| Description |
During emergent situations critical care nurses must recognize changes in the patient's condition, rapidly select relevant hemodynamic variables, then interpret the data in order to intervene appropriately. Studies in anesthesia have shown that graphical monitoring displays have the potential to improve detection and management of adverse physiological events. Despite the fact that nurses are the primary users of patient monitoring technologies, the application of graphical displays has not been well explored within the domain of nursing practice. The first aim of this research was to describe the cognitive aspects of the hemodynamic monitoring task of critical care nurses. The data, collected during interviews with 13 nurses, supported the use of graphical displays in hemodynamic monitoring and the findings were used as the basis for a series of preliminary display design strategy recommendations. The second aim was to compare the performance of critical care nurses using a new integrated graphical cardiovascular display versus a traditional numerical-waveform display to interpret hemodynamic data using a computerized, scenario-based test (n = 15/group). Although use of the graphical display did not improve accuracy of data interpretation, it did not significantly reduce it, despite limited training on the new graphical display technology. Response times among the two display conditions were equivalent. On subjective measures, the graphical display was favorably rated in terms of acceptance and usability. Interviews conducted following the display testing sessions found that nurses using the graphical display used fewer variables in their assessment, as well as more conceptual but less precise language during the interview. Nurses who used imprecise language scored lower on the scenario-based test, regardless of display type. The most common sources of error among nurses in both display conditions were inattention to key variables, misinterpretation of variables, and being misled by the patient's history. Graphical displays for hemodynamic monitoring may be able to enhance nursing practice with relevant, cue-based design development and additional training prior to testing. Advancing the design of monitoring displays for use by critical care nurses also requires further study of the cognitive tasks involved in patient monitoring and the sources of error during data interpretation. |
