The University of Arizona College of Nursing, Tucson, AZ, United States.
Int J Med Inform. 2011 Oct;80(10):698-707. doi: 10.1016/j.ijmedinf.2011.07.003. Epub 2011 Aug 20.
To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager's work domain.
Data for the WDA were obtained from semi-structured interviews with nurse managers, division directors, CNOs, and other managers (n = 20) on 10 patient care units in three Arizona hospitals. The WDA described the nurse manager's environment in terms of the constraints it imposes on the nurse manager's ability to achieve targeted outcomes through organizational goals and priorities, functions, processes, as well as work objects and resources (e.g., people, equipment, technology, and data). Constraints were identified and summarized through qualitative thematic analysis.
The results highlight the competing priorities, and external and internal constraints that today's nurse managers must satisfy as they try to improve quality and safety outcomes on their units. Nurse managers receive a great deal of data, much in electronic format. Although dashboards were perceived as helpful because they integrated some data elements, no decision support tools were available to help nurse managers with planning or answering "what if" questions. The results suggest both the need for additional decision support to manage the growing complexity of the environment, and the constraints the environment places on the design of that technology if it is to be effective. Limitations of the study include the small homogeneous sample and the reliance on interview data targeting safety and quality.
为了更好地理解影响护士管理者对决策支持工具需求和使用的环境限制因素，我们进行了认知工作分析（CWA）。完整的 CWA 包括五个层次的系统分析：工作领域、决策程序、决策策略、社会组织/协作和工人技能水平。在这里，我们详细描述了工作领域分析（WDA）部分的结果，然后将 WDA 与 CWA 的其他部分（先前报告过）整合，以生成更完整的护士管理者工作领域的画面。
WDA 的数据来自对亚利桑那州三家医院的 10 个患者护理单元的护士管理者、部门主管、首席护理官和其他管理者（n=20）进行的半结构化访谈。WDA 根据约束条件描述了护士管理者的环境，这些约束条件限制了护士管理者通过组织目标和优先事项、职能、流程以及工作对象和资源（如人员、设备、技术和数据）实现目标的能力。通过定性主题分析确定和总结了约束条件。
结果突出了当今护士管理者在努力改善其单位的质量和安全结果时必须满足的竞争优先事项以及外部和内部约束条件。护士管理者收到大量数据，其中许多是电子格式。尽管仪表板被认为是有帮助的，因为它们整合了一些数据元素，但没有决策支持工具可帮助护士管理者进行规划或回答“如果……会怎样”的问题。结果表明，不仅需要额外的决策支持来管理环境日益增加的复杂性，而且还需要考虑环境对该技术设计的限制因素，以便其有效。该研究的局限性包括小而同质的样本和依赖于针对安全和质量的访谈数据。
