Barriers to critical thinking: workflow interruptions and task switching among nurses.

Nurses are increasingly called upon to engage in critical thinking. However, current workflow inhibits this goal with frequent task switching and unpredictable demands. To assess workflow's cognitive impact, nurses were observed at 2 hospitals with different patient loads and acuity levels. Workflow on a medical/surgical and pediatric oncology unit was observed, recording tasks, tools, collaborators, and locations. Nineteen nurses were observed for a total of 85.2 hours. Tasks were short with a mean duration of 62.4 and 81.6 seconds on the 2 units. More than 50% of the recorded tasks were less than 30 seconds in length. An analysis of task sequence revealed few patterns and little pairwise repetition. Performance on specific tasks differed between the 2 units, but the character of the workflow was highly similar. The nonrepetitive flow and high amount of switching indicate nurses experience a heavy cognitive load with little uninterrupted time. This implies that nurses rarely have the conditions necessary for critical thinking.

Transforming nursing workflow, part 2: the impact of technology on nurse activities.

OBJECTIVE: To assess the impact of new technology on nurse workflow, nurses at 2 hospitals were observed before and after implementation of an electronic medication charting system. In part 1 (September 2010 issue), we discussed the chaotic nature of nurse activities and its implications on transforming workflow. BACKGROUND: Numerous studies have documented the impact of technology on performance and satisfaction, but technology's impact on the frequency, duration, and pattern of activities is less understood. These patterns are important to the development of new care models. METHODS: Observers shadowed nurses at 2 hospitals before and after the implementation of an electronic medication charting system. A total of 196 hours of observation was recorded at one site, and 185 hours at the other site. RESULTS: Analysis of variance revealed a number of significant differences in the time spent on a variety of activities, but the duration and frequency of nurse activities were not drastically altered by the additional technology. CONCLUSIONS: Computer use increased; however, the impact was evenly distributed among other activities. More importantly, time with patients and verbal communication remained unchanged as nurses seemed to incorporate the new requirements into their normal routine.

Psychophysiological Evidence of Response Conflict and Strategic Control of Responses in Affective Priming.

This experiment investigated the role of conflict in the response and evaluative categorization systems in the affective congruency effect using event-related brain potentials (ERPs). Participants completed a primed evaluative decision task in which the proportion of congruent to incongruent trials was manipulated. The size of the affective congruency effect increased along with the proportion of congruent trials. ERP data identified the locus of this effect in the response system: the lateralized readiness potential (LRP) showed that preferential response activation occurred in motor cortex following prime onset, and the fronto-central N2 (conflict monitoring) component indicated that conflict occurred when the response activated by the prime differed from the target response, irrespective of the affective congruency of the prime and target. The extent of this conflict covaried with strategic processing of primes, as participants directed less attention to primes that were likely to elicit conflict. These data support a response conflict account of affective congruency effects in the evaluative decision task and indicate that strategic control of attention is important in determining the extent to which conflict occurs.