Loma Linda University

Enrollment Information
Call us at: 909-558-1000

Faculty Directory
Christiane Schubert, PhD
Assistant Professor, Medical Education
School of Medicine
Assistant Professor, Social Work & Social Ecology
Member, Faculty of Graduate Studies
Publications    Scholarly Journals--Published
  • Holden R J, Schubert C C, Eiland E C, Storrow A B, Miller K F, & Collins S P. (2015). Self-care Barriers Reported by Emergency Department Patients With Acute Heart Failure: A Sociotechnical Systems-Based Approach. Ann Emerg Med, 66(1), 1-12. ( 7/2015 ) Link...
    Study objective: We pilot tested a sociotechnical systems-based instrument that assesses the prevalence and nature of self-care barriers among patients presenting to the emergency department (ED) with acute heart failure. Methods: A semistructured instrument for measuring self-reported self-care barriers was developed and administered by ED clinicians and nonclinician researchers to 31 ED patients receiving a diagnosis of acute heart failure. Responses were analyzed with descriptive statistics and qualitative content analysis. Feasibility was assessed by examining participant cooperation rates, instrument completion times, item nonresponse, and data yield. Results: Of 47 distinct self-care barriers assessed, a median of 15 per patient were indicated as "sometimes" or "often" present. Thirty-four specific barriers were reported by more than 25% of patients and 9 were reported by more than 50%. The sources of barriers included the person, self-care tasks, tools and technologies, and organizational, social, and physical contexts. Seven of the top 10 most prevalent barriers were related to patient characteristics; the next 3, to the organizational context (eg, life disruptions). A preliminary feasibility assessment found few item nonresponses or comprehension difficulties, good cooperation, and high data yield from both closed- and open-ended items, but also found opportunities to reduce median administration time and variability. Conclusion: An instrument assessing self-care barriers from multiple system sources can be feasibly implemented in the ED. Further research is required to modify the instrument for widespread use and evaluate its implementation across institutions and cultural contexts. Self-care barriers measurement can be one component of broader inquiry into the distributed health-related "work" activity of patients, caregivers, and clinicians.
  • Holden Richard J, Schubert Christiane C, & Mickelson Robin S. (2015). The patient work system: An analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers. Applied Ergonomics, 47, 133-150. ( 0/2015 ) Link...
    Human factors and ergonomics approaches have been successfully applied to study and improve the work performance of healthcare professionals. However, there has been relatively little work in â??patient-engaged human factors,â?? or the application of human factors to the health-related work of patients and other nonprofessionals. This study applied a foundational human factors tool, the systems model, to investigate the barriers to self-care performance among chronically ill elderly patients and their informal (family) caregivers. A Patient Work System model was developed to guide the collection and analysis of interviews, surveys, and observations of patients with heart failure (n = 30) and their informal caregivers (n = 14). Iterative analyses revealed the nature and prevalence of self-care barriers across components of the Patient Work System. Person-related barriers were common and stemmed from patients' biomedical conditions, limitations, knowledge deficits, preferences, and perceptions as well as the characteristics of informal caregivers and healthcare professionals. Task barriers were also highly prevalent and included task difficulty, timing, complexity, ambiguity, conflict, and undesirable consequences. Tool barriers were related to both availability and access of tools and technologies and their design, usability, and impact. Context barriers were found across three domainsâ??physicalâ??spatial, socialâ??cultural, and organizationalâ??and multiple â??spacesâ?? such as â??at home,â?? â??on the go,â?? and â??in the community.â?? Barriers often stemmed not from single factors but from the interaction of several work system components. Study findings suggest the need to further explore multiple actors, contexts, and interactions in the patient work system during research and intervention design, as well as the need to develop new models and measures for studying patient and family work. (PsycINFO Database Record (c) 2015 APA, all rights reserved). (journal abstract)
  • Jadalla Ahlam A, Hattar Marianne, & Schubert Christiane C. (2015). Acculturation as a predictor of health promoting and lifestyle practices of Arab-Americans: A descriptive study. Journal of Cultural Diversity, 22(1), 15-22. ( 0/2015 ) Link...
    A cross-sectional descriptive study was done using the Acculturation Rating scale of Arab Americans-ll, and the Health Promotion and Lifestyle Profile II to assess the relationship between acculturation and health promotion practices among Arab Americans. Findings showed that attraction to American culture was the most important predictor of physical activity; whereas attraction to Arabic culture was the most important predictor of stress management and nutritional practices. Results suggest that, when demographics are controlled, acculturation predicts various health promotion practices in different patterns among members of this group. These findings contribute to a better understanding of acculturation's influence on immigrants' health promotion practices. [ABSTRACT FROM AUTHOR] Copyright of Journal of Cultural Diversity is the property of Tucker Publications, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
  • Hunte, G. S., Wears, R. L., & Schubert, C. C. (2014). Structure, agency and resilience. Proceedings of the 5th Symposium of the Resilience Engineering Association: Managing tradeoffs. Resilience Engineering Association, Sophia Antipolis Cedex, France. ( 0/2014 )
  • Sweeney T J, Kenny D J, & Schubert C C. (2013). Inpatient insulin pump therapy: assessing the effectiveness of an educational program. J Nurses Prof Dev, 29(2), 84-9. ( 3/2013 ) Link...
    Technological advances in diabetes management include continuous subcutaneous insulin infusion. This article describes a pilot project using an educational intervention by a diabetes nurse educator aimed at familiarizing nurses with insulin pump therapy at a large teaching hospital. Teaching points included appropriate patient selection, principles of insulin therapy, and safe insulin pump operation. An embedded mixed-method design was employed to assess educational effectiveness. Results of the pretest and posttest analysis indicated that the program significantly increased knowledge and confidence among nurses for managing pump therapy.
  • Schubert, C., Denmark, K., Crandall, B., Grome, A., and Pappas, J. (2012). "Characterizing novice-expert differences in macrocognition: An exploratory study of cognitive work in the Emergency Department."Annals of Emergency Medicine 




    ( 10/2012 ) Link...

    ABSTRACT Study objectives The objectives of this study were to elicit and document descriptions of Emergency Department (ED) physician expertise, to characterize cognitive differences between novice and expert physicians, and to identify areas where novices’ skill and knowledge gaps are most pronounced. The nature of the differences between novices and experts need to be explored in order to develop effective instructional modalities that accelerate the learning curve of inexperienced physicians who work in high complexity environments.   Methods We interviewed novice emergency medicine physicians (first-year residents) and attending physicians with significant expertise working in an academic level-one trauma center in Southern California. Using Cognitive Task Analysis (CTA), we employed task diagrams to capture non-routine critical incidents that required the use of complex cognitive skills. Time-lines were constructed to develop a detailed understanding of challenging incidents and the decisions involved as the incident unfolded, followed by progressive deepening to tease out situation specific cues, knowledge, and information that experts and novices used. A thematic analysis of the interview transcripts was conducted to identify key categories. Using classification techniques for data reduction, we identified a smaller set of key themes, which comprised the core findings of the study.   Results Five interns and six attending physicians participated in the interviews. Novice physicians reported having difficulties representing the patient’s story to attendings and other health care providers. Over-relying on objective data, novice physicians use linear thinking to move to diagnosis quickly and are likely to discount and explain away data that do not “fit” the frame. Experienced physicians draw on previous expertise to recognize cues and patterns while leaving room for altering or even changing their initial diagnosis. While experts maintain high levels of spatial, temporal, and organizational systems awareness when overseeing treatment modalities of multiple patients, novices have difficulty seeing and maintaining the “big picture.” Conclusion Novice physicians employ sense-making styles that differ from those of experts. Training novices to respond to the high cognitive demand of complex environments early on in their careers requires instructional modalities that not only increase their knowledge base, but accelerate the integration of knowledge and practice. Simulation and custom designed avatar mediated virtual worlds are a promising new technology that may facilitate such training. Future research should expand on the results of this study using a larger sample size and conducting interviews at multiple sites to increase generalizability.  

  • Schubert, C., Winslow, G., Montgomery, S., & Jadalla, A. (2012). "Defining failure: The language, meaning and ethics of medical error." International Journal of Humanities and Social Science, 2(22), 30-42. ( 2/2012 )

    Abstract:Despite the technical sophistication of modern medicine errors cannot be avoided. As errors are situated in the complexity and dynamicity that characterize healthcare environments they are difficult to define. A conceptual framework of medical error needs to account for the reality of medical work and the nature of error as a language-mediated social and legal construct. We identify four aspects that serve as a distinct framework: the notion of intent, the etiology of medical error and its multi-factorial flow, peer-reviewed contexts, and outcomes that may or may not result in harm to patients. The former assume moral quality and become concerns of justice. Specifically, a restorative justice approach supports the disclosure of errors to patients and addresses their physical, mental, spiritual, and social effects. The result of this contextually grounded, outcome-oriented model and accompanying definition of medical error provides practical guidance for hospital policies on dealing with medical error issues.  

    Keywords: Medical error, ethics, restorative justice, conceptual model, healthcare, wholeness. 

  • Romanishin, W., Taylor, B. W., Morris, A., Lamkin, M., Crabtree, C., Ishibashi, K., and Schubert, C. C.  “Eclipse Timings of UX Urase Majoris.”  IAPPP Communications, 1, 56, 1994.

    ( 1/1994 )
  • Rohrer, M. D. and Schubert, C. C.  “The Cutting-Grinding Technique for Histologic Preparation of Undecalcified Bone and Bone-Anchored Implants.”  Oral Surgery, Oral Medicine, Oral Pathology, 7, 73, 1992.

    ( 7/1992 )

    Abstract: An improved technique for histologic sectioning of hard tissues is described. Thin sections (5 to 15 microns) of undecalcified tissues such as bones with ceramic and metallic implants as well as teeth with enamel and fillings can be produced. Implant-tissue and hard tissue-soft tissue interfaces are well preserved. Because of the development of equipment and materials designed specifically for this technique, consistently good results are obtained. Most stains used in the paraffin technique may also be used in these sections.

  • Rohrer, M. D. and Schubert, C. C.  “A Cutting-Grinding Technique for the Preparation of Undecalcified Hard Tissue Materials.”  Biomaterials Forum, 13(3), 21, 1991.

    ( 7/1991 )
  Books and Chapters
  • Schubert, C. C., Wears, R. L., & Holden, R. J., & Hunte, G. S. (2015). Patients as a source of resilience. Chapter 15 in R. L. Wears, E. Hollnagel, & J. Braithwaite (Eds.) Resilience in Everyday Clinical Work. Ashgate. 

    ( 0/2015 )
  • Wears, R. L., Schubert, C. C., & Hunte, G. S. (2015). Individual – Collective Tradeoffs:  Implications for Resilience. Chapter 6 in R. L. Wears, E. Hollnagel, & J. Braithwaite (Eds.) Resilience in Everyday Clinical Work. Ashgate. 

    ( 0/2015 )
  Non-Scholarly Journals
  • Schubert, C. C. (2008). "The Role of Restorative Justice in Peace Education." Journal of Adventist Education, 2(3).

    ( 3/2008 ) Link...
  • Schubert, C. C. and Jackson, V.  (2006). “Building Social Capital: The Importance of Community Engagement.”  Restorative Justice Gazette, 2(2). 

    ( 2/2006 )
  • Hunte, G. S., Schubert, C. C., Wears, R. L. Dialogic sense-making as a resource for resilience and safety. 6th Symposium of the Resilience Engineering Association. Lisbon, Portugal. 

    ( 6/2015 )
  • Anand, P. and Schubert, C. “Understanding the role of support groups in promoting multi-dimensional wellbeing in family caregivers of dementia patients.” 140th Annual Meeting & Exposition of the American Public Health Association, San Francisco, CA.  ( 10/2012 )
  • Sweeney, T., Kenney, D., and Schubert, C. “Inpatient Insulin Pump Therapy: Assessing the Effectiveness of an Educational Program.” 5thAnnual Doctors of Nursing Practice Conference, St. Louis Missouri. ( 9/2012 )
  • McField, E., Montgomery, S., Belliard, J. C., James, S., Schubert, C. C., and Schuh, H. "Promoting Equity in Access to Mental Health Services: Exploring Cultural Attitudes Among Latinos." 138th APHA Annual Meeting. ( 11/2010 )
  • Rohrer, M. D., Schubert, C. C., and Johnson, J. "Cementoblastoma Arising from a Primary and Secondary Tooth, Preventing Eruption of Several Secondary Teeth.” Annual Meeting of the American Society of Oral Pathology. Minneapolis. ( 5/1991 )