Greaterhealthcaredemands      !!
Healthcare meltdownAging and nursing    shortage
400,000                   1:20 vs  shortage                   ideal of   by 2020                     1:10INCREASING DEMAND...
At least 1adverse effect              70% of              deaths  INCREASED INCIDENCES of ERROR
Heterogeneous concept that must be broken down There is no specialized concept or metric for thecognitive aspect of work a...
Measure Cognitive Work Ability
Job reassignment & interventionsPredicting stress levels and likelihood of         adverse effects (ADEs)
Existing methods are insufficient &          subject to bias.
Automated and Performance-Based
CASNUR: Developing a software to assess cognitivework ability among aging nursesby Maria Dominique Rustia & Rosemary SevaH...
Background   Method   Concept & Design   Testing   ConclusionPROBLEM STATEMENT                                            ...
Background   Method   Concept & Design   Testing   ConclusionOBJECTIVES, SCOPE & LIMITATIONS                              ...
Background   Method   Concept & Design   Testing   ConclusionCOGNITIVE WORK ABILITY                                       ...
Background   Method   Concept & Design   Testing   ConclusionEXISTING ASSESSMENT METHODS                                  ...
CASNURCognitive work ability Assessment      Software for NURses
Background   Method   Concept & Design   Testing   ConclusionMETHODOLOGY                                                  ...
Background   Method   Concept & Design   Testing   ConclusionMETHODOLOGY                                                  ...
Background    Method       Concept & Design   Testing   ConclusionSOFTWARE DESIGN- Software Concept                       ...
Background   Method   Concept & Design   Testing   ConclusionSOFTWARE DESIGN – Requirements Planning                      ...
Background   Method   Concept & Design   Testing   ConclusionSOFTWARE DESIGN – Requirements Planning                      ...
Background   Method   Concept & Design   Testing   ConclusionSOFTWARE DESIGN – Requirements Planning                      ...
Background    Method   Concept & Design   Testing    ConclusionSOFTWARE DESIGN – Requirements Planning                    ...
Background   Method   Concept & Design   Testing   ConclusionSOFTWARE DESIGN - Conceptual Model                           ...
Background   Method   Concept & Design   Testing   ConclusionSOFTWARE DESIGN - Software Features                          ...
Background   Method   Concept & Design   Testing   ConclusionSOFTWARE DESIGN – Software Features                          ...
Background   Method   Concept & Design   Testing   ConclusionEXPERIMENTATION- Factor Selection                            ...
Background    Method    Concept & Design    Testing   Conclusion PILOT TEST – Subjects & Assumptions                      ...
Background   Method   Concept & Design   Testing   ConclusionPILOT TEST - Methodology                                     ...
Background   Method   Concept & Design   Testing   ConclusionPILOT TEST - Methodology                                     ...
Background    Method    Concept & Design    Testing   Conclusion  PILOT TEST - Results and Analysis                       ...
Background   Method   Concept & Design    Testing   ConclusionPILOT TEST - Results and Analysis                           ...
Background   Method   Concept & Design   Testing     ConclusionPILOT TEST - Results and Analysis                          ...
Background   Method     Concept & Design   Testing   ConclusionPILOT TEST - Results and Analysis                          ...
Background   Method   Concept & Design   Testing   ConclusionPILOT TEST - Results and Analysis                            ...
Background   Method   Concept & Design   Testing   ConclusionPILOT TEST - Results and Analysis                            ...
Background   Method   Concept & Design   Testing   ConclusionPILOT TEST - Results and Analysis                            ...
Background   Method   Concept & Design    Testing   Conclusion PILOT TEST - Results and Analysis                          ...
Background   Method   Concept & Design   Testing   ConclusionPILOT TEST - Results and Analysis                            ...
Background   Method   Concept & Design   Testing   ConclusionPILOT TEST - Results and Analysis                            ...
Background   Method   Concept & Design   Testing   Conclusion  CONCLUSION & RECOMMENDATIONS                               ...
“With society becoming older and more active, willwe change the way we work…? Does it make anysense to stop being producti...
TRY OUT CASNURLook for me after the presentation / session / anytime during the IFA 2012 Conference.
Questions / Comments?            Thank you.  Feel free to e-mail them to:    rustiamd@gmail.com
3 rustia casnur-ifa2012
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3 rustia casnur-ifa2012

  1. 1. Greaterhealthcaredemands !!
  2. 2. Healthcare meltdownAging and nursing shortage
  3. 3. 400,000 1:20 vs shortage ideal of by 2020 1:10INCREASING DEMANDS on SENIOR NURSES Retention of Workers Strategy
  4. 4. At least 1adverse effect 70% of deaths INCREASED INCIDENCES of ERROR
  5. 5. Heterogeneous concept that must be broken down There is no specialized concept or metric for thecognitive aspect of work ability and there are also no methods at present to measure / assess this.
  6. 6. Measure Cognitive Work Ability
  7. 7. Job reassignment & interventionsPredicting stress levels and likelihood of adverse effects (ADEs)
  8. 8. Existing methods are insufficient & subject to bias.
  9. 9. Automated and Performance-Based
  10. 10. CASNUR: Developing a software to assess cognitivework ability among aging nursesby Maria Dominique Rustia & Rosemary SevaHuman Factors and Ergonomics Center, De La Salle University, Manila, Phil.rustiamd@gmail.comMay 28, 2012IFA 2012 Global Conference on Ageing
  11. 11. Background Method Concept & Design Testing ConclusionPROBLEM STATEMENT 1• Existing assessment methods for work ability among nurses are subject to response bias and fail to consider the cognitive dimension of tasks.• There is a need for a performance-based assessment method for cognitive work ability (CWA) to be established, especially in the context of ICU nursing.
  12. 12. Background Method Concept & Design Testing ConclusionOBJECTIVES, SCOPE & LIMITATIONS 1OBJECTIVES• to provide a reliable and valid measure of CWA among hospital nurses by developing a software application that can assess CWA among them.1. To test the validity of the CWA assessment software2. To perform an initial evaluation of the usability of the software3. To determine the reliability & effectiveness of software in capturing data for CWA metric derivation4. To identify areas for improvement in the softwareSCOPE & LIMITATIONS Hospital nurses, ages 40-65, Intensive Care Unit (ICU) setting Philippine setting Will only test variables of CWA model of Rustia & Seva (2011) Will not propose any interventions Conceptualization and design of software Gender, affective & physical needs not considered
  13. 13. Background Method Concept & Design Testing ConclusionCOGNITIVE WORK ABILITY 1Work Ability Index (WAI)  “how good workers are at present and in thenear future, and how they will be able to do their work with respect to work demands, health and mental resources” (Ilmarinen & Tuomi, 2003) speed accuracy Cognitive Work Ability (CWA)  the ability of a person to fulfill mentally demanding tasks efficiently and effectively
  14. 14. Background Method Concept & Design Testing ConclusionEXISTING ASSESSMENT METHODS 1 • Reliability and validity have Work Ability WHO Quality of been verified but coverage of Index (Ilmarinen Life (WHO, components of CWA is poor & Tuomi, 1992) 1991) • Questionnaire-based, risk of biased and inaccurate answers Expanded • No performance-based TISS-28 evaluation methods to date Nursing Stress (Miranda et al., Scale (French et 1996) al., 2007) Revised Nursing Work Index SIMULATION OF THE (Aiken & NURSING ENVIRONMENT Patrician, 2000) (low cost  software)
  15. 15. CASNURCognitive work ability Assessment Software for NURses
  16. 16. Background Method Concept & Design Testing ConclusionMETHODOLOGY 2
  17. 17. Background Method Concept & Design Testing ConclusionMETHODOLOGY 2 Systems Development Life Cycle
  18. 18. Background Method Concept & Design Testing ConclusionSOFTWARE DESIGN- Software Concept 31 SIMULATION 2 DATA-GATHERING 3 EVALUATION
  19. 19. Background Method Concept & Design Testing ConclusionSOFTWARE DESIGN – Requirements Planning 3 ACCURACY SPEED PERFORMANCE QUALITY• Applied Cognitive Task Analysis (ACTA) applied to determine cognitive processes in regular ICU nursing tasks.
  20. 20. Background Method Concept & Design Testing ConclusionSOFTWARE DESIGN – Requirements Planning 3 SIMULATION INTERVIEW & KNOWLEDGE AUDIT MONITOR and ALARM hard to say immediately where the problem is EMERGENCIES lead to improvising presence of mind and alertness, prioritization, good memory, speed checking, finding discrepancies in medicine arrangement and labeling of medicine, better systems
  21. 21. Background Method Concept & Design Testing ConclusionSOFTWARE DESIGN – Requirements Planning 3
  22. 22. Background Method Concept & Design Testing ConclusionSOFTWARE DESIGN – Requirements Planning 3 Constantly changing E-cart to concentrate on individual skill Computerized to remove bias related to handwriting & techniqueOther Characteristics: Simulation must also have the same layout as actual ICU generation• 1 SIMULATION Abnormal event in the Philippines• Emergency ICU case  feeling of “time pressure” and urgency DATA-GATHERING Errors, Actions, Responses 2
  23. 23. Background Method Concept & Design Testing ConclusionSOFTWARE DESIGN - Conceptual Model 3
  24. 24. Background Method Concept & Design Testing ConclusionSOFTWARE DESIGN - Software Features 3
  25. 25. Background Method Concept & Design Testing ConclusionSOFTWARE DESIGN – Software Features 3
  26. 26. Background Method Concept & Design Testing ConclusionEXPERIMENTATION- Factor Selection 3 Measurable by CASNUR Measurable by CASNUR and eye-tracker software Measurable by CASNUR and eye-tracker software Measurable by CASNUR
  27. 27. Background Method Concept & Design Testing Conclusion PILOT TEST – Subjects & Assumptions 4SUBJECTS & ENVIRONMENT• Filipino nurses, ages 45+• Fluent in English and Filipino• Capable of using computers• No physical or mental diseases / impairments• Must have had experience in ICU / emergencies• Day shift to avoid influence of night shifts• Pre-scheduled appointments to avoid rushingASSUMPTIONS The participants selected are representative of thetargeted users of CASNUR. The medications are assumed to be correct even ifthey medically are not. The frequency of errors is assumed to be correct. The subjects were physically, mentally andemotionally fit before testing.
  28. 28. Background Method Concept & Design Testing ConclusionPILOT TEST - Methodology 4 Subject Profile Survey CASNUR software Usability Plan, CASNUR Usability Questionnaire Dikablis Eye-Tracker & Software CASNUR + Eye-Tracker + Morae Simulation Evaluation Survey
  29. 29. Background Method Concept & Design Testing ConclusionPILOT TEST - Methodology 4 RELIABILITY VALIDITY USABILITY EFFICIENCY Testing of successful How close the simulation generation of variables EFFECTIVENESS is to real-life situations and events SATISFACTION
  30. 30. Background Method Concept & Design Testing Conclusion PILOT TEST - Results and Analysis 4 RELIABILITY SIMULATION DATA- Vital Signs Monitor changes, GATHERINGalarms and indicates abnormality Error identification, counting and recording• Emergency cart with fullfunctionality of selecting and Response / actionadding medicine to table identification, counting and recording• Medicine Table with maximumcapacity of 3 medications Visual timer on interface• Administration of oxygen, Export feature to EXCELdextrose and medicine (input ofdosage)
  31. 31. Background Method Concept & Design Testing ConclusionPILOT TEST - Results and Analysis 4 RELIABILITY 10 variables measured
  32. 32. Background Method Concept & Design Testing ConclusionPILOT TEST - Results and Analysis 4 VALIDATION OF CWA MODEL FROM RESULTS Working Memory Attentive Resources CapacityTESTSCONDUCTED: Perception Responsiveness Collinearity Heteroskedasticity Normality Task structure
  33. 33. Background Method Concept & Design Testing ConclusionPILOT TEST - Results and Analysis 4 VALIDITY Shapiro-Wilk W-test for normality Mostly normal in distribution Correlation analysis Number of wrong medicine types = positive correlation with unnecessary actions Response time = +correlation with suffering Simulation evaluation survey duration Correct responses = -correlation w/ wrong type errors Rating of how realistic simulation is 4 / 5 (5 = very realistic)
  34. 34. Background Method Concept & Design Testing ConclusionPILOT TEST - Results and Analysis 4 USABILITYEFFECTIVENESS High Learnability (12.03%unnecessary actions)• 40.66% of abnormal eventssolved by the users EFFICIENCY “Normal” task completiontimes
  35. 35. Background Method Concept & Design Testing ConclusionPILOT TEST - Results and Analysis 4 USABILITYSATISFACTION 50% satisfaction rating 5.25 / 6 in ease of use Second trial slightly easier than first
  36. 36. Background Method Concept & Design Testing ConclusionPILOT TEST - Results and Analysis 4 DEBRIEFING RESULTS
  37. 37. Background Method Concept & Design Testing Conclusion PILOT TEST - Results and Analysis 4 AREAS FOR IMPROVEMENTNORMALITY OF DATA More runs / replicationsPREPARATION1. Only qualitative testing for presenceof mental impairments Use of COGLAB Memory Test2. Inconsistencies in pacing and tone of Design of a briefing video for CASNURbriefing voice.SOFTWARE1. Unstoppable alarms make nurses more irritable or tense.2. Nurses tend to forget to select the medicine first before clicking on GIVE MEDICINE.3. Confusion with color on vital signs monitor.4. Nurses forget to click DONE / CANCEL to return to main interface from e-cart.5. Scattering of physician’s orders during experiment6. Too many abnormal events occurring within the span of 5 minutes.
  38. 38. Background Method Concept & Design Testing ConclusionPILOT TEST - Results and Analysis 4 AREAS FOR IMPROVEMENTSOFTWARE ON/OFF toggling of alarm Reprogramming of functions Use of brighter color (YELLOW) Placing of “GO BACK TO PATIENT”button in e-cart and changing CANCELto “CANCEL addition”
  39. 39. Background Method Concept & Design Testing ConclusionPILOT TEST - Results and Analysis 4 AREAS FOR IMPROVEMENTEXPERIMENT Touchscreens1. Difficulty moving mouse around. More subjects and runs2. More than one run per setting is Do not use beyond 3 tries perneeded. subject.3. Subjects tend to get significantly Compute for performancebetter after 4th / 5th try. value through control limit4. Need a basis / ideal performance computation & interviews withvalue for the task times. nursing educators.5. Usability testing needs more Inclusion of NASA TLX test.standardization.
  40. 40. Background Method Concept & Design Testing Conclusion CONCLUSION & RECOMMENDATIONS 5• Cognitive Work Ability (CWA) is a specialized • Larger experiment with more concept for the ability of a person to fulfill samples and actual derivation mentally demanding tasks efficiently and and evaluation of CWA index. effectively.• Simulation as performance-based method for • Incorporation of eye-tracking and assessing CWA among ICU nurses. screen-recording features in• A simulation software has been successfully system to reduce CASNUR’s designed with acceptable usability ratings, usage costs. reliability in data collection & simulation, and • Testing by wider demographic validity (face and construct). (young and old).• Recommended use of software by the academe, health professionals, nurses, • Longitudinal testing of software hospitals. and CWA index.
  41. 41. “With society becoming older and more active, willwe change the way we work…? Does it make anysense to stop being productive at a particular age?” – Ken Dychtwald (1990)
  42. 42. TRY OUT CASNURLook for me after the presentation / session / anytime during the IFA 2012 Conference.
  43. 43. Questions / Comments? Thank you. Feel free to e-mail them to: rustiamd@gmail.com

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