Nancy Staggers

Mental models: concepts for human-computer interaction research

Abstract In interacting with the world, people form internal representations or mental models of themselves and the objects with which they interact (Norman, 1983a). According to Norman, mental models provide predictive and explanatory powers for understanding the interaction. More abstractly, Gentner and Stevens (1983) propose that mental models focus on the way people understand a specific knowledge domain. More concretely, Carroll (1984) views mental models as information that is input into cognitive structures and processes. What are mental models? Are they always formed? When formed, what are their characteristics? What are the functional consequences of having no model (if that is possible), an immature model, or a mature model? This paper intends to explore these questions.

A Delphi study to determine informatics competencies for nurses at four levels of practice.

BackgroundDespite its obvious need, a current, research-based list of informatics competencies for nurses is not available. ObjectiveTo produce a research-based master list of informatics competencies for nurses and differentiate these competencies by level of nursing practice. MethodsAfter a comprehensive literature review and item consolidation, an expert panel defined initial competencies. Subsequently, a three round Delphi study was conducted to validate the items. Participants were expert informatics nurse specialists in the United States of America. ResultsOf the initial 305 competencies proposed, 281 competencies achieved an 80% or greater agreement for both importance as a competency and appropriateness for the correct practice level. Five competencies were rejected. Six competencies were considered valid competencies but the appropriate level of practice could not be agreed upon. Thirteen competencies did not reach any consensus after the three Delphi rounds. DiscussionThe Delphi study had a high rate of participation, demonstrating the great level of interest and need for a list of informatics competencies for nurses. Out of the initial 305 competencies, only 24 items were not validated. Respondents commented during each round about whether computer skills should be considered informatics competencies. The authors propose that computer skills, while not high level, are one set of tools within the larger category of informatics competencies. This sample of experts did not deem programming skills as necessary for informatics nurses. This research study is an initial effort to fill the void of valid and reliable informatics competencies. It is the first study to span four levels of nurses, create competencies for both entry-level and experienced informatics nurse specialists, and examine the categories of computer skills, informatics knowledge and informatics skills.

Informatics competencies for nurses at four levels of practice.

Valid and comprehensive nursing informatics (NI) competencies currently are lacking. Meanwhile, nursing leaders are emphasizing the need to include NI in nursing curricula, as well as within the roles of practicing nurses in all settings. This article presents the initial work of a team of NI experts toward development of a valid and reliable set of NI competencies. Previous work primarily has focused on computer-related skills, rather than examining a broad definition of informatics competencies. For this current work, NI competencies encompass all skills, not only computer-related skills, as well as knowledge and attitudes needed by nurses. The first two authors created a database of NI competencies from the existing literature. A larger panel of NI experts then affirmed, modified, added, or deleted competencies from this database. Competencies were placed into four distinct skill levels. Definitions of each skill level and an initial master list of competencies are provided.

The Evolution of Definitions for Nursing Informatics: A Critical Analysis and Revised Definition

Despite the fact that nursing informatics is entering its third decade as a specialty within nursing, many definitions still exist to describe the field. This paper offers a rationale for a definition for nursing informatics and a critical analysis of past definitions. An organizing framework of technology-oriented, conceptual, and role-oriented definitions is used to critique these definitions. Subsequently, a revised definition is proposed. This evolutionary definition integrates critical concepts from past work and adds components that are currently missing--patients, information communication, information structures, and decision making. A separate role specification for informatics nurse specialists is provided.

The Content and Context of Change of Shift Report on Medical and Surgical Units

Objective: This study was conducted to describe the current content and context of change of shift report (CoSR) on medical and surgical units and explore whether nurses use computerized support during the CoSR process. Background: Change of shift report is a commonly occurring handoff that could contribute to gaps in care. Methods: Bedside, face-to-face, and audiotaped CoSRs were audiotaped and observed on 7 medical and surgical units in 3 acute care facilities in the Western United States. Results: Conventional content analysis revealed 4 themes: the Dance of Report, Just the Facts, Professional Nursing Practice, and Lightening the Load. Observations exposed the lack of content structure, high noise levels, interruptions, and no use of electronic health records in these facilities as a part of the report process. Conclusion: Improvements to CoSR include determining a consistent and tailored structure for report, evaluating types of report suitable for particular units, reducing interruptions and noise, and determining content amenable to computerization.

Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses’ handoffs on medical and surgical units: Insights from interviews and observations

Patient care handoffs are cognitively intense activities, especially on medical and surgical units where nurses synthesize information across an average of four to five patients every shift. The objective of this study was to examine handoffs and nurses’ use of computerized patient summary reports in an electronic health record after computerized provider order entry (CPOE) was installed. We observed and audio taped 93 patient handoffs on 25 occasions on 5 acute care units in 2 different facilities sharing a vendor’s electronic health record. We found that the computerized patient summary report and the electronic health record were minimally used during the handoff and that the existing patient summary reports did not provide adequate cognitive support for nurses. The patient summary reports were incomplete, rigid and did not offer “at a glance” information, or help nurses encode information. We make recommendations about a redesign of patient summary reports and technology to support the cognitive needs of nurses during handoffs at the change of shift.

A systematic review of the designs of clinical technology: findings and recommendations for future research.

Human factors (HF) studies are increasingly important as technology infuses into clinical settings. No nursing research reviews exist in this area. The authors conducted a systematic review on designs of clinical technology, 34 articles with 50 studies met inclusion criteria. Findings were classified into 3 categories on the basis of HF research goals. The majority of studies evaluated effectiveness of clinical design; efficiency was fewest. Current research ranges across many interface types examined with no apparent pattern or obvious rationale. Future research should expand types, settings, and participants; integrate displays; and expand outcome variables.

The state of the evidence for computerized provider order entry: A systematic review and analysis of the quality of the literature

OBJECTIVE This paper presents the results of a systematic literature review and a formal analysis of the scientific quality of empirical research on computerized provider order-entry (CPOE) applications. DESIGN Formal, systematic review techniques were used to search the literature, determine study relevance, and evaluate study quality. MEASUREMENT A search of multiple databases from 1976 through mid-2007 yielded a final set of 46 articles. Relevance criteria included: (1) a direct comparison of a CPOE system with a non-CPOE system; (2) implementation in a clinical setting; and (3) clinically relevant outcomes. RESULTS Study quality varied widely. Three major areas were identified for improvement in future studies: (1) internal validity, especially in terms of study designs, blinding, and instrumentation bias; (2) construct validity of the phenomenon of CPOE itself; and (3) measurement strategies, including reliability and validity assessments. CONCLUSIONS The evidence for the impact of CPOE needs to be improved to support scientific generalizability. Several common confounds are found in this literature. Future researchers will want to address them to improve the strength of the inference between CPOE and clinical outcomes. Discussion focuses on methods to improve future CPOE research.

A critical analysis of hardiness.

Hardiness is a construct with widespread appeal to nurse researchers. Of 97 papers reviewed, 35 were written by nurses. Because of its popularity, there is a pressing need to analyze hardiness carefully. This critical analysis of hardines describes Kobasas work as the foundation of hardiness research, provides a review of hardiness in the nursing literature, and recommends future hardiness research.

Nursing informatics competencies required of nurses in Taiwan

PURPOSE In todays workplace, nurses are highly skilled professionals possessing expertise in both information technology and nursing. Nursing informatics competencies are recognized as an important capability of nurses. No established guidelines existed for nurses in Asia. This study focused on identifying the nursing informatics competencies required of nurses in Taiwan. METHODS A modified Web-based Delphi method was used for two expert groups in nursing, educators and administrators. Experts responded to 323 items on the Nursing Informatics Competencies Questionnaire, modified from the initial work of Staggers, Gassert and Curran to include 45 additional items. Three Web-based Delphi rounds were conducted. Analysis included detailed item analysis. Competencies that met 60% or greater agreement of item importance and appropriate level of nursing practice were included. RESULTS N=32 experts agreed to participate in Round 1, 23 nursing educators and 9 administrators. The participation rates for Rounds 2 and 3=68.8%. By Round 3, 318 of 323 nursing informatics competencies achieved required consensus levels. Of the new competencies, 42 of 45 were validated. A high degree of agreement existed for specific nursing informatics competencies required for nurses in Taiwan (97.8%). CONCLUSIONS This study provides a current master list of nursing informatics competency requirements for nurses at four levels in the U.S. and Taiwan. The results are very similar to the original work of Staggers et al. The results have international relevance because of the global importance of information technology for the nursing profession.