A Framework to Assess Alarm Fatigue Indicators in Critical Care Staff.

This article examines work-related and Personality personality factors that could influence health providers in experiencing alarm fatigue. The purpose of this study is to provide a basis to determine factors that may predict the potential of alarm fatigue in critical care staff. DESIGN: A questionnaire-based survey and an observational study were conducted to assess factors that could contribute to indicators of alarm fatigue. INTERVENTIONS: Factors included patient-to-staff ratio, criticality of the alarm, priority of different tasks, and personality traits. SETTING: The study was conducted at an eight-bed ICU in a mid-size hospital in Montana. SUBJECTS: Data were collected for six day shifts and six night shifts involving 24 critical care professionals. Within each 12-hour shift, six 15-minute intervals were randomly generated through work sampling for 6 days; a total of 1,080 observations were collected. MEASUREMENTS: Alarm fatigue was assessed with the subjective workload assessment technique and Boredom, Apathy, and Distrust Affects, which were measured through validated questionnaires. The Big Five Personality model was used to assess personality traits. MAIN RESULTS: Work factors including task prioritization, nurse-to-patient ratio, and length of shifts were associated with indicators of alarm fatigue. Personality traits of openness, conscientiousness, and neuroticism were also associated. CONCLUSIONS: We recommend assessing personality traits for critical care staff to be aware of how their individualities can affect their behavior towards alarm fatigue. We also recommend an examination of alternative strategies to reduce alarm fatigue, including examining the use of breaks, work rotation, or shift reduction.

Impact of Virtual Reality-Generated Construction Environments at Different Heights on Postural Stability and Fall Risk.

BACKGROUND: Falls due to postural instability are common in construction environments especially from a height. The purpose of the study was to investigate the impact of virtual reality (VR)-generated environments at different virtual heights on postural stability. METHODS: Nineteen adults were analyzed for postural stability, tested in real (No VR) environment and in three VR environments, randomly assigned, at virtual heights of 0 ft. (VR0), 40 ft. (VR40), and 120 ft. (VR120). Postural stability was quantified using center of pressure postural sway variables and analyzed using a repeated measures analysis of variance (ANOVA). Participants also completed a simulation sickness questionnaire (SSQ) before and after VR exposure and a presence questionnaire (PQ) after VR exposure. FINDINGS: Significant postural instability (p < .05) was identified between VR and No VR, in which increased postural instability was evident in all VR conditions compared with No VR. Scores from SSQ were within a pre-post score difference of five and the PQ score was (104.21 ± 14.03). CONCLUSION/APPLICATION TO PRACTICE: Findings suggest that VR environments, regardless of virtual height, induced increased postural instability, which can be attributed to visual sensory conflicts to the postural control system created by VR exposure. Participants' subjective responses on SSQ and PQ confirmed the feasibility of using VR to represent realistic immersions in virtual heights. However, objectively, VR could potentially lead to postural instability, stressing caution. VR can be a potential tool for providing virtual high-altitude environment exposure for fall prevention training, however, more research is needed on postural adaptation with acute and chronic exposure to VR.

Virtual-Reality-Induced Visual Perturbations Impact Postural Control System Behavior.

BACKGROUND: Virtual reality (VR) is becoming a widespread tool in rehabilitation, especially for postural stability. However, the impact of using VR in a "moving wall paradigm" (visual perturbation), specifically without and with anticipation of the perturbation, is unknown. METHODS: Nineteen healthy subjects performed three trials of static balance testing on a force plate under three different conditions: baseline (no perturbation), unexpected VR perturbation, and expected VR perturbation. The statistical analysis consisted of a 1 × 3 repeated-measures ANOVA to test for differences in the center of pressure (COP) displacement, 95% ellipsoid area, and COP sway velocity. RESULTS: The expected perturbation rendered significantly lower (p < 0.05) COP displacements and 95% ellipsoid area compared to the unexpected condition. A significantly higher (p < 0.05) sway velocity was also observed in the expected condition compared to the unexpected condition. CONCLUSIONS: Postural stability was lowered during unexpected visual perturbations compared to both during baseline and during expected visual perturbations, suggesting that conflicting visual feedback induced postural instability due to compensatory postural responses. However, during expected visual perturbations, significantly lowered postural sway displacement and area were achieved by increasing the sway velocity, suggesting the occurrence of postural behavior due to anticipatory postural responses. Finally, the study also concluded that VR could be used to induce different postural responses by providing visual perturbations to the postural control system, which can subsequently be used as an effective and low-cost tool for postural stability training and rehabilitation.

Efficacy of virtual reality in pedestrian safety research.

Advances in virtual reality technology present new opportunities for human factors research in areas that are dangerous, difficult, or expensive to study in the real world. The authors developed a new pedestrian simulator using the HTC Vive head mounted display and Unity software. Pedestrian head position and orientation were tracked as participants attempted to safely cross a virtual signalized intersection (5.5 m). In 10% of 60 trials, a vehicle violated the traffic signal and in 10.84% of these trials, a collision between the vehicle and the pedestrian was observed. Approximately 11% of the participants experienced simulator sickness and withdrew from the study. Objective measures, including the average walking speed, indicate that participant behavior in VR matches published real world norms. Subjective responses indicate that the virtual environment was realistic and engaging. Overall, the study results confirm the effectiveness of the new virtual reality technology for research on full motion tasks.

Evaluating pedestrian behavior at crosswalks: Validation of a pedestrian behavior questionnaire for the U.S. population.

The aim of this study was to develop and validate a self-reporting Pedestrian Behavior Questionnaire (PBQ) for the U.S. population to measure frequency of risky behaviors among pedestrians. The PBQ includes 50 survey items that allow respondents to rate the frequency with which they engage in different types of road-using behaviors as pedestrians. The validation study was conducted on 425 participants (228 males and 197 females) between the ages of 18 and 71. Confirmatory factor analysis differentiated pedestrian behaviors into five factor categories: violations, errors, lapses, aggressive behaviors, and positive behaviors. A short version of the PBQ with 20 items was also created by selecting four items with high factor loadings from each of the five factor categories. Regression analyses investigated associations with scenario-based survey behavioral responses to validate the five-factor PBQ subscale scores and composite score. For both long and short versions, each of these five individual factor scales were found to be reliable (0.7