An Analysis of Nurses' Cognitive Work: A New Perspective for Understanding Medical Errors

Abstract

Health care researchers agree that the acute care hospital environment is filled with numerous distractions. Within this environment, professional nurses make clinical judgments about their patients, whose conditions may change minute by minute. As a result, nurses constantly organize and reorganize the priorities and tasks of care to accommodate patients' fluctuating status. To date, little attention has been given to how interruptions in the workplace influence nurses' ability to anticipate and carry out the actions directed by their clinical judgment. This paper describes an ongoing research study aimed at exploring the effect of interruptions on the cognitive work of nursing. A methodology combining human factors techniques and qualitative observation of nurses in practice has produced a cognitive pathway. The pathway is a unique visual graphic that offers a perspective of the nature of nurses' work and the relationship interruptions and cognitive load may have on omissions and errors in care. The approach to analyzing the cognitive work of nurses has important implications for understanding the origins of medical errors.

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Document Details

Document Type
Technical Report
Publication Date
May 01, 2005
Accession Number
ADA433840

Entities

People

  • Bradley Evanoff
  • Clay Dunagan
  • Deborah Grayson
  • Jennifer Sledge
  • Laurie Wolf
  • Patricia Potter
  • Stuart Boxerman

Organizations

  • United States Agency for Healthcare Research and Quality

Tags

Communities of Interest

  • Biomedical
  • Engineered Resilient Systems

DTIC Thesaurus Topics

  • Cognition
  • Cognitive Workload
  • Data Analysis
  • Education
  • Engineering
  • Health Care
  • Health Services
  • Human Factors Engineering
  • Link Analysis
  • Measurement
  • Medical Personnel
  • Observation
  • Patient Care
  • Psychology
  • Reasoning
  • Task Performance And Analysis
  • Test And Evaluation

Fields of Study

  • Medicine

Readers

  • Educational Psychology
  • Medical or Health Care Field.
  • Team-Based Human-Centered Cognitive Task Decision Making and Information Performance.