The most common change facing nurses today is new technology, particularly bar-coded medication administration technology (BCMA). However, there is a dearth of knowledge on how BCMA alters nursing work. This study investigated how BCMA technology affected nursing work, particularly nurses’ operational problem-solving behavior. Cognitive systems engineering observations and interviews were conducted after the implementation of BCMA in three nursing units of a freestanding pediatric hospital. Problem-solving behavior, associated problems, and goals were specifically defined and extracted from observed episodes of care. Three broad themes regarding BCMA’s impact on problem solving were identified. First, BCMA allowed nurses to invent new problem-solving behavior to deal with pre-existing problems. Second, BCMA made it difficult or impossible to apply some problem-solving behaviors that were commonly used pre-BCMA, often requiring nurses to use potentially risky workarounds to achieve their goals. Third, BCMA created new problems that nurses were either able to solve using familiar or novel problem-solving behaviors, or unable to solve effectively. Results from this study shed light on hidden hazards and suggest three critical design needs: (1) ecologically valid design; (2) anticipatory control; and (3) basic usability. Principled studies of the actual nature of clinicians’ work, including problem solving, are necessary to uncover hidden hazards and to inform health information technology design and redesign.

中文翻译：

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自动化与适应：实施条形码给药技术后护士解决问题的行为

当今护士面临的最常见的变化是新技术，特别是条形码给药技术 (BCMA)。然而，人们对 BCMA 如何改变护理工作知之甚少。本研究调查了BCMA技术如何影响护理工作，特别是护士解决操作问题的行为。在一家独立儿科医院的三个护理单位实施 BCMA 后，进行了认知系统工程观察和访谈。解决问题的行为、相关问题和目标是从观察到的护理事件中具体定义和提取的。确定了关于 BCMA 对问题解决的影响的三大主题。首先，BCMA 允许护士发明新的问题解决行为来处理先前存在的问题。其次，BCMA 使得应用 BCMA 之前常用的一些解决问题的行为变得困难或不可能，通常要求护士使用潜在风险的解决方法来实现其目标。第三，BCMA 创造了新问题，护士要么能够使用熟悉或新颖的问题解决行为来解决，要么无法有效解决。这项研究的结果揭示了隐藏的危险，并提出了三个关键的设计需求：（1）生态有效的设计；(2) 预期控制；(3) 基本可用性。对临床医生工作的实际性质（包括解决问题）进行原则性研究对于发现隐藏的危险并为健康信息技术的设计和重新设计提供信息是必要的。