Pingenot Alleene Anne, Shanteau James, Sengstacke L T C Daniel N
California State University Stanislaus, Turlock, CA, USA.
Comput Inform Nurs. 2009 Nov-Dec;27(6):379-92. doi: 10.1097/NCN.0b013e3181bcad2f.
The purpose of this article was to describe key elements of an inpatient medication system using the cognitive work analysis method of Rasmussen et al (Cognitive Systems Engineering. Wiley Series in Systems Engineering; 1994). The work of nurses and physicians were observed in routine care of inpatients on a medical-surgical unit and attached ICU. Interaction with pharmacists was included. Preoperative, postoperative, and medical care was observed. Personnel were interviewed to obtain information not easily observable during routine work. Communication between healthcare workers was projected onto an abstraction/decomposition hierarchy. Decision ladders and information flow charts were developed. Results suggest that decision making on an inpatient medical/surgical unit or ICU setting is a parallel, distributed process. Personnel are highly mobile and often are working on multiple issues concurrently. In this setting, communication is key to maintaining organization and synchronization for effective care. Implications for research approaches to system and interface designs and decision support for personnel involved in the process are discussed.
本文旨在运用拉斯穆森等人的认知工作分析方法（《认知系统工程》，威利系统工程系列；1994年）描述住院用药系统的关键要素。在内科-外科病房及附属重症监护病房对住院患者的常规护理过程中观察护士和医生的工作。其中包括与药剂师的互动。观察了术前、术后及医疗护理情况。对工作人员进行访谈以获取常规工作中不易观察到的信息。医护人员之间的沟通被投射到一个抽象/分解层次结构上。制定了决策阶梯和信息流图。结果表明，在内科/外科病房或重症监护病房环境中的决策是一个并行的、分布式的过程。工作人员流动性很强，经常同时处理多个问题。在这种情况下，沟通是维持组织和同步以提供有效护理的关键。文中还讨论了对系统和界面设计的研究方法以及对参与该过程的人员的决策支持的影响。
