Health Care Comes Home The Human Factors (2011) / Chapter Skim
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4 Health Care Tasks
4 Health Care Tasks
Pages 75-102
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From page 75... ...
Complex health care tasks often require nuanced understanding of a health condition and its treatment as well as the ability to manage symptoms, detect complications, provide hands-on care, offer emotional support, and communicate effectively with health care providers to participate in decisions and manage logistical aspects of health care. This chapter describes the wide range of tasks related to health care that, with increasing frequency, take place in the home.
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From page 76... ...
.* Personal care aides help Ed bathe, and an occupational therapist monitors his functional status, oversees his exercise program, and evaluates his use of assistive devices.
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From page 77... ...
TYPES OF TASKS Health-related tasks involve many aspects of daily function, including personal hygiene and nutrition, safety and comfort, physical fitness, sleep quality, stress management, as well as the planning and coordination to accomplish these personal tasks. Health care–specific tasks may entail obtaining routine health examinations, screenings, and immunizations, instituting prescribed treatment, monitoring disease progression and treat
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From page 78... ...
Activities of Daily Living Basic activities of daily living (ADLs) are among tasks performed regularly by or for all community-residing individuals.
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From page 79... ...
Regular medical and dental examinations, screenings, immunizations, and care Episodic care Medication management for minor illnesses First aid provision for minor injuries Wound care Burn care Recovery from serious injuries Recovery from major incidents (e.g., heart attack, stroke) Recovery from surgeries Allergy treatment Pregnancy management and postpartum recovery Chronic care Diabetes management Asthma management Apnea management Nutritional therapy Home infusion therapy Respiratory therapy Home dialysis Chronic obstructive pulmonary disease (COPD)
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From page 80... ...
Episodic care may require care recipients or caregivers to quickly learn care procedures and operation of medical equipment, and it may require temporary home adjustments to adapt to short-term needs or activity limitations. Episodic care does not require long-term lifestyle changes, although, for example after a stroke or heart attack, episodic care may transition to chronic care.
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From page 81... ...
Chronic care is often more challenging and stressful than episodic care because of its greater effects on daily living and its continuing burden. Although many of the tasks mentioned above for episodic care exist for chronic care, such care often requires regular sustained tasks and tasks involving medical devices.
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From page 82... ...
Coordination of Care Tasks for coordinating care are logistical in nature: scheduling medical or dental appointments, arranging for transportation, ordering prescriptions and other medical supplies, renting or purchasing medical equipment, arranging for pick-up or delivery of supplies or equipment, managing health-related finances, and maintaining personal health records. In addition, informal caregivers must interact, to varying degrees, with physicians and other health care professionals about care recipient status and care needs, hire nurses and aides, communicate and negotiate with other family members about care decisions, and provide companionship and emotional support to recipients.
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From page 83... ...
Personnel in home visiting programs routinely show individuals and members of their households how to modify daily living activities to accommodate functional limitations, perform medical procedures or therapies, watch for changes in health status, and troubleshoot clinical or technical problems that arise. Formal caregivers expend considerable effort bolstering the health management capabilities of persons who care for themselves or provide assistance to others as informal caregivers.
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From page 84... ...
Thus, psychomotor skills, as well as adequate vision, tactile sensation, knowledge, memory, and judgment, are needed to administer medications safely and effectively, regardless of who performs the task. Caring for a surgical incision at home following a total knee replacement is an example of an episodic care task that involves many capability domains.
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From page 85... ...
In order to reduce the probability of errors and improve the efficiency of care, it is first necessary to assess both the task demands and the capabilities of the individuals performing the tasks to determine where potential mismatches occur and, second, to design the system or the processes to reduce the mismatch. Assessment Tools A number of tools are available for assessing functional capabilities of individuals, providing objective data to assist with targeting individualized rehabilitation needs or planning for specific in-home services, such as meal preparation, nursing care, homemaker services, personal care, or continuous supervision.
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From page 86... ...
A number of other clinical and research tools exist that permit assessment, in general, of individuals' cognitive and physical function, emotional status, and level of preparedness for the health care and health management tasks they need to assume. An important limitation of all these measures, including those of ADL and IADL capabilities, is that they commonly do not evaluate the extent of correspondence between specific capabilities of the individual and the capabilities needed to perform each of the specific tasks and subtasks required for managing his or her health at home.
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From page 87... ...
For example, task analysis has been used to study system interactions with people who have physical or cognitive impairments, and the results of the analysis have been used to develop training programs tailored to the needs of these individuals. Currently, the success of task analysis applied to health care in the home depends on the analyst's human factors expertise, domain knowledge regarding health care and health management at home, understanding of tasks and task demands, and direct experience with task performance (Drury, 2010)
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From page 88... ...
Thus, for many tasks in the home care domain, it is necessary to consider task demands in relation to the capabilities of the specific actor who performs the
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From page 89... ...
A simple task analysis of medical device use may include identification of the subtasks involved in performance of a task (i.e., task decomposition) , the information required by the user to complete each, the feedback that the device or environment provides, and the potential problems that could arise if the task were not carried out properly.
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From page 90... ...
. Hierarchical Task Analysis Hierarchical task analysis is the task analysis methodology used most frequently in industrial settings.
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From page 91... ...
or in an outline-like formatted table. The first example of a hierarchical task analysis is for washing hands, from a project that focused on the development of cognitive aids to enable individuals with mild cognitive impairment to perform a variety of simple tasks (Mihailidis et al., 2008; Hoey et al., 2010)
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From page 92... ...
b. A state-transition diagram of task decomposition for hierarchical task analysis for washing hands.
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From page 93... ...
Cognitive Task Analysis As illustrated by the examples given above, in many health care situations in the home, the most critical user capabilities are cognitive rather than physical or sensory/perceptual. Although the importance of other user capabilities is hard to overestimate, many home care tasks depend heavily on the cognitive functions and processes of the individual performing them.
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From page 94... ...
FIGURE 4-2 Example of a result of task decomposition for hierarchical task analysis for medication administration in a hospital setting. SOURCE: Reprinted from Lane, Stanton, and Harrison (2006)
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From page 95... ...
Examples of cognitive processes include searching memory for appointments or medications, directing one's attention to the particular source of visual or auditory information, recognizing alerts, etc. A subset of these processes is associated with perception, but a number of the more complex cognitive processes, such as planning, problem solving, and decision making, are generally subsumed under the term "executive function." As for any type of task analysis, in cognitive task analysis, the development of knowledge structures (such as concept maps or semantic networks)
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From page 96... ...
GOMS is a human information processing model that stands for Goals, Operators, Methods, and Selection rules. Much like hierarchical task analysis, the application of GOMS leads to a decomposition of cognitive tasks into component tasks until the desired level of analysis is reached.
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From page 97... ...
We expect that the results of task analysis will shortly become a key tool for developing intelligent, networked cognitive assistive devices that will compensate for the cognitive limitations of the care recipients and their caregivers. Checklists developed from task analyses are a particularly effective kind of performance aid for prompting correct execution of health-related tasks.
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From page 98... ...
Then, whenever a provider was considering recommending (for example) that lancing device for a care recipient, the task demands of the device and of alternative devices performing the same function could be retrieved from the database and compared with the care recipient's capabilities.
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From page 99... ...
In-home assessment tools could draw on these analyses to measure if potential task performers have the capabilities to perform the tasks. When they do not, a professional, such as an occupational therapist, can consider the options for matching tasks and performers: adapting devices or their operational requirements, choosing different devices, training, professional support, etc.
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From page 100... ...
. Activities of daily living and instrumental activities of daily living assessment.
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From page 101... ...
. Hierarchical task anlysis.
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Key Terms
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