Standardizing handoffs has been recommended to improve communication, with electronic tools as the primary recommendation. Despite widespread adoption of EHRs and the availability of electronic handoff tools, nurses continue to rely on paper handoff tools they refer to as "brains." This could be traced to insufficient understanding of the role that brains play in nurse'clinical work. Research has yet to examine how, when, or why brains are used throughout a shift-fundamental information needed to design an effective, usable electronic handoff tool. Though the role of nurses'brains during handoff is beginning to be addressed in the literature, without an understanding of the role brains play beyond inter-shift handoff, existing descriptions of nurses'brains are incomplete. This gap will be addressed in this study. The purpose of this dissertation research is to develop a deep understanding of nurses'brains in the context of a medical oncology unit. A grounded theory approach utilizing a symbolic interactionism framework will allow for the development of a theory of nurses'brains, including the meanings ascribed to brains, how nurses produce their brains, and understanding of the functions brains serve for nurses in a medical oncology setting. Successful strategies for the development of electronic tools will be derived from the developed theory. The study aims support AHRQ's mission to improve the quality, safety, efficiency, and effectiveness of health care for all Americans by laying the groundwork for improving the coordination of care across inter-shift transitions via the future development of better electronic tools to provide up-to-date clinical information to nurses at the bedside. Data collection and analysis will occur in two phases. During Phase 1, field observation and informal interviews will provide an initial understanding of the production and use of brains, and will inform the selection of potential participants to shadow in Phase 2. During Phase 2, participants will be shadowed during an entire shift on the unit, photographs of participants'brains at multiple points during te shift will be collected, and participants will be formally interviewed after the shadowed shifts ar completed. All data collected will be analyzed using grounded theory methods including constant comparative analysis, multiple levels of coding (open, axial, and theoretical coding), and analytic memo writing. The resulting theory will provide the proper understanding of nurses'brains and their functions is necessary to address the limited adoption of computerized handoff tools.

Public Health Relevance

The proposed project examines how nurses produce and use informal documentation in a medical oncology unit and the meaning informal documentation has within the unit culture. The results of this study will be used to develop functional and technical requirements for electronic tools to support nurses'clinical practice including inter-shift handof. Future electronic tools developed using the results of this study will address the current limited adoption of electronic nursing inter-shift handoff tools.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Dissertation Award (R36)
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Health Care Technology and Decision Science (HTDS)
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Willis, Tamara
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University of Utah
Schools of Nursing
Salt Lake City
United States
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