Effects of jet engine noise and performance feedback on perceived workload in a monitoring task

Boredom and engagement at work: do they have different antecedents and consequences?

This study aimed to demonstrate the empirical distinctiveness of boredom at work and work engagement in relation to their potential antecedents (job demands and job resources) and consequences (psychological distress and turnover intention) based on the Job Demands-Resources model. A three-wave longitudinal survey was conducted among registered monitors of an Internet survey company in Japan. The questionnaire included scales for boredom at work, work engagement, psychological distress, and turnover intention as well as participants' job characteristics and demographic variables. The hypothesized model was evaluated via structural equation modeling with 1,019 participants who were employed full-time. As expected, boredom at work was negatively associated with quantitative job demands and job resources and positively associated with psychological distress and turnover intention. In contrast, work engagement was positively associated with job resources and negatively associated with turnover intention. Thus, boredom at work and work engagement had different potential antecedents and were inversely related to employee well-being and organizational outcomes. However, contrary to expectations, qualitative job demands were not significantly associated with boredom at work. Further investigation is needed to understand the relationship between boredom and qualitative job demands, which require sustained cognitive load and the use of higher skills.

Hybrid multi-criteria decision making approach proposal for evaluating workloads of aircraft maintenance technicians

BACKGROUND

Aircraft maintenance technicians (AMTs) have the most difficulty in terms of total workload criteria working in line maintenance. This is a very important problem for the Aircraft Maintenance Organization. A systematic and scientific approach is required for its solution.

OBJECTIVE

This study proposes a new Multi-Criteria Decision Making (MCDM) based approach to evaluating the total workloads of AMTs to identify the most challenging AMT tasks in the aircraft maintenance organization.

METHODS

A new hybrid MCDM approach is proposed by integrating the Decision-Making Trial and Evaluation Laboratory (DEMATEL) and Technique for Order Preference by Similarity (TOPSIS) methods to compare AMTs on the basis of workloads according to license categories. The hybrid method proposed in this study evaluates the total workload under three main titles: mental, physical, and environmental workload.

RESULTS

Focusing on AMTs working in line maintenance of an aircraft maintenance organization, this study revealed that the most important workload criteria determined by the DEMATEL method are lower back strain, upper back strain, time pressure, and air temperature criteria. The results of the TOPSIS method showed that the license categories of AMTs are sorted according to the workloads as follows: A, B2, B1, and B1 + B2. The AMTs holding a "Category A" license have fewer workloads than the other categories.

CONCLUSION

The findings of the study reveal some measures that might allow authorities to minimize the workload of AMTs. In addition, the study contributes to the literature because there are few studies that systematically analyze total workloads by using MCDM methods.

Examining Care Planning Efficiency and Clinical Decision Support Adoption in a System Tailoring to Nurses' Graph Literacy: National, Web-Based Randomized Controlled Trial

BACKGROUND

The proliferation of health care data in electronic health records (EHRs) is fueling the need for clinical decision support (CDS) that ensures accuracy and reduces cognitive processing and documentation burden. The CDS format can play a key role in achieving the desired outcomes. Building on our laboratory-based pilot study with 60 registered nurses (RNs) from 1 Midwest US metropolitan area indicating the importance of graph literacy (GL), we conducted a fully powered, innovative, national, and web-based randomized controlled trial with 203 RNs.

OBJECTIVE

This study aimed to compare care planning time (CPT) and the adoption of evidence-based CDS recommendations by RNs randomly assigned to 1 of 4 CDS format groups: text only (TO), text+table (TT), text+graph (TG), and tailored (based on the RN's GL score). We hypothesized that the tailored CDS group will have faster CPT (primary) and higher adoption rates (secondary) than the 3 nontailored CDS groups.

METHODS

Eligible RNs employed in an adult hospital unit within the past 2 years were recruited randomly from 10 State Board of Nursing lists representing the 5 regions of the United States (Northeast, Southeast, Midwest, Southwest, and West) to participate in a randomized controlled trial. RNs were randomly assigned to 1 of 4 CDS format groups-TO, TT, TG, and tailored (based on the RN's GL score)-and interacted with the intervention on their PCs. Regression analysis was performed to estimate the effect of tailoring and the association between CPT and RN characteristics.

RESULTS

The differences between the tailored (n=46) and nontailored (TO, n=55; TT, n=54; and TG, n=48) CDS groups were not significant for either the CPT or the CDS adoption rate. RNs with low GL had longer CPT interacting with the TG CDS format than the TO CDS format (P=.01). The CPT in the TG CDS format was associated with age (P=.02), GL (P=.02), and comfort with EHRs (P=.047). Comfort with EHRs was also associated with CPT in the TT CDS format (P<.001).

CONCLUSIONS

Although tailoring based on GL did not improve CPT or adoption, the study reinforced previous pilot findings that low GL is associated with longer CPT when graphs were included in care planning CDS. Higher GL, younger age, and comfort with EHRs were associated with shorter CPT. These findings are robust based on our new innovative testing strategy in which a diverse national sample of RN participants (randomly derived from 10 State Board of Nursing lists) interacted on the web with the intervention on their PCs. Future studies applying our innovative methodology are recommended to cost-effectively enhance the understanding of how the RN's GL, combined with additional factors, can inform the development of efficient CDS for care planning and other EHR components before use in practice.

Stress degrades working memory-related frontostriatal circuit function

Goal-directed behavior is dependent on neuronal activity in the prefrontal cortex (PFC) and extended frontostriatal circuitry. Stress and stress-related disorders are associated with impaired frontostriatal-dependent cognition. Our understanding of the neural mechanisms that underlie stress-related cognitive impairment is limited, with the majority of prior research focused on the PFC. To date, the actions of stress across cognition-related frontostriatal circuitry are unknown. To address this gap, the current studies examined the effects of acute noise-stress on the spiking activity of neurons and local field potential oscillatory activity within the dorsomedial PFC (dmPFC) and dorsomedial striatum (dmSTR) in rats engaged in a test of spatial working memory. Stress robustly suppressed responses of both dmPFC and dmSTR neurons strongly tuned to key task events (delay, reward). Additionally, stress strongly suppressed delay-related, but not reward-related, theta and alpha spectral power within, and synchrony between, the dmPFC and dmSTR. These observations provide the first demonstration that stress disrupts the neural coding and functional connectivity of key task events, particularly delay, within cognition-supporting dorsomedial frontostriatal circuitry. These results suggest that stress-related degradation of neural coding within both the PFC and striatum likely contributes to the cognition-impairing effects of stress.

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.

Brain Network Research of Skilled Shooters in the Shooting Preparation Stage under the Condition of Limited Sensory Function

Shooting is a sport dominated by psychological factors. Hence, disturbing the shooter's sensory function during aiming will seriously affect his psychological state and shooting performance. Electroencephalograph (EEG) measurements of 30 skilled marksmen in the shooting preparation stage under noisy disturbance, weak light, and normal conditions were recorded. Therefore, the differences in neural mechanisms in the shooter's brain during shooting aiming in different disturbance conditions were explored using an analytical approach that employs functional connectivity and brain network analysis based on graph theory. The relationship between these brain network characteristics and shooting performance was also compared. The results showed that (1) the average connection strength in the beta frequency band and connection intensity in the left and right temporal lobes of the shooters under noise disturbance were significantly higher than those under the other two conditions, and their brain networks also showed a higher global and local efficiency. In addition, (2) the functional connection intensity in the occipital region of the beta band was higher than that in the normal condition in the weak-light condition. The information interaction in the left parietal region also increased continually during the shooting process. (3) Furthermore, the shooters' eigenvector centrality in the temporal and occipital regions with limited sensory function in the two conditions was lower than those in the normal condition. These findings suggest that noise disturbance activates the arousal level of the shooter's brain and enhances the information processing efficiency of the brain network; however, it increases the mental workload. In weak-light conditions, shooters focus more on visual information processing during aiming and strengthen the inhibition of functions in the brain regions unrelated to shooting behavior. Audiovisual disturbance renders the cortical regions equivalent to the audiovisual perception function in the shooter's brain less important in the entire brain network than in the normal condition. Therefore, these findings reveal the effect of audiovisual disturbance on the functional network of the cortex in the shooting preparation stage and provide a theoretical basis for further understanding the neural mechanism of the shooting process under sensory disturbances.

Noise exposure and mental workload: Evaluating the role of multiple noise exposure metrics among surface miners in the US Midwest

This study examined associations between metrics of noise exposure and mental workload. In this cross-sectional study, five occupational noise metrics computed from full-shift dosimetry were evaluated among surface mine workers in the US Midwest. Mental workload was evaluated using a modified, raw NASA-TLX and clustered with a k-means clustering algorithm. Mixed effects logistic regression and Bayesian Kernel Machine Regression (BKMR) was utilized for analysis. Average noise exposure, the difference between peak and mean noise exposure, and the number of peaks >135 dB were each strongly associated with mental workload, while the kurtosis and standard deviation of noise throughout a shift were not. An exposure-response relationship between average noise exposure and mental workload may exist, with elevated risk of high mental workload beginning at 80 dBA. These results suggest that high noise exposure may be an independent risk factor of high mental workload, and impulse events and the difference between the peak and mean noise exposure may have interactive effects with average noise exposure.

How Noise Can Influence Experience-Based Decision-Making under Different Types of the Provided Information

Pervasive noise undermines many cognitive processes. Across two studies, we examined how noise influences experience-based decision-making and whether the nature of the information provided moderates this influence. Study 1 used the repeated choice paradigm and found that noise can significantly reduce people's performance in experience-based decision-making by increasing the likelihood of choosing the option with the lower expected value. This negative influence can be attenuated when experience-congruent suggestions are provided, but significantly worsened when experience-incongruent suggestions are provided. Study 2 investigated how noise influences decision-making performance in two experience-incongruent conditions differing in error salience. By replicating noise's general negative effect, we found that the noise effect could be attenuated when incongruent suggestions were obvious. We suggest that noise can undermine the information updating and integration process, which is necessary for experience-based decision-making. We also discuss the principles for designing better information aids based on these findings.

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.

Measured effects of workload and auditory feedback on remote pilot task performance

Absent or reduced sensory cueing can deprive pilots operating remotely piloted aircraft beyond visual line of sight (BVLOS) of vital information necessary for safe flight. The present study tested the effects of real-time auditory feedback on remote pilot perception and decision-making task performance in an automated BVLOS flight, under three levels of workload (Low, Moderate and High). Results from 36 participants revealed workload and auditory feedback influenced perception task performance in terms of error type count, with misses more frequent than wrong identifications. In terms of performance in the decision-making task, under low and moderate levels of workload, auditory feedback was found to improve performance. Conversely, under high workloads, an inflexion or tipping point occurred whereby auditory feedback became detrimental to task performance. These results correspond with the expected behavioural responses to external stressors as predicted by the Arousal and Maximal Adaptability theory, and build upon previous findings related to workload, auditory feedback and remote pilot task performance. Practitioner summary: This study tested the effect of real-time auditory feedback and dynamic workloads on remote pilots' task performance. Auditory feedback and workload each influenced the perception tasks in terms of error types committed. Auditory feedback improved decision-making task performance under low and moderate workloads, and reduced performance under high workloads. These results may benefit practitioners by considering the nuanced effects of auditory feedback on human task performance within sensory deprived working environments, including those utilising teleoperated systems.

Does music from noise-canceling headphones have a beneficial effect on men undergoing transrectal ultrasound-guided prostate biopsy?

Background

The objective of this study was to evaluate the effect of music with noise-canceling headphones on men undergoing transrectal ultrasound–guided prostate biopsy (TRUSPB) in a prospective randomized study.

Methods

From January to February 2020, 94 men underwent TRUSPB at our institution. They were divided into two groups and wore noise-cancelling headphones—group 1 (n = 47) did not listen to music and group 2 (n = 47) listened to music. We examined the patients’ clinical characteristics and compared the objective and subjective measurements before and after the procedures. Primary outcomes included vital signs, the State-Trait Anxiety Inventory (STAI, 20–80) scale; and the visual analog scale (VAS, 0–10) for the assessments of pain, satisfaction, and willingness to repeat the procedure.

Results

There were no significant differences in patients' characteristics or the prebiopsy status between the groups. Postbiopsy vital signs for objective parameters were statistically similar between the groups; however, the subjective parameters were not. Postbiopsy STAI-state and VAS scores were significantly lower and VAS scores for the patients’ satisfaction and willingness to repeat the procedure were significantly higher in Group 2 than in Group 1 (p = 0.004, p = 0.009, p = 0.004, and p = 0.003, respectively). In addition, changes in the STAI-state score before and after the procedure were significant in Group 2 (p = 0.001).

Conclusions

Music from noise-canceling headphones may have beneficial effects on anxiety, pain, satisfaction, and willingness to repeat the procedure in men undergoing TRUSPB.

Electronic health record usability and workload changes over time for provider and nursing staff following transition to new EHR

The ubiquity of EHRs in healthcare means that small EHR inefficiencies can have a major impact on clinician workload. We conducted a sequential explanatory mixed methods study to: 1) identify EHR-associated workload and usability effects for clinicians following an EHR change over time, 2) determine workload and usability differences for providers (MD and Advance Practice Nurses) versus nurses (RNs and MAs), 3) determine if usability predicts workload, 4) identify potential sources of EHR design flaws. Workload (NASA-Task Load Index) and usability (System Usability Scale) measures were administered pre, 6-8 month and 30-32 months post-implementation. We found significant increase in perceived workload post-implementation that persisted for 2.5 years (p < .001). The workload increase was associated with usability ratings, which in turn may relate to EHR interface design violations identified by a heuristic evaluation. Our findings suggest further innovation and attention to interface design flaws are needed to improve EHR usability and reduce clinician workload.

Effects of auditory and visual feedback on remote pilot manual flying performance

Remotely Piloted Aircraft Systems (RPAS) have facilitated new growth in civil aviation. Unlike manned aircraft, however, they are operated without auditory feedback and normally flown under two visual conditions: in direct visual-line-of-sight to the remote pilot (VLOS) and beyond VLOS with first-person-view imagery transmitted via onboard cameras (BVLOS). The present research examined the effectiveness of audiovisual cueing on remote pilot manual flying performance. Eighteen pilots (three female) completed six navigation and 12 spotting tasks. Their flying performance (horizontal accuracy, vertical accuracy and timeliness) was examined under three different visual display types (VLOS (Control), BVLOS-Monitor & BVLOS-Goggles), with and without real-time auditory feedback, and two wind component (no wind and wind) conditions. Horizontal deviation and timeliness improved in the BVLOS-Monitor condition navigation task, while auditory feedback produced nuanced examples of improved and degraded pilot performance. These results indicate how the specificity of the task, combined with different levels of audiovisual feedback influences remote pilot performance. These findings support the rationalisation for the provision of multimodal dynamic sensory cueing in future RPAS. Practitioner summary: Accuracy and timeliness of remote pilot manual flying performance was measured under a combination of audiovisual feedback in calm and wind shear conditions. The inclusion of real-time auditory feedback as an additional sensory cue is uncommon; this study demonstrated nuanced examples of improved and degraded manual flying performance. The provision of dynamic sensory cueing made available to remote pilots in future RPAS should be considered.

Sustained Attention to Science: A Tribute to the Life and Scholarship of Joel Warm

OBJECTIVE

To provide an evaluative synthesis of the life and scientific contributions of the late Joel Warm.

BACKGROUND

As the doyen of vigilance research, Joel Warm expanded our understanding and horizons concerning this critical response capacity. However, he also made widespread and profound contributions to many other areas of perception and applied psychology, as we elucidate here.

METHOD

Using archival sources, personal histories, and analysis of extant literature documenting Warm's own productivity, we articulate his life in science.

RESULTS

Our synthesis illustrates the continued, broad, influential, and expanding impact that one individual can exert on diverse fields of study. Whole bodies of understanding of human behavior have been illuminated by his exemplary career.

APPLICATION

By understanding his path to success in applied experimental psychology, we anticipate that others will be motivated, inspired, and guided to replicate and even outstrip a lifetime of such seminal and influential contributions. The presence of individuals such as Warm serves as a primary motive in enhancing Humans Factors/Ergonomics Science.

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.

Training for vigilance on the move: a video game-based paradigm for sustained attention

The capacity for superior vigilance can be trained by using knowledge of results (KR). Our present experiments demonstrate the efficacy of such training using a first-person perspective movement videogame-based platform in samples of students and Soldiers. Effectiveness was assessed by manipulating KR during a training phase and withdrawing it in a subsequent transfer phase. Relative to a no KR control condition, KR systematically improved performance for both Soldiers and students. These results build upon our previous findings that demonstrated that a video game-based platform can be used to create a movement-centred sustained attention task with important elements of traditional vigilance. The results indicate that KR effects in sustained attention extend to a first person perspective movement based paradigm, and that these effects occur in professional military as well as a more general population. Such sustained attention training can save lives and the present findings demonstrate one particular avenue to achieve this goal. Practitioner Summary: Sustained attention can be trained by means of knowledge of results using a videogame-based platform with samples of students and Soldiers. Four experiments demonstrate that a dynamic, first-person perspective video game environment can serve to support effective sustained attention training in professional military as well as a more general population.

Effectiveness of auditory and tactile crossmodal cues in a dual-task visual and auditory scenario

In this study, we examined how spatially informative auditory and tactile cues affected participants' performance on a visual search task while they simultaneously performed a secondary auditory task. Visual search task performance was assessed via reaction time and accuracy. Tactile and auditory cues provided the approximate location of the visual target within the search display. The inclusion of tactile and auditory cues improved performance in comparison to the no-cue baseline conditions. In comparison to the no-cue conditions, both tactile and auditory cues resulted in faster response times in the visual search only (single task) and visual-auditory (dual-task) conditions. However, the effectiveness of auditory and tactile cueing for visual task accuracy was shown to be dependent on task-type condition. Crossmodal cueing remains a viable strategy for improving task performance without increasing attentional load within a singular sensory modality. Practitioner Summary: Crossmodal cueing with dual-task performance has not been widely explored, yet has practical applications. We examined the effects of auditory and tactile crossmodal cues on visual search performance, with and without a secondary auditory task. Tactile cues aided visual search accuracy when also engaged in a secondary auditory task, whereas auditory cues did not.

Stress Degrades Prefrontal Cortex Neuronal Coding of Goal-Directed Behavior

Stress, pervasive in modern society, impairs prefrontal cortex (PFC)-dependent cognitive processes, an action implicated in multiple psychopathologies and estimated to contribute to nearly half of all work place accidents. However, the neurophysiological bases for stress-related impairment of PFC-dependent function remain poorly understood. The current studies examined the effects of stress on PFC neural coding during a working memory task in rats. Stress suppressed responses of medial PFC (mPFC) neurons strongly tuned to a diversity of task events, including delay and outcome (reward, error). Stress-related impairment of task-related neuronal activity included multidimensional coding by PFC neurons, an action that significantly predicted cognitive impairment. Importantly, the effects of stress on PFC neuronal signaling were highly conditional on tuning strength: stress increased task-related activity in the larger population of PFC neurons weakly tuned to task events. Combined, stress elicits a profound collapse of task representations across the broader population of PFC neurons.

Detection-Action Linkage in Vigilance: Effects on Workload and Stress

Using a simulated UAV control task in which a vigilance display warned observers of the presence of enemy threats, Gunn et al. (2005) reported that perceived mental workload in relation to the vigilance task was unexpectedly low. The present study did not confirm that finding. It did show, however, that vigilance performance was greater and task induced stress was less among observers who had the opportunity to act upon vigilance signal detections by destroying the enemy threats than among those who detected threats but had no opportunity to counter them. Accordingly, the results point to the importance of a detection-action linkage to enhance signal detection and reduce stress in the performance of vigilance tasks.

Further Tests of an Abbreviated Vigilance Task: Effects of Signal Salience and Jet Aircraft Noise on Performance and Stress

The effects of signal salience and jet-aircraft noise on performance and self-reports of stress were examined in an abbreviated vigilance task (12 min) that duplicates many of the findings with longer duration vigilance tasks (Temple et al., 2000). As is the case with longer vigils, signal detection in the abbreviated task was poorer for low salience than for high salience signals and stress scores, as indexed by the Dundee Stress State Questionnaire (Matthews, Joiner, Gilliland, Campbell, & Falconer, 1999), were generally greater when observers were required to detect low as compared to high salience signals. Unlike longer vigils, however, signal detection in the abbreviated task was superior in the presence of noise than in quiet, and noise generally attenuated self-reports of stress. The beneficial effect of jet-aircraft noise for the abbreviated task differentiates it from longer vigilance tasks and suggests that noise may have short-term positive value in vigilance.

Effect of Noise Intensity and Illumination Intensity on Visual Performance

The results of Experiment 1 indicated that noise and illumination intensity have a significant effect on character identification performance, which was better at 30 dBA than at 60 and 90 dBA, and better at 500 and 800 lux than at 200 lux. However, the interaction of noise and illumination intensity did not significantly affect visual performance. The results of Experiment 2 indicated that noise and illumination intensity also had a significant effect on reading comprehension performance, which was better at 30 dBA than at 60 and 90 dBA, and better at 500 lux than at 200 and 800 lux. Furthermore, reading comprehension performance was better at 500 lux lighting and 30 dBA noise than with 800 lux and 90 dBA. High noise intensity impaired visual performance, and visual performance at normal illumination intensity was better than at other illumination intensities. The interaction of noise and illumination had a significant effect on reading comprehension. These results indicate that noise intensity lower than 30 dBA and illumination intensity approximately 500 lux might be the optimal conditions for visual work.

Simulation to assess the safety of new healthcare teams and new facilities

INTRODUCTION

: Our institution recently opened a satellite hospital including a pediatric emergency department. The staffing model at this facility does not include residents or subspecialists, a substantial difference from our main hospital. Our previous work and published reports demonstrate that simulation can identify latent safety threats (LSTs) in both new and established settings. Using simulation, our objective was to define optimal staff roles, refine scope of practice, and identify LSTs before facility opening.

METHODS

: Laboratory simulations were used to define roles and scope of practice. After each simulation, teams were debriefed using video recordings. The National Aeronautics and Space Administration-Task Load Index was completed by each participant to measure perceived workload. Simulations were scored for team behaviors by video reviewers using the Mayo High Performance Team Scale. Subsequent in situ simulations focused on identifying LSTs and monitoring for unintended consequences from changes made.

RESULTS

: Twenty-four simulations were performed over 3 months before the hospital opening. Laboratory debriefing identified the need to modify provider responsibilities. National Aeronautics and Space Administration-Task Load Index scores and debriefings demonstrated that the medication nurse had the greatest workload during resuscitations. Modifying medication delivery was deemed critical. Lower Mayo High Performance Team Scale scores, implying less teamwork, were noted during in situ simulations. In situ sessions identified 37 LSTs involving equipment, personnel, and resources.

CONCLUSIONS

: Simulation can help determine provider workload, refine team responsibilities, and identify LSTs. This pilot project provides a template for evaluation of new teams and clinical settings before patient exposure.

The effect of two different electronic health record user interfaces on intensive care provider task load, errors of cognition, and performance

OBJECTIVES

The care of critically ill patients generates large quantities of data. Increasingly, these data are presented to the provider within an electronic medical record. The manner in which data are organized and presented can impact on the ability of users to synthesis that data into meaningful information. The objective of this study was to test the hypothesis that novel user interfaces, which prioritize the display of high-value data to providers within system-based packages, reduce task load, and result in fewer errors of cognition compared with established user interfaces that do not.

DESIGN

Randomized crossover study.

SETTING

Academic tertiary referral center.

SUBJECTS

Attending, resident and fellow critical care physicians.

INTERVENTIONS

Novel health care record user interface.

MEASUREMENT

Subjects randomly assigned to either a standard electronic medical record or a novel user interface, were asked to perform a structured task. The task required the subjects to use the assigned electronic environment to review the medical record of an intensive care unit patient said to be actively bleeding for data that formed the basis of answers to clinical questions posed in the form of a structured questionnaire. The primary outcome was task load, measured using the paper version of the NASA-task load index. Secondary outcome measures included time to task completion, number of errors of cognition measured by comparison of subject to post hoc gold standard questionnaire responses, and the quantity of information presented to subjects by each environment.

MAIN RESULTS

Twenty subjects completed the task on eight patients, resulting in 160 patient-provider encounters (80 in each group). The standard electronic medical record contained a much larger data volume with a median (interquartile range) number of data points per patient of 1008 (895-1183) compared with 102 (77-112) contained within the novel user interface. The median (interquartile range) NASA-task load index values were 38.8 (32-45) and 58 (45-65) for the novel user interface compared with the standard electronic medical record (p < .001). The median (interquartile range) times in seconds taken to complete the task for four consecutive patients were 93 (57-132), 60 (48-71), 68 (48-80), and 54 (42-64) for the novel user interface compared with 145 (109-201), 125 (113-162), 129 (100-145), and 112 (92-123) for the standard interface (p < .0001), respectively. The median (interquartile range) number of errors per provider was 0.5 (0-1) and two (0.25-3) for the novel user interface and standard electronic medical record interface, respectively (p = .007).

CONCLUSIONS

A novel user interface was designed based on the information needs of intensive care unit providers with a specific goal of development being the reduction of task load and errors of cognition associated with filtering, extracting, and using medical data contained within a comprehensive electronic medical record. The results of this simulated clinical experiment suggest that the configuration of the intensive care unit user interface contributes significantly to the task load, time to task completion, and number of errors of cognition associated with the identification, and subsequent use, of relevant patient data. Task-specific user interfaces, developed from an understanding of provider information requirements, offer advantages over interfaces currently available within a standard electronic medical record.

Improving resident education and patient safety: a method to balance initial caseloads at academic year-end transfer

PURPOSE

In outpatient continuity clinics, incoming trainees may receive caseloads that are unbalanced in terms of the mental workload required from each resident. When significant, these imbalances may compromise resident learning and patient safety. Using data from psychiatric outpatient continuity clinics, this study tested a method for balancing initial caseloads.

METHOD

Adapting prior research on mental workload, the authors developed and implemented a workload-balancing method to balance initial caseloads regarding factors contributing to mental workload: number of patients, number of acute patients, complexity/time demands outside clinic, visits per month, and collaboration demands. For academic years 2006-2007, 2007-2008, 2008-2009, and 2009-2010, they compared these balanced caseloads with those that would have been created by the clinic's traditional method of largely preserving prior caseloads (with some redistribution to balance only the number of patients). The outcome measure was the intercaseload coefficient of variation for each of the chosen mental workload factors and for all factors combined.

RESULTS

Compared with the traditional method, the workload-balancing method generated lower intercaseload variation for each mental workload factor. Also, this method reduced overall intercaseload variation for all factors combined by 50% to 61% in each of the intervention years.

CONCLUSIONS

The workload-balancing method evenly distributes among resident panels factors known to contribute to mental workload. This method may reduce errors and stress likely to occur when residents inherit unbalanced caseloads that are overly challenging and, thus, may improve patient safety and resident learning. This model could be applicable to other caseload situations.

Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting

OBJECTIVE

To identify factors in the nursing work domain that contribute to the problem of inpatient falls, aside from patient risk, using cognitive work analysis.

DESIGN

A mix of qualitative and quantitative methods were used to identify work constraints imposed on nurses, which may underlie patient falls.

MEASUREMENTS

Data collection was done on a neurology unit staffed by 27 registered nurses and utilized field observations, focus groups, time-motion studies and written surveys (AHRQ Hospital Survey on Patient Culture, NASA-TLX, and custom Nursing Knowledge of Fall Prevention Subscale).

RESULTS

Four major constraints were identified that inhibit nurses' ability to prevent patient falls. All constraints relate to work processes and the physical work environment, opposed to safety culture or nursing knowledge, as currently emphasized. The constraints were: cognitive 'head data', temporal workload, inconsistencies in written and verbal transfer of patient data, and limitations in the physical environment. To deal with these constraints, the nurses tend to employ four workarounds: written and mental chunking schemas, bed alarms, informal querying of the previous care nurse, and informal video and audio surveillance. These workarounds reflect systemic design flaws and may only be minimally effective in decreasing risk to patients.

CONCLUSION

Cognitive engineering techniques helped identify seemingly hidden constraints in the work domain that impact the problem of patient falls. System redesign strategies aimed at improving work processes and environmental limitations hold promise for decreasing the incidence of falls in inpatient nursing units.

Mental strain and annoyance during cognitive performance in different traffic noise conditions

In built-up areas, an increasing number of persons are affected by road traffic noise while performing mental work. This experimental study focused on annoyance and mental strain due to various noise scenarios. A total of 102 healthy, young persons (51 women, 51 men, aged 18-31 years) were randomly assigned to one of five experimental conditions determined by traffic flow (even, lumped) and traffic composition (20%, 40% heavy vehicles). While exposed to noise they performed a grammatical reasoning and a mathematical processing task. Performance and mental strain were not affected by any of the five noisy conditions. Individuals with high noise sensitivity were partially more annoyed and performed less than persons with low sensitivity. STATEMENT OF RELEVANCE: The present study provides information about mental strain due to tasks with different cognitive demands and the role of noise sensitivity in various traffic noise conditions. The results show that measures aiming at the reduction of the proportion of heavy vehicles should additionally consider particular traffic flow.

Knowledge of Results and Signal Salience Modify Vigilance Performance and Cerebral Hemovelocity

Transcranial Doppler sonography was used to measure cerebral blood flow velocity (hemovelocity, CBFV) from the left and right middle cerebral arteries during the performance of a 30-min simulated air-traffic control task in which knowledge of results (KR) and signal salience were manipulated. Critical signals were situations in which the simulated aircraft were on a potential collision course. Findings show that overall signal detection and CBFV both declined over time. While performance was more stable over time in the KR condition, performance declined in the no-KR condition. In addition, the initial level and temporal decline in CBFV were both greater for the KR condition than the no-KR condition. Results are interpreted in terms of the motivational effects induced by feedback and a resource model of vigilance.

Stress state mediation between environmental variables and performance: the case of noise and vigilance

Effects of environmental variables on performance may be mediated by individual stress states. In this study the effects of jet-aircraft engine noise and signal salience on vigilance performance and self-reported stress state were examined. One hundred and ninety-two (96 female and 96 male) participants were randomly assigned to four experimental conditions consisting of 48 participants each resulting from the factorial combination of signal salience (high and low salience signals) and noise (95 dBA intermittent aircraft noise or quiet). Performance metrics and self-reported stress state (Task Engagement, Distress, and Worry) were collected. Performance in the noise conditions was significantly better than in the quiet conditions. Performance in the high salience conditions was significantly better than the low salience conditions. Noise elevated Task Engagement and low signal salience elevated Distress. Moreover, structural equation model analyses were used to examine stress state mediation between the experimental variables and performance. These analyses indicated Engagement mediates between noise and vigilance performance.

Assessment of workload using NASA Task Load Index in perianesthesia nursing

According to the Institute of Medicine (IOM), as many as 44,000 to 98,000 people in the United States die in hospitals every year due to medical errors. Multiple physiological and psychological factors can impact the health care provider's attention span, making medical errors more likely. Some of these factors include increased workload, fatigue, cognitive overload, ineffective interpersonal communications, and faulty information processing. Postanesthesia nurses, responsible for providing care to unstable patients emerging from anesthesia with multiple life-threatening conditions, must make critical decisions on a minute-by-minute basis. The current ASPAN Patient Classification/Recommended Staffing Guidelines does not adequately take into account varying care requirements among the patients. If a tool could be found that effectively evaluated staff's workload, ongoing assessment would be enhanced and resources better used. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX), a multifaceted tool for evaluating perceptual (subjective) workload, has seen extensive applications and is widely regarded as the strongest tool available for reporting perceptions of workload. This article will survey various uses of the NASA-TLX and consider the potential uses for this tool in perianesthesia nursing.

The abbreviated vigilance task and cerebral hemodynamics

Transcranial Doppler sonography (TCD) and transcranial cerebral oximetry (TCCO) measures of cerebral blood flow velocity and oxygenation levels were collected during an abbreviated 12-min vigilance task. Both the TCD and TCCO measures showed higher levels of cerebral vascular activity in the right than in the left cerebral hemisphere; the cerebral laterality of vigilance occurs in an abbreviated task. Although there was a significant decline in performance over time, there was no significant change in the physiological measures over time during the abbreviated vigil. This latter finding does not match the physiological changes detected in long-duration vigils.

The joint effect of noise exposure and job complexity on distress and injury risk among men and women: the cardiovascular occupational risk factors determination in Israel study

We sought to explore the possibility that exposure to noise at work might interact with job complexity and gender to affect the incidence of occupational injury among industrial employees. In this study, we examined 4084 men and 1643 women from 21 industrial plants while controlling for a number of potent confounding variables, among them active safety hazards. Logistic regression results showed that the predictor variables interacted and that the highest injury risk (odds ratio = 2.72) was observed in women in high noise and high job complexity, compared with the referents scoring low on these predictors. The comparable injury risk in men was only 1.3. Parallel results were observed for three noise stress indicators: workload, noise annoyance and postwork irritability. We conclude that the joint exposure to noise and high job complexity is disruptive, resulting in higher distress and occupational injury risk, particularly among women.

Effects of sensory modality and task duration on performance, workload, and stress in sustained attention

The workload and stress associated with a 40-min vigilance task were examined under conditions wherein observers monitored an auditory or a visual display for changes in signal duration. Global workload scores fell in the midrange of the NASA Task Load Index, with scores on the Frustration subscale increasing linearly over time. These effects were unrelated to the sensory modality of signals. However, sensory modality was a significant moderator variable for stress. Observers became more stressed over time as indexed by responses to the Dundee Stress State Questionnaire, with evidence of recovery in the auditory but not the visual condition toward the end of the watch. This result and the finding that signal detection accuracy - although equated for difficulty under alerted conditions - favored the auditory mode, indicate that display modality and time on task should be considered carefully in the design of operations requiring sustained attention in order to enhance performance and reduce stress. Actual or potential applications of this research include domains in which monitoring is a crucial part, such as baggage screening, security operations, medical monitoring, and power plant operations.

Effects of cueing and knowledge of results on workload and boredom in sustained attention

Two models of recently reported high workload associated with vigilance tasks are the direct-cost and indirect-cost views. The former attributes high workload to the need for continuous observation in discriminating signals from neutral events; the latter attributes it to efforts to combat the boredom associated with monotonous vigilance tasks. These opposing views were tested by providing observers with reliable cueing, which rendered observation necessary only when low-probability critical signals were imminent, or with knowledge of results (KR) regarding performance efficiency. On the basis of cue and KR differences in elicited observation activity and motivational value, the direct-cost model led to the anticipation that cueing would result in a high-boredom, low-workload profile and a greater reduction in workload than KR. The indirect-cost model led to the prediction that cueing would result in a high-boredom, high-workload profile and a lesser reduction in workload than KR. The results clearly supported the direct-cost view that the workload of vigilance is task-induced. Consequently, efforts to combat high workload in complex automated systems requiring substantial monitoring by operators should focus specifically upon task-related determinants.