Matching Items (2)
Description
Critical care environments are complex in nature. Fluctuating team dynamics and the plethora of technology and equipment create unforeseen demands on clinicians. Such environments become chaotic very quickly due to the chronic exposure to unpredictable clusters of events. In order to cope with this complexity, clinicians tend to develop ad-hoc adaptations to function in an effective manner. It is these adaptations or "deviations" from expected behaviors that provide insight into the processes that shape the overall behavior of the complex system. The research described in this manuscript examines the cognitive basis of clinicians' adaptive mechanisms and presents a methodology for studying the same. Examining interactions in complex systems is difficult due to the disassociation between the nature of the environment and the tools available to analyze underlying processes. In this work, the use of a mixed methodology framework to study trauma critical care, a complex environment, is presented. The hybrid framework supplements existing methods of data collection (qualitative observations) with quantitative methods (use of electronic tags) to capture activities in the complex system. Quantitative models of activities (using Hidden Markov Modeling) and theoretical models of deviations were developed to support this mixed methodology framework. The quantitative activity models developed were tested with a set of fifteen simulated activities that represent workflow in trauma care. A mean recognition rate of 87.5% was obtained in automatically recognizing activities. Theoretical models, on the other hand, were developed using field observations of 30 trauma cases. The analysis of the classification schema (with substantial inter-rater reliability) and 161 deviations identified shows that expertise and role played by the clinician in the trauma team influences the nature of deviations made (p<0.01). The results shows that while expert clinicians deviate to innovate, deviations of novices often result in errors. Experts' flexibility and adaptiveness allow their deviations to generate innovative ideas, in particular when dynamic adjustments are required in complex situations. The findings suggest that while adherence to protocols and standards is important for novice practitioners to reduce medical errors and ensure patient safety, there is strong need for training novices in coping with complex situations as well.
ContributorsVankipuram, Mithra (Author) / Greenes, Robert A (Thesis advisor) / Patel, Vimla L. (Thesis advisor) / Petitti, Diana B. (Committee member) / Dinu, Valentin (Committee member) / Smith, Marshall L. (Committee member) / Arizona State University (Publisher)
Created2012
Description
Emotion regulation repertoire, or the number of emotion regulation strategies one is able to employ when needed, is an important element of emotion regulation flexibility. Emotion regulation flexibility, the ability to regulate in accordance with changing situational contexts and demands, is predictive of emotion regulation success. Currently, little is known about emotion regulation repertoire and its association with emotional health and well-being. In particular, more can be learned about how the different strategies in one’s repertoire interact, and which strategies show stronger relationships with mental health. The current study aimed to assess the relationship of different emotion regulation strategies to mental health, including their individual and combined influence. In addition, the interaction between the use of specific emotion regulation strategies and emotion regulation flexibility with respect to mental health was examined. I hypothesized (1a) reappraisal and (1b) acceptance, two strategies previously associated with positive psychological outcomes, would be significant predictors of mental health, and (2) better flexibility would predict better mental health. In addition, I hypothesized that (3) strategies often found to be maladaptive (suppression, distraction, rumination, and experiential avoidance) would have an inverse relationship with mental health. Finally, (4) maladaptive strategies would be associated with worse mental health for those lower in flexibility. These hypotheses were tested through a questionnaire as part of a larger in-lab study. Results revealed that reappraisal and rumination were the strongest predictors of mental health. Emotion regulation flexibility did not predict mental health or moderate the relationship between individual emotion regulation strategies and mental health. Results from this study suggest some emotion regulation strategies are stronger predictors of mental health than others. This will guide future research on specific emotion regulation strategies in a repertoire as well as their combined effect on mental health. Creating a clearer picture of how different strategies interact and influence mental health will also be vital for clinical interventions.
ContributorsSchmitt, Marin (Author) / Roberts, Nicole A. (Thesis advisor) / Burleson, Mary (Committee member) / Robles-Sotelo, Elias (Committee member) / Arizona State University (Publisher)
Created2018