RN Stacking: Cognitive Workflow Management Process with Implications for Patient Safety and Quality Care

18.00
Hdl Handle:
http://hdl.handle.net/10755/160783
Type:
Presentation
Title:
RN Stacking: Cognitive Workflow Management Process with Implications for Patient Safety and Quality Care
Abstract:
RN Stacking: Cognitive Workflow Management Process with Implications for Patient Safety and Quality Care
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2009
Author:Ebright, Patricia, DNS
P.I. Institution Name:Indiana University
Title:Adult Health Nursing
Contact Address:1111 Middle Drive, NU 412, Indianapolis, IN, 46202, USA
Contact Telephone:317-274-7912
Co-Authors:P.R. Ebright, School of Nursing, Indiana University, Indianapolis, IN; E.S. Patterson, Engineering, Ohio State University, Columbus, OH; J.J. Saleem, VA HSR&D Center on Implementing Evidence-Based Practice, Roudebush VMAC, Indianapolis, IN;
Given the increasingly higher acuity of patients and complexity of healthcare systems, understanding and supporting critical features of RN cognitive work regarding organization and prioritization in delivering care will affect patient care safety and quality. Stacking is an RN cognitive process involving decision-making about workflow priorities. A previous study identified stacking as an important strategy used by experienced RNs for management of the complexity surrounding nursing care in medical surgical units. The purpose of this descriptive study was to identify common attributes of RN stacking across multiple clinical settings and differences by three levels of RN experience. Our specific aims were to describe: 1) types of activities stacked by RNs in the context of real-life care situations; 2) factors that influence RN stacking decisions; and 3) types of stacking decisions. We utilized a multi-method ethnographic approach that included direct observations and cognitive task analysis interviews of RNs with varied experience and in multiple healthcare settings. We followed each observation of 30 RNs with a semi-structured taped interview to collect detailed data about factors that influenced decision-making about prioritizing care. With an additional 24 RNs we conducted focus groups for each of 3 levels of RN experience (< 1 year, 1 to 5 years, and > 5 years). Through independent content analysis followed by repeated iterative discussions about data transcripts the primary author and two additional reviewers reached consensus on the types of activities stacked, themes characterizing factors that influenced decision-making, and types of stacking decisions. We identified the following across RNs and settings: 1) a hierarchy of care activities reflecting priority in the stack; 2) seven stacking decisions; 3) variation in flexibility and use of decisions across experience levels; and 4) constraints to choice of decisions. Findings provide information to guide the following: 1) basic RN education program curricula; 2) education and orientation for effective support of new graduate RNs; and 3) redesign of processes and systems to support novice RN stacking capabilities and implications for patient care safety and quality.
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.titleRN Stacking: Cognitive Workflow Management Process with Implications for Patient Safety and Quality Careen_GB
dc.identifier.urihttp://hdl.handle.net/10755/160783-
dc.description.abstract<table><tr><td colspan="2" class="item-title">RN Stacking: Cognitive Workflow Management Process with Implications for Patient Safety and Quality Care</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">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Ebright, Patricia, DNS</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">Adult Health Nursing</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1111 Middle Drive, NU 412, 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 class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">P.R. Ebright, School of Nursing, Indiana University, Indianapolis, IN; E.S. Patterson, Engineering, Ohio State University, Columbus, OH; J.J. Saleem, VA HSR&amp;D Center on Implementing Evidence-Based Practice, Roudebush VMAC, Indianapolis, IN;</td></tr><tr><td colspan="2" class="item-abstract">Given the increasingly higher acuity of patients and complexity of healthcare systems, understanding and supporting critical features of RN cognitive work regarding organization and prioritization in delivering care will affect patient care safety and quality. Stacking is an RN cognitive process involving decision-making about workflow priorities. A previous study identified stacking as an important strategy used by experienced RNs for management of the complexity surrounding nursing care in medical surgical units. The purpose of this descriptive study was to identify common attributes of RN stacking across multiple clinical settings and differences by three levels of RN experience. Our specific aims were to describe: 1) types of activities stacked by RNs in the context of real-life care situations; 2) factors that influence RN stacking decisions; and 3) types of stacking decisions. We utilized a multi-method ethnographic approach that included direct observations and cognitive task analysis interviews of RNs with varied experience and in multiple healthcare settings. We followed each observation of 30 RNs with a semi-structured taped interview to collect detailed data about factors that influenced decision-making about prioritizing care. With an additional 24 RNs we conducted focus groups for each of 3 levels of RN experience (&lt; 1 year, 1 to 5 years, and &gt; 5 years). Through independent content analysis followed by repeated iterative discussions about data transcripts the primary author and two additional reviewers reached consensus on the types of activities stacked, themes characterizing factors that influenced decision-making, and types of stacking decisions. We identified the following across RNs and settings: 1) a hierarchy of care activities reflecting priority in the stack; 2) seven stacking decisions; 3) variation in flexibility and use of decisions across experience levels; and 4) constraints to choice of decisions. Findings provide information to guide the following: 1) basic RN education program curricula; 2) education and orientation for effective support of new graduate RNs; and 3) redesign of processes and systems to support novice RN stacking capabilities and implications for patient care safety and quality.</td></tr></table>en_GB
dc.date.available2011-10-26T23:10:35Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T23:10:35Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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