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Stangl FJ, Riedl R. Interruption science as a research field: Towards a taxonomy of interruptions as a foundation for the field. Front Psychol 2023; 14:1043426. [PMID: 37034958 PMCID: PMC10074991 DOI: 10.3389/fpsyg.2023.1043426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/30/2023] [Indexed: 04/11/2023] Open
Abstract
Interruptions have become ubiquitous in both our personal and professional lives. Accordingly, research on interruptions has also increased steadily over time, and research published in various scientific disciplines has produced different perspectives, fundamental ideas, and conceptualizations of interruptions. However, the current state of research hampers a comprehensive overview of the concept of interruption, predominantly due to the fragmented nature of the existing literature. Reflecting on its genesis in the 1920s and the longstanding research on interruptions, along with recent technological, behavioral, and organizational developments, this paper provides a comprehensive interdisciplinary overview of the various attributes of an interruption, which facilitates the establishment of interruption science as an interdisciplinary research field in the scientific landscape. To obtain an overview of the different interruption attributes, we conducted a systematic literature review with the goal of classifying interruptions. The outcome of our research process is a taxonomy of interruptions, constituting an important foundation for the field. Based on the taxonomy, we also present possible avenues for future research.
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Affiliation(s)
- Fabian J. Stangl
- Digital Business Institute, School of Business and Management, University of Applied Sciences Upper Austria, Steyr, Austria
- *Correspondence: Fabian J. Stangl,
| | - René Riedl
- Digital Business Institute, School of Business and Management, University of Applied Sciences Upper Austria, Steyr, Austria
- Institute of Business Informatics – Information Engineering, Johannes Kepler University Linz, Linz, Austria
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Wilson E, Daniel M, Rao A, Torre D, Durning S, Anderson C, Goldhaber NH, Townsend W, Seifert CM. A scoping review of distributed cognition in acute care clinical decision-making. Diagnosis (Berl) 2022; 10:68-88. [PMID: 36512433 DOI: 10.1515/dx-2022-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Abstract
Abstract
Objectives
In acute care settings, interactions between providers and tools drive clinical decision-making. Most studies of decision-making focus on individual cognition and fail to capture critical collaborations. Distributed Cognition (DCog) theory provides a framework for examining the dispersal of tasks among agents and artifacts, enhancing the investigation of decision-making and error.
Content
This scoping review maps the evidence collected in empiric studies applying DCog to clinical decision-making in acute care settings and identifies gaps in the existing literature.
Summary and Outlook
Thirty-seven articles were included. The majority (n=30) used qualitative methods (observations, interviews, artifact analysis) to examine the work of physicians (n=28), nurses (n=27), residents (n=16), and advanced practice providers (n=12) in intensive care units (n=18), operating rooms (n=7), inpatient units (n=7) and emergency departments (n=5). Information flow (n=30) and task coordination (n=30) were the most frequently investigated elements of DCog. Provider-artifact (n=35) and provider-provider (n=30) interactions were most explored. Electronic (n=18) and paper (n=15) medical records were frequently described artifacts. Seven prominent themes were identified. DCog is an underutilized framework for examining how information is obtained, represented, and transmitted through complex clinical systems. DCog offers mechanisms for exploring how technologies, like EMRs, and workspaces can help or hinder clinical decision-making.
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Affiliation(s)
- Eric Wilson
- University of Michigan Medical School , Ann Arbor , MI , USA
| | - Michelle Daniel
- University of California, San Diego School of Medicine , La Jolla , CA , USA
| | - Aditi Rao
- University of Michigan Medical School , Ann Arbor , MI , USA
| | - Dario Torre
- University of Central Florida College of Medicine , Orlando , FL , USA
| | - Steven Durning
- Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Clare Anderson
- University of Michigan Medical School , Ann Arbor , MI , USA
| | - Nicole H. Goldhaber
- University of California, San Diego School of Medicine , La Jolla , CA , USA
| | - Whitney Townsend
- Taubman Health Sciences Library , University of Michigan , Ann Arbor , MI , USA
| | - Colleen M. Seifert
- Department of Psychology , University of Michigan College of Literature, Science, and the Arts , Ann Arbor , MI , USA
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Yu EJ, Lee EN. Development and Validation of a Nursing Work Interruption Scale. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13487. [PMID: 36294067 PMCID: PMC9602459 DOI: 10.3390/ijerph192013487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Work interruption disturbs nurses' flow of thinking, diminishes work efficiency, induces burnout, and causes errors that can threaten patients' lives. Therefore, it is important to identify the causes and measure the extent of work interruption. This study developed a self-report scale and established its validity and reliability for use in hospital settings. Through literature review and in-depth interviews with nurses, we identified two components and developed 25 preliminary items. These items were reviewed by nursing experts for content validity and pilot tested among 20 hospital nurses; subsequently, a 16-item preliminary instrument was finalized. A total of 359 questionnaires were included in the final analysis, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. Two factors and 12 items were derived from two rounds of EFA, with a cumulative percentage of variance of 55.73%. Construct validity was established through CFA. The predictive validity and internal consistency reliability of the developed scale were also established. Thus, the 12-item Work Interruption Measurement Scale for Nurses comprising two domains (human and environmental factors) was developed. This scale can be useful in assessing work interruption experienced by nurses and for developing and assessing the effectiveness of interventions pertaining to nurses' work interruption.
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Affiliation(s)
- Eun-Jeong Yu
- Nursing Department, Busan Institute of Science and Technology, Busan 6639, Korea
| | - Eun-Nam Lee
- College of Nursing, Dong-A University, Busan 49201, Korea
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Di Rocco JR, Kimata C, Barat M, Kodama S. Paediatric resident workflow observations in a community-based hospital. BMJ Open Qual 2022; 11:bmjoq-2021-001607. [PMID: 35241437 PMCID: PMC8896048 DOI: 10.1136/bmjoq-2021-001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/20/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Residency graduates need to demonstrate competence in prioritising safe patient care through appropriate management of multiple competing tasks and workflow interruptions. This pilot study aimed to characterise and correlate interruptions in paediatric resident workflow at an academically affiliated, community-based hospital. Methods One of three trained observers followed a resident physician during a convenience sample of 1–2 hour increments, either in the emergency department or on the wards, and recorded all observed activities and interruptions using an established time-motion tool. All participants completed a baseline Multi-Tasking Ability Test (MTAT) and pre-observation and post-observation surveys. Statistical approach included descriptive statistics, logistic regression, mixed model and ORs. Results 18 paediatric residents were observed for 57.5 total hours (an average of 3.2 hours/resident) which included 329 interruptions, defined as any external event drawing the resident’s attention away from a primary task. Interruptions occurred an average of 5.9 times per resident per hour. Interrupted primary tasks were not resumed during the observation period 11% of the time. A personal/social-related interruption yielded an OR of 0.29 that the resident will return to a primary task within 5 min (p=0.007) when compared with patient-related verbal interruptions by the medical team. The MTAT Score indicated decreased efficiency for interns versus postgraduate year 2 residents (p=0.029). Residents’ MTAT Scores did not correlate with their time to return to a primary task following an interruption (p=0.11). Conclusions Paediatric resident workflow interruptions in the hospital were observed to occur frequently and should be expected. Personal/social interruptions were most likely to delay prompt return to a primary task. The MTAT Score, although improved between the first 2 years of residency training, did not correlate with efficient return to a primary task. Interruption management and mitigation strategies should be developed as part of a standardised residency task management curriculum.
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Affiliation(s)
- Jennifer R Di Rocco
- Pediatrics, Kapi'olani Medical Center for Women and Children, Honolulu, Hawaii, USA .,Pediatrics, University of Hawai'i at Mānoa John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Chieko Kimata
- Patient Safety & Quality Services, Hawai'i Pacific Health, Honolulu, Hawaii, USA
| | - Masihullah Barat
- University of Hawai'i at Mānoa John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Samantha Kodama
- University of Hawai'i at Mānoa John A Burns School of Medicine, Honolulu, Hawaii, USA
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Using Simulation-Based Education to Teach Interruption Management Skills: An Integrative Review. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Freitas WCJD, Menezes AC, Mata LRFD, Lira ALBDC, Januário LH, Ribeiro HCTC. Interruption in the work of nursing professionals: conceptual analysis. Rev Bras Enferm 2021; 75:e20201392. [PMID: 34705993 DOI: 10.1590/0034-7167-2020-1392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/18/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the concept of "interruption in the work of nursing professionals". METHODS conceptual study according to the method proposed by Walker and Avant through integrative literature review. The study searched the databases using the descriptors: "Attention", "Attention Bias", "Health Personnel", "Nurses", "Patient Safety" and "Medical Malpractices". The sample consisted of 36 studies. RESULTS the antecedents were alarms, answering phone calls, providing patient care, and lack of material/medicine. The defining attributes were pause, suspension, breakage, and intrusion. In relation to the consequences, the study highlighted the increase in frequency and severity of medication errors and change of focus. FINAL CONSIDERATIONS theconceptual analysis identified the attributes, antecedents, and consequences and allowed to build an operational definition for "interruption in the work of nursing professionals". It will contribute to the improvement of the work process and the creation of strategies that ensure safer care for the patient.
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Zhang WG, Liu JW, Yang SY, Wang QQ, Liu CX, Li Y. A Study on the Improvement of Nursing Interruption Risk by a Closed-Loop Management Model. Risk Manag Healthc Policy 2021; 14:2945-2952. [PMID: 34285608 PMCID: PMC8285302 DOI: 10.2147/rmhp.s301108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to evaluate the effect of closed-loop management on nursing disruption risk. Methods Using a quasi-experimental research method, convenient sampling was used to extract 20 nurses working at our hospital as the research objects. The control group members were selected from January to March 2018 via the traditional method, and the experimental group members were selected from April to June 2018 via the closed-loop management method. At three months before and after the implementation of the management model, a self-designed quantitative test form and satisfaction questionnaire were used to analyze the frequency of nursing disruption events, the accuracy rate of doctors’ advice, the average drug delivery time of the static distribution center, the implementation rate of personal digital assistant (PDA) code scanning, and the report rate of risk-outcome nursing disruption events. Results After the implementation of the management model, the frequency of nursing disruptions and average drug delivery time of the static distribution center were significantly lower than before, and the differences were statistically significant (p < 0.05). Moreover, the accuracy rate of doctors’ advice, the implementation rate of PDA code scanning, and the reporting rate of risk-outcome nursing disruption events were significantly higher than before, and these differences were statistically significant as well (p < 0.05). Conclusion The application of a closed-loop management model could significantly reduce the occurrence and optimize the outcomes of nursing disruption events and improve the work processes of medical care.
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Affiliation(s)
- Wen-Guang Zhang
- Department of Nursing, The First Hospital of Shanxi Medical University, Taiyuan, 030000, People's Republic of China
| | - Jia-Wei Liu
- School of Nursing, Shanxi Medical University, Taiyuan, 030000, People's Republic of China
| | - Su-Yun Yang
- Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan, 030000, People's Republic of China
| | - Qiao-Qian Wang
- Department of Hypertension, The First Hospital of Shanxi Medical University, Taiyuan, 030000, People's Republic of China
| | - Chen-Xing Liu
- School of Nursing, Shanxi Medical University, Taiyuan, 030000, People's Republic of China
| | - Yao Li
- School of Nursing, Shanxi Medical University, Taiyuan, 030000, People's Republic of China
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Interrupções de atividades de enfermeiros: contribuições para a segurança do paciente e do profissional. ACTA PAUL ENFERM 2020. [DOI: 10.37689/acta-ape/2020ao0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Laustsen S, Brahe L. Coping with interruptions in clinical nursing-A qualitative study. J Clin Nurs 2018; 27:1497-1506. [DOI: 10.1111/jocn.14288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Sussie Laustsen
- Department of Cardiothoracic and Vascular Surgery; Aarhus University Hospital; Aarhus N Denmark
- Department of Clinical Medicine; Centre of Research in Rehabilitation (CORIR); Aarhus University; Aarhus N Denmark
| | - Liselotte Brahe
- Department of Cardiothoracic and Vascular Surgery; Aarhus University Hospital; Aarhus N Denmark
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Jiang SY, Murphy A, Heitkemper EM, Hum RS, Kaufman DR, Mamykina L. Impact of an electronic handoff documentation tool on team shared mental models in pediatric critical care. J Biomed Inform 2017; 69:24-32. [PMID: 28286030 DOI: 10.1016/j.jbi.2017.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 02/27/2017] [Accepted: 03/06/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the impact of the implementation of an electronic handoff tool (the Handoff Tool) on shared mental models (SMM) within patient care teams as measured by content overlap and discrepancies in verbal handoff presentations given by different clinicians caring for the same patient. MATERIALS AND METHODS Researchers observed, recorded, and transcribed verbal handoffs given by different members of patient care teams in a pediatric intensive care unit. The transcripts were qualitatively coded and analyzed for content overlap scores and the number of discrepancies in handoffs of different team members before and after the implementation of the tool. RESULTS Content overlap scores did not change post-implementation. The average number of discrepancies nearly doubled following the implementation (from 0.76 discrepancies per handoff group pre-implementation to 1.17 discrepancies per handoff group post-implementation); however, this change was not statistically significant (p=0.37). Discrepancies classified as related to dosage of treatment or procedure and to patients' symptoms increased in frequency post-implementation. DISCUSSION The results suggest that the Handoff Tool did not have the desired positive impact on SMM within patient care teams. Future electronic tools for facilitating team handoff may need longer implementation times, complementary changes to handoff process and structure, and improved designs that integrate a common core of shared information with discipline-specific records. CONCLUSION While electronic handoff tools provide great opportunities to improve communication and facilitate the formation of shared mental models within patient care teams, further work is necessary to realize their full potential.
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Affiliation(s)
- Silis Y Jiang
- Department of Biomedical Informatics, Columbia University, United States.
| | - Alexandrea Murphy
- Department of Biomedical Informatics, Columbia University, United States
| | | | - R Stanley Hum
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, United States
| | - David R Kaufman
- Department of Biomedical Informatics, Arizona State University, United States; Mayo Clinic Arizona, United States
| | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University, United States
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