OBJECTIVE: To conduct a meta-ethnographic synthesis summarizing the overarching themes of the qualitative literature on nurse interaction with medication administration technologies (MAT) comprising electronic medication administration record (eMAR) and bar-coded medication administration (BCMA). MATERIALS AND METHODS: We searched scientific databases from their inception until September 23, 2024, resulting in 2270 unique articles, and extracted data from 27 articles. Scientific rigor was assessed by the Standards for Reporting Qualitative Research (SRQR) checklist. Noblit and Hare's methodology was used to conduct a meta-ethnography to identify and interpret emergent themes. RESULTS: SRQR revealed low-to-medium methodological quality and theoretical framing of the literature. We found 6 overarching themes connecting MAT with nursing work: (1) View of the MAT system as mechanistic and invariant vs living and co-evolving with its users drives the research approach; (2) MAT limits nurse autonomy; (3) MAT unnaturally splits the medication administration workflow; (4) Nurses must manage MAT challenges at the sharp end; (5) MAT does not align with social dependencies of nursing work; and (6) MAT increases perceived safety but can also result in new types of errors. DISCUSSION: MAT does not support key cognitive work that nurses must perform to maintain safety. Additionally, MAT can impede problem solving during medication management and limit nursing autonomy that is essential for safe medication administration. CONCLUSION: Recommendations based in human factors engineering recognizing how MAT design impacts nursing work and workload are essential in improving the fit of MAT to nurse cognitive workflows.

OBJECTIVES: (1) Characterize persistent hazards and inefficiencies in inpatient medication administration; (2) Explore cognitive attributes of medication administration tasks; and (3) Discuss strategies to reduce medication administration technology-related hazards. MATERIALS AND METHODS: Interviews were conducted with 32 nurses practicing at 2 urban, eastern and western US health systems. Qualitative analysis using inductive and deductive coding included consensus discussion, iterative review, and coding structure revision. We abstracted hazards and inefficiencies through the lens of risks to patient safety and the cognitive perception-action cycle (PAC). RESULTS: Persistent safety hazards and inefficiencies related to MAT organized around the PAC cycle included: (1) Compatibility constraints create information silos; (2) Missing action cues; (3) Intermittent communication flow between safety monitoring systems and nurses; (4) Occlusion of important alerts by other, less helpful alerts; (5) Dispersed information: Information required for tasks is not collocated; (6) Inconsistent data organization: Mismatch of the display and the user's mental model; (7) Hidden medication administration technologies (MAT) limitations: Inaccurate beliefs about MAT functionality contribute to overreliance on the technology; (8) Software rigidity causes workarounds; (9) Cumbersome dependencies between technology and the physical environment; and (10) Technology breakdowns require adaptive actions. DISCUSSION: Errors might persist in medication administration despite successful Bar Code Medication Administration and Electronic Medication Administration Record deployment for reducing errors. Opportunities to improve MAT require a deeper understanding of high-level reasoning in medication administration, including control over the information space, collaboration tools, and decision support. CONCLUSION: Future medication administration technology should consider a deeper understanding of nursing knowledge work for medication administration.

The aim of this study was to explore the extent to which increasing engagement would negate vigilance decrements in monitoring during a realistic air traffic control monitoring task. Technological advances in aircraft and navigation may change the controller's job from directing air traffic to more of a monitoring role with supervisory control. Research shows that humans are not effective monitors and can be subject to vigilance decrements. Even though vigilance decrements have been demonstrated in some settings, it is still not known if they are likely in a future ATC monitoring role. Sixteen undergraduates from the Georgia Institute of Technology trained for 6 weeks on NextSim, a medium fidelity ATC research simulator of the NextGen environment. They then performed 4 weeks of scenarios that required monitoring of flow corridors for failures of conflict evading technology. Two levels of engagement and two levels of attentional focus while monitoring were analyzed. Participants showed a significant vigilance decrement except after extended practice in the engaged condition. The findings of this study suggest that engaging the operator may alleviate the vigilance decrement, however only after practice.