A Review of the Use of Gaze and Pupil Metrics to Assess Mental Workload in Gamified and Simulated Sensorimotor Tasks.

Gaze and pupil metrics are used to represent higher cognitive processes in a variety of contexts. One growing area of research is the real-time assessment of workload and corresponding effort in gamified or simulated cognitive and motor tasks, which will be reviewed in this paper. While some measurements are consistent across studies, others vary and are likely dependent on the nature of the effort required by the task and the resulting changes in arousal. Pupil diameter is shown to consistently increase with task effort and arousal; however, the valence of arousal must be considered. In many cases, measures of pupil diameter were sensitive to both excessive and insufficient challenge. Overall, it is evident that gaze and pupil metrics are valuable to assess the cognitive state during gamified and simulated tasks, and further research is indicated regarding their use in clinical populations in rehabilitation to inform optimally engaging interventions.

Determining Cognitive Workload Using Physiological Measurements: Pupillometry and Heart-Rate Variability.

The adoption of Industry 4.0 technologies in manufacturing systems has accelerated in recent years, with a shift towards understanding operators' well-being and resilience within the context of creating a human-centric manufacturing environment. In addition to measuring physical workload, monitoring operators' cognitive workload is becoming a key element in maintaining a healthy and high-performing working environment in future digitalized manufacturing systems. The current approaches to the measurement of cognitive workload may be inadequate when human operators are faced with a series of new digitalized technologies, where their impact on operators' mental workload and performance needs to be better understood. Therefore, a new method for measuring and determining the cognitive workload is required. Here, we propose a new method for determining cognitive-workload indices in a human-centric environment. The approach provides a method to define and verify the relationships between the factors of task complexity, cognitive workload, operators' level of expertise, and indirectly, the operator performance level in a highly digitalized manufacturing environment. Our strategy is tested in a series of experiments where operators perform assembly tasks on a Wankel Engine block. The physiological signals from heart-rate variability and pupillometry bio-markers of 17 operators were captured and analysed using eye-tracking and electrocardiogram sensors. The experimental results demonstrate statistically significant differences in both cardiac and pupillometry-based cognitive load indices across the four task complexity levels (rest, low, medium, and high). Notably, these developed indices also provide better indications of cognitive load responding to changes in complexity compared to other measures. Additionally, while experts appear to exhibit lower cognitive loads across all complexity levels, further analysis is required to confirm statistically significant differences. In conclusion, the results from both measurement sensors are found to be compatible and in support of the proposed new approach. Our strategy should be useful for designing and optimizing workplace environments based on the cognitive load experienced by operators.

Non-invasive stress estimation in simulative endoscopy setting: literature review.

One of the most common stressors is so-called "occupational stress." It is defined as the sum of physical, mental and physiological responses to work in situations where the workload or stress associated with it intensifies for an extended period of time. It is a gradual process in which individual cognitive assessments of occupational stressors generate adverse health events and may lead to burnout. Since it has become a major problem in the medical field, studying, measuring and limiting it have been set as goals for the future.

Comparing Synchronous and Asynchronous Task Delivery in Mixed Reality Environments.

Asynchronous digital communication is a widely applied and well-known form of information exchange. Most pieces of technology make use of some variation of asynchronous communication systems, be it messaging or email applications. This allows recipients to process digital messages immediately (synchronous) or whenever they have time (asynchronous), meaning that purely digital interruptions can be mitigated easily. Mixed Reality systems have the potential to not only handle digital interruptions but also interruptions in physical space, e.g., caused by co-workers in workspaces or learning environments. However, the benefits of such systems previously remained untested in the context of Mixed Reality. We conducted a user study ($\mathrm{N}=26$) to investigate the impact that the timing of task delivery has on the participants' performance, workflow, and emotional state. Participants had to perform several cognitively demanding tasks in a Mixed Reality workspace. Inside the virtual workspace, we simulated in-person task delivery either during tasks (i.e., interrupting the participant) or between tasks (i.e., delaying the interruption). Our results show that delaying interruptions has a significant impact on subjective metrics like the perceived performance and workload.

EEG Dataset Collection for Mental Workload Predictions in Flight-Deck Environment.

High mental workload reduces human performance and the ability to correctly carry out complex tasks. In particular, aircraft pilots enduring high mental workloads are at high risk of failure, even with catastrophic outcomes. Despite progress, there is still a lack of knowledge about the interrelationship between mental workload and brain functionality, and there is still limited data on flight-deck scenarios. Although recent emerging deep-learning (DL) methods using physiological data have presented new ways to find new physiological markers to detect and assess cognitive states, they demand large amounts of properly annotated datasets to achieve good performance. We present a new dataset of electroencephalogram (EEG) recordings specifically collected for the recognition of different levels of mental workload. The data were recorded from three experiments, where participants were induced to different levels of workload through tasks of increasing cognition demand. The first involved playing the N-back test, which combines memory recall with arithmetical skills. The second was playing Heat-the-Chair, a serious game specifically designed to emphasize and monitor subjects under controlled concurrent tasks. The third was flying in an Airbus320 simulator and solving several critical situations. The design of the dataset has been validated on three different levels: (1) correlation of the theoretical difficulty of each scenario to the self-perceived difficulty and performance of subjects; (2) significant difference in EEG temporal patterns across the theoretical difficulties and (3) usefulness for the training and evaluation of AI models.

Cognitive Job Demands and Sports Participation among Young Workers: What Moderates the Relationship?

Cognitive job demands are theoretically and empirically associated with sports participation in various ways. Workers may be overwhelmed by stress and fatigue from their workload and therefore refrain from sports activities, but they can also feel the need to use sports as a way to recover and detach from work. The strategy to which workers adhere can depend on workers' resources that moderate the cognitive job demands and sports participation relationship, such as educational attainment, being a parent, or having worktime and work location control. To test our expectations, we used recent information on sports participation by young working adults from the Netherlands (N = 2032). Using multinomial logistic regression modelling, we found that workers in mentally demanding jobs were more likely to participate in sports more than three times a week. In particular, workers without children reported a higher likelihood of participating in sports more than three times a week when they experienced high cognitive job demands. Among the higher-educated, workers with high cognitive job demands were less likely to participate in sports one to three times a week. We reflect on the academic and policy-related implications of our findings.

Prediction of cognitive conflict during unexpected robot behavior under different mental workload conditions in a physical human-robot collaboration.

Objective. Brain-computer interface (BCI) technology is poised to play a prominent role in modern work environments, especially a collaborative environment where humans and machines work in close proximity, often with physical contact. In a physical human robot collaboration (pHRC), the robot performs complex motion sequences. Any unexpected robot behavior or faulty interaction might raise safety concerns. Error-related potentials, naturally generated by the brain when a human partner perceives an error, have been extensively employed in BCI as implicit human feedback to adapt robot behavior to facilitate a safe and intuitive interaction. However, the integration of BCI technology with error-related potential for robot control demands failure-free integration of highly uncertain electroencephalography (EEG) signals, particularly influenced by the physical and cognitive state of the user. As a higher workload on the user compromises their access to cognitive resources needed for error awareness, it is crucial to study how mental workload variations impact the error awareness as it might raise safety concerns in pHRC. In this study, we aim to study how cognitive workload affects the error awareness of a human user engaged in a pHRC.Approach. We designed a blasting task with an abrasive industrial robot and manipulated the mental workload with a secondary arithmetic task of varying difficulty. EEG data, perceived workload, task and physical performance were recorded from 24 participants moving the robot arm. The error condition was achieved by the unexpected stopping of the robot in 33% of trials.Main results. We observed a diminished amplitude for the prediction error negativity (PEN) and error positivity (Pe), indicating reduced error awareness with increasing mental workload. We further observed an increased frontal theta power and increasing trend in the central alpha and central beta power after the unexpected robot stopping compared to when the robot stopped correctly at the target. We also demonstrate that a popular convolution neural network model, EEGNet, could predict the amplitudes of PEN and Pe from the EEG data prior to the error.Significance. This prediction model could be instrumental in developing an online prediction model that could forewarn the system and operators of the diminished error awareness of the user, alluding to a potential safety breach in error-related potential-based BCI system for pHRC. Therefore, our work paves the way for embracing BCI technology in pHRC to optimally adapt the robot behavior for personalized user experience using real-time brain activity, enriching the quality of the interaction.

Assessing mental demand in consecutive interpreting: Insights from an fNIRS study.

Consecutive interpreting involves a demanding language task where mental workload (MWL) is crucial for assessing interpreters' performance. An elevated cognitive load in interpreters may lead to the interpretation failures. The widely used NASA-TLX questionnaire effectively measures MWL. However, a global score was employed in previous interpretation studies, overlooking the distinct contributions of MWL components to the interpreters' performance. Accordingly, we recruited twenty novice interpreters who were postgraduate students specializing in interpreting to complete the consecutive interpreting task. Throughout the process, we used functional near-infrared spectroscopy (fNIRS) to monitor the hemodynamic response in participants' brains. The NASA-TLX was used to measure the MWL during interpreting with six components, including mental demand, physical demand, temporal demand, performance, effort, and frustration. Five interpretation experts were invited to assess the interpretation quality. The Bayes factor approach was employed to explore the components that contributes the most to the interpretation quality. It indicated that mental demand strongly contributed to the interpretation quality. Moreover, the mediation analysis revealed a positive correlation between mental demand and brain activation in three brain areas, which, in turn, was negatively correlated with interpretation quality, indicating the predictive role of mental demand in interpretation quality through the mediating of brain activation. The functions of the mediating brain areas, including the inferior frontal gyrus, middle temporal gyrus, and inferior temporal gyrus, aligned with the three efforts proposed by Gile's effort model, which emphasizes the significance of three fundamental efforts in achieving successful interpreting. These findings have implications for interpreter learning and training.

The dynamic interplay of job characteristics and psychological capital with employee health: A longitudinal analysis of reciprocal effects.

The dynamic development of employee health is increasingly addressed by occupational health scholarships. Based on the job demands-resources theory, this study examines reciprocal relationships among job resources, job demands, psychological capital (PsyCap), work engagement, and burnout over time. We hypothesize that PsyCap, job resources, and work engagement are part of a reciprocal gain cycle that is based on static levels and changes in these variables. Further, we assume that PsyCap has multiplicative buffering and boosting relationships with job demands and burnout. We test our hypotheses using latent change score modeling with data from 661 employees surveyed over 3 consecutive months. The results reveal a complex reciprocal cycle between PsyCap, work engagement, and job resources. However, PsyCap does not interact with the reciprocal relationship between job demands and burnout, as it is directly reciprocally related to burnout and certain types of job demands. Against the background of these results, our study contributes to research and practice on the role of personal resources, specifically PsyCap, by identifying individual differences in change patterns and highlighting the importance of considering individual differences and temporal aspects in the context of occupational health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Review of Cognitive Support Systems in the Operating Room.

BACKGROUND: In recent years, numerous innovative yet challenging surgeries, such as minimally invasive procedures, have introduced an overwhelming amount of new technologies, increasing the cognitive load for surgeons and potentially diluting their attention. Cognitive support technologies (CSTs) have been in development to reduce surgeons' cognitive load and minimize errors. Despite its huge demands, it still lacks a systematic review. METHODS: Literature was searched up until May 21st, 2021. Pubmed, Web of Science, and IEEExplore. Studies that aimed at reducing the cognitive load of surgeons were included. Additionally, studies that contained an experimental trial with real patients and real surgeons were prioritized, although phantom and animal studies were also included. Major outcomes that were assessed included surgical error, anatomical localization accuracy, total procedural time, and patient outcome. RESULTS: A total of 37 studies were included. Overall, the implementation of CSTs had better surgical performance than the traditional methods. Most studies reported decreased error rate and increased efficiency. In terms of accuracy, most CSTs had over 90% accuracy in identifying anatomical markers with an error margin below 5 mm. Most studies reported a decrease in surgical time, although some were statistically insignificant. DISCUSSION: CSTs have been shown to reduce the mental workload of surgeons. However, the limited ergonomic design of current CSTs has hindered their widespread use in the clinical setting. Overall, more clinical data on actual patients is needed to provide concrete evidence before the ubiquitous implementation of CSTs.

Gender differences in self-assessed performance and stress level during training of basic interventional radiology maneuvers.

OBJECTIVES: Gender differences have been reported to influence medical training. We investigated gender differences encountered during training in interventional radiology maneuvers. METHODS: Catheter handling was analyzed under standardized conditions in 64 participants naïve to endovascular procedures (26 women, 38 men). Objective (e.g., catheter pathway, catheter movements, required time) and subjective parameters (stress level) were recorded. The NASA-Task Load Index (NASA-TLX; 1-20 points) was used to assess participants' stress levels and perceived workload. RESULTS: In the easier tasks, no significant differences between male and female participants regarding catheter handling were observed. In the most complex task, female participants took themselves more time (688 ± 363 vs. 501 ± 230 s; p = 0.02), asked for help more frequently (n = 19 vs. n = 8) and earlier than men (203 ± 94 vs. 305 ± 142 s; p = 0.049), whereas men stood out by more agitated catheter handling (6.0 ± 1.8 vs. 4.8 ± 1.6 movements/s; p = 0.005). Overall, female participants perceived tasks to be more difficult (11.5 ± 4.2 vs. 9.6 ± 3.3; p = 0.016), perceived higher stress levels (8.9 ± 4.9 vs. 6.3 ± 4.4; p = 0.037), and rated their own performance lower (9.12 ± 3.3 vs. 11.3 ± 3.3; p = 0.009). However, female participants were able to correlate self-assessed with objective parameters correctly (r between -0.555 and -0.469; p = 0.004-0.018), whereas male participants failed to correctly rate their performance (p between 0.34 and 0.73). Stress levels correlated with objective parameters in males (r between 0.4 and 0.587; p < 0.005), but not in female participants. CONCLUSION: Perceived stress levels, self-evaluation skills, and catheter handling differ greatly between untrained male and female participants trying to solve interventional radiological tasks. These gender-specific differences should be considered in interventional radiology training. CLINICAL RELEVANCE STATEMENT: As psychological aspects may influence individual working strategies gender-specific differences in self-perception while learning interventional radiology maneuvers could be essential regarding success in teaching and treatment outcomes. KEY POINTS: • After performing standardized training, 38 male and 26 female volunteers showed significant differences regarding objective and self-assessed performance, as well as in perceived workload while performing simulated endovascular catheter maneuvers. • After solving simulated endovascular radiological tasks, female participants were able to self-assess their objective performance much more accurately than male participants. • Women took more time to solve simulated endovascular tasks and asked earlier and more frequently for help than men.

GP perspectives on a psychiatry phone line in Western Australia's Great Southern region: implications for addressing rural GP workload.

BACKGROUND: Mental illness is a public health challenge disproportionately affecting rural Australians. GPs provide most of the mental health care, and they report increasing levels of burnout and unsustainable workload in the context of increased patient complexity. This may be more salient in rural settings characterised by resource constraints. In this paper, we use evaluation data from a GP psychiatry phone line established in Western Australia's Great Southern region in 2021 to describe GPs' perspectives on the service and reflect on how it may help alleviate rural GP workload. METHODS: The sample was recruited among GPs practicing in the region. Data were collected through an online survey and semistructured interviews. Descriptive statistics were used to analyse the survey data. Interview data were subjected to thematic analysis; qualitative survey data were used for triangulation. RESULTS: A total of 45GPs completed the survey and 14 were interviewed. Interview data yielded three themes: the criticality of timeliness; the building blocks of confidence; and trust. GPs were highly satisfied with the service, and timeliness and trust were the characteristics underpinning its effectiveness. The service built GPs' confidence in managing mental health and alcohol and other drug use issues through strengthening knowledge and providing reassurance. CONCLUSIONS: Our results suggest that a telephone line operated by trusted, local psychiatrists with knowledge of the local mental health ecosystem of support can reduce rural GP workload through building confidence and strengthening personal agency, helping GPs navigate the ethical and clinical labyrinth of managing patient complexity in rural settings.

Extended-Duration Work Shifts in Surgical Specialties: A Systematic Review.

INTRODUCTION: There has been widespread international implementation of duration-hour restrictions to prevent surgical resident burnout and promote patient safety and wellbeing of doctors. A variety of Extended-Duration Work Shifts (EDWS) have been implemented, with a variety of studies examining the effect of shift systems on both surgical performance and the stress response unestablished in the literature. METHODS: This was a systematic review evaluating the impact of extended working hours on surgical performance, cognitive impairment, and physiological stress responses. The review used PubMed, Ovid Medline, Embase, and Google Scholar search engines between September and October 2021 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Filters including studies carried out after 2002 and published in the English language were applied. RESULTS: In total, 30 studies were included for analysis. General surgery was the most commonly studied rotation, with Neurosurgical, Orthopedic, and ear, nose and throat specialties also included. The majority of studies found no difference or a significant improvement in post-EDWS on simulated performance. EDWS appeared to have the greatest impact on physiological stress markers in junior surgical trainees. CONCLUSIONS: Experience appears to confer a protective element in the postcall period, with preservation of skill demonstrated. More experienced clinicians yielded lower levels of physiological markers of stress, although variability in hierarchical workload should be considered. Heterogeneity of findings across physiological, cognitive, and psychomotor assessments highlights the need for robust research on the optimum shift pattern prevents worker burnout and promotes patient safety. Future research to evaluate correlation between stress, on-call workload, and performance in the postcall period is warranted.

[Perceived changes in the workload of home care nurses during the COVID-19 pandemic: Results of an online survey]. / Wahrgenommene Veränderungen der Belastungssituation ambulant Pflegender während der COVID-19-Pandemie: Ergebnisse einer Online-Befragung.

BACKGROUND: The COVID-19 pandemic posed major challenges to the health care system, particularly to nursing. Intensive care was often the focus of attention. However, home care nursing was also confronted with drastic changes, while it is largely unknown how the work situation changed for employees as a result of the pandemic - also depending on the sponsorship of home care nursing services. METHODS: A nationwide online survey of home-care nurses was conducted in May and June 2022. The Intensification of Job Demands Scale (IDS) and an open question regarding changes in the work situation due to the pandemic were used among other instruments. RESULTS: More than two-thirds of the 976 home-care nurses surveyed agreed with the respective statements regarding work intensification (e.g., taking fewer breaks, doing work activities at the same time, not having enough time). Additional factors for psychological workload during the pandemic primarily fell within the scope of work organization (e.g., staff absences due to illness and quarantine, vaccination related leaves and terminations, additional workload due to handling protective clothing). Employees of privately run care services experienced fewer COVID-19-related changes than home care nurses employed by non-profit providers. CONCLUSION: In future crisis situations, good information management (e.g., uniform, consistent and comprehensible guidelines and recommendations for action) and ways to compensate for staff shortages should be created.

Cusp Catastrophe Models for Cognitive Workload and Fatigue for Teams Making Dynamic Decisions.

This study evaluated cusp models of workload and fatigue experienced by teams on a dynamic decision making task. Cognitive workload is the amount of information that a person is required to process in a given way in a fixed amount of time. Fatigue, which is captured by a work curve or a cubic polynomial function, is the loss of work capacity that is produced by an extended amount of time spent on a particular cognitive or physical task. In this experiment, 32 groups of three, four or five members (136 individuals) played two matches of a first-person shooter computer game, and completed subjective measures of workload and cognitive measures of elasticity versus rigidity. For the workload cusp models with elasticity-rigidity components, the bifurcation in performance levels occurred when teams expressed greater emotional intelligence, anxiety, levels of fluid intelligence, coping flexibility, cognitive flexibility, and were more decisive (R2=.54-.56, linear alternative, .09-.23). For workload cusp models assessing subjective ratings of workload, bifurcation occurred with groups who reported greater levels of performance demand and effort required (R2=.51, linear alternative, .20). For fatigue cusp models, bifurcation occurred for groups that played fewer rounds of the game before winning or losing the match, or came from the smaller-sized groups, which were supplemented by computer-generated agents (R2=.66-.67, linear alternative, .21-.68). Results supported the general-ization of the cusp models for workload and fatigue to situations requiring teamwork in dynamic decision making environments. The study also raised new questions about the role of autonomic synchrony in the workload or fatigue processes and similarity of the dynamics of human-autonomy teams compared to all-human teams.

Factors influencing the mental health status of support nurses and their workload during the COVID-19 epidemic.

OBJECTIVES: The authors used the National Aeronautics and Space Administration Task Load Index (NASA-TLX) and general health questionnaire to analyze the factors influencing the mental health status and the workload of support nurses during the COVID-19 epidemic. MATERIAL AND METHODS: The authors conducted a cross-sectional survey of 349 support nurses in April-October 2022. Using QuestionStar, a powerful online survey tool, the authors administered surveys to the participants, collected data on the mental health status and workload of support nurses, and analyzed the influencing factors based on the collected data. RESULTS: A total of 316 questionnaires were successfully collected, with an effective rate of 98.75%. The proportion of support nurses with mental health problems was 25% and the value of the NASA-TLX questionnaire was: M±SD 68.91±7.28 pts. Multi-factor analysis revealed that the number of children, family support, and nursing support location were the influencing factors of mental health status, while the multivariate analysis revealed that the presence of symptoms, nursing support location, support work type, and total 12-item General Health Questionnaire (GHQ-12) score were the influencing factors of the workload of support nurses. CONCLUSIONS: Compared to their counterparts in the plains, nurses working in isolated plateau regions who were caring for children and lacked family support, were more likely to have mental health issues. There was a positive correlation between the changes in GHQ-12 and NASA-TLX scores of the study participants. Compared to their counterparts in the plains and the tropical regions, nurses working in plateau regions had a heavier workload. As part of the follow-up measures to prevent and treat patients impacted by the COVID-19 epidemic, it is important to improve the mental health evaluation, consultation, and treatment of the support nurses to guarantee the high quality of the first-line support work. Int J Occup Med Environ Health. 2023;36(6)761-72.

Investigation of the neural correlation with task performance and its effect on cognitive load level classification.

Electroencephalogram (EEG)-based cognitive load assessment is now an important assignment in psychological research. This type of research work is conducted by providing some mental task to the participants and their responses are counted through their EEG signal. In general assumption, it is considered that during different tasks, the cognitive workload is increased. This paper has investigated this specific idea and showed that the conventional hypothesis is not correct always. This paper showed that cognitive load can be varied according to the performance of the participants. In this paper, EEG data of 36 participants are taken against their resting and task (mental arithmetic) conditions. The features of the signal were extracted using the empirical mode decomposition (EMD) method and classified using the support vector machine (SVM) model. Based on the classification accuracy, some hypotheses are built upon the impact of subjects' performance on cognitive load. Based on some statistical consideration and graphical justification, it has been shown how the hypotheses are valid. This result will help to construct the machine learning-based model in predicting the cognitive load assessment more appropriately in a subject-independent approach.

The occupational burnout among medical staff with high workloads after the COVID-19 and its association with anxiety and depression.

Objective: After the end of COVID-19, medical staff were immediately faced with a high workload, leading to widespread occupational burnout. This study aims to explore the level and influencing factors of burnout among medical staff during this period, as well as its relationship with anxiety and depression. Methods: The participants' levels of burnout were assessed using Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and the reliability and validity of the questionnaire were evaluated through Cronbach's α and Confirmatory Factor Analysis (CFA). Independent sample t-test, chi-square test, and Pearson analysis were employed to determine the correlation between two sets of variables. Univariate and multivariate logistic regression analyses were conducted to identify significant factors influencing burnout. Finally, nomograms were used to predict the probability of burnout occurrence. Results: This study collected a total of 1,550 questionnaires, and after excluding 45 questionnaires that were duplicates or incomplete, a sample of 1,505 (97.1%) participants were included in the final statistical analysis. Both Cronbach's α and the fit indices of CFA demonstrated excellent adaptability of the Chinese version of MBI-HSS in this study. The overall prevalence rates for emotional exhaustion (EE), depersonalization (DP), and diminished personal accomplishment (PA) were 52.4, 55.3, and 30.6%, respectively. Obtaining psychological support, health condition, relationship with family members, and insufficient sleep were identified as common contributing factors to burnout among medical staff. Additionally, age and promotion pressure were also associated with burnout among doctors, and exceeding legal working hours was an important factor for nurse burnout. The C-index for the nomograms predicting burnout among doctors and nurses was 0.832 and 0.843, respectively. Furthermore, burnout exhibited a significant linear correlation with anxiety and depression. Conclusion: After the end of COVID-19, medical staff in high workload environments were facing severe burnout, which might lead to anxiety and depression. The occupational burnout of medical staff needed to be taken seriously and actively intervened.

Affective work rumination as a mediator of the reciprocal relationships between job demands and exhaustion.

High levels of job demands are considered as the main predictor for teachers' exhaustion, but longitudinal studies of the causal effects are few. Recently it has been suggested that research should further explore possible reciprocal relationships between stressors and strain and investigate if work rumination contributes to explain these relationships. In a sample of teachers (n = 1067) using a three-wave design, we hypothesized positive causal effects of job demands (work pace and role conflict) on affective work rumination, and of affective work rumination on exhaustion. We also hypothesized a positive reversed causal effect of exhaustion on affective work rumination, and of affective work rumination on job demands. Furthermore, affective work rumination was expected to mediate the positive causal and reversed causal effects between job demands and exhaustion. The results partly confirmed the expected causal and reversed causal effects. However, affective work rumination was only found to mediate the reversed causal effect of exhaustion and role conflict. Furthermore, a reciprocal relationship was only found between role conflict and exhaustion. The empirical, theoretical, and practical implications of the study are discussed.

What makes nurses flourish at work? How the perceived clinical work environment relates to nurse motivation and well-being: A cross-sectional study.

BACKGROUND: Literature shows that the work environment is a main determinant of nurses' well-being and psychological strain; yet, the (psychological) mechanisms underlying this relationship remain understudied. OBJECTIVE: This study explored the underlying (psychological) mechanisms (why) and boundary conditions (when) by which characteristics present in the clinical work environment influence nurses' well-being. We investigated the mediating role of intrinsic motivation in the relationship of job demands and job resources with burnout vs. work engagement. In addition, we examined if job resources strengthen the relationship of job demands with intrinsic motivation and burnout. DESIGN: A cross-sectional survey study. SETTING(S): General acute care hospitals in Belgium (n = 14). PARTICIPANTS: Direct care nurses (n = 1729). METHODS: Data were collected by means of online questionnaires between October 2020 and July 2021. Study variables included burnout, work engagement, intrinsic motivation and a set of different job demands (workload, role conflicts, emotional demands, red tape) and job resources (performance feedback, autonomy, skill use, opportunity for growth, and value congruence). All variables were obtained using self-report measures. The central hypotheses were tested using structural equation modeling. RESULTS: Job resources appeared to be a crucial factor for nurses' health showing positive associations with work motivation (ß = 0.513) and work engagement (ß = 0.462) and negative associations with burnout (ß = -0.216). Job demands remained an essential factor that harms psychological health and is associated with increased burnout (ß = 0.489). Our results confirmed that intrinsic motivation mediated the relationship of job resources with work engagement (ß = 0.170) and burnout (ß = -0.135). In addition, job resources moderated the relationship of job demands with burnout (ß = -0.039). Against our expectations, we found no associations between job demands and intrinsic motivation or a moderation effect of job resources on the respective relationship. CONCLUSIONS: A highly demanding work environment can be a source of significant stress which may put nurses' health at severe risk. Nurses who perceive sufficient job resources such as feedback, autonomy and opportunities for growth and development, are likely to feel intrinsically motivated at work. In addition, it will foster their work engagement and prevent them from burning out, particularly when job demands are high. REGISTRATION: The study described herein is funded under the European Union's Horizon 2020 Research and Innovation program from 2020 to 2023 (Grant Agreement 848031). The protocol of Magnet4Europe is registered in the ISRCTN registry (ISRCTN10196901). TWEETABLE ABSTRACT: Providing nurses with sufficient resources will not only increase their motivation and engagement at work but also reduce their feelings of burnout.