Using a procedure doesn’t mean following it: A cognitive systems approach to how a cockpit manages emergencies

Carim, Guido; Saurin, Tarcísio Abreu; Havinga, Jop; Rae, Andrew; Dekker, Sidney; Henriqson, Éder

doi:10.1016/j.ssci.2016.06.008

Cited by 39 publications

(45 citation statements)

References 25 publications

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“…Extensive academic literature has been dedicated to the evaluation of emergency response plans in a variety of industries and events, such as natural hazards (An, Bai, Xu, Nie, & Wang, 2015;Bisri, 2013), nuclear (Ten Hoeve & Jacobson, 2012), industrial (Krausmann, Cozzani, Salzano, & Renni, 2011;Lindøe, Engen, & Olsen, 2011;Wei & Lu, 2015) and transport accidents (Carim Jr et al, 2016;Fan, Li, Pei, Li, & Sun, 2015). A burgeoning field of research, emergency management in the healthcare sector deserves further attention by researchers and practitioners, in order to diffuse best practices and reduce costs of accident prevention and response (Alves, Cagliuso, & Dunne, 2015;Lakbala, 2016;Orlando, Danna, Giarratano, Prepas, & Johnson, 2010).…”

Section: Introductionmentioning

confidence: 99%

Implementation of best practices for emergency response and recovery at a large hospital: A fire emergency case study

et al. 2017

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This paper illustrates a study conducted into the managerial practices implemented to mitigate the consequences of a major fire emergency and to promptly restore normal business operations at a large pediatric hospital. Stemming from prior research on crisis response and recovery in critical infrastructures, this investigation demonstrates that factors such as the complexity of the underlying stakeholder networks, the vulnerability of the involved actors, and several temporal and spatial constraints, all contribute in hampering the intervention of crisis managers. In these situations, relying on consolidated best practices may enable more rapid response and more adequate recovery.This study adopts a qualitative approach to build a retrospective case study that highlights the crucial issues that healthcare crisis managers are requested to face when exposed to thorny work conditions: presence of numerous actors from the public and the private sector, involvement of organizations with contrasting interests, need for a balance among public health, cost containment and legitimacy, etc. The findings of the present investigation expand the theoretical knowledge on the dynamics that characterize crises occurring at critical infrastructures and provide practical recommendations for healthcare emergency managers to improve their response to, and recovery from, major fire emergencies.

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Section: Introductionmentioning

confidence: 99%

Implementation of best practices for emergency response and recovery at a large hospital: A fire emergency case study

et al. 2017

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“…However, we suggest that further investigation into the arrangements necessary for the alignment of multiple elements required to enact practice consistently, and in a variety of highly localized situations, is required. Like the study of airline pilots (Carim et al., ), the use of evidence‐based guidelines is likely only one element that is aligned into a stable practice in each of the observed 41 unique care situations. Further research into the contingencies that disrupt the arrangements for falls prevention activities in older patients with cognitive impairment is required.…”

Section: Discussionmentioning

confidence: 99%

“…Taken‐for‐granted activities are often an active alignment of human and nonhuman elements to become a stable “practice,” noting that the ordering processes required to keep the practice going are fragile (Law, ). A study of airplane pilots found that in emergencies and other non‐normal situations, pilots drew upon a range of resources, using only fragments of the procedures and checklists as resources in their actions (Carim et al., ). From this perspective, nursing practice is inseparable from the networks that produce it, including the number of staff rostered on a shift, availability of equipment, accessibility of information, and presence of other staff such as doctors, allied health, cleaner, administrator, wards men, and kitchen staff.…”

Section: Introductionmentioning

confidence: 99%

Implementing Evidence‐Based Guidelines for Falls Prevention: Observations of Nursing Activities During the Care of Older People With Cognitive Impairment

Grealish

Real

Todd

et al. 2019

Worldviews Ev Based Nurs

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Background: Evidence-based guidelines assist clinicians in practice, but how the guidelines are implemented is less established.Aim: To describe the nurses' implementation of activities recommended in evidence-based guidelines for falls prevention and care of older people with cognitive impairment.Methods: Structured observation with a categorical checklist was used. Nursing personnel were recruited from one subacute and two acute wards in two hospitals in one tertiary-level health service in south-eastern Queensland, Australia. The data collection instrument identified 31 activities drawn directly from the evidence-based guidelines, which were categorized into six domains of nursing practice: clinical care, comfort, elimination, mobility, nutrition and hydration, and social engagement. Four-hour observation periods, timed to occur across the morning and evening shifts, were conducted over 2 months.Results: Nineteen registered nurses, six enrolled nurses, and 16 assistants in nursing (N = 41) were observed for 155 hr of observation. There was variability in adherence with specific activities, ranging from 21% to 100% adherence. Three categories with the highest adherence were nutrition and hydration, mobilization safety, and social engagement. The clinical care, comfort, and elimination categories had lower adherence, with lowest adherence in activities of education provision about falls risk, pain assessment, using a clock or calendar to reorient to time and place, and bowel care.Linking Evidence to Action: Nursing care is delivered within an interdisciplinary team. Therefore, responsibility for the everyday fundamental care activities known to prevent falls in older people with cognitive impairment requires localized negotiation. A practical guide for preventing in-hospital falls in older people with cognitive impairment addressing the interdisciplinary context of practice is required. Interdisciplinary teams should develop strategies to enhance the implementation of pain assessment and prevention of constipation in the context of regularly implemented hydration, nutrition, and mobilization care strategies.

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“…From this point of view actions and reasoning unfold as an integrated and continuous flow, where no discrete actions and decisions are taken separately (Carim Jr. et al, 2016). One of the characteristics of the study, and something which might be said to be recurring theme in Rasmussen's work (section 5 of this paper), is that it on the one hand harks back to earlier work which emphasises the role played by the environment on cognition and the inter-relationships between various data sources and mental representations involved in complex work tasks (in the case of this paper, Bartlett, 1958 andCraik, 1943), but also crucially anticipates or points forward to later developments (e.g.…”

Section: Relation To Other Workmentioning

confidence: 99%

Recurring themes in the legacy of Jens Rasmussen

2017

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Using a procedure doesn’t mean following it: A cognitive systems approach to how a cockpit manages emergencies

Cited by 39 publications

References 25 publications

Implementation of best practices for emergency response and recovery at a large hospital: A fire emergency case study

Implementation of best practices for emergency response and recovery at a large hospital: A fire emergency case study

Implementing Evidence‐Based Guidelines for Falls Prevention: Observations of Nursing Activities During the Care of Older People With Cognitive Impairment

Recurring themes in the legacy of Jens Rasmussen

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