Sara E. McBride

Self-Management of Wellness and Illness in an Aging Population

In this chapter, we review the last 10 years of literature on self-management of illnesses (acute/episodic and chronic) and wellness (e.g., health promotion). We focus on health self-management in the context of an aging population, wherein middle-aged adults are more likely to be managing wellness activities and older adults are often managing both maintenance of health and chronic illnesses. The critical issues related to self-management of health are discussed, including those imposed by health care demands and those stemming from individual differences in general abilities (e.g., motor, perception, cognition) and socioemotional characteristics. The dynamic relationship between theory and practice is highlighted. Health care demands reflect the nature of the illness or wellness activity and include managing comorbidities, symptoms, and medications; engaging in health promotion activities (e.g., exercise, diet); the required use of health technologies; the need for health-related information; and coordi...

Understanding Challenges in the Front Lines of Home Health Care: A Human-Systems Approach

A human-systems perspective is a fruitful approach to understanding home health care because it emphasizes major individual components of the system - persons, equipment/technology, tasks, and environments - as well as the interaction between these components. The goal of this research was to apply a human-system perspective to consider the capabilities and limitations of the persons, in relation to the demands of the tasks and equipment/technology in home health care. Identification of challenges and mismatches between the person(s) capabilities and the demands of providing care provide guidance for human factors interventions. A qualitative study was conducted with 8 home health Certified Nursing Assistants and 8 home health Registered Nurses interviewed about challenges they encounter in their jobs. A systematic categorization of the challenges the care providers reported was conducted and human factors recommendations were proposed in response, to improve home health. The challenges inform a human-systems model of home health care.

Understanding the Effect of Workload on Automation Use for Younger and Older Adults

Objective: This study examined how individuals, younger and older, interacted with an imperfect automated system. The impact of workload on performance and automation use was also investigated. Background: Automation is used in situations characterized by varying levels of workload. As automated systems spread to domains such as transportation and the home, a diverse population of users will interact with automation. Research is needed to understand how different segments of the population use automation. Method: Workload was systematically manipulated to create three levels (low, moderate, high) in a dual-task scenario in which participants interacted with a 70% reliable automated aid. Two experiments were conducted to assess automation use for younger and older adults. Results: Both younger and older adults relied on the automation more than they complied with it. Among younger adults, high workload led to poorer performance and higher compliance, even when that compliance was detrimental. Older adults’ performance was negatively affected by workload, but their compliance and reliance were unaffected. Conclusion: Younger and older adults were both able to use and double-check an imperfect automated system. Workload affected how younger adults complied with automation, particularly with regard to detecting automation false alarms. Older adults tended to comply and rely at fairly high rates overall, and this did not change with increased workload. Application: Training programs for imperfect automated systems should vary workload and provide feedback about error types, and strategies for identifying errors. The ability to identify automation errors varies across individuals, thereby necessitating training.

Challenges for Home Health Care Providers: A Needs Assessment

ABSTRACT Home health care is the delivery of predominantly medically related services to patients in a home setting rather than in a medical facility. It provides substantial benefits over traditional, hospital-based health care, such as supporting older adults’ independence and quality of life, as well as being more cost-effective. This aspect of the health care industry could be enhanced through increased technological supports. When providing health care in a home setting, formal caregivers, such as certified nursing assistants (CNAs), registered nurses (RNs), physical therapists (PTs), and occupational therapists (OTs), are faced with many challenges that impede their ability to perform their jobs. Technological interventions have the potential to alleviate many of these challenges. However, to achieve this potential, new technologies must be created to meet the needs of home health care providers. To date, these providers’ specific and most critical needs are not thoroughly understood. This understanding can be gained by conducting a detailed needs assessment that captures the common challenges and difficulties that home health care providers encounter. We conducted a needs assessment comprising three phases: (a) an extensive literature review of research regarding the needs of home health providers, both hospital and home-based (CNAs, RNs, PTs, and OTs); (b) subject matter expert interviews with experienced individuals from home health care; and (c) structured interviews with CNAs. We identified several significant sources of frustration and difficulty faced by CNAs including medical device usage, patient education, family involvement, provider isolation, and barriers to communication. This analysis provides an understanding of the challenges confronting home health care providers that can provide guidance for interventions. Future home health care technology can be developed to specifically target these workers’ most urgent needs and allow them to perform their jobs with greater ease. Moreover, RNs, PTs, and OTs can benefit from understanding some of the challenges faced by their teammates in the home health care process.

Understanding human management of automation errors

Automation has the potential to aid humans with a diverse set of tasks and support overall system performance. Automated systems are not always reliable, and when automation errs, humans must engage in error management, which is the process of detecting, understanding and correcting errors. However, this process of error management in the context of human–automation interaction is not well understood. Therefore, we conducted a systematic review of the variables that contribute to error management. We examined relevant research in human–automation interaction and human error to identify critical automation, person, task and emergent variables. We propose a framework for management of automation errors to incorporate and build upon previous models. Further, our analysis highlights variables that may be addressed through design and training to positively influence error management. Additional efforts to understand the error-management process will contribute to automation designed and implemented to support safe and effective system performance.

Supporting the management of osteoarthritis pain: A needs analysis

Osteoarthritis is expected to affect approximately 72 million older adults by the year 2030. It is one of the top causes of disability, mobility problems, and chronic pain among older adults. With so many individuals affected, it is important to identify how to effectively manage the pain associated with osteoarthritis. The purpose of the present investigation was to determine the factors and knowledge critical to the successful management of osteoarthritis pain and to evaluate the management tools currently available to the general public. We conducted structured interviews with three subject matter experts (SMEs). The interviews identified critical variables in pain management, such as physical activity, mood, and medication taking behavior, as well as common misconceptions about pain management held by many older adults. In addition, we assessed the usability of available pain management tools with six older adults and conducted a heuristic analysis of several additional pain management tools available on the market. All of the tools reviewed were found to be lacking in several key areas, such as failing to include critical variables and difficulty integrating the data collected into a meaningful representation of one’s pain experience. Resolving these issues will improve the quality of life for individuals suffering from osteoarthritis.

Applied Experimental Psychology: A Capstone Course for Undergraduate Psychology Degree Programs

Learning-by-doing and a transgenerational educational format are incorporated into a semesterlong undergraduate capstone course. The goal of the course is to provide students with an understanding of the fundamentals of applied experimental psychology (e.g., applications of methods), and using that understanding in the context of design. Students participate in seminarstyle class meetings and a weekly laboratory meeting. Every class meeting is devoted to discussing a reading assignment related to the fundamentals of aging, as well as a breadth of applied experimental psychology domains. The students are encouraged to engage in collaborative discussion to critique the main points of the reading. In the laboratory, each student learns about and applies human factors methods. The students work in teams and develop a project in which they apply their fundamental knowledge of experimental psychology to the domain of successful aging. Each team develops or redesigns a technology, device, or environment to aid older adults to live independently, maintain their health, and/or improve their well-being. Transgenerational education is promoted through the students’ interaction with a panel of elders, who participate in user testing and feedback. The students and older adults alike reported that the course is beneficial. Students learned about the fundamentals of applying experimental psychology and aging, whereas older adults increased their awareness of technology development and how technology can impact successful aging.

Challenges of Training Older Adults in a Home Health Care Context

The health care domain is experiencing a shift from traditional hospital-based care to care delivered in a patient’s home setting. Although home health care provides many benefits, it creates new challenges and difficulties for professional caregivers (e.g., registered nurses) who are performing complex medical tasks without the support often present in a health care environment. In addition to performing these tasks themselves, registered nurses are also responsible for training patients to perform many of these tasks, which may include using medical devices and managing complex medication regimens. The purpose of this research was to identify and systematically categorize the issues facing registered nurses (RNs) when training older adult patients. Eight RNs participated in individual structured interviews wherein they were asked to describe the difficulties and frustrations associated with training older adult patients to use medical devices and manage medication independently. The data were categorized as patient-related, RN-related, or situation-related issues. The results highlight the complexity of training device use and medication management, as well as the needs of RNs for forms of additional support in training older adult patients.

Needs Assessment for Certified Nursing Assistants Providing Personal Care

Home health care allows individuals to receive care in a home setting rather than a medical facility. This increasingly popular alternative to health care has many benefits; however, providing health care in a home setting involves unique challenges and difficulties for the health care providers, such as certified nursing assistants (CNAs). Human factors interventions and technological supports may ease difficulties home health care providers experience performing caregiving tasks. However, for such interventions to be effective there is a need to understand patient care within the context of a home environment. The purpose of this research was to conduct a needs assessment to identify 1) personal caretask characteristics, including the context in which they are carried out, and 2) challenges encountered during these tasks. Eight CNAs participated in structured interviews where in they were asked to describe difficulties and frustrations experienced when performing the tasks of toileting, bathing, and transfer. The results were categorized as patient- or provider-based difficulties, as well as along dimensions related to the environment, device design, and social influences. These data provide an understanding of the complexity of each task, and a means of highlighting areas of difficulty to provide guidance for designers of assistive technologies and other supportive interventions.

How Do Older Adults Manage Osteoarthritis Pain? The Need for a Person-Centered Disease Model

In the United States, chronic pain affects at least 116 million Americans, differentially impacting older adults. One of the leading causes of pain for older adults is osteoarthritis. This disease affects approximately 14% of the United States population and can cause disability and mobility problems, in addition to having a high cost for the healthcare system. The methods individuals use to manage their pain are contingent upon their model of the disease (e.g., their beliefs about osteoarthritis pain management). The purpose of the present investigation was to: 1) understand what variables older adults with osteoarthritis believe impact pain, and 2) understand current approaches for self-management of osteoarthritis pain. We conducted structured interviews with eight older adults who have osteoarthritis. The interviews revealed current approaches in pain management, as well as gaps in knowledge. We propose an expansion of the idea of a general disease model for pain management that is patient-centered, allowing for personal customization of factors for reducing pain and increasing successful pain-management.