A Novel Interruption Management Intervention for New Graduate Nurses During Medication Administration

Experimentell: Stay S.A.F.E. Interruption Management Education

Övrig: Experimental: Stay S.A.F.E. Interruption Management Education

The Stay S.A.F.E. strategy is a structured, behavioral approach designed to support task focus and safe task resumption during interruptions. It consists of the following steps:

Stay physically in the current location and remain engaged in the primary task; when possible, physically hold task-related items.

Say aloud what you are doing at the moment of interruption, being as specific as possible while maintaining patient privacy.

Acknowledge the person interrupting you without looking away from the primary task.

Fixate visually and cognitively on the current place in the task for one to two seconds and identify a natural stopping point.

Estimate the time needed to complete or pause the task before attending to the interrupter, providing a realistic timeframe.

Övrig: Medication Safety Education

11 slide narrated PowerPoint presentation focused on medication safety practices.

Sham Comparator: Medication Safety Education

Övrig: Medication Safety Education

11 slide narrated PowerPoint presentation focused on medication safety practices.

Response to Interrupter Using the Stay S.A.F.E. Strategy

The primary outcome is the participant's response to a clinical interruption, assessed using an eye tracking device (ETD). Study personnel recorded interruption management behaviors, Stay S.A.F.E., using a structured data collection tool and whether the participant immediately accepted the interruption ("took report").

Time away from primary task

Time away from the primary medication-administration task is measured using eye tracking device (ETD) recordings. Two trained study team members review recorded sessions to determine the duration between the onset of the interruption and the participant's return to the primary task, defined as the point at which the participant's ETD crosshairs re-engage with the medication-administration activity. Time is calculated using timestamp data captured within the ETD recordings.

medication administration errors

Medication administration errors are assessed during the simulation using a structured observational checklist. Evaluated components include patient identification (e.g., armband scanning and electronic medical record verification), medication identification, dosage, route, and timing.

Each task component is documented as:

Yes (correct task completion) No (incorrect task completion) Corrected (initially incorrect but subsequently corrected by the participant)

Data are initially recorded on a standardized paper checklist during the simulation. To ensure accuracy and reliability, two study team members perform an independent review of eye tracking device (ETD) recordings to validate observed performance and recorded outcomes.

Outcome data may be summarized as proportions of correctly completed tasks, error rates, and frequency of corrected actions.

Perceived Workload (NASA Task Load Index)

Perceived workload is assessed using the NASA Task Load Index (NASA-TLX), a validated self-report instrument developed by the NASA Ames Research Center. Participants complete the NASA-TLX electronically on an iPad immediately following the simulation The NASA-TLX consists of six subscales: mental demand, physical demand, temporal demand, performance, effort, and frustration. Each subscale is rated on a 20-point scale, with higher scores indicating greater perceived workload. Both overall workload scores and individual subscale scores are calculated and analyzed to characterize participant workload during the simulation.

The NASA-TLX has demonstrated reliability and validity across simulation, laboratory, and applied clinical settings.