Designing study nurses' training to enhance research integrity: a macroergonomic approach.

Successful field evaluation of informatics initiatives designed to create technology-enhanced professional practice relies on adequate training of experimental participants. However, such training presents design, implementation and evaluation challenges. A macroergonomic approach, focusing on an organizational view of people, technology, task and environment interactions in work systems, provides a framework for training that allows anticipation and compensation for challenges. In the HeartCare II project, we developed a multi-level training program for nurses and patients enrolled in a field trial of an innovative technology-enhanced professional practice model. Using a macroergonomic approach, we designed three waves of training centered on a train-the-trainer model. Evaluation tools for each training wave provided improvement feedback. Despite planning, a drop-off occurred between training waves, affecting both recruitment and patient training. Troubleshooting identified people, task, technology, and organizational concerns. Strategies to increase nurse buy-in and improve technical performance are making a difference. Organizational challenges remain the most intractable.