Social practices of nurse care coordination using sensor technologies e Challenges with an alert system adoption in assisted living communities for older adults

美国老年人辅助生活社区应用智能警报系统的挑战

Objectives:From the view of everyday practices and the socio-technical coordination lens,this study aimed to analyz the gap between creators’intention and the users’implementation(mainly nursing staff and social workers)of an alert system in assisted living communities.Methods:Qualitative methods were employed by way of five user interviews and focus groups with six system developers.Modeling instruments were applied for data collection to analyze the different clinical workflows versus the expectations of the system development team.Results:Results indicate that the clinical workflow changed over time,which led to a mismatch of nurse care coordination,social practices,and technology use.The results show different mental models of the socio-technical practice.Applying the coordination theory,the following recommendations could be developed to overcome the mismatch.First,it is recommended that nursing staff set goals together.Second,a communication rhythmwith the nursing staff and developer teams should be established,with guided questions to facilitate the conversation,to shed light on the different workflows and the difference in social practices when using sensor technologies or alert systems.Third,a checklist for new employees should be created so they know how and on which devices to use the alert system.Fourth,the user experience with the alert system should be improved(e.g.,an improved user interface).Conclusions:This work indicates recommendations to close the mental model gap to overcome the mismatch between optimal use of the alert system and how the nursing staff is actually using it.

目的本研究旨在从日常实践和社会-技术协调角度分析美国辅助生活社区中智能警报系统使用者(主要是护理人员和社会工作者)实践与开发者的意图之间的差距.方法采用质性研究方法,研究者分别对5名系统使用者进行访谈,并与6名系统开发人员进行焦点小组讨论.在收集数据时采用了建模工具,以分析不同的临床工作流程与系统开发团队期望之间的差距.结果结果表明,临床工作流程随时间的推移而变化,导致医疗护理服务协调、社会实践和技术应用不匹配,并显示了社会技术实践过程中的不同心理模式.应用协调理论,采用以下建议可以解决不匹配的问题:建议护理人员共同制订目标;护理人员和开发者团队之间应建立沟通频率,并采用引导式问题进行对话,以阐明使用传感技术或警报系统时的不同工作流程和社会实践的差距;应该为新员工制订检查清单,让他们知道如何以及在哪些设备上使用智能警报系统;应该改善智能警报系统的用户体验(如改进用户界面).结论本研究指出了缩小系统开发者与使用者间心理模式差距的建议,以解决智能警报系统的最佳用法和护理人员实际使用之间的不匹配问题.