Perceptions Of Workload Research Articles

Multilevel analysis exploring the relative importance of workplace resources in explaining nurses' workload perceptions: Are we setting the right focus?

Nurses' workload has become increasingly recognized as an important determinant of nurse turnover and shortage and has been also associated with poorer quality of care. Despite strong evidence that heavy workloads have negative consequences, we still lack a comprehensive understanding of the workplace characteristics that contribute most to improving nurses' workload, the relative importance of each in doing so, or indeed the workplace characteristics and other factors that drive nurses' perceptions of their workload. The aim of this study was to examine workplace resources as antecedents of nurses' perceptions of their workload and to investigate their relative importance in explaining workload perceptions. We considered workplace resources related to staffing, professional relationships, and technology. The study sample comprised nurse-reported and administrative data from U.S. Veterans Health Administration hospitals between 2014 and 2017. Our multilevel analyses are based on data from 20,330 nurses working in 273 work groups at 123 hospitals. We developed and empirically tested a theoretical model using multilevel mixed-effects linear regression. The relative importance of workplace resources was assessed by dominance analysis. Staffing levels, relational climate, and information technology were significantly associated with nurses' workload perceptions. Dominance analysis indicated that relational resources are the most important measure in explaining nurses' workload perceptions. This is the first study to examine the relative importance of workplace resources in explaining nurses' perceptions of their workload. Our results suggest that much might be gained by investing in interventions to boost relational resources. In turn, these findings could lead to more targeted, effective, and resource efficient interventions to improve nurses' workload.

Psychosocial Risk, Work-Related Stress, and Job Satisfaction among Domestic Waste Collectors in the Ho Municipality of Ghana: A Phenomenological Study.

Domestic waste collectors play key roles in the collection and disposal of solid waste in Ghana. The work environment and conditions under which domestic waste collectors operate influence their job satisfaction ratings and health outcomes. This study investigated psychosocial risk factors, work-related stress and job satisfaction needs among municipal solid waste collectors in the Ho Municipality of Ghana. A phenomenological design was applied to collect data among 64 domestic waste collectors, 12 managers, and 23 supervisors of two waste companies in Ho Municipality, Ghana. Data were collected from June–August 2018 using in-depth interview and focus group discussion guides. Interviews were supplemented by field observations. Data were analyzed using inductive and deductive content procedures to form themes based on the study aim. Four themes emerged from the study. The study results revealed that domestic waste collector’s poor attitudes and safety behaviors such as not wearing personal protective equipment, poor enforcement of safety standards by supervisors and managers, and work-related stress caused by poor working environments impact negatively on domestic waste collector’s health and safety. Other factors such as poor enforcement of standard company regulations, poor work relations, non-clear work roles, lack of social protection to meet medical needs, poor remuneration, negative community perceptions of domestic waste collectors job, work environments, and workloads of domestic waste collectors were reported to negatively impact on work stress and job satisfaction needs. In conclusion, the findings are important in informing the necessary waste management policies aimed at improving decent work environments, as well as improving the health and well-being of domestic waste collectors in both the formal and informal sectors in Ghana.

Medication errors in prescription and administration in critically ill patients.

To determine the prevalence and magnitude of medication errors and their association with patients' sociodemographic and clinical characteristics and nurses' work conditions. An observational, analytical, cross-sectional and ambispective study was conducted in critically ill adult patients. Data concerning prescription errors were collected retrospectively from medical records and administration errors were identified through direct observation of nurses during drug administration. Those data were collected between April and July 2015. A total of 650 prescription errors were identified for 961 drugs in 90 patients (mean error 7[SD 4.1] per patient) and prevalence of 47.1% (95% CI 44-50). The most frequent error was omission of the prescribed medication. Intensive care unit stay was a risk factor associated with omission error (OR 2.14; 1.46-3.14: p<.01). A total of 294 administration errors were identified for 249 drugs in 52 patients (mean error 6 [SD 6.7] per patient) and prevalence of 73.5% (95% CI 68-79). The most frequent error was interruption during drug administration. Admission to the intensive care unit (OR 0.37; 0.21-0.66: p<.01), nurses' morning shift (OR 2.15; 1.10-4.18: p=.02) and workload perception (OR 3.64; 2.09-6.35: p<.01) were risk factors associated with interruption. Medication errors in prescription and administration were frequent. Timely detection of errors and promotion of a medication safety culture are necessary to reduce them and ensure the quality of care in critically ill patients. Medication errors occur frequently in the intensive care unit but are not always identified. Due to the vulnerability of seriously ill patients and the specialized care they require, an error can result in serious adverse events. The study shows that medication errors in prescription and administration are recurrent but preventable. These findings contribute to promote awareness in the proper use of medications and guarantee the quality of nursing care.

Relationships between workload perception, burnout, and intent to leave among medical-surgical nurses.

These are turbulent times for hospitals, patients, and nurses. Nurse turnover is a global issue across all specialties but are exacerbated in medical-surgical areas where high nurse-patient ratios, use of point-of-care technologies, and stressful working conditions require sufficient numbers of highly trained nurses. These workload factors are further exaggerated by the current nursing shortage. The current nursing shortage crisis makes nursing job conditions more important than ever to examine. Despite heavy emphasis on promoting healthy work environments, job satisfaction, and retention of nurses working in intensive care and emergency room settings, limited research is available about the workload perception, burnout, and intent to leave among medical-surgical nurses. This study aimed to describe the relationships between workload perception, burnout, and intent to leave among medical-surgical nurses at two teaching hospitals in Southeastern United States. A survey design and convenience sampling method was used. A sample of 58 medical-surgical staff nurses participated in the study. A 42-item questionnaire composed of a demographic survey, Individual Workload Perception Scale, and Maslach Burnout Inventory Scale were used. Simple descriptive statistics, Pearson's product-moment correlations, and multiple regression analysis procedures were used to analyze the data. More than half of the respondents reported high workloads and intentions to leave their current position. The overall burnout level for the sample was moderate to high. Moderate-to-strong intercorrelations were found between workload perception and intent to leave (r = 0.513, P < 0.0001), burnout and intent to leave (r = -0.435, P < 0.0006), and workload perception and burnout (r = -0.588, P < 0.0001). Workload perception and burnout among medical-surgical nurses both factored significantly on the intent to leave a current job (P < 0.05). The current study provides new insights about the relationships between workload perception, burnout, and intent to leave among medical-surgical nurses. The findings indicate the higher the nurses' workload perception, the more likely they will leave their current job. Nurse managers should consider these findings when developing strategies to improve the work environment and nurse retention. Additional research is needed to gain more insight into the causality among workload perception, burnout, and intent to leave a current job among medical-surgical nurses.

Promotion of Low-cost Package of Technologies for Drudgery Mitigation in Turmeric Production System

Major role of farm women in the turmeric production system in Marathwada region was found to be in planting rhizomes, weeding, harvesting and cleaning activities. Ploughing, forming ridges, irrigation are performed solely by male farmers. Whereas participation of farm women in earthing up activity was 85 per cent, it was followed by fertilizer application (83%). Majority of the activities such as planting, earthing up, harvesting in turmeric production system were performed manually. Data on time spent by the female workers in performing different activities in turmeric production system indicated that maximum time-consuming activity was hand weeding (84 man-days/ season) followed by earthing up (63 man-days/ season) and cutting, sorting and cleaning roots (56 days/ season). As per the work demand score, all the activities performed in turmeric production system were very time demanding and very exhaustive as per the psychological feeling of the farm women. Earthing up is an important intercultural operation which is normally carried out twice or thrice during the crop season, accompanied by weeding and side dressing the crop with fertilizers. No tool or implement is used by farmers for earthing up activity. All the farmers were unaware of the hand-operated machines available for earthing up activity. After performing these activities continuously for 6 h, major health problems of the farm women reported were burning sensation to the skin, skin peeling and allergy. Hence, earthing up tool (Sawdi) small digging tool (Ukari), set of five finger guards (Nakhalya) for planting rhizomes, drying tool (wooden rake) (for making upside down while drying turmeric fingers), sulbha bag for fertilizer application, mittens for cleaning and sorting and new khurpi for weeding were developed and tested. The ergonomic assessment revealed that the physiological cost of selected activities performed by farm women in existing and improved method was same but the perception of workload was found to be reduced (13-32%) in an improved method. All the developed technologies used by farm women in the turmeric production system for planting, earthing up, fertilizer application and drying were successful in increasing space of work. In all these activities, the output was significantly increased by 10-26 per cent due to the use of developed technologies.

A pilot study on the possibility of human‐centred participative redesign of work organization at psychiatric wards

WHAT IS KNOWN ON THE SUBJECT?: Rationalization and an increasing shortage of nurses in psychiatric care require the improvement of working conditions. Work organization of hospital wards determines nurses' well-being on the job. In somatic care, observation-based assessments and participative improvements of work organization in the wards by involved nurses can reduce workload. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: In psychiatric nursing, observation-based assessment as well as nurses' self-reports may identify characteristics of ward organization that determine nurses' well-being. This study suggests a system of characteristics of work organization at psychiatric wards that may guide participative analyses and improvement measures. This may contribute to the research on prevention of conflicts and aggressive behaviour in psychiatric wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Participative analysis and, if necessary, participative redesign of work organization at psychiatric wards may reduce nurses' perceived work load. An approach to address the above is suggested for psychiatric nursing, which, in another version, is proven effective in somatic care. ABSTRACT: Introduction The study was based on an approach for participative improvement of work organization at somatic hospital wards related to characteristics that determine nurses' health. It differed from research seeking to adjust the environment to prevent aggressive behaviour at psychiatric wards. The focus was on the ergonomic principles of the whole work system and its impact on the nurses' health. Aim/Question We analysed the prerequisites for a transfer of this approach to psychiatric nursing. Method This study employed a cross-sectional design examining 11 wards of a hospital for psychiatry and neurology; 109 nurses participated. We used a multi-method design with observation-based assessments and nurses' self-reports of ward organization. Results Two clusters with wards of different work organization were identified. One cluster consisted of better-organized wards. The other included wards with a worse organization. We found substantial convergence between the observation-based assessments and nurses' self-reports. Discussion This study results indicated that observation-based assessments were an acceptable alternative to nurses' self-reports, enabling the evaluation of ward organization in a feasible and reliable way. Implications for practice This study showed an approach with a specific view on the structural quality of psychiatric wards; this may support work improvement processes in a more systematic way.

An efficient screening technique for acceptable mental workload based on the NASA Task Load Index—development and application to control room validation

Workload assessment is required for human factors validation of control rooms. The NASA Task Load Index (TLX) is a popular measure for this purpose. However, acceptability of workload is difficult to interpret based on the scores, and the measure is time consuming for use in test scenario breaks. This paper reports the identification and evaluation of a one-item subjective rating for the acceptability of mental workload. Study 1 found that one item, mental demand, highly represented the multidimensional TLX and that operators rated this item to be distinct from performance and situation awareness. Study 2 investigated the acceptance scale's sensitivity to control room modification, and the study found that operators' rating of level of mental demand and rating of acceptability of mental demand were moderately related. The rating of acceptability, compared with the original scale, was more sensitive to control room modernisation and was more strongly related to subjective performance. Operators' rating of acceptable workload was significantly related to observers' assessment of team performance, while the rating of level was not. Both acceptable and non-acceptable workload were related to high levels of the original TLX scales, indicating that operators' perception of acceptable workload was not fixated on a particular level of the original TLX scale. The results supported that efficient assessment can be achieved by applying only the TLX mental demand item and by supplementing or replacing the original rating scale with an acceptability rating scale. The approach presented applies to establishing ‘redlines’ for human performance constructs beyond mental workload. Relevance to industryHigh-consequence industries are required to perform human factors validation for new and substantially modified design. While numerous human factors measures are available, approaches for establishing cut-off scores or ‘redlines’ are lacking. This paper investigates acceptability rating to address this challenge.

Physical and mental workload interactions in a sterile processing department

Work in healthcare facilities has been categorized as a high-risk job for developing Work-Related Musculoskeletal Disorders (WMSDs). Little attention has been given to the Sterile Processing Department (SPD) employees who are exposed to both mentally and physically demanding conditions, factors that may impose an elevated risk in the development of WMSDs. Previous studies have shown that WMSDs can be a result of complex interactions between physical, psychosocial, biological, and individual characteristics. However, the evidence of specific associations is still inconclusive. The objective of this study was to determine if the perception of mental workload causes workers to adopt more risky body postures. The study was carried out in four phases: 1) identification of musculoskeletal disorders using customized Nordic questionnaires, 2) ergonomic assessment of SPD using REBA method, 3) mental workload assessment of SPD using NASA-TLX, and 4) interaction between physical (postural risk) and mental workload through the performance of a task at two different levels of workload conducted through a controlled experiment. The findings indicate that increases in REBA scores and NASA-TLX indices were associated with days and conditions with higher workloads. Results showed evidence that increments on mental workload are related to worsening postures, increasing the risk of developing musculoskeletal disorders. These results serve to raise awareness and warn employees about the need to pause and analyze the way they perform their duties under high levels of workload in an attempt to reduce WMSDs risk in healthcare sector employees.

The impact of heavy nurse workload and patient/family complaints on workplace violence: An application of human factors framework.

AimTo examine the relationships between workload factors at different systems levels (unit level, job level and task level), patients/family complaints and nurse reports of patient violence towards them using a human factors framework.DesignThis is a secondary analysis of cross‐sectional data.MethodsData from 528 nurses working in medical–surgical settings in British Columbia, Canada, were analysed. At the unit‐level workload factors included patient‐RN ratios, patient acuity and dependency; at the job‐level perceptions of heavy workload, undone nursing tasks and compromised professional standards due to workload; and at the task‐level interruptions to workflow.ResultsWorkload factors at multiple levels were directly related to workplace violence. Nurses' increased reports of compromised standards (job level) and interruptions (task level) were related to increased reports of physical and emotional violence, and higher patient acuity (unit level) was related to increased reports of emotional violence. Patient/family complaints mediated the relationship between almost all the workload factors and workplace violence.

Occupational History as a Predictor of Cognitive Ability in the Elderly

Cognitive ability is important for the elderly to be able to live independently. Many factors influence this ability in elderly, one of them being occupational history. The purpose of this study was to analyze occupational history as a cause of decreased cognitive ability. An observational analytic study with a cross-sectional approach. 87 subjects who met the inclusion criteria were recruited from Nursing Homes in Surabaya. 71.3% of the subjects have a history of physical-dominated occupation and 28.7% have intelectual-dominated occupation. There were no differences regarding duration of work and perception of workload in both groups. The average cognitive score is 18.57 (SD 5.939). The ANOVA test between occupational history and cognitive abilities shows p = 0.001, R Square = 0.172, and estimated standard of error of 5.501. This study concluded that occupational history can be used as a predictor of cognitive ability in elderly.

Carga de trabalho da enfermagem em unidade de terapia intensiva: um estudo de método misto

O presente estudo objetivou analisar a carga de trabalho da equipe de enfermagem de uma Unidade de Terapia Intensiva. Trata-se de um estudo de método misto, do tipo paralelo convergente. Os dados quantitativos foram coletados por meio do Nursing Activities Scores, em 73 prontuários de pacientes e submetidos a análise descritiva e correlacional. Os dados qualitativos foram coletados por meio de entrevista, com 18 trabalhadores de enfermagem e analisados via análise de conteúdo. Após, os dados quantitativos e qualitativos, foram analisados conjuntamente, visando a integração entre os mesmos. Verificou-se que os pacientes ocupam em média 70% do tempo de um trabalhador de enfermagem, o que indica alta carga de trabalho. Esse resultado foi confirmado por meio dos dados qualitativos, organizados nas seguintes categorias: Demanda de cuidados dos pacientes atendidos na UTI de um hospital universitário e Organização do trabalho: repercussões na carga de trabalho da enfermagem e na segurança do paciente, as quais evidenciaram uma percepção de elevada carga de trabalho e problemas na organização do trabalho que interferem, inclusive, na segurança do paciente. Os dados quantitativos e qualitativos convergiram entre si e apontaram que os trabalhadores de enfermagem estão sobrecarregados.

Evaluation of the individual workload perception of the personnel in food service system

AbstractIntroductionOrganizational factors, insufficient wages, inadequate work performance of their co-workers and lack of physical working environment in the hospital food service system (FSS) cause the increase of the workload. This study aims to determine the individual workload perception of the FSS personnel and to ascertain whether the individual workload perception differs across demographic variables and occupational groups.Materials and MethodsThe population of this descriptive study consists of the personnel working in the kitchen of the Akdeniz University Hospital, and the sample consists of 87 people who accepted to participate in the study by filling out the questionnaire forms on a voluntary basis. Individual Workload Perception Scale was used to evaluate the personnel's perception on their work environment and Personal Information Form was used to detect the participants’ data related to the independent variables.ResultsApproximately half of the individuals (47.1%) participating in the study were aged 31–40 years (33.5 ± 7.32). 56.3% of the individuals were waiter and three quarters of the individuals worked in shifts. Total individual workload perception of the FSS personnel was detected as 64.7 ± 15.25 on average. The mean score of the colleague support sub-group of the individuals was the highest and the mean score of the unit support was the lowest. It was determined that FSS personnel did not display a statistically significant difference across age groups, gender, marital status, educational status and individual workload sub-groups. It was only seen that there was a significant association between the work distribution of the individuals and the colleague&amp;unit support (p &lt; 0.05). A positively significant correlation was detected in FSS personnel between colleague support (r = 0.859), unit support (r = 0.473), work environment perception (r = 0.647) and intention to resume current work (r = 0.434) subscales and total individual workload perception scale (p &lt; 0.01).DiscussionThe workload of the FSS personnel working in the hospital was found to be high, and it is necessary to evaluate the individual workload and develop solutions for the provision of dietary services in a safe, high quality and efficient manner.

Comparison of Workload Perception for Original and Modified Cognitive Tasks

Comparison of Workload Perception for Original and Modified Cognitive Tasks

Investigation of burnout syndrome and job-related risk factors in veterinary technicians in specialty teaching hospitals: a multicenter cross-sectional study.

ObjectivesTo investigate veterinary technician burnout and associations with frequency of self‐reported medical error, resilience, and depression and job‐related risk factors.DesignCross‐sectional observational study using an anonymous survey conducted between November 2017 and June 2018.SettingFour referral teaching hospitals in the United States and Canada.SubjectsA total of 344 veterinary technicians were invited to participate. Response rate was 95%. Overall 256 surveys were ultimately analyzed.InterventionsBurnout, depression, and resilience were measured using validated instruments. Respondents reported perceptions of workload, working environment, and medical error frequency. Associations between burnout and factors related to physical work environment, workload and schedule, compensation package, interpersonal relationships, intellectual enrichment, and exposure to ethical conflicts were analyzed.Measurements and Main ResultsBurnout, characterized by high emotional exhaustion, depersonalization, and low sense of personal accomplishment was common, and was positively associated with perceived medical errors, desire to change career, and depression. Burnout levels on all 3 burnout subscales were higher in this population than previously reported for a contemporaneous group of trauma nurses working with human patients (P < 0.05). Burnout was negatively associated with resilience. Respondents’ feelings of fear or anxiety around supervisor communications, perception that patient load was too high to allow for excellent patient care, and perceived lack of available assistance during sudden workload increases were all associated with burnout.ConclusionsBurnout in veterinary technicians is common and is associated with numerous undesirable outcomes. Work‐related interventions to reduce burnout should focus on improving supervisor relationships and maintaining an appropriate patient:caregiver ratio.

Physiological Responses During Hybrid BNCI Control of an Upper-Limb Exoskeleton.

When combined with assistive robotic devices, such as wearable robotics, brain/neural-computer interfaces (BNCI) have the potential to restore the capabilities of handicapped people to carry out activities of daily living. To improve applicability of such systems, workload and stress should be reduced to a minimal level. Here, we investigated the user’s physiological reactions during the exhaustive use of the interfaces of a hybrid control interface. Eleven BNCI-naive healthy volunteers participated in the experiments. All participants sat in a comfortable chair in front of a desk and wore a whole-arm exoskeleton as well as wearable devices for monitoring physiological, electroencephalographic (EEG) and electrooculographic (EoG) signals. The experimental protocol consisted of three phases: (i) Set-up, calibration and BNCI training; (ii) Familiarization phase; and (iii) Experimental phase during which each subject had to perform EEG and EoG tasks. After completing each task, the NASA-TLX questionnaire and self-assessment manikin (SAM) were completed by the user. We found significant differences (p-value < 0.05) in heart rate variability (HRV) and skin conductance level (SCL) between participants during the use of the two different biosignal modalities (EEG, EoG) of the BNCI. This indicates that EEG control is associated with a higher level of stress (associated with a decrease in HRV) and mental work load (associated with a higher level of SCL) when compared to EoG control. In addition, HRV and SCL modulations correlated with the subject’s workload perception and emotional responses assessed through NASA-TLX questionnaires and SAM.

Networked Decisions: Decision-Making Thresholds in Child Protection

AbstractFamilies are significantly affected by decisions made in the child protection context, yet decision outcomes differ even when cases are similar. Understanding the concepts, practices and processes of differentiation that push some cases over the threshold of key decision points, but not other similar cases, is crucial. Drawing on interviews and focus groups with child protection social workers from three site offices in Aotearoa New Zealand (interviews, n = 26; focus groups, n = 25) and using thematic analysis, this study identified the case, internal organisational, inter-site organisational and external elements that contributed to threshold decisions. Case factors such as children’s age, abuse type and chronicity recorded family history and perceptions of family compliance interacted with internal organisational processes and practices, social negotiations and hierarchical power differences to produce decision outcomes. Inter-site differences in decision thresholds resulted from differences in site managers’ perceptions of acceptable case type, site workloads, resources, size and cultural commitment to family preservation. External demographic inequalities were perceived as causing differing levels of site workload. This ‘networked decision-making’ process is theorised drawing on an extended version of the decision-making ecology (DME), by using qualitative methods to examine interactions between the DME elements and their relationship with risk regimes.

Higher social cue utilisation improves communication, reduces perceived workload, and improves performance amongst ad hoc dyads in simulated rail control

The objective was to examine whether ad hoc dyads with different collective social cue utilisation would record differences in performance and perceptions of workload during a simulated rail control task that incorporated distinct levels of demand. The frequency of two types of communicative statements was also examined as mediating factors: closing the loop and informative responding. A quasi-experimental design was employed using 40 dyadic teams. The results indicated that ad hoc teams whose members comprised higher social cue utilisation recorded relatively faster response times and perceived lower levels of workload, and engaged in a greater frequency of communicative statements that involved ‘closing the loop’ and ‘informative responses’. Social cue utilisation also exerted an indirect effect on perceived workload through informative responding. The outcomes have theoretical implications for models of ad hoc team performance, and practical implications for the selection and training of teams that operate on an ad hoc basis. Practitioner summary: This study indicates that, in the context of simulation tasks requiring teamwork, higher social cue utilisation amongst ad hoc team members is associated with communication, workload perception, and overall performance.

Session RPE During Prolonged Exercise Training.

Although the session rating of perceived exertion (sRPE) is primarily a marker of internal training load (TL), it may be sensitive to external TL determining factors, such as duration and volume. Thus, sRPE could provide further information on accumulated fatigue not available from markers of internal TL. Therefore, the purpose of this study was to investigate sRPE during heavy training bouts at relatively constant intensity. Eleven university swimmers performed a high-volume training session consisting of 4 × 10 × 100-yd (4 × 10 × 91.4m). Repetition lap time and heart rate were measured for each repetition and averaged for each set. Blood lactate concentration was measured after each set. At the end of each set, a 10-minute rest period was allowed, during which sRPE values were obtained, as if the training bout had ended. There were no differences between sets for lap time (P = .096), heart rate (P = .717), and blood lactate concentration (P = .466), suggesting that the subjects were working at the same external and internal intensity. There was an increase (P = .0002) in sRPE between sets (first 4 [1.2], second 5 [1.3], third 7 [1.3], and fourth 8 [1.5]), suggesting that even when maintaining the same intensity, the perception of the entire workload increased with duration. Increases in duration, although performed with a consistent internal and external intensity, influences sRPE. These findings support the concept that sRPE may provide additional information on accumulated fatigue not available from other markers of TL.

Comparing internet-delivered cognitive therapy and behavior therapy with telephone support for insomnia disorder: a randomized controlled trial.

Study ObjectivesOur aim was to compare the effects of Internet-delivered cognitive therapy (CT) and behavior therapy (BT) against a waitlist (WL) condition to better understand their unique contribution in the treatment of insomnia.MethodsTwo hundred and nineteen participants with insomnia disorder were randomized to CT (n = 72), BT (n = 73), or WL (n = 74). The treatment arms consisted of 10 weekly internet-delivered modules with 15 min of telephone support per week. At pre, post, and follow-up, participants completed measures of insomnia severity, sleep diaries, functional impairment, anxiety, depression, quality of life, adverse events, satisfaction and perception of content, workload, and activity in treatment. Measures of completed exercises, modules, therapist support, and platform logins were also measured at posttreatment.ResultsModerate to large effect sizes for both CT and BT outperformed the WL on the majority of outcomes, with significant differences in favor of both therapy groups. Both treatment groups had significantly larger proportion of treatment remitters (CT: 35.8%, BT: 40%, WL: 2.7%) and responders (CT: 74.6%, BT 58.6%, WL: 10.8%) compared to the WL at posttreatment. There were no significant differences between the two therapy groups in terms of outcomes, except for sleep onset latency in favor of BT (6 min difference at posttreatment) and adverse events in favor of CT (CT 14.1% vs BT 43.2%).ConclusionsThis study indicates that both Internet-delivered CT and BT are effective as stand-alone therapies for insomnia disorder. Results highlight the need for examining which therapy and subcomponents that are necessary for change.ClinicalTrials.gov IdentifierNCT02984670

Investigating Cyber Threats in a Nuclear Power Plant

Malicious cyber-attacks are becoming increasingly prominent due to the advance of technology and attack methods over the last decade. These attacks have the potential to bring down critical infrastructures, such as nuclear power plants (NPP's), which are so vital to the country that their incapacitation would have debilitating effects on national security, public health, or safety. Despite the devastating effects a cyber-attack could have on NPP's, it is unclear how control room operations would be affected in such a situation. In this project, the authors are collaborating with NPP operators to discern the impact of cyber-attacks on control room operations and lay out a framework to better understand the control room operators' tasks and decision points. A cyber emulation of a digital control system was developed and coupled with a generic pressurized water reactor (GPWR) training simulator at Idaho National Laboratories. Licensed operators were asked to complete a series of scenarios on the simulator in which some of the scenarios were purposely obfuscated; that is, in which indicators were purposely displaying inaccurate information. Of interest is how this obfuscation impacts the ability to keep the plant safe and how it affects operators' perceptions of workload and performance. Results, conclusions and lessons learned from this pilot experiment will be discussed. This research sheds light onto about how cyber events impact plant operations.