The importance of understanding human factors in the healthcare setting didn’t really hit me until my first day on the ward as a newly qualified registered nurse. Despite the previous three years of clinical training, which involved numerous placements in a variety of acute and community care environments, it was only when I was no longer under the ‘protection’ of being a student did the reality of working in an acute nursing role hit. Three separate incidents during my first month as a staff nurse, each concerning a different area of human factors, demonstrated to me how far behind the healthcare sector was in recognising human factors issues, and how little clinical staff were actually compelled to change their working environment.
The first incident wasn’t a specific event as such, but more of a general feeling of being completely overwhelmed by the sheer number of issues that were occurring on the ward continually throughout the shift. Call bells, ward rounds, telephone calls, clinical interventions, admissions, discharges, theatre lists, medications, relative meetings, personal care, paperwork, etc, etc. Every time I completed a task five more had been added to the bottom of my mental checklist. There was no ability to control the inputs, everything was reactive and rushed. I was suffering from complete task saturation. I couldn’t believe that this state of working was considered normal by the experienced staff, and that you either got used to it or left.
The second incident took place in the anaesthetic room. I had escorted a patient with a fractured ankle to theatres, and was asked by the anaesthetist to help out in the anaesthetic room by positioning the patient’s leg whilst she attempted to put in a local nerve block. The patient was duly anaesthetised, and attention was switched to getting the nerve block done. This proved to rather tricky, so much so that both the anaesthetist and the ODP became so fixated with getting the block in the ankle that they lost track with what was happening at the other end of the trolley. The patient has stopped breathing.
The final incident occurred on the orthopaedic ward itself. I had joined the ward at the height of the summer, and as is common with many public sector buildings, the environmental controls left a lot to be desired. The temperature on the ward was constantly over 90ºF with little air movement, and many staff and patients were struggling to cope. Our calls to senior staff were unheeded, so I decided to take an hourly reading so I would have some data to back up our concerns. After three days of collecting readings I submitted them to the senior nurse. A day later the divisional senior nurse walked onto the ward and without saying a word confiscated the thermometer I had been using.
Having previously worked as an engineer and project manager in both aviation and maritime settings, I was astounded at how antiquated working practices and attitudes were. I started to carry out some small scale research projects, mainly looking at how nurses cope with the demands of the contemporary acute nursing. I also enrolled onto the Health Ergonomics MSc online at the University of Derby. Below is a list of some of the research I have conducted in the past 7 years:
Edwards R, J (2011) Neglect: An ergonomic assessment of the issues surrounding nursing and failures in care, In Alblino S, Baqnara S, Bellandi T, Llaneza J, Rosal-Lopez G & Tartaglia R (Eds) Healthcare Systems Ergonomics and Patient Safety: Proceedings on the International Conference on Healthcare Systems Ergonomics and Patient Safety, CRC Press, Boca Raton.
Edwards R, J (2010) Stress and burnout in acute sector ward based nursing: An ergonomic assessment, In The Ergonomist.
Edwards R, J (2009) Task saturation in orthopaedic nursing: Recognising the dangers and formulating solutions, In Journal of Orthopaedic Nursing, 13, 1. p31.
Edwards R, J (2013) The problem of the superficial femoral vein: A short case study. Paper presented at the 2nd World Congress on Clinical Safety, Heidelberg, Germany.
Edwards R, J (2009) Task saturation in orthopaedic nursing. Paper presented at the Canadian Orthopaedic Nursing Association 32nd annual conference, Kelowna, Canada.
Edwards R, J (2008) Task saturation in orthopaedic nursing: Recognising the dangers and formulating solutions. Paper presented at the Royal College of Nursing Society of Orthopaedic and Trauma Nurses 22nd annual conference, Llandudno, UK.
Edwards R, J (2006) Health promotion and the tenets of successful communication. Poster presented at the Royal College of Nursing Society of Orthopaedic and Trauma Nurses 20th annual conference, Southport, UK.
Having now completed the MSc, I’m continuing to independently research a variety of ergonomic issues within healthcare, specifically human error, stress, work design and human performance. If you would like copies of any of the above papers and presentations, or to discuss any points further, please feel free to contact me on Robin.Edwards@nobles.dhss.gov.im