I am currently devoting the majority of my research efforts to the HeartCare II project. My role in this project involves working with research team members at UW and Aurora Health Care Systems, Milwaukee , WI. We are conducting a randomized field experiment in which we used human factors design strategies to create a Technology Enhanced Practice (TEP) to support the home care of patients with heart failure. This study provides an opportunity to understand the impact of TEP on patient self-management and self-monitoring of CHF.
Design strategies included a Work Systems Analysis of the home care nurses' practice to identify aspects of the practice that could be enhanced by technology and to characterize aspects of the clinical situation amenable to consumer health informatics tools/interventions. Participatory design elements included focus groups with nurses, individual interviews and integration of clinical guidelines in the TEP.
Aims of the HeartCare II study are to design the technology and examine its impact on patient outcomes.
Because this project is unique in that it provides the opportunity to integrate consumer health informatics tools in the formal nursing care system, I hope to be able to evaluate the impact of the technology on nursing practice. The following is the abstract of the study I propose to conduct:
This study proposes to document the nursing practice consequences of a Technology Enhanced Practice (TEP) on nursing care delivery in the home and explore the processes nurses used to facilitate self-management in patients with CHF. It will capitalize on the parent study, “Custom Computer Support: Home Care of CHF Patients”, which will provide the Technology Enhanced Practice (TEP) to home care nurses and their patients with CHF. In the parent study, evaluation of the impact of the TEP will focus on patient outcomes, patient use of the system, and health care service utilization.
Evaluation of technology implementation in health care frequently focuses on the outcomes of the intervention, to the exclusion of the technology’s impact on the process of delivering care. As an adjunct to the parent study, this study proposes to examine the impact of the TEP on the processes of care. It will benefit from on the extensive work analysis done in the design of the TEP. The proposed study provides the opportunity to describe changes in nursing care practices following the implementation of the TEP, to understand nurses’ use of the TEP, their perception of their role in facilitating patient self-monitoring and symptom management, as well as the impact of the use of the TEP on implementing this role. This is a unique opportunity in that the TEP is designed to address both patient self-management practices and nurse use to facilitate self-care behaviors.
This exploratory study will use an open-ended interview technique with 10 home care nurses and their patients with CHF to enable data collection related to: nursing care practices, knowledge and use of the TEP to promote self-monitoring and symptom management, perceived effectiveness of these strategies, and patient use of self-management strategies. The actual and potential uses of the TEP to facilitate self care will be examined. Nurses will be followed through their period of participation in the parent study, approximately 18 months. Analysis of the interview tapes will employ content analysis strategies with validation by participants and expert cardiac nurses in the home care agency.
Results of this study will be used to develop a description of the impact of TEP and a model of the strategies that nurses use with the aid of a TEP to enable patient self-management. Results can serve as a benchmark for measuring the impact of technology in home care nursing and as a model against which nurses can evaluate the care they provide and the self-management their patients use.
Date last modified: 10/13/2005 10:00:14 AM CST
Date created: 04-Oct-2004
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