Presentation
Capturing Nursing Students' Cognitive Challenges and Efforts in EHR-related Tasks: Findings from a Thematic Analysis
DescriptionAn electronic health records (EHR) system is to maintain an organized and accessible repository of patient medical information. This information includes medical histories, patient demographics, and laboratory examinations and results. Despite the anticipated benefits of the EHR system, there have been persistent problems. Such problems include usability and user interface issues, low information quality, limited support for new treatments, and lack of interoperability with other health information technologies. These problems have then increased nurse frustration and burnout. To address these issues, prior research has primarily focused on the usability of EHR systems. While the usability is an important aspect of EHR user interface, what challenges and efforts occur for user cognitive processes (e.g., perception, memory, decision-making) remain unclear. Therefore, the current work aims to investigate cognitive challenges and efforts during EHR-related tasks. Additionally, previous research has adopted a patient-focused approach that examined how patient information changes from patient admission to discharge. Our research focuses on how nurses, one of the primary user groups, manage EHR information along the data lifecycle. To this end, the current study has two research objectives: (1) to understand the cognitive challenges related to nursing students’ usage of EHR systems during EHR-related tasks, and 2) to identify nursing students’ efforts and workarounds made to overcome such challenges.
The current work is built upon our prior research that identified how EHR-related tasks are expected to be carried out or "Work-as-Imagined (WAI)" based on an expert’s live demonstration and focus group validation of the WAI. Then, the current effort seeks to understand how such tasks are actually performed among nursing students, or “Work-As-Done (WAD)”. We conducted one-on-one virtual interviews with fourteen nursing students with varied EHR use experiences. The interviews were transcribed and analyzed using a thematic analysis to determine common themes with respect to nursing students’ problems with the EHR systems and their strategies to tackle the problems.
Preliminary results from the thematic analysis indicate that nursing students encounter common cognitive challenges between both assessment and identification tasks. Two major themes were (1) conflicting patient information, and (2) protocol-influenced errors. The first theme encompasses a set of codes that similarly describes the difficulties associated with recalling key data from multiple patients. Our study found that nurses struggled to properly recall correct findings from each patient after conducting assessments for multiple patients. In a similar sense, nursing students indicated that they choose to write most extracted patient data onto an “external brain” (paper notes, electronic notes). Nursing students resort to using these external brains to avoid overreliance on their memory and failure to recall. The second theme relates to the accuracy errors that emerge when nurses attempt to collect data within certain timeframes according to administrative policies. Nursing students reported that certain hospital policies required nurses to retrieve vitals from patients every 15 minutes within the first hour of admission. Due to this demanding policy, they indicated that the quality of their collected data decreases as the number of admitted patients increases. Other participants reported their difficulty remembering certain assessment information under time pressure. Work is currently in progress to identify additional themes relevant to nursing students’ cognitive challenges and their efforts to overcome these challenges. Findings from the current study provide a deeper understanding of nursing student’s actual interaction with the EHR system to work around challenges associated with nursing tasks themselves as well as the user interface of the EHR system. Results from our work will inform future efforts to improve the design of the EHR system and EHR-related tasks that support user’s cognitive processes along the EHR data lifecycle.
The current work is built upon our prior research that identified how EHR-related tasks are expected to be carried out or "Work-as-Imagined (WAI)" based on an expert’s live demonstration and focus group validation of the WAI. Then, the current effort seeks to understand how such tasks are actually performed among nursing students, or “Work-As-Done (WAD)”. We conducted one-on-one virtual interviews with fourteen nursing students with varied EHR use experiences. The interviews were transcribed and analyzed using a thematic analysis to determine common themes with respect to nursing students’ problems with the EHR systems and their strategies to tackle the problems.
Preliminary results from the thematic analysis indicate that nursing students encounter common cognitive challenges between both assessment and identification tasks. Two major themes were (1) conflicting patient information, and (2) protocol-influenced errors. The first theme encompasses a set of codes that similarly describes the difficulties associated with recalling key data from multiple patients. Our study found that nurses struggled to properly recall correct findings from each patient after conducting assessments for multiple patients. In a similar sense, nursing students indicated that they choose to write most extracted patient data onto an “external brain” (paper notes, electronic notes). Nursing students resort to using these external brains to avoid overreliance on their memory and failure to recall. The second theme relates to the accuracy errors that emerge when nurses attempt to collect data within certain timeframes according to administrative policies. Nursing students reported that certain hospital policies required nurses to retrieve vitals from patients every 15 minutes within the first hour of admission. Due to this demanding policy, they indicated that the quality of their collected data decreases as the number of admitted patients increases. Other participants reported their difficulty remembering certain assessment information under time pressure. Work is currently in progress to identify additional themes relevant to nursing students’ cognitive challenges and their efforts to overcome these challenges. Findings from the current study provide a deeper understanding of nursing student’s actual interaction with the EHR system to work around challenges associated with nursing tasks themselves as well as the user interface of the EHR system. Results from our work will inform future efforts to improve the design of the EHR system and EHR-related tasks that support user’s cognitive processes along the EHR data lifecycle.
Event Type
Oral Presentations
TimeWednesday, March 278:52am - 9:15am CDT
LocationSalon A-2
Digital Health