1.
Carry on Pumping
Franny Gant
UX Architect
Haematology Nurses
&
Digital Infusion Pumps
HCI MSc UCL
CHI+MED

2.
I have a Social Anthropology bachelors degree and
I’m drawn to this type of research because of
- The social aspect
- And looking at the whole workspace and
technology within it
there’s a lot going on
“the messy details” of the workplace
Need to focus research on the right things

3.
Something cool that came out of California in the 80s

4.
Distributed Cognition Framework
Distributed Cognition
understand group work situations
using ethnographic research techniques
Hutchins et al

5.
Distributed Cognition Perspective
DCog looks at
cognitive processing of the whole
workplace system
Extending on models of individual
cognition to LARGER UNIT
It adds a social aspect
Understand normal work practices better...
helps design technology to support work
rather than disrupt it

6.
DiCoT methodology (drawing from... CI
& GT)
To structure observations and analysis.
Distributedlayout to
Paying attention
physical
Cognition for flow
artefacts
information
social structures
Teamworking
(DiCoT) Contextual Inquiry
UCLiC Grounded Theory

7.
Challenges
Ethical clearance
Gaining access
Serious illness
Challenges of fieldwork in healthcare
settings:
- focus on pumps, not people
- Vetted by hospital – background check,
blood tests – because of vulnerable people
- Emotionally charged environment –
sensitivity needed

8.
Open jotting of notes brings up some
issues
People can feel uncomfortable
They got used to me being there
Open jotting
Kitchen Stories is a good film… even if
you’re not an ethnographer
Kitchen Stories
Bent Hamer
2003

9.
Important to build trust and rapport with
people
INTRODUCE-
I put this notice up in shared spaces
Email sent round
EXPLAIN-
“I’m here to study the how the devices fit
Introducing
with your work, not auditing you”.
myself

10.
Getting consent from everyone followed
Consent gained
(don’t follow people who decline)
Permission from each patient (nurses help)
One nurse who sternly questioned me
became a key informant

11.
Night & Day?
Spent 28 hours total on two haematology
wards
all times of day and night over 4 weeks
Thought there might be some major
contrast between night and day work

12.
Round-the-clock
•I found there was a continuous flow to the work that carried on around the clock.

13.
Pumps
Pumps used all the time in haematology
accurate delivery of drugs
‘high risk’ devices - A mis-entered
number...
support the nurses’ cognitive work of
giving treatments:
...nurses said things like... “the pump
backs up my maths”...
“it reminds you... and gives you a few
minutes to go and get the new drug”

14.
“It’s about safetytoand speed...
infusions can last up 36 hours
we’re givingistime. much fluid.
“Line space” so
depending on
a limited resource
We normally give reminders to flush it
nurses use the pumps as a drug,
through,ofgivenotanother, flush it
save time between end of one infusion and
start the next
a workaround designed for by the
through...”
manufacturer

15.
I shadowed nurses in their work.
unstructured ad hoc questions when I
Data collection
could.
semi-structured interviews to check
understanding
Noted things they said and did
Letter coding system for later analysis
(thanks Atish Rajkomar)

16.
Web of artefacts in their work
a “web of artefacts” is used
These
process information and
- communicate status of the ward system
Written notes
Drug charts
Whiteboards
Drug labels

17.
Physical layout
In Dcog – pay attention to physical space
Horizons of observation
Side rooms that have closed doors to
control infection.
Nurses can’t see the status of pumps
behind the doors (and sometimes, can’t
hear them alarming).

18.
Flow of
information
Flow of information …
nurses rely on patients as part of the
communication loop with the pumps
If a patient is asleep, nurses may not get
called
breakdown in communication which can
lead to delays

19.
Outcomes
Technology design for
- continuous use contexts
- communication from side rooms
My study highlights that...
Pump technology needs to be designed for
use over long periods of time.
- Nurses are using pumps in non-
prescribed ways as reminders to save time
On wards with side rooms...
Nurses are reliant on patients to
communicate pump alerts
- need to enable pumps to communicate
directly with ward staff

20.
Best times
Right people
Tips:
Equipment they will be doing what
Best times – when
you want to see
Reflection doing the work; with an
Right people –
overview; supportive of the research
I took camera, voice recorder, note book --
spare pens & batteries.
Reflect on method and own biases.

21.
“Needs further investigation…”
How I would like to do it differently…
Research in two phases
one without domain knowledge (see more
details)
one with
Interesting to
follow the events with one pump for a day
and one nurse for a shift
Be able to look at the patient experience of
the pumps –they have a direct relationship
with the technology.

22.
Time =
Pros & Cons
Ethnographic studies can take time.
Gives - in depth knowledge of activities
that need to be seen in the wild.
DCog & DiCoT is a great way of looking at
the coordinated action of teamwork
how technology can support, not disrupt it
Combining qualitative studies with
quantitive – to see what’s happening at key
stroke level – build complete picture.
Can take this domain knowledge and use
it in other research.

23.
Behind closed doors
– a distributed cognition study of infusion
pump use in round-the-clock haematology
treatment http://bit.ly/gant2011ucl
Look ups…
University College London Interaction Centre – UCLiC http://
www.ucl.ac.uk/uclic
CHI+MED http://www.chi-med.ac.uk/
DiCoT – Furniss, Blandford, et al
Distributed Cognition – Hutchins
Contextual Design – Beyer and Holtzblatt
Grounded Theory – Charmaz
Type of pump – BBraun Infusomat Space
Kitchen Stories, Bent Hamer 2003