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Greater healthcare demands

Greater healthcare demands. !!. Healthcare meltdown. Aging and nursing shortage. 400,000 shortage by 2020. 1:20 vs ideal of 1:10. INCREASING DEMANDS on SENIOR NURSES. Retention of Workers Strategy. At least 1 adverse effect. 70% of deaths. INCREASED INCIDENCES of ERROR. WORK ABILITY.

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Greater healthcare demands

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  1. Greater healthcare demands !!

  2. Healthcare meltdown Aging and nursing shortage

  3. 400,000 shortage by 2020 1:20 vs ideal of 1:10 INCREASING DEMANDSon SENIOR NURSES Retention of Workers Strategy

  4. At least 1 adverse effect 70% of deaths INCREASED INCIDENCES of ERROR

  5. WORK ABILITY Physical Mental Heterogeneous concept that must be broken down There is no specialized concept or metricfor the cognitive aspect of work ability and there are also no methods at present to measure / assess this.

  6. Measure Cognitive Work Ability

  7. Job reassignment & interventions Predicting stress levels and likelihood of adverse effects (ADEs)

  8. Existing methods are insufficient & subject to bias.

  9. Automated and Performance-Based

  10. CASNUR: Developing a software to assess cognitive work ability among aging nurses • by Maria Dominique Rustia& Rosemary Seva • Human Factors and Ergonomics Center, De La Salle University, Manila, Phil. • rustiamd@gmail.com • May 28, 2012 • IFA 2012 Global Conference on Ageing

  11. PROBLEM STATEMENT Background Method Concept & Design Testing Conclusion 1 • Existing assessment methods for work ability among nurses are subject to response bias and fail to consider the cognitive dimension of tasks. • There is a need for a performance-based assessment method for cognitive work ability (CWA) to be established, especially in the context of ICU nursing.

  12. OBJECTIVES, SCOPE & LIMITATIONS Background Method Concept & Design Testing Conclusion 1 OBJECTIVES • to provide a reliable and valid measure of CWA among hospital nurses by developing a software application that can assess CWA among them. To test the validity of the CWA assessment software To perform an initial evaluation of the usabilityof the software To determine the reliability & effectiveness of software in capturing data for CWA metric derivation To identify areas for improvement in the software SCOPE & LIMITATIONS • Hospital nurses, ages 40-65, Intensive Care Unit (ICU) setting • Philippine setting • Will only test variables of CWA model of Rustia & Seva (2011) • Will not propose any interventions • Conceptualization and design of software • Gender, affective & physical needs not considered

  13. COGNITIVE WORK ABILITY Background Method Concept & Design Testing Conclusion 1 Work Ability Index (WAI)  “how good workers are at present and in the near future, and how they will be able to do their work with respect to work demands, health and mental resources” (Ilmarinen & Tuomi, 2003) accuracy speed Cognitive Work Ability (CWA)  the ability of a person to fulfill mentally demanding tasks efficiently and effectively

  14. EXISTING ASSESSMENT METHODS Background Method Concept & Design Testing Conclusion 1 • Reliability and validity have been verified but coverage of components of CWA is poor • Questionnaire-based, risk of biased and inaccurate answers • No performance-based evaluation methods to date SIMULATION OF THE NURSING ENVIRONMENT (low cost  software)

  15. CASNUR Cognitive work ability Assessment Software for NURses

  16. METHODOLOGY Background Method Concept & Design Testing Conclusion 2

  17. METHODOLOGY Background Method Concept & Design Testing Conclusion 2 Systems Development Life Cycle

  18. SOFTWARE DESIGN- Software Concept Background Method Concept & Design Testing Conclusion 3 SIMULATION 1 DATA-GATHERING 2 EVALUATION 3

  19. PERFORMANCE QUALITY SOFTWARE DESIGN – Requirements Planning Background Method Concept & Design Testing Conclusion 3 ACCURACY SPEED • Applied Cognitive Task Analysis (ACTA) applied to determine cognitive processes in regular ICU nursing tasks.

  20. SOFTWARE DESIGN – Requirements Planning Background Method Concept & Design Testing Conclusion 3 SIMULATION INTERVIEW & KNOWLEDGE AUDIT • MONITOR and ALARM hard to say immediately where the problem is • EMERGENCIES lead to improvising • presence of mind and alertness, prioritization, good memory, speed • checking, finding discrepancies in medicine • arrangement and labeling of medicine, better systems

  21. SOFTWARE DESIGN – Requirements Planning Background Method Concept & Design Testing Conclusion 3

  22. DATA-GATHERING SIMULATION 1 2 SOFTWARE DESIGN – Requirements Planning Background Method Concept & Design Testing Conclusion 3 Abnormal event generation Errors, Actions, Responses

  23. SOFTWARE DESIGN - Conceptual Model Background Method Concept & Design Testing Conclusion 3

  24. SOFTWARE DESIGN - Software Features Background Method Concept & Design Testing Conclusion 3

  25. SOFTWARE DESIGN – Software Features Background Method Concept & Design Testing Conclusion 3

  26. Measurable by CASNUR and eye-tracker software • Measurable by CASNUR • Measurable by CASNUR and eye-tracker software EXPERIMENTATION- Factor Selection Background Method Concept & Design Testing Conclusion 3 • Measurable by CASNUR

  27. PILOT TEST – Subjects & Assumptions Background Method Concept & Design Testing Conclusion 4 SUBJECTS & ENVIRONMENT • Filipino nurses, ages 45+ • Fluent in English and Filipino • Capable of using computers • No physical or mental diseases / impairments • Must have had experience in ICU / emergencies • Day shift to avoid influence of night shifts • Pre-scheduled appointments to avoid rushing • The participants selected are representative of the targeted users of CASNUR. • The medications are assumed to be correct even if they medically are not. • The frequency of errors is assumed to be correct. • The subjects were physically, mentally and emotionally fit before testing. ASSUMPTIONS

  28. PILOT TEST - Methodology Background Method Concept & Design Testing Conclusion 4 Subject Profile Survey CASNUR software Usability Plan, CASNUR Usability Questionnaire Dikablis Eye-Tracker & Software CASNUR + Eye-Tracker + Morae Simulation Evaluation Survey

  29. PILOT TEST - Methodology Background Method Concept & Design Testing Conclusion 4 RELIABILITY USABILITY VALIDITY Testing of successful generation of variables and events How close the simulation is to real-life situations EFFICIENCY EFFECTIVENESS SATISFACTION

  30. RELIABILITY PILOT TEST - Results and Analysis Background Method Concept & Design Testing Conclusion 4 DATA-GATHERING SIMULATION • Vital Signs Monitor changes, alarms and indicates abnormality • Emergency cart with full functionality of selecting and adding medicine to table • Medicine Table with maximum capacity of 3 medications • Administration of oxygen, dextrose and medicine (input of dosage) • Error identification, counting and recording • Response / action identification, counting and recording • Visual timer on interface • Export feature to EXCEL

  31. RELIABILITY PILOT TEST - Results and Analysis Background Method Concept & Design Testing Conclusion 4 10 variables measured

  32. VALIDATION OF CWA MODEL FROM RESULTS PILOT TEST - Results and Analysis Background Method Concept & Design Testing Conclusion 4 Attentive Resources Working Memory Capacity • TESTS CONDUCTED: • Collinearity • Heteroskedasticity • Normality Responsiveness Perception Task structure

  33. Mostly normal in distribution Number of wrong medicine types = positive correlation with unnecessary actions Response time = +correlation with suffering duration Correct responses = -correlation w/ wrong type errors 4 / 5 (5 = very realistic) VALIDITY PILOT TEST - Results and Analysis Background Method Concept & Design Testing Conclusion 4 • Shapiro-Wilk W-test for normality • Correlation analysis • Simulation evaluation survey • Rating of how realistic simulation is

  34. USABILITY PILOT TEST - Results and Analysis Background Method Concept & Design Testing Conclusion 4 EFFECTIVENESS • High Learnability (12.03% unnecessary actions) • 40.66% of abnormal events solved by the users EFFICIENCY • “Normal” task completion times

  35. USABILITY PILOT TEST - Results and Analysis Background Method Concept & Design Testing Conclusion 4 SATISFACTION • 50% satisfaction rating • 5.25 / 6 in ease of use • Second trial slightly easier than first

  36. DEBRIEFING RESULTS PILOT TEST - Results and Analysis Background Method Concept & Design Testing Conclusion 4

  37. Use of COGLAB Memory Test • Design of a briefing video for CASNUR AREAS FOR IMPROVEMENT • More runs / replications PILOT TEST - Results and Analysis Background Method Concept & Design Testing Conclusion 4 NORMALITY OF DATA PREPARATION • Only qualitative testing for presence of mental impairments • Inconsistencies in pacing and tone of briefing voice. SOFTWARE • Unstoppable alarms make nurses more irritable or tense. • Nurses tend to forget to select the medicine first before clicking on GIVE MEDICINE. • Confusion with color on vital signs monitor. • Nurses forget to click DONE / CANCEL to return to main interface from e-cart. • Scattering of physician’s orders during experiment • Too many abnormal events occurring within the span of 5 minutes.

  38. AREAS FOR IMPROVEMENT PILOT TEST - Results and Analysis Background Method Concept & Design Testing Conclusion 4 SOFTWARE • ON/OFF toggling of alarm • Reprogramming of functions • Use of brighter color (YELLOW) • Placing of “GO BACK TO PATIENT” button in e-cart and changing CANCEL to “CANCEL addition”

  39. AREAS FOR IMPROVEMENT • Touchscreens • More subjects and runs • Do not use beyond 3 tries per subject. • Compute for performance value through control limit computation & interviews with nursing educators. • Inclusion of NASA TLX test. PILOT TEST - Results and Analysis Background Method Concept & Design Testing Conclusion 4 EXPERIMENT • Difficulty moving mouse around. • More than one run per setting is needed. • Subjects tend to get significantly better after 4th / 5th try. • Need a basis / ideal performance value for the task times. • Usability testing needs more standardization.

  40. CONCLUSION & RECOMMENDATIONS Background Method Concept & Design Testing Conclusion 5 CONCLUSION NEXT STEPS • Cognitive Work Ability (CWA) is a specialized concept for the ability of a person to fulfill mentally demanding tasks efficiently and effectively. • Simulation as performance-based method for assessing CWA among ICU nurses. • A simulation software has been successfully designed with acceptable usability ratings, reliability in data collection & simulation, and validity (face and construct). • Recommended use of software by the academe, health professionals, nurses, hospitals. • Larger experiment with more samples and actual derivation and evaluation of CWA index. • Incorporation of eye-tracking and screen-recording features in system to reduce CASNUR’s usage costs. • Testing by wider demographic (young and old). • Longitudinal testing of software and CWA index.

  41. “With society becoming older and more active, will we change the way we work…? Does it make any sense to stop being productive at a particular age?” – Ken Dychtwald (1990)

  42. TRY OUT CASNUR Look for me after the presentation / session / anytime during the IFA 2012 Conference.

  43. Questions / Comments? Feel free to e-mail them to: rustiamd@gmail.com • Thank you.

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