User-Centered Mapping of Nurses’ Workarounds to Design Principles for Interactive Systems in Home Wound Care

Abstract

The trend to discharge patients early from acute care settings to the home has increased the demand put on homecare nurses. Substantial portions of homecare patients have chronic or difficult to heal wounds. Homecare nurses use electronic patient documentation systems to input data, to support clinical decisions and to provide appropriate care for patients. These systems often do not support aspects of nurses' clinical work. Finding themselves facing barriers related to these systems, nurses create and use alternatives to overcome the barriers. These alternatives are called workarounds. The study presented here aims to identify possible mappings of workarounds as user feedback to design principles for wound documentation applications. Homecare nurses providing wound care were followed for 120 hours. Workarounds created and used by these nurses to provide care for patients with wounds were identified and mapped to design principles. The instances of workarounds were topically coded to identify their attributes. These attributes were used to extend previous work situation analysis models and form a new conceptual model called the "workaround situation model". The workaround situation model was used to identify the most common workaround situations and these were validated using a follow-up survey. After validation, a mapping process was formalized to identify and contextualize relevant design principles for patient documentation systems with the attributes of common workaround situations. The results were a set of mapped patient documentation system design principles for patients with wounds. Our results indicate it is possible that use of the workarounds as user feedback can inform new design principles and support nurse-centered design.