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Uncovering the Value of a Historical Paper-Based Collaborative Artifact: The Nursing Unit's Kardex System.

We identify useful functions and usability characteristics of a historical cognitive artifact used by nurses working in a hospital unit, the Kardex. By identifying aspects of a widely used artifact, we uncover opportunities to improve the usefulness of current systems for hospital nurses. We conducted semi-structured interviews with registered nurses about their prior experience with the Kardex. Questions included what elements of the Kardex are missing from their current electronic support. Memos were generated iteratively from interview transcript data and grouped into themes. Eighteen nurses from multiple clinical areas participated and had a median of 25-29 years of nursing experience. The themes were: (1) a status at a glance summary for each patient, (2) a prospective memory aid, (3) efficiency and ease of use, (4) updating information required to maintain value, (5) activity management, (6) verbal handover during shift-to-shift report, (7) narrative charting and personalized care, and (8) non-clinical care communication. Implications for digital support are to provide immediate, portable access to a standardized patient summary, support for nurses to manage their planned activities during a series of shifts, provide unstructured text fields for narrative charting, and to support adding informal notes for personalized care.

HOW NURSES IDENTIFY HOSPITALIZED PATIENTS ON THEIR PERSONAL NOTES: FINDINGS FROM ANALYZING 'BRAINS' HEADERS WITH MULTIPLE RATERS.

The overarching objective of this research is to reduce the burden of documentation in electronic health records by registered nurses in hospitals. Registered nurses have consistently reported that e-documentation is a concern with the introduction of electronic health records. As a result, many nurses use handwritten notes in order to avoid using electronic health records to access information about patients. At the top of these notes are patient identifiers. By identifying aspects of good and suboptimal headers, we can begin to form a model of how to effectively support identifying patients during assessments and care activities. The primary finding is that nurses use room number as the primary patient identifier in the hospital setting, not the patient's last name. In addition, the last name, gender, and age are sufficiently important identifiers that they are frequently recorded at the top of handwritten notes. Clearly distinguishable field labels and values are helpful in quickly scanning the identifier for identifying information. A web based annotator was designed as a first step towards machine learning approaches to recognize handwritten or printed data on paper sheets in future research.

USE PREFERENCES FOR CONTINUOUS CARDIAC AND RESPIRATORY MONITORING SYSTEMS IN HOSPITALS: A SURVEY OF PATIENTS AND FAMILY CAREGIVERS.

The overarching objective of this research is to reduce the burden of 'alert fatigue' on patients and family caregivers who stay overnight in hospitals on units that provide continuous monitoring of cardiac and respiratory systems. When a patient develops respiratory compromise on the medical-surgical units of the hospital, the mortality rate is 29 times higher. Alarms require nurses to quickly respond, even when it is likely a false alarm. An anonymous survey was distributed to patients and family caregivers with 72 responses. Alarm sounds were judged most helpful to detect a high heart rate or unusual rhythm, and less helpful to detect a patient exiting from bed. The expectation was for an immediate response to an alarm, and that it would be annoying to have an alarm go off for hours. There was strong agreement with wanting alarm sounds to go to the nurse, but not be heard in the hospital room by patients or caregivers. Implications of these findings are discussed.