Supporting Decision-Making About Patient Mobility in the Intensive Care Unit Nurse Work Environment: Work Domain...

Area of Science:

• Human Factors Engineering
• Nursing Science
• Healthcare Systems Engineering

Background:

• Patient mobility is a crucial, evidence-based intervention in intensive care units (ICUs) to maintain patient function.
• Despite its importance, patient mobility implementation is inconsistent due to the complexity of the ICU environment.
• Cognitive Work Analysis (CWA) offers a framework to understand complex systems and guide technology design for improved outcomes.

Purpose of the Study:

• To apply CWA to understand the ICU work environment's complexities and constraints.
• To analyze how these factors influence nurses' execution of patient mobility interventions.

Main Methods:

• A Work Domain Analysis and Abstraction Hierarchy were constructed using the CWA framework.
• Data collection involved document review, 32 hours of direct observation, and interviews with 20 nurses across two hospitals.

Main Results:

• Nurses integrate diverse patient and unit information for decision-making, balancing quality care with unit throughput.
• The abstraction hierarchy illustrates the multifaceted priorities nurses manage.
• Opportunities for technology design to aid nurse decision-making in patient mobility were identified.

Conclusions:

• Future interventions must address the ICU's complexity and the information nurses require for mobility decisions.
• Developing and testing clinical decision support tools that integrate patient and unit data is recommended for system redesign.