An observational study of hands-free communication devices mediated interruption dynamics in a nursing work system

• HCDs facilitate nurses׳ workflow continuity and the efficiency of communication.
• HCD-mediated interruptions are interrupter-oriented.
• The interruptee׳s overprotection of workflow may delay the delivery of information.
• Interruptee has challenges to anticipate HCD-mediated interruption content.
• Environmental cues may support anticipation and improve system performance.

ObjectiveThe objective of this study is to examine how the integration of Hands-free Communication Devices (HCDs) differentiates the interruption dynamics from the existing knowledge of face-to-face interruptions in a nursing work system.IntroductionMany aspects of nursing workflow and work efficiency have been improved with the implementation of HCDs; however, the frequency of interruptions in the work place has not been reduced. The complexity of HCD-mediated interruption dynamics needs to be studied using a Socio-technical Systems (STS) approach in order to holistically understand the problem and their effects.MethodsWe conducted field observations in the acute care setting. A total of 12 nurses across two units were selected as participants in this study. Each participant was shadowed for 2.5 h totaling 30 h of observations. We iteratively coded the data into overarching themes using content analysis.ResultsWe determined three overarching themes: (1) assessment prior to interrupting, (2) interruption content delivery, and (3) response to interruptions. Based the coding structure and the observation events in each theme, we identified facilitators and barriers for nursing work related to the HCD-mediated interruption dynamics. The facilitators included “intact workflow continuity”, “reduced time pressure”, and “increased flexibility to respond to interruptions”. The barriers included “interrupter-oriented nature”, “interruptee׳s overprotection of workflow”, “delay of information delivery”, and “inaccuracy of information communicated”.ConclusionThe findings of this study reflect the unique role of HCD in affecting interruption dynamics and nursing work. Based on the findings, we proposed system design recommendations, organizational-level interventions, and policy suggestions.