The Information Seeking of On-Duty Critical Care Nurses: Evidence from Participant Observation and In-Context Interviews IRP
McKnight, Michelynn, Journal of the Medical Library Association
Objectives: An observational study describes on-duty nurses' informative behaviors from the perspective of library and information science, rather than patient care,. It reveals their information sources, the kinds of information they seek, and their barriers to information acquisition.
Methods: Participant observation and in-context interviews were used to record in detail fifty hours of the information behavior of a purposive sample of on-duty critical care nurses on twenty-bed critical care unit in a community hospital. The investigator used rigorous ethnographic methods-including open, in vivo, and axial coding-to analyze the resulting rich textual data.
Results: The nurses' information behavior centered on the patient, seeking information from people, the patient record, and other systems. The nurses mostly used patient-specific information, but they also used some social and logistic information. They occasionally sought knowledge-based information. Barriers to information acquisition included illegible handwriting, difficult navigation of online systems, equipment failure, unavailable people, social protocols, and mistakes caused by people multitasking while working with multiple complex systems. Although the participating nurses understood and respected evidence-based practice, many believed that taking time to read published information on duty was not only difficult, but perhaps also ethically wrong. They said that a personal information service available to them at all hours of the day or night would be very useful.
Conclusions: On-duty critical care nursing is a patient-centric information activity. A major implication of this study for librarians is that immediate professional reference service-including quality and quantity filtering-may be more useful to on-duty nurses than do-it-yourself searching and traditional document delivery are.
This study presents evidence of on-duty critical care nurses' information behavior. It describes the kinds of information they seek, their information sources, and their barriers to information acquisition at the point of care. As Dalrymple writes,
Observation of information-gathering behaviors ... contributes to developing delivery systems that actually work. Understanding the information behaviors of clinicians-how they seek information and how they apply it to practice-is a crucial first step in designing information delivery systems. 
Hospital librarians decry practicing nurses' lack of use of traditional library services [2-9]. They are perplexed when service, marketing, and teaching strategies developed for libraries in large university health sciences centers do not work well in libraries in community hospitals. It is unreasonable to expect working nurses to use hospital libraries in the same manner that they used academic libraries when they were in school or to assume that the on-duty hospital nurses' information ecology is similar to that of the nursing student. With the exception of the rare clinical librarians, informationists, and clinical information specialists in context (all of whom practice in teaching hospitals), most hospital librarians have spent little, if any, time with nurses on a hospital unit.
To provide effective library services for practicing hospital nurses, librarians need to understand the nurses' on-the-job information behavior. Many research studies of the information seeking of faculty and students, and of practicing physicians in teaching hospitals, have been conducted, but few have been conducted of community hospital nurses. Existing studies of nurses seeking knowledge-based information rely on post hoc self-report data gathered through surveys and interviews, not direct observation in a naturalistic context.
Registered nurses (RNs) are the largest group of professional health care providers . The Statistical Abstract of the United States: 2004-2005 reports 2,449,000 registered nurses in 2003, almost 3 times as many as the next largest group, physicians (819,000), in the United States . …