ABSTRACT
Introduction ......................................................................................................... 128 Background .......................................................................................................... 128 Research Design and Methods .......................................................................... 129
Quality ............................................................................................................. 130 Research Design.............................................................................................. 130 Research Site .................................................................................................. 131 Sample .............................................................................................................. 132 Methods ........................................................................................................... 132
Observation ................................................................................................ 132 Structured Interviews ............................................................................... 133 Artifact Analysis ........................................................................................ 133
Research Process ............................................................................................. 134 Data Collection........................................................................................... 134 Data Analysis ............................................................................................. 135
Limitations ...................................................................................................... 136 Preliminary Findings .......................................................................................... 136
Unit Activity .................................................................................................... 136 Network ........................................................................................................... 137 Information Resources ................................................................................... 138 Cognitive Work ............................................................................................... 141 Challenges ....................................................................................................... 142
Discussion ............................................................................................................ 143 The ICU Work Setting .................................................................................... 143 Communication among Care Team Members ........................................... 145 The Role of CSE .............................................................................................. 147 CSE in Health Care ......................................................................................... 147 Validity ............................................................................................................. 148
Aspects of Resilience .......................................................................................... 148 Self-Aware ....................................................................................................... 148
Cognitive systems engineering (CSE) has been proven to be useful in revealing key aspects of operator behavior as they pursue goals in complex work domains, providing the foundation for the development of solutions that are ecologically valid. Health care work settings, particularly the intensive care unit, present one of the most challenging work domains for a researcher to study. Cognitive engineering methods (Hollnagel and Woods 1983; Woods and Roth 1988; Roth et al. 2002; Militello et al. 2010) can be applied to understand characteristics of complex work domains such as the ICU as well as the behavior of workers including clinicians and their support staff. The use of CSE methods makes it possible to identify key traits of health care work settings, such as decisions clinicians make, obstacles clinicians face, and initiatives they take to overcome these obstacles in their efforts to restore patients to the best possible health. CSE methods also have the potential to enable workers to better understand their unit’s performance and more successfully adapt to unforeseen challenges-in other words, to be resilient.
