Medication errors in residential aged care facilities: A distributed cognition analysis of the information exchange process

Background Medication safety is a pressing concern for residential aged care facilities (RACFs). Retrospective studies in RACF settings identify inadequate communication between RACFs, doctors, hospitals and community pharmacies as the major cause of medication errors. Existing literature offers limited insight about the gaps in the existing information exchange process that may lead to medication errors. The aim of this research was to explicate the cognitive distribution that underlies RACF medication ordering and delivery to identify gaps in medication-related information exchange which lead to medication errors in RACFs. Methods The study was undertaken in three RACFs in Sydney, Australia. Data were generated through ethnographic field work over a period of five months (May–September 2011). Triangulated analysis of data primarily focused on examining the transformation and exchange of information between different media across the process. Results The findings of this study highlight the extensive scope and intense nature of information exchange in RACF medication ordering and delivery. Rather than attributing error to individual care providers, the explication of distributed cognition processes enabled the identification of gaps in three information exchange dimensions which potentially contribute to the occurrence of medication errors namely: (1) design of medication charts which complicates order processing and record keeping (2) lack of coordination mechanisms between participants which results in misalignment of local practices (3) reliance on restricted communication bandwidth channels mainly telephone and fax which complicates the information processing requirements. The study demonstrates how the identification of these gaps enhances understanding of medication errors in RACFs. Conclusions Application of the theoretical lens of distributed cognition can assist in enhancing our understanding of medication errors in RACFs through identification of gaps in information exchange. Understanding the dynamics of the cognitive process can inform the design of interventions to manage errors and improve residents’ safety.

The Masculine Habitus as 'Distributed Cognition': A Case Study of 5- to 6-Year-Old Boys in an English Inner-City, Multi-Ethnic Primary School

This article provides a case study demonstrating the active role that 5- to 6-year-old boys in an English inner-city, multi-ethnic primary school play in the appropriation and reproduction of their masculine identities. It is argued that the emphasis on physicality, violence and racism found among the boys cannot be understood without reference to the immediate contexts of the local community and the school within which they are located. In making this argument the article draws upon and applies the concept of the habitus and develops this with the notion of 'distributed cognition' as proposed in sociocultural theory. Some of the implications of this analysis for working with boys in early years settings are discussed in the conclusion.

UNDERSTANDING NURSE CREATED COGNITIVE ARTIFACTS: PERSONALLY-CREATED-COGNITIVE-ARTIFACTS AS EXTERNAL REPRESENTATIONS OF DISTRIBUTED COGNITION

Manuscript 1: “Conceptual Analysis: Externalizing Nursing Knowledge” We use concept analysis to establish that the report tool nurses prepare, carry, reference, amend, and use as a temporary data repository are examples of cognitive artifacts. This tool, integrally woven throughout the work and practice of nurses, is important to cognition and clinical decision-making. Establishing the tool as a cognitive artifact will support new dimensions of study. Such studies can characterize how this report tool supports cognition, internal representation of knowledge and skills, and external representation of knowledge of the nurse. Manuscript 2: “Research Methods: Exploring Cognitive Work” The purpose of this paper is to describe a complex, cross-sectional, multi-method approach to study of personal cognitive artifacts in the clinical environment. The complex data arrays present in these cognitive artifacts warrant the use of multiple methods of data collection. Use of a less robust research design may result in an incomplete understanding of the meaning, value, content, and relationships between personal cognitive artifacts in the clinical environment and the cognitive work of the user. Manuscript 3: “Making the Cognitive Work of Registered Nurses Visible” Purpose: Knowledge representations and structures are created and used by registered nurses to guide patient care. Understanding is limited regarding how these knowledge representations, or cognitive artifacts, contribute to working memory, prioritization, organization, cognition, and decision-making. The purpose of this study was to identify and characterize the role a specific cognitive artifact knowledge representation and structure as it contributed to the cognitive work of the registered nurse. Methods: Data collection was completed, using qualitative research methods, by shadowing and interviewing 25 registered nurses. Data analysis employed triangulation and iterative analytic processes. Results: Nurse cognitive artifacts support recall, data evaluation, decision-making, organization, and prioritization. These cognitive artifacts demonstrated spatial, longitudinal, chronologic, visual, and personal cues to support the cognitive work of nurses. Conclusions: Nurse cognitive artifacts are an important adjunct to the cognitive work of nurses, and directly support patient care. Nurses need to be able to configure their cognitive artifact in ways that are meaningful and support their internal knowledge representations.

Artefact ecologies : supporting embodied meeting practices with distance access

Frameworks such as activity theory, distributed cognition and structuration theory, amongst others, have shown that detailed study of contextual settings where users work (or live) can help the design of interactive systems. However, these frameworks do not adequately focus on accounting for the materiality (and embodiment) of the contextual settings. Within the IST-EU funded AMIDA project (Augmented Multiparty Interaction with Distance Access) we are looking into supporting meeting practices with distance access. Meetings are inherently embodied in everyday work life and that material artefacts associated with meeting practices play a critical role in their formation. Our eventual goal is to develop a deeper understanding of the dynamic and embodied nature of meeting practices and designing technologies to support these. In this paper we introduce the notion of "artefact ecologies" as a conceptual base for understanding embodied meeting practices with distance access. Artefact ecologies refer to a system consisting of different digital and physical artefacts, people, their work practices and values and lays emphasis on the role artefacts play in embodiment, work coordination and supporting remote awareness. In the end we layout our plans for designing technologies for supporting embodied meeting practices within the AMIDA project.

On the Origin of Ideas : An Abductivist Approach to Discovery

The purpose of this study is to analyze and develop various forms of abduction as a means of conceptualizing processes of discovery. Abduction was originally presented by Charles S. Peirce (1839-1914) as a "weak", third main mode of inference -- besides deduction and induction -- one which, he proposed, is closely related to many kinds of cognitive processes, such as instincts, perception, practices and mediated activity in general. Both abduction and discovery are controversial issues in philosophy of science. It is often claimed that discovery cannot be a proper subject area for conceptual analysis and, accordingly, abduction cannot serve as a "logic of discovery". I argue, however, that abduction gives essential means for understanding processes of discovery although it cannot give rise to a manual or algorithm for making discoveries. In the first part of the study, I briefly present how the main trend in philosophy of science has, for a long time, been critical towards a systematic account of discovery. Various models have, however, been suggested. I outline a short history of abduction; first Peirce's evolving forms of his theory, and then later developments. Although abduction has not been a major area of research until quite recently, I review some critiques of it and look at the ways it has been analyzed, developed and used in various fields of research. Peirce's own writings and later developments, I argue, leave room for various subsequent interpretations of abduction. The second part of the study consists of six research articles. First I treat "classical" arguments against abduction as a logic of discovery. I show that by developing strategic aspects of abductive inference these arguments can be countered. Nowadays the term 'abduction' is often used as a synonym for the Inference to the Best Explanation (IBE) model. I argue, however, that it is useful to distinguish between IBE ("Harmanian abduction") and "Hansonian abduction"; the latter concentrating on analyzing processes of discovery. The distinctions between loveliness and likeliness, and between potential and actual explanations are more fruitful within Hansonian abduction. I clarify the nature of abduction by using Peirce's distinction between three areas of "semeiotic": grammar, critic, and methodeutic. Grammar (emphasizing "Firstnesses" and iconicity) and methodeutic (i.e., a processual approach) especially, give new means for understanding abduction. Peirce himself held a controversial view that new abductive ideas are products of an instinct and an inference at the same time. I maintain that it is beneficial to make a clear distinction between abductive inference and abductive instinct, on the basis of which both can be developed further. Besides these, I analyze abduction as a part of distributed cognition which emphasizes a long-term interaction with the material, social and cultural environment as a source for abductive ideas. This approach suggests a "trialogical" model in which inquirers are fundamentally connected both to other inquirers and to the objects of inquiry. As for the classical Meno paradox about discovery, I show that abduction provides more than one answer. As my main example of abductive methodology, I analyze the process of Ignaz Semmelweis' research on childbed fever. A central basis for abduction is the claim that discovery is not a sequence of events governed only by processes of chance. Abduction treats those processes which both constrain and instigate the search for new ideas; starting from the use of clues as a starting point for discovery, but continuing in considerations like elegance and 'loveliness'. The study then continues a Peircean-Hansonian research programme by developing abduction as a way of analyzing processes of discovery.

Los sistemas de cognición distribuida en la enseñanza universitaria en función del tipo de ciencia

Desde el enfoque psicológico denominado “Cognición Distribuida” es posible postular tres formas de distribución de la cognición en el interior de los sistemas de actividad: física, sociocomunicacional y simbólico-instrumental. Esta comunicación aborda la configuración de dichos sistemas, en función de las prácticas institucionales prevalecientes en la Universidad Nacional de Rosario (UNR), Argentina. Se postula que dichas prácticas institucionales varían según el tipo de conocimiento que se vehiculiza en la acción enseñante: social y no social. La investigación consistió en la observación naturalista de 28 clases universitarias pertenecientes a tres carreras sociales y tres carreras exactas-naturales (14 clases por tipo epistémico de carrera). La observación estuvo focalizada en los tres sistemas de distribución de la cognición. Los resultados obtenidos sugieren una relación de sentido entre los mencionados tipos epistémico-institucionales y la configuración de los sistemas físico y simbólico.

coconceptmap: a system for collaborative concept mapping

Concept mapping is a technique for visualizing the relationships between different concepts, and collaborative concept mapping is used to model knowledge and transfer expert knowledge. Because of lacking some features,existing systems can’t support collaborative concept mapping effectively. In this paper, we analysis the collaborative concept mapping process according to the theory of distributed cognition, and argue the functions effective systems ought to include. A collaborative concept mapping system should have the following features: visualization of concept map, flexible collaboration style,supporting natural interaction, knowledge management and history management. Furthermore, we describe every feature in details. Finally,a prototype system has been built to fully explore the above technologies.

基于分布式认知理论的扩展资源模型

分布式认知理论通过协调人机对话，结合人和计算机各自的优势解决问题，在人机交互研究中扮演了指导者的角色．尽管分布式认知理论支持的资源模型在分析人机交互时取得了成功，但模型存在不能提供复杂用户任务支持、缺乏对模型中元素的准确定义等问题，在一定程度上导致了表现形式上的混乱．使用分布式认知理论构造了扩展资源模型，建立人机交互活动中的动作和表征之间的联系，从而指导界面的设计和实现．扩展资源模型从静态结构和交互策略两个方面对界面交互动作提供支持，在交互中减少人的认知负担．该研究对设计符合人的认知特点的界面具有一定的指导作用．

An exploration of leadership in Irish post-primary education

The purpose of this study is to explore the nature and how of leadership in Irish post-primary schools. It considers school leadership within the context of contemporary Distributed Leadership theory. Associated concepts such as Distributed Cognition and Activity Theory are used to frame the study. From a distributed perspective, it is now widely accepted that other agents (e.g. teachers) have a leadership role, as part of collaborative, participative and supportive learning communities. Thus, this study considers how principals interact and build leadership capacity throughout the school. The study draws on two main sources of evidence. In analysing the implications of accountability agendas for school leadership, there is an exploration and focus on the conceptualisations of school leadership that are fore-grounded in 21 WSE reports. Elements of Critical Discourse Analysis are employed as an investigative tool to decipher how the construction of leadership practice is produced. The second prong of the study explores leadership in 3 case-study post-primary schools. Leadership is a complex phenomenon and not easy to describe. The findings clarify, however, that school leadership is a construct beyond the scope of the principal alone. While there is widespread support for a distributed model of leadership, the concept does not explicitly form part of the discourse in the case-study schools. It is also evident that any attempt to understand leadership practice must connect local interpretations with broader discourses. The understanding and practice of leadership is best understood in its sociohistorical context. The study reveals that, in the Irish post-primary school, the historical dimension is very influential, while the situational setting, involving a particular set of agents and agendas, strongly shapes thinking and practices. This study is novel as it synthesises two key sources of evidence. It is of great value in that it teases out the various historical and situational aspects to enhance understandings of school leadership in contemporary Ireland. It raises important questions for policy, practice and further research.

The Implementation of Jenkins’s 21st-Century Skills in the Curriculum: A Cross-National Policy Analysis

This meta-analytic study sought to determine if cross-national curricula are aligned with burgeoning digital learning environments in order to help policy makers develop curriculum that incorporates 21st-century skills instruction. The study juxtaposed cross- national curricula in Ontario (Canada), Australia, and Finland against Jenkins’s (2009) framework of 11 crucial 21st-century skills that include: play, performance, simulation, appropriation, multitasking, distributed cognition, collective intelligence, judgment, transmedia navigation, networking, and negotiation. Results from qualitative data collection and analysis revealed that Finland implements all of Jenkins’s 21st-century skills. Recommendations are made to implement sound 21st-century skills in other jurisdictions.