Knowledge Bank

Objective: We identify useful functions and usability characteristics of a historical cognitive artifact used by nurses working in a hospital unit, the card-based system.

Background: By identifying aspects of a widely used historical artifact, we uncover opportunities to improve the usefulness of current systems for hospital nurses.

Method: We conducted semi-structured interviews with registered nurses about their prior experience with the card-based system. Questions included what elements of the card-based system are missing from their current electronic support. Memos were generated iteratively from interview transcript data and grouped into themes.

Results: 18 nurses from multiple clinical areas participated and had a median of 25 years of nursing experience. The six themes were: 1) Supporting a status at a glance summary for each patient on the unit, 2) A prospective memory aid, 3) Efficient and easy to use, 4) Updating information required to maintain value, 5) Activity management and 6) Supporting a verbal handover.

Conclusion: The card-based system facilitated maintaining a shared situation awareness across shifts for current patients on a nursing unit as long as the information was updated frequently.

Application: Immediacy of portable access to succinctly documented information, ease of updating information automatically, and support for a standardized structure for displaying a summary could be incorporated into electronic support to increase usability.