute Care Settings
Abstract:
Identification of Environmental Factors That Increase Complexity in Acute Care Settings
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2002
Author:Ebright, Patricia, DNS/DNSc/DSN
P.I. Institution Name:Indiana University
Title:Assistant Professor
Contact Address:School of Nursing, 1111 Middle Drive, NU 413, Indianapolis, IN, 46202, USA
Contact Telephone:317.274.7912
The ability of registered nurses (RNs) to manage workload effectively for safe patient care and quality outcomes in acute care is challenged by an increasingly complex healthcare environment. The purpose of this research was to discover the human and environmental factors that contribute to RN decisions in the midst of workload management in complex acute care settings. This work builds on the work of human performance experts and uses a model of complex system failure as a theoretical framework. Decision making in complex environments is influenced by time pressure, uncertain information, conflicting goals, high stakes, stress, and dynamic conditions such as variable staffing, high acuity, and unpredictability. While these variables are difficult to control, there may be more discrete physical and operational aspects of work settings that are worthwhile targets for more immediate redesign to support RN decision making in the midst of workload management. Data were collected through direct observation and follow-up interviews of eight expert RNs about actual working conditions in seven different acute care settings. A panel of nursing and human performance experts analyzed the data for patterns of environmental factors across these settings that affected information gathering, judgments, interventions, and outcomes. Findings from this study support characterization of acute care settings as complex. Physical and operational structures were identified across settings that affected RN decision making and resulted in multiple potential paths to failure including increased stacking of incomplete tasks, increased opportunity for interruption, decreased time getting to "know" patients, and complicated access to human and material resources. Results of this study have implications for nursing administrators and practitioners related to fairly straightforward changes in the design of systems that have the potential for decreasing complexity, and supporting RN decision making in the midst of workload management.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Midwest Nursing Research Society

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleIdentification of Environmental Factors That Increase Complexity in Acute Care Settingsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/160585-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Identification of Environmental Factors That Increase Complexity in Acute Care Settings</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Midwest Nursing Research Society</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2002</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Ebright, Patricia, DNS/DNSc/DSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Indiana University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">School of Nursing, 1111 Middle Drive, NU 413, Indianapolis, IN, 46202, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">317.274.7912</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">prebrigh@iupui.edu</td></tr><tr><td colspan="2" class="item-abstract">The ability of registered nurses (RNs) to manage workload effectively for safe patient care and quality outcomes in acute care is challenged by an increasingly complex healthcare environment. The purpose of this research was to discover the human and environmental factors that contribute to RN decisions in the midst of workload management in complex acute care settings. This work builds on the work of human performance experts and uses a model of complex system failure as a theoretical framework. Decision making in complex environments is influenced by time pressure, uncertain information, conflicting goals, high stakes, stress, and dynamic conditions such as variable staffing, high acuity, and unpredictability. While these variables are difficult to control, there may be more discrete physical and operational aspects of work settings that are worthwhile targets for more immediate redesign to support RN decision making in the midst of workload management. Data were collected through direct observation and follow-up interviews of eight expert RNs about actual working conditions in seven different acute care settings. A panel of nursing and human performance experts analyzed the data for patterns of environmental factors across these settings that affected information gathering, judgments, interventions, and outcomes. Findings from this study support characterization of acute care settings as complex. Physical and operational structures were identified across settings that affected RN decision making and resulted in multiple potential paths to failure including increased stacking of incomplete tasks, increased opportunity for interruption, decreased time getting to &quot;know&quot; patients, and complicated access to human and material resources. Results of this study have implications for nursing administrators and practitioners related to fairly straightforward changes in the design of systems that have the potential for decreasing complexity, and supporting RN decision making in the midst of workload management.</td></tr></table>en_GB
dc.date.available2011-10-26T23:05:06Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T23:05:06Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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