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Understanding Nurse Created Cognitive Artifacts: Personally-Created-Cognitive-Artifacts as External Representations of Distributed Cognition

Author: Sharon McLane, MS, MBA, RN-BC (2009)

Primary Advisor: James P. Turley, RN, PhD

Committee Members: Joan Engebretson, Dr.PH, RN; Geri L Wood, PhD, RN, FAAN; Jiajie Zhang, PhD

PhD Thesis, The University of Texas School of Health Information Sciences at Houston.

Nurses are knowledge workers who require, evaluate, and integrate a complex array of data to guide their decisions their patients’ plan of care on a daily basis. The volume, complexity, and diversity of data necessitate development of a cognitive artifact that summarizes the detailed information nurses want to have immediately available throughout the course of the shift. As the shift progresses, the nurse amends the cognitive artifact, adding new clinical data, notes, reminders, and personal alerts that support care delivery decisions. While nurse cognitive artifacts support nursing practice, they also present a risk to patient safety through possible transcription error and as a result of the diminishing currency of the data recorded hours earlier. The nurse is updated regarding new lab or other diagnostic test results, new orders, and changes in medication orders by accessing the appropriate resources. Access of resource systems for new data may be deterred by the busyness of the unit or by changing condition of a patient. Acquiring updated data may also be thwarted by delays in entry of new data in information systems. This research was developed to define and characterize the purpose of nurses’ cognitive artifacts and how it supports cognition and clinical practice. The goal of the research was to define the requirements of an information technology solution to the cognitive artifact nurses create each day. Our results disclose that nurse cognitive artifacts are a very complex documents containing multiple information visualization, working memory support, and organizational dimensions that support the cognitive work of the nurse. We identify basic requirements for an information technology alternative to nurse prepared cognitive artifacts, and describe future research necessary to increase our understanding of the cognitive artifacts that support nursing practice and the cognitive work of nurses.