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1.
Pediatr Emerg Care ; 38(1): e343-e348, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33136833

RESUMO

BACKGROUND: Children are more vulnerable to medication errors during prehospital care because of paramedic staff having less experience with pediatric patients. One of the possible solutions to this problem is the use of technologies as cognitive aids to medication dosage calculation. OBJECTIVE: Design and empirically test a graphic dosage calculator tailored for pediatric medication calculation in prehospital emergency care. METHODS: The design and development of the calculator followed an iterative user-centered design process. Fourteen novice and 16 experienced paramedics participated in the empirical test of the graphic calculator by running 3 pediatric medication scenarios with both the graphic calculator and a pocket handbook used currently to aid calculations. RESULTS: It took significantly less time to complete the scenarios with the graphic calculator compared with the handbook. Both novice and experienced paramedics expressed similar levels of confidence with using the graphic calculator. Participants expressed a strong preference for the graphic calculator. Finally, the graphic calculator was scored significantly above a standard usability benchmark. DISCUSSION: The results show that the graphic calculator was usable, more effective, efficient, and preferred compared with the current dosage calculation method. Technologies such as the graphic calculator designed and tested in this study can help not only with the rare cases, such as pediatrics, but might also mitigate skill decay.


Assuntos
Serviços Médicos de Emergência , Auxiliares de Emergência , Pessoal Técnico de Saúde , Criança , Humanos , Erros de Medicação/prevenção & controle
2.
J Minim Invasive Gynecol ; 27(3): 728-737.e2, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31146028

RESUMO

STUDY OBJECTIVE: To introduce and examine a single session of spatial skill training as an efficient means of improving surgical suturing performance in robot-assisted surgery. DESIGN: A randomized, controlled trial. SETTING: A tertiary university medical center in Israel. PARTICIPANTS: A purposive sample composed of 41 residents with no robotic suturing skills. INTERVENTIONS: A computer-based simulator training of spatial skills. MEASUREMENTS AND MAIN RESULTS: Participants were randomly assigned to training (n = 21: mean age of 34 years [standard deviation (SD) = 1.92]) and control (n = 20: mean age of 32 years [SD = 3.17]) conditions. The training group underwent a session of spatial skills training, whereas the control group engaged in a neutral activity. After 1 participant was lost to the follow-up of the posttraining performance test, data of 40 participants were analyzed. Robotic suturing task performance with the da Vinci Skills Simulator (Intuitive Surgical, Sunnyvale, CA) was evaluated using the da Vinci Skills Simulator built-in measure of "excess tissue piercing" and an expert rating of "tissue tearing." The mean number of excess tissue piercing after training (but not after the neutral activity) was significantly lower than before training (3.25 [SD = 1.996] vs 6.75 [SD = 3.68], respectively; p <.001), reflecting an improvement of 52% (decreasing the mean number of excess tissue piercing in a single suture by 3.5 excess piercing trials). After the interventions, the extent of tissue tearing was rated lower in the training group (p = .01), and there was no change in the control group (p = .14). CONCLUSION: We showed the efficiency of a training approach that focuses on spatial skills critical in robot-assisted surgery. We showed that surgeons who received a 1 session spatial skill training with a cognitive spatial skill trainer immediately improved the performance of a robotic suturing task compared with surgeons who did not receive such training.


Assuntos
Competência Clínica , Internato e Residência , Procedimentos Cirúrgicos Robóticos/educação , Treinamento por Simulação/métodos , Cirurgiões/educação , Realidade Virtual , Adulto , Simulação por Computador , Feminino , Humanos , Internato e Residência/métodos , Israel , Masculino , Comportamento Espacial/fisiologia , Cirurgiões/normas , Técnicas de Sutura/educação , Técnicas de Sutura/normas , Suturas/normas , Análise e Desempenho de Tarefas
3.
J Med Internet Res ; 22(6): e19947, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32511099

RESUMO

BACKGROUND: Full level 1 personal protective equipment (PPE) is used in various domains and contexts. Prior research has shown influences of such equipment on performance, comfort, and contamination levels. The coronavirus disease (COVID-19) pandemic forced a pervasive requirement of PPE, with little preparation, rushed deployment, inadequate time for training, and massive use by personnel who are inexperienced or not qualified in its effective use. OBJECTIVE: This study aims to examine the key human factors (physical and ergonomic, perceptual and cognitive) that influence the use of level 1 PPE when attending to patients with suspected or confirmed COVID-19. METHODS: The research approach consisted of a short survey disseminated to health care professionals in two countries, Israel and Portugal, with similar demographics and health care systems. The survey included 10 items with a 5-point Likert scale regarding the key human factors involved in level 1 PPE, as identified in prior research. RESULTS: A total of 722 respondents from Israel and 301 respondents from Portugal were included in the analysis. All the respondents reported using level 1 PPE with patients with COVID-19 in the range of several hours daily to several hours weekly. The Cronbach α was .73 for Israel and .75 for Portugal. Responses showed high levels of difficulty, with medians of 4 for items related to discomfort (n=539/688, 78% in Israel; n=328/377, 87% in Portugal), hearing (n=236/370, 64% in Portugal; n=321/642, 50% in Israel), seeing (n=697/763, 89% in Israel; n=317/376, 84% in Portugal), and doffing (n=290/374, 77% in Portugal; n=315/713, 44% in Israel). A factor analysis showed a set of strongly related variables consisting of hearing, understanding speech, and understanding the situation. This suggests that degradation in communication was strongly associated with degradation in situational awareness. A subsequent mediation analysis showed a direct effect of PPE discomfort on situational awareness (P<.001); this was also influenced (mediated) by difficulties in communicating, namely in hearing and understanding speech. CONCLUSIONS: In 2020, the COVID-19 pandemic is paving the way for updating PPE design. The use of already deployed technology affords ample opportunities to improve, adapt, and overcome caveats. The findings here suggest that the use of level 1 PPE with patients with COVID-19 has perceptual and cognitive effects, in addition to physical and ergonomic influences. Efforts should be taken to mitigate the harmful effects of such influences, both regarding the performance of medical actions and the risk of contamination to health care workers. Such efforts involve the design of PPE; the introduction of technologies to enhance vision, hearing, and communicating during the use of PPE; and training staff in using the equipment and in effective communication and teamwork protocols.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/prevenção & controle , COVID-19 , Humanos , SARS-CoV-2
4.
Int J Qual Health Care ; 30(1): 16-22, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29194491

RESUMO

IMPORTANCE: Emergency resuscitation of critically ill patients can challenge team communication and situational awareness. Tools facilitating team performance may enhance patient safety. OBJECTIVES: To determine resuscitation team members' perceptions of the Situational Awareness Display's utility. DESIGN: We conducted focus groups with healthcare providers during Situational Awareness Display development. After simulations assessing the display, we conducted debriefs with participants. SETTING: Dual site tertiary care level 1 trauma centre in Ottawa, Canada. PARTICIPANTS: We recruited by email physicians, nurses and respiratory therapist. INTERVENTION: Situational Awareness Display, a visual cognitive aid that provides key clinical information to enhance resuscitation team communication and situational awareness. MAIN OUTCOMES AND MEASURES: Themes emerging from focus groups and simulation debriefs. Three reviewers independently coded and analysed transcripts using content qualitative analysis. RESULTS: We recruited a total of 33 participants in two focus groups (n = 20) and six simulation debriefs with three 4-5 member teams (n = 13). Majority of participants (10/13) strongly endorsed the Situational Awareness Display's utility in simulation (very or extremely useful). Focus groups and debrief themes included improved perception of patient data, comprehension of context and ability to project to future decisions. Participants described potentially positive and negative impacts on patient safety and positive impacts on provider performance and team communication. Participants expressed a need for easy data entry incorporated into clinical workflow and training on how to use the display. CONCLUSION: Emergency resuscitation team participants felt the Situational Awareness Display has potential to improve provider performance, team communication and situational awareness, ultimately enhancing quality of care.


Assuntos
Conscientização , Serviço Hospitalar de Emergência/organização & administração , Ressuscitação , Comunicação , Feminino , Grupos Focais , Pessoal de Saúde , Humanos , Masculino , Ontário , Equipe de Assistência ao Paciente , Segurança do Paciente , Pesquisa Qualitativa , Centros de Traumatologia/organização & administração
5.
Med Educ ; 49(5): 476-86, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25924123

RESUMO

CONTEXT: As electronic health records (EHRs) are adopted by teaching hospitals, educators must examine how this change impacts trainee development. OBJECTIVES: We investigate this influence by studying clinician experiences of a hospital's move from paper charts to an EHR. We ask: how does each chart modality present conceptions of time and data interconnections? How do these conceptions affect clinical reasoning? METHODS: This two-phase, longitudinal study employed constructivist grounded theory. Data were collected at a paediatric teaching hospital before (Phase 1), during and after (Phase 2) the transition from a paper chart to an EHR system. Data collection consisted of field observations (146 hours involving 300 health care providers, 22 patients and 32 patient family members), think-aloud (n = 13) and think-after (n = 11) sessions, interviews (n = 39) and document retrieval (n = 392). Theories of rhetorical genre studies and visual rhetoric informed analysis. RESULTS: In the paper flowsheet, clinicians recorded and viewed patient data in chronologically organised displays that emphasised data interconnections. In the EHR flowsheet, clinicians viewed and recorded individual data points that were largely chronologically and contextually isolated. Clinicians reported that this change resulted in: (i) not knowing the patient's evolving status; (ii) increased cognitive workload, and (iii) loss of clinical reasoning support mechanisms. CONCLUSIONS: Understanding how patient data are interconnected is essential to clinical reasoning. The use of EHRs supports this goal because the EHR is a tool for collecting dispersed data; however, these collections often deconstruct data interconnections. Where the paper flowsheet emphasises chronology and interconnectedness, the EHR flowsheet emphasises individual data values that are largely independent of time and other patient data. To prepare trainees to work with EHRs, the ways of thinking and acting that were implicitly learned through the use of paper charts must be made explicit. To support clinical reasoning, medical educators should provide lessons in connectivity ­ the chronologically framed data interconnections upon which clinicians rely to provide patient care.


Assuntos
Coleta de Dados/métodos , Registros Eletrônicos de Saúde , Relações Interprofissionais , Equipe de Assistência ao Paciente , Centros Médicos Acadêmicos , Competência Clínica , Teoria Fundamentada , Hospitais Pediátricos , Humanos , Estudos Longitudinais , Estudantes de Medicina , Fatores de Tempo
6.
J Perianesth Nurs ; 30(2): 92-104, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25813295

RESUMO

PURPOSE: The transfer of patient care from one health care worker to another involves communication in high-pressure contexts that are often vulnerable to error. This research project captured current practices for handoffs during the critical care stage of surgical recovery in a hospital setting. The objective was to characterize information flow during transfer and identify patterns of communication between nurses and physicians. DESIGN AND METHODS: Observations were used to document communication exchanges. The data were analyzed qualitatively according to the types of information exchanged and verbal behavior types. FINDINGS: Reporting and questions were the most common verbal behaviors, and retrospective medical information was the focus of information exchange. The communication was highly interactive when discussing patient status and future care plans. Nurses proactively asked questions to capture a large proportion of the information they needed. CONCLUSIONS: Findings reflect positive and constructive patterns of communication during handoffs in the observed hospital unit.


Assuntos
Continuidade da Assistência ao Paciente/normas , Cuidados Críticos/normas , Transferência de Pacientes/normas , Humanos , Comunicação Interdisciplinar , Relações Interprofissionais , Relações Médico-Enfermeiro , Estudos Retrospectivos , Inquéritos e Questionários
7.
Can J Anaesth ; 64(8): 797-800, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28577165
8.
J Biomed Inform ; 44(3): 477-85, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20381642

RESUMO

Team Situation Awareness (TSA) is one of the critical factors in effective Operating Room (OR) teamwork and can impact patient safety and quality of care. While previous research showed a relationship between situation awareness, as measured by communication events, and team performance, the implications for developing technology to augment and facilitate TSA were not examined. This research aims to further study situation-related communications in the cardiac OR in order to uncover potential degradation in TSA which may lead to adverse events. The communication loop construct-the full cycle of information flow between the participants in the sequence-was used to assess susceptibility to breakdown. Previous research and the findings here suggest that communication loops that are open, non-directed, or with delayed closure, can be susceptible to information loss. These were quantitatively related to communication indicators of TSA such as questions, replies, and announcements. Taken together, both qualitative and quantitative analyses suggest that a high proportion of TSA-related communication (63%) can be characterized as susceptible to information loss. The findings were then used to derive requirements and design a TSA augmentative display. The design principles and potential benefits of such a display are outlined and discussed.


Assuntos
Comunicação , Salas Cirúrgicas , Apresentação de Dados , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Relações Interprofissionais , Equipe de Assistência ao Paciente
9.
Stud Health Technol Inform ; 286: 26-30, 2021 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-34755685

RESUMO

With the onset of the coronavirus pandemic, clinicians, public officials, and citizens alike struggled to stay abreast of the constant and evolving stream of information about the clinical manifestations of illness, epidemiology of the disease, and the public health response. In this paper, we adapted (i.e., added and modified elements) Beasley and colleagues' information chaos framework to understand the context of citizens' experiences with information during the COVID-19 pandemic. We will show how our adapted framework can be used to characterize information associated challenges observed during this time and the possible impact of information chaos on peoples' cognition and behaviours. Ultimately, we believe that research will benefit by adopting a more holistic perspective using the information chaos framework than strictly studying the independent factors in isolation.


Assuntos
COVID-19 , Pandemias , Humanos , Saúde Pública , SARS-CoV-2
10.
Vaccines (Basel) ; 9(8)2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34452027

RESUMO

Domestic "vaccine passports" are being implemented across the world as a way of increasing vaccinated people's freedom of movement and to encourage vaccination. However, these vaccine passports may affect people's vaccination decisions in unintended and undesirable ways. This cross-sectional study investigated whether people's willingness and motivation to get vaccinated relate to their psychological needs (autonomy, competence and relatedness), and how vaccine passports might affect these needs. Across two countries and 1358 participants, we found that need frustration-particularly autonomy frustration-was associated with lower willingness to get vaccinated and with a shift from self-determined to external motivation. In Israel (a country with vaccine passports), people reported greater autonomy frustration than in the UK (a country without vaccine passports). Our findings suggest that control measures, such as domestic vaccine passports, may have detrimental effects on people's autonomy, motivation, and willingness to get vaccinated. Policies should strive to achieve a highly vaccinated population by supporting individuals' autonomous motivation to get vaccinated and using messages of autonomy and relatedness, rather than applying pressure and external controls.

11.
JMIR Form Res ; 4(2): e16410, 2020 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-32130144

RESUMO

BACKGROUND: Medical care is highly complex in that it addresses patient-centered health goals that require the coordination of multiple care providers. Emergency department (ED) patients currently lack a sense of predictability about ED procedures. This increases frustration and aggression. Herein, we describe a system for providing real-time information to ED patients regarding the procedures in their ED medical journey. OBJECTIVE: This study aimed to develop a system that provides patients with dynamically updated information about the specific procedures and expected waiting times in their personal ED journey, and to report initial evaluations of this system. METHODS: To develop the myED system, we extracted information from hospital databases and translated it using process mining and user interface design into a language that is accessible and comprehensible to patients. We evaluated the system using a mixed methods approach that combined observations, interviews, and online records. RESULTS: Interviews with patients, accompanying family members, and health care providers (HCPs) confirmed patients' needs for information about their personal ED journey. The system developed enables patients to access this information on their personal mobile phones through a responsive website. In the third month after deployment, 492 of 1614 (30.48%) patients used myED. Patients' understanding of their ED journey improved significantly (F8,299=2.519; P=.01), and patients showed positive reactions to the system. We identified future challenges, including achieving quick engagement without delaying medical care. Salient reasons for poor system adoption were patients' medical state and technological illiteracy. HCPs confirmed the potential of myED and identified means that could improve patient experience and staff cooperation. CONCLUSIONS: Our iterative work with ED patients, HCPs, and a multidisciplinary team of developers yielded a system that provides personal information to patients about their ED journey in a secure, effective, and user-friendly way. MyED communicates this information through mobile technology. This improves health care by addressing patients' psychological needs for information and understanding, which are often overlooked. We continue to test and refine the system and expect to find positive effects of myED on patients' ED experience and hospital operations.

12.
Stud Health Technol Inform ; 257: 341-345, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30741220

RESUMO

The practice of patient-centric empowerment with health information delivered through various channels is widespread and often effective. While empowering patients improves the sharing of power between patients and healthcare professionals, it can also inadvertently disempowers healthcare professionals. This paper proposes an approach to the design of health information with the aim of mutually empowering patients and healthcare professionals. The approach consists of mapping a joint journey, identifying the intersecting information points serving both patients and healthcare professionals, and designing the information in a shareable and mutually empowering fashion.


Assuntos
Pessoal de Saúde , Informática Médica , Poder Psicológico , Humanos , Participação do Paciente
13.
Health Informatics J ; 24(3): 277-292, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-27738260

RESUMO

This article focuses on a conceptual framework that can be applied to the use of mobile technology in the waiting room with the goal of empowering women recently diagnosed with abnormal Pap test results. It further describes trends which indicate a need for improved and timely information dissemination. Genecology practice outpatients report a predominant feeling of worry on receipt of abnormal medical test results, along with a clearly expressed wish for additional information. This research suggests that there is room for improvement in existing processes through use of mobile technology with carefully vetted materials which indicate a doctor is interested in the patient's well-being.


Assuntos
Tomada de Decisões , Teste de Papanicolaou/efeitos adversos , Educação de Pacientes como Assunto , Poder Psicológico , Feminino , Humanos , Relações Médico-Paciente , Neoplasias do Colo do Útero
14.
Int J Emerg Med ; 10(1): 24, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28707273

RESUMO

BACKGROUND: In order to enhance patient safety during resuscitation of critically ill patients, we need to optimize team communication and enhance team situational awareness but little is known about resuscitation team communication patterns. The objective of this study is to understand how teams communicate during resuscitation; specifically to assess for a shared mental model (organized understanding of a team's relationships) and information needs. METHODS: We triangulated 3 methods to evaluate resuscitation team communication at a tertiary care academic trauma center: (1) interviews; (2) simulated resuscitation observations; (3) live resuscitation observations. We interviewed 18 resuscitation team members about shared mental models, roles and goals of team members and procedural expectations. We observed 30 simulated resuscitation video recordings and documented the timing, source and destination of communication and the information category. We observed 12 live resuscitations in the emergency department and recorded baseline characteristics of the type of resuscitations, nature of teams present and type and content of information exchanges. The data were analyzed using a qualitative communication analysis method. RESULTS: We found that resuscitation team members described a shared mental model. Respondents understood the roles and goals of each team member in order to provide rapid, efficient and life-saving care with an overall need for situational awareness. The information flow described in the interviews was reflected during the simulated and live resuscitations with the most responsible physician and charting nurse being central to team communication. We consolidated communicated information into six categories: (1) time; (2) patient status; (3) patient history; (4) interventions; (5) assistance and consultations; 6) team members present. CONCLUSIONS: Resuscitation team members expressed a shared mental model and prioritized situational awareness. Our findings support a need for cognitive aids to enhance team communication during resuscitations.

15.
Int J Med Inform ; 93: 2-13, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27435942

RESUMO

INTRODUCTION: Members of the healthcare team must access and share patient information to coordinate interprofessional collaborative practice (ICP). Although some evidence suggests that electronic health records (EHRs) contribute to in-team communication breakdowns, EHRs are still widely hailed as tools that support ICP. If EHRs are expected to promote ICP, researchers must be able to longitudinally study the impact of EHRs on ICP across communication types, users, and physical locations. OBJECTIVE: This paper presents a data collection and analysis tool, named the Map of the Clinical Interprofessional Communication Spaces (MCICS), which supports examining how EHRs impact ICP over time, and across communication types, users, and physical locations. METHODS: The tool's development evolved during a large prospective longitudinal study conducted at a Canadian pediatric academic tertiary-care hospital. This two-phased study [i.e., pre-implementation (phase 1) and post implementation (phase 2)] of an EHR employed a constructivist grounded theory approach and triangulated data collection strategies (i.e., non-participant observations, interviews, think-alouds, and document analysis). The MCICS was created through a five-step process: (i) preliminary structural development based on the use of the paper-based chart (phase 1); (ii) confirmatory review and modification process (phase 1); (iii) ongoing data collection and analysis facilitated by the map (phase 1); (iv) data collection and modification of map based on impact of EHR (phase 2); and (v) confirmatory review and modification process (phase 2). RESULTS: Creating and using the MCICS enabled our research team to locate, observe, and analyze the impact of the EHR on ICP, (a) across oral, electronic, and paper communications, (b) through a patient's passage across different units in the hospital, (c) across the duration of the patient's stay in hospital, and (d) across multiple healthcare providers. By using the MCICS, we captured a comprehensive, detailed picture of the clinical milieu in which the EHR was implemented, and of the intended and unintended consequences of the EHR's deployment. The map supported our observations and analysis of ICP communication spaces, and of the role of the patient chart in these spaces. CONCLUSIONS: If EHRs are expected to help resolve ICP challenges, it is important that researchers be able to longitudinally assess the impact of EHRs on ICP across multiple modes of communication, users, and physical locations. Mapping the clinical communication spaces can help EHR designers, clinicians, educators and researchers understand these spaces, appreciate their complexity, and navigate their way towards effective use of EHRs as means for supporting ICP. We propose that the MCICS can be used "as is" in other academic tertiary-care pediatric hospitals, and can be tailored for use in other healthcare institutions.


Assuntos
Comunicação , Comportamento Cooperativo , Registros Eletrônicos de Saúde/estatística & dados numéricos , Relações Interprofissionais , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente/organização & administração , Canadá , Coleta de Dados , Humanos , Disseminação de Informação , Estudos Longitudinais , Estudos Prospectivos
16.
Intensive Crit Care Nurs ; 31(3): 155-64, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25456856

RESUMO

Patient hand-offs involve the exchange of critical information. Ineffective hand-offs can result in reduced patient safety by leading to wrong treatment, delayed diagnoses or other outcomes that can negatively affect the healthcare system. The objectives of this study were to uncover the structure of the information conveyed during patient hand-offs and look for principles characterising the organisation of the information. With an observational study approach, data was gathered during the morning and evening nursing change of shift hand-offs in a Paediatric Intensive Care Unit. Content analysis identified a common meta-structure used for information transfer that contained categories with varying degrees of information integration and the repetition of high consequence information. Differences were found in the organisation of the hand-off structures, and these varied as a function of nursing experience. The findings are discussed in terms of the potential benefits of computerised tools which utilise standardised structure for information transfer and the implications for future education and critical care skill acquisition.


Assuntos
Criança Hospitalizada , Competência Clínica , Continuidade da Assistência ao Paciente , Enfermagem Pediátrica/normas , Admissão e Escalonamento de Pessoal/organização & administração , Criança , Humanos , Unidades de Terapia Intensiva Pediátrica , Ontário , Inquéritos e Questionários
17.
Int J Med Inform ; 84(12): 1019-28, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26432683

RESUMO

BACKGROUND: Recent research has suggested that using electronic health records (EHRs) can negatively impact clinical reasoning (CR) and interprofessional collaborative practices (ICPs). Understanding the benefits and obstacles that EHR use introduces into clinical activities is essential for improving medical documentation, while also supporting CR and ICP. METHODS: This qualitative study was a longitudinal pre/post investigation of the impact of EHR implementation on CR and ICP at a large pediatric hospital. We collected data via observations, interviews, document analysis, and think-aloud/-after sessions. Using constructivist Grounded Theory's iterative cycles of data collection and analysis, we identified and explored an emerging theme that clinicians described as central to their CR and ICP activities: building the patient's story. We studied how building the patient's story was impacted by the introduction and implementation of an EHR. RESULTS: Clinicians described the patient's story as a cognitive awareness and overview understanding of the patient's (1) current status, (2) relevant history, (3) data patterns that emerged during care, and (4) the future-oriented care plan. Constructed by consolidating and interpreting a wide array of patient data, building the patient's story was described as a vitally important skill that was required to provide patient-centered care, within an interprofessional team, that safeguards patient safety and clinicians' professional credibility. Our data revealed that EHR use obstructed clinicians' ability to build the patient's story by fragmenting data interconnections. Further, the EHR limited the number and size of free-text spaces available for narrative notes. This constraint inhibited clinicians' ability to read the why and how interpretations of clinical activities from other team members. This resulted in the loss of shared interprofessional understanding of the patient's story, and the increased time required to build the patient's story. CONCLUSIONS: We discuss these findings in relation to research on the role of narratives for enabling CR and ICP. We conclude that EHRs have yet to truly fulfill their promise to support clinicians in their patient care activities, including the essential work of building the patient's story.


Assuntos
Atitude do Pessoal de Saúde , Documentação/métodos , Registros Eletrônicos de Saúde/organização & administração , Disseminação de Informação/métodos , Anamnese/métodos , Pesquisa Qualitativa , Registros de Saúde Pessoal
18.
J Exp Psychol Appl ; 10(2): 89-96, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15222803

RESUMO

The present study evaluated the convention to design training environments by giving access to easy strategies first and progressing to more difficult and efficient strategies thereafter. An experiment was conducted focusing on training in a simplified editing task. This task could be performed with an easy (mouse-based) strategy as well as with a more efficient (script-based) strategy. Two learning environments were compared, based on the order of the introduction of the following 2 strategies to participants: an easy-first program and a difficult-first program. The results highlight 2 interesting patterns. First, initial training in an easy strategy impaired the acquisition of a more efficient strategy. Second, learning the easy strategy first reduced between-subjects variability. It helped poor performers but resulted in a lower proportion of high-level performers.


Assuntos
Meio Ambiente , Ensino/métodos , Comportamento de Escolha , Humanos
19.
Neurosci Lett ; 558: 132-6, 2014 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-24269980

RESUMO

In this study, the notion of additivity in perception of affect from limb motion is investigated. Specifically, we examine whether the impact of multiple limbs in perception of affect is equal to the sum of the impacts of each individual limb. Several neutral, happy, and sad walking sequences are first aligned and averaged. Four distinct body regions or limbs are defined for this study: arms and hands, legs and feet, head and neck, and torso. The three average walks are used to create the stimuli. The motion of each limb and combination of limbs from the neutral sequence are replaced with those of the happy and sad sequences. Through collecting perceptual ratings for when individual limbs contain affective features, and comparing the sums of these ratings to instances where multiple limbs of the body simultaneously contain affective features, additivity is investigated. We find that while the results are highly correlated, additivity does not hold in the classical sense. Based on the results, a mathematical model is proposed for describing the observed relationship.


Assuntos
Afeto , Extremidades , Movimento , Percepção , Adolescente , Adulto , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Postura , Caminhada , Adulto Jovem
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