Ethical decision-making interrupted: Can cognitive tools improve decision-making following an interruption?

This study examined the effects of interruptions and the use of cognitive decision-making tools on ethical decision-making. Participants completed a structured cognitive tool, an unstructured decision-making technique, or no decision-making technique, and half of the participants were interrupted during the decision-making task, whereas half were allowed to complete the decision-making task without interruption. Results revealed that 1) participants who completed the structured cognitive tool (ACED-IT map) performed better on a number of markers of ethical decision-making, 2) interruptions reduced participants’ plan quality, and 3) participants who were interrupted, and who completed the structured cognitive tool exhibited perceptions that suggested that they felt better prepared to handle the ethical dilemma. These results could have important implications for professionals in jobs that experience frequent interruptions, particularly those in management positions

The Effect of Interruptions on Primary Task Performance in Safety-Critical Environments

Safety critical systems in medicine utilize alarms to signal potentially life threatening situations to professionals and patients. In particular, in the medical field multiple alarms from equipment are activated daily and often simultaneously. There are a number of alarms which require caregivers to take breaks in complex, primary tasks to attend to the interruption task which is signaled by the alarm. The motivation for this research is the knowledge that, in general, interrupting tasks can have a potentially negative impact on performance and outcomes of the primary task. The focus of this research is on the effect of an interrupting task on the cognitive behavior of nurses on a primary task: administering medication to a simulated patient. Fifty-eight student nurses were monitored with eye-tracking technology as they perform direct patient care and a medication administration task. There are four hypotheses. First, it is hypothesized that an interruption generated by an alarm during medication administration significantly increases errors because it causes caregivers to forget components of the original task. These errors result when the primary task is suspended in memory, as a result of the intervening task, and because of this suspension, memory for the original task can decay. Second, it is hypothesized that interrupting tasks result in time delays on the primary task (the time during which the caregiver is performing the interrupting task is not included in the time to perform the original task). Third, it is hypothesized that metacognition training will mitigate the negative effects of the interrupting task on the primary task. The metacognition training is based on knowledge of how memory processes are affected by interruptions and how modifying these processes can potentially result in a reduction of errors. Fourth, it is hypothesized that the intervention strategy will lead to improvements in the memory for the material that is required to resume and complete the primary task. This improvement will be measured by increases in the number of eye fixations to the primary task before attending to the secondary task. Furthermore, this measurement will correlate with a reduction in errors

USE OF STAY S.A.F.E. STRATEGY DURING MEDICATION ADMINISTRATION IN REDUCING ERRORS

Healthcare related medical errors are the third leading cause of death in the United States. Interruptions and distractions can lead to an increased risk of nurses making errors in healthcare, particularly during medication administration. Student nurses should receive education during their prelicensure period on the management of interruptions especially before being given the responsibility of performing high risk tasks such as medication administration. Using a novel interruption management strategy called Stay S.A.F.E., nursing students were interrupted during a simulated medication administration. Students were evaluated on the time spent on the task and if errors were committed. Lastly, perceived workload was measured using the NASA Task Load Index (TLX) tool

What makes an interruption disruptive? Understanding the effects of interruption relevance and timing on performance

Interruptions disrupt activity, hindering performance and provoking errors. They present an obvious challenge in safety-critical environments where momentary slips can have fatal consequences. Interruptions are also a problem in more workaday settings, like offices, where they can reduce productivity and increase stress levels. To be able to systematically manage the negative effects of interruptions, we first need to understand the factors that influence their disruptiveness. This thesis explores how the disruptiveness of interruptions is influenced by their relevance and timing. Seven experimental studies investigate these properties in the context of a routine data-entry task. The first three experiments explore how relevance and timing interact. They demonstrate that the relevance of interruptions depends on the contents of working memory at the moment of interruption. Next, a pair of experiments distinguish the oft-conflated concepts of interruption relevance and relatedness. They show that interruptions with similar content to the task at hand can negatively affect performance if they do not contribute toward the rehearsal of goals in working memory. By causing active interference, seemingly useful interruptions that are related to the task at hand have the potential to be more disruptive than entirely unrelated, irrelevant interruptions. The final two experiments in this thesis test the reliability of the effects observed in the first five experiments through alternative experimental paradigms. They show that relevance and timing effects are consistent even when participants are given control over interruptions and that these effects are robust even in an online setting where experimental control is compromised. The work presented in this thesis enhances our understanding of the factors influencing the disruptiveness of interruptions. Its primary contribution is to show that when we talk about interruptions, ‘relevance’, ‘irrelevance’ and ‘relatedness’ must be considered in the context of the contents of working memory at the moment of interruption. This finding has implications for experimental investigations of interrupted performance, efforts to under- stand the effects of interruptions in the workplace, and the development of systems that help users manage interruptions

Étude des mécanismes impliqués dans la reprise d'une tâche dynamique interrompue

Les études empiriques concernant les conséquences des interruptions de tâche et les façons de limiter ces répercussions se sont principalement intéressées aux situations statiques, dont l’état demeure inchangé pendant une interruption. Dans diverses circonstances liées au travail (p. ex., contrôle du trafic aérien) ou à la vie quotidienne (p. ex., conduite automobile), les individus peuvent toutefois être confrontés à des situations en constante évolution. Malgré la fréquence des interruptions dans de tels environnements dynamiques, la performance doit demeurer optimale, sans quoi la sécurité du public peut être menacée. Afin de faciliter l’élaboration de solutions visant à minimiser les conséquences des interruptions, il importe d’approfondir notre compréhension du processus de reprise d’une tâche évolutive, au sujet duquel les modèles théoriques actuels émettent peu de propositions. L’objectif général de la présente thèse est donc d’étudier les mécanismes impliqués dans la récupération postinterruption en contexte dynamique. À travers trois expériences, diverses mesures comportementales et oculaires sont recueillies pendant que les participants effectuent une tâche qui continue d’évoluer même lorsqu’une activité interruptive doit être gérée. Ensemble, les deux premières études révèlent que la présentation d’un avertissement annonçant l’arrivée d’une interruption accélère la reprise subséquente de la tâche primaire, sans engendrer de coûts significatifs dans d’autres aspects de la tâche. Contrairement aux contextes statiques, dans lesquels les bénéfices d’un avertissement sont attribués strictement aux processus mnésiques, les bienfaits de l’alarme en situation dynamique semblent dus non seulement à la mémoire, mais aussi à une reconstruction visuelle plus efficace et moins exigeante du contexte de la tâche primaire. En plus de la mémoire et du balayage visuel, la troisième étude s’intéresse aussi à deux fonctions potentiellement pertinentes pour la reprise d’une tâche dynamique, soit la conscience temporelle et la reconfiguration du schéma d’action. Les résultats révèlent que la mémoire et la conscience temporelle appuient surtout la récupération après de courtes interruptions, tandis que le balayage visuel et la reconfiguration du schéma d’action soutiennent le processus de reprise sans égard à la durée de l’interruption. Globalement, les résultats de la thèse permettent de complémenter les théories actuelles en définissant davantage le processus de recouvrement d’une tâche évolutive. Sur le plan appliqué, la thèse montre que les avertissements pré-interruptions représentent une solution prometteuse pour faciliter la reprise d'une tâche interrompue dans les milieux dynamiques.Empirical studies about the consequences of task interruptions and ways to reduce them have centered mostly on static situations, which remain unchanged during an interruption. In various circumstances related to work (e.g., air traffic control) or to everyday life (e.g., driving), however, individuals may face continuously evolving situations. Despite the prevalence of interruptions in such dynamic environments, performance must remain optimal, otherwise public safety may be at risk. In order to facilitate the development of solutions aimed to minimize the consequences of interruptions, it is imperative to deepen our understanding of the recovery process of a dynamically evolving task, about which current theoretical models make few propositions. Therefore, the general aim of this thesis is to study the mechanisms involved in dynamic task resumption. Across three experiments, various behavioral and ocular measures are collected as participants perform a task which continues to evolve even when an interrupting activity needs to be managed. Together, the first two studies reveal that the presentation of a warning announcing the occurrence of an interruption accelerates the subsequent recovery of the primary task, without incurring significant costs in other aspects of the task. Unlike static contexts, in which the benefits of a warning are attributed strictly to memory processes, the benefits of the alarm in a dynamic situation also seem to be due to a more efficient and less demanding visual reconstruction of the primary task context. In addition to memory and visual scanning, the third study is also interested in two functions that are potentially relevant to dynamic task resumption, namely temporal awareness and task-set reconfiguration. The results reveal that memory and temporal awareness mostly support recovery after short interruptions, while visual scanning and taskset reconfiguration assist the resumption process regardless of interruption duration. Overall, the results of the thesis allow to complement current theories by helping to further define the resumption process of a dynamically evolving task. At the applied level, this thesis shows that pre-interruption warnings represent a promising solution to facilitate interruption recovery in dynamic environments

Adapting interfaces to induce behaviour change and mitigate the negative effects of interruptions in safety critical healthcare settings

Due to the fast-paced, dynamic, and sometimes unpredictable nature of the environment’s healthcare professionals work within, it is inevitable that task interruptions will occur. Such clinical task interruptions are consistently cited as a contributing factor to the manifestation of clinical errors. Various theoretical approaches to exploring task interruptions and their varying characteristics have provided valuable insights into their role in task performance (positive and negative). Furthermore, applied research has revealed the complex nature of trying to understand task interruptions within safety critical, multifaceted working environments such as healthcare. Bridging an evidential gap in the literature with theoretically informed studies using developed tasks (primary and interrupting) with a level of ecological validity is an important step to understanding the nature of task interruptions in healthcare and can guide work towards developing interventions that are beneficial towards appropriate handling of task interruptions in healthcare. Through an exploratory study and a series of six experiments the following thesis develops a more ecological primary (procedural memory drug administration task) and interruption task (clinical decision-making task) that mimics those likely to be used daily by healthcare professionals. The parameters of the task and performance are explored through interruption manipulations that mimic those healthcare professionals are likely to experience (e.g., including interruption complexity, frequency, and source), whilst also considering unique characteristics of the healthcare environment (e.g., interruption urgency, and emotional valance of interruption). Key findings include positive emotionally valanced interruptions increasing error rates, urgent interruptions have more of a profound effect on performance and reducing information access costs significantly reduces task errors following an interruption. Findings using experimental tasks progresses the healthcare interruption literature in providing novel insight into the nature of task interruptions in healthcare, and the potential role the ecological nature the tasks may have on performance. Furthermore, adopting a different approach to explore task interruptions in healthcare allows for the exploration of novel interventions and their utility in mitigating the negative effects of interruptions. Interventions are explored in the final experiment, whereby the cost of accessing information is manipulated to induce an implicit cognitive behavioural change whereby such behavioural changes may be protective to the negative effects of task interruptions. Taken together, this work has made significant contributions to the current literature through extrapolating results to the context that the experiments are meant to probe (e.g., healthcare medication administration), thus providing additional utility when considering designs to mitigate the profound effects of task interruptions that are representative of that context