Understanding Nurses’ Strategies to Handle (Un)wanted Nurse Calls

Abstract

Nurse calls in a hospital can constitute either positive or negative (wanted or unwanted) interruptions depending on various factors. This study aims to understand nurses' strategies in facilitating the reception of wanted nurse calls and the restriction of unwanted nurse calls. Applying a resilience engineering perspective, nurses' performance variability is investigated as a basis to design appropriate computer support to enhance efficiency and patient safety. A qualitative case study was conducted for a period of 4 years with focus on nurses' use of a wireless nurse call system at a Norwegian university hospital. The study involved various data collection methods such as observations, interviews, and workshops. The collected data were then transcribed and analyzed using a combined inductive and deductive approach. Results indicate that nurses use four main strategies involving a large degree of collaboration to allow or avoid interruptions in the form of nurse calls depending on situation and circumstances. However, these strategies are not supported by the wireless nurse call system, which requires nurses to use suboptimal workarounds to enable the necessary performance variability. Interruptions have been largely perceived as a threat to patient safety. However, nurses' handling of calls illustrates that, when aiming to introduce interventions to manage interruptions, a detailed understanding of work as done is important. Nurses continuously make appropriate adjustments to cope with challenges that characterize hospital work to ensure efficient and safe operations. Hence, technology, in terms of a nurse call system, needs to be designed to afford the adjustments made to support a resilient practice and, as such, leverage patient safety.

Implementation and experience of an innovative smart patient care system: a cross-sectional study

“…Patient care system alarms, by nature, are a source of interruption for nurses [ 4 , 21 , 24 ]. These interruptions have been shown as a potential contributory factor leading to medical errors in clinical environments [ 31 – 33 ].…”

“…Many studies have tried to reduce medical errors by reducing the frequency of interruptions, the effect and safety of which, however, remain questionable [ 21 , 34 , 35 ]. The main reason for this may be due to the complex nature of interruptions in hospital settings, in which not all interruptions are undesirable [ 14 , 17 , 20 , 24 ]. Moreover, patients think that it is essential that their requests are taken seriously and that they can receive support whenever needed [ 2 , 7 ].…”

“…With limited information on an alarm provided by patient care systems, nurses tend to lower their prioritization in responding to it [ 14 , 22 ]. There are some other barriers, such as limited access to an alarm if it is only displayed in fixed places, such as monitors in the corridor or at nursing stations [ 23 ], a lack of ways to share alarm-responding responsibilities with colleagues [ 24 ], and insufficient time to respond to a bed-exit alert [ 25 ]. Responding to the demands of the current situation implies dealing with reality, which is an organizational ability [ 26 ].…”

Knowledge, Attitude, And Practice Regarding Nursing Interruptions Among Nurses in Tertiary Care Hospital: A Cross-Sectional Study

“…Shiferaw (2020) exclaims Leaders of nursing teams ought to impose workflow conductive by limiting the non-urgent interruptions and guide nurses to mitigate obstructions lead to patient harm cause experience to become worse. Training will adapt strategies to avoid interruption minimize the risk of healthy injury research (Klemets & Evjemo, 2017) concluded that interruptions directly link performance variability to significantly unwanted and wanted interruptions. Health care resilience aligned by responding to non-avoidable distractions and avoiding unnecessary.…”

Safety II Behavior in a Pediatric Intensive Care Unit

“…The difference between "work as imagined" and "work as done" forced nurses to be resilient and change their work as done with the new system to create the desired effect. 26 Our study has some potential weaknesses. Participants in the focus groups were not entirely randomly selected.…”