Micro- and macroergonomic changes in mental workload and medication safety following the implementation of new health IT

Health information technology (IT) is a promising way to achieve safer medication management in the delivery of healthcare. However, human factors/ergonomics dictates that in order to make the complex, cognitive work of healthcare delivery safer, health IT must properly support human cognition. This means, for example, that new health IT must reduce, not increase, workload during safety-critical tasks. The present study was the first to quantitatively assess the short- and long-term impact of bar coded medication administration (BCMA) IT on nurses' mental workload as well as on perceived medication safety. One-hundred seventy registered nurses across 3 dissimilar clinical units at an academic, freestanding pediatric hospital in the Midwest US participated in surveys administered before, 3 months after, and 12 months after the hospital implemented BCMA. Nurses rated their external mental workload (interruptions, divided attention, being rushed) and internal mental workload (concentration, mental effort) during medication administration tasks as well as the likelihood of each of three medication safety events: medication administration errors, medication errors on the clinical unit, and clinical unit-level adverse drug events. Clinical unit differences were assessed. Findings generally confirmed the hypothesis that external but not internal mental workload was associated with the perceived likelihood of a medication safety event. Comparisons of mental workload from pre- to post-BCMA revealed statistically significant changes in the critical care unit only. Medication safety appeared to improve over the long term in the hematology/oncology unit only. In the critical care and medical/surgical units, medication safety exhibited short-term improvements that were eliminated over time. Changes in mental workload and medication safety, two classically microergonomic constructs, were deeply embedded in macroergonomic phenomena. These included the fit between the BCMA system and the nature of nursing work, the process of BCMA implementation, and BCMA interactions with concurrent changes occurring in the hospital. Findings raise questions about achieving sustainable performance improvement with health IT as well as the balance between micro- and macroergonomic approaches to studying technology change.Relevance to industryDesigners must consider how technology changes cognitive work, including mental workload. Hospitals and other implementers of technology must ensure that new technology fits its users, their tasks, and the context of use, which may entail tailoring implementation, for example, to specific clinical units. Evaluators must look over time to assess both changes in cognitive work and implementation issues. Healthcare practitioners must also recognize that new technology means a complex transformation to an already complex sociotechnical system, which calls for a macroergonomic approach to design and analysis.     

基于老年人情感需求的养老院康复景观设计

文章阐述了养老院中老年人的情感需求和行为方式,研究了景观和老年人的生活、健康、康复之间的关系。总结了使用康复景观设计为老年人创造满足其情感需求帮助他们缓解压力、安度晚年的空间场所的方法。     

Effects of mental process integrated nursing training using mobile device on students’ cognitive load,learning attitudes,acceptance, and achievements

Clinical nursing training is important to nursing educators and student nurses in nursing education since safe and competent care depends on good clinical problem solving skills. Therefore, developing better cognitive problem-solving strategies or tools are essential for clinical nursing practices. Moreover, learning diagnosis is also a critical determinant in the acquisition, processing, and application of clinical skills in nursing practices. Bearing this in mind, this study aims to develop a mobile interactive learning and diagnosis (MILD) system to support problem-based learning (PBL) in a clinical nursing course based on the testing-based approach. Using mobile devices as a learning tool to integrate both real-world and digital-world resources for students and adopting PBL as a learning strategy to facilitate the development of the clinical problem solving skills. To show the effectiveness of the proposed approach, an experiment was conducted in a foundations of nursing course at a nursing college in Taiwan. The experimental results show that the proposed approach is helpful to students in improving learning performance and reducing cognitive loads. Moreover, it was also found that most students showed positive perceptions toward the usage of the proposed system.     

Application of MSD prevention practices by nursing staff working in healthcare settings

ObjectiveThe objective of this article is to examine the application of MSD prevention practices among nursing staff and to identify organizational factors that may or may not support their application.MethodsWe measured the application of prevention practices and its determinants by means of a questionnaire filled out by 399 nurses and nursing staff in Canada. A qualitative component was conducted with two focus groups in order to validate and enrich the interpretation of the survey results.ResultsResults show that most respondents “often” (4) apply MSD prevention practices in their daily professional tasks. Significant differences were observed based on position, mission of the institution, degree, and training.ConclusionsThe characteristics of the nursing staff (position, training, etc.) and the specificities of the setting must be taken into consideration in MSD prevention interventions for nursing staff.     

舒适护理在神经内科患者全面护理中的作用分析

目的：分析舒适护理这一护理模式在神经内科护理工作中的作用。方法：随机选取2015年1月1日至2016年1月1日期间入住我神经内科二病区的患者300例（患者在研究过程中昏迷时间＜48h )作为研究对象。据比较,两组患者在性别、年龄、病情方面差异无显著性（P＞0.05）,资料具有可比性。对观察组患者采取舒适护理的方法进行护理,对照组采取传统护理法进行护理。然后在治疗即将结束时对患者进行满意程度的调查,同时比较两组的主院时间。结果：观察组在患者满意百分比明显大于对照组（P＜0.05）,观察组平均住院时间明显短于对照组（P＜0.05）。结论：舒适护理是神经内科患者急需的一种优良护理模式,我们应该大力推广。     

腹膜透析患者出口处感染和隧道炎的原因分析及护理对策

目的通过分析影响持续非卧床腹膜透析(CAPD)患者发生出口处感染和隧道炎的因素,以减少此并发症的发生及避免其所致的严重后果。方法调查2005年2月1日至2009年10月31日在本腹透中心进行CAPD的终末期肾病的临床资料,发生出口处感染和隧道炎的原因,时间及相应的护理措施对其预后的影响。以单因素方差分析分别观察白蛋白及血红蛋白对出口处感染和隧道炎的影响。结果105例患者中有32例发生37次出口处感染和隧道炎,占我院腹透患者的30.4%,出口处感染31例,隧道炎6例。发生时间集中于6、7、8三月,该3个月发生的例数占总数的52.9%。其中致涤纶套外露4例,腹膜炎2例,住院6例。经相应的护理措施后均痊愈。白蛋白及血红蛋白对出口处感染和隧道炎无影响。结论营养因素对出口处感染和隧道炎的发生影响少,而出口处的损伤、出血及护理不佳是导致出口处感染和隧道炎的重要因素。因此应注重CAPD患者出院的培训与教育。小心放置导管并防止任何可能的外伤有重要意义。出口处感染和隧道炎的发生时间大多集中在夏季,故在此季节更应加强观察、随访及护理。当患者已发生出口处感染和隧道炎时,可通过加强换药、适当使用抗生素,可避免进一步发展至隧道脓肿、腹...     

乳腺癌术后化疗患者健康教育效果调查分析

目的 探讨对乳腺癌术后化疗患者实施健康教育的效果。方法 将60例乳腺癌术后化疗患者随机分为对照组和试验组,对照组采用传统健康教育法,试验组按指定的临床护理程序进行健康教育。结果 试验组患者满意度及健康教育达标率明显高于对照组(P<0.05)。结论 采用临床护理程序进行健康教育,能提高乳腺癌术后化疗患者的满意度及健康教育达标率,改善患者生活质量。     

模块化多功能护理床抬背机构设计与分析

针对康养行业的需求,基于模块化设计方法,对多功能护理床进行了模块划分和功能分析,完成了多功能护理床的整体方案设计。基于人机工程学原理,对抬背机构进行研究,通过分析对比现有抬背机构的优劣,设计了一种两折抬背机构;建立了相应的运动数学模型,借助Matlab对其进行理论运动分析,并与Adams运动学仿真结果进行对比,验证了机构设计的合理性。借助Ansys对抬背机构的关键部件进行有限元分析,确保了机构的安全性,并制作实验样机进行了验证。     

Physical examination of arteriovenous fistula: The influence of professional experience in the detection of complications

Vascular access is one of the leading causes of mobilization of financial resources in health systems for people with chronic kidney disease on hemodialysis. Physical examination of the arteriovenous fistula (AVF) has demonstrated its effectiveness in identifying complications. We decided to evaluate the influence of nurses' professional experience in the detection of complications of the AVF (venous stenosis and steal syndrome). The study took place in eight hemodialysis centers between May and September of 2011 in the north of Portugal. Sample was constituted by registered nurses. The nurses involved in the experiment were divided in two groups: those who had more than 5 years of experience and those who had less than 5 years of experience. Ninety‐two nurses participated in the study: 34 nurses had less than 5 years of professional experience and 58 had more than 5 years of professional experience. In the practices considered by nurses in the detection of venous stenosis, there were no differences observed between the groups (P > 0.05). In steal syndrome, there were no differences observed between the groups in the practices of the nurses in the detection of this complication of the AVF (P > 0.05). We concluded that professional experience does not influence the detection of venous stenosis and steal syndrome.     

人工气道内持续湿化护理观察

目的探讨气道内持续湿化方法对人工气道建立患者预防肺部感染的护理治疗效果。方法 35例进入急诊科和重症监护室的人工气道建立患者随机分成实验组20例和对照组15例,实验组患者采用微量注射泵持续湿化的方法对人工气道进行护理,对照组采用常规护理方法间断给予气道内湿化的方法对人工气道进行护理,分别观察记录2组患者体温、吸痰间隔时间、拔管时间并进行痰液细菌培养,主要以体温和痰液细菌培养结果判断是否有肺部感染的发生评价疗效,卡方检验方法对临床采集数据进行统计学处理。结果实验组与对照组比较,实验组发生肺部感染例数明显减少,统计学处理差异有显著性。结论与传统的间断气道湿化相比,采用微量注射泵持续气道湿化操作简单,安全可靠,效果确切,并发症少。