{"id":{"repo_id":"uwo","oai_identifier":"oai:uwo.scholaris.ca:20.500.14721/28047"},"canonical_url":"https://search.dev.ndltd.org/etd/uwo/oai:uwo.scholaris.ca:20.500.14721/28047","repository":{"repo_id":"uwo","name":"Western University","base_url":"https://uwo.scholaris.ca/server/oai/request"},"display":{"title":"Supporting dynamic and distributed decision making in acute care environments: Insights from a cognitive ethnography","abstract":"The way that medical decisions are carried out in hospital environments has undergone radical changes in recent years, in part as a result of the changing landscape of care. To make decisions, physicians are expected to keep abreast of a growing and changing body of medical and patient knowledge, collaborate more with clinical colleagues, and utilize more technologies to inform care than ever before. This dissertation reports on a five month cognitive ethnography in an ICU in Ontario Canada, and utilizes distributed cognition to understand the challenges that physicians face in making decision in modern acute care environments. It also seeks to elucidate the strategies used by ICU physicians to cope with the challenges associated with using information from social, material and technological sources in decision-making. My findings demonstrate how information resources are (1) Objectivist, in that too much attention is paid to supporting the formalized, outcome-centered aspects of medical thinking, without due regard to the processes involved in adapting decisions to their situation; (2) Fragmented, in that, while information resources are often well-designed when considered in isolation, they force physicians to bridge gaps in the logic of access or representation when working between resources; (3) Individualistic, in that information resources are often tailored to support the cognitive needs of individual physicians, leaving the cognitive needs associated with collaboration unsupported, and sometimes undermining them. To compensate for the challenges associated with using objectivist, fragmented and individualistic information resources, physicians employed a number techniques, including relying in paper and other flexible artifacts, interpersonal clinical communications, and engaging in mobility work. This research brings us a step closer to understanding how people, paper, and technologies function together to fulfill the complex and dynamic needs associated with making medical decisions.","abstract_html":"The way that medical decisions are carried out in hospital environments has undergone radical changes in recent years, in part as a result of the changing landscape of care. To make decisions, physicians are expected to keep abreast of a growing and changing body of medical and patient knowledge, collaborate more with clinical colleagues, and utilize more technologies to inform care than ever before. This dissertation reports on a five month cognitive ethnography in an ICU in Ontario Canada, and utilizes distributed cognition to understand the challenges that physicians face in making decision in modern acute care environments. It also seeks to elucidate the strategies used by ICU physicians to cope with the challenges associated with using information from social, material and technological sources in decision-making. My findings demonstrate how information resources are (1) Objectivist, in that too much attention is paid to supporting the formalized, outcome-centered aspects of medical thinking, without due regard to the processes involved in adapting decisions to their situation; (2) Fragmented, in that, while information resources are often well-designed when considered in isolation, they force physicians to bridge gaps in the logic of access or representation when working between resources; (3) Individualistic, in that information resources are often tailored to support the cognitive needs of individual physicians, leaving the cognitive needs associated with collaboration unsupported, and sometimes undermining them. To compensate for the challenges associated with using objectivist, fragmented and individualistic information resources, physicians employed a number techniques, including relying in paper and other flexible artifacts, interpersonal clinical communications, and engaging in mobility work. This research brings us a step closer to understanding how people, paper, and technologies function together to fulfill the complex and dynamic needs associated with making medical decisions.","abstract_has_math":false,"creators":["Naimi, Anthony"],"institution":"The University of Western Ontario","degree_name":"Ph D","degree_level":null,"degree_discipline":"Health Information Science","degree_department":null,"school":null,"contributors":[],"advisors":["Haggerty, Nicole","Sedig, Kamran"],"committee_chairs":[],"committee_members":[],"year":2018,"date_issued":"2018-03-23","date_published":"2018-03-23","updated_at":"2026-07-27T21:55:59Z","subjects":["Distributed Cognition","Decision-making","Information","Activity System","Medical Communication"],"languages":["en_ca"],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://hdl.handle.net/20.500.14721/28047","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Haggerty, Nicole","Sedig, Kamran"]},{"key":"dc:creator","label":"Author","values":["Naimi, Anthony"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2025-07-10T16:07:02Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2025-07-10T16:07:02Z"]},{"key":"dc:date.issued","label":"Date","values":["2018-03-23"]},{"key":"dc:publisher","label":"Institution","values":["The University of Western Ontario"]},{"key":"dc:type","label":"Dc Type","values":["thesis"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Health Information Science"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Ph D"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Distributed Cognition","Decision-making","Information","Activity System","Medical Communication"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en_ca"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://hdl.handle.net/20.500.14721/28047"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["The thesis cover page in the PDF document includes references to Western University’s previous institutional repository platform, known as Scholarship@Western, and links to that platform (beginning with ir.lib.uwo.ca). In citing or referring to this thesis, use the DOI or handle from this page instead. Sample citation: Author name, \"Thesis title.\" (Year). Western University Open Repository. https://doi.org/10.71858/123456."]},{"key":"dc:description.abstract","label":"Abstract","values":["The way that medical decisions are carried out in hospital environments has undergone radical changes in recent years, in part as a result of the changing landscape of care. To make decisions, physicians are expected to keep abreast of a growing and changing body of medical and patient knowledge, collaborate more with clinical colleagues, and utilize more technologies to inform care than ever before. This dissertation reports on a five month cognitive ethnography in an ICU in Ontario Canada, and utilizes distributed cognition to understand the challenges that physicians face in making decision in modern acute care environments. It also seeks to elucidate the strategies used by ICU physicians to cope with the challenges associated with using information from social, material and technological sources in decision-making. My findings demonstrate how information resources are (1) Objectivist, in that too much attention is paid to supporting the formalized, outcome-centered aspects of medical thinking, without due regard to the processes involved in adapting decisions to their situation; (2) Fragmented, in that, while information resources are often well-designed when considered in isolation, they force physicians to bridge gaps in the logic of access or representation when working between resources; (3) Individualistic, in that information resources are often tailored to support the cognitive needs of individual physicians, leaving the cognitive needs associated with collaboration unsupported, and sometimes undermining them. To compensate for the challenges associated with using objectivist, fragmented and individualistic information resources, physicians employed a number techniques, including relying in paper and other flexible artifacts, interpersonal clinical communications, and engaging in mobility work. This research brings us a step closer to understanding how people, paper, and technologies function together to fulfill the complex and dynamic needs associated with making medical decisions."]},{"key":"dc:title","label":"Title","values":["Supporting dynamic and distributed decision making in acute care environments: Insights from a cognitive ethnography"]}]}],"canonical_facts":{"dc:contributor.advisor":["Haggerty, Nicole","Sedig, Kamran"],"dc:creator":["Naimi, Anthony"],"dc:date.accessioned":["2025-07-10T16:07:02Z"],"dc:date.available":["2025-07-10T16:07:02Z"],"dc:date.issued":["2018-03-23"],"dc:description":["The thesis cover page in the PDF document includes references to Western University’s previous institutional repository platform, known as Scholarship@Western, and links to that platform (beginning with ir.lib.uwo.ca). In citing or referring to this thesis, use the DOI or handle from this page instead. Sample citation: Author name, \"Thesis title.\" (Year). 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My findings demonstrate how information resources are (1) Objectivist, in that too much attention is paid to supporting the formalized, outcome-centered aspects of medical thinking, without due regard to the processes involved in adapting decisions to their situation; (2) Fragmented, in that, while information resources are often well-designed when considered in isolation, they force physicians to bridge gaps in the logic of access or representation when working between resources; (3) Individualistic, in that information resources are often tailored to support the cognitive needs of individual physicians, leaving the cognitive needs associated with collaboration unsupported, and sometimes undermining them. 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