| Background and objectivesAs a traditional human-machine task,intravenous infusion has the advantages of exact and rapid curative effect and has become one of the most widely used treatment methods in clinic.As an auxiliary tool of intravenous infusion,infusion pump can accurately control the infusion volume,dropping velocity and duration,improve the effectiveness and safety of infusion,and reduce the mental workload of nurses.Nevertheless,the wide application of intravenous infusion auxiliary equipment such as infusion pump also makes nurses face many changes under human-machine tasks.Therefore,the impact on nurses’mental workload and safety performance also needs to be paid attention to.Under the guidance of relevant theories,this study intends to focus on the traditional human-machine task intravenous infusion,explore the influencing factors of nurses’mental workload and safety performance from the aspects of human,mechaine,task and environment,so as to provide theoretical reference and empirical basis for in-depth discussion of optimization strategy of nurses’mental workload and improving safety performance in the context of human-machine task,which has practical guiding significance for optimizing clinical safety management.Contents and Methods1.The influencing factors of nurses’mental workload and safety performance in the context of intravenous infusion task:An observational studyThe convenience sampling method was used to conduct clinical field observation and investigation on nurses in a hospital in Shanghai.An intravenous infusion task observation form was used to record the implementation(number of tasks,duration and safety performance),interruption(time,stage,source,reason)and their coping behavior(task-switching and multitasking)in the process of intravenous infusion task in each shift;The NASA-TLX of nurses was used to evaluate the mental workload of nurses when completing the tasks.At the same time,the possible influencing factors of nurses’mental workload and safety performance were investigated,mainly including human factors(general information questionnaire,General Self-Efficacy Scale),machine factors(System Usability Scale),task factors(nursing operation technical difficulty evaluation scale)and environmental factors(environmental noise level evaluation scale).Multiple linear regression analysis was used to explore the influencing factors of mental workload and safety performance of nurses in the context of intravenous infusion task.2.Nurses’mental workload and safety performance in the context of intravenous infusion task:A psychological behavioral experimentBased on the results of observational study,the draft of eye movement experimental research scheme was designed,and the final eye movement experimental research scheme was formed through expert demonstration.The factorial design of 2(work experience:novice,veteran)×2(task-switching:continuous,task-switching)×2(system usability of infusion pump:high and low)was adapted.By controlling the confounding factors in the simulation laboratory and adjusting the three factors of human(work experience),machine(system usability of infusion pump)and environment(task-switching)when the subjects complete the intravenous infusion task,the nurse’s NASA-TLX and eye movement instrument are used to measure the nurse’s mental workload(subjective and objective),The general linear model analysis of variance and Pearson correlation analysis were used to explore the influence of human-machine-environment on nurses’mental workload and safety performance,and the relationship between them.Results1.An observational study on the influencing factors of nurses’mental workload and safety performance in the context of intravenous infusion task(1)The implementation and interference of intravenous infusion tasks in 240 shifts were recorded by using the intravenous infusion task observation form from April to December,2021.The results showed that nurses performed 852 tasks,with a total time of3,181.29 minutes.A total of 1,487 times of interruption occurred,with an average of once every 2.14 minutes.The total duration of interruption was 612.77 minutes,accounting for about 19.30%of the total time of the task.About 36.50%of the interruption leads to task-switching,and the rest leads to multitasking.A total of 292 errors were observed,255 errors were corrected(87.33%),and 37 were uncorrected(12.67%).Among all errors,the top three were incomplete preparation of appliances(168 times,57.53%),puncture failure(61 times,20.89%),and non-standard disinfection(19 times,6.51%).(2)In the process of performing intravenous infusion task,the mental workload of nurses was(37.28±16.15),and scores of effort and time demand were relatively high,which were(50.04±27.04)and(42.56±23.30),respectively.(3)Among the three different intravenous infusion tasks,the mental workload of nurses in the infusion task after intravenous indwelling needle or steel needle puncture was relatively high,which was(45.14±14.70)points,and the safety performance was low,which was(96.55±3.36)points;The mental workload of connecting venous indwelling needle and using infusion pump was the second,which was(35.24±14.30)points,and the safety performance was(99.44±0.67)points.When performing the task of connecting venous indwelling needle and using disposable infusion set,the mental workload was the lowest,which was(24.20±11.49)points,and the safety performance was higher,which was(99.48±0.84)points.There was significant difference in the mental workload of nurses in the context of three tasks(F=42.878,P<0.001).There was significant difference between the performance of nurses in the infusion task after intravenous indwelling needle or steel needle puncture and the performance of the infusion task of connecting venous indwelling needle and using infusion pump or connecting venous indwelling needle and using disposable infusion set(P<0.001).(4)Multiple linear regression results showed that safety performance,task difficulty,task-switching times,environmental noise level and system usability would affect nurses’mental workload when performing intravenous infusion task(R~2=0.625,adjusted R~2=0.617,F=78.006,P<0.001),and nurses’mental workload and interruption times would affect nurses’safety performance when performing this task(R~2=0.325,adjusted R~2=0.319,F=56.938,P<0.001).2.Eye movement experimental study on nurses’mental workload and safety performance in the context of intravenous infusion task(1)Through expert demonstration,the final eye movement experimental research scheme was formed.From January to February 2022,25 novice nurses and 24 veteran nurses were recruited.The results of variance analysis of general linear model showed that work experience(F=73.681,P<0.001),task-switching(F=8.931,P=0.003)and the system usability of infusion pump system(F=8.792,P=0.003)had statistical effects on nurses’mental workload,and there was no interaction effect among them.(2)The results of objective mental workload analysis in the puncture stage showed that the total fixation duration(F=4.654,P=0.032)and average visit duration(F=4.404,P=0.037)of novices were significantly more than those of veterans;The time to the first fixation(F=53.293,P<0.001),the time to the first whole fixation(F=46.406,P<0.001)and the average visit time(F=4.458,P=0.036)under the task-switching condition were significantly more than those under the continuous condition;On average glance duration(F=4.348,P=0.038),the interaction between work experience and task-switching was significant;On average glance duration,the system usability and task-switching were significant(F=7.821,P=0.006).(3)The results of objective mental workload analysis in the pump programing stage showed that the average visit duration of novices(F=7.070,P=0.009)was significantly more than that of veterans;The time to the first fixation(F=67.822,P<0.001)and the time to the first whole fixation(F=68.921,P<0.001)under the task-switching condition were significantly more than those under the continuous condition;The interaction between work experience and task-switching was significant in the total fixation duration(F=3.948,P=0.048),the total whole fixation duration(F=5.180,P=0.024),the number of whole fixation(F=5.499,P=0.020),the total glance duration(F=4.588,P=0.033)and the total visit duration(F=4.576,P=0.034);Total fixation duration(F=7.536,P=0.007),number of fixation(F=9.462,P=0.002),total duration of whole fixation(F=7.232,P=0.008),number of whole fixation(F=10.303,P=0.002),total glance duration(F=9.409,P=0.002),number of glance(F=5.378,P=0.021),number of saccades(F=10.593,P=0.001)The interaction between work experience and system usability of infusion pump was significant in the total visit duration(F=9.391,P=0.003)and the number of visits(F=5.378,P=0.021).(4)The effects of work experience(F=43.673,P<0.001)and task-switching(F=6.820,P=0.010)on operation scores were statistically significant.The influence of work experience(F=13.264,P<0.001),task-switching(F=5.867,P=0.016)and the system usability of infusion pump(F=6.372,P=0.012)on the task completion time was significant.And in terms of task completion time,the interaction among work experience,task-switching and the system usability of infusion pump was significant(F=4.259,P=0.040).(5)There was a negative correlation between nurses’mental workload and safety performance(P<0.05).Conclusions1.In the real clinical situation,the interruption occurs frequently and takes a long time when nurses perform intravenous infusion tasks.In view of the interruption,nurses adopt task-switching and multitasking coping behaviors.The errors mainly include incomplete preparation of appliances,puncture failure and non-standard disinfection,and most of them can be corrected.2.In the context of intravenous infusion task,nurses’mental workload and safety performance are affected by many factors,such as human,machine,environment,task and so on.3.The mental workload of novice nurses is higher under the condition of task-switching or low system usability,while the mental workload of veteran nurses has no significant change under this condition.When novice nurses use the infusion pump with low system usability and under the condition of task-switching in the process of task,their task completion time is longer,while the that of veteran nurses has no significant change.4.In the context of intravenous infusion task,nurses’mental workload and safety performance affect each other.High mental workload will lead to poor safety performance. |
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