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PubMed2001

A prospective study of the workload of a newly formed PEG advice team.

BACKGROUND: A multidisciplinary advice team may be the optimal way of providing the long-term nutritional and percutaneous endoscopic gastrostomy (PEG)-related care for patients dependent on PEG feeding but the workload involved is unknown. AIM: To study prospectively the workload of a proactive, multidisciplinary PEG advice team over a 2-year period. METHODS: Separate documentation from main case notes of each episode of the team's contact with PEG or potential PEG patients, including assessment, advice and therapy given, from the time of its establishment, for four consecutive 6-monthly periods. RESULTS: During the audit, 89 patients were referred to the team for consideration of PEG insertion and PEGs were placed in 74. Eighty-nine additional patients were referred for follow up having had a PEG placed elsewhere. During the four audit periods the rate of new PEG insertions increased by 53%, the rate of PEG replacements by 315%, and the number of patients under the team increased from 16 to 70, an increase of 337%. Numbers of inpatient and outpatient consultations, and visits to other institutions by members of the team increased commensurately. CONCLUSIONS: The rapidly increasing workload of the team suggests it is playing a valued role but there are significant resource implications.

Enteral Nutrition↗

PubMed1999

Nursing workload: an unquantifiable entity.

BACKGROUND: In the increasingly prominent drives towards cost containment and efficiency nursing is under pressure to justify its value to healthcare. On the surface nursing workload assessment methods would appear to offer a means to quantify the nursing input to patient care. AIMS: To examine the validity of nursing workload methods with respect to nursing practice and nursing knowledge. FINDINGS: Previous studies and the conclusions of subject reviews have cast doubt on the reliability and validity of most methods and indicate that they have no clear theoretical base. CONCLUSION: It appears that nursing is more concerned with knowledge processing and nurses' intentions than just with the activities of caring. It is suggested that patients control the time element of nursing care. The need for nursing workload information, despite its validity problems, is discussed and a pragmatic solution is suggested.

Diagnosis-Related Groups↗

PubMed1999

Nurses' workload associated with 16-h night shifts on the 2-shift system. I: Comparison with the 3-shift system.

To assess nurses' workload with 16-h night shifts on a 2-shift system, we investigated the differences between workloads with each shift on the 2- and 3-shift systems with questionnaires on subjective symptoms and measuring heart rate and physical activity. It was found that the 2-shift nurses during the 16-h night shifts complained of fatigue less frequently and showed general decreases in heart rate and physical activity compared with the 3-shift nurses during 8-h evening and night shifts. The results suggest that a 2-h nap, an increase of staff, and a day off may reduce the nurses' workload when they have 16-h night shifts.

Adult↗

PubMed2000

Projected workload for a vascular service in 2020.

OBJECTIVE: to estimate the workload of a vascular service during the next two decades as the proportion of people aged over 65 years increases. METHODS: the study used the vascular registry data of Tampere University Hospital and the population data of Pirkanmaa region provided by the Central Statistical Office in Finland. The current workload is 1420 vascular procedures per million inhabitants yearly (951 surgical and 207 endovascular). Sixty-five per cent of all procedures are done on people over 65 years old. Pirkanmaa has a population of 440 000 persons of whom 15.6% are over 65 years. According to the population data the population will increase to 460 000 persons by the year 2020 and 22.9% of them will be over 65 years old. RESULTS: The total amount of procedures will rise by 40.5% (1906) and the increase in endovascular and surgical group will be 39.2% (640) and 43.5% (1265) respectively. The proportion of treated patients over 65 years will rise from 65.0% to 70.5%. In the next two decades the amount of patients with claudication will increase by 35.4%, critical limb ischaemia by 44.2%, carotid surgery by 34.0%, abdominal aortic aneurysms by 40.7%, acute limb ischaemia by 45.0% and access surgery by 27.4%. CONCLUSION: In the next two decades the number of elderly people will increase so rapidly that, whatever happens to the incidence and prevalence of peripheral vascular disease, the workload for a vascular service will increase significantly.

Age Distribution↗

PubMed2001

GRASPing infection: a workload measurement tool for infection control nurses.

The GRASP nursing workload management system was used over a five-month period by both the infection control nurses (ICNs) in an infection control team (ICT) in a 1200-bedded university teaching hospital trust. GRASP data were used to quantify and qualify patient and Trust requirements for infection control (IC). The results indicated that care was being prioritised as the average daily patient care requirement was 15.9 h, whereas the ICNs were only able to provide 12.7 h to meet this. Infection control nurses spent 5.3 h dealing with methicillin-resistant Staphylococcus aureus (MRSA), and only 3.9 h in preparation and delivery of education. A 'fire brigade service' was being provided at the expense of developmental and strategic issues. GRASP provided a method of quantifying, recording and analysing workload. It was used to support recommendations from the Health Quality Service Organizational Audit (Kings Fund), the Department of Health (DoH), the National Audit Office (NAO), and the Health and Safety Executive (HSE) for an increased focus on education and risk management in IC. It was also used in a skill-mix exercise, and resulted in the appointment of additional staffing to the ICT. GRASP data could be used for benchmarking with other institutions to provide a flexible system which may be adapted to meet the changing demands of the health service. It provides a means for ICNs to measure and manage their workload, and may be adapted to other members of the ICT.

Hospitals, University↗

PubMed2003

[A theory-based study on psychosocial workload as an instrument of health promotion in a hospital].

Starting with theory-based assessment of workload as experienced by employees of a hospital we aim at facilitating measures of health promotion. Using the effort-reward-imbalance model of psychosocial stress we look for differences in stress experience as related to objective work stressors and for associations of stress experience and subjective health. Two assessments (in 2000 and in 2002) showed pronounced differences in stress experience between professional groups and between points in time, which were both related to differences in objective workload. The expected associations between psychosocial stress and subjective health (assessed only in 2002) could be demonstrated consistently. As was shown by logistic regression analysis the risk for reduced subjective health was roughly 4 times higher for those in the upper tertile of the effort-reward-imbalance index as compared to all others when controlling for age, sex and professional group. Sources of psychosocial workload could be identified which are modifiable by measures of health promotion.

Adult↗

PubMed2002

Relationship between maximum acceptable work time and physical workload.

For safe job design, it is necessary to know the maximum acceptable work time (MAWT) for a given workload. The aim was to establish the relationship between MAWT and physical workload. Cycling tests at six different work rates relative to personal maximum working capacity were performed by 12 young adults in the laboratory. The oxygen uptake (VO(2)) in the per cent maximum aerobic capacity (%VO(2max)), relative heart rate (RHR) and relative oxygen uptake (RVO(2)) were collected throughout the test. MAWT was determined by observing the heart rate data during the test. The results showed that MAWT was negatively correlated with %VO(2max), RHR and RVO(2) (p < 0.01). Three exponential regression models were obtained and all their R(2) > 0.80. These models suggest that long-hour shifts (> 10 h) should assign a lower work intensity than for an 8-h workday. It is also logical that the workload limit for a 4-h work shift could be set at about 10% VO(2max) higher than the suggested limit for an 8-h workday.

Adult↗

PubMed2004

Taking the load off: investigations of how adaptive cruise control affects mental workload.

It has been posited that Adaptive Cruise Control (ACC) represents a new generation of vehicle automation, in that it has the potential to relieve drivers of mental as well as physical workload. The results of previous research however, have raised some confusing issues about the specific effects of Adaptive Cruise Control (ACC) on driver mental workload (MWL)--some studies report reduced MWL compared to manual driving, while others find no effect. Two hypotheses are proposed in an attempt to explain these discrepancies: (a) that any potential MWL reductions due to ACC could be masked by the overriding influence of steering demand; or (b) that the tasks designed in some experiments do not exploit the adaptive nature of the ACC system, therefore precluding any potential benefits. Two related experiments were designed to test these hypotheses. It was found that the main reason for the discrepant findings was the nature of the driving task chosen--constant-speed tasks do not realise the mental workload benefits of ACC. Future researchers using ACC devices are advised to use variable-speed tasks to ensure that all aspects of device functionality are covered.

Adult↗

PubMed2006

Pilot mental workload: how well do pilots really perform?

The purpose of this study was to investigate the effects of increasing mental demands on various aspects of aircrew performance. In particular, the robustness of the prioritization and allocation hierarchy of aviate-navigate-communicate was examined, a hierarchy commonly used within the aviation industry. A total of 42 trainee pilots were divided into three workload groups (low, medium, high) to complete a desktop, computer-based exercise that simulated combinations of generic flight deck activities: flight control manipulation, rule-based actions and higher level cognitive processing, in addition to Air Traffic Control instructions that varied in length from one chunk of auditory information to seven chunks. It was found that as mental workload and auditory input increased, participants experienced considerable difficulty in carrying out the primary manipulation task. A similar decline in prioritization was also observed. Moreover, when pilots were under a high mental workload their ability to comprehend more than two chunks of auditory data deteriorated rapidly.

Adult↗

PubMed1993

Air-to-ground training missions: a psychophysiological workload analysis.

Psychophysiological measures are used to assess the workload of F4 Phantom aircraft pilots and weapon systems officers (WSOs) during air-to-ground training missions and during the performance of two levels of difficulty of a laboratory tracking task. The bombing range portion of the missions was associated with the highest pilot workload, while the WSO flying the aircraft was the highest workload segment for the WSOs. The pilots' data were found to have a wider range of values for the physiological measures than were found in the WSO data. The different levels of tracking task difficulty produced significant physiological effects but the range of values found for most of the flight segments were much greater. These data demonstrate that extrapolating laboratory data to the flight environment is risky at best. The various physiological measures were differentially sensitive to the different demands of the various flight segments.

Adult↗

PubMed1993

Evaluation of workload in air traffic controllers.

This study examined 20 air traffic controllers from the Rome Regional Air Control Centre for three successive work shifts: afternoon (13:00-20:00), morning (07:00-13:00) and night (20:00-07:00). The number of aircraft under control per hour was recorded as index of workload. Recordings involved subjective ratings (mood, physical fitness, fatigue) and objective measures (heart rate, vanillyl mandelic acid excretion, reaction times, critical flicker fusion, oral temperature). In addition, the subjects filled out questionnaires for personality traits (extroversion, neuroticis, anxiety) and behavioural characteristics (morningness, rigidity of sleeping habits, vigourness to overcome drowsiness). The volume of air traffic varied greatly with peaks during the day and low levels at night. Nevertheless, the heart rates of the group members showed quite constant levels in all the three shifts, irrespective of the workload. The same pattern appeared in the controllers' excretion of VMA, which remained high during both day and night shifts, regardless of the reduced workload. The subjective mood and physical fitness decreased similarly, while feelings of fatigue increased on all three shifts, particularly on the night shift. The circadian rhythm of the oral temperature showed a slight modification of the nocturnal depression during the night shift, caused by the state of awakeness and activity. However, the rhythm was not altered in its normal circadian phase, due to the fast shift rotation adopted. The psychophysiological responses were affected by personal characteristics, in particular morningness and ability to overcome drowsiness.

Adult↗

PubMed1994

Workload and psychophysiological stress reactions in air traffic controllers.

Interactions between workload and psychophysiological stress symptoms were investigated in a population of 205 predominantly male air traffic controllers (ATCs) from the area control centre (ACC) and the airport control tower (TWR) in Zurich and Geneva. Each subject completed two questioning sessions and two working sessions, the first time during a period of low traffic and the second time during a period of high traffic. For the questioning sessions standardized questionnaires were used. For all investigated working sessions, different aspects of the subjective and objective workload were recorded. Before and after each session, a saliva sample for assessing the concentration of secreted cortisol was taken. The questionnaire parameters represented psychological stress symptoms, such as complaints of physical discomfort, depression, negative self-communication, work-increased anxiety, coping behaviour and subjective rating, and interpretation of various aspects of the working situation. The mean values measured were within the normal range, and only a few significant differences between the two questioning sessions were found. However, about 10 to 15% of the ATCs showed elevated values in psychological stress symptoms to an extent indicating that they might have serious stress problems at work and/or in their private life. The investigated working sessions showed that the ATCs' subjective ratings correspond clearly to their cortisol response and the objective workload. Thus, ATCs' complaints regarding excess work stress should be taken seriously.

Adult↗

PubMed1995

Physical workload of ambulance assistants.

The physical workload of ambulance assistants was assessed by means of the Ovako Working posture Analysis System (OWAS) observation method and a Work and Health Questionnaire (WHQ) for measuring perceived workload. In addition, a biomechanical model was applied to several specifically strenuous conditions that were simulated in a laboratory situation. Bad postures were identified for a number of activities: 16% to 29% of a work shift was spent in harmful positions. Strenuous situations occur particularly during rides in emergency situations. The results of observed and perceived workload are generally in agreement. A number of practical recommendations are made. They concern, for example, the equipment in ambulance cars, training of ambulance assistants and adaptations in working procedures.

Ambulances↗

PubMed1999

Job rotation as a factor in reducing physical workload at a refuse collecting department.

The effect of job rotation on the physical workload was investigated for male employees working at a refuse collecting department. Before the introduction of job rotation, an employee worked as a street sweeper, as a refuse collector or as a driver. After the introduction of job rotation, every employee was allowed to alternate between two of the three possible jobs during the day, i.e. refuse collecting/street sweeping, refuse collecting/driving or street sweeping/driving. Two non-rotation groups (i.e. refuse collectors and street sweepers) and two rotation groups (i.e. refuse collectors/street sweepers and street sweepers/drivers) were mutually compared. The physical workload was determined by measuring the perceived load, energetic load and postural load during a full working day. Job rotation resulted in a significant decrease of the perceived load and energetic load and a slight decrease of the postural load. The results indicate that the total amount of work performed by means of job rotation resulted in an overall reduced physical workload of the employees of the refuse collecting department.

Adult↗

PubMed1993

Sex differences in vigilance performance and perceived workload.

Female and male subjects monitored the repetitive presentation of a pair of lines for occasional changes in height (spatial task) or duration (temporal task). Perceptual sensitivity for critical signals favored men in the spatial task, whereas no sex differences in signal detectability existed in the temporal task. Measurements of perceived workload using the NASA-TLX scale mirrored these performance effects. Women tended to rate the overall workload associated with the spatial task to be greater in comparison with men. In addition, women found the spatial task to be significantly more frustrating, mentally demanding, and effortful than men did and rated their own performance lower than their male counterparts did. In contrast, no sex-linked differences in perceived workload were noted in regard to the temporal task. The results support the suggestion by Dittmar, Warm, and Dember (1987) that sex differences in sustained attention are task specific.

Adolescent↗

PubMed1995

The Subjective Rating Scales for Measurement of Mental Workload-Thurstonian Scaling.

Subjective rating scales for measuring work demands and individual capabilities to cope with work requirements were developed using the Thurstonian procedure. The scales measure six dimensions of mental workload: mental difficulties, feeling of responsibility, awareness of risk, interpersonal conflicts, monotony, and time pressure. Individual scale results make it possible to assess the level of mental workload understood as a relation between the subjective rating of work demands and individual capabilities in each of the six dimensions. Two versions of scales were prepared: classic and modified ones. To assess the level of reliability of the particular scales, 481 participants were examined twice at a 1-month interval. A procedure to prepare scales for the measurement of other dimensions of mental workload is also presented.

Thurstonian scaling↗

PubMed2003

Effect of subjective and objective workload on asthenopia at VDU workplaces.

An ergophthalmological tool has been developed to investigate effects of subjective and objective workload on work-related visual complaints (asthenopia). In field studies on different visual display unit (VDU) workplaces effects of objective and subjective workload, work intensity, and work breaks (5-9 min/hour) could be found. It could be shown that during the first hours of VDU work, asthenopic complaints have the tendency to follow effective workload. With increasing working time the effect of a general and visual fatigue overlaps other reported visual complaints in the majority of cases.

Asthenopia↗

PubMed2001

GP income in relation to workload in deprived urban areas in The Netherlands. Before and after the 1996 pay review.

BACKGROUND: General practitioner workload is higher in deprived urban areas and for the elderly. This led to the introduction of additional GP payments regarding these patients, in the UK and in the Netherlands. This study examines whether this has resulted in more equal payment for work done in the Netherlands. METHODS: GP workload and income have been assessed on the basis of a survey among 1154 GPs (response: 62%). RESULTS: Suggest that total GP income is still lower in deprived areas, but per hour and per patient contact the additional payments gave equity. CONCLUSION: It is thus concluded that Dutch deprivation payments effectively compensate GPs in deprived areas for their higher workload.

Health Services Research↗