Journal of Diagnostic Medical Sonography, Jul 5, 2023
Objective: This work aimed to explore how the COVID-19 pandemic affected the work of sonographers... more Objective: This work aimed to explore how the COVID-19 pandemic affected the work of sonographers and vascular technologists. Materials and Methods: A follow-up questionnaire was sent to an established registry of ultrasonography users who opted into a longitudinal research study examining worker health and wellbeing. Multiple questions related to the general impacts of COVID-19 on sonography work practices, workload, and considerations of remaining or leaving their current job were included; responses to these questions were descriptively tabulated. Participants indicated specific changes that occurred and provided general comments related to COVID-19 impacts in two free-text questions. These comments were qualitatively analyzed by two sonographers who used an interpretive grounded theory approach to formatively code and memo the comments. Four summative interviews were conducted with participants who represented varied practice areas to gain deeper insights into the experiences expressed by the total respondent pool. Qualitative coding of the free-text responses and interview transcripts was completed independently by the two sonographers using the Sonography Work Systems (SWS) framework, and the full research team contributed to the interpretation of the findings. Results: A total of 1389 ultrasonography users completed the questionnaire. The pandemic changed the ways in which examinations were performed for approximately half of the respondents. A higher or somewhat higher workload was noted by 48% of the sample, while only 10% experienced a lower or somewhat lower workload. Components of the work system were a major concern for respondents, and a lack of support from supervisors and hospital administration was a key finding. Participants felt limited in their ability to provide care, experienced posttraumatic stress, and reported a lack of reciprocity, which were all underscored as undesirable outcomes. Conclusion: Sonographers and vascular technologists suffered negative consequences during the COVID-19 pandemic. The most marked outcome was the undesirable effects on the work system, which resulted in the need for these workers to engage in herculean efforts over a sustained period. Findings suggest that these health care heroes may have experienced physical and mental harm while trying to provide health care services, despite numerous institutional challenges.
Journal of Diagnostic Medical Sonography, May 23, 2023
Objective: Work-related discomfort is a pervasive issue among ultrasonography users. The Sonograp... more Objective: Work-related discomfort is a pervasive issue among ultrasonography users. The Sonography Work Systems (SWS) framework was constructed as a means of examining relationships within and across components of the sonography work systems, work processes, and work/worker outcomes. A database of ultrasonography users was established as a foundation for a longitudinal survey study to examine worker health and well-being and explore the most salient work systems and process factors associated with work-related discomfort. Materials and Methods: An estimated 100 000 unique ultrasonography users were invited to complete the online questionnaire through an e-mail campaign. Snowball sampling occurred through social media posts and encouragement for respondents to share the survey link with colleagues. The questionnaire included items that examined participant demographics, selected constructs from the SWS, and the prevalence of work-related musculoskeletal discomfort, visual discomfort, and headaches. Individual and multi-factorial regression models were conducted to examine SWS factors associated with the likelihood of experiencing the three types of work-related discomfort. Results: A total of 3659 valid responses were included in the analysis, with 86% of respondents reporting that they regularly experienced musculoskeletal discomfort that they directly attributed to their work. About half (54.2%) of the respondents have engaged in sonography-related ergonomics training, and respondents indicated using adjustable equipment approximately 74% of the time. Workplace culture was rated as primarily positive, but respondents indicated that employers implement only two of seven commonly recommended ergonomic policies and procedures. Working in an organization with more policies, using adjustable equipment more frequently, taking more work breaks, engaging in a positive work culture, and minimizing interruptions to workflow were key factors associated with reduced likelihood of work-related discomfort. Conclusion: This study provides a new framework for examining and addressing factors that contribute to ultrasonography users’ experience of work-related discomfort. Despite increased participation in ergonomics training and the use of adjustable equipment, the prevalence of work-related discomfort remains high among ultrasonography users. The findings highlight the need for attention to be directed at organizational factors and work processes to identify and implement evidence-based solutions to improve the health and well-being of medical ultrasound users.
Journal of Diagnostic Medical Sonography, Apr 25, 2022
This article discusses the importance of conducting a longitudinal data collection concerning wel... more This article discusses the importance of conducting a longitudinal data collection concerning well-being and the risk for work-related musculoskeletal injuries (WRMSI) among sonographers and vascular technologists. There is a need for changes in the manner that sonographic work is done, but this should be nested in empirical evidence. This gives the rational for conducting the study titled Documenting the overall wellness of ultrasound users and the risk of progressive WRMSI: A national longitudinal study. The objective of this longitudinal work is to better understand collective practice patterns and examine the relationship of sonographic work conditions and performance to the user’s health and well-being. This symposium provides the foundational understanding of the strength of this type of study and how it may help to influence behavior and organizational change.
An increase in providing hospital bedside imaging examinations could be contributing to the risk ... more An increase in providing hospital bedside imaging examinations could be contributing to the risk of musculoskeletal injuries among imaging professionals. Given the increasing demand for portable bedside imaging, a research project was conducted in three phases: (1) interviews and focus group sessions, (2) full-scale mock-up sessions where occupational stakeholders created prototype rooms, and (3) evaluation sessions of inpatient room prototypes by all stakeholders. The study data from diagnostic medical sonographers (DMS), cardiac sonographers (CS), vascular technologists (VT), and radiographers (RTs) were retrospectively pulled from the overall research to address the following research question: What hospital room designs and components facilitate or hinder medical imaging professionals in providing bedside imaging? Data analyses utilize constant comparative analysis, quantitative counts, and discourse analysis across all three phases of the project. The results highlight the impo...
HERD: Health Environments Research & Design Journal, 2019
Objectives: This research investigated medical/surgical (Med/Surg) patient room design to accommo... more Objectives: This research investigated medical/surgical (Med/Surg) patient room design to accommodate the needs of hospital staff, while at the same time accommodating the needs of patients and their visitors. Background: Designing hospital patient rooms that provide a comfortable healing experience for patients, while at the same time meeting the needs of the hospital staff, is a challenging process. Prior research has shown that many hospital patient room designs adversely affect the ability of hospital staff to perform their tasks effectively, efficiently, and safely. Method: Twenty-seven design sessions were conducted in which 104 participants, representing 24 different occupations, worked in small mixed occupational groups to design an ideal single patient Med/Surg patient room to fit their collective needs using a full-scale mock-up. During analysis, the investigators reduced the resulting 27 room designs to 5 hybrid designs that were sequentially reviewed by patients and visi...
To identify family members' and visitors' needs with relation to the design of a hospital... more To identify family members' and visitors' needs with relation to the design of a hospital room. There is a trend toward incorporating family zones in hospital patient rooms in order to improve patient satisfaction and encourage family caregivers to stay longer and overnight. A mixed-method study was employed. Interviews of patients and family caregivers were conducted to understand opportunities to improve hospital room designs based on recent experiences. Features intended to support short-term and overnight visitors were embedded in five full-scale simulated room design concepts. Small groups of family caregivers and patients toured two room design concepts and reacted real time to room features. A grounded theory approach was employed to identify emerging themes. A theoretical design framework is developed for the needs of family members and visitors for a range of time periods. This framework is founded upon desires to help make the patient feel more comfortable. There a...
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2016
Increasing interest in acuity-adaptable patient rooms, performing more services in patient rooms,... more Increasing interest in acuity-adaptable patient rooms, performing more services in patient rooms, and the increasing size of the population all have implications for the patient room as a workspace, including the number of people working in the room, types of tasks performed, and amount and layout of the space in which tasks are performed. This presentation describes an analysis of the opinions of professionals who typically control the design of hospital patient rooms, concerning five med/surg patient room designs developed through a participatory process involving mixed groups of hospital staff members, all of whom work in patient rooms. Ratings and comments provided by the design professionals identified clear preferences for one of the designs, as well as rooms and design elements for which there were more mixed or negative opinions. It is important for architects and designers to understand how room size, layout, and organization of features can be used to facilitate work for t...
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2014
Infection control is of central importance when designing hospital rooms, particularly to reduce ... more Infection control is of central importance when designing hospital rooms, particularly to reduce hospital-acquired infections. Existing room design standards include private rooms, toilets, and showers, ample space between a patient’s bed and a family member’s bed, and separate spaces for clean and dirty nursing activities. We investigated various hospital room factors that make it challenging for staff to reduce hospital-acquired infections. Focus groups and interviews were conducted with multiple stakeholder groups as part of a larger research effort to generate guidelines for hospital room design. Transcripts were generated for eight of these stakeholder groups, including housekeeping staff, and qualitatively analyzed for emerging themes. The insights suggest additional areas for consideration during the design of hospital rooms, in particular the need for standardized, dedicated locations for supplies brought into the patient room and inclusion of the perspective of housekeeping staff in the design process.
HERD: Health Environments Research & Design Journal, 2017
Objectives: To identify patient needs and expectations that can be utilized to inform the design ... more Objectives: To identify patient needs and expectations that can be utilized to inform the design or renovation of medical–surgical patient rooms in a hospital. Background: There is an increased interest in supportive room design to increase patient satisfaction and improve the healing process. Methods: Patients’ and family caregivers’ reactions were elicited to intentional room elements embedded in a set of five full-scale simulated room prototypes. Small groups of patients and caregivers toured two of the five rooms and provided verbal and written evaluations of room features. A grounded theory approach was employed to generate a codebook, identify the frequency of codes, and to group codes and memos into emerging themes. Insights from emergent themes were compared with findings from written surveys on the importance of various room design elements completed at the beginning of each session. Results: A theoretical design framework was generated, showing patients expect a hospital r...
Molecular ultrasound imaging provides the ability to detect physiologic processes non-invasively ... more Molecular ultrasound imaging provides the ability to detect physiologic processes non-invasively by targeting a wide variety of biological markers in vivo. The current study investigates the novel application of molecular ultrasound imaging for the detection of neural inflammation. Using a murine model with acutely injured spinal cords (n=31), subjects were divided into four groups, each being administered ultrasound contrast microbubbles bearing antibodies against various known inflammatory molecules (P-selectin, vascular cell adhesion protein 1 [VCAM-1], intercellular adhesion molecule 1 [ICAM-1], and isotype control) during molecular ultrasound imaging. Upon administration of the targeted contrast agent, ultrasound imaging of the injured spinal cord was performed at 40MHz for seven minutes, followed by a bursting pulse. We observed significantly enhanced signals from contrast targeted to P-selectin and VCAM-1, using a variety of outcome measures. These findings provide preclinica...
ObjectivesThe use of sonography in musculoskeletal research and clinical applications is increasi... more ObjectivesThe use of sonography in musculoskeletal research and clinical applications is increasing; however, measurement techniques for diagnosing carpal tunnel syndrome with sonography continue to be inconsistent. Novel methods of measurement using internal comparisons to identify swelling of the median nerve require investigation and comparison to currently used techniques.MethodsThe flattening ratio of the median nerve, bowing of the flexor retinaculum, and cross‐sectional area of the median nerve were collected in the forearm, at the radiocarpal joint, and at the level of the pisiform in both symptomatic patients and asymptomatic control participants. Electrodiagnostic testing was completed in symptomatic patients as a diagnostic standard.ResultsMedian nerve measurements were collected from 166 wrists of symptomatic and asymptomatic participants. The flattening ratio did not show any correlation to electrodiagnostic testing and was identical between both symptomatic and asympto...
Mammographers are an understudied group of health care workers, yet the prevalence of musculoskel... more Mammographers are an understudied group of health care workers, yet the prevalence of musculoskeletal (MSK) symptoms in mammographers appears to be elevated, similar to many occupations in health care. In this study, we used a participatory approach to identify needs and opportunities for developing interventions to reduce mammographers' exposures to risk factors that lead to the development of MSK symptoms. In this paper, we present a number of those needs and several intervention concepts along with evaluations of those concepts from experienced mammographers. We include findings from a preliminary field test of a novel intervention concept to reduce the need to adopt awkward postures while positioning patients for a screening or diagnostic mammogram. Practitioner Summary: This paper discusses needs, opportunities and methods for working with mammographers in order to develop interventions to reduce their exposure to risk factors for work-related musculoskeletal discomfort. Re...
Journal of Diagnostic Medical Sonography, Jul 5, 2023
Objective: This work aimed to explore how the COVID-19 pandemic affected the work of sonographers... more Objective: This work aimed to explore how the COVID-19 pandemic affected the work of sonographers and vascular technologists. Materials and Methods: A follow-up questionnaire was sent to an established registry of ultrasonography users who opted into a longitudinal research study examining worker health and wellbeing. Multiple questions related to the general impacts of COVID-19 on sonography work practices, workload, and considerations of remaining or leaving their current job were included; responses to these questions were descriptively tabulated. Participants indicated specific changes that occurred and provided general comments related to COVID-19 impacts in two free-text questions. These comments were qualitatively analyzed by two sonographers who used an interpretive grounded theory approach to formatively code and memo the comments. Four summative interviews were conducted with participants who represented varied practice areas to gain deeper insights into the experiences expressed by the total respondent pool. Qualitative coding of the free-text responses and interview transcripts was completed independently by the two sonographers using the Sonography Work Systems (SWS) framework, and the full research team contributed to the interpretation of the findings. Results: A total of 1389 ultrasonography users completed the questionnaire. The pandemic changed the ways in which examinations were performed for approximately half of the respondents. A higher or somewhat higher workload was noted by 48% of the sample, while only 10% experienced a lower or somewhat lower workload. Components of the work system were a major concern for respondents, and a lack of support from supervisors and hospital administration was a key finding. Participants felt limited in their ability to provide care, experienced posttraumatic stress, and reported a lack of reciprocity, which were all underscored as undesirable outcomes. Conclusion: Sonographers and vascular technologists suffered negative consequences during the COVID-19 pandemic. The most marked outcome was the undesirable effects on the work system, which resulted in the need for these workers to engage in herculean efforts over a sustained period. Findings suggest that these health care heroes may have experienced physical and mental harm while trying to provide health care services, despite numerous institutional challenges.
Journal of Diagnostic Medical Sonography, May 23, 2023
Objective: Work-related discomfort is a pervasive issue among ultrasonography users. The Sonograp... more Objective: Work-related discomfort is a pervasive issue among ultrasonography users. The Sonography Work Systems (SWS) framework was constructed as a means of examining relationships within and across components of the sonography work systems, work processes, and work/worker outcomes. A database of ultrasonography users was established as a foundation for a longitudinal survey study to examine worker health and well-being and explore the most salient work systems and process factors associated with work-related discomfort. Materials and Methods: An estimated 100 000 unique ultrasonography users were invited to complete the online questionnaire through an e-mail campaign. Snowball sampling occurred through social media posts and encouragement for respondents to share the survey link with colleagues. The questionnaire included items that examined participant demographics, selected constructs from the SWS, and the prevalence of work-related musculoskeletal discomfort, visual discomfort, and headaches. Individual and multi-factorial regression models were conducted to examine SWS factors associated with the likelihood of experiencing the three types of work-related discomfort. Results: A total of 3659 valid responses were included in the analysis, with 86% of respondents reporting that they regularly experienced musculoskeletal discomfort that they directly attributed to their work. About half (54.2%) of the respondents have engaged in sonography-related ergonomics training, and respondents indicated using adjustable equipment approximately 74% of the time. Workplace culture was rated as primarily positive, but respondents indicated that employers implement only two of seven commonly recommended ergonomic policies and procedures. Working in an organization with more policies, using adjustable equipment more frequently, taking more work breaks, engaging in a positive work culture, and minimizing interruptions to workflow were key factors associated with reduced likelihood of work-related discomfort. Conclusion: This study provides a new framework for examining and addressing factors that contribute to ultrasonography users’ experience of work-related discomfort. Despite increased participation in ergonomics training and the use of adjustable equipment, the prevalence of work-related discomfort remains high among ultrasonography users. The findings highlight the need for attention to be directed at organizational factors and work processes to identify and implement evidence-based solutions to improve the health and well-being of medical ultrasound users.
Journal of Diagnostic Medical Sonography, Apr 25, 2022
This article discusses the importance of conducting a longitudinal data collection concerning wel... more This article discusses the importance of conducting a longitudinal data collection concerning well-being and the risk for work-related musculoskeletal injuries (WRMSI) among sonographers and vascular technologists. There is a need for changes in the manner that sonographic work is done, but this should be nested in empirical evidence. This gives the rational for conducting the study titled Documenting the overall wellness of ultrasound users and the risk of progressive WRMSI: A national longitudinal study. The objective of this longitudinal work is to better understand collective practice patterns and examine the relationship of sonographic work conditions and performance to the user’s health and well-being. This symposium provides the foundational understanding of the strength of this type of study and how it may help to influence behavior and organizational change.
An increase in providing hospital bedside imaging examinations could be contributing to the risk ... more An increase in providing hospital bedside imaging examinations could be contributing to the risk of musculoskeletal injuries among imaging professionals. Given the increasing demand for portable bedside imaging, a research project was conducted in three phases: (1) interviews and focus group sessions, (2) full-scale mock-up sessions where occupational stakeholders created prototype rooms, and (3) evaluation sessions of inpatient room prototypes by all stakeholders. The study data from diagnostic medical sonographers (DMS), cardiac sonographers (CS), vascular technologists (VT), and radiographers (RTs) were retrospectively pulled from the overall research to address the following research question: What hospital room designs and components facilitate or hinder medical imaging professionals in providing bedside imaging? Data analyses utilize constant comparative analysis, quantitative counts, and discourse analysis across all three phases of the project. The results highlight the impo...
HERD: Health Environments Research & Design Journal, 2019
Objectives: This research investigated medical/surgical (Med/Surg) patient room design to accommo... more Objectives: This research investigated medical/surgical (Med/Surg) patient room design to accommodate the needs of hospital staff, while at the same time accommodating the needs of patients and their visitors. Background: Designing hospital patient rooms that provide a comfortable healing experience for patients, while at the same time meeting the needs of the hospital staff, is a challenging process. Prior research has shown that many hospital patient room designs adversely affect the ability of hospital staff to perform their tasks effectively, efficiently, and safely. Method: Twenty-seven design sessions were conducted in which 104 participants, representing 24 different occupations, worked in small mixed occupational groups to design an ideal single patient Med/Surg patient room to fit their collective needs using a full-scale mock-up. During analysis, the investigators reduced the resulting 27 room designs to 5 hybrid designs that were sequentially reviewed by patients and visi...
To identify family members' and visitors' needs with relation to the design of a hospital... more To identify family members' and visitors' needs with relation to the design of a hospital room. There is a trend toward incorporating family zones in hospital patient rooms in order to improve patient satisfaction and encourage family caregivers to stay longer and overnight. A mixed-method study was employed. Interviews of patients and family caregivers were conducted to understand opportunities to improve hospital room designs based on recent experiences. Features intended to support short-term and overnight visitors were embedded in five full-scale simulated room design concepts. Small groups of family caregivers and patients toured two room design concepts and reacted real time to room features. A grounded theory approach was employed to identify emerging themes. A theoretical design framework is developed for the needs of family members and visitors for a range of time periods. This framework is founded upon desires to help make the patient feel more comfortable. There a...
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2016
Increasing interest in acuity-adaptable patient rooms, performing more services in patient rooms,... more Increasing interest in acuity-adaptable patient rooms, performing more services in patient rooms, and the increasing size of the population all have implications for the patient room as a workspace, including the number of people working in the room, types of tasks performed, and amount and layout of the space in which tasks are performed. This presentation describes an analysis of the opinions of professionals who typically control the design of hospital patient rooms, concerning five med/surg patient room designs developed through a participatory process involving mixed groups of hospital staff members, all of whom work in patient rooms. Ratings and comments provided by the design professionals identified clear preferences for one of the designs, as well as rooms and design elements for which there were more mixed or negative opinions. It is important for architects and designers to understand how room size, layout, and organization of features can be used to facilitate work for t...
Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 2014
Infection control is of central importance when designing hospital rooms, particularly to reduce ... more Infection control is of central importance when designing hospital rooms, particularly to reduce hospital-acquired infections. Existing room design standards include private rooms, toilets, and showers, ample space between a patient’s bed and a family member’s bed, and separate spaces for clean and dirty nursing activities. We investigated various hospital room factors that make it challenging for staff to reduce hospital-acquired infections. Focus groups and interviews were conducted with multiple stakeholder groups as part of a larger research effort to generate guidelines for hospital room design. Transcripts were generated for eight of these stakeholder groups, including housekeeping staff, and qualitatively analyzed for emerging themes. The insights suggest additional areas for consideration during the design of hospital rooms, in particular the need for standardized, dedicated locations for supplies brought into the patient room and inclusion of the perspective of housekeeping staff in the design process.
HERD: Health Environments Research & Design Journal, 2017
Objectives: To identify patient needs and expectations that can be utilized to inform the design ... more Objectives: To identify patient needs and expectations that can be utilized to inform the design or renovation of medical–surgical patient rooms in a hospital. Background: There is an increased interest in supportive room design to increase patient satisfaction and improve the healing process. Methods: Patients’ and family caregivers’ reactions were elicited to intentional room elements embedded in a set of five full-scale simulated room prototypes. Small groups of patients and caregivers toured two of the five rooms and provided verbal and written evaluations of room features. A grounded theory approach was employed to generate a codebook, identify the frequency of codes, and to group codes and memos into emerging themes. Insights from emergent themes were compared with findings from written surveys on the importance of various room design elements completed at the beginning of each session. Results: A theoretical design framework was generated, showing patients expect a hospital r...
Molecular ultrasound imaging provides the ability to detect physiologic processes non-invasively ... more Molecular ultrasound imaging provides the ability to detect physiologic processes non-invasively by targeting a wide variety of biological markers in vivo. The current study investigates the novel application of molecular ultrasound imaging for the detection of neural inflammation. Using a murine model with acutely injured spinal cords (n=31), subjects were divided into four groups, each being administered ultrasound contrast microbubbles bearing antibodies against various known inflammatory molecules (P-selectin, vascular cell adhesion protein 1 [VCAM-1], intercellular adhesion molecule 1 [ICAM-1], and isotype control) during molecular ultrasound imaging. Upon administration of the targeted contrast agent, ultrasound imaging of the injured spinal cord was performed at 40MHz for seven minutes, followed by a bursting pulse. We observed significantly enhanced signals from contrast targeted to P-selectin and VCAM-1, using a variety of outcome measures. These findings provide preclinica...
ObjectivesThe use of sonography in musculoskeletal research and clinical applications is increasi... more ObjectivesThe use of sonography in musculoskeletal research and clinical applications is increasing; however, measurement techniques for diagnosing carpal tunnel syndrome with sonography continue to be inconsistent. Novel methods of measurement using internal comparisons to identify swelling of the median nerve require investigation and comparison to currently used techniques.MethodsThe flattening ratio of the median nerve, bowing of the flexor retinaculum, and cross‐sectional area of the median nerve were collected in the forearm, at the radiocarpal joint, and at the level of the pisiform in both symptomatic patients and asymptomatic control participants. Electrodiagnostic testing was completed in symptomatic patients as a diagnostic standard.ResultsMedian nerve measurements were collected from 166 wrists of symptomatic and asymptomatic participants. The flattening ratio did not show any correlation to electrodiagnostic testing and was identical between both symptomatic and asympto...
Mammographers are an understudied group of health care workers, yet the prevalence of musculoskel... more Mammographers are an understudied group of health care workers, yet the prevalence of musculoskeletal (MSK) symptoms in mammographers appears to be elevated, similar to many occupations in health care. In this study, we used a participatory approach to identify needs and opportunities for developing interventions to reduce mammographers' exposures to risk factors that lead to the development of MSK symptoms. In this paper, we present a number of those needs and several intervention concepts along with evaluations of those concepts from experienced mammographers. We include findings from a preliminary field test of a novel intervention concept to reduce the need to adopt awkward postures while positioning patients for a screening or diagnostic mammogram. Practitioner Summary: This paper discusses needs, opportunities and methods for working with mammographers in order to develop interventions to reduce their exposure to risk factors for work-related musculoskeletal discomfort. Re...
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