Abstract. Distributed cognition as an approach to collaborative work holds that a work unit is cognitive system in which cognitive activities are carried out jointly by workers with the use of tools. This approach has several direct implications to the study of collaborative work In this paper, we analysed staff interactions with a large display board in a Level I trauma centre operating room unit. Coordination needs are exacerbated by the unpredictability of incoming emergency surgery patients admitted to the trauma centre as well as other contingencies (such as changes in scheduled surgery cases or staffing) The public display board has evolved into a key component for supporting collaborative work. The physical and perceptual properties of the board are exploited by the clinicians to support rapid paced, highly dynamic work. The canvas-like appearances of the display board, combined with magnetic objects attached to the board, afford its users to taylor the board as an effective coordinative tool and to invent new ways of representing information Based on the concept of display-based cognition, our analysis illustrates the role of public displays in facilitating negotiation of scheduling, joint planning, and augmenting inter-personal communication.

The use of personal digital assistants (PDAs) in healthcare has expanded exponentially in the past several years. In addition to common feature functions such as contact lists, calculators, calendars, and expense logs, current PDAs boast a wide variety of practical healthcare-related applications such pharmacologic databases, infectious disease programs, medication calculators, and patient scheduling and billing applications. This article examines PDAs in general and the Palm series of handheld devices in particular for use in the advanced practice setting. These devices have several implications for advanced practice nursing including support of both differential diagnosis and diagnostic reasoning, reduction of medication errors, and development of effective treatment protocols. Personal digital assistant technology will inevitably become part and parcel of advanced practice nursing. The rapid, almost daily, changes in the healthcare environment require immediate access to the myriad resources and databases used by advanced practice nurses. Personal digital assistant technology provides such access.

The investigators conducted a formal usability evaluation of the military's electronic health record known as Armed Forces Health Longitudinal Technology Application (AHLTA). Seventeen providers from different specialties in the ambulatory setting were interviewed and observed at a military medical center. Data were analyzed by human factors experts. Observations and interviews yielded four major usability findings: (1) limited AHLTA use during the actual encounter, (2) difficulties in obtaining situational awareness of the patient, (3) work-arounds with nonintegrated systems, and (4) frustrations in the use of the structured documentation. This assessment is congruent with usability concerns voiced in other military health system (MHS) and nonmilitary clinical systems. Improving the usability of future MHS clinical systems could lead to improved clinical decision making, patient safety, and increased information accuracy.

Is there a better way to train and prepare our health care personnel to function in a chemical biological environment while continuing to provide for patient care in a variety of healthcare settings? The purpose of this pilot work was to compare the effectiveness and user satisfaction of the Cath-Sim Intravenous Training System to the traditional IV arm model for teaching and achieving competence at IV insertion while in Mission-Oriented Protective Posture level 4 for Army medical personnel. Grounded in adult psychomotor learning principles and in an established evaluation model, participants were tested on both the traditional IV arm and Cath-Sim models and then allowed to practice on each model while at Mission-Oriented Protective Posture level 4. One week later, participants were again tested on both models. Outcome measures included (1) a computer-generated score sheet measuring time to success and criterion success/nonsuccess on the Cath-Sim; (2) time and success rating for IV insertion on the IV arm model; and (3) satisfaction evaluations completed by the participants. There were conflicting evaluation scores for recommending one model over the other. Participants felt that there was some benefit to each model depending on user, setting, and purpose.

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