A method is presented for understanding how people interact with information sources in complex work environments. The method is based on 1) the importance of focusing on information transformations in cognitive work systems articulated in the information trails model and 2) the concept of mediated actions from activity theory as a framework for systematically describing the activities of a human actor. The method was applied to data from a single observation of a home healthcare nurse completing medication-related activities during an admission visit. During the visit, the nurse provided or obtained information using 21 different action patterns to interact with information sources. Using these action patterns, the complexity of different care activities was inspected. The presented method provides a tool for identifying work system redesign opportunities for improving information flow.
A study was conducted to investigate how well the design of an electronic health record (EHR) supported the shared understanding of medication-related information between home healthcare team members. EHR data from a home healthcare admission visit was obtained and reviewed for medication-related entries. Entries were characterized based on their location within the EHR interface. The analysis identified 50 different medication-related entries which were distributed across 18 EHR sections. The results highlight opportunities to improve the EHR design to better support a shared understanding between healthcare team members of medication-related information, and patient information more generally.
A prototype medical device and protocol that work well in a clinic would not necessarily work reliably in the home setting. The goal of this work is to identify factors to consider when translating a device evaluated in a clinic for use by home caregivers providing chronic wound care for persons living with dementia. One must consider the current device, the associated bundle, the protocol and how they may need to be modified. Semi-structured interviews with the research assistants who have applied a prototype device were conducted to generate a list of known issues with the current clinical protocol in terms of ultrasound application The researchers performed a set of specified tasks by following the current device protocol and explaining any difficulties with use\execution. They embellished the descriptions with details about what had happened with actual patients in the clinic. Using thematic analysis, analysts identified themes and subthemes. Issues potentially relevant to translating medical devices to the home are discussed.
Background: Persons living with dementia (PLWD) are at risk for chronic wounds; however, they are rarely included in research.Objectives: To inform practice and research directions, the aim of this integrative review was to identify and synthesise previous knowledge about the characteristics of chronic wounds in PLWD, in terms of chronic wound types, prevalence, setting and
interventions.Design: A literature search was conducted for publications in English using PubMed, Web of Science and CINAHL. The minimum information required for inclusion was how many PLWD enrolled in the study had wounds.Methods: This integrative review followed the Whittemore and Knafl methodology.Data extraction and synthesis were guided by a directed content analysis, with a coding structure based on an initial review of the literature.Results: Thirty-six articles met the inclusion criteria. The majority were missing characteristics of PLWD including severity of dementia and race/ethnicity/nationality, and none mentioned skin tone. Most focused on pressure injuries in the nursing home and acute care setting. Few included information on interventions. Only one discussed challenges of wound care for a PLWD exhibiting aggression.
Conclusion:There is a gap in the literature regarding PLWD and chronic wounds other than pressure injuries that are common in older adults (e.g. diabetic foot ulcers, venous leg ulcers). Research is warranted among those PLWD who live alone and those who receive wound care from family caregivers to understand experiences. Knowledge can inform the development of future novel interventions for wound healing. Future research is needed regarding chronic wounds in those who exhibit behavioural and psychological symptoms of dementia.Relevance to Clinical Practice: Nurses that care for chronic wounds in PLWD can contribute their knowledge to include information in guidelines on best care practices and contribute their perspective to research teams for future research.
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