Deriving Information Requirements for a Smart Nursing System for Intensive Care Units

摘要

The workplace environment for nurses is highly stressful, with long working hours (3 or more12-hour shifts) and a dynamic workload that may induce fatigue. These factors reduce nurses’efficiency and may contribute to medical errors. The Institute of Medicine (IOM) estimates thatin the United States (U.S.) 100,000 deaths are caused by preventable medical errors (Kohn et al.,2002). In the U.S. Intensive Care Units (ICU) alone, 1.7 errors per patient per day are reported(Donchin et al., 1995; Wu et al., 2002). Moreover, it is documented in the literature that stressand fatigue are two important factors that contribute to medical errors in nursing (Wu et al.,2002). Factors that affect nurses’ stress and fatigue in the workplace are also well documented(e.g., Foxall et al., 1990; Sawatzky, 1996; Erlen & Sereika, 1997; Meltzer & Huckabay, 2004;McHugh et al., 2011). In previous studies, Khamisa et al., (2016) conducted a longitudinal studyof 277 nurses from four hospitals in South Africa. Findings revealed health workforce wellbeingis not prioritized and mostly lacking with existing policies failing to address psychosocialstressors among nurses. The authors suggested the need for further studies using biomarkerassessments and other cellular variables to investigate the health impact of stress, burnout andjob satisfaction. In recent years, the advancement in technology has made wearable tools such assmartwatches easily accessible and widely used (Jovanov, 2015). Despite these advances, thereare no validated intervention, continuous monitoring systems or tools to mitigate ill effects ofstress and fatigue among nurses in critical care areas such as the ICU (Khanade et al., 2017). It isevident in the literature that accurate detection of stress and fatigue levels remains a researchgap; one explanation for such gap would be that such tools could potentially be intrusive andinterrupt an already complex task of working in a critical care area. In spite of the challenges, asystem that provides continuous monitoring and alerts regarding abnormal physiologicalreactions might help in increasing nurses’ awareness regarding personal responses to their tasksand environment and may contribute to improved patient safety and nurses’ well-being. Bymaking this information visible, these systems may also help nurse managers and administratorsto improve work environment practices to reduce stressful tasks and reduce effects of fatigue andstress on their nurses. This current study focus is to address the research gap of accuratedetection of stress and fatigue levels. A smart wearable system is being designed to help nurseswho experience high levels of stress and workload at work. This paper documents the systematicprocess of deriving information requirements from two focus groups conducted with deliverycare nurses and nurse managers working in various Southeastern Texas hospitals. A focus groupwas conducted to obtain a more in-depth understanding of nurses’ expectations of a tool that canhelp with periods of high-stress and fatigue as well as some of the problems nurses face in theirdaily work life. The second focus group was conducted to inform the design of an informationdisplay for nurse managers to monitor the ICU unit’s status in terms of collective stress andfatigue levels. A moderator and two co-moderators led the focus group interviews. Previouslyformulated questions were presented to the group to guide the discussions. There were 13questions followed by probing questions to obtain more information or clarification. Questionswere organized into four groups to investigate 1) participants’ task/roles, 2) situations wherehigh-levels of stress/fatigue are experienced and their effects on performance, 3) expectationfrom a tool to help in those instances, and 4) specific expectations from a smart-watch (orsupervisory-control) interface. The feedback from participants was documented as FIRs. TheFIR method provides a set of design-independent requirements that can be used as objectiveassessment of needs for displays. Additionally FIRs served to inform the design of a smartwatchbasedtool for nurses and supervisory-level interface for nurse managers. While the overallfindings from the focus groups are discussed in the paper, the FIRs are out of the scope of thisshort paper and will be reported elsewhere. The study also sought to determine how the use oftechnology could assist nurses during the periods of high stress and/or workload.