Journal article
Understanding the distributed cognitive processes of intensive care patient discharge
Journal of Clinical Nursing, Vol.23(5-6), pp.673-682
03/2014
PMID: 24175884
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Source: InCites
Abstract
Aims and objectives
To better understand and identify vulnerabilities and risks in the ICU patient discharge process, which provides evidence for service improvement.
Background
Previous studies have identified that ‘after hours’ discharge and ‘premature’ discharge from ICU are associated with increased mortality. However, some of these studies have largely been retrospective reviews of various administrative databases, while others have focused on specific aspects of the process, which may miss crucial components of the discharge process.
Design
This is an ethnographic exploratory study.
Methods
Distributed cognition and activity theory were used as theoretical frameworks. Ethnographic data collection techniques including informal interviews, direct observations and collecting existing documents were used. A total of 56 one‐to‐one interviews were conducted with 46 participants; 28 discharges were observed; and numerous documents were collected during a five‐month period. A triangulated technique was used in both data collection and data analysis to ensure the research rigour.
Results
Under the guidance of activity theory and distributed cognition theoretical frameworks, five themes emerged: hierarchical power and authority, competing priorities, ineffective communication, failing to enact the organisational processes and working collaboratively to optimise the discharge process. Issues with teamwork, cognitive processes and team members' interaction with cognitive artefacts influenced the discharge process.
Conclusion
Strategies to improve shared situational awareness are needed to improve teamwork, patient flow and resource efficiency. Tools need to be evaluated regularly to ensure their continuous usefulness.
Relevance to clinical practice
Health care professionals need to be aware of the impact of their competing priorities and ensure discharges occur in a timely manner. Activity theory and distributed cognition are useful theoretical frameworks to support healthcare organisational research.
Details
- Title
- Understanding the distributed cognitive processes of intensive care patient discharge
- Creators
- Frances Lin - Griffith UniversityWendy Chaboyer - Griffith UniversityMarianne Wallis - Griffith University
- Publication Details
- Journal of Clinical Nursing, Vol.23(5-6), pp.673-682
- Publisher
- Wiley-Blackwell Publishing Ltd.
- Number of pages
- 10
- Grant note
- Queensland Nursing Council Clinical Practice Improvement Centre (CPIC) Queensland Health, Australia
- Identifiers
- 991012927098902368
- Academic Unit
- Nursing; Faculty of Health
- Language
- English
- Resource Type
- Journal article