Utvärdering av en inskrivningsprocess : Hur fungerar interaktionen mellan sjuksköterskor, journalsystem och arbetsorganisation

Sammanfattning: Background: In recent years’ complaints on medical IT-systems has been seen in scientific journals concerning lack of usability, non-adequacy and deficiency of adaptation to the work activity. With a take-off point in safety work, MTO (Man - Technology - Organization), the nurses’ work in admission process has been studied in relation to a medical IT-system (Cosmic) and the routines of the organisation. Purpose: The purpose is to evaluate the nurses work process during admission patients in interaction with the medical IT-system (Cosmic). The strengths and weakness of the work process is mapped out and important protection barriers are shown with aim to enhance the work process with regards to nurses’ well-being and patient safety. Method: A qualitative field study was conducted at a ward at an emergency hospital. Observations of the nurses’ work process has been made as well as six interviews with nurses and one with their unit manager. In addition to that 13 nurses answered a questionnaire. Collected data has been categorized aided by a hierarchic task analysis and barrier analysis. Results: During interviews it was phrased that nurses mainly perceived the admission process well-functioning and Cosmic as a good work tool. However, there was a dissatisfaction with the number of clicks required to fulfil a task and a certain inconsistency with menus in Cosmic. It took long time to learn how to use Cosmic for the nurses. The biggest strength in Man - Technology - Organization identified as nurses work along with templates created by organization and used by nurses. The nurses make the process work despite deficits in Cosmic. Even tough templates exist because of deficits in Cosmic they are important complements that aids nurses collecting patient information in a standardized way. Nurses work process as well as complementary aid was identified as a barrier for information loss. A barrier for protecting nurses from frequent interruption in the work process was identified lacking. Conclusion: Technical systems (T) are available for the work process but these systems are not completely purposive. It is with the complementary aid (T) that nurses (M) through the organisations routines (O) make the admission process to work well. Keywords: MTO, usability, healthcare, nurses, Cosmic, admission process, work process, interactions, IT-system.