Deborah Grayson

Mapping the Nursing Process A New Approach for Understanding the Work of Nursing

The work of nursing is nonlinear and involves complex reasoning and clinical decision making. The use of human factors engineering (HFE) as a sole means for analyzing the work of nursing is problematic. Combining HFE analysis with qualitative observation has created a new methodology for mapping the nursing process. A cognitive pathway offers a new perspective for understanding the work of nursing and analyzing how disruptions to the nursing process may contribute to errors in the acute care environment.

Is Disability Underreported Following Work Injury

Existing national data may underreport the full burden of occupational injuries and illnesses. This study sought to provide more complete reporting and to assess disability that persisted following return to work. Workers (n = 205) with a musculoskeletal injury resulting in 5 or more days of lost time or restricted duty were recruited from three employers. Data on work status and functional limitations were derived from multiple sources including administrative records, medical records, and patient interviews at baseline and 6 months. Results indicate that many workers reported continuing difficulties functioning at work following return to full duty. Measures of health-related quality of life improved over 6 months, but bodily pain and physical functioning scores remained lower than expected based on national averages. Sixteen percent of workers were reinjured within a year following initial injury. Following return to work, many workers experienced reinjury or reported persistent limitations in function 6 months following injury. Based on study findings the conclusion is drawn that OSHA logs may provide accurate measures of initial episodes of time loss from work but may underrepresent the full magnitude of lost time following work injury.

Human Factors in Healthcare: Combining Quantitative and Qualitative Analysis

The increasing physical, emotional and cognitive demands placed on nurses and other health care workers, coupled with higher patient acuity levels in the healthcare settings, have increased the risks of employee work stress and potential errors. Large-scale re-engineering efforts to contain costs through staff reduction and streamlining of processes over the past two decades have contributed seemingly to increased job stress of healthcare workers. Traditional human factors engineering methods used to evaluate activities yield a linear listing of activities, time, and motions involved in the patient care process. However, this approach does not provide an understanding of the cognitive work of clinical decision-making. Without this understanding, it is impossible to make judgements on “value added” or wasted motions, and errors. Traditional Human Factors methodology can be enhanced by adding qualitative observation of the nursing care process. The combined methodology provides detailed documentation of environmental conditions, sources of interruptions, and cognitive demands which may contribute to medical errors and compromised quality of care.