An Analysis of Nurses’ Cognitive Work: A New Perspective for Understanding Medical Errors

Health care researchers agree that the acute care hospital environment is filled with numerous distractions. Within this environment, professional nurses make clinical judgments about their patients, whose conditions may change minute by minute. As a result, nurses constantly organize and reorganize the priorities and tasks of care to accommodate patients’ fluctuating status. To date, little attention has been given to how interruptions in the workplace influence nurses’ ability to anticipate and carry out the actions directed by their clinical judgment. This paper describes an ongoing research study aimed at exploring the effect of interruptions on the cognitive work of nursing. A methodology combining human factors techniques and qualitative observation of nurses in practice has produced a cognitive pathway. The pathway is a unique visual graphic that offers a perspective of the nature of nurses’ work and the relationship interruptions and cognitive load may have on omissions and errors in care. The approach to analyzing the cognitive work of nurses has important implications for understanding the origins of medical errors.