Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)

Legacy Department

Industrial Engineering

Committee Member

Dr. David M. Neyens, Committee Chair

Committee Member

Dr. A. Joy Rivera, Committee Co-Chair

Committee Member

Dr. James H. Abernathy

Committee Member

Dr. Kelly E. Caine

Committee Member

Dr. Joel S. Greenstein

Committee Member

Dr. J. Cole Smith


Interruptions occur frequently in healthcare work systems. Hands-free Communication Devices (HCDs) were implemented in healthcare work systems to support the interruption process. However, from a sociotechnical systems perspective, HCDs may introduce new complications and unintended consequences to the work system. Research gaps exist in investigating the complexity of HCD interruptions in the real-world context. This dissertation aims to understand HCD interruption dynamics in the nursing work systems, using qualitative research methods. The first study examined the major differences between face-to-face and HCD-mediated interruptions, based on 30 hours of field observations in the acute care setting. Three major differences included: (1) The available cues to understand interruptee’s interruptibility, (2) The delivery of interruption content, and (3) The options to manage interruptions. The results uncovered facilitators and barriers that appeared to influence nursing work in the interruption process. The second study explored HCD interruption dynamics in more depth. It examined which system factors impact the interruption dynamics and how they influence nurses’ decisions and performance regarding the use of HCDs, based on 15 hours of field observations and 15 in-depth interviews with registered nurses in the pediatric intensive care units. This study was framed by the meso-ergonomics paradigm and activity theory. A descriptive model of HCD interruption dynamics was developed, comprising of five proximal system factors, 17 indicator and moderator system factors, and four distal system factors. These system factors interact and create integrated causal chains to impact interruption dynamics and influence the nurses’ decisions and performance regarding the use of HCDs. Specifically, the proximal system factors immediately impact interruption dynamics, the indicator or moderator system factors provide partial inputs and contextual circumstances of the proximal system factors, and the distal system factors are further down the causal chain. The results of the dissertation provided the basis for improving the design of interruption-mediating tools as well as the nursing work system, to better support the HCD-mediated interruption process, which may ultimately enhance the quality and safety of healthcare work systems.



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