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Vincent G. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Cognitive strategies analysis results in a description of the cognitive strategies that might be used to execute cognitive processes identified in work task analysis. While it is possible map the alternate strategies onto a decision ladder, a two-column table offers a more convenient representational format.

The first column identifies the potential strategies with sufficient detail to clarify how the strategy is executed. The second column specifies the circumstances under which a particular strategy may be preferred. Cognitive strategies analysis can then be used to identify a range of generic methods for executing some of the cognitive processes. A competency is a capability to perform a task to a certain level of effectiveness. Cognitive work analysis focuses on cognitive competencies of three types;. Cognitive competencies analysis identifies the competencies used with various cognitive processes or strategies in the execution of a work task.

Cognitive processes and cognitive strategies do not typically involve only one level of cognitive competency but rather may rely on a combination of two competencies or on all three. The product of this stage of analysis is a description of the activity elements associated with the different modes of cognitive processing. As in cognitive strategies analysis, it is possible to annotate a decision ladder with the appropriate information but an adaptation of the two-column table developed for cognitive strategies analysis offers a more convenient representational format.

As before, the first column identifies the potential strategies or, alternatively, other work task elements such as cognitive processes or clusters of cognitive processes. The second column specifies the cognitive competencies associated with particular strategies or work task elements. Cognitive competencies analysis can be used to identify the competency levels at which each of the cognitive processes is executed.

Within a work environment, social organization refers to the way in which work is distributed, coordinated and managed. Social organization analysis identifies how work can be shared between workers, how it can be distributed temporally and spatially, and how it can be supported and guided through the hierarchical levels of an enterprise.

Applications of Cognitive Work Analysis

Social organization analysis is concerned firstly with organizational structure and distribution of work. Organizational structures will necessarily be based on needs for authority, oversight, strategic guidance and reporting, and on the size of the organization. For large enterprises, structures will need to be designed at several levels of scale, for example at the scale of the whole organization, at the scale of individual business units within the organization, and at the scale of work teams.

It is unlikely that a particular organizational structure will work for all business units or all teams. Additionally, the work teams must be structured to accommodate the nature of the work. Skill levels and experience needed for work components, needs for assistance, and requirements for specialty expertise must all be considered. Once a structure is in place, work units are coordinated through collaboration between peers and collaboration between management and workers; the lateral connectivity that supports essential collaboration and sometimes, competition between peers and the vertical connectivity that supports essential manager-worker coordination.

There will also be needs interaction, information access and product delivery across the boundary of the organization. The supporting coordination processes are primarily communication events of various types. Social organization analysis identifies the generic properties of characteristic communication events that maintain social organization within a work domain.

Social organization analysis results in a description of the organizational structures and of the coordinative work processes that support collaboration between peers within a team or work group at any of the hierarchical levels within an organization. It also develops a description of the overall organizational structure and of the coordinative work processes that support interactions between the hierarchical levels within an organization such as those between a team leader and team members or between management and workers.

Processes that support organizational integration such as statements of intent by senior management, rules, processes and procedures that guide the organization, and worker support processes such as those that may be provided by human resource or administrative support departments constitute important elements of the vertical connectivity that supports organizational integration. Finally, social organization analysis takes account of interactions with entities external to the organization, interactions such as acquisition of information and promulgation of plans and reports.

As a result of the analyses that have been conducted since the work organization analysis, it should be possible to think about which work tasks can be undertaken with a particular skill set and level of expertise. A set of closely linked tasks that demand a common skill set and level of expertise can be viewed as a module of work. The prior analyses will also have generated ideas for technological support for these work tasks and so it may now be possible to propose staffing levels.

Where the work demands within a module exceed what can be handled by one person, staffing numbers can be increased to the appropriate level. The nature of the work will suggest how the work might be distributed among workers and that will lead to development of an appropriate teaming structure. For example, it may be preferable to give different workers responsibility for different components of a work module or it may be preferable to have the different workers take care of complete jobs within that work module.

The nature of the work and the way in which it is distributed will have implications for communication demands within a work module.


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Additionally, it will be useful to assess the communication demands with external agencies and to that end, it will be necessary to articulate to at least some degree the functional structures of those entities and the sorts of roles they play in shaping the work within the organizational entity that is being analyzed. A situation-specific scratch pad for analysis of the social organization of work. CWA incorporates a set of analytic tools for exploration of different types of work capabilities and constraints.

At their simplest, the CWA phases can be applied using pen and paper only. However, typically interviews and observational study are required, and so audio and video recorded equipment may be needed. CWA outputs are also typically large and require software support in their construction. CWA offers a mechanism to transfer results from an in-depth analysis of human-information-work interaction directly to design requirements. Objective measures cannot consciously be influenced by individuals and they not only provide a measure of mental effort for a task as a whole, but also indicate how it varies throughout the task.

The methods within the framework are extremely useful. The abstraction decomposition space in particular can be used for a wide range of purposes.

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CWA can elicit a large amount of data which correspondingly takes a long time to analyze and because of the amount of data generated, Cognitive Work Analysis researchers, who often work alone or in small research groups, do not use large sample sizes. To apply additional theories, the researcher must become familiar with literatures outside of his or her field and be comfortable with multidisciplinary work.

Knowledge of LIS or computer science theories alone are generally insufficient to explain all of the observations uncovered during the study.

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In the ideal situation, after system design, researchers and designers would return to evaluate the system and make changes as necessary. Unfortunately, this is expensive and time consuming.


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It is easier for organizations to go with the initial design until problems erupt again. Taking physiological measurements such as heart and respiration rate can itself appear intimidating. Vicente describes the following approaches for the CWA framework: the abstract ion — decomposition space work domain analysis , decision ladders, control task analysis , information flow maps strategies analysis and the SRK framework workers competencies analysis.

Cognitive work analysis will not always be appropriate for analysis of small, contained systems or for independent analyses of parts of systems but for analysis of large-scale socio-technical systems, it adds a unique capability to our human factors and cognitive systems engineering tool set. The reliability and validity of the CWA framework is difficult to assess. The flexibility and diversity of the methods used ensure that reliability is impossible to address, although it is apparent that the reliability of the approaches used may be questionable.

Empirical studies and conceptual developments were documented in a series of internal publications analyzing mental strategies Rasmussen and Jensen , control tasks Rasmussen , work domains Rasmussen , and worker competencies Rasmussen As they were not informed of patient fall risk or RN fall prevention interventions, they relied instead on visual cues eg, bracelets, slippers, stickers to determine fall risk.

The nurses' workaround to decipher patient fall risk was to rely on informal querying of the previous care nurse about fall status. It is possible than an inadequate understanding of or lack of confidence in the current MIS may have led to its underutilization. It is also important to note that informal querying contributes to human error; formalized documentation systems would better inform fall risk while decreasing the time spent obtaining a patient's status.

The physical layout of the unit removed nurses from physical proximity to their patients and did not permit direct patient visibility. It is quite difficult for a nurse to prevent a fall when positioned far from the patient—while at the nursing station, for example, to mix medication, access equipment, or update documentation. There were no means of formal surveillance to deal with this constraint. In particular, from the location of the nursing station figure 1 there was a direct viewing angle into only 3 of 17 patient rooms.

The nurses' workaround was to add informal video and audio surveillance to improve patient visibility. Many nurses sought to monitor patients by using closed-circuit video or relying on video assistants to watch the monitors to patient rooms. However, most cases where an impending fall might be detected would be caught essentially by chance when a nurse happened to be in position near the camera.

Also, video cameras were used only in those rooms five in total, apart from the three with direct visual angles where epileptic patients were assigned. Other nurses relied on reports from the unit clerk, the person to whom patients in all rooms could call over the audio intercom. In one observed case, a nurse was able to use this means to talk a patient back into bed, but this likely is a rare occurrence. While increased audio and video surveillance of patients may alert nurses to an impending fall, the knowledge often occurs too late to prevent it.

Patients at risk for falling benefit from having people nearby who can quickly respond to an impending fall. Some redesign strategies to overcome this constraint include relocating nurses' indirect care tasks to be in close physical proximity to the patients' bedside and to allow more space for patient family members to stay overnight.

The study methodology yields a few limitations. First, as with all single-site research, the findings are unlikely to generalize completely to all inpatient nursing units. The similarity of the other nursing units and their work processes to the one studied must be considered before applying the results of this research. Second, a convenience sample of nursing unit volunteers was used and as such the potential for bias exists. Fourth, there are some inconsistencies in the data from different data sources. For example, respondents rated themselves highly on the Nursing Knowledge of Fall Prevention Subscale while in focus groups, and they discussed inadequate understanding of how to use the MIS for fall prevention.

Perhaps part of the reason nurses reported this constraint is because there are no prompts or fields related to fall prevention in the MIS. Additional reasons for differences between data sources are likely due to the differences between open ended focus group and closed response survey forms of questioning. The surveys used in this study did not directly assess nursing knowledge, and self-report data of this nature can have systematic self-report bias.

Finally, the void of psychometrically validated tools for extrinsic systems factors led us to develop the Fall Prevention Survey. While its face validity was assessed by cognitive engineers and advanced practice nurses, there is a need for full psychometric testing. This study indicates that constraints in the acute care environment may lead to increased patient falls. Traditionally, extrinsic work system factors, such as nurse staffing, knowledge of fall prevention, and safety culture, have been emphasized along with intrinsic patient risk factors.

Despite the emphasis in these areas, patients continue to fall. This study sheds greater light on how nursing work processes and the physical work environment contribute to the risk of patient falls. Some of the factors identified can be rectified rather simply, as in the case of standardizing hand-offs between nurses and nurse assistants. Other factors—such as limitations in the physical environment, lack of capability in the MIS, ineffective bed alarms, and unique aspects of nursing workload—are more systemic and require complex solutions.

Solutions must consider the low mental but high temporal demands of the work domain, that nurses track and execute numerous tasks in parallel, and are often physically separated from individual patients for large chunks of time. Moving forward, when nursing work processes and the physical work environment are considered together with traditional factors, broader solutions can be developed with greater potential for preventing patient falls.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Library of Medicine or the National Institutes of Health. Oxford University Press is a department of the University of Oxford.

It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Specific aims. Overview of cognitive work analysis.

Study limitations. Competing interests. Ethics approval. Provenance and peer review. Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting Karen Dunn Lopez. Oxford Academic. Google Scholar. Gregory J Gerling. Michael P Cary. Mary F Kanak. Cite Citation. Permissions Icon Permissions. Abstract Objective To identify factors in the nursing work domain that contribute to the problem of inpatient falls, aside from patient risk, using cognitive work analysis. Human factors , cognitive engineering , patient falls , safety , nursing , work analysis , adverse events.

Open in new tab Download slide. Table 1. Open in new tab. Table 2. FG: Fall prevention takes a lower priority amid more acute and immediate problems. FPS: Nurses report that timed voids, ambulation assistance, and use of restraints are difficult. FO: Inadequate exchange of fall risk information between RNs at shift change.

Cognitive Work Analysis: Toward Safe, Productive, and Healthy Computer-Based Work

Informal audio and video surveillance. Table 3. See text for more details on anchors. Table 4. Risk of falls for hospitalized patients: A predictive model based on routinely available data. Search ADS. Implications of medicare reimbursement changes related to inpatient nursing care quality. Intervention to prevent falls on the medical service in a teaching hospital. Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. To err is human: building a safer health system committee on quality of health care in America.

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