How does the use of digital tools and clinical information systems affect the sharing of patient information? How can nurses be trained to use digital devices and applications appropriately? These are the questions Thomas Bürkle and his colleagues at BFH Technik & Informatik are investigating in the “Digi-Care” project.

The Institute for Medical Informatics I4MI at the BFH and the Swiss Federal Institute for Vocational Education and Training are jointly researching this topic in the SNSF-funded project “Digitisation and transmission of clinical information in nursing: implications and perspectives (digi-care)” [1]. The project is part of the National Research Programme “Digital Transformation” (NRP 77).

With “Digi-Care”, the researchers want to:

• Identify and describe situations in which clinical patient information is communicated.
• Identify how the use of digital tools affects this.
• Analyse what the design of the digital tools contributes to the situation, especially in ‘critical’ situations.
• Select a number of typical situations that are significant from a technological point of view on the one hand, or significant from the point of view of the competences required from the nurses concerned on the other.
• Create video-based learning situations from these situations.
• Recommend technological measures for improvement for these situations.

An example of a filmed observation situation at the patient’s bedside. (BFH)

For this purpose, trained members of the team observed and filmed four different nurses for three shifts each at six hospitals in Switzerland. From this, a one-hour video was edited for each nurse, in which typical communication situations were recorded. These videos were discussed in a mostly two-hour auto-confrontation interview with the previously observed nurse in order to capture the invisible, implicit background of the observed activity.

Data analysis with nurses

The data analysis of the EHB follows semiological principles [2,3] and aims to identify the subjective meaning of the situations for the nurses.

1. What do the nurses perceive as significant in the observed situations?
2. How do they deal with these situations, and what knowledge is retrieved and built up in the situations?
3. What problems occur and what skills are required in these situations?

From the perspective of I4MI, “critical incidents” in connection with IT use are considered in particular. These are differentiated into:

• technical problems (e.g. system failure, missing interfaces and lack of communication between IT systems),
• Usability-related problems (e.g. inappropriate list sorting, missing “undo” function)
• procedure-related problems (e.g. too many open windows, wrong input too often).

Context analysis with managers

Accompanying semi-structured interviews for context analysis were conducted in each hospital with the ward managers, the nursing staff and the IT managers. The following questions were asked:

1. Function and tasks of the specialist
2. Interaction between the care and IT sectors
3. Digital (and non-digital) modalities of sharing clinical-nursing information
4. Digitalisation features of the hospital
5. Training of nurses on the sharing of clinical care information.

The researchers expect new findings from this basic research project on the impact of IT use in the hospital environment and especially on the extent and type of practical use of the available IT tools. In the sense of “human centred design”, it will be interesting to explore whether, for example, critical incidents can be understood and possibly explained by the design of the IT systems concerned, and whether this can be avoided by better design.

Data analysis is ongoing

The 37-month project started successfully in October 2020 and 16 context analysis interviews were conducted in four hospitals until October 2021. 320 hours of job shadowing were captured on video and 16 self-confrontation interviews were conducted. By this time, 140 information sharing situations and 76 IT-related incidents could be selected and documented from the first four hospitals. In the meantime, data collection has been successfully completed in all 6 hospitals. Currently, the data analysis is being carried out in order to discuss the results step by step with the hospitals concerned and with experts from the field of continuing education in a multi-stage procedure starting in the second quarter of 2022 and to select particularly interesting situations and incidents for which training videos, process descriptions and mock-ups for a better IT design will then be developed.

The Team

In addition to the author, the Digi-Care team includes: Kezia Löffel, Christopher Lueg, Jürgen Holm, François von Kaenel, Lea Meier, Stephy-Mathew Moozhiyil, Sandro Perrini, Patrizia Salzmann, Ines Trede, Deli Salini and Andrea Volpe.

References

1. Salini, D; Löffel K; Moozhiyil S-M. et.al. Observed situations involving transmission of patient care information: A basis for promoting learning and development among nursing staff. Accepted for^7th international Vet congress 2022, Zollikofen.
2. Theureau, J. (2003). Course-of-action analysis and course-of-action centred design. In E. Hollnagel (Ed.), Handbook of cognitive task design (pp. 55-81). Mahwah, NJ: Lawrence Erlbaum.
3. Theureau, J. (2006). Le cours d’action. Méthode développée. Toulouse: Octarès.