Information systems and their effect upon nursing workflow  

Part of the job for a Nurse informaticist working in a hospital setting is to serve as a member of a team addressing issues related to information systems and their effect upon nursing workflow.   This work often includes root cause analysis, which is a process of identifying root causes for a problem, then prioritizing them to allow for an organized means of correcting the problem through improvements in policy and procedure.

The Ishikawa (fishbone or cause & effect) diagram is a graphic structural tool used to facilitate this analysis by exploring the many primary, secondary, and tertiary causes that contribute to a certain effect or outcome. It helps team members to explore and understand how the many causes can contribute to an identified outcome and thus identify areas for improvement. For benefit of this assignment, the secondary causes will be the root causes and we will not explore the tertiary causes which drive them.

Primary causes are the identified action or influence resulting in the undesired outcome and are grouped naturally into categories such as People, Process, Environment, & Equipment that are used in this assignment.  Secondary causes are the actions or influences that contribute to the primary cause, driving it to produce the undesired outcome.

The diagram displays the relationship of the identified causes to the outcome and to each other.  It looks like the bones of a fish, with the head being the place to put the undesired outcome.  Each vertical branch off the central horizontal spine is associated with a category and has horizontal branches from it that hold the primary causes.  Each primary cause has a secondary cause attached below it.

In this assignment, you are given a scenario that has been adapted with a few revisions from a nursing research study.

  1. View the Cause & Effect Instructional diagram provided to see the form and how it is to be filled out
  2. Download and save the Cause & Effect diagram template to use for this assignment
  3. Read the Case Study below to help you determine primary and secondary causes for the workflow issue
  4. Edit the template diagram to include the causes by clicking on the appropriate boxes and adding your text
  5. Causes for all headings should be taken directly from the scenario provided
  6. Review the Rubric for grading criteria
  7. Submit the completed diagram to the assignment link


Workflow Analysis Scenario Nurses working on a Labor and Delivery Unit have been experiencing an increased need for translation services.  Currently they have access to a service paid for by the hospital that utilizes the phone in the labor room.  Most nurses find the phone use cumbersome and invasive during labor.

It is awkward as it doesn’t facilitate visual communication and doesn’t apply to deaf patients.  Nurses frequently rely on family members present in the room, which can result in miscommunication and faulty understanding.

The unit is usually staffed with 62 nurses to cover two 12-hour shifts.  The patient population is diverse with at least 10% of patients speaking no English and an additional 15% where English is not the first language.  There are also occasional deaf patients who use sign language for communication.  This patient diversity translates to an average of 10 nurses per shift requiring some form of communication assistance. The hospital has purchased two tablets to facilitate additional communication access.

Each tablet has its own password protection.  The tablets are capable of making audio and video calls via the internet to a translation service that includes sign language and over 500 different languages and dialects.  The tablets are kept by the L&D Nursing Staff Educator in an office on another unit.

She is responsible for tracking the tablets using a system where nurses log the devices in and out when they are taken to the L&D unit.After using the tablets for 60 days, the staff, including the nurse educator, was asked to complete a survey regarding use of the tablets and any pros and cons they noted. After interpreting the survey results, the following issues were noted:

  • Tablets not located on the unit
  • Not enough tablets available
  • Nurses’ failure to check out tablets
  • Passwords difficult to remember
  • Different password for each tablet
  • Nurses misplace tablet chargers
  • Limited internet service in some patient rooms
  • Long wait times for translator service due to increased demand and patient diversity
  • Nurses’ using tablets for other purposes
  • Short battery life of tablets
  • Lack of available charging stations
  • Frequent software updates interrupt service

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