A comparison of computerized graphical display formats for the titration of sodium nitroprusside

Abstract

This study focused on a comparison of 2 different graphical display formats for use by critical care nurses when making decisions about titration of vasoactive drug infusions. A novel display format, the metaphor icon display for drug titration, which was designed by the researcher, was compared to a more traditional display format, the line graph display. The study examined (1) which display format facilitated better decision-making performance, i.e., faster and more accurate decisions, (2) whether the nurses' decision-making performance differed by skill level or type of ICU and, (3) what decision-making processes nurses used in those titration decisions.;A mixed model within subjects design was used for the study. The between subjects variables were unit type and skill level. Data from the think aloud portion of the pilot study and survey data from the final study were used to derive decision-making processes used by critical care nurses when making decisions about titration of Sodium Nitroprusside. Speed and accuracy of decision-making were measured using six simulated problems presented in both a metaphor icon and line graph format. Each problem and display type had a unique case scenario. Thus, each subject responded to 12 different case situations, but only 6 different problems. The sample for the study consisted of 72 adult critical care nurses working in either a medical or surgical ICU. Nurses were sampled by skill level (4 levels) and unit type (2 types). Display format did impact decision-making performance. Two problems showed that critical care nurses were more accurate with the line graph display format, one problem found them more accurate with metaphor icon displays and the other 3 problems showed no significant differences in decision-making performance. Nurses were much quicker making judgments using the line graph display format than when using the metaphor icon display. Four of the 6 problems were significant for speed of decision-making. There were no significant differences found by type of ICU or skill level. Twenty-one decision-making processes were identified. Five exploratory variables (gender, learning preferences, display preferences, frequency of managing patients on vasoactive drug infusions and years of experience caring for this type of patient) showed significant results.