title: Mismatched concepts in a neonatal intensive care unit (NICU): further issues for computer decision support?
abstract: BACKGROUND
  Common concepts and definitions are important for the effective practice of medicine. In an intensive care unit clear understanding of terminology and communication between different staff groups may be critical for optimal care. If computerised decision support tools are to be successfully deployed in these high intensity environments, all staff must understand the concepts and information that is to be portrayed.
  
  
  OBJECTIVE
  To examine the similarity of language and concepts related to newborn infants and their care in staff groups with different experience.
  
  
  METHODS
  An experimental study in a tertiary regional neonatal intensive care unit involved 32 staff in 4 groups with varying experience (junior and senior / nurses and doctors). A psychologist developed a lexicon of clinical actions and a second lexicon of possible patient descriptors applicable to newborn infants receiving all degrees of neonatal care by conducting interviews with staff on the unit. Card sorting experiments were performed on the terms in the action and descriptor lexicons, the staff being asked to group words that were related to the same or similar concepts. The card sort data were analysed using conventional cluster analysis to produce tree-diagrams or dendrograms and then by distance matrix analysis to give cumulative probability plots.
  
  
  RESULTS
  Differences were shown in the way various classes of staff and staff with different experience mentally map clinical concepts. Clinical actions were grouped more randomly by nurses and by those with less experience with a polarisation between senior doctors and junior nurses. Descriptors were classed more definitively and similarly by junior and senior nurses and senior doctors but more randomly and quite differently by junior doctors. Thus there were differences seen between nurses and doctors with different roles within the unit and differences related to experience.
  
  
  CONCLUSIONS
  Concepts are used differently by various staff groups in a neonatal unit: this may have an impact on the effectiveness of computerised decision aids unless it is taken into account during their development.
authors.affiliation: Department of Neonatology, University of Edinburgh, UK.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Freer
authors.forename: Lindsey
authors.initials: L
authors.lastname: Ferguson
authors.forename: Gary
authors.initials: G
authors.lastname: Ewing
authors.forename: Jim
authors.initials: J
authors.lastname: Hunter
authors.forename: Robert
authors.initials: R
authors.lastname: Logie
authors.forename: Sue
authors.initials: S
authors.lastname: Rudkin
authors.forename: Neil
authors.initials: N
authors.lastname: McIntosh
mesh_terms: D000328:Adult; D002983:Clinical Competence; D016000:Cluster Analysis; D003657:Decision Making; D003661:Decision Support Techniques; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal; D008505:Medical Staff, Hospital; D008991:Monitoring, Physiologic; D009483:Neuropsychological Tests; D009741:Nursing Staff, Hospital