Intraoperative Noise Increases Perceived Task Load and Fatigue in Anesthesiology Residents: A Simulation-Based Study.
Intraoperative Noise Increases Perceived Task Load and Fatigue in Anesthesiology Residents: A Simulation-Based Study.
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DOI：
10.1213/ane.0000000000001067
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发表时间：
2016-02-01
影响因子：
5.7
通讯作者：
Dudaryk, Roman
中科院分区：
文献类型：
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作者：
McNeer, Richard R;Bennett, Christopher L;Dudaryk, Roman
背景：手术室被认为是最嘈杂的临床环境之一，术中噪音会对工作人员和患者的安全产生不利影响。基于模拟的实验将为研究这一噪音问题提供可控和安全的场所。然而，在目前的模拟器中，对临床听觉环境的真实模拟很少。因此，我们改造了我们的手术室模拟器，使其能够使用手术中遇到的典型声源产生沉浸式听觉模拟。然后，我们测试了假设，麻醉住院医师在嘈杂的环境中比在安静的环境中得到模拟午休时，会感觉到更大的任务负荷和疲劳。作为次要目标，我们提出并测试了一种新的心理测量工具的可行性，用于评估压力。方法：在这项基于模拟、随机、重复测量、交叉研究中，采用2种经过验证的心理测量调查工具，NASA任务负荷指数（NASA- tlx）（包含6个项目）和瑞典职业疲劳量表（SOFI）（包含5个项目），分别评估第一年麻醉住院医师的感知任务负荷和疲劳。住院医师在安静和嘈杂的术中环境（声景）中午休后完成心理测量仪。采用分图分析法分析了声景分组对心理测量工具及其组成项目的影响。提出了一种结合NASA-TLX和SOFI仪器的新型应力心理测量仪模型，并对收集到的数据进行了因子分析，以确定模型的合理性。结果：20名住院医师参与了本研究。多变量方差分析显示，声景观分组对NASA- tlx和SOFI仪器组合项目有显著影响（P = 0.003），单变量项目对NASA时间需求项目（P = 0.0004）和SOFI缺乏能量项目（P = 0.001）的比较具有显著性。因子分析提取了4个因子，分别为心理任务负荷、心理疲劳、急性物理负荷和表现-慢性物理负荷，为模型的构建命名。当我们将数据拟合到所提出的模型时，在部分验证性因子分析中使用的7个拟合检验中有6个是积极的，这表明有必要进一步验证。结论：本研究提供的证据表明，手术期间的噪音会增加麻醉师的压力感，通过感知任务负荷和疲劳水平来测量，并增加了越来越多的文献指出临床噪音对护理人员和患者安全的总体不利影响。基于因子分析，本研究提出的心理测量模型是可信的，将有助于在未来的研究中描述临床环境对受试者压力水平的影响。
BACKGROUND: Operating rooms are identified as being one of the noisiest of clinical environments, and intraoperative noise is associated with adverse effects on staff and patient safety. Simulation-based experiments would offer controllable and safe venues for investigating this noise problem. However, realistic simulation of the clinical auditory environment is rare in current simulators. Therefore, we retrofitted our operating room simulator to be able to produce immersive auditory simulations with the use of typical sound sources encountered during surgeries. Then, we tested the hypothesis that anesthesia residents would perceive greater task load and fatigue while being given simulated lunch breaks in noisy environments rather than in quiet ones. As a secondary objective, we proposed and tested the plausibility of a novel psychometric instrument for the assessment of stress.METHODS: In this simulation-based, randomized, repeated-measures, crossover study, 2 validated psychometric survey instruments, the NASA Task Load Index (NASA-TLX), composed of 6 items, and the Swedish Occupational Fatigue Inventory (SOFI), composed of 5 items, were used to assess perceived task load and fatigue, respectively, in first-year anesthesia residents. Residents completed the psychometric instruments after being given lunch breaks in quiet and noisy intraoperative environments (soundscapes). The effects of soundscape grouping on the psychometric instruments and their comprising items were analyzed with a split-plot analysis. A model for a new psychometric instrument for measuring stress that combines the NASA-TLX and SOFI instruments was proposed, and a factor analysis was performed on the collected data to determine the model's plausibility.RESULTS: Twenty residents participated in this study. Multivariate analysis of variance showed an effect of soundscape grouping on the combined NASA-TLX and SOFI instrument items (P = 0.003) and the comparisons of univariate item reached significance for the NASA Temporal Demand item (P = 0.0004) and the SOFI Lack of Energy item (P = 0.001). Factor analysis extracted 4 factors, which were assigned the following construct names for model development: Psychological Task Load, Psychological Fatigue, Acute Physical Load, and Performance-Chronic Physical Load. Six of the 7 fit tests used in the partial confirmatory factor analysis were positive when we fitted the data to the proposed model, suggesting that further validation is warranted.CONCLUSIONS: This study provides evidence that noise during surgery can increase feelings of stress, as measured by perceived task load and fatigue levels, in anesthesiologists and adds to the growing literature pointing to an overall adverse impact of clinical noise on caregivers and patient safety. The psychometric model proposed in this study for assessing perceived stress is plausible based on factor analysis and will be useful for characterizing the impact of the clinical environment on subject stress levels in future investigations.