{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T21:45:32Z","timestamp":1776116732656,"version":"3.50.1"},"reference-count":45,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"crossref","award":["R36HS022183"],"award-info":[{"award-number":["R36HS022183"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Standardizing nursing handoffs at shift change is recommended to improve communication, with electronic tools as the primary approach. However, nurses continue to rely on personally created paper-based cognitive artifacts - their \u201cpaper brains\u201d - to support handoffs, indicating a deficiency in available electronic versions.<\/jats:p><jats:p>The purpose of this qualitative study was to develop a deep understanding of nurses\u2019 paper-based cognitive artifacts in the context of a cancer specialty hospital.<\/jats:p><jats:p>After completing 73 hours of hospital unit field observations, 13 medical oncology nurses were purposively sampled, shadowed for a single shift and interviewed using a semi-structured technique. An interpretive descriptive study design guided analysis of the data corpus of field notes, transcribed interviews, images of nurses\u2019 paper-based cognitive artifacts, and analytic memos.<\/jats:p><jats:p>Findings suggest nurses\u2019 paper brains are personal, dynamic, living objects that undergo a life cycle during each shift and evolve over the course of a nurse\u2019s career. The life cycle has four phases: Creation, Application, Reproduction, and Destruction. Evolution in a nurse\u2019s individually styled, paper brain is triggered by a change in the nurse\u2019s environment that reshapes cognitive needs. If a paper brain no longer provides cognitive support in the new environment, it is modified into (adapted) or abandoned (made extinct) for a different format that will provide the necessary support.<\/jats:p><jats:p>The \u201chidden lives\u201d - the life cycle and evolution - of paper brains have implications for the design of successful electronic tools to support nursing practice, including handoff. Nurses\u2019 paper brains provide cognitive support beyond the context of handoff. Information retrieval during handoff is undoubtedly an important function of nurses\u2019 paper brains, but tools designed to standardize handoff communication without accounting for cognitive needs during all phases of the paper brain life cycle or the ability to evolve with changes to those cognitive needs will be underutilized.<\/jats:p><jats:p>Citation: Blaz JW, Doig AK, Cloyes KG, Staggers N. 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