May 2007

Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Background: Hands free communication devices (HFCDs) are an information and communication technology comprised of wearable "badges" and server-based software. The technology is distinguishable by three traits: 1. It utilizes voice-over Internet protocol (VoiP) and wireless local area networks (WLANs), 2. The communication devices are wearable, and 3. The technology possesses voice control capability. HFCDs are increasingly used in clinical care settings, particularly among nursing staff. Quantitative studies and surveys report that clinicians who use HFCDs experience faster communication times but also have concerns about reliability and patient confidentiality. Methods: The researcher identified and recruited three groups ofHFCD stakeholders: staff nurses, nurse managers, and information technology (IT) staff; to participate in a qualitative research project. Twenty-seven subjects from two separate health care organizations participated in semi-structured, recorded interviews and discussed with the researcher what communication effects resulted from the use of HFCDs. The researcher also conducted on-site observations of HFCD use among nurses and clinical staff. Three questions were of central importance: 1. What effect did HFCDs have upon communication among staff? 2. What effect did HFCDs have upon communication in the organization? 3. What unintended consequences, or "surprises," resulted from the use of HFCDs? Interviews were transcribed and coded using a grounded theory approach. Results: Subjects reported HFCDs helped nurses and nurse managers communicate more efficiently and expediently than telephones, pagers, or overhead pages. Nurses and nurse managers also felt HFCDs enabled them to find help from one another faster than with previously used communication technologies. Subjects, particularly staff nurses, described the use of HFCDs required them to alter certain functions of their work and forced them to adjust to increased interruptions and develop methods for "controlling" HFCDs. In addition, nurses and nurse managers described the importance of developing communication etiquette. IT subjects described gaining better understanding of clinical work whereas staff nurses and nurse managers described only limited gains in understanding the work of IT staff. Other identified themes were training and the environment and infrastructure. Conclusion: Subjects reported HFCDs having positive impact upon workflow and helping staff achieve improved communication as well as improved patient care. The use of HFCDs resulted in changes in nursing tasks that required staff nurses and nurse managers to learn how to effectively use the technology. The implementation of HFCDs brought about organizational change in the ways clinicians and IT communicate within and across teams. In summary, HFCDs positively impact clinical and organizational communication but policies and procedures that support HFCDs are essential to success.




School of Medicine



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