The Interruption Management Strategy “Stay S.A.F.E.” Program development and evaluation for operating nurses in China: a pre-post study design

The Interruption Management Strategy “Stay S.A.F.E.” Program development and evaluation for operating nurses in China: a pre-post study design | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Interruption Management Strategy “Stay S.A.F.E.” Program development and evaluation for operating nurses in China: a pre-post study design Xiaomeng Wen, Qing qing Zhang, Chenghuan Zhang, Xiaoyun Han This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9194764/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Operating rooms are complex, high-risk environments where interruptions frequently occur, potentially compromising workflow reliability and patient safety. Training in interruption management, grounded in cognitive theory, may help nurses cope with unavoidable disruptions; however, evidence from perioperative practice remains limited. This study evaluated the effects of the Interruption Management Strategy Stay S.A.F.E. on operating room (OR) nurses’ interruption management, cognitive processing, and workload. Methods A quasi-experimental, single-group pre-test and post-test design was conducted in the central OR of a tertiary hospital in Jiangsu, China, with 82 registered nurses (≥ 1 year OR experience). The intervention, developed via a two-round Delphi process, combined didactic teaching and simulation of five interruption scenarios based on the Memory for Goals framework ( Stay, Say, Acknowledge, Fixate, Estimate ). Observations captured interruption characteristics, strategies, outcomes, and task resumption. Secondary outcomes included NASA-TLX and the Operating Room Nursing Interruption Cognitive Ability Inventory (ORNICAI). Chi-square/Fisher tests and paired t-tests were applied (α = 0.05). Results A total of 1,090 interruption events were recorded (541 vs 549). While event frequency was unchanged, strategy use shifted: slightly delayed interruptions increased (8.13%→17.85%), immediate interruptions (65.80%→58.29%) and multitasking (23.66%→22.04%) decreased (p < 0.0001). Positive outcomes rose (7.39%→10.75%) and negative outcomes declined (79.85%→72.86%, p = 0.023). Failures to resume tasks fell (4.81%→0.73%), while “original task completed” increased (4.99%→13.84%, p < 0.0001). ORNICAI scores improved significantly (112.40 ± 12.54→115.2 ± 12.52, p < 0.001). NASA-TLX scores slightly decreased (67.56 ± 13.31→67.12 ± 13.10, p = 0.003), mainly due to lower mental demand. Conclusions The Stay S.A.F.E. strategy improved OR nurses’ interruption cognition, promoted safer strategies, enhanced task resumption, and modestly reduced workload without affecting interruption frequency. Integration into OR training is warranted, with multi-center studies and longer follow-up recommended. Interruptions operating room interruption management simulation Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction A nursing interruption is a sudden interruption that delays or distracts a nurse from delivering care to a patient at a specific time or in a specific role or environment [ 1 ] .Nursing interruptions are common events that disrupt the workflow of nurses, potentially leading to errors, delays, and omissions in patient care [ 2 – 4 ] . These interruptions are a complex phenomenon, involving the suspension of an ongoing primary task to address a secondary task. They can arise from multiple interconnected factors, including equipment issues, organizational processes, task characteristics, and external environmental conditions [ 5 ] . Interruptions can negatively impact task completion, reduce attention, and result in medication errors, ultimately disrupting the continuity of care and compromising patient safety [ 6 – 8 ] .The cognitive changes caused by interruptions can increase the time required to complete tasks, as attention is diverted from the primary task, leading to errors. This shift in focus not only prolongs task completion but also heightens the risk of mistakes, further exacerbating the disruption in patient care [ 9 ] .Even under high cognitive load, the most common response to interruptions is task switching, which involves stopping the current task to address a new issue or engaging in multitasking [ 9 , 10 ] . Given the complexity of nursing interruptions, research has shown [ 11 ] that when they occur, the management and response strategies play a critical role in minimizing their impact.When nurses recognize the risk of errors associated with interruptions, they begin to develop preventive strategies to help them remember to resume interrupted tasks [ 9 , 10 ] . Strategies such as using checklists, waiting for appropriate stopping points, and creating memory aids can minimize the harmful effects of interruptions [ 13 , 14 ] . Nurses in the operating room are responsible not only for their own tasks but also for addressing the needs of surgeons, anesthesiologists, and other healthcare professionals. The American Association of Perioperative Nurses (AORN) [ 15 ] stresses the importance of developing effective strategies to minimize interruptions or disruptions at critical times. While managing the multiple tasks associated with surgical procedures, nurses must prioritize these various demands to ensure timely and effective attention to essential needs. Interruptions are not always preventable, and some interruptions are necessary for providing patient care [ 16 ] . Therefore, it is crucial to implement interruption management strategies aimed at minimizing the negative impacts of interruptions. This study draws on the interruption management strategies developed by Henneman et al. [ 17 ] , which are based on the“Memory for Goals”(MFG) model supported by the experiences of Altmann and Trafton [ 18 ] . The model Memory for Goals explains how environmental and cognitive cues are utilized to create a“place mark”that helps in the effective and efficient resumption of a task. Building on the Interruption Management Strategy Stay S.A.F.E. developed by Henneman et al. [ 17 ] , we developed a nursing interruption management strategy tailored specifically for the operating room setting. Purpose and theoretical framework The primary goal of this study was to determine the effects of the intervention on operating room nurses’ interruption management strategies, including the sources of interruptions, strategies for managing interruptions, outcomes of interruption events, and the ability to resume tasks. The secondary outcomes were mental workload and nurses’ cognitive awareness of interruptions. The Memory for Goals (MFG) model underpins interruption management strategies. According to the MFG model, cognitive strategies that facilitate the safe resumption of interrupted tasks are mediated through associative cues (i.e., retrieval cues). These strategies include prioritizing both the ongoing and interrupted tasks, waiting for a natural cessation point, pausing to rehearse the current task, creating visual and verbal reminders, and swiftly resuming the task. The strategies demonstrated during training employ visual aids to illustrate their impact on the secure resumption of interrupted tasks, as depicted in Appendix A. Methods Study design We conducted a quasi-experimental study to evaluate the impact of the Stay S.A.F.E. Strategy for Managing Interruptions on operating room nurses. Participants and sampling This study was conducted in the central operating room of a tertiary-level hospital in Jiangsu Province, China. The hospital has a centralized operating department comprising 46 rooms and employing 126 registered nurses. It primarily serves elective surgical patients. All nurses working in the central operating room were introduced to the study. They were informed that the purpose of the study was to explore work patterns in the operating room. Subsequently, individual nurses were invited to participate.All participants were registered nurses and had a minimum of one year of experience working in the operating room. Development of Strategy and Procedure The development of the intervention strategy was informed by the Stay S.A.F.E. Strategy for Managing Interruptions The Interruption Management Strategy Stay S.A.F.E. proposed by Henneman et al [ 17 ] . An expert panel was established, consisting of researchers and nursing administrators. In December 2024, a two-round Delphi survey of experts was conducted to establish the management strategy. The Delphi expert panel comprised 12 members, all specialists in operating room nursing management. The panel’s mean (SD) age was 49.75 (3.19) years, and their mean (SD) length of professional experience was 30.08 (4.03) years. Kendall’s coefficients of concordance (W) for the two rounds were 0.225 and 0.220, respectively (both P < 0.001).The strategy included the following components: (1) Baseline phase ,This involved theoretical training on the concept of nursing interruptions. Participants viewed a standardized instructional PowerPoint and completed a baseline assessment survey.(2) Intervention phase ,The intervention comprised both didactic teaching and scenario-based simulation training, centered around the Stay S.A.F.E. strategy for managing interruptions. This strategy includes five key behavioral components:(a) Stay : Physically remain in your current location and stay engaged in the task at hand. Whenever possible, hold any tools or items involved in the task.(b) Say : Verbally state what you are doing, using specific language while maintaining patient privacy. (c) Acknowledge : Acknowledge the interrupting individual without breaking visual or physical engagement with the ongoing task.(d) Fixate : Refocus briefly—typically for 1 to 2 seconds—on the point within the task where you left off, identifying a natural pause point if possible.(e) Estimate : Mentally estimate the time required before you can safely address the interruption.Details of the intervention components are shown in Appendix A , and five simulated interruption scenarios were developed based on this management strategy ( Appendix B ). Following the intervention, a post-intervention survey was administered and data were collected. The baseline period took place from December 2023 to June 2024, and the intervention period occurred from December 2024 to June 2025. Ethical Considerations This study was conducted in accordance with all ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Third Affiliated Hospital of Soochow University(2023-CL039). Data collection The baseline and post-intervention data of nursing interruption were observed by two nursing postgraduate researchers.Observers were trained prior to the observation to understand the basic steps of each procedure to be observed. Intra-observer bias was minimized through the use of standard data collection and classification methods, practice, cross-observer comparisons, mutual and expert support, and ongoing feedback and discussion during training. The first ten surgical cases observed were used to train the researchers and were excluded from the final data analysis. Intraclass correlation coefficients were calculated to guarantee inter-rater dependability. Upon obtaining informed consent, observers closely followed individual nurses for up to 3 consecutive hours during day shifts (08:00–18:00) between July 2024 and June 2025. Observations exceeding 3 hours were avoided to reduce observer fatigue and minimize the risk of compromised data quality due to prolonged observation.This was a non-probability convenience sample [ 19 ] . Measures Observation Indexes Interruption events were recorded using an observation log sheet developed by the authors based on existing literature. Depending on the type of surgery, the interruption events were mainly divided into open surgery and minimally invasive surgery. The record sheet includes the following 7 sections. the type of surgery in which the event was interrupted: open surgery and minimally invasive surgery; interruption time: recorded in seconds; interrupted nursing procedures: Nursing recording,Nursing therapy,Surgery items counting,Management ,Surgical specimen Management,Medication/Blood transfusion; causes of interruption:case relevant communication,case irrelevant communication,equipment,phone,surgical instrument related,other nursing staff who need help,others; interruption Management Strategy:immediate interruption,multi-task,slightly delayed interruption,refused interruption; outcome of interrupting events: positive,negative and neutral type (positive type is an interruption that leads to a positive nursing outcome, e.g., timely termination of the event or can prevent/avoid an adverse outcome. negative type events are temporary interruptions that may prolong the duration of nursing procedures, increase the workload of nurses, affect the quality of care or cause adverse events,neutral type are interruptions that occurs during natural workflow transitions or involves non-critical tasks, with no impact on procedure duration, nursing workload, care quality or patient safety); return to original task: yes,no,original task completed NASA Task Load Index The subjective workload assessment was conducted using the Chinese version of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) [ 20 ] . NASA-TLX represents a well-validated and widely adopted measurement tool in human factors and ergonomics research, comprising six sub-scales or dimensions that evaluate distinct aspects of workload: mental demand, physical demand, temporal demand, performance, effort, and frustration.The instrument employs either a scaled scoring system (0–7) or a raw scoring system (0-100), with higher scores indicating greater perceived cognitive workload. This study utilized the raw scoring method. A score of 0 denotes the minimal task load across all dimensions, except for the performance sub-scale which is inversely scored,0 represents optimal task performance and maximum satisfaction with performance outcomes.The Chinese version of the scale demonstrated acceptable internal consistency, with a Cronbach's α coefficient of 0.782 [ 21 ] . Operating Room Nursing Interruption Cognitive Ability Inventory We used the Chinese Version of the Operating Room Nursing Interruption cognitive ability inventory (ORNICAI) [ 22 ] developed by our research team. This instrument contains three dimensions (nursing interruption definition, influencing factors, and coping strategies) with 28 items totaling 58 scored elements. Responses were measured using a 5-point Likert scale, where higher scores indicate greater cognitive ability of interruption events. The scale demonstrated good reliability with an overall Cronbach's α coefficient of 0.902. Data Analysis Statistical analyses were performed using SPSS 26.0 software (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean and standard deviation (SD), while categorical data were presented as percentages (%). The Shapiro-Wilk test was employed to assess normality of distribution. Homogeneity of variance was evaluated using Levene's test. For comparisons involving non-normally distributed continuous variables or heterogeneous variances across multiple groups, nonparametric tests were applied. Categorical variables were compared using the chi-square test. A two-tailed p-value < 0.05 was considered statistically significant. Results Demographics of Participants A total of 82 registered nurses were enrolled in this study. Most participants were female (84.15%) and 89.02% were educated to a bachelor's degree or higher (Table 1 ). Clinical characteristics for the baseline and post-intervention periods The number of observed surgeries at baseline and after intervention was 47 and 56 respectively (Table 2 ). The interruption frequency (n/hour) was 6.29 ± 2.66 and 6.38 ± 3.16 respectively (Table 2 ). The observation time and cumulative interruption time (hours) at baseline and after intervention were 98.73/6.79 and 97.60/6.13 respectively (Fig. 1 ). Nursing interruption management strategy The analysis of nursing procedure interruptions revealed no statistically significant difference between baseline and post-intervention periods ( P = 0.104)Table 2 (Fig. 2). However, significant variations were observed in interruption management strategies,The proportion of using Slightly delayed interruption strategy post intervention was significantly higher than baseline, and the proportion of using Immediate interruption and multitasking was lower than baseline. chi square analysis showed that the difference was statistically significant ( P < 0.001).The proportion of the original task completed after the intervention was significantly higher than at baseline, with a statistically significant difference observed (P < 0.001), Table 2 (Fig. 3). NASA Task Load Index The NASA-TLX comprises six dimensions: mental demand, physical demand, temporal demand, performance, effort, and frustration.At baseline and after the intervention, the mean (SD) total score was 67.56 (13.31) and 67.12 (13.10), and the mean (SD) mental-demand score was 80.44 (19.05) and 78.44 (18.75), respectively (Table 3 ). Operating Room Nursing Interruption cognitive ability inventory The impact of the Stay S.A.F.E. program on nurses’ cognition of nursing interruptions is presented in Table 3 .After the Stay S.A.F.E. intervention, a statistically significant increase in nurses’ cognitive ability was observed ( P < 0.001), with mean (SD) scores of 112.40(12.54) at baseline and 115.21(12.52) post-intervention(Fig. 4 ).There were significant differences between baseline and post-intervention in the sub-scales of Nursing Interruption Definition, Influencing Factors, and Coping Strategies. Discussion This study, conducted in the operating room—a highly dynamic, high-complexity setting with concurrent sources of interruption—evaluated the feasibility and mechanistic plausibility of the Stay S.A.F.E. strategy for managing interruptions, as grounded in the Memory for Goals (MFG) model.There was no statistically significant difference in the number of nursing-interruption events between baseline and post-intervention ( P > 0.05).Work in the operating room is inherently unpredictable [ 23 ] , which implies that interruptions and concurrent multitasking cannot be entirely eliminated [ 23 , 24 ] .Prior studies also indicate [ 7 ] ,that perioperative nursing practice, the ability to recognize and manage interruptions constitutes a tacit yet essential professional competence.Interruptions may threaten situational awareness and prospective memory, both of which are essential for continuous monitoring and for effective team information sharing [ 25 ] .Following the intervention, nurses’ willingness to accept immediate interruptions declined and their use of multitasking strategies decreased significantly, indicating better discrimination of interruption priority and greater avoidance of interruptions during critical phases [ 26 ] .When interruptions were unavoidable, adherence to a fixed-point marking–cueing–“respond after completing the current subtask” protocol improved the reliability of task resumption and reduced the risks of cognitive overload and task omission . This behavioral shift accords with evidence from cognitive science, individual working-memory capacity is inversely associated with task error rates [ 27 ] , and the use of external cues and procedural scripts facilitates post-interruption memory retrieval and task resumption.Put differently, the contribution of this work is not the pursuit of “eliminating interruptions,” but the optimization of their management. By translating the Memory for Goals (MFG) framework into trainable behavioral routines, the approach enhances the team’s ability to perform safely in interruption-rich environments.The study sought to develop nurses’ understanding of interruption consequences and to establish decision rules for whether and how to enact a contingency response.It is recommended that the strategy be incorporated into routine training programs. In follow-up studies, safety-proximal end points—such as task-resumption time, task error rates, and patient-related outcomes—should be quantified to verify the strategy’s durable benefits for clinical performance and patient safety. The NASA Task Load Index (NASA-TLX) assesses perceived workload across six dimensions, capturing demands on mental processing and attentional resources [ 27 ] .Although the overall workload score differed significantly ( P = 0.003), no between-group differences were detected for the temporal, physical, performance, effort, or frustration subscales ,by contrast, the mental demand subscale showed a significant difference ( P < 0.01).At baseline, the mean mental demand score was 80.44/100, decreasing to 78.44/100 post-intervention. Because the baseline score was entered as a covariate to account for inter-individual variability, higher ratings among participants prior to training indicate greater perceived mental demand before the intervention [ 20 ] .Across the six dimensions, the mental demand subscale requires participants to rate the cognitive challenge posed by a task,accordingly, even in the absence of differences in the overall workload score, the salience of this dimension warrants investigation. Moreover, increases in cognitive load during complex problem solving have been repeatedly reported in the literature [ 28 ] .Episodes of nursing interruption are frequently accompanied by negative affect among nurses, commonly evidenced by declines in cognitive functioning and task performance [ 29 , 30 ] .Accordingly, minimizing mental workload is essential; sustained high strain can precipitate cognitive fatigue and thereby adversely affect work performance [ 29 , 30 ] . Post-intervention, nurses’ awareness scores regarding nursing interruptions increased significantly ( P < 0.05). When nurses recognize the error risks associated with interruptions, they are more likely to deploy strategies that protect cognitive resources and safely resume the primary task [ 9 ] .Consistent with prior findings [ 31 ] , all participants in the present study engaged in multitasking at baseline, a practice shown to increase the risk of errors [ 32 ] .Accordingly, it is essential that nurses acquire interruption-management strategies to mitigate errors. Our findings indicate that enhancing awareness enables nurses to respond more judiciously to interruption events, reduce their occurrence and impact, and improve the efficiency of patient-safety management.Nursing managers and staff should deepen their understanding of nursing-interruption events [ 29 , 33 ] ,and formulate evidence-informed response protocols to mitigate care-related risks and safeguard patient safety. Limitations The pre–post design facilitated data analysis but also heightened the risk of bias due to reliance on the same cohort for both assessments (e.g., testing or carryover effects).Moreover, the sample was drawn from a single hospital, which may limit external validity; whether similar results would be observed across other healthcare institutions remains to be determined.Future studies should evaluate the effectiveness of implementing Stay S.A.F.E. across diverse healthcare institutions.Second, this was a real-world study,heterogeneity in task complexity may have shaped nurses’ task responses and context-specific judgments. In addition, mental workload was assessed at a single, static time point, which introduces the potential for recall bias and limits the strength of the inferences.Moreover, mental workload was evaluated at a single, static time point, which may introduce recall bias and constrain the strength of the inferences. Future studies should employ interruption-simulation paradigms to directly observe nurses’ strategies for managing interruptions. Conclusion Being interrupted elevates stress and cognitive load and heightens error risk [ 34 , 35 ] , preparation for practice ought to center on reducing these potential adverse outcomes.The operating room is a high-risk environment, and intraoperative interruptions are a risk factor for near-miss events [ 36 , 37 ] .To promote safety, nurses need to learn strategies for managing interruptions [ 38 ] .The findings of this study indicate that interruption-management training is effective. Managers should consider the unique work characteristics of operating room (OR) nurses and the complexity of the OR environment, and incorporate interruption-management strategies into routine OR training curricula. Abbreviations OR Operating Room NASA-TLX National Aeronautics and Space Administration Task Load Index ORNICAI Operating Room Nursing Interruption cognitive ability inventory Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of The Third Affiliated Hospital of Soochow University(Ethics code: 2023-CL039). All participants provided written informed consent before participation. The study was conducted according to the Declaration of Helsinki and relevant ethical guidelines and regulations. Conflict of Interest All authors declare no conflict of interest. Funding Information This study was supported by the Science and Technology Project of Changzhou Municipal Health Commission (grant number: ZD202312).The authors declare that no other financial support was received for this study. Author Contribution All authors participated and approved the study design. Xiaomeng Wen and Qingqing Zhang contributed to designing the study. Chenghuan Zhang and Xiaomeng Wen collected the data, and data analyses were done by Xiaomeng Wen and Chenghuan Zhang. The final report and article were written by Xiaomeng Wen, Qingqing Zhang, Chenghuan Zhang, and Xiaoyun Han. All authors read and approved the final manuscript. Acknowledgements We would like to thank the assistance of all the participating nurses, researchers, and research assistants. Data Availability The data supporting the study's conclusions are accessible upon request from the corresponding author. References Zhang W, Liu J, Yang S, et al. A Study on the Improvement of Nursing Interruption Risk by a Closed-Loop Management Model. Risk Manag Healthc Policy. 2021;14:2945–52. Westbrook JI, Raban MZ, Walter SR, et al. Task errors by emergency physicians are associated with interruptions, multitasking, fatigue, and working memory capacity: a prospective, direct observation study. BMJ Qual Saf. 2018;27(8):655–63. Schutijser BCFM, Klopotowska JE, Jongerden IP, et al. 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Tables Table 1 Demographic characteristics of the participants(n = 82) Demographics n(%) M(SD) Age, M (SD), years 22 ~ 53 32.06(6.76) Gender Male 13(15.85%) Female 69(84.15%) Working years 10.37(7.44) 20 10(12.19%) Educational Background Junior college or lower 9(10.98%) Undergraduate or higher 73(89.02%) Professional title Nurse Practitioner or below 47(57.32%) Nurse-in-charge 31(37.80%) Deputy Director Nurse 4(4.88%) Specialist nurse 9(10.98%) Table 2 Clinical characteristics for the baseline and post-intervention periods Variable Baseline Post-intervention Types of Operation Open 28 29 Minimally invasive 19 26 Observation time in hours 98.73 97.60 Cumulative interruption time (h) 6.79 6.13 Number of interruption events, n 541 549 Interruption event frequency, n/hour 6.29 ± 2.66 6.38 ± 3.16 Table 3 Nursing procedures interrupted,causes,management strategies and outcomes for the baseline and post-intervention Variable Baseline Post-intervention P -value* n = 541 n = 549 Nursing procedures interrupted, n(%) Nursing recording 287(53.05%) 263(47.91%) 0.104 Nursing therapy 130(24.03%) 151(27.50%) Surgery items counting 63(11.65%) 67(12.20%) Management 50(9.24%) 64(11.66%) Surgical specimen Management 2(0.37%) 2(0.36%) Medication/Blood transfusion 9(1.66%) 2(0.36%) Causes of interruption, n(%) Case relevant communication 321(59.33%) 352(64.12%) 0.022 Case irrelevant communication 39(7.21%) 26(4.74%) Equipment 21(3.88%) 22(4.01%) Phone 67(12.38%) 71(12.93%) Surgical instrument related 10(1.85%) 5(0.91%) Other nursing staff who need help 33(6.10%) 46(8.38%) Others 50(9.24%) 27(4.92%) Interruption Management Strategy, n(%) <0.0001 Immediate interruption 356(65.80%) 320(58.29%) Multi-task 128(23.66%) 121(22.04%) Slightly delayed interruption 44(8.13%) 98(17.85%) Refused interruption 13(2.40%) 10(1.82%) Outcomes of interruption, n(%) 0.023 Positive 40(7.39%) 59(10.75%) Negative 432(79.85%) 400(72.86%) Neutral 69(12.75%) 90(16.39%) Return to Original Task, n(%) <0.0001 Yes 488(90.20%) 469(85.43%) No 26(4.81%) 4(0.73%) Original Task Completed 27(4.99%) 76(13.84%) * P -value corresponds to either a Fisher test or a Chi- 2 test Measure Baseline mean(SD) Post-intervention mean(SD) t** P -value ORNICAI(Overall) 112.40(12.54) 115.21(12.52) 6.518 <0.001 Nursing interruption definition 40.30(5.55) 41.44(5.41) 4.278 <0.001 Influencing factors 51.01(6.24) 52.48(6.11) 6.576 <0.001 Coping strategies 17.50(2.42) 17.69(2.44) 2.555 0.012 NASA-TLX 67.56(13.31) 67.12(13.10) −3.002 0.003 Mental demand 80.44(19.05) 78.44(18.75) −4.420 <0.001 Physical demand 82.17(18.18) 81.94(17.44) −0.615 0.540 Temporal demand 80.67(18.39) 80.56(18.27) −0.630 0.530 Effort 77.39(20.38) 77.44(20.39) 1.000 0.320 Performance 31.50(25.83) 31.67(25.74) 0.831 0.408 Frustration 53.17(26.11) 52.67(26.07) −1.823 0.072 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9194764","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":620326146,"identity":"1ddb20f5-564f-4676-be98-f7a1cb2e4aae","order_by":0,"name":"Xiaomeng Wen","email":"","orcid":"","institution":"The Third Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Xiaomeng","middleName":"","lastName":"Wen","suffix":""},{"id":620326148,"identity":"7a82510d-3263-4e4f-91a9-ce3bd3514324","order_by":1,"name":"Qing qing Zhang","email":"","orcid":"","institution":"The Third Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Qing","middleName":"qing","lastName":"Zhang","suffix":""},{"id":620326149,"identity":"b6920ee7-8688-4c62-9949-99be9fdb4fb2","order_by":2,"name":"Chenghuan Zhang","email":"","orcid":"","institution":"The Third Affiliated Hospital of Soochow University","correspondingAuthor":false,"prefix":"","firstName":"Chenghuan","middleName":"","lastName":"Zhang","suffix":""},{"id":620326150,"identity":"44af734a-dd98-4718-b99f-41963fd2e1ea","order_by":3,"name":"Xiaoyun Han","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBACAwjJJmd/vLHx4QfitRTwGTOcOdxsLEG8lg9yiQ030tsEeIjRYi6RY/jxh4EZY+PMh20MEgx2croNBLRY9pwxlpAwSGNmlk5se1DAkGxsdoCQw473mDEYGBxjY5NObDeQYDiQuI2glsM8ZgwJBv95eCQPtknwEKUFZMsBAzYJCQlGYrWcOVYs2WDAZmDAkwgMZANi/HIjeePHH3/Y6jewH3/48EOFnRxBLQwMHAbIJhBUDgLsD4hSNgpGwSgYBSMYAACb1UAP12BQJQAAAABJRU5ErkJggg==","orcid":"","institution":"The Third Affiliated Hospital of Soochow University","correspondingAuthor":true,"prefix":"","firstName":"Xiaoyun","middleName":"","lastName":"Han","suffix":""}],"badges":[],"createdAt":"2026-03-23 02:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9194764/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9194764/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106870463,"identity":"d532daff-dc58-4a99-8039-790645456287","added_by":"auto","created_at":"2026-04-14 09:42:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29062,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eObservation Time and Cumulative Interruption Time in Hours\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9194764/v1/f3c3ea60753481a81dc0f554.png"},{"id":106870492,"identity":"8fdbb2bf-b4f6-4fa8-ba05-4ce3b4866a42","added_by":"auto","created_at":"2026-04-14 09:42:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":153642,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNursing procedures interrupted and causes for the baseline and post-intervention\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9194764/v1/57183a15a0bfdac96c837d14.png"},{"id":106870441,"identity":"25b671c5-8927-4753-a367-9da287e2e8c1","added_by":"auto","created_at":"2026-04-14 09:42:33","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":184447,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNursing interruption management strategies and outcomes for the baseline and post-intervention\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9194764/v1/fb065b5c0adf1198c853335e.png"},{"id":106870459,"identity":"aabee96c-ce28-41fc-b527-25094bfe0644","added_by":"auto","created_at":"2026-04-14 09:42:36","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":73944,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMean baseline and post-intervention Interruption cognitive ability inventory scores（\u003c/strong\u003e\u003cem\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e=82）\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9194764/v1/0674793876bee1b65f3b78d2.png"},{"id":106871002,"identity":"4832f5d4-bcb5-4325-80f3-b8c1dea6d157","added_by":"auto","created_at":"2026-04-14 09:44:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1690719,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9194764/v1/4db99f58-098a-49ba-a1fb-1b629e1126b3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Interruption Management Strategy “Stay S.A.F.E.” Program development and evaluation for operating nurses in China: a pre-post study design\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA nursing interruption is a sudden interruption that delays or distracts a nurse from delivering care to a patient at a specific time or in a specific role or environment\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.Nursing interruptions are common events that disrupt the workflow of nurses, potentially leading to errors, delays, and omissions in patient care \u003csup\u003e[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. These interruptions are a complex phenomenon, involving the suspension of an ongoing primary task to address a secondary task. They can arise from multiple interconnected factors, including equipment issues, organizational processes, task characteristics, and external environmental conditions\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Interruptions can negatively impact task completion, reduce attention, and result in medication errors, ultimately disrupting the continuity of care and compromising patient safety\u003csup\u003e[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.The cognitive changes caused by interruptions can increase the time required to complete tasks, as attention is diverted from the primary task, leading to errors. This shift in focus not only prolongs task completion but also heightens the risk of mistakes, further exacerbating the disruption in patient care\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.Even under high cognitive load, the most common response to interruptions is task switching, which involves stopping the current task to address a new issue or engaging in multitasking\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGiven the complexity of nursing interruptions, research has shown\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e that when they occur, the management and response strategies play a critical role in minimizing their impact.When nurses recognize the risk of errors associated with interruptions, they begin to develop preventive strategies to help them remember to resume interrupted tasks\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Strategies such as using checklists, waiting for appropriate stopping points, and creating memory aids can minimize the harmful effects of interruptions\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNurses in the operating room are responsible not only for their own tasks but also for addressing the needs of surgeons, anesthesiologists, and other healthcare professionals. The American Association of Perioperative Nurses (AORN)\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003estresses the importance of developing effective strategies to minimize interruptions or disruptions at critical times. While managing the multiple tasks associated with surgical procedures, nurses must prioritize these various demands to ensure timely and effective attention to essential needs.\u003c/p\u003e \u003cp\u003eInterruptions are not always preventable, and some interruptions are necessary for providing patient care\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Therefore, it is crucial to implement interruption management strategies aimed at minimizing the negative impacts of interruptions. This study draws on the interruption management strategies developed by Henneman et al.\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, which are based on the\u0026ldquo;Memory for Goals\u0026rdquo;(MFG) model supported by the experiences of Altmann and Trafton\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. The model Memory for Goals explains how environmental and cognitive cues are utilized to create a\u0026ldquo;place mark\u0026rdquo;that helps in the effective and efficient resumption of a task.\u003c/p\u003e \u003cp\u003eBuilding on the Interruption Management Strategy Stay S.A.F.E. developed by Henneman et al.\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, we developed a nursing interruption management strategy tailored specifically for the operating room setting.\u003c/p\u003e\n\u003ch3\u003ePurpose and theoretical framework\u003c/h3\u003e\n\u003cp\u003eThe primary goal of this study was to determine the effects of the intervention on operating room nurses’ interruption management strategies, including the sources of interruptions, strategies for managing interruptions, outcomes of interruption events, and the ability to resume tasks. The secondary outcomes were mental workload and nurses’ cognitive awareness of interruptions.\u003c/p\u003e \u003cp\u003eThe Memory for Goals (MFG) model underpins interruption management strategies. According to the MFG model, cognitive strategies that facilitate the safe resumption of interrupted tasks are mediated through associative cues (i.e., retrieval cues). These strategies include prioritizing both the ongoing and interrupted tasks, waiting for a natural cessation point, pausing to rehearse the current task, creating visual and verbal reminders, and swiftly resuming the task. The strategies demonstrated during training employ visual aids to illustrate their impact on the secure resumption of interrupted tasks, as depicted in Appendix A.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy design\u003c/h2\u003e\n\u003cp\u003eWe conducted a quasi-experimental study to evaluate the impact of the Stay S.A.F.E. Strategy for Managing Interruptions on operating room nurses.\u003c/p\u003e\n\u003ch3\u003eParticipants and sampling\u003c/h3\u003e\n\u003cp\u003eThis study was conducted in the central operating room of a tertiary-level hospital in Jiangsu Province, China. The hospital has a centralized operating department comprising 46 rooms and employing 126 registered nurses. It primarily serves elective surgical patients. All nurses working in the central operating room were introduced to the study. They were informed that the purpose of the study was to explore work patterns in the operating room. Subsequently, individual nurses were invited to participate.All participants were registered nurses and had a minimum of one year of experience working in the operating room.\u003c/p\u003e\n\u003ch3\u003eDevelopment of Strategy and Procedure\u003c/h3\u003e\n\u003cp\u003eThe development of the intervention strategy was informed by the Stay S.A.F.E. Strategy for Managing Interruptions The Interruption Management Strategy Stay S.A.F.E. proposed by Henneman et al\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. An expert panel was established, consisting of researchers and nursing administrators. In December 2024, a two-round Delphi survey of experts was conducted to establish the management strategy. The Delphi expert panel comprised 12 members, all specialists in operating room nursing management. The panel\u0026rsquo;s mean (SD) age was 49.75 (3.19) years, and their mean (SD) length of professional experience was 30.08 (4.03) years. Kendall\u0026rsquo;s coefficients of concordance (W) for the two rounds were 0.225 and 0.220, respectively (both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).The strategy included the following components: (1)\u003cstrong\u003eBaseline phase\u003c/strong\u003e,This involved theoretical training on the concept of nursing interruptions. Participants viewed a standardized instructional PowerPoint and completed a baseline assessment survey.(2)\u003cstrong\u003eIntervention phase\u003c/strong\u003e,The intervention comprised both didactic teaching and scenario-based simulation training, centered around the Stay S.A.F.E. strategy for managing interruptions. This strategy includes five key behavioral components:(a)\u003cstrong\u003eStay\u003c/strong\u003e: Physically remain in your current location and stay engaged in the task at hand. Whenever possible, hold any tools or items involved in the task.(b)\u003cstrong\u003eSay\u003c/strong\u003e: Verbally state what you are doing, using specific language while maintaining patient privacy. (c)\u003cstrong\u003eAcknowledge\u003c/strong\u003e: Acknowledge the interrupting individual without breaking visual or physical engagement with the ongoing task.(d)\u003cstrong\u003eFixate\u003c/strong\u003e: Refocus briefly\u0026mdash;typically for 1 to 2 seconds\u0026mdash;on the point within the task where you left off, identifying a natural pause point if possible.(e)\u003cstrong\u003eEstimate\u003c/strong\u003e: Mentally estimate the time required before you can safely address the interruption.Details of the intervention components are shown in \u003cstrong\u003eAppendix A\u003c/strong\u003e, and five simulated interruption scenarios were developed based on this management strategy ( \u003cstrong\u003eAppendix B\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eFollowing the intervention, a post-intervention survey was administered and data were collected. The \u003cstrong\u003ebaseline period\u003c/strong\u003e took place from December 2023 to June 2024, and the \u003cstrong\u003eintervention period\u003c/strong\u003e occurred from December 2024 to June 2025.\u003c/p\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eThis study was conducted in accordance with all ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Third Affiliated Hospital of Soochow University(2023-CL039).\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eData collection\u003c/h2\u003e\n\u003cp\u003eThe baseline and post-intervention data of nursing interruption were observed by two nursing postgraduate researchers.Observers were trained prior to the observation to understand the basic steps of each procedure to be observed. Intra-observer bias was minimized through the use of standard data collection and classification methods, practice, cross-observer comparisons, mutual and expert support, and ongoing feedback and discussion during training. The first ten surgical cases observed were used to train the researchers and were excluded from the final data analysis. Intraclass correlation coefficients were calculated to guarantee inter-rater dependability.\u003c/p\u003e\n\u003cp\u003eUpon obtaining informed consent, observers closely followed individual nurses for up to 3 consecutive hours during day shifts (08:00\u0026ndash;18:00) between July 2024 and June 2025. Observations exceeding 3 hours were avoided to reduce observer fatigue and minimize the risk of compromised data quality due to prolonged observation.This was a non-probability convenience sample\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eObservation Indexes\u003c/h2\u003e\n\u003cp\u003eInterruption events were recorded using an observation log sheet developed by the authors based on existing literature. Depending on the type of surgery, the interruption events were mainly divided into open surgery and minimally invasive surgery. The record sheet includes the following 7 sections.\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003ethe type of surgery in which the event was interrupted: open surgery and minimally invasive surgery;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003einterruption time: recorded in seconds;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003einterrupted nursing procedures: Nursing recording,Nursing therapy,Surgery items counting,Management ,Surgical specimen Management,Medication/Blood transfusion;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ecauses of interruption:case relevant communication,case irrelevant communication,equipment,phone,surgical instrument related,other nursing staff who need help,others;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003einterruption Management Strategy:immediate interruption,multi-task,slightly delayed interruption,refused interruption;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eoutcome of interrupting events: positive,negative and neutral type (positive type is an interruption that leads to a positive nursing outcome, e.g., timely termination of the event or can prevent/avoid an adverse outcome. negative type events are temporary interruptions that may prolong the duration of nursing procedures, increase the workload of nurses, affect the quality of care or cause adverse events,neutral type are interruptions that occurs during natural workflow transitions or involves non-critical tasks, with no impact on procedure duration, nursing workload, care quality or patient safety);\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ereturn to original task: yes,no,original task completed\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eNASA Task Load Index\u003c/h2\u003e\n\u003cp\u003eThe subjective workload assessment was conducted using the Chinese version of the National Aeronautics and Space Administration Task Load Index (NASA-TLX)\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. NASA-TLX represents a well-validated and widely adopted measurement tool in human factors and ergonomics research, comprising six sub-scales or dimensions that evaluate distinct aspects of workload: mental demand, physical demand, temporal demand, performance, effort, and frustration.The instrument employs either a scaled scoring system (0\u0026ndash;7) or a raw scoring system (0-100), with higher scores indicating greater perceived cognitive workload. This study utilized the raw scoring method. A score of 0 denotes the minimal task load across all dimensions, except for the performance sub-scale which is inversely scored,0 represents optimal task performance and maximum satisfaction with performance outcomes.The Chinese version of the scale demonstrated acceptable internal consistency, with a Cronbach's \u0026alpha; coefficient of 0.782\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eOperating Room Nursing Interruption Cognitive Ability Inventory\u003c/h2\u003e\n\u003cp\u003eWe used the Chinese Version of the Operating Room Nursing Interruption cognitive ability inventory (ORNICAI)\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e developed by our research team. This instrument contains three dimensions (nursing interruption definition, influencing factors, and coping strategies) with 28 items totaling 58 scored elements. Responses were measured using a 5-point Likert scale, where higher scores indicate greater cognitive ability of interruption events. The scale demonstrated good reliability with an overall Cronbach's \u0026alpha; coefficient of 0.902.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eData Analysis\u003c/h2\u003e\n\u003cp\u003eStatistical analyses were performed using SPSS 26.0 software (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean and standard deviation (SD), while categorical data were presented as percentages (%). The Shapiro-Wilk test was employed to assess normality of distribution. Homogeneity of variance was evaluated using Levene's test. For comparisons involving non-normally distributed continuous variables or heterogeneous variances across multiple groups, nonparametric tests were applied. Categorical variables were compared using the chi-square test. A two-tailed p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDemographics of Participants\u003c/h2\u003e \u003cp\u003eA total of 82 registered nurses were enrolled in this study. Most participants were female (84.15%) and 89.02% were educated to a bachelor's degree or higher (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eClinical characteristics for the baseline and post-intervention periods\u003c/h2\u003e \u003cp\u003eThe number of observed surgeries at baseline and after intervention was 47 and 56 respectively (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The interruption frequency (n/hour) was 6.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66 and 6.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16 respectively (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The observation time and cumulative interruption time (hours) at baseline and after intervention were 98.73/6.79 and 97.60/6.13 respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eNursing interruption management strategy\u003c/h2\u003e \u003cp\u003eThe analysis of nursing procedure interruptions revealed no statistically significant difference between baseline and post-intervention periods (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.104)Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e(Fig.\u0026nbsp;2). However, significant variations were observed in interruption management strategies,The proportion of using Slightly delayed interruption strategy post intervention was significantly higher than baseline, and the proportion of using Immediate interruption and multitasking was lower than baseline. chi square analysis showed that the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).The proportion of the original task completed after the intervention was significantly higher than at baseline, with a statistically significant difference observed (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e(Fig.\u0026nbsp;3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eNASA Task Load Index\u003c/h2\u003e \u003cp\u003eThe NASA-TLX comprises six dimensions: mental demand, physical demand, temporal demand, performance, effort, and frustration.At baseline and after the intervention, the mean (SD) total score was 67.56 (13.31) and 67.12 (13.10), and the mean (SD) mental-demand score was 80.44 (19.05) and 78.44 (18.75), respectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eOperating Room Nursing Interruption cognitive ability inventory\u003c/h2\u003e \u003cp\u003eThe impact of the Stay S.A.F.E. program on nurses\u0026rsquo; cognition of nursing interruptions is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.After the Stay S.A.F.E. intervention, a statistically significant increase in nurses\u0026rsquo; cognitive ability was observed (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with mean (SD) scores of 112.40(12.54) at baseline and 115.21(12.52) post-intervention(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e4\u003c/span\u003e).There were significant differences between baseline and post-intervention in the sub-scales of Nursing Interruption Definition, Influencing Factors, and Coping Strategies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study, conducted in the operating room—a highly dynamic, high-complexity setting with concurrent sources of interruption—evaluated the feasibility and mechanistic plausibility of the Stay S.A.F.E. strategy for managing interruptions, as grounded in the Memory for Goals (MFG) model.There was no statistically significant difference in the number of nursing-interruption events between baseline and post-intervention (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05).Work in the operating room is inherently unpredictable\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, which implies that interruptions and concurrent multitasking cannot be entirely eliminated\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.Prior studies also indicate\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e,that perioperative nursing practice, the ability to recognize and manage interruptions constitutes a tacit yet essential professional competence.Interruptions may threaten situational awareness and prospective memory, both of which are essential for continuous monitoring and for effective team information sharing\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.Following the intervention, nurses’ willingness to accept \u003cstrong\u003eimmediate interruptions\u003c/strong\u003e declined and their use of \u003cstrong\u003emultitasking strategies\u003c/strong\u003e decreased significantly, indicating better discrimination of interruption priority and greater avoidance of interruptions during critical phases \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e.When interruptions were unavoidable, adherence to a \u003cstrong\u003efixed-point marking–cueing–“respond after completing the current subtask”\u003c/strong\u003e protocol improved the reliability of task resumption and reduced the risks of \u003cstrong\u003ecognitive overload\u003c/strong\u003e and \u003cstrong\u003etask omission\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eThis behavioral shift accords with evidence from cognitive science, individual \u003cstrong\u003eworking-memory capacity\u003c/strong\u003e is inversely associated with \u003cstrong\u003etask error rates\u003c/strong\u003e\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e, and the use of \u003cstrong\u003eexternal cues\u003c/strong\u003e and \u003cstrong\u003eprocedural scripts\u003c/strong\u003e facilitates post-interruption memory retrieval and task resumption.Put differently, the contribution of this work is not the pursuit of “eliminating interruptions,” but the optimization of their management. By translating the Memory for Goals (MFG) framework into trainable behavioral routines, the approach enhances the team’s ability to perform safely in interruption-rich environments.The study sought to develop nurses’ understanding of interruption consequences and to establish decision rules for whether and how to enact a contingency response.It is recommended that the strategy be incorporated into routine training programs. In follow-up studies, safety-proximal end points—such as task-resumption time, task error rates, and patient-related outcomes—should be quantified to verify the strategy’s durable benefits for clinical performance and patient safety.\u003c/p\u003e\n\u003cp\u003eThe NASA Task Load Index (NASA-TLX) assesses perceived workload across six dimensions, capturing demands on mental processing and attentional resources\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.Although the overall workload score differed significantly (\u003cem\u003eP\u003c/em\u003e = 0.003), no between-group differences were detected for the temporal, physical, performance, effort, or frustration subscales ,by contrast, the mental demand subscale showed a significant difference (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01).At baseline, the mean mental demand score was 80.44/100, decreasing to 78.44/100 post-intervention. Because the baseline score was entered as a covariate to account for inter-individual variability, higher ratings among participants prior to training indicate greater perceived mental demand before the intervention\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e.Across the six dimensions, the \u003cstrong\u003emental demand\u003c/strong\u003e subscale requires participants to rate the cognitive challenge posed by a task,accordingly, even in the absence of differences in the overall workload score, the salience of this dimension warrants investigation. Moreover, increases in cognitive load during complex problem solving have been repeatedly reported in the literature\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e.Episodes of nursing interruption are frequently accompanied by negative affect among nurses, commonly evidenced by declines in cognitive functioning and task performance\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.Accordingly, minimizing mental workload is essential; sustained high strain can precipitate cognitive fatigue and thereby adversely affect work performance\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003ePost-intervention, nurses’ \u003cstrong\u003eawareness scores regarding nursing interruptions\u003c/strong\u003e increased significantly (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). When nurses recognize the error risks associated with interruptions, they are more likely to deploy strategies that \u003cstrong\u003eprotect cognitive resources\u003c/strong\u003e and \u003cstrong\u003esafely resume\u003c/strong\u003e the primary task\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.Consistent with prior findings \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e, all participants in the present study engaged in multitasking at baseline, a practice shown to increase the risk of errors\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e.Accordingly, it is essential that nurses acquire interruption-management strategies to mitigate errors. Our findings indicate that enhancing awareness enables nurses to respond more judiciously to interruption events, reduce their occurrence and impact, and improve the efficiency of patient-safety management.Nursing managers and staff should deepen their understanding of nursing-interruption events\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e,and formulate evidence-informed response protocols to mitigate care-related risks and safeguard patient safety.\u003c/p\u003e\n"},{"header":"Limitations","content":"\u003cp\u003eThe pre–post design facilitated data analysis but also heightened the risk of bias due to reliance on the same cohort for both assessments (e.g., testing or carryover effects).Moreover, the sample was drawn from a single hospital, which may limit external validity; whether similar results would be observed across other healthcare institutions remains to be determined.Future studies should evaluate the effectiveness of implementing Stay S.A.F.E. across diverse healthcare institutions.Second, this was a real-world study,heterogeneity in task complexity may have shaped nurses’ task responses and context-specific judgments. In addition, mental workload was assessed at a single, static time point, which introduces the potential for recall bias and limits the strength of the inferences.Moreover, mental workload was evaluated at a single, static time point, which may introduce recall bias and constrain the strength of the inferences. Future studies should employ interruption-simulation paradigms to directly observe nurses’ strategies for managing interruptions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBeing interrupted elevates stress and cognitive load and heightens error risk \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e, preparation for practice ought to center on reducing these potential adverse outcomes.The operating room is a high-risk environment, and intraoperative interruptions are a risk factor for near-miss events\u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e.To promote safety, nurses need to learn strategies for managing interruptions\u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e.The findings of this study indicate that interruption-management training is effective. Managers should consider the unique work characteristics of operating room (OR) nurses and the complexity of the OR environment, and incorporate interruption-management strategies into routine OR training curricula.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eOR Operating Room\u003c/p\u003e\u003cp\u003eNASA-TLX National Aeronautics and Space Administration Task Load Index\u003c/p\u003e\u003cp\u003eORNICAI Operating Room Nursing Interruption cognitive ability inventory\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e This study was approved by the Ethics Committee of The Third Affiliated Hospital of Soochow University(Ethics code: 2023-CL039). All participants provided written informed consent before participation. The study was conducted according to the Declaration of Helsinki and relevant ethical guidelines and regulations.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflict of Interest\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eAll authors declare no conflict of interest.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003ch2\u003eFunding Information\u003c/h2\u003e \u003cp\u003eThis study was supported by the Science and Technology Project of Changzhou Municipal Health Commission (grant number: ZD202312).The authors declare that no other financial support was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors participated and approved the study design. Xiaomeng Wen and Qingqing Zhang contributed to designing the study. Chenghuan Zhang and Xiaomeng Wen collected the data, and data analyses were done by Xiaomeng Wen and Chenghuan Zhang. The final report and article were written by Xiaomeng Wen, Qingqing Zhang, Chenghuan Zhang, and Xiaoyun Han. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eWe would like to thank the assistance of all the participating nurses, researchers, and research assistants.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data supporting the study's conclusions are accessible upon request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZhang W, Liu J, Yang S, et al. A Study on the Improvement of Nursing Interruption Risk by a Closed-Loop Management Model. Risk Manag Healthc Policy. 2021;14:2945\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWestbrook JI, Raban MZ, Walter SR, et al. 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Beyond 'find and fix': improving quality and safety through resilient healthcare systems. Int J Qual Health Care. 2020;32(3):204\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlin K, Goras C, Nilsson U, et al. Mapping registered nurse anaesthetists' intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study. BMJ Open. 2022;12(1):e52283.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStanton NA. Hierarchical task analysis: developments, applications, and extensions. Appl Ergon. 2006;37(1):55\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSweller J. Cognitive Load Theory: Recent Theoretical Advances. Cambridge University Press; 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa J, Bai Y, Xie D, et al. Factors Influencing the Interruption of Nursing Document Writing in the Intensive Care Unit: A Cross-Sectional Survey. J Multidiscip Healthc. 2023;16:419\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNasri B, Mitchell JD, Jackson C, et al. Distractions in the operating room: a survey of the healthcare team. Surg Endosc. 2023;37(3):2316\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchroers G, Pfieffer J, Andersen B, et al. An Interruption Management Education Bundle: Feasibility Testing With Nursing Students. Nurse Educ. 2024;49(4):189.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas L, Donohue-Porter P, Stein Fishbein J. Impact of Interruptions, Distractions, and Cognitive Load on Procedure Failures and Medication Administration Errors. J Nurs Care Qual. 2017;32(4):309\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShan Y, Shang J, Yan Y, et al. Workflow interruption and nurses' mental workload in electronic health record tasks: An observational study. BMC Nurs. 2023;22(1):63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas CM, McIntosh CE, Allen R. Creating a Distraction Simulation for Safe Medication Administration. Clin Simul Nurs. 2014;10(8):406\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson M, Sanchez P, Langdon R, et al. The impact of interruptions on medication errors in hospitals: an observational study of nurses. J Nurs Manag. 2017;25(7):498\u0026ndash;507.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLujun Z, Yuan G, Wei W. Surgical counting interruptions in operating rooms. BMC Nurs. 2024;23(1):241.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa L, Shan R, Lu Y, et al. Systematic Risk Analysis and Mitigation Strategies for Near-Miss Events in Interventional Operating Room Nursing. Risk Manag Healthc Policy. 2025;18:239\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHockey GRJ. Applied Attention Theory. Ergonomics. 2008;52(2):270\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic characteristics of the participants(n\u0026thinsp;=\u0026thinsp;82)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDemographics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eM(SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge, M (SD), years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u0026thinsp;~\u0026thinsp;53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e32.06(6.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(15.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69(84.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorking years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e10.37(7.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51(62.20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026thinsp;~\u0026thinsp;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21(25.61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(12.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational Background\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior college or lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(10.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndergraduate or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73(89.02%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse Practitioner or below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47(57.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse-in-charge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31(37.80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDeputy Director Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(4.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpecialist nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(10.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinical characteristics for the baseline and post-intervention periods\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost-intervention\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTypes of Operation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinimally invasive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObservation time in hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCumulative interruption time (h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of interruption events, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e549\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInterruption event frequency, n/hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eNursing procedures interrupted,causes,management strategies and outcomes for the baseline and post-intervention\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost-intervention\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;541\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;549\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNursing procedures interrupted, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNursing recording\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e287(53.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e263(47.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNursing therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e130(24.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e151(27.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgery items counting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e63(11.65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e67(12.20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eManagement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e50(9.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e64(11.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical specimen Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e2(0.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e2(0.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedication/Blood transfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e9(1.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e2(0.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCauses of interruption, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCase relevant communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e321(59.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e352(64.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCase irrelevant communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e39(7.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e26(4.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEquipment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e21(3.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e22(4.01%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e67(12.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e71(12.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical instrument related\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e10(1.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e5(0.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther nursing staff who need help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e33(6.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e46(8.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e50(9.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e27(4.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInterruption Management Strategy, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eImmediate interruption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e356(65.80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e320(58.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMulti-task\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e128(23.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e121(22.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSlightly delayed interruption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e44(8.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e98(17.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRefused interruption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e13(2.40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e10(1.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutcomes of interruption, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e40(7.39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e59(10.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e432(79.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e400(72.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e69(12.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e90(16.39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReturn to Original Task, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e488(90.20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e469(85.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e26(4.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e4(0.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOriginal Task Completed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e27(4.99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\"\u003e\n \u003cp\u003e76(13.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e*\u003cem\u003eP\u003c/em\u003e-value corresponds to either a Fisher test or a Chi-\u003csup\u003e2\u003c/sup\u003e test\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr style=\"height: 59px;\"\u003e\n \u003cth style=\"height: 59px;\" align=\"left\"\u003e\n \u003cp\u003eMeasure\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 59px;\" align=\"left\"\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003cp\u003emean(SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 59px;\" align=\"left\"\u003e\n \u003cp\u003ePost-intervention\u003c/p\u003e\n \u003cp\u003emean(SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 59px;\" align=\"left\"\u003e\n \u003cp\u003et**\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"height: 59px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003eORNICAI(Overall)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e112.40(12.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e115.21(12.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e6.518\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003eNursing interruption definition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e40.30(5.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e41.44(5.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e4.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003eInfluencing factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e51.01(6.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e52.48(6.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e6.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003eCoping strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e17.50(2.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e17.69(2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e2.555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003eNASA-TLX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e67.56(13.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e67.12(13.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e\u0026minus;3.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 35px;\"\u003e\n \u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n \u003cp\u003eMental demand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e80.44(19.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd 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35px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e0.408\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr style=\"height: 35.1876px;\"\u003e\n \u003ctd style=\"height: 35.1876px;\" align=\"left\"\u003e\n \u003cp\u003eFrustration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35.1876px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e53.17(26.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35.1876px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e52.67(26.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35.1876px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e\u0026minus;1.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"height: 35.1876px;\" align=\"char\" char=\".\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u0026nbsp;\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Interruptions, operating room, interruption management, simulation","lastPublishedDoi":"10.21203/rs.3.rs-9194764/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9194764/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOperating rooms are complex, high-risk environments where interruptions frequently occur, potentially compromising workflow reliability and patient safety. Training in interruption management, grounded in cognitive theory, may help nurses cope with unavoidable disruptions; however, evidence from perioperative practice remains limited. This study evaluated the effects of the Interruption Management Strategy \u003cem\u003eStay S.A.F.E.\u003c/em\u003e on operating room (OR) nurses\u0026rsquo; interruption management, cognitive processing, and workload.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA quasi-experimental, single-group pre-test and post-test design was conducted in the central OR of a tertiary hospital in Jiangsu, China, with 82 registered nurses (\u0026ge;\u0026thinsp;1 year OR experience). The intervention, developed via a two-round Delphi process, combined didactic teaching and simulation of five interruption scenarios based on the Memory for Goals framework (\u003cem\u003eStay, Say, Acknowledge, Fixate, Estimate\u003c/em\u003e). Observations captured interruption characteristics, strategies, outcomes, and task resumption. Secondary outcomes included NASA-TLX and the Operating Room Nursing Interruption Cognitive Ability Inventory (ORNICAI). Chi-square/Fisher tests and paired t-tests were applied (α\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA total of 1,090 interruption events were recorded (541 vs 549). While event frequency was unchanged, strategy use shifted: slightly delayed interruptions increased (8.13%\u0026rarr;17.85%), immediate interruptions (65.80%\u0026rarr;58.29%) and multitasking (23.66%\u0026rarr;22.04%) decreased (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Positive outcomes rose (7.39%\u0026rarr;10.75%) and negative outcomes declined (79.85%\u0026rarr;72.86%, p\u0026thinsp;=\u0026thinsp;0.023). Failures to resume tasks fell (4.81%\u0026rarr;0.73%), while \u0026ldquo;original task completed\u0026rdquo; increased (4.99%\u0026rarr;13.84%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). ORNICAI scores improved significantly (112.40\u0026thinsp;\u0026plusmn;\u0026thinsp;12.54\u0026rarr;115.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.52, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). NASA-TLX scores slightly decreased (67.56\u0026thinsp;\u0026plusmn;\u0026thinsp;13.31\u0026rarr;67.12\u0026thinsp;\u0026plusmn;\u0026thinsp;13.10, p\u0026thinsp;=\u0026thinsp;0.003), mainly due to lower mental demand.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe \u003cem\u003eStay S.A.F.E.\u003c/em\u003e strategy improved OR nurses\u0026rsquo; interruption cognition, promoted safer strategies, enhanced task resumption, and modestly reduced workload without affecting interruption frequency. Integration into OR training is warranted, with multi-center studies and longer follow-up recommended.\u003c/p\u003e","manuscriptTitle":"The Interruption Management Strategy “Stay S.A.F.E.” Program development and evaluation for operating nurses in China: a pre-post study design","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 09:38:12","doi":"10.21203/rs.3.rs-9194764/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-22T13:06:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-19T03:20:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-18T23:27:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238586555876496344436583984055748512594","date":"2026-04-16T12:28:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325091979308142927294899810922230846022","date":"2026-04-15T14:52:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30564545881748778532133255977543912183","date":"2026-04-13T17:16:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"185871380734189143303641436197153963189","date":"2026-04-09T12:30:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T05:43:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-02T07:11:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-01T12:06:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-01T12:05:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-03-23T02:36:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0949b463-36d8-48ef-a206-ab86598bf085","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T09:38:12+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 09:38:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9194764","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9194764","identity":"rs-9194764","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}