The hospital in-patient setting is often chaotic and unpredictable. At the center of it all are the unit nurses, tasked with keeping patients safe as well as keeping their families informed. Increasing nurse to patient ratios, frequent phone calls from physicians, and countless alarm notifications contribute to high workload situations that have the potential to affect the quality and safety of patient care.
In an effort to improve patient safety while also reducing the workload nurses experience, our team has laid out a multi-year quality improvement plan to address current inefficiencies often found on the hospital unit. The plan relies upon a systems engineering framework and includes 5 phases: problem analysis, design, development, implementation, and evaluation. Currently, our team is in the problem analysis phase.
In order to improve the workload nurses experience each day, it is necessary to understand which components of their responsibilities contribute most to their experience of workload. To do this, our team employed the use of the NASA Task Load Index, or NASA-TLX. This validated, multi-dimensional measure of subjective workload has its roots in aviation, but has been used in many other applications, including healthcare, in recent years. A short questionnaire, the NASA-TLX asks nurses to rate defined aspects of their workload on 6 distinct scales. The aspects of workload as defined by the NASA-TLX are physical demand, mental demand, temporal demand, performance, effort, and frustration.
The goal was for our team to ask a cohort of 20-30 nurses to complete the NASA-TLX 10-20 times each during various shifts and times over the course of the summer. In addition, our team collected data on the number of patients covered and alarms received at the time of each survey. By pairing the NASA-TLX and the patient and alarm contextual data, we hope to identify the extent of alarm fatigue, defined as the desensitization to alarms after experiencing many false notifications, nurses experience as well as which of the 6 aspects of the NASA-TLX nurses feel contributes most to their workload.
My role on the team was to operationalize the administration of the NASA-TLX across 2 patient care units at CHOP. I gained first-hand experience of what being on a hospital unit is like. Oftentimes, a nurse would be interrupted by a notification on her phone and have to pause the questionnaire to attend to a patient. I also gained insight to the organizational structure of hospitals on the most visible level: face-to-face patient care. I learned about nursing assignments, the distribution of tasks, and the expectation that nurses go above and beyond their job description everyday.
As a Materials Science and Engineering major, this research showed me how engineered solutions can be applied to real world situations. As a result, this experience has certainly informed my interest in having a career in healthcare. I thoroughly enjoyed being engrossed in the larger hospital setting this Summer and know that it is certainly something I would like to be involved with in some capacity in the future.