Alarm Fatigue, Cognitive Load, Cognitive Load, Performance, Patient Safety, Performance, Perioperative
Conditions
Keywords
NASA-TLX, Anesthesia Nursing, Perioperative Nursing, Mental Workload, Intraoperative, Patient Safety, Monitor Alarms, Operating Room
Brief summary
The goal of this observational study is to measure the cognitive load (mental effort) of anesthesia nurses during real surgical procedures at Hospital Clínic de Barcelona, Spain. The main questions it aims to answer are: * Does cognitive load vary across the three phases of anesthetic care (induction, maintenance, and emergence/recovery)? * Is cognitive load higher during general anesthesia than during spinal anesthesia with sedation? * How do surgical specialty and patient complexity relate to cognitive load? * How does monitor alarm perception relate to cognitive load during surgery? Participants (anesthesia nurses) will complete the NASA Task Load Index (NASA-TLX) questionnaire - a validated 6-item tool measuring mental effort - three times per surgical case: after induction or spinal block, during maintenance, and after patient awakening or sedation reversal. They will also answer 4 brief questions about alarm management at the end of each case. No changes are made to clinical care. Participation adds approximately 11 minutes per surgical case.
Detailed description
Anesthesia nurses manage up to 72 tasks per hour during surgical procedures, including vital sign monitoring, drug administration, airway management, alarm response, and surgical team coordination. Despite this high workload, the cognitive load of anesthesia nurses has received little scientific attention. Most studies focus on simulation rather than real clinical settings. This prospective observational study uses the Raw NASA Task Load Index (NASA-TLX) to quantify subjective cognitive load in anesthesia nurses across three phases of anesthetic care (T1: post-induction/spinal block; T2: maintenance; T3: extubation/wake up), comparing general anesthesia (endotracheal intubation or laryngeal mask) versus spinal anesthesia with sedation. Additionally, an exploratory module examines nurses' perception and management of monitor alarms and its association with cognitive load. This is the first European study to measure cognitive load in anesthesia nurses using a validated instrument in a real surgical setting.
Interventions
The Raw NASA Task Load Index (NASA-TLX) is a validated self-report questionnaire measuring subjective cognitive load across six dimensions: mental demand, physical demand, temporal demand, performance, effort, and frustration (scale 0-100). Administered three times per surgical case (T1, T2, T3) by the participating anesthesia nurse. Additionally, four questions about monitor alarm perception and management are completed after T3.
Sponsors
Hospital Clinic of Barcelona
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Registered nurse anesthetist actively working at Hospital Clínic de Barcelona. * Minimum 3 months in the current anesthesia nursing position. * Voluntary participation with signed informed consent. * Scheduled surgery (including deferred urgent surgery) or solid organ transplantation. * General anesthesia (endotracheal intubation or laryngeal mask airway) or spinal anesthesia with sedation. * Minimum duration of 30 minutes.
Exclusion criteria
* Refusal to participate or withdrawal of informed consent. * Spinal anesthesia without sedation. * Exclusive regional anesthesia without sedation. * Sedation alone without regional technique. * Duration less than 30 minutes. * Cases involving an unexpected intraoperative emergency requiring urgent additional personnel. * Cases started under spinal anesthesia converted to general anesthesia for any clinical or technical reason.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Global Raw NASA-TLX Score | At three time points per surgical case: T1 (5 minutes post-induction/spinal block), T2 (during maintenance, before surgical closure), and T3 (5 minutes after extubation/end of sedation ). | Subjective cognitive load measured using the Raw NASA Task Load Index (NASA-TLX), calculated as the arithmetic mean of six subscales (mental demand, physical demand, temporal demand, performance, effort, and frustration), each rated on a 0-100 scale. Administered three times per surgical case: after induction or spinal block (T1), during maintenance (T2), and after extubation or end of sedation (T3). Study duration: approximately 8 months. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| NASA-TLX Subscale Scores | Assessed at three intraoperative time points per surgical case: 5 minutes post-induction or post-spinal block, during maintenance before surgical closure, and 5 minutes post-extubation or end of sedation, over approximately 8 months of data collection. | Individual scores for each of the six NASA-TLX subscales (mental demand, physical demand, temporal demand, performance, effort, and frustration), each rated on a 0-100 scale, to identify which dimensions of cognitive load predominate at each anesthetic phase. |
| Monitor Alarm Perception Visual Analog Scale (VAS) | Assessed once per surgical case, immediately after patient awakening or sedation reversal, over approximately 8 months of data collection. | Exploratory measure of nurses' perceived alarm burden during each surgical case, rated on a visual analog scale from 0 (not at all) to 100 (extremely). Assessed after patient awakening or sedation reversal. Used to explore the association between alarm perception and cognitive load (NASA-TLX score). |
Countries
Spain
Contacts
CONTACTVictor Caro-Frechilla, RN, MSc
PRINCIPAL_INVESTIGATORVictor Caro-Frechilla, RN, MSc
Hospital Clinic of Barcelona
Outcome results
None listed