Nurses’ responses to interruptions during medication tasks: A time and motion study

Methods used to examine technology in relation to the quality of nursing work in acute care: A systematic integrative review

“…A majority used time and motion methods ( n = 26) where a range of classifications of nurse activities were used; in 27% ( n = 13) of these studies, multiple dimensions of nursing work were examined. Organisational aspects of nursing work were examined in 31.7% ( n = 13) of studies and included costings, access to resources and satisfaction. Ten of these studies examined multiple dimensions of nursing work. Cognitive nursing work was examined in only 17.1% ( n = 8) of studies; these examined cognitive workload (Colligan, Potts, Finn, & Sinkin, ), interruptions (Probst et al, ; Reed, Minnick, & Dietrich, ), multi‐tasking (Reed et al, ), work sequence (Cornell, Riordan, Townsend‐Gervis, & Mobley, ), errors (Cordero, Kuehn, Kumar, & Mekhjian, ; Westbrook, Li, Georgiou, Paoloni, & Cullen, ) and information sources for decision‐making (Asaro & Boxerman, ; Westbrook et al, ; Zadvinskis, Chipps, & Yen, ; Zuzelo, Gettis, Hansell, & Thomas, ) in nursing work. Emotional nursing work was examined in only 12.2% ( n = 5) of studies; all these studies also captured other dimensions of nursing work. Emotional aspects of nursing work included nurses' feelings about the technology and their work (Bennett, Harper‐Femson, Tone, & Rajmohamed, ; Gomes, Hash, Orsolini, Watkins, & Mazzoccoli, ; Kossman & Scheidenhelm, ; Zuzelo et al, ), and providing emotional support to patients (Gomes et al, ) and their families (Schenk et al, ).…”

“…The direct observation method was used to examine a range of technologies in relation to nursing work; a persistent theme was examination of how nurses spent their time. Most common was examination of EMM or physician ordering systems (Ampt & Westbrook, ; Asaro & Boxerman, ; Dwibedi et al, , ; Leung, Chan, Wong, & Law, ; Poon et al, ; Reed et al, ; Westbrook et al, ; Yen et al, ). Next most common was examination of nurses' clinical documentation (Ballermann, Shaw, Arbeau, Mayes, & Noel Gibney, ; Banner & Olney, ; Hurst, ; Ravat et al, ; Schachner et al, ; Wong et al, ) and EMR (Chung et al, ; Hakes & Whittington, ; Korst, Eusebio‐Angeja, Chamorro, Aydin, & Gregory, ; Read‐Brown et al, ; Roumeliotis et al, ).…”

“…For example, time spent at the bedside, direct and indirect care, communication, administration, housekeeping, documentation, social and waste (or inefficient activity) were common categories used to classify nursing work. Most studies used between four and eight categories to classify nursing work, with one study using up to 64 tasks (Banner & Olney, ). Productivity and error were examined in 31.7% ( n = 13) of studies using measures of efficiency (Ballermann et al, ; Banner & Olney, ; Bennett et al, ; Hurst, ; Kossman & Scheidenhelm, ), interruptions (Ampt & Westbrook, ; Bennett et al, ; Cornell et al, ; Edwards et al, ; Probst et al, ; Reed et al, ; Tang et al, ; Wong et al, ), multi‐tasking (Edwards et al, ) and patient safety or errors (Ampt & Westbrook, ; Bennett et al, ; Dearmon et al, ; Probst et al, ). Environmental measures described the location of nursing work (Fahey et al, ), distances travelled (Ravat et al, ) and interaction points (Fahey et al, ; Gomes et al, ). A small number of studies ( n = 4) captured detailed descriptions of nurse activities such as perceptions of competency, relationships, communication, decision‐making and intent or goals (Gomes et al, ; Schenk et al, ). For example, Gomes et al () and Schenk et al () both reported increased time listening and providing a caring environment for patients after the implementation of EMR technology.…”

“…Speed and accuracy are critical to capture frequent short events in a reliable way. One solution was to focus data collection on a single nursing activity related to the technology, for example medication administration was a common focus (Ampt & Westbrook, ; Ballermann et al, ; Cornell et al, , ; Dwibedi et al, , ; Leung et al, ; Reed et al, ; Westbrook et al, ). But the data show this single nursing care activity can involve going to multiple locations, obtaining many types of supplies and information, and communicating with patients, their companions and other clinicians.…”

“…But the data show this single nursing care activity can involve going to multiple locations, obtaining many types of supplies and information, and communicating with patients, their companions and other clinicians. Further, as evidenced in some of these studies, several nursing activities may co‐occur further complicating data capture (Reed et al, ; Westbrook et al, ; Zhang et al, ).…”