Question 1
The origins of the definition of cognitive artifacts, comes from the roles they play in human learning, decision making and understanding: artifacts augment, influence or communicate these aspects. The term “artifact” refers to an object that is manmade. As such, cognitive artifacts are physical artificial devices designed by man to serve a specific purpose, by facilitating thinking, evaluation, as well as stimulate consequent actions or responses. The term itself (“Cognitive Artifacts”) was actually coined by Donald Norman, in reference to artificial devices designed to affect human behavior, through displaying, maintaining and operating upon information while serving a representational function. These artifacts help in the sharing of information and in everyday operations, with road signs serving as excellent examples.
Question 2
These definitions are relevant to nursing, as cognitive artifacts, similar to other professions, are universally acceptable and provide standard means of communication. In practice, cognitive artifacts are used in practice to ensure continuity of care following a handover process. Continuity of care is made possible by the effective sharing of information between nurses through patient reports. Furthermore, information shared through cognitive artifacts usually serve to influence the actions of the oncoming nurse, as they are forced to base and organize their actions on the information provided. Cognitive artifacts may also stimulate critical thinking and the formulation of individualized care plans, through providing information on the patient’s condition (McLane et al, 2010).
Question 3
Cognitive artifacts are identified through various attributes, which also serve as specific measures of the concept itself. These attributes include:
- Relevance to the context
- Reduction in the memory load of the user
- Supports rapid assimilation of data
- Augmentation of the user’s internal representation and knowledge
- Supports a users cognition and perception without the need for conscious effort
- Promotion of more effective and efficient user action
- Making invisible and transient data sustainable and visible.
- Facilitation of critical thinking
- Channeling of decision making by minimizing user effort, while maximizing accuracy.
- Limiting of abstraction
Question 4
The cognitive artifacts support cognitive work in the clinical setting, by improving, influencing, augmenting or changing cognition. Surrogate terms to them can therefore be written manuals, written guidelines. Within the practice of nursing, cognitive artifacts may refer to patient reports, and nursing care plans among others.
Question 5
In my case, the use of the Emergency Medical Records is essential in every day care. The system works in such a way that when ordering a certain procedure, a pop up usually comes up and asks a number of relevant questions about the order. For instance, I once ordered a Foley catheter. The evidence base window popped up with a question regarding why the procedure was required. Upon indicating that it was for urinary retention, (a baby had had no urine output for 8 hrs) laboratory and other procedures came up as a resource in helping me enhance my knowledge on urinary retention. Emergency medical records (cognitive artifacts) not only make my job more enjoyable, but also more efficient. It stimulates evaluation of the content by my personal knowledge, as well as an assessment of validity and the making of judgments on whether to use the information or not. This allows me to work more efficiently while improving my practice. Antecedents to Emergency medical records would include patient admission, nursing assessment, diagnostic and therapeutic interventions as well as the creation of data repositories. In addition, the presence of attributes such as relevance, reduction of memory load, support for the rapid assimilation of data, augmentation of knowledge regarding urinary retention and promotion of effective and efficient action highlight the importance of cognitive artifacts, when it comes to improving evidence based practice. Knowledge and application of the concept of EMR as a cognitive artifact, will serve to improve my practice and its use (McLane et al 2010).
Question 6
Walker and Avant’s 8 step concept analysis process is applied by McLane et al (2010). The application of this process provides an objective and accurate framework through which the concept of cognitive artifacts can be done. The end product is the outlining of distinct empirical referents in the form of cognitive artifact attributes. The step by step application of the 8 step process by McLane et al (2010) makes it easy to follow and understand the concept of cognitive artifacts.
Question 7
` The authors’ decision to carry out a concept analysis of mainly motivated by the ubiquity of cognitive artifacts in contemporary health care settings. The intent was, therefore, to guide nursing care and influence the future of nursing in theory, knowledge, and practice, by clearly outlining the importance of cognitive artifacts and ways in which to identify them. The authors see a need for modification of current system, not only to ensure that their (artifacts) input is easily appraised and recognized. This intent is also motivated by concern for the lack of a proper cultural understanding of cognitive artifacts, evidenced by the implementation of new workflow processes without identification and studying of existing cognitive artifacts. Within a cultural context, this introduces dissonance to the cognitive work of clinicians, creating unplanned and unexplained disruption for clinicians. This potentially adds new and unanticipated risks to patient safety (Mclane).
Question 8
The authors posit that the study of cognitive artifacts, “frames a new and robust understanding of the role that cognitive artifacts serve in the clinical practice of users” (McLane et al, 2010). Further, considering the fact that cognitive artifacts provide a way to contribute and distribute information, their recognition and understanding puts informaticists, process improvement specialists and engineers, in a better position to develop processed as well as systems to effectively assist in cognitive work within the clinical setting, as well as ensure safer patient care. The deeper understanding generated by the concept analysis also puts clinicians in a better position to utilize cognitive artifacts in nursing practice.
Question 9
Even though McLane et al (2010) utilize Walker and Avant’s 8 step model in their concept analysis, while Simmons uses Rodger’s evolutionary model, the two do display certain similarities. In both cases, the authors start by identifying the concept to be analyzed. Secondly, both approaches to concept analysis require the identification of a model case. Simmon’s however, does not provide a clear step by step analysis that integrates the steps proposed by Rodgers, making an understanding of the concept a bit harder. This is unlike the approach taken by McLane et al (2010).
Question 10
The concept analysis by McLane et al makes it clear that cognitive artifacts are tangible physical devices which tend to be standard and applicable to more than one individual, as it focuses on multiple users. Clinical reasoning on the other hand, is not only intangible, but it is also individual and unique to a particular entity (Simmons, 2010).
Question 11
I do agree with Fawcett et al (2010) that Simmons has not identified an intellectual context or structure for clinical reasoning. The brief manner with which Simmons carries out the concept analysis provides no room for the creation or inclusion of an intellectual context.
References
Fawcett, J., McDowell, B., & Newmann, D. (2010). JAN Forum: Your Views and Letters.
McLane, S., Turley, J., Esquivel, A., Engebretson, J., Smith, K., Wood, G., & Zhang, J. (2010). Concept Analysis of Cognitive Artifacts. Advances in Nursing Sciences 33(4), 352-361.
Simmons, B. (2010). Clinical Reasoning: Concept Analysis. Journal of Advanced Nursing 66(5), 1151-1158.
