儿童重症医学中的认知负荷:海啸和千刀万剐。

IF 2.7 Q4 Medicine
Critical care explorations Pub Date : 2025-10-06 eCollection Date: 2025-10-01 DOI:10.1097/CCE.0000000000001329
Daniel E Ehrmann, Sara N Gallant, Sunkyung Yu, Danny Eytan, Elaine Gilfoyle, Azadeh Assadi, Seth Gray, Oshri Zaulan, Mjaye Mazwi
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引用次数: 0

摘要

重要性:过度的认知负荷会损害任务表现并导致倦怠,但在儿科重症医学(PCCM)环境中对认知负荷的研究有限。目的:更好地了解学术PCCM环境下的认知负荷,以及认知负荷如何根据经验、角色、任务类型和任务频率而变化。设计、设置和参与者:一家第四系儿童医院PCCM部门的前瞻性两部分调查。第一部分(2022年2月至3月)评估常规角色特定任务;第二部分(2022年6月至8月)评估急性复苏。参与者是注册护士(RNs)、呼吸治疗师(RTs)和医生+高级执业提供者(APPs)。主要结果和测量:急性复苏的原始认知负荷(1-9 Paas量表)、净认知负荷(Paas ×任务频率)和nasa -任务负荷指数(NASA-TLX)子域评分(0-100)。角色是主要暴露;组间差异分析采用两两比较的方差分析。结果:调查对象1部分109人,2部分79人。在所有任务中,医生+ app的平均原始Paas得分最高(5.2±1.1),其次是RNs(4.8±1.0)和RTs(4.0±1.4;p = 0.004)。在三个负荷最高的共享任务中——急性复苏、抢救失代偿患者和管理高级生命支持设备——注册护士报告的原始负荷明显高于医生+ app和即时护士。在床边患者评估中,RNs的净认知负荷(25.0±8.7)高于内科医生+ app(20.3±7.0;p = 0.01)和RTs(18.9±8.9;p = 0.01)。护理经验与整体净认知负荷相关(r = 0.30; p = 0.02)。在复苏期间,注册护士在除两个子域外的所有子域的NASA-TLX评分均高于其他提供者。结论及相关性:PCCM的认知负荷因角色和任务类型而有显著差异。护士从关键事件中经历了高的原始认知负荷,从床边病人评估中经历了高的净认知负荷,这表明有机会重新设计角色特定的工作流程和减少认知负荷的策略,以使工作人员和患者受益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cognitive Load in Pediatric Critical Care Medicine: Tsunamis and a Thousand Cuts.

Importance: Excessive cognitive load impairs task performance and contributes to burnout, but studies of cognitive load in pediatric critical care medicine (PCCM) settings are limited.

Objectives: To better understand cognitive load in an academic PCCM setting and how cognitive load differs based on experience, role, task type, and task frequency.

Design, settings, and participants: Prospective two-part survey at a quaternary children's hospital PCCM department. Part 1 (February to March 2022) assessed routine role-specific tasks; part 2 (June to August 2022) evaluated acute resuscitation. Participants were registered nurses (RNs), respiratory therapists (RTs), and physicians + advanced practice providers (APPs).

Main outcomes and measures: Raw cognitive load (1-9 Paas scale), net cognitive load (Paas × task frequency), and NASA-Task Load Index (NASA-TLX) subdomain scores (0-100) for acute resuscitation. Role was the primary exposure; between-group differences were analyzed using analysis of variance with pairwise comparisons.

Results: There were 109-part 1 and 79-part 2 survey respondents. Across all tasks, mean raw Paas scores were highest for physicians + APPs (5.2 ± 1.1), followed by RNs (4.8 ± 1.0) and RTs (4.0 ± 1.4; p = 0.004). In the three highest-load shared tasks-acute resuscitation, rescuing a decompensating patient, and managing advanced life-support devices-RNs reported significantly higher raw load than physicians + APPs and RTs. For bedside patient assessment, RNs had higher net cognitive load (25.0 ± 8.7) than physicians + APPs (20.3 ± 7.0; p = 0.01) and RTs (18.9 ± 8.9; p = 0.01). Nursing experience correlated with overall net cognitive load (r = 0.30; p = 0.02). During resuscitation, RNs reported higher NASA-TLX scores than other providers in all but two subdomains.

Conclusions and relevance: Cognitive load in PCCM varies significantly by role and task type. Nurses experience high raw cognitive load from critical events and net cognitive load from bedside patient assessment, suggesting opportunities for role-specific workflow redesign and cognitive load reduction strategies to benefit staff and patients.

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