Assessment of workload using NASA Task Load Index in perianesthesia nursing

Comparison of proactive and reactive interaction modes in a mobile robotic telecare study

Mobile robotic telepresence systems require that information about the environment, the task, and the robot be presented to a remotely located user (operator) who controls the robot for a specific task. In this study, two interaction modes, proactive and reactive, that differ in the way the user receives information from the robot, were compared in an experimental system simulating a healthcare setting. The users controlled a mobile telepresence robot that delivered and received items (medication, food, or drink), and also obtained metrics (vital signs) from a simulated patient while the users performed a secondary healthcare-related task (they compiled health records which were displayed to them on the screen and answered related questions). The effect of the two interaction modes on overall performance and user perception was evaluated through a within-participant study design conducted with 50 participants belonging to two different types of populations (with and without a technological background). Efficiency, effectiveness, understanding, satisfaction, and situation awareness were defined as the dependent variables measured both objectively and subjectively. The proactive mode increased user performance, and understanding of the system and reduced the workload compared to the reactive mode. However, several of the users valued the option of increased user control experienced in the reactive mode. We, therefore, proposed design suggestions to highlight some of the benefits of factoring the reactive mode into the design as a hybrid mode.

Anaesthesia clinicians' perception of safety, workload, anxiety, and stress in a remote hybrid suite compared with the operating room

BACKGROUND

Anaesthesia care outside of the standard operating room (OR) can be challenging. This prospective matched case-pair study describes the difference in anaesthesia clinicians' perception of safety, workload, anxiety, and stress in two settings by comparing similar neurosurgical procedures performed in either the OR or a remote hybrid room with intraoperative MRI (MRI-OR).

METHODS

A visual numeric scale for safety perception and validated instruments for workload, anxiety, and stress were administered to enrolled anaesthesia clinicians after induction of anaesthesia and at the end of eligible cases. The difference in outcomes reported by the same clinician for unique pairs of similar operations performed in both settings (OR vs MRI-OR) was compared using the Student t-test with the general bootstrap algorithm to address the presence of clusters.

RESULTS

Over 15 months, 37 clinicians provided data for 53 case pairs. Working in the remote MRI-OR vs OR was associated with lower perceived safety (7.3 [2.0] vs 8.8 [0.9]; P<0.001), higher scores in the workload subdomains effort and frustration (41.6 [24.1] vs 31.3 [21.6]; P=0.006 and 32.4 [22.9] vs 20.7 [17.2]; P=0.002, respectively), and higher anxiety (33.6 [10.1] vs 28.4 [9.2]; P=0.003) at the end of the case. Stress was rated higher in the MRI-OR after induction of anaesthesia (26.5 [15.5] vs 20.9 [13.4]; P=0.006). Effect sizes (Cohen's D) were moderate to good.

CONCLUSIONS

Anaesthesia clinicians reported lower perceived safety and higher workload, anxiety, and stress in a remote MRI-OR compared with a standard OR. Improving non-standard work settings should benefit clinician well-being and patient safety.

CLINICAL TRIAL REGISTRATION

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Exploring the influence of individual factors on the perception of mental workload and body postures

Studies have revealed that physical and mental demands, psychosocial factors, and individual factors can contribute to the development of WMSDs. Yet, much is still unknown regarding the effects of individual characteristics on WMSDs susceptibility. Previous studies discovered people assumed more awkward body postures to perform an activity when the perception of mental workload is higher. This research study explored if individual characteristics such as age, sex, personality, and anxiety help explain changes or differences in the perception of mental workload and body postures assume when performing activities. The study provided evidence that these individual characteristics have a modifying role on perceived mental workload and body postures. The results suggest that perceived mental workload is influenced to a higher extent by individual characteristics such as anxiety, sex, and personality traits. Women have a higher (18.7%) mental workload perception than men. Likewise, NASA-TLX scores are 22% higher for feelers than thinkers. In general, higher perceptions of mental workload were observed in participants with higher anxiety levels. On the other hand, body postures seem to be influenced by different individual factors depending on the nature of the activity. RULA scores increased on average by 13.1% between baseline and time constraint conditions. Larger differences were observed in certain individuals (e.g. introverts (19.7%) and intuitors (13.8%)) across conditions.

Workload In Neonatology (WORKLINE): Validation and feasibility of a system for measuring clinician workload integrated into the electronic health record

OBJECTIVE

The purpose of the study was to validate WORKLINE, a NICU specific clinician workload model and to evaluate the feasibility of integrating WORKLINE into our EHR.

STUDY DESIGN

This was a prospective, observational study of the workload of 42 APPs and physicians in a large academic medical center NICU over a 6-month period. We used regression models with robust clustered standard errors to test associations of WORKLINE values with NASA Task Load Index (NASA-TLX) scores.

RESULTS

We found significant correlations between WORKLINE and NASA-TLX scores. APP caseload was not significantly associated with WORKLINE scores. We successfully integrated the WORKLINE model into our EHR to automatically generate workload scores.

CONCLUSION

WORKLINE provides an objective method to quantify the workload of clinicians in the NICU, and for APPs, performed better than caseload numbers to reflect workload. Integrating the WORKLINE model into the EHR was feasible and enabled automated workload scores.

Development of a metric to evaluate the ergonomic principles of assistive systems, based on the DIN 92419

The DIN 92419 defines six principles for assistive systems' ergonomic design. There is, however, a lack of measurement tools to evaluate assistive systems considering these principles. Consequently, this study developed a measurement tool for the quantitative evaluation of the fulfilment of each principle for assistive systems. A systematic literature review was performed to identify dimensions belonging to the principles, identify how previous research evaluated these dimensions, and develop a measurement tool for assistive systems. Findings show that scales commonly used for evaluating assistive systems disregard several aspects highlighted as relevant by research, implying the need for considering the DIN 92419 principles. Based on established scales and theoretical findings, a questionnaire, and a checklist for evaluating assistive systems were developed. The work provides a grounding for measuring relevant aspects of assistive systems. Further development is needed to substantiate the reliability and validity of the proposed questionnaire scales and items. Practitioner Summary: Responding to the gap of a holistic measurement tool to evaluate assistive systems, a systematic literature review was performed considering the DIN 92419 principles. This resulted in a comprehensive summary of relevant aspects of assistive systems that were made numerically measurable, which proposes better criteria to assess assistive systems. Abbreviations: IoT: internet of things; RQ: research question; TAM: technology acceptance model; UTAUT: unified theory of acceptance and use of technology; AaaS: adaptivity as a service; SAR: socially assistive robots; SEEV: salience, effort, expectancy, and value; PRISMA: preferred reporting items for systematic reviews and meta-analyses; HMI: human-machine interaction; HRI: human-robot interaction; BCI: brain-computer interface; QUEST: Quebec user evaluation of satisfaction with assistive technology; SUS: system usability scale; NASA-TLX: NASA task load index; ATD PA: assistive technology device predisposition assessment; Wheel Con: wheelchair use confidence scale; CATOM: caregiver assistive technology outcome measure; CBI: caregiver burden inventory; RoSAS: robotic social attributes scale; WheelCon: wheelchair use confidence scale; IMI: intrinsic motivation inventory; ATD PA: assistive technology device predisposition assessment; UEQ: User experience questionnaire; USEUQ: usefulness satisfaction and ease of use questionnaire; USPW: usability scale for power wheelchairs; UES: user engagement scale; SUTAQ: service user technology acceptability questionnaire; QUEAD: questionnaire for the evaluation of physical assistive devices; FATCAT: functional assessment tool for cognitive assistive technology; SE-HRI: human-robot interaction scale; SART: situation awareness rating technique; TSQ;WT: tele-healthcare satisfaction questionnaire-wearable technology; PAIF: participants' assessment of the intervention's feasibility; SWAT: subjective workload assessment technique; MARS-HA: measure of audiologic rehabilitation self-efficacy for hearing aids; IOI-HA: International outcome inventory for hearing aids; FMA: functional mobility assessment; FBIS: familiarity and behavioural intention survey; CSQ: client satisfaction questionnaire; COPM: canadian occupational performance measure; ATCS: assistive technology confidence scale; ACC: acceptance; SSP: safety, security and privacy; OPT: optimisation of resultant internal load; CTRL: controllability; ADAPT: adaptability; P&I: perceptibility and identifiability; AAL: ambient assisted living; VR: virtual reality; AS: assistive system; WEIRD: Western, educated, industrialised, rich, and democratic; HEART: horizontal european activities of rehabilitation technology; AAATE: advancement of assistive technology in Europe's; GATE: global collaboration on assistive technology; ATA-C: assistive technology assessment toolkit.

Fatigue, Work Overload, and Sleepiness in a Sample of Spanish Commercial Airline Pilots

Commercial aviation pilots are an occupational group that work in particular conditions, with frequent schedule changes, shift work, unfavorable environmental conditions, etc. These circumstances can lead to fatigue, work overload (WO), and daytime sleepiness, factors that can affect their health and safety. This study aimed to assess the prevalence and the association between these parameters in a sample of Spanish commercial airline pilots. The Raw TLX, Fatigue Severity Scale, and the Epworth Sleepiness Scale questionnaires were administered in a sample of 283 participants. The relationships of the total scores between all the questionnaires were studied by the chi-square test and the risk scores (odds ratio) were calculated. Different models using multiple linear regression were carried out to evaluate the effects of WO, fatigue, and daytime sleepiness, among the total scores, age, and flight hours. Additionally, the internal consistency of each questionnaire was estimated. A total of 28.2% presented WO above the 75th percentile, with mental and temporal demand the dimensions with the greatest weight. A total of 18% of pilots presented fatigue, 15.8% moderate sleepiness, and 3.9% severe sleepiness. We observed an association among WO, fatigue, and daytime sleepiness, important factors related to pilot health and aviation safety.

Automating Perioperative Inventory Management: A Quality Improvement Project

Preference cards are a foundation for perioperative inventory management processes; however, they can add to nurses' perceived workload, introduce variability into supply management processes, and increase costs. The purpose of this quality improvement project was to implement an automated perioperative inventory management system to decrease nurses' workload and increase their efficiency. Goals included improving preference card accuracy, decreasing add-on supplies, and decreasing the supply costs for each procedure. Using a preintervention-postintervention survey design, the project team evaluated the outcomes of workload, preference card accuracy, add-on supplies, and procedural cost. Nurses' perception of workload decreased in the supply management processes and cost of supplies categories and increased in the documenting supply use category. A four-month 7.7% improvement in preference card accuracy reduced the average procedure supply cost by $86.72 for each procedure and saved the hospital $260,467. The number of add-on supplies was reduced by 4,177 for a 20% reduction.

Repeated assessments and predictors of nurses' shift-specific perceived workload

BACKGROUND

Workload perception is of interest to researchers and policymakers as it captures subjective assessments of nurses' workload which has implications for staffing and patient outcomes.

AIMS

We aimed to describe repeated assessments of nurses' perceived workload among registered nurses (RNs) in day and night shifts and to examine the association of perceived workload with workdays, units, and nurse-staffing.

METHODS

Repeated data on the indictors of interest were collected from 90 RNs across 91 shifts in a Lebanese acute-care hospital. Perceived workload was assessed using the NASA-Task-Load Index (NASA-TLX). Linear mixed-effect models were used for analysis.

RESULTS

Mean perceived workload was high reaching 6.63 (95% confidence interval [CI] = 6.34, 6.92) in day and 5.90 (95% CI = 5.43, 6.36) in night shifts. In mixed-effect models, perceived workload was lower on weekends/holidays as compared to weekdays in day (ß = -.32; 95% CI = -0.53, -0.12) and night (ß = -.46; 95% CI = -0.85, -0.07) shifts. Higher perceived workload (ß = .19; 95% CI = 0.04, 0.33) was associated with higher patient-to-nurse ratio in the day but not night shifts.

CONCLUSION

Repeated workload assessments support the presence of elevated perceived workload among RNs which is related to weekdays and higher patient-to-nurse ratio. Future investigations would benefit from better characterization of workload particularities to address perceived burden and improve organizational and management decisions.

The National Aeronautics and Space Administration-task load index: NASA-TLX: evaluation of its use in surgery

BACKGROUND

The technical difficulty an operation creates for a surgeon is difficult to measure. Current measures are poor surrogates. In both research and teaching settings it would be valuable to be able to accurately measure this degree of difficulty. The National Aeronautics and Space Administration Task Load Index (NASA TLX) is a multi-dimensional scale designed to obtain workload estimates relating to a task. This study aimed to evaluate the NASA TLX as an objective measure of technical difficulty of an operation.

METHODS

Seven surgeons performed 127 pre-defined operations (minimally invasive right hemicolectomy & re-do bariatric surgery) and recorded a NASA TLX score after each operation. These scores were compared to numerous clinical parameters and the score was correlated with the subjective measure of whether the surgeon categorized the operation as "easy", "moderate" or "difficult".

RESULTS

The NASA TLX score was significantly correlated with operative duration, blood loss, previous abdominal surgery and the surgeons' assessment of difficulty. It did not correlate with intra-operative or post-operative complications, conversion to open surgery or length of stay.

CONCLUSIONS

The NASA TLX score provides a graded numerical score that that correlated significantly with the surgeon's assessment of the technical difficulty, and with operative duration, intra-operative blood loss and previous abdominal surgery. This novel application of this tool could be employed in both research and teaching settings to score surgical difficulty and monitor a trainee's proficiency over time.

Human Mental Workload: A Survey and a Novel Inclusive Definition

Human mental workload is arguably the most invoked multidimensional construct in Human Factors and Ergonomics, getting momentum also in Neuroscience and Neuroergonomics. Uncertainties exist in its characterization, motivating the design and development of computational models, thus recently and actively receiving support from the discipline of Computer Science. However, its role in human performance prediction is assured. This work is aimed at providing a synthesis of the current state of the art in human mental workload assessment through considerations, definitions, measurement techniques as well as applications, Findings suggest that, despite an increasing number of associated research works, a single, reliable and generally applicable framework for mental workload research does not yet appear fully established. One reason for this gap is the existence of a wide swath of operational definitions, built upon different theoretical assumptions which are rarely examined collectively. A second reason is that the three main classes of measures, which are self-report, task performance, and physiological indices, have been used in isolation or in pairs, but more rarely in conjunction all together. Multiple definitions complement each another and we propose a novel inclusive definition of mental workload to support the next generation of empirical-based research. Similarly, by comprehensively employing physiological, task-performance, and self-report measures, more robust assessments of mental workload can be achieved.

Usability of smart infusion pumps: A heuristic evaluation

Although smart infusion pumps were built to eliminate medication errors, new types of usability errors have arisen. The purposes of this study were to determine potential risks when using smart pumps during secondary medication administration and to identify opportunities for design improvements. We observed and analyzed nurses when they interacted with smart pumps and heuristically evaluated the smart pump to identify usability problems. Forty-three usability problems were identified with the smart pump. The usability problems have the potential to create high cognitive burden on nurses and to increase the likelihood of mistakes. We discuss design and process improvement recommendations for each major finding from this study.

Subtypes of nurses' mental workload and interaction patterns with fatigue and work engagement during coronavirus disease 2019 (COVID-19) outbreak: A latent class analysis

BACKGROUND

Nurses play critical roles when providing health care in high-risk situations, such as during the COVID-19 outbreak. However, no previous study had systematically assessed nurses' mental workloads and its interaction patterns with fatigue, work engagement and COVID-19 exposure risk.

METHODS

A cross-sectional study was conducted via online questionnaire. The NASA Task Load Index, Fatigue Scale-14, and Utrecht Work Engagement Scale were used to assess nurses' mental workload, fatigue and work engagement, respectively. A total of 1337 valid questionnaires were received and analyzed. Nurses were categorized into different subgroups of mental workload via latent class analysis (LCA). Cross-sectional comparisons, analysis of covariance (ANCOVA), and multivariate (or logistic) regression were subsequently performed to examine how demographic variables, fatigue and work engagement differ among nurses belonging to different subgroups.

RESULTS

Three latent classes were identified based on the responses to mental workload assessment: Class 1 - low workload perception & high self-evaluation group (n = 41, 3.1%); Class 2 - medium workload perception & medium self-evaluation group (n = 455, 34.0%); and Class 3 - high workload perception & low self-evaluation group (n = 841, `62.9%). Nurses belonging into class 3 were most likely to be older and have longer professional years, and displayed higher scores of fatigue and work engagement compared with the other latent classes (p < 0.05). Multivariate analysis showed that high cognitive workload increased subjective fatigue, and mental workload may be positively associated with work engagement. Group comparison results indicated that COVID-19 exposure contributed to significantly higher mental workload levels.

CONCLUSIONS

The complex scenario for the care of patients with infectious diseases, especially during an epidemic, raises the need for improved consideration of nurses' perceived workload, as well as their physical fatigue, work engagement and personal safety when working in public health emergencies.

Does heavy mental workload affect moral sensitivity among critical care unit nursing professionals? a cross-sectional study

Background

Moral sensitivity creates the basic attitude in providing effective ethical care to patients. Heavy mental workload is a major concern of critical care nursing professionals, which could adversely affect nursing staff and patients. The present study aimed to investigate the effects of mental workload and some demographic variables on the moral sensitivity of critical care nursing professionals.

Methods

This cross-sectional, descriptive-correlational study was performed on 181 nursing professionals working in the critical care units of Shahid Rajaei Cardiovascular Medical and Research Center in Tehran, Iran. Data were collected using a demographic questionnaire, the moral sensitivity questionnaire, and the NASA-task load index to assess mental workload. Data analysis was performed in SPSS version 22 using descriptive statistics, independent t-test, Pearson’s correlation-coefficient, and regression analysis.

Results

The results of regression analysis yielded no statistical significant relationship between heavy mental workload and moral sensitivity of the critical care nursing professionals, while clinical experience had a positive, significant association with moral sensitivity.

Conclusions

Although care nursing professionals experience a heavy mental workload in critical care units, it does not decrease their moral sensitivity. In addition, experienced nurses have higher moral sensitivity and lower mental workload. Therefore, it seems that nursing managers should pay special attention to the importance of employing experienced nurses along with younger nurses.

A Time and Motion Analysis of Nursing Workload and Electronic Health Record Use in the Emergency Department

INTRODUCTION

The use of an electronic health record may create unanticipated consequences for emergency care delivery. We sought to describe emergency department nursing task distribution and the use of the electronic health record.

METHODS

This was a prospective observational study of nurses in the emergency department using a time-and-motion methodology. Three trained research assistants conducted 1:1 observations between March and September 2019. Nurse tasks were classified into 6 established categories: electronic health record, direct/indirect patient care, communication, personal time, and other. Nurses' perceived workload was assessed using the National Aeronautics and Space Administration (NASA) Task Load Index.

RESULTS

Twenty-three observations were conducted over 46 hours. Overall, nurses spent 27% of their time on electronic health record tasks, 25% on direct patient care, 17% on personal time, 15% on indirect patient care, and 6% on communication. During morning (7 am-12 pm) and afternoon shifts (12 pm-3 pm), the use of the health record was the most commonly performed task, whereas indirect patient care was the task most performed during evening shifts (3 pm-12 pm). Using the National Aeronautics and Space Administration (NASA) Task Load Index, nurses reported an increase in mental demand and effort during afternoon shifts compared with morning shifts.

DISCUSSION

We observed that emergency nurses spent more time using the electronic health record as compared to other tasks. Increased usability of the electronic health record, particularly during high occupancy periods, may be a target for improvement.

Measuring the Cognitive Workload During Dual-Task Walking in Young Adults: A Combination of Neurophysiological and Subjective Measures

Background: Walking while performing a secondary task (dual-task (DT) walking) increases cognitive workload in young adults. To date, few studies have used neurophysiological measures in combination to subjective measures to assess cognitive workload during a walking task. This combined approach can provide more insights into the amount of cognitive resources in relation with the perceived mental effort involving in a walking task.

Research Question: The objective was to examine cognitive workload in young adults during walking conditions varying in complexity.

Methods: Twenty-five young adults (mean = 24.4 ± 5.4) performed four conditions: (1) usual walking, (2) simple DT walking, (3) complex DT walking and (4) standing while subtracting. During the walking task, mean speed, cadence, stride time, stride length, and their respective coefficient of variation (CV) were recorded. Cognitive workload will be measured through changes in oxy- and deoxy-hemoglobin (ΔHbO₂ and ΔHbR) during walking in the dorsolateral prefrontal cortex (DLPFC) and perceived mental demand score from NASA-TLX questionnaire.

Results: In young adults, ΔHbO₂ in the DLPFC increased from usual walking to both DT walking conditions and standing while subtracting condition. ΔHbO₂ did not differ between the simple and complex DT and between the complex DT and standing while subtracting condition. Perceived mental demand gradually increased with walking task complexity. As expected, all mean values of gait parameters were altered according to task complexity. CV of speed, cadence and stride time were significantly higher during DT walking conditions than during usual walking whereas CV of stride length was only higher during complex DT walking than during usual walking.

Significance: Young adults had greater cognitive workload in the two DT walking conditions compared to usual walking. However, only the mental demand score from NASA-TLX questionnaire discriminated simple from complex DT walking. Subjective measure provides complementary information to objective one on changes in cognitive workload during challenging walking tasks in young adults. These results may be useful to improve our understanding of cognitive workload during walking.

The objective nursing workload and perceived nursing workload in Intensive Care Units: Analysis of association

BACKGROUND

A range of classification systems are in use for the measurement of nursing workload in Intensive Care Units. However, it is unknown to what extent the measured (objective) nursing workload, usually in terms of the amount of nursing activities, is related to the workload actually experienced (perceived) by nurses.

OBJECTIVES

The aim of this study was to assess the association between the objective nursing workload and the perceived nursing workload and to identify other factors associated with the perceived nursing workload.

METHODS

We measured the objective nursing workload with the Nursing Activities Score and the perceived nursing workload with the NASA-Task Load Index during 228 shifts in eight different Intensive Care Units. We used linear mixed-effect regression models to analyze the association between the objective and perceived nursing workload. Furthermore, we investigated the association of patient characteristics (severity of illness, comorbidities, age, body mass index, and planned or unplanned admission), education level of the nurse, and contextual factors (numbers of patients per nurse, the type of shift (day, evening, night) and day of admission or discharge) with perceived nursing workload. We adjusted for confounders.

RESULTS

We did not find a significant association between the observed workload per nurse and perceived nursing workload (p=0.06). The APACHE-IV Acute Physiology Score of a patient was significantly associated with the perceived nursing workload, also after adjustment for confounders (p=0.02). None of the other patient characteristics was significantly associated with perceived nursing workload. Being a certified nurse or a student nurse was the only nursing or contextual factor significantly associated with the perceived nursing workload, also after adjustment for confounders (p=0.03).

CONCLUSION

Workload is perceived differently by nurses compared to the objectively measured workload by the Nursing Activities Score. Both the severity of illness of the patient and being a student nurse are factors that increase the perceived nursing workload. To keep the workload of nurses in balance, planning nursing capacity should be based on the Nursing Activities Score, on the severity of patient illness and the graduation level of the nurse.

The Psychometric Analysis of an Instrument to Measure the Perceived Workload for Certified Registered Nurse Anesthetists

BACKGROUND AND PURPOSE

In a previous study, the CRNA Workload Perception Scale (CWPS) was developed. The purpose of this study was to investigate the psychometrics of the CWPS.

METHODS

The CWPS was tested in a population of CRNAs. This study was conducted in two phases. Phase I consisted of classical psychometrics; the 12-item instrument was piloted in a sample of 265 CRNAs. Phase II consisted of qualitative analysis to provide feedback on items that did not perform well.

RESULTS

Phase I: Instrument demonstrated good reliability (r = .77). Parametric and nonparametric analysis indicated 6 of 12 items were good fit to measure perception of workload.

PHASE II

Qualitative analysis resulted in refinement of four items, addition of one item, and elimination of two items.

CONCLUSIONS

A revised 11-item CWPS was developed.

Use of the ReCIVA device in breath sampling of patients with acute breathlessness: a feasibility study

Introduction

Investigating acute multifactorial undifferentiated breathlessness and understanding the driving inflammatory processes can be technically challenging in both adults and children. Being able to validate noninvasive methods such as breath analysis would be a huge clinical advance. The ReCIVA® device allows breath samples to be collected directly onto sorbent tubes at the bedside for analysis of exhaled volatile organic compounds (eVOCs). We aimed to assess the feasibility of using this device in acutely breathless patients.

Methods

Adults hospitalised with acute breathlessness and children aged 5–16 years with acute asthma or chronic stable asthma, as well as healthy adult and child volunteers, were recruited. Breath samples were collected onto sorbent tubes using the ReCIVA® device and sent for analysis by means of two-dimensional gas chromatography-mass spectrometry (GCxGC-MS). The NASA Task Load Index (NASA-TLX) was used to assess the perceived task workload of undertaking sampling from the patient's perspective.

Results

Data were available for 65 adults and 61 children recruited. In total, 98.4% of adults and 75.4% of children were able to provide the full target breath sample using the ReCIVA® device. NASA-TLX measurements were available in the adult population with mean values of 3.37 for effort, 2.34 for frustration, 3.8 for mental demand, 2.8 for performance, 3.9 for physical demand and 2.8 for temporal demand.

Discussion

This feasibility study demonstrates it is possible and acceptable to collect breath samples from both adults and children at the bedside for breathomics analysis using the ReCIVA® device.

It is feasible to collect breath samples for breath analysis at the bedside using the ReCIVA device in acutely breathless adults and childrenhttps://bit.ly/2ZTonWo

Covid-19 effects on the workload of Iranian healthcare workers

BACKGROUND

In this study, we aimed to evaluate the impact of the COVID-19 epidemic on the workload and mental health of Iranian medical staff using the General Health Questionnaire (GHQ-12) and NASA -Task Load Index (NASA-TLX) Questionnaire between March and April 2020, respectively.

METHODS

The present cross-sectional study was conducted from March 5th to April 5th, 2020. To evaluate the workload and mental health of participants NASA-TLX and GHQ-12 online questionnaires were distributed. Data were entered into software SPSS (Version 23) and T-test, ANOVA, Regression methods were used for data analysis.

RESULTS

Health workers who encountered COVID- 19 patients, were subjected to more task load compared to those who had no contact with COVID- 19 patients at the workplace (p <  0.001). In terms of the subscale score of NASA-TLX, nurses had more scores in mental pressure, physical pressure, time pressure (temporal), and frustration compared to the other jobs (p <  0.05). Moreover, nurses had significantly more workload compared to the other jobs.

CONCLUSIONS

Type of job, the shift of work, educational level, and facing COVID-19 affected the score of NASA-TLX. NASA-TLX scores were higher in nursing compared to the scores of other health staff groups. The results of this study indicate that the scores of NASA-TLX and GHQ-12 among staff who had contact with COVID-19 patients were significantly higher than those who did not face COVID-19 patients. We suggested that a comprehensive assistance should be provided to support the well-being of healthcare workers especially nurses and healthcare workers who treated COVID-19 patients.

[Mental Workload Assessment of Health Care Staff by NASA-TLX]

The National Aeronautics Space Administration Task Load Index (NASA-TLX) is the most frequently used mental workload assessment method. This article reviews 26 papers which report mental workload evaluation in health care staff, categorizing them into laparoscopic surgery, anesthesia, ICU, electronic record, patient controlled analgesia, emergency, display and others. Although indices other than NASA-TLX were also used in these papers, this review describes the results of NASA-TLX only.

Exploring the use of high and low demand simulation for human performance assessment during multiorgan retrieval with the joint scrub practitioner

Introduction

The National Organ Retrieval Service (NORS) 2015 review recommended a Joint Scrub Practitioner for abdominal and cardiac teams during combined organ retrieval. To evaluate the feasibility of this role, and to understand the functional implications, this study explores the use of simulation and provides a novel and comprehensive approach to assess individual and team performance in simulated multiorgan retrievals.

Methods

Two high-fidelity simulations were conducted in an operating theatre with porcine organs, en bloc, placed in a mannequin. For donation after brainstem death (DBD) simulation, an anaesthetic machine provided simulated physiological output. Retrievals following donation after circulatory death (DCD) began with rapid arrival in theatre of the mannequin. Cardiothoracic (lead surgeon) and abdominal (lead and assistant surgeons; joint scrub practitioner, n=9) teams combined for the retrievals. Data collected before, during and after simulations used self-report and expert observers to assess: attitudinal expectations, mental readiness, mental effort, non-technical skills, teamwork, task workload and social validation perceptions.

Results

Attitudinal changes regarding feasibility of a joint scrub practitioner for DBD and DCD are displayed in the main body. There were no significant differences in mental readiness prior to simulations nor in mental effort indicated afterwards; however, variance was noted between simulations for individual team members. Non-technical skills were slightly lower in DCD than in DBD. Global ratings of teamwork were significantly (p<0.05) lower in DCD than in DBD. Measures of attitude indicated less support for the proposed joint scrub practitioner role for DCD than for DBD.

Discussion

The paper posits that the joint scrub practitioner role in DCD multiorgan retrieval may bring serious and unanticipated challenges. Further work to determine the feasibility of the NORS recommendation is required. Measures of team performance and individual psychological response can inform organ retrieval feasibility considerations nationally and internationally.

Relationship between number of health problems addressed during a primary care patient visit and clinician workload

INTRODUCTION

Primary care is complex due to multiple health problems being addressed in each patient visit. Little is known about the effect of the number of problems per encounter (NPPE) on the resulting clinician workload (CWL), as measured using the National Aeronautics and Space Administration Task Load Index (NASA-TLX).

METHODS

We evaluated the relationship between NPPE and CWL across 608 adult patient visits, conducted by 31 clinicians, using hierarchical linear regression. Clinicians were interviewed about outlier visits to identify reasons for higher or lower than expected CWL.

RESULTS

Mean NPPE was 3.30 ± 2.0 (sd) and CWL was 47.6 ± 18.4 from a maximum of 100. Mental demand, time demand and effort accounted for 71.5% of CWL. After adjustment for confounders, each additional problem increased CWL by 3.9 points (P < 0.001). Patient, problem, environmental and patient-physician relationship factors were qualitatively identified from interviews as moderators of this effect.

CONCLUSION

CWL is positively related to NPPE. Several modifiable factors may enhance or mitigate this effect. Our findings have implications for using a Human Factors (HF) approach to managing CWL.

Overnight cross-coverage on hospital medicine services: perceived workload based on patient census, pager volumes, and patient acuity

OBJECTIVE

Little is understood about what contributes to perceived workload for those providing overnight coverage to hospitalized patients overnight, which limits the ability to modify these factors or to proactively identify appropriate staffing levels. The objective of this study is to understand the major contributors to perceived overnight cross-coverage workload.

METHODS

Cross-covering advanced practice providers (APPs) in a large academic hospitalist group completed the National Aeronautics and Space Administration Task Load Index (NASA-TLX) at the end of each night shift. Other shift characteristics were collected, including patient load, assigned action items, watcher/unstable patients, newly admitted patients, number of units covered, total pages, peak pager density, rapid response team (RRT) activations, and intensive care unit (ICU) transfers.

RESULTS

For 14 APP participants, who completed 271 post-shift surveys, the mean (SD) patient load was 49.9 (6.4) patients per night, and providers received a mean (SD) of 40.8 (13.7) total pages per shift. Mean (SD) NASA-TLX score was 35.1 (19.0). In multivariate modeling, total pages, action items, and any RRT or ICU transfer were associated with significant increases in the mean NASA-TLX score, with estimated effect sizes of 0.5, 0.8, and 14.3, respectively, per 1-unit increase in each shift characteristic. The greatest cumulative contributor to perceived workload was total number of pages, followed by the presence of any RRT activation/ICU transfer, with estimated effect sizes of 20.4 and 14.9, respectively.

CONCLUSIONS

Total number of pages was the greatest contributor to perceived workload. This study suggests that quality improvement initiatives designed to improve pager communication may considerably improve provider-perceived workload.

Association of Health Record Visualizations With Physicians' Cognitive Load When Prioritizing Hospitalized Patients

IMPORTANCE

Current electronic health records (EHRs) contribute to increased physician cognitive workload when completing clinical tasks.

OBJECTIVE

To assess the association of different design features of an EHR-based information visualization tool with the cognitive load of physicians during the clinical prioritization process.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study included a convenience sample of 29 attending physicians at Seattle Children's Hospital, a large tertiary academic pediatric hospital. Data collection took place from August 2017 through October 2017, and analysis occurred from August to October 2018.

EXPOSURE

Physician participants used 3 prototypes with novel visualizations of simulated EHR data that highlighted 1 of 3 key patient characteristics, as follows: (1) acuity, (2) clinical problem list, and (3) clinical change.

MAIN OUTCOMES AND MEASURES

Cognitive workload was measured using the NASA Task Load Index (TLX) scale (range, 1-100, with lower scores indicating lower cognitive workload). Cognitive workload was assessed for the 2 following clinical prioritization tasks: (1) finding information for a specific patient and (2) comparing results among patients for each prototype. Participants ranked 5 hypothetical patients from having the highest to the lowest priority in each design.

RESULTS

A total of 29 physician participants (15 [52%] men; 14 [48%] women; mean [range] age, 43 [35-58] years; mean [range] time in practice, 11 [3-30] years) completed the study. For task 1, the prototype highlighting clinical change was associated with lower median (interquartile range) NASA TLX scores compared with the prototype highlighting acuity (30.3 [15.2-41.6] vs 48.5 [18.7-59.3]; P = .02). For task 2, the prototype highlighting clinical change was associated with lower median (interquartile range) NASA TLX scores compared with the prototype highlighting the clinical problem list (29.1 [16.3-50.8] vs 43.5 [26.6-55.9]; P = .02). The prototype highlighting clinical change had the lowest TLX score in 17 of 29 rankings (59%) for task 1 (χ24 = 24.4; P < .001) and 18 of 29 rankings (62%) for task 2 (χ24 = 17.2; P = .002).

CONCLUSIONS AND RELEVANCE

In this study, well-designed EHR-based information visualizations that highlighted and featured clinically meaningful information patterns significantly reduced physician cognitive workload when prioritizing patient needs.

Developing a light-based intervention to reduce fatigue and improve sleep in rapidly rotating shift workers

Over a quarter of employees in North America and a fifth of those in the European Union do shift work. Working these schedules increases fatigue, sleepiness, and errors at work. In the long term, it may also increase the risk of cardiovascular disease, gastrointestinal problems, and cancer. Some of these consequences may be partly due to circadian misalignment, in which sleep and activity patterns no longer align with one's circadian rhythms. Previous research has found that controlling light exposure can improve circadian alignment in individuals who work permanent night shifts. However, light-based interventions are rarely tested with rapidly rotating shift schedules, which include more than one type of shift within the same week (e.g., day shifts followed by night shifts). Further, many of the available interventions are seldom used in the workplace and may be less feasible in healthcare environments. In hospitals, the health and safety of both workers and patients can be compromised by increases in fatigue. We thus developed a practical intervention based on circadian and sleep hygiene principles to reduce some of the negative consequences associated with shift work. We then tested this intervention in a feasibility study of 33 nurses working rapidly rotating shifts. The study took place over two separate periods: the control (observation) period and the intervention period. Each period included two to four consecutive night shifts as well as the two days before and after those shifts. Nurses completed daily self-report questionnaires during both periods. During the intervention period, the nurses additionally followed a fatigue reduction plan. The plan involved 40 min of bright light exposure from a portable light box before night shifts, light avoidance using sunglasses after those shifts, and suggestions regarding the ideal times to sleep and nap. Results showed that nurses complied with the large majority of these recommendations. During the intervention period, nurses reported less fatigue, fewer work errors, better and longer sleep, and a more positive mood. Moreover, nurses with a preference for evenings (i.e., later chronotypes) reported the strongest benefits. Though more controlled studies are needed to assess causal mechanisms and long-term effectiveness, these promising results suggest that light-based interventions are feasible and may be effective at reducing fatigue in rapidly rotating shift workers.

Virtual Reality Triage Training Can Provide Comparable Simulation Efficacy for Paramedicine Students Compared to Live Simulation-Based Scenarios

Background: Mass-casualty incidents (MCIs) are catastrophic. Whether they arise from natural or man-made disasters, the nature of such incidents and the multiple casualties involved can rapidly overwhelm response personnel. Mass-casualty triage training is traditionally taught via either didactic lectures or table top exercises. This training fails to provide an opportunity for practical application or experiential learning in immersive conditions. Further, large-scale simulations are heavily resource-intensive, logistically challenging, require the coordination and time of multiple personnel, and are costly to replicate. This study compared the simulation efficacy of a bespoke virtual-reality (VR) MCI simulation with an equivalent live simulation scenario designed for undergraduate paramedicine students. Methods: Both simulations involved ten injured patients resulting from a police car chase and shooting. Twenty-nine second-year paramedicine students completed the live and VR simulation in a random order. The training efficacy of the VR and live simulation was evaluated with respect to student immersion and task-difficulty, clinical decision-making (i.e. triage card allocation accuracy and timeliness), learning satisfaction, and cost of delivery. Results: While perceived physical demand was higher in the live simulation compared to VR (p < 0.001), no differences were observed across mental demand, temporal demand, performance, effort or frustration domains. No differences were found for participant satisfaction across the two platforms. No differences were observed in the number of triage cards correctly allocated to patients in each platform. However, participants were able to allocate cards far quicker in VR (p < .001). Cost of running the VR came to AUD $712.04 (staff time), compared to the live simulations which came to AUD $9,413.71 (staff time, moulage, actors, director, prop vehicle), approximately 13 times more expensive. Conclusion: The VR simulation provided near identical simulation efficacy for paramedicine students compared to the live simulation. VR MCI training resources represent an exciting new direction for authentic and cost-effective education and training for medical professionals.

Assessment of perceived workload in academic health center community pharmacies before and after implementation of a central call center

PURPOSE

Results of a study to determine whether reducing pharmacy phone call workload through implementation of a pharmacy services call center (PSCC) led to decreased employee workload, improved efficiency, and increased pharmacist availability for patient care are reported.

METHODS

A pre-post study was conducted using the NASA Task Load Index (NASA-TLX) instrument. Pharmacists, pharmacy technicians at 7 academic health center community pharmacies, and PSCC staff provided NASA-TLX data over 5 days during 3 data collection periods before and after PSCC implementation. Perceived workload was measured as an overall workload score (OWS) and mean scores for 6 NASA-TLX workload dimensions (mental demand, physical demand, temporal demand, performance, effort, and frustration).

RESULTS

Relative to pre-PSCC values, mean postimplementation OWS scores significantly decreased in all 7 pharmacies (from 33.3 to 29.1 overall, p < 0.001) but especially in small pharmacies (from 31.7 to 27.6, p < 0.001). Scores for the physical demand and frustration dimensions were low in both the PSCC and in the 7 pharmacies, while scores for the performance dimension remained high (range, 6.8-8.3). In general, scores for all other measured NASA-TLX dimensions decreased after PSCC implementation, more so at smaller pharmacies. The PSCC staff mean OWS score increased over time (from 26.8 to 28.6, p < 0.0001) but remained near the overall pharmacy average of 29.1.

CONCLUSION

Use of the NASA TLX allowed for a direct subjective measurement of workload as perceived by pharmacy and PSCC employees before and after PSCC implementation. Long-term effects of the PSCC on workload should be assessed.

An Ergonomic Assessment Of Four Different Donor Nephrectomy Approaches For The Surgeons And Their Assistants

Introduction

Open surgery is increasingly being replaced by laparoscopic approaches that are more demanding for the surgical team. The physical and mental workload of these approaches have not been quantified.

Materials and methods

A multicenter prospective study was performed evaluating the physical and mental stresses of 4 surgical approaches (open surgery [OS], standard laparoscopy [SL], hand-assisted laparoscopy [HAL], and robot-assisted laparoscopy [RAL]) for donor nephrectomy for the surgeon and their assistant. The Borg Scale was used to evaluate exertion in different body parts every 30 mins during surgery and the NASA-TLX score was used to evaluate overall workload.

Results

264 nephrectomies were performed over a 33-month period and 258 questionnaires evaluating these surgeries were obtained. Surgeons experienced less left shoulder and arm exertion and left forearm and hand exertion, but greater lower back exertion, as measured by the Borg scale, with RAL. Leg exertion was significantly greater with OS. Assistant surgeons experienced increased exertion in the back, right shoulder and arm, and right forearm and hand with RAL. NASA Task load index (TLX) surgeon scores showed mental demand was similar for all 4 surgical approaches. Physical demand was lower and overall performance was higher with RAL.

Discussion

Four different nephrectomy surgical approaches were evaluated in a multicenter setting. Surgeon and assistant scores of physical exertions were generally in the "easy" range but confirmed that robotic surgery is an ergonomic progress compared to other techniques, except for the axial skeleton. Further, it degrades the working conditions for the assistant.

Impact of robotic assistance on mental workload and cognitive performance of surgical trainees performing a complex minimally invasive suturing task

BACKGROUND

Few studies have investigated the potential impact of robotic assistance on cognitive ergonomics during advanced minimally invasive surgery. The purpose of this study was to assess the impact of robotic assistance on mental workload and downstream cognitive performance in surgical trainees.

METHODS

Robot-naïve trainees from general surgery, urology and gynaecology, stratified by specialty and level of training, were randomised to either laparoscopic surgery (LS) or robotic-assisted laparoscopic surgery (RALS) and performed a time-limited, complex laparoscopic suturing task after watching a 5-min instructional video. The RALS group received an additional 5-min orientation to the robotic console. Subjective mental workload was measured using NASA Task Load Index. Concentration and executive cognitive function were assessed using Psychomotor Vigilance Task (PVT) and Wisconsin Card Sorting Test (WCST), respectively. A p value of 0.05 was considered significant.

RESULTS

Sixteen senior residents (SR; ≥ PGY3) and 14 junior residents (JR; PGY1-2) completed the study. There was no difference in mental workload between LS and RALS. Within JR there was no difference in task completion time comparing LS versus RALS; however, LS was associated with impaired concentration post-task versus pre-task (PVT reaction time 306 versus 324 ms, p = 0.03), which was not observed for RALS. In contrast, amongst SR, RALS took significantly longer than LS (10.3 vs. 14.5 min, p = 0.02) and was associated with significantly worse performance on WCST (p < 0.01).

CONCLUSIONS

Robotic assistance, in this setting, did not provide a technical performance advantage nor impact subjective mental workload with novice users regardless of level of surgery training. We observed a protective effect on cognitive performance offered by RALS to junior trainees with limited LS experience, yet a detrimental effect on senior trainees with greater LS ability and inadequate pre-study robotic training, suggesting that robotic consoles may be mentally taxing for robotic novices and consideration should be given to formal console training prior to initial clinical exposure.

An Evaluation of the Impact of High-Fidelity Endovascular Simulation on Surgeon Stress and Technical Performance

OBJECTIVE

To measure the physiological stress response associated with high-fidelity endovascular team simulation.

DESIGN

This is a prospective cohort study.

SETTING

This study was performed at St Mary's Hospital (Imperial College London, London, UK), in a tertiary setting.

PARTICIPANTS

Thirty-five participants (10 vascular surgical residents, 4 surgical interns, 12 theatre nurses, 2 attending vascular surgeons, 6 medical students and 1 technician) were recruited from the Imperial Vascular Unit at St Mary's Hospital, Imperial College London by direct approach. All participants finished the study.

RESULTS

Junior surgeons experienced significantly increased sympathetic tone (Low frequency/high frequency (LF/HF) ratio) during team simulation compared to individual simulation (6.01 ± 1.68 vs. 8.32 ± 2.84, p < 0.001). Within team simulation junior surgeons experienced significantly higher heart rate (beats per minute) than their senior counterparts (82 ± 5.83 vs. 76 ± 6.02, p = 0.033). Subjective workload scores (NASA Task Load Index [NASA-TLX]) correlated moderately and significantly with sympathetic tone in surgeons across all stages of simulation. (r = 0.39, p = 0.01).

CONCLUSIONS

A discrete, measurable increase in stress is experienced by surgeons during high-fidelity endovascular simulation and differentially effects junior surgeons. High-fidelity team simulation may have a role to play in improving nontechnical skill, reducing intra-operative stress, and reducing error.

Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians

IMPORTANCE

Current electronic health record (EHR) user interfaces are suboptimally designed and may be associated with excess cognitive workload and poor performance.

OBJECTIVE

To assess the association between the usability of an EHR system for the management of abnormal test results and physicians' cognitive workload and performance levels.

DESIGN, SETTING, AND PARTICIPANTS

This quality improvement study was conducted in a simulated EHR environment. From April 1, 2016, to December 23, 2016, residents and fellows from a large academic institution were enrolled and allocated to use either a baseline EHR (n = 20) or an enhanced EHR (n = 18). Data analyses were conducted from January 9, 2017, to March 30, 2018.

INTERVENTIONS

The EHR with enhanced usability segregated in a dedicated folder previously identified critical test results for patients who did not appear for a scheduled follow-up evaluation and provided policy-based decision support instructions for next steps. The baseline EHR displayed all patients with abnormal or critical test results in a general folder and provided no decision support instructions for next steps.

MAIN OUTCOMES AND MEASURES

Cognitive workload was quantified subjectively using NASA-Task Load Index and physiologically using blink rates. Performance was quantified according to the percentage of appropriately managed abnormal test results.

RESULTS

Of the 38 participants, 25 (66%) were female. The 20 participants allocated to the baseline EHR compared with the 18 allocated to the enhanced EHR demonstrated statistically significantly higher cognitive workload as quantified by blink rate (mean [SD] blinks per minute, 16 [9] vs 24 [7]; blink rate, -8 [95% CI, -13 to -2]; P = .01). The baseline group showed statistically significantly poorer performance compared with the enhanced group who appropriately managed 16% more abnormal test results (mean [SD] performance, 68% [19%] vs 98% [18%]; performance rate, -30% [95% CI, -40% to -20%]; P < .001).

CONCLUSIONS AND RELEVANCE

Relatively basic usability enhancements to the EHR system appear to be associated with better physician cognitive workload and performance; this finding suggests that next-generation systems should strip away non-value-added EHR interactions, which may help physicians eliminate the need to develop their own suboptimal workflows.

Nursing Perceptions and Workload Impact of a Standardized Emergence Delirium Assessment Scale in a Postanesthesia Care Unit

PURPOSE

Emergence delirium (EDL) is a psychomotor behavioral phenomenon that occurs immediately after emergence from general anesthesia. EDL is nearly 1.5 times more common among military than nonmilitary patients. Indirect delirium scales have precluded understanding of EDL in military patients. This quality improvement project assesses the feasibility of adopting a population-specific scale, the Emergence Delirium in the Wounded Warrior (ED-WW) Tool.

DESIGN

Pre-post implementation design.

METHODS

Postanesthesia care unit (PACU) nurses were surveyed on the clinical utility of the ED-WW Tool and its impact on their workload. The incidence of EDL behaviors in a Veterans Administration PACU was also recorded using the ED-WW Tool.

FINDINGS

PACU nurses agreed the ED-WW Tool was of clinical value to military patients and had a very low workload impact. Twenty-one percent of patients demonstrated at least one behavior associated with EDL.

CONCLUSIONS

ED-WW Tool adoption is clinically feasible and recommended for practice.

A Review of Measuring the Cognitive Workload of Electronic Health Records

The To Err Is Human report stated that 98 000 patients die yearly because of medical errors, and that medication errors kill more people than workplace injuries. The inadequate design and utilization of the electronic health record have been identified as major contributing factors to medical errors. Increased cognitive workload of clinicians has consistently been linked to the occurrence of medical errors. The purpose of this article was to synthesize the current state of the science on measuring clinicians' cognitive workload associated with using electronic health records in order to inform evidence-based guidelines. The major considerations identified in the literature involve the use of psychometric instruments, using efficiency as a proxy for cognitive workload, and eye tracking. The National Aeronautics and Space Administration Task Load Index was the most used psychometric instrument, but reliability measures were not reported. It is important to evaluate reliability of psychometric instruments because the consistency of the instrument can change when administered to different populations. Efficiency is an observable measure defined by the total time to complete a task and the total number of physical interactions with the user interface. Efficiency can allow the use of statistical modeling, but it does not directly evaluate the mental activity associated with using an electronic health record interface. Eye tracking has been used extensively in the literature to measure cognitive workload via changes in pupil size related to mental activity, but it is not often used to measure the cognitive workload associated with using the electronic health record. Eye tracking is very useful for continuous monitoring of cognitive workload.

The associations of workload, individual and organisational factors on nurses' occupational injuries

AIMS AND OBJECTIVES

To determine the prevalence and type of occupational injuries in nurses and their associations with workload, working shift, and nurses' individual and organisational factors.

BACKGROUND

Nurses are vulnerable to occupational injuries due to the nature of their job.

DESIGN

A cross-sectional correlational design (based on STROBE Statement) was conducted.

METHODS

This study was conducted among 616 nurses of four public hospitals located in four different provinces in Iran. Data were collected using three questionnaires including an organisational and demographic questionnaire, an occupational injuries checklist and the NASA-TLX questionnaire (about mental workload). Chi-square test, one-way ANOVA and multivariate logistic regression were used in SPSS version 23.0 for statistical analysis.

RESULTS

Blood and body fluid exposures had the highest prevalence (47.4%) among all injuries. Needlestick injuries showed a significant relation with gender, age, number of shifts in a month and work experience. With increase in mental workload, needlestick injuries increase by 35%. Also, injuries reported by nurses working in rotating shifts were 15%-53% more than nurses working in fixed shifts.

CONCLUSION

Working in rotating shifts and work overload was significantly related to all injuries. Decreasing nurses' mental workload, introducing guidelines and efficient training in shift work schedules can help decrease occupational injuries among nurses.

RELEVANCE TO CLINICAL PRACTICE

In order to reduce occupational injuries among nurses, in addition to incorporating advanced management and technology, it is necessary to pay attention to psychosocial, individual and organisational risk factors related to occupational injuries and their frequency in nurses. Also, reducing personnel's mental and occupational pressure should be considered.

Alarm-Related Workload in Default and Modified Alarm Settings and the Relationship Between Alarm Workload, Alarm Response Rate, and Care Provider Experience: Quantification and Comparison Study

Background

Delayed or no response to impending patient safety–related calls, poor care provider experience, low job satisfaction, and adverse events are all unwanted outcomes of alarm fatigue. Nurses often cite increases in alarm-related workload as a reason for alarm fatigue, which is a major contributor to the aforementioned unwanted outcomes. Increased workload affects both the care provider and the patient. No studies to date have evaluated the workload while caring for patients and managing alarms simultaneously and related it to the primary measures of alarm fatigue—alarm response rate and care provider experience. Many studies have assessed the effect of modifying the default alarm setting; however, studies on the perceived workload under different alarm settings are limited.

Objective

This study aimed to assess nurses’ or assistants’ perceived workload index of providing care under different clinical alarm settings and establish the relationship between perceived workload, alarm response rate, and care provider experience.

Methods

In a clinical simulator, 30 participants responded to alarms that occurred on a physiological monitor under 2 conditions (default and modified) for a given clinical condition. Participants completed a National Aeronautics and Space Administration-Task Load Index questionnaire and rated the demand experienced on a 20-point visual analog scale with low and high ratings. A correlational analysis was performed to assess the relationships between the perceived workload score, alarm response rate, and care provider experience.

Results

Participants experienced lower workloads when the clinical alarm threshold limits were modified according to patients’ clinical conditions. The workload index was higher for the default alarm setting (57.60 [SD 2.59]) than for the modified alarm setting (52.39 [SD 2.29]), with a statistically significant difference of 5.21 (95% CI 3.38-7.04), t₂₈=5.838, P<.05. Significant correlations were found between the workload index and alarm response rate. There was a strong negative correlation between alarm response rate and perceived workload, ρ₂₈=−.54, P<.001 with workload explaining 29% of the variation in alarm response rate. There was a moderate negative correlation between the experience reported during patient care and the perceived workload, ρ₂₈=−.49, P<.05.

Conclusions

The perceived workload index was comparatively lower with alarm settings modified for individual patient care than in an unmodified default clinical alarm setting. These findings demonstrate that the modification of clinical alarm limits positively affects the number of alarms accurately addressed, care providers’ experience, and overall satisfaction. The findings support the removal of nonessential alarms based on patient conditions, which can help care providers address the remaining alarms accurately and provide better patient care.

Developing a Basic Scale for Workers' Psychological Burden from the Perspective of Occupational Safety and Health

Background

Organizations are pursing complex and diverse aims to generate higher profits. Many workers experience high work intensity such as workload and work pressure in this organizational environment. Especially, psychological burden is a commonly used term in workplace of Republic of Korea. This study focused on defining the psychological burden from the perspective of occupational safety and health and tried to develop a scale for psychological burden.

Methods

The 48 preliminary questionnaire items for psychological burden were prepared by a focus group interview with 16 workers through the Copenhagen Psychosocial Questionnaire II and Mindful Awareness Attention Scale. The preliminary items were surveyed with 572 workers, and exploratory factor analysis, confirmatory factor analysis, and correlation analysis were conducted for a new scale.

Results

As a result of the exploratory factor analysis, five factors were extracted: organizational activity, human error, safety and health workload, work attitude, and negative self-management. These factors had significant correlations and reliability, and the stability of the model for validity was confirmed using confirmatory factor analysis.

Conclusion

The developed scale for psychological burden can measure workers' psychological burden in relation to safety and health. Despite some limitations, this study has applicability in the workplace, given the relatively small-sized questionnaire.

Exploring the Validity of Developing an Interdisciplinarity Score of a Patient's Needs: Care Coordination, Patient Complexity, and Patient Safety Indicators

Despite the Affordable Care Act's push to improve the coordination of care for patients with multiple chronic conditions, most measures of coordination quality focus on a specific moment in the care process (e.g., medication errors or transfer between facilities), rather than patient outcomes. One possible supplementary way of measuring the care coordination quality of a facility would be to identify the patients needing the most coordination, and to look at outcomes for that group. This paper lays the groundwork for a new measure of care coordination quality by outlining a conceptual framework that considers the interaction between a patient's interdisciplinarity, biological susceptibility, and procedural intensity. Interdisciplinarity captures the degree of specialized medical expertise needed for a patient's care and will be an important measure to estimate the number of specialists a patient might see. We then develop a preliminary measure of interdisciplinarity and run tests linking interdisciplinarity to medical mistakes, as defined by Agency for Healthcare Research and Quality's Patient Safety Indicators. Finally, we use our preliminary measure to verify that interdisciplinarity is likely to be statistically different from existing measures of comorbidity, like the Charlson score. Future research will need to build upon our findings by developing a more statistically validated measure of interdisciplinarity.

Anesthesiology Control Tower: Feasibility Assessment to Support Translation (ACT-FAST)-a feasibility study protocol

BACKGROUND

Major postoperative morbidity and mortality remain common despite efforts to improve patient outcomes. Health information technologies have the potential to actualize advances in perioperative patient care, but failure to evaluate the usability of these technologies may hinder their implementation and acceptance. This protocol describes the usability testing of an innovative telemedicine-based intra-operative clinical support system, the Anesthesiology Control Tower, in which a team led by an attending anesthesiologist will use a combination of established and novel information technologies to provide evidence-based support to their colleagues in the operating room.

METHODS

Two phases of mixed-methods usability testing will be conducted in an iterative manner and will evaluate both the individual components of the Anesthesiology Control Tower and their integration as a whole. Phase I testing will employ two separate "think-aloud" protocol analyses with the two groups of end users. Segments will be coded and analyzed for usability issues. Phase II will involve a qualitative and quantitative in situ usability and feasibility analysis. Results from each phase will inform the revision and improvement of the Control Tower prototype throughout our testing and analysis process. The final prototype will be evaluated in the form of a pragmatic randomized controlled clinical trial.

DISCUSSION

The Anesthesiology Control Tower has the potential to revolutionize the standard of care for perioperative medicine. Through the thorough and iterative usability testing process described in this protocol, we will maximize the usefulness of this novel technology for our clinicians, thus improving our ability to implement this innovation into the model of care for perioperative medicine.

TRIAL REGISTRATION

The study that this protocol describes has been registered in clinicaltrials.gov as NCT02830126.

Changes in motor performance and mental workload during practice of reaching movements: a team dynamics perspective

Few investigations have examined mental workload during motor practice or learning in a context of team dynamics. This study examines the underlying cognitive-motor processes of motor practice by assessing the changes in motor performance and mental workload during practice of reaching movements. Individuals moved a robotic arm to reach targets as fast and as straight as possible while satisfying the task requirement of avoiding a collision between the end-effector and the workspace limits. Individuals practiced the task either alone (HA group) or with a synthetic teammate (HRT group), which regulated the effector velocity to help satisfy the task requirements. The findings revealed that the performance of both groups improved similarly throughout practice. However, when compared to the individuals of the HA group, those in the HRT group (1) had a lower risk of collisions, (2) exhibited higher performance consistency, and (3) revealed a higher level of mental workload while generally perceiving the robotic teammate as interfering with their performance. As the synthetic teammate changed the effector velocity in specific regions near the workspace boundaries, individuals may have been constrained to learn a piecewise visuomotor map. This piecewise map made the task more challenging, which increased mental workload and perception of the synthetic teammate as a burden. The examination of both motor performance and mental workload revealed a combination of both adaptive and maladaptive team dynamics. This work is a first step to examine the human cognitive-motor processes underlying motor practice in a context of team dynamics and contributes to inform human-robot applications.

Workload of Team Leaders and Team Members During a Simulated Sepsis Scenario

OBJECTIVES

Crisis resource management principles dictate appropriate distribution of mental and/or physical workload so as not to overwhelm any one team member. Workload during pediatric emergencies is not well studied. The National Aeronautics and Space Administration-Task Load Index is a multidimensional tool designed to assess workload validated in multiple settings. Low workload is defined as less than 40, moderate 40-60, and greater than 60 signify high workloads. Our hypothesis is that workload among both team leaders and team members is moderate to high during a simulated pediatric sepsis scenario and that team leaders would have a higher workload than team members.

DESIGN

Multicenter observational study.

SETTING

Nine pediatric simulation centers (five United States, three Canada, and one United Kingdom).

PATIENTS

Team leaders and team members during a 12-minute pediatric sepsis scenario.

INTERVENTIONS

National Aeronautics and Space Administration-Task Load Index.

MEASUREMENTS AND MAIN RESULTS

One hundred twenty-seven teams were recruited from nine sites. One hundred twenty-seven team leaders and 253 team members completed the National Aeronautics and Space Administration-Task Load Index. Team leader had significantly higher overall workload than team member (51 ± 11 vs 44 ± 13; p < 0.01). Team leader had higher workloads in all subcategories except in performance where the values were equal and in physical demand where team members were higher than team leaders (29 ± 22 vs 18 ± 16; p < 0.01). The highest category for each group was mental 73 ± 13 for team leader and 60 ± 20 for team member. For team leader, two categories, mental (73 ± 17) and effort (66 ± 16), were high workload, most domains for team member were moderate workload levels.

CONCLUSIONS

Team leader and team member are under moderate workloads during a pediatric sepsis scenario with team leader under high workloads (> 60) in the mental demand and effort subscales. Team leader average significantly higher workloads. Consideration of decreasing team leader responsibilities may improve team workload distribution.