Date of Award
12-2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Biomedical Engineering
Committee Chair/Advisor
Melinda K. Harman, PhD
Committee Member
John D. DesJardins, PhD
Committee Member
David M. Neyens, PhD
Committee Member
Eliza Gallagher, PhD
Abstract
Analysis of human behavior and work performance in healthcare systems is important because it has implications in patient safety, and the quality of care. Human factors engineering, and usability data are recognized by the Food and Drug Administration as important for ensuring medical device safety and effectiveness. While human factors studies are common in healthcare, few studies have looked at nursing care and self-care after ostomy surgery within a human factors context.
There are approximately 1 million Americans living with a stoma. Stoma complications are influenced by the fit and adhesion of the external pouching system and are less common when ostomy care involves nurses with specialized ostomy care training. Upon discharge from hospital, people living with a stoma are responsible for ostomy self-care. Therefore, there is a critical need to advance the understanding of psychomotor and cognitive skills used by different individuals in clinical and non-clinical settings. The broad objective of this dissertation was to gain a better understanding of current practices in ostomy nursing care and self-care of people living with a stoma, and end-user experience with ostomy appliance change technology within a human factors context.
This dissertation was completed in three aims. Aim 1 developed a reliable and validated metric-based clinical simulation procedure for assessing ostomy nursing care and usability of ostomy appliance change technology. Aim 2 used this metric-based clinical simulation to explore clinical practice and decisions made by 24 nurses with different nursing credentials. Differences between nurse groups were observed for product selection, baseplate sizing and adhesion, stoma & peristomal skin care, infection control, final iii baseplate opening size, and time duration task categories. Certified ostomy care nurses guided their clinical decisions based on the holistic assessment and perceived the ostomy appliance change technology more usable when compared to student nurses whose clinical decision making was mostly driven by procedural checklists. Aim 3 investigated end-user experience with ostomy appliance technology and ostomy self-care and identified common challenges, end-user needs, and successful strategies for management of ostomy self-care and adaptation to life with a stoma.
This dissertation evaluates and enhances the current ostomy simulation procedure that is applicable in simulation pedagogy and skill-based assessment. It highlights clinically relevant procedural tasks and decision making and their variations in ostomy nursing care practice and thus the need for extended non-specialty nurses training supporting the development of expertise. It highlights how patient education translates into home settings and how ostomates adapt to life with a stoma. Overall, this dissertation addresses the need for human factors engineering and usability data in ostomy nursing care and individuals living with a stoma self-care that have implications for addressing patient safety and quality of care issues.
Recommended Citation
Haughey, Marketa, "Application of Human Factors Approaches in Ostomy Nursing Care and Ostomy Self-Care" (2024). All Dissertations. 3806.
https://open.clemson.edu/all_dissertations/3806
