Biomedical subjects

Deborah Grayson

Publications and source records attributed to Deborah Grayson.

5 recordsLinked to original sources

PubMed2006

Describing nurses' work: combining quantitative and qualitative analysis.

OBJECTIVE: To better understand nursing activities and working conditions. BACKGROUND: Nursing practice involves astute clinical decision making and the competent delivery of nursing care procedures. To complete nursing procedures, nurses must simultaneously organize and reorganize priorities and manage changing clinical information for multiple patients. Few researchers have examined the specific nature of nurses' activities and the effect of the environment on their work. METHODS: Quantitative and qualitative methods were used to collect data on 7 nurses engaged in nursing activities. Examples of methods include link analysis, subject matter expert, task analysis, cognitive pathway, and "stacking." Data collection focused on how nurses managed priorities, changing clinical information, and interruptions. RESULTS: The "cognitive pathway" graphically depicts the nature of nurses' work. Specifically, it reveals the shifting of the nurse's attention from patient to patient and the occurrence of interruptions. "Stacking" shows the number of tasks a nurse must balance at any one time. On average, nurses had 10 or more activities waiting to be performed and experienced 3.4 interruptions/hr. CONCLUSION: These methods provide unique insight into the dynamic nature of patient care and nursing work. APPLICATION: Extension of the methods demonstrated here may be useful in guiding efforts to change the work of nursing to better provide quality care and less stressful work environments.

Evaluation Studies as Topic↗

PubMed2005

Ergonomic evaluation: part of a treatment protocol for musculoskeletal injuries.

Ergonomic analyses and interventions are used as primary prevention methods to reduce physical stressors in the workplace and to prevent work-related musculoskeletal disorders (WMSDs). These methods can also be used for the treatment of injured employees. In this study, 103 employees with WMSDs resulting in more than 5 days away from usual work received an ergonomic evaluation which consisted of observation of usual work tasks, recommendations to minimize identified stressors, and case coordination. The goal of the intervention was to make simple job changes that would assist employees to return safely to usual job duties. The process for implementing this protocol for health care, airline, and university employees is described. The results show that after ergonomic evaluations were performed, the majority of recommendations were fully or partially (89%) implemented. Behavior changes were more likely to occur than administrative and equipment changes (p < .001). Occupational health nurses can use a similar program to enhance treatment plans for clients with WMSDs.

Aviation↗

PubMed2004

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.

Acute Disease↗

PubMed2002

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 under-represent the full magnitude of lost time following work injury.

Accidents, Occupational↗

PubMedDate not supplied

Understanding the cognitive work of nursing in the acute care environment.

OBJECTIVE: To combine human factors engineering techniques with qualitative observation of nurses in practice to analyze the nature of nurses' cognitive work and how environmental factors create disruptions that pose risks for medical errors. BACKGROUND: Few researchers have examined the nature of nurses' cognitive work while in practice with patients. Researchers have described the broad range of thinking processes required in the acute care work setting, but have failed to examine how such processes are conducted and influenced by the complex care environment. A combined research methodology enables researchers to better understand how the nursing process becomes disrupted and the potential influence of this disruption on the safe and effective care of patients. METHODS: An ethnographic study, using mixed-methodological approaches, involved 7 staff registered nurses. The quantitative and qualitative data collection included field observation and summarative interviews. FINDINGS: A high number of cognitive shifts and interruptions, and a nurse's cumulative cognitive load, create the potential for disrupting a nurse's attention focus during care of patients. A majority of interruptions occurred as nurses performed interventions, particularly medication preparation. CONCLUSION: New attention must be given to how care systems and work processes complement or interfere with nurses' cognitive work.

Attention↗