Carry on Pumping
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Franny Gant's talk at The Research Thing event: RESEARCH IN THE FIELD, March 2013. Qualitative research study of haematology nurses' work with digital infusion pumps.
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Carry on Pumping
- 1. Carry on Pumping Franny Gant UX Architect Haematology Nurses & Digital Infusion Pumps HCI MSc UCL CHI+MED
- 2. I have a Social Anthropology bachelors degree and I’m drawn to this type of research because of - The social aspect - And looking at the whole workspace and technology within it there’s a lot going on “the messy details” of the workplace Need to focus research on the right things
- 3. Something cool that came out of California in the 80s
- 4. Distributed Cognition Framework Distributed Cognition understand group work situations using ethnographic research techniques Hutchins et al
- 5. Distributed Cognition Perspective DCog looks at cognitive processing of the whole workplace system Extending on models of individual cognition to LARGER UNIT It adds a social aspect Understand normal work practices better... helps design technology to support work rather than disrupt it
- 6. DiCoT methodology (drawing from... CI & GT) To structure observations and analysis. Distributedlayout to Paying attention physical Cognition for flow artefacts information social structures Teamworking (DiCoT) Contextual Inquiry UCLiC Grounded Theory
- 7. Challenges Ethical clearance Gaining access Serious illness Challenges of fieldwork in healthcare settings: - focus on pumps, not people - Vetted by hospital – background check, blood tests – because of vulnerable people - Emotionally charged environment – sensitivity needed
- 8. Open jotting of notes brings up some issues People can feel uncomfortable They got used to me being there Open jotting Kitchen Stories is a good film… even if you’re not an ethnographer Kitchen Stories Bent Hamer 2003
- 9. Important to build trust and rapport with people INTRODUCE- I put this notice up in shared spaces Email sent round EXPLAIN- “I’m here to study the how the devices fit Introducing with your work, not auditing you”. myself
- 10. Getting consent from everyone followed Consent gained (don’t follow people who decline) Permission from each patient (nurses help) One nurse who sternly questioned me became a key informant
- 11. Night & Day? Spent 28 hours total on two haematology wards all times of day and night over 4 weeks Thought there might be some major contrast between night and day work
- 12. Round-the-clock •I found there was a continuous flow to the work that carried on around the clock.
- 13. Pumps Pumps used all the time in haematology accurate delivery of drugs ‘high risk’ devices - A mis-entered number... support the nurses’ cognitive work of giving treatments: ...nurses said things like... “the pump backs up my maths”... “it reminds you... and gives you a few minutes to go and get the new drug”
- 14. “It’s about safetytoand speed... infusions can last up 36 hours we’re givingistime. much fluid. “Line space” so depending on a limited resource We normally give reminders to flush it nurses use the pumps as a drug, through,ofgivenotanother, flush it save time between end of one infusion and start the next a workaround designed for by the through...” manufacturer
- 15. I shadowed nurses in their work. unstructured ad hoc questions when I Data collection could. semi-structured interviews to check understanding Noted things they said and did Letter coding system for later analysis (thanks Atish Rajkomar)
- 16. Web of artefacts in their work a “web of artefacts” is used These process information and - communicate status of the ward system Written notes Drug charts Whiteboards Drug labels
- 17. Physical layout In Dcog – pay attention to physical space Horizons of observation Side rooms that have closed doors to control infection. Nurses can’t see the status of pumps behind the doors (and sometimes, can’t hear them alarming).
- 18. Flow of information Flow of information … nurses rely on patients as part of the communication loop with the pumps If a patient is asleep, nurses may not get called breakdown in communication which can lead to delays
- 19. Outcomes Technology design for - continuous use contexts - communication from side rooms My study highlights that... Pump technology needs to be designed for use over long periods of time. - Nurses are using pumps in non- prescribed ways as reminders to save time On wards with side rooms... Nurses are reliant on patients to communicate pump alerts - need to enable pumps to communicate directly with ward staff
- 20. Best times Right people Tips: Equipment they will be doing what Best times – when you want to see Reflection doing the work; with an Right people – overview; supportive of the research I took camera, voice recorder, note book -- spare pens & batteries. Reflect on method and own biases.
- 21. “Needs further investigation…” How I would like to do it differently… Research in two phases one without domain knowledge (see more details) one with Interesting to follow the events with one pump for a day and one nurse for a shift Be able to look at the patient experience of the pumps –they have a direct relationship with the technology.
- 22. Time = Pros & Cons Ethnographic studies can take time. Gives - in depth knowledge of activities that need to be seen in the wild. DCog & DiCoT is a great way of looking at the coordinated action of teamwork how technology can support, not disrupt it Combining qualitative studies with quantitive – to see what’s happening at key stroke level – build complete picture. Can take this domain knowledge and use it in other research.
- 23. Behind closed doors – a distributed cognition study of infusion pump use in round-the-clock haematology treatment http://bit.ly/gant2011ucl Look ups… University College London Interaction Centre – UCLiC http:// www.ucl.ac.uk/uclic CHI+MED http://www.chi-med.ac.uk/ DiCoT – Furniss, Blandford, et al Distributed Cognition – Hutchins Contextual Design – Beyer and Holtzblatt Grounded Theory – Charmaz Type of pump – BBraun Infusomat Space Kitchen Stories, Bent Hamer 2003
Notas do Editor
- Franny Gant UX Architect at House of Fraser ...talk about my in-the-field research of haematology nurses and their work with digital infusion pumps Used Distributed Cognition. the layout and culture of the wards impact on the use of the infusion pumps. For my HCI masters dissertation at UCL in 2011. Part of the CHI+MED project. [Notes for each page are pasted in the back of the slide – so they show up on slideshare as transcript]
- Have a Social Anthropology bachelors degree I’m drawn to this type of research because of - social aspect - looking at the whole workspace and technology within it there’s a lot going on “ the messy details” of the workplace Need to focus research on the right things
- Something cool that came out of California in the 80s
- Distributed Cognition Framework understand group work situations using ethnographic research techniques
- DCog looks at cognitive processing of the whole workplace system Extending on models of individual cognition to LARGER UNIT It adds a social aspect Understand normal work practices better... helps design technology to support work rather than disrupt it
- DiCoT methodology (drawing from... CI & GT) To structure observations and analysis. Paying attention to physical layout artefacts information flow social structures
- Challenges of fieldwork in healthcare settings: - focus on pumps, not people - Vetted by hospital – background check, blood tests – because of vulnerable people - Emotionally charged environment – sensitivity needed
- Open jotting of notes brings up some issues People can feel uncomfortable They got used to me being there Kitchen Stories is a good film… even if you’re not an ethnographer
- Important to build trust and rapport with people INTRODUCE- I put this notice up in shared spaces Email sent round EXPLAIN- “ I’m here to study the how the devices fit with your work, not auditing you” .
- Consent gained from everyone followed (don’t follow people who decline) Permission from each patient (nurses help) One nurse who sternly questioned me became a key informant
- Spent 28 hours total on two haematology wards all times of day and night over 4 weeks Thought there might be some major contrast between night and day work
- I found there was a continuous flow to the work that carried on around the clock.
- Pumps used all the time in haematology accurate delivery of drugs ‘ high risk’ devices - A mis-entered number... support the nurses’ cognitive work of giving treatments: ...nurses said things like... “the pump backs up my maths”... “ it reminds you... and gives you a few minutes to go and get the new drug”
- infusions can last up to 36 hours “ Line space” is a limited resource depending on time. nurses use the pumps as reminders to save time between end of one infusion and start of the next a workaround not designed for by the manufacturer
- I shadowed nurses in their work. unstructured ad hoc questions when I could. semi-structured interviews to check understanding Noted things they said and did Letter coding system for later analysis (thanks Atish Rajkomar)
- a “web of artefacts” is used in their work These process information and - communicate status of the ward system Written notes Drug charts Whiteboards Drug labels
- In Dcog – pay attention to physical space Horizons of observation Side rooms that have closed doors to control infection. Nurses can’t see the status of pumps behind the doors (and sometimes, can’t hear them alarming).
- Flow of information … nurses rely on patients as part of the communication loop with the pumps If a patient is asleep, nurses may not get called breakdown in communication which can lead to delays
- My study highlights that... Pump technology needs to be designed for use over long periods of time. - Nurses are using pumps in non-prescribed ways as reminders to save time On wards with side rooms... Nurses are reliant on patients to communicate pump alerts - need to enable pumps to communicate directly with ward staff
- Tips: Best times – when they will be doing what you want to see Right people – doing the work; with an overview; supportive of the research I took camera, voice recorder, note book -- spare pens & batteries. Reflect on method and own biases.
- How I would like to do it differently… Research in two phases one without domain knowledge (see more details) one with Interesting to follow the events with one pump for a day and one nurse for a shift Be able to look at the patient experience of the pumps –they have a direct relationship with the technology.
- Pros & Cons Ethnographic studies can take time. Gives - in depth knowledge of activities that need to be seen in the wild. DCog & DiCoT is a great way of looking at the coordinated action of teamwork how technology can support, not disrupt it Combining qualitative studies with quantitive – to see what’s happening at key stroke level – build complete picture. Can take this domain knowledge and use it in other research.
- Behind Closed Doors is the (appropriate) name of my study. Online distinction project – UCLiC site And some references to look up if you want to know more.