First observation day, part 2: the perks of immersion

When it comes to analyzing work practice, I have found that one of the main challenges for the researcher is to learn to “speak the language” of the observed population. The researcher needs to develop an understanding for those aspects of the work practice that practitioners don’t explicitly mention, but which nonetheless are a significant part of their work and work environment. The problem is that the more experience we have with doing something, the more difficult it becomes to verbalize how we go about doing it. In addition, many work environment factors are simply difficult to put into words.

Observation provides, to a certain extent, a solution to that problem as it makes it unnecessary for the observed individuals to verbalize every aspect of their work. Until recently, my experience with observation within healthcare was limited to watching video recordings of emergency medical interventions and a live streaming of an open-heart surgery. Those instances provided me with a basic understanding of the workflow of an operation and the specific role taken on by each clinician involved in the intervention. However, I realized during my observation day at the Department of Pediatric Surgery that I had overlooked several essential factors specific to the work environment of clinical nurses. This realization came from the fact that for the first time, I wasn´t an outsider looking in any more, but immersed in the work environment I wanted to learn about. This made for a very different, and instructive, experience.

Here are the different “perks” I have identified in relation to my immersion into nurses’ work environment:

  • More than just a clinical understanding for nurses’ work environment, I got an insight into the “feeling” of it. By wearing the same clothes, sharing the same space and following the same daily routine as nurses, I was able to experience, albeit to a limited degree, how it feels like to be a nurse. This led to my uncovering aspects of the work environment I had not thought of so far.
  • Being a participant observer, I felt that I disposed of a higher degree of freedom when it came to deciding what to focus on. I was able to move freely within the operation theatre (being of course careful not to be in anyone’s way in order not to disrupt anybody’s workflow) and could choose what and whom to focus my attention on. While it is the camera’s positioning that determines and limits the field of vision on a video recording, immersion makes it possible to continuously change observation angle and thus to look at anything that catches one’s attention.
  • In contrast to my previous experiences with video recordings, where one generally only has access to a specific sequence of the work practice of interest, I got a much more complete picture of the workflow this time around. Being there for a whole day, I was able to see not only how an operation unfolds, but also, among other things, how an operation theatre is prepared, how nurses are made aware that the operation is about to begin as well as what happens in the operation theatre once the patient has left. This gave me a better and more accurate understanding of the context in which operations take place at a hospital.

In my next and last blog post within this short series of posts about my first experience as a participant observer, I will address a few aspects that I felt were a bit more challenging in regard with being out on the field.

Walkthrough of MetaVision and Orbit with two nurses from the Uppsala University Hospital

Paper-based forms for the daily documentation of a patient in the intensive care unit

With the DISA kick-off approaching, we have been working hard on acquiring the background knowledge necessary to getting the project started on the right track. In this context, Gerolf, Ida and I were given this week an exciting insight into the functionality and layout of two computerized systems that have recently been or will shortly be introduced at the Uppsala University Hospital, namely MetaVision and Orbit. MetaVision is a clinical information system intended to support patient monitoring in the intensive care unit and during operations. Its implementation started about one year and half ago and is now almost completed. Orbit, on the other hand, is an operation planning system whose implementation process will start at the end of the month at the Uppsala University Children’s Hospital.

Two nurses who have been actively involved in the implementation of, respectively, MetaVision and Orbit, kindly accepted to walk us through the main components of each system. In so doing, they also provided us with essential contextual information which enabled us to develop a more complete understanding of the current and upcoming situation at the University Hospital.

As I had never seen what a patient’s bedside looked like in the intensive care, I was impressed to see the number of devices connected to the patient. However, I was even more taken aback by the multitude of paper sheets that had to be filled in by nurses for each patient every day prior to the implementation of MetaVision. As the system now automatically gathers data from the different devices connected to the patient, the need for manual documentation is estimated to have been reduced of approximately 80%. The remaining 20% encompasses such information as the meals and drinks given to the patient, the activities related to personal hygiene provided by the nurses (hair washing, teeth brushing etc.), the patient’s position (back, right / left side) or the evaluation of the pupils.

In regard with operation planning, it is now handled by means of different physical folders containing waiting lists. Orbit is expected to replace those folders as well as to support the documentation of operations, where it would partly overlap with MetaVision’s functionality. However, as no integration of the two systems is possible at this point, the implementation of Orbit will require for nurses to enter twice certain pieces of information in order for patient data to be complete in both MetaVision and Orbit. This situation can be explained by the different origins behind the implementation of the two systems: MetaVision’s acquisition and implementation process was launched by the Uppsala University Hospital before the Uppsala County Council decided to have Orbit implemented as a measure to guarantee a safer operations planning.