A Researcher's View of the NurseMind Tool
Marcelline Harris, RN, PhD
Univ. of Michigan, Fall 2011
The mobile application ("app") is a dynamic to-do list with timings and a unique graphical user interface. This version is for use by inpatient nurses in acute care hospitals to support the time management aspect of their work. By addressing the need for nurses to manage their workload within the context of time, it fills a gap in the set of tools and resources available to nurses.
While the personal experience of Dan Keller motivated the development of this app, his experience is not unique. Nurses commonly describe their work as complex, challenged by increasing volumes of data and information to remember, frequent interruptions, and rapidly-changing demands throughout the course of a shift. These features of nursing work impose a substantial cognitive load with often-overlooked opportunities to optimize the management of an individual nurse’s workload.
Ref: What's Hard about Nursing
The most common solution that nurses employ to deal with this situation is to develop some sort of paper document that helps them organize their work for the upcoming shift that can be carried in a pocket. Nurses commonly refer to this document as a “brain sheet”. Unfortunately, these brain sheets are developed anew on every shift by every nurse, are not easily shared with co-workers, and are usually discarded at the end of a shift.
A review of the research on work environments and working conditions for nurses noted that while nursing work in the inpatient care setting has long been recognized as stress-filled, that stress has escalated since the mid-1980s due to changes in health care financing and the increasing use of technology and turbulence within the work environment. The research evidence suggests this situation has contributed to increased role stress, absenteeism, less teamwork, increased turnover and burnout, and importantly has had a negative effect on patient care quality and safety.
Ref: Nurses: Role of the Work Environment and Working Conditions
More recently, another team of nurse researchers have identified and defined the concept of missed nursing care. Missed nursing care is an error of omission in which an aspect of required patient care is omitted (either in part or in whole) or delayed. Investigators noted that the concept has been "conspicuously absent" in quality and patient safety literature, with individual aspects of nursing care left undone given only occasional mention.
Ref: Missed nursing care: a concept analysis
The tools and resources most commonly available to nurses are limited in several ways:
- They focus on individual patients over a hospital stay (e.g., care plans and worklists) and not a group of patients over a shift,
- Highly "local" procedures for a particular work area (e.g., policy and procedure guidelines) may not be included in the care plan and are rarely included in worklists, and
- Even if electronic tools are available, they are modeled after the types of paper documents currently in use. Most importantly, none of the current set of tools and resources was specifically designed to meet the need of nurses to manage their work from a time management perspective.
We believe that this app has potential to meet a critical gap in the toolset available to nurses, and will contribute to the problem of missed care and stressful work environments that are associated with compromised patient quality and safety.
The key function of this app is the generation of time-oriented "to-do" lists in the context of specific patient care units, specific shifts, and one or more specific patients. The application presents the to-do list with a dynamic graphical display including look-ahead and look-back features for purposes of time management. The "to-do" list includes specific treatments and cares required by patients (e.g. mobilization, wound care, medication administration, etc.), as well as critical surveillance and precautionary activities to reduce the risk of specific complications.
In addition, the app "knows" what a nurse needs to do in the course of a shift for a single patient or a group of patients.< Each task has a start time and duration, and the nurse checks it off once it is completed. If a task is late, it turns red. New tasks can be added on the fly. Task lists ("shift definitions") vary to meet local routines related to the type of patient care unit and shift, a feature of particular value to nurses who may be floating from another patient care unit, and to student nurses.
Thus, the app promises to help the nurse to:
- Be certain that no tasks are forgotten,
- Manage workflow by anticipating bottlenecks,
- Optimize task combinations such as trips to the supplies room,
- Prioritize by being able to see all pending tasks at a glance and choose what’s most important, and
- Keep track of what’s done and when.
The expectation is that using this app will result in less missed care, lower cognitive burden, and less stress.